Quality Improvement in Irish Designated Centres: HIQA and HSE Guide

This guide covers Ireland. For the UK equivalent, see our guide: Quality Improvement in Social Care: The PDSA Method Explained.

Quality improvement in an Irish designated centre is not just good practice. For centres for older people, the Health Act 2007 Regulations require an annual review of the quality and safety of care and a quality improvement plan, and HIQA's Standards expect quality to be monitored and improved on an ongoing basis. This guide explains what those requirements say, what HIQA and the HSE publish to help, and a simple improvement cycle that we suggest. It is written for providers, persons in charge and managers in Dublin and nationally, because the rules are the same across the State.

Quality improvement belongs within wider governance, so it helps to read this alongside our guide to governance and management in designated centres.

What the Regulations require for older people's centres

Regulation 23 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (S.I. 415 of 2013) was replaced by S.I. 98 of 2025, which came into operation on 31 March 2025. Under the new Regulation 23(1), the registered provider must ensure that:

• the centre has sufficient resources to deliver effective care in line with its statement of purpose;
• there is a clearly defined management structure with lines of authority and accountability, and deputising arrangements for key management roles;
• management systems ensure the service is safe, appropriate, consistent and effectively monitored;
• there is an annual review of the quality and safety of care, checked against the standards set by HIQA and approved by the Minister;
• the review is prepared in consultation with residents and their families;
• a copy of the review is made available to residents and, if requested, to the Chief Inspector; and
• a quality improvement plan is developed and implemented to address issues the review highlights.

Regulation 23(2) adds that effective arrangements must be in place for staff to raise concerns about the quality and safety of care and support. In the substituted wording, Regulation 23 sets no date or deadline for completing the annual review or the quality improvement plan beyond the word "annual", and it does not say who must write the review. Check the current text.

Regulation 26(1), the risk management provision, was also amended in 2025. It now requires arrangements for identifying, recording and investigating serious incidents or adverse events, a process for implementing actions and recommendations arising from them, and a process for audit, review and learning from events. Together with Regulation 23, this makes learning from events part of the legal framework.

Other types of designated centre

Centres for people with disabilities have their own regulations. In S.I. 367 of 2013, as made, Regulation 23(1) similarly requires an annual review of the quality and safety of care and support, with consultation with residents and their representatives, and a copy made available to residents. Regulation 23(2) of that instrument also requires an unannounced visit by the provider or a nominee at least every six months, a written report, and a plan to address concerns. Providers of disability services should check the current consolidated text, because the text described here is S.I. 367 of 2013 as made and may have been amended since.

What HIQA's Standards say

For older people's services, HIQA's National Standards for Residential Care Settings for Older People in Ireland (2016) cover quality improvement in Theme 5, Leadership, Governance and Management:

• Standard 5.4 states that the quality of care and experience of residents is monitored, reviewed and improved on an ongoing basis.

Standard 5.1 states that the residential service performs its functions as outlined in relevant legislation, regulations, national policies and standards to protect each resident and promote their welfare. If you are new to the regulator, our explainer on what HIQA is and what it does sets out how the Standards, Regulations and inspections fit together.

HIQA's annual review template

HIQA publishes a template for the annual review of older people's centres (version 2, effective from 31 March 2025). It is not statutory, so providers do not have to use it, but they must still produce an annual review and make it available. The template measures performance against the 2016 Standards and is organised in two sections: Quality and Safety (Person-centred Care and Support, Effective Services, Safe Services, and Health and Wellbeing) and Capacity and Capability (Leadership, Governance and Management, Use of Resources, Responsive Workforce, and Use of Information).

Each theme has a table of standards with a "Quality improvement required? Y/N" column, space for findings, and a quality improvement plan table. The template suggests that each action should state the improvement to be achieved, the actions needed, any resources required, how improvement will be measured, timescales and who is responsible. It also lists ways to gather residents' views, such as resident forums, house meetings, surveys, comment boxes and communication with relatives.

