A HSE internal review has reported problems with poor compliance from staff with checks carried out to see whether hospitals and other health sector agencies are sticking to quality and safety guidelines and policies.

The review says in some cases, agencies failed to provide the evidence required to demonstrate they were adhering to safety standards.

The audits are carried out by the HSE's Quality and Patient Safety Audit (QPSA) section, and are, according to the HSE, aimed at driving the quality improvement agenda 'through promoting accountability for quality and safety'.

The HSE audit unit checks whether health agencies, including hospitals, primary care centres, mental health units and social care, are adhering to quality and safety standards and recommendations in the provision of services.

The review of audits carried out in 2011 and 2012 expressed concern over a number of issues relating to maintaining quality and safety.

These included:

* Uncertainty regarding who was the senior most accountable person to take responsibility for implementing safety recommendations.

* Lack of 'ownership' within a service, resulting in delayed responses to audit requests.

* 'Abdication or evading of ownership and accountability' for the risk management process.

* Inadequate understanding of implementation of compliance with and access to safety policies, procedures, protocols and guidelines.

*Deficits in communication between services and in communication with patients or service users.

The report says it is apparent that the safety audit process is a new experience for quite a number of services and in particular, non-acute hospital services.

"This lack of familiarity is challenging for services but also for QPSA auditors. Arguably, the most significant difficulty encountered is the ability of services to provide the evidence required to demonstrate compliance (with quality/safety standards)."

"While in many cases there is simply no evidence available, in other cases there is poor comprehension of what constitutes 'evidence'," the report states.

The report said greater commitment was needed from some HSE services in terms of prioritisation of QPSA audits and the quality of data submitted.

"From 2013, auditors will be instructed to gradually harden their approach to unexplained or otherwise unreasonable delays in responding to requests for necessary information."

The review, which was completed in the spring of last year, says the QPSA section is committed to a system that 'recognises and applies the values of transparency, honesty and candour'.

It adds that HSE auditors had been well-received across the organisation and progress was made with audits in 2011-12.

However, the report notes that during this period, auditors were unable to progress 17 audit requests due to factors such as guidelines not being implemented; governance issues; insufficient information provided and organisation restructuring issues.

The QPSA unit says its aim is to embed a culture of compliance in the health service, so that accountability for maintaining safety standards is clear at all levels.

The unit says it progressed 47 audits on safety compliance in various sectors of the health service during 2011 and 2012, including audits in 21 hospitals.

Patience wearing thin on safety guarantees