Responsibility for complex surgery and, potentially, the intensive care unit, will be removed from the Midlands Hospital in Portlaoise, the director general of the Health Service Executive has said.
Tony O’Brien said colorectal surgery would be moved to St James’s Hospital in Dublin, and patients with higher risk pregnancies would be transferred to the Coombe hospital.
The intensive care unit at Portlaoise may also be removed, he added.
A report by the Health Information and Quality Authority (Hiqa) published this week found managers at all levels in the HSE - local, regional and national - were aware of patient safety risks at Portlaoise hospital but failed to act on them.
It was commissioned following the deaths of five babies in the hospital’s maternity unit and said the HSE and the hospital failed to learn from the recommendations made in previous reports.
Speaking on RTÉ Radio’s This Week programme on Sunday, Mr O’Brien said a “significant lack of compassion” had been shown at the maternity unit at Portlaoise.
Problems at the hospital went beyond a lack of resources, he added.
“Many of the issues that arise in Portlaoise aren’t about the quality of clincial care but about the human and compassionate care that was or was not provided,” he said.
“It is important, starting in the maternity unit in Portlaoise and other maternity hospitals that we have a thorough review of the issues that contributed to what appears to be a significant lack of compassion, what we do about it and whether there is anybody in the service who shouldn’t be in the service,” he said.
Health Information and Quality Authority (Hiqa) inspectors noted that while Portlaoise hospital was listed a a ‘model three’ hospital it was not resourced or equipped to safely deliver the level of service.
Mr O’Brien said the Government, not the HSE, had made the decision to make Portlaoise a level three hospital.
“Model two hospitals do not generally have maternity services but Portlaoise does. The HSE view at the time that was this was a two-star hospital but because of the model groupings which were done as a way of resource allocation, it became a hallmark or badge of honour for different types of environments
He said while the models were “arbitrary in some respects” it was an important hospital because of its location and said it would deliver between 1,800 and 1,900 babies this year.
“The level and volume of demand it faces creates particular challenges around sustainable intensive care unit and sustainability around certain types of surgical services.
“Any decision about the nature and type of healthcare delivery is deeply political,” he said.
He said with the introduction of the Dublin Midlands hospital group, more resources and additional consultant posts would be made available to Portlaoise.
He said following the recommendations of the Hiqa report, some services will be removed from Portlaoise.
Complex surgery, particularly colorectal surgery will be moved to St James’s Hospital in Dublin, and patients with higher risk pregnancies will be transferred to the Coombe hospital.
The intensive care unit at Portlaoise may also be removed, he added.
Mr O’Brien said he would increase accountability in hospitals by bringing in an external reviewer “in accordance with discplinary procedure to look at issues of concern”.
“They were many issues which escalated; they didn’t always find their way to the right decision making levels and I need to look at that, including in particular the way that issues escalated to the regional level found their way, only after a very extended period of time to the national level,” he said.
When asked if he thought the scrapping of the HSE board and the introduction of the HSE directorate gave the Department of Health more political input into decision making at the HSE he said.
“No. Either approach is a valid approach. A director or a board approach. The designation of the model of hospital in Portlaoise, happened long before the director was established so I don’t think that has a part to play.”
“One of the key lessons out of this report is that regulators are inclined to hold the HSE accountable for decisions that others make. That obviously is going to lead the HSEto be more robust about the decisions that other people make.”