HIQA's guidance for assessing older people's centres (version 3.1, May 2025) describes how inspectors view this. It treats a review that is in place and available to residents as compliant, a missing written record of consultation or a quality improvement plan that is not fully developed or implemented as substantially compliant, and no annual review, or no consultation, as non-compliant. These are examples from the guidance, not a complete list.

Putting the Standards into practice

In October 2024 HIQA and the Mental Health Commission published an implementation guide for health, mental health and social care services. An accompanying infographic lists five stages: engage with senior leadership, convene a working group, develop an action plan, implement the action plan, and evaluate outcomes and impact. The guide is supported by a self-appraisal tool, an action plan template and a progress checklist.

HSE quality improvement resources

The HSE's National Quality and Patient Safety Directorate publishes a Quality Improvement Guide and Toolkit (version 02, published June 2024; check the HSE site for any later edition) for people running improvement projects in Irish health services. It is written for individuals and teams running quality improvement projects in health services, but its methods can be a useful reference for any provider. The guide describes quality improvement as the ongoing effort of everyone, including staff, patients and families, to make changes that improve outcomes, care experiences and staff development, using data.

The guide uses the Model for Improvement, which asks three questions: what are we trying to accomplish, how will we know that a change is an improvement, and what change can we make that will result in improvement? Each small test of change follows the PDSA cycle:

• Plan: define what is being tested, who is involved and what you predict will happen.
• Do: carry out the test on a small scale and record observations and data.
• Study: compare the results with your prediction and reflect on what was learned.
• Act: decide whether to adopt, adapt or abandon the change, then plan the next cycle.

The guide's six steps are to identify the quality issue, understand the problem, develop a strategy and change ideas, measure for improvement, test on a small scale, and sustain and spread. It also advises establishing baseline data, tracking data over time, and involving patients, families and carers in the work.

A practical quality improvement cycle (our suggestion)

Our suggestion: use the annual review as the start of a continuous cycle rather than a once-a-year document. This is not a legal requirement.

• Gather evidence all year. Collect audit results, incident reviews, complaints, compliments and resident feedback in one place, so the annual review draws on records rather than memory.
• Pick a few priorities. Choose a small number of issues from the review and write a clear aim for each.
• Name an owner and a date. Each action in the quality improvement plan should have a responsible person and a timescale, as the HIQA template suggests.
• Test small. Try a change with one unit or one shift using PDSA before rolling it out across the centre.
• Measure simply. Agree what you will count before you start, and compare it with a baseline.
• Involve residents and staff. Take ideas from residents, families and frontline staff, and use the staff concerns arrangements in Regulation 23(2).
• Close the loop. Report progress through your governance meetings and carry unfinished actions into next year's review.

For how this evidence appears during inspections, see our overview of HIQA inspections and staff training in Ireland.

Learnsignal's offices are off Baggot Street in Dublin, and we offer in-person training from there. For current details, see our CPD pages.

Frequently asked questions

Is an annual review of quality and safety mandatory?

For designated centres for older people, yes. Regulation 23(1)(e), as substituted in 2025, requires an annual review of the quality and safety of care, prepared in consultation with residents and their families.

Do we have to use HIQA's annual review template?

No. HIQA's template states that it is not statutory. Providers must still produce an annual review report and make it available to residents, and to the Chief Inspector on request.

Is a quality improvement plan required?

Yes, for older people's centres. Regulation 23(1)(h) requires a quality improvement plan to be developed and implemented to address issues the annual review highlights.

Is PDSA required by HIQA?

Neither the Regulations nor the HIQA material described above requires PDSA or any specific method. PDSA appears in the HSE Quality Improvement Guide and Toolkit as part of the Model for Improvement.

Do residents need to see the annual review?

Yes. Regulation 23(1)(g) requires a copy of the review to be made available to residents and, if requested, to the Chief Inspector.

Quality improvement works best when it is a routine part of running the centre rather than an annual exercise.