Certification of Healthcare Services

Questions and Answers on the Health and Disability Services (Safety) Act 2001

Health and disability standards for hospitals, rest homes and residential disability services are aimed at improving safety levels and quality of care. They are mandatory for all providers covered by the Health and Disability Services (Safety) Act 2001.

Back to the Health and Disability Services (Safety) Act 2001

1. Where can I find more information about applying for certification and agencies designated to audit healthcare services?

View the following pages in this website:

2. What is the purpose of the health and disability standards?

The health and disability standards support the safe provision of services to consumers and set the minimum standard for rest homes hospitals and providers of residential care. The standards are mandatory for providers of health care services that are subject to the Health and Disability Services (Safety) Act 2001. This includes rest homes, hospitals and those providers of residential disability care that have five or more residents. The standards are designed to establish safe and reasonable levels of service for consumers and reduce the risk of harm. They are minimum standards and as such, some providers will exceed these. For example, most new residences for elderly people have rooms with ensuites although this is not required, Areas covered by the standards include:

Consumer rights
Organisational management
Service delivery
Safe and appropriate environments
Infection control
Restraint Minimisation.

3. What is the purpose of the Health and Disability Services (Safety) Act?

The purpose of the Act is to:

Promote the safe provision of health and disability services to the public
Enable the establishment of consistent and reasonable standards for providing health and disability services to the public safely
Encourage providers of health and disability services to take responsibility for providing those services to the public safely
Encourage providers of health and disability services to the public to continuously improve the quality of those services.

4. How were the health and disability standards developed?

The health and disability standards were developed by expert technical committees drawn from the health and disability sector and included consumer representatives. The standards were released for extensive public consultation before being finalised in 2001. The standards were overseen by an overarching Standards Management Committee that included 9 sector representatives.

The Minister of Health is required to review the Health & Disability Services Standards (“The Standards”) at least every four years. The most recent review process began with an informal review in 2005, followed by a formal review in 2008. As part of the 2008 review process, Standards New Zealand, working on behalf of the Ministry of Health, convened an expert committee, made up of representatives from the sector, to review and update the Standards.

The revised sector-agreed Health and Disability Services Standards 2008 are the result of three years extensive collaboration with many groups including consumers, providers, government and non-government agencies and the Ministry of Health.

The Standards are clearer, more up to date, better reflect the concerns of the sector and are structured in a way that will make them easier to review in the future.

5. How are the standards audited?

The Health and Disability Services (Safety) Act aims to improve provider accountability using approved independent auditing to ensure compliance with the health and disability standards. Service providers can choose from a list of designated audit agencies provided by the Ministry of Health.

Designated audit agencies are charged with auditing services against the appropriate standards.

Providers have to demonstrate to the auditors that the services they provide are:

safe
focused on patient services and the outcomes
continually improving the quality of the service
compliant with the standards
meeting Director-General conditions.

6. How are providers certified?

The auditors report their findings to the Ministry of Health. If providers meet the required standards, the Director-General of Health will then issue a Certificate for relevant services to the provider. That provider is then "certified".

7. How long does certification last?

Certification will usually last three years although in some instances it may only run for one or two years. Safety and continual improvement in service provision may result in a longer than three year certification period.

8. Who audits the auditors?

Audit agencies have to demonstrate their compliance with requirements set out in the Health and Disability Services (Safety) Act 2001 before being designated.

The Ministry will require audit agencies to have:

technical expertise to audit
effective systems and resources in place to audit the specified services
effective arrangements to avoid conflicts of interest that may arise and
competent commercial systems and arrangements

In response to sector desire for a "level playing field" in the auditing process, audit "tools" were developed to make it clear what providers will be measured against.
Providers may choose either to be audited against the standards using the sector developed audit tools or by audit tools developed by their designated audit agency and approved by the Ministry of Health.

9. What is the Ministry of Health's involvement?

The Ministry of Health is responsible for reviewing the audit reports, issuing the certificate, administering and enforcing the legislation and managing legal issues. The Ministry of Health also becomes involved if a designated audit agency reports a critically unsafe service.

10. What if providers fail to meet the standards?

All providers under the legislation must comply with the standards and the Ministry of Health offers all the assistance it can to ensure they do.

The Director-General of Health has statutory authority to close a service where there are serious concerns for patient safety.

11. Are home support services required to comply with the same standards as rest homes?

Home support services are not be covered by the Act The Act applies to hospitals (public and private), rest homes and residential homes for those with disabilities. There is an enabling clause in the Act that allows the Governor-General, on the advice of the Minister of Health, to extend coverage of the Act to another specified health or disability service in the future. The Minister must ensure that there exist relevant standards for application to the new specified service area. In addition, the Ministry must undertake the appropriate policy analysis to justify extension of the Act to the new specified service area. Also, a good sample of affected providers must be consulted about the proposal to include new specified services under the Act.

