I fear findings will fall on deaf ears - like many recommendations in the past
Published 09/05/2015 | 02:30
The Hiqa investigation team has clearly carried out a thorough and devastating review of the performance of the HSE and local management of the Midland Regional Hospital, Portlaoise over the last number of years and the findings cannot make easy reading for those who are responsible for the management of the hospital.
The report highlights a dysfunctional hospital lacking amongst other things effective corporate accountability, effective clinical governance in the Emergency Department and effective risk management structures to deal with adverse patient events or complaints. The investigation team gathered evidence which showed that up until late 2014, patient safety issues were not even a standing agenda item for discussion at the highest level of management within the HSE.
Such was the disregard for patient safety that the team could find no evidence that any senior HSE managers visited the hospital in the immediate aftermath of the RTÉ 'Prime Time' broadcast in early 2014.
There are quite startling revelations contained within the report dealing with the services provided by the hospital's other clinical units which thus far appear to have received little, if any, attention. The Emergency Department, which is open 24 hours a day, seven days a week for adult and paediatric patients only, has a consultant in emergency medicine on site for six hours a day, four days a week - or a little over 14pc.
An as yet unpublished performance review carried out by the HSE in 2014 concluded, "a 24-seven emergency care service at Portlaoise Hospital was not clinically sustainable".
The problem extends to intensive and critical care services.
What is worse is that it appears that through a culture of lack of interest in patient safety and a failure to act on foot of previous investigations, patients and service users have been put at significant risk. A particularly damning phrase notes that "it appeared that senior HSE managers were predominantly focused on controlling healthcare expenditure".
Where is the culture of learning that seeks to improve healthcare services in this country by learning from previous mistakes? The investigation team referred to six previous investigations in hospital care carried out by Hiqa itself between 2007 and 2013 which made findings and recommendations which "were to be intended to be used by all healthcare services to inform and improve practice. Had the relevance of these investigation findings been reviewed in the context of Portlaoise Hospital... the Authority is of the opinion this could have vastly reduced the identifiable risks in the services being provided to patients."
Here lies the heart of the problem in my view and is the fate which I feel may very well befall the recommendations of this Hiqa report.
There is nothing to suggest that