Sir, – Paul Cullen ("Slow response to Halappanavar report", September 12th) deserves credit for his report on the slow implementation of recommendations made following the death of Savita Halappanavar in University Hospital Galway almost two years ago. It's encouraging to see that apparently significant work has since taken place with many recommendations implemented in UHG. Most worrying, however, is the slow pace of change and that only one of 39 hospitals ranked itself as "excellent". A further concern is the use of self-assessment as the method to assess performance in the implementation of recommendations.
Qualitative self-assessment by hospital management is, by itself, a most unsatisfactory way to measure patient safety. Quantitative standards of performance, subject to independent audit, are required. The fundamental flaw throughout our health service is lack of responsibility and accountability. If hospital management is slow to accept responsibility for the speedy implementation of patient safety recommendations, what hope for accountability?
Perhaps the more interesting revelation in Paul Cullen’s report is that the validation of UHG’s self-assessment comes from external management consultants, and not the Health Information and Quality Authority (Hiqa) – the statutory body established under the Health Act 2007 to set standards and monitor compliance. I believe that patient safety verification is too important to be delegated, with or without regulatory control, to private enterprise.
Many of the problems in our health service can be linked to the failure of successive governments to clearly define the role of public bodies such as Hiqa and the HSE. These bodies should be empowered to accept responsibility and be accountable.
The Health Act 2007 is the classic example of ambiguity. Hiqa is required to set standards on safety and quality, and then monitor compliance in relation to services provided by the HSE or service provider. Hiqa’s only function thereafter is to advise the Minister and the HSE. Hiqa claims that it’s not responsible for patient safety, but rather the HSE.
The HSE is compromised in its approach to patient safety. The patient safety test it uses is a self-assessed assurance provided by a public hospital that the resources provided by the HSE are being used by the hospital in the most efficient and effective manner. This assurance is accepted even if the resources provided by the HSE are inadequate to ensure the necessary standard of patient safety. Hiqa is also required to operate within the constraints of inadequate resources even if, as a result, patient safety standards are not in line with best international practice. A review of the Health Act 2007 is long overdue. – Yours, etc,
JIM LAWLESS, MBA
Cypress Downs
Templeogue, Dublin 6W.