12. What is the difference between a service contract and certification?

A service contract is a legal agreement between the Ministry and a service provider. This agreement is covered by contractual law.

Certification is a statutory requirement covered by an Act of Parliament.

13. Can Intellectual Disability service agreement audits and certification audits be combined?

Disability Support services within the Health & Disability National Services Directorate have changed the approach from one of compliance against the service agreement to the current approach of developmental evaluations. Developmental evaluations focus on quality of life outcomes for clients, which is quite different to certification audits which measure compliance against the standards. The skills to complete a developmental evaluation are quite different to a compliance audit against the standards. However, providers who have their certification audit date scheduled should contact the Quality Team within the Health & disability National Services directorate to discuss whether a developmental evaluation needs to take place within the same six month period.

14. Why do we need both certification audits and Intellectual Disability service agreement audits?

Certification audits check compliance against the standards, whereas a developmental evaluation approach looks at quality of life outcomes for clients using the service. A developmental evaluation looks at different things and its focus is quality improvement in service delivery. To avoid duplication many of the things covered by certification will not be reviewed as part of a developmental evaluation approach. The Ministry is looking at the desirability and feasibility of implementing quality of life monitoring of residential disability care under the Health & Disability (Safety) Act 2001.

15. What happens if I fail an audit?

Services covered by the Act must be certified in order to deliver relevant health or disability services covered by the Act.

Relevant services must comply with all approved standards before certification can be granted.

Relevant services that do not comply with approved standards will not be certified and therefore cannot legally deliver services to the public.

16. Can I use audit findings about my business for marketing purposes?

Yes.

17. Can audit findings be made public?

Designated Audit Agencies send audit reports to providers and the Director-General. The Ministry of Health is subject to the Official Information Act so audit reports may be provided to requestors under that Act.

18. What information must a provider give to the Director-General?

Providers must supply the Director-General with the following:

Contact person’s:

Name
Address
Telephone number

Notice of the locations at which services are to be provided.
All changes of name, address and telephone number of a specified contact person.
Notice of any new location at which services are being provided.
Change of membership of a body corporate.
Change of membership of a Trust Board.
Change in trustees in any other trust.
Change in partners in a partnership.
Notice of any incident, investigation or reportable (to the Coroner) death (of Consumer)

19. What is meant by an incident?

An incident is any situation that puts at risk, may put at risk or has put at risk the health and safety of consumers of the service. Examples include: fire, flood, significant building damage or equipment failure.

20. What process is used to designate audit agencies?

The Director-General will designate audit agencies, if and only if

The person has:
- applied in writing to the Director-General o paid to the Director-General the prescribed fee
The Director-General is satisfied that the person:
- has the technical expertise
- has effective auditing systems
- has effective arrangements to avoid or manage conflicts of interest
- will administer those systems and arrangements properly and
- competently and in compliance with any conditions
- will comply with the Act.

21. Are there standards for audit agencies?

Audit agencies may be accredited by a third-party agency. These third-party agencies normally use ISO based criteria standards for evaluation of policies and procedures. Third party accreditation would therefore mean that those audit agencies were deemed to be compliant with internationally recognised standards of good, quality practice.

22. Can a designated audit agency be involved in other businesses such as training, service and systems development and accreditation?

If audit agencies wish to engage in business other than certification audits that may cause a potential conflict of interest, they must demonstrate appropriate management of this conflict. The Director-General must be satisfied that an audit agency can demonstrate clearly that it can robustly manage this conflict of interest before he can designate such an agency.

23. How do designated audit agencies report audit findings to the Ministry?

Designated audit agencies provide audit reports electronically to a Ministry developed database. Briefly, this audit report covers specific compliance with standards criteria. In addition designated audit agencies provide an overall assessment of service compliance with each standard under the Act.

24. If additional improvement is recommended in the audit report, how is this reported back to the Ministry?

Designated audit agencies are expected to follow-up recommended improvements and report these to the Ministry. The initial report with improvement recommendations have associated timelines which serve as reminders to the Ministry to ensure follow-up has occurred.

25. How can providers get information about the standards?

Copies of the Standards can be purchased from Standards New Zealand, Private Bag 2439, Wellington 6140. Telephone: 0800 782 632, Fax: (04) 498 5994. www.standards.co.nz.

They can also be viewed and downloaded in the Introduction of the Health and Disability Services Standards section - View the Health and Disability Services Standards 2008.

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Page last updated: 5 March 2009