It’s six weeks since the the Health Information and Quality Authority (Hiqa) published one of the most damning reports on the public health system ever produced.
The Hiqa review into the deaths of five babies in the maternity unit at the Midland Regional Hospital, Portlaoise, which examined patient-safety practices at the hospital, uncovered multiple examples of poor oversight and a failure to take action by the Health Service Executive (HSE) at national, regional and local level.
It showed how poorly the families of the dead babies were treated: “Narratives provided by patients and families demonstrated that the failure by some staff to show compassion in the care they provided, and what those patients and families felt to be the absence of openness from those managers and clinical staff that they subsequently engaged with, resulted in devastating consequences for them,” the report states.
We have been told that clinical staff involved in unprofessional practice at the hospital have been identified and referred to the Medical Council and the Nursing and Midwifery Board respectively in order for their fitness to practise to be objectively examined. That is as it should be, and is a welcome response.
But what of the managers involved? In a forensic analysis Hiqa found evidence of neglect and failure by HSE managers in how they dealt with clearly documented problems at the Midland Regional Hospital. This failure occurred at local, regional and national level.
Worse still, Hiqa was able to demonstrate that “previous investigations have highlighted serious deficiencies within the HSE in relation to its ability to learn from adverse findings”; and, crucially, found that “six separate reports on other hospitals between 2008 and 2013 that should have led to improvements at facilities, including Portlaoise, were not fully acted on”.
In other words poor professional performance by health service managers is embedded in the system.
So what has been done about this? Tony O’Brien, the chief executive of the HSE, has said that internal disciplinary procedures are being followed. But is this enough? If the performance of doctors and nurses is assessed by statutory independent bodies why do we not have a similar structure and process for managers?
The Health Management Institute of Ireland (HMI) is the professional body for healthcare managers in the Republic. It would be helpful to hear the HMI’s view of the Hiqa conclusion that “ there was no evidence that the HSE nationally was proactively exercising meaningful oversight of the hospital and the inherent risks there”.
Clearly HMI cannot be both a representative body and a regulator, but the question must be asked: has it lobbied the Department of Health for the creation of an independent regulatory body for health service managers?
The health management landscape here could not be more different to that in Britain. It is facing up to the failure of a number of NHS hospital trusts and how to deal with the problem. A Health Service Journal report has found that there were far too many NHS organisations and a chronic shortage of good managers. "There are too many separate NHS organisations given the talent available to staff them all at board level," it says. A likely solution will be a significant reduction in the number of trusts.
Meanwhile, the National Health Service Act 2006 could not be more clear in how to deal with failing trusts and their senior managers. Section 52 of the Act states: “The regulator may require the trust, the directors or the board of governors to do, or not to do, specified things or things of a specified description within a specified period.”
The legislation also says: “The regulator’s power to remove a director, or member of the board of governors, of the trust includes power to suspend him from office, or to disqualify him from holding office, as a director or member of the board of governors of the trust for a specified period.”
In the aftermath of Portlaoise, could the Irish Government please copy?
mhouston@irishtimes.com
muirishouston.com