The Health Information and Quality Authority (HIQA) has published 12 inspection reports on compliance in healthcare services with the National Standards for Safer Better Healthcare. Inspections were conducted between December 2024 and March 2025 at:

• Clifden District Hospital, Galway
• St. Theresa’s Hospital, Tipperary
• St. Mary’s Hospital, Phoenix Park 
• St. Michael’s Hospital, Dun Laoghaire 
• St. Luke’s Radiation Oncology Network @ Rathgar
• University Hospital Kerry
• St. Columba’s Hospital, Kilkenny
• South Infirmary Victoria University Hospital
• St. John’s Community Hospital, Sligo
• Killarney Community District Hospital
• National Rehabilitation Hospital, Dun Laoghaire
• Fermoy Welfare Home, Cork

Inspections found many hospitals achieved substantial to full compliance in all areas inspected, including St. Theresa’s Hospital, South Infirmary Victoria University Hospital, St. John’s Community Hospital, Killarney Community Hospital District Unit and Fermoy Welfare Home. Examples of areas that required attention in one or more of the other inspections included workforce planning, environmental infrastructure, medication safety, and governance oversight.

Governance arrangements were evident in most services. Services found to be compliant had demonstrated well-structured oversight, clear lines of accountability, and effective leadership. Inspectors identified opportunities for improvement in governance and oversight in other hospitals, for example, inspectors observed that aspects of corporate and clinical governance arrangements required improvement for Clifden District Hospital and St. Mary’s Hospital. 

At University Hospital Kerry, inspectors noted improvement in the corporate and clinical governance structures, however further work was required in the effectiveness and monitoring of these arrangements. Since the previous inspection, staffing deficits within quality functions were addressed. The hospital was monitoring its performance against key performance indicators (KPIs) for infection prevention and control, but there was opportunity for improvement in relation to medication safety. Continued focus on improving compliance with recognition of deteriorating patient, escalation and response was also identified. On the day of inspection patient experience times (PETs) within the emergency department did not meet HSE national KPIs, however there were no patients in the ED over 24 hours at the time of the inspection. Measures to mitigate risks to patient safety were being implemented, however evidence observed on the day of inspection indicated that these measures were not as effective as they should be. In addition, the sharing of learning and timely implementation of recommendations from the review of patient-safety incidents are areas that could be further improved, to support a reduction in recurrence of similar incidents.

While most hospitals demonstrated strong oversight of workforce arrangements, staffing and training issues continued to be a challenge in some services. Records in relation to training required improvement in St. Michael’s Hospital, St. Luke’s Rathgar, University Hospital Kerry and St. Mary’s Hospital, with additional work needed on clinical and health and social care vacancies in University Hospital Kerry and St. Mary’s Hospital.  

Across the board, all hospitals were found to promote a culture of kindness, dignity and respect with improvements required in St. Michael’s Hospital to support privacy arrangements for some patients.  

Most hospitals provided healthcare in a physical environment which supported the delivery of high-quality, safe, reliable care. Clifden District Hospital, St. Michael’s Hospital and St. Columba’s Hospital were impacted by the design and layout of the physical environment which presented infection prevention and control challenges, namely the availability of adequate isolation facilities in St. Michael’s Hospital and St. Columba’s Hospital, as well as a designated cleaning room in Clifden District Hospital. Availability of suitable storage was also an issue in these three hospitals.  

In four of the 12 hospitals inspected, further improvements were identified to ensure service users were protected from the risk of harm associated with the delivery of healthcare services. St. Marys Hospital required improvements to support medicine management practices and arrangements to ensure formalised access to microbiologist advice, where required. St. Columba’s Hospital required improvements in relation to the recording and completion of risk assessments and mechanism to support clinical handover. 

HIQA continues to engage with each hospital where non-compliance was identified to ensure compliance with the national standards. 

Notes to Editors:

• As of 26 September 2024, under Section 8 of the Health Act 2007 (as amended), HIQA is responsible for monitoring compliance with national standards in publicly-funded healthcare services and private hospitals. Using these powers, HIQA may make recommendations for improvement of care, but under current legislation HIQA cannot enforce their implementation.
• The National Standards for Safer Better Healthcare describe a vision for high-quality, safe healthcare and provide a roadmap for improving the quality, safety and reliability of healthcare. They aim to ensure consistent quality care across both public and private hospitals.
• HIQA judges the service to be compliant, substantially compliant, partially compliant or non-compliant with the standards. These are defined as follows:
  • Compliant: A judgment of compliant means that on the basis of this inspection, the service is in compliance with the relevant national standard.
  • Substantially compliant: A judgment of substantially compliant means that on the basis of this inspection, the service met most of the requirements of the relevant national standard, but some action is required to be fully compliant.
  • Partially compliant: A judgment of partially compliant means that on the basis of this inspection, the service met some of the requirements of the relevant national standard while other requirements were not met. These deficiencies, while not currently presenting significant risks, may present moderate risks, which could lead to significant risks for people using the service over time if not addressed.
  • Non-compliant: A judgment of non-compliant means that this inspection of the service has identified one or more findings, which indicate that the relevant national standard has not been met, and that this deficiency is such that it represents a significant risk to people using the service.