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Implementation of the Care Institutions (Quality) Act
This audit considers the implementation of the Care Institutions (Quality) Act. This Act is one of the instruments available to the Minister of Health, Welfare and Sport (VWS) to fulfil his responsibility for the quality of care. We looked at how the parties concerned have implemented the principles underlying the Act (self-regulation and supervision of supervision).
Audit106
Conclusions
Our main conclusion is that self-regulation in the care
sectors has not produced the intended results. Between 1996 and
2006, care providers, care insurers and clients inadequately
developed a shared vision (quality frameworks with indicators and
standards) of what they understood appropriate care to be.
Furthermore, self-regulation during this period did not lead to all
care providers operating adequate quality systems. Our audit could
not fully establish the current status of the quality systems. We
did find that the number of certificates and accreditations had
increased, often under pressure from the care insurers, who insist
on the inclusion of certification of quality systems in their
contracts with care providers. Many care providers satisfy the
certification requirements because they would otherwise lose out
financially. They are sceptical, however, about the presumed
relationship between certification and the quality of care.
Although the minister thinks certification is important, he did not
want it to be compulsory. We found that the benefit of and need for
certification is uncertain.
It is assumed that system supervision requires less capacity than other forms of supervision. In our opinion, extra capacity will in any event be needed at the Netherlands Health Care Inspectorate (IGZ) during the introduction of system supervision because the IGZ will have to assess the design and operation of quality assurance and good governance systems at every institution. We investigated the introduction of this phased supervision in hospital care for the elderly and disabled care. These sectors do not satisfy three conditions for the smooth operation of phased supervision, however. It is therefore uncertain that the risk analysis necessary for the first phase works properly.
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It is assumed that system supervision requires less capacity than other forms of supervision. In our opinion, extra capacity will in any event be needed at the Netherlands Health Care Inspectorate (IGZ) during the introduction of system supervision because the IGZ will have to assess the design and operation of quality assurance and good governance systems at every institution. We investigated the introduction of this phased supervision in hospital care for the elderly and disabled care. These sectors do not satisfy three conditions for the smooth operation of phased supervision, however. It is therefore uncertain that the risk analysis necessary for the first phase works properly.
Recommendations
The minister's ambition is that everyone should have an
insight into the provision and quality of nearly all care services
in 2011. We recommend that the minister formulate this goal in
concrete, specific and measurable terms. We also recommend that an
action plan be drawn up laying down what performance the
stakeholders must deliver and when. We recommend that the minister
clarify what measures will be taken if the required performance and
goals are not delivered.
We also recommend that the minister investigate to what extent the care providers have properly functioning quality systems and that he accordingly formulate a policy on non-compliance with the Act. We further recommend that a rigorous study be carried out of the relationship between certification of quality systems and the quality of care.
We recommend that the minister have the IGZ prepare an action plan to clarify how system supervision will be given form and substance, what conditions must be in place and when, and what instruments the IGZ will need. Finally, we recommend that the minister express an opinion on the capacity necessary at the IGZ.
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We also recommend that the minister investigate to what extent the care providers have properly functioning quality systems and that he accordingly formulate a policy on non-compliance with the Act. We further recommend that a rigorous study be carried out of the relationship between certification of quality systems and the quality of care.
We recommend that the minister have the IGZ prepare an action plan to clarify how system supervision will be given form and substance, what conditions must be in place and when, and what instruments the IGZ will need. Finally, we recommend that the minister express an opinion on the capacity necessary at the IGZ.
Response of the minister and state secretary
The Minister and State Secretary of VWS write in their
response that publication of their 'Stance on an evaluation of the
Care Institutions (Quality) Act' in December 2002 had provided a
strong catalyst for the necessary follow-up measures for the good
implementation of the Act. A series of improvement programmes, they
write, had boosted the quality of care provided by the
institutions. They refer to the results achieved so far, which
underpin their confidence in further progress. They also note that
further actions are necessary in many areas to realise their
ambitions.
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Current status
The report was submitted to the House of Representatives on 10
June 2009.
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