It was one of the better examples of how appearances can deceive. Last week, it emerged that the Health Service Executive underspent its capital budget by almost €100 million, and now has to give the money back. On the same day, it was reported that the National Maternity Hospital (in Holles Street, Dublin) had been turned down by the HSE for additional funding to enable it to clean its facility more thoroughly, writes Mary Raftery.
Clearly another example of HSE incompetence, one might think, in this instance potentially endangering babies and their mothers by refusing essential funding to clean a busy maternity hospital, while at the same time handing money back because it was incapable of spending it on a health service which remains chronically underfunded.
However, while there is little excuse for the HSE's underspend, things are not quite as clear when it comes to Holles Street.
The hospital was commendably frank in its recently published annual report for 2006 on its cleaning problems, particularly about the "urgent need" for more frequent cleaning. As everyone is now well aware of the connection between dirty hospitals and life-threatening infections, the allocation of sufficient funding to hygiene should be a key priority for all health facilities. In the case of Holles Street, however, there are other items of major expenditure that it is not quite so frank about. These concern the substantial legal costs of its battle to keep secret some of the records relating to the retention by the hospital of the organs of deceased babies.
Holles Street was one of the more active hospitals in terms of retaining babies' organs after postmortem examination, invariably without either the consent or the knowledge of the infants' parents. These parents, through the organisation Parents For Justice, sought the release of the relevant documentation from all the maternity and paediatric hospitals involved in this practice throughout the State. All but one eventually capitulated. Holles Street not only refused, but then took a High Court action against the Information Commissioner, who had ruled that the Holles Street records be released under the Freedom of Information Act.
The documents in question relate to the material sent by Holles Street to the Dunne inquiry, which had been established to examine the entire issue of organ retention, and which was closed down by the government in 2005 without publishing a full report.
In the absence of such a report, the parents are attempting to piece together exactly what the various hospitals told the inquiry. In the case of Holles Street, according to its legal representatives, these records contain "highly confidential and sensitive information [providing] information on post mortem practices and procedures".
Two months ago, the High Court dismissed the appeal by Holles Street against the decision of the Information Commissioner that the records be released. It found against the hospital on all six grounds quoted and ruled that the Information Commissioner had been correct in each instance.
The hospital had 28 days from the date of this judgment to release the records to Parents For Justice. This deadline ran out weeks ago, and still no documents have been handed over.
In addition, Holles Street refuses to say how much the legal action has cost the hospital. It will have to pay the costs of the other side in addition to its own. At a rough and highly conservative estimate, these will amount to at least €250,000 - a figure which would buy quite a lot of cleaning materials.
Holles Street receives most of its funding from the taxpayer, through the HSE. The State, however, does not own the hospital and it remains unclear what, if any, sanctions can be applied in the context of a hospital spending exchequer funds on futile legal battles rather than on, for instance, cleanliness and infection control.
In terms of the hospital's governance, it is worth noting that the 2006 annual report for Holles Street informs us that of the six ex-officio members of the hospital's board of governors, no fewer than four are Roman Catholic priests.
The expenditure by Holles Street on its legal battles was firmly criticised by the Information Commissioner, Emily O'Reilly. In her 2004 annual report, she wrote that "the behaviour of the Hospital in this case amounted to obstruction of my Office . . . In conducting its business with my Office in this manner, the Hospital is likely to have incurred substantial and mostly unnecessary legal costs which ultimately must be at the expense of the taxpayer."
Meanwhile, in the cleanliness stakes, Holles Street is the dirtiest of the three large Dublin maternity hospitals. Although it did improve last year, its record on general cleanliness in wards, toilets and kitchens, and on hand hygiene in some areas, remains in the "poor" category.
The attempt by Holles Street to blame the HSE and its refusal to release funds for this simply will not wash.