In one of the most damning reports on the public health system produced, the Health Information and Quality Authority (Hiqa) has found evidence of neglect and failure by Health Service Executive managers in how they dealt with clearly documented problems at Midland Regional Hospital, Portlaoise. Of particular concern is that the authority says that, given the level of risks found across the hospital, it cannot say that, even now, services for patients at the midlands unit are safe.
The Hiqa review into the deaths of five babies at the hospital’s maternity unit was prompted by concerns expressed in a preliminary report by chief medical officer Dr Tony Holohan. The review, 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 at national, regional and local level.
Managerial inaction
Hiqa was able to follow a thread of inaction by managers at all levels after risks to patient safety were clearly identified. Compounding this inaction was a decision to continue to operate a full range of hospital services on a 24/7 basis in a unit that was underfunded and without adequate governance.
Heart-rending examples of how mothers who lost babies in the maternity unit were treated are most upsetting: “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.
However, the continuing risks to the safety of current and future patients at Portlaoise identified in the review must be highlighted.
Specifically, Hiqa has identified a risk to people who attend the hospital’s emergency department. Due to the lack of a unifying governance structure, and notwithstanding the intense focus on safety issues in recent months, the safety of patients presenting with emergencies cannot be guaranteed. The report is effectively saying it is unsafe for anyone to attend the emergency department.
Hiqa questions the ongoing safety of maternity patients due to a failure to upskill all nursing and medical staff by way of practical CTG (tracing of baby wellbeing) training. It was the lack of an appropriate response to signs of foetal distress and oxygen deprivation that led to the deaths of up to eight babies at the unit.This is an incredible finding given the concerns, identified by the State Claims Agency in 2007, about the safety of pregnant women at the hospital; and subsequent baby deaths.
The review also highlights ongoing risks to people admitted to the hospital with medical problems. In the ongoing absence of medical assessment units at Portlaoise, and without a bed-management structure in place, the safety of patients admitted with common medical illnesses cannot be assured.
What can we infer about the safety of sick people admitted to other public hospitals in the State? The Hiqa investigation team says it is not satisfied the National Standards for Better Safer Healthcare, which specify the prompt actions to be taken when safety deficits are identified, are being followed nationally. Worryingly, the team was able to show that, up until late 2014, patient-safety issues were not even a standing agenda item for discussion at the highest level of HSE management.
There are clear messages from this damning report. HSE managers nationally appear unable to manage the health service in a safe and responsible way. And the temporary closure of Portlaoise hospital to prevent harm to current and future patients must be given serious consideration by Government.
Dr Muiris Houston is The Irish Times health analyst