Hiqa CEO highlights lack of leadership in hospital management

OIREACHTAS COMMITTEE ON HEALTH:THERE IS "not necessarily a sufficient number of strong leaders at local level" to ensure recommendations made by the Health Information and Quality Authority about the running of acute hospitals can be implemented, the organisation's chief executive has said.

Tracey Cooper also told the Oireachtas Committee on Health Hiqa would shortly begin a “substantial monitoring programme” in all hospitals focusing on leadership, governance, management and safe care. This would include monitoring the implementation of the recommendations made in the Tallaght investigation report.

The report, released last week, was triggered by the death of Thomas Walsh (65) on a trolley in the corridor next to the emergency department in Tallaght in March 2011. It found the hospital had significant governance problems, patients were waiting too long in its emergency department and their accommodation on trolleys in a corridor was unsafe and put them at risk.

Yesterday, Ms Cooper said Tallaght hospital should never have been allowed to “get into the state it was in” and should never have been allowed to continue in that way. There had been budget overruns and governance challenges, she said. Hiqa’s concern was “at what point did the HSE say, ‘Stop, we need to do something more about it’”. Many staff at the hospital raised concerns but they were not acted upon.

“As a State we have difficulty addressing poor performance and holding people to account for poor performance,” she said.

There were monthly meetings between the HSE and the hospital, but “quality and safety of service didn’t appear on the agenda until August of last year”, she said.

The recommendations made by Hiqa, many of which related to good governance and expertise on hospital boards, were “not rocket science” and should be in place for any hospital, she said.

Strong leadership was essential and there was “not necessarily a sufficient number of strong leaders at local level” to implement the recommendations. When people found themselves in jobs they were not equipped to discharge, a change in leadership was needed, she said.

She also said the decision-making around who had authorised “top-up” payments to some hospital staff was “not at all clear”.

Deputy Eamonn Maloney (Lab) said the Hiqa report made startling reading.

“Some facts you’ve highlighted in relation to public hospitals in general are frightening,” he said.

Deputy Caomhín Ó Caoláin (SF) said he hoped Hiqa would press for the implementation of its recommendations, but said funding would be needed.