HIGH LEVELS of “mistrust” at all levels in the organisation were found by PricewaterhouseCoopers (PwC) when it conducted a review at Dublin’s Tallaght hospital last year.
A further report is now awaited from PwC on how to change the hospital’s existing board structure, which may require legislation.
The independent consultants’ report last year found limited real delegation of power and accountability, and “unconvincing leadership at board and management level”.
PwC recommended a smaller board and management team, and yesterday the hospital, following a special board meeting on Monday night, said it was taking steps to implement the report’s findings.
The hospital, which has been at the centre of controversy over the past week since it emerged that nearly 58,000 X-rays went unreported by consultant radiologists at the hospital over a four-year period and thousands of GP letters were left processed, said one of the fundamental changes now being made is the appointment of a director of quality at the hospital.
At present the hospital is run by a 22-member board. Most of its functions in relation to overseeing the management of the hospital’s activities on a month-to-month basis will now be delegated to a 10-member interim board of management. Membership of this board will include the hospital’s chief executive, Prof Kevin Conlon, chairman of the existing board Lyndon MacCann, a staff representative, co-opted external persons representing patients, and personnel with business expertise and financial skills.
This interim arrangement will remain in place while a further report from PwC is awaited on how to change the hospital’s existing board structure, which may require legislation. This next report from PwC is expected in about three months.
The PwC report highlighted “obvious deficiencies in information flow to and from members of the senior management team”, a document put before this week’s board meeting said. It said senior management team members’ decisions are frequently subject to change after appeal to a higher authority in the hospital. “This results in serious emasculation and very poor morale,” it said.
“There is no meaningful monitoring of senior management team performance, nor incentives for strong performance,” it added.
In a statement, the hospital confirmed the PwC report findings had been presented to the hospital’s existing board last October, and that on foot of it Mr MacCann presented proposals for the creation of new management structures to board members on Monday night. The board unanimously accepted the changes.
Minister for Health Mary Harney welcomed the new organisational arrangements. “The only priority must be that the new arrangements are to the benefit of patients,” she said.
Former Labour party leader and Dublin South West TD Pat Rabbitte said while the statement from Tallaght hospital on governance changes should help restore the reputation of the hospital, it did not answer several outstanding questions such as to what extent did consultants’ private workload at the hospital contribute to the crisis over unreported X-rays and unopened GP referral letters.
Local Fianna Fáil TD Charlie O’Connor also welcomed planned changes in the hospital’s management structure, but said that he was “concerned that change on this scale will be bogged down by internal politics”.
Meanwhile, the HSE would not say yesterday how many hospitals across the State have responded to its request for information on whether they too have X-rays that have not been reported by a consultant radiologist, or “other suitably-trained doctor in line with your local protocols”. It said this was a work in progress.