Final Report > Chapter 6: Quality, Standards and Information > Monitoring > The role of the regional health authority

The role of the regional health authority

38 Miss Hawkins told the Inquiry that the main function of the RHA was the strategic planning of services. Asked by Leading Counsel to the Inquiry whether her role as the RGM involved her in directly supervising the various different districts within the Region, she replied:

`It was a very difficult system because the Regional Health Authority had monitoring and a degree of control, in italics, of its districts without the actual authority to affect them directly, because each district had its own Chair and non-Executive Board who actually managed the districts. So it was a situation where you had accountability and responsibility without true authority.' [17]

39 Miss Hawkins was asked whether she or the Regional Medical Officer tried to get figures from the BRI about the performance of the Cardiac Unit, particularly as regards adult cardiac surgery. She stated:

`I would have to say no, because I would not have had the evidence to go in and demand such figures. A reluctance on the part of districts who were very content to refer out of region and not to the BRI, without being able to identify what they meant - what did they mean by unsatisfactory outcomes - was not a reason to put in two or three people to try and identify and collate statistics by hand, which is what it would be. There was no computerised record at that time.' [18]

40 She said that there was, after 1991: `a shift of emphasis on monitoring which would move away from the providing of the service to the purchasing of the service, because we would be working through the purchasing DHAs, whereas the performance monitoring of the provider was the DHSS [sic] if they were a Trust.' [19]

41 In addition to its monitoring role, the Region also had an important role in implementing the national policy on medical and later clinical audit. Following the publication of `Working for Patients; Medical Audit Working Paper No. 6' [20] in January 1989, arrangements to support medical audit were to be made at regional level, with funds allocated centrally. The Regional Hospital Medical Advisory Committee (RHMAC) took on the responsibility for these funds and for reporting on progress to the DoH. The RHMAC accepted the prevailing view that audit was essentially a professional educational activity and that: `Health authorities and managers ... are not competent to make judgements on the technical quality of medical care.' [21]

Footnotes

[17] T56 p.22 Miss Hawkins

[18] T56 p.65 Miss Hawkins

[19] T56 p.125 Miss Hawkins

[20] HOME 0003 0124

[21] UBHT 0068 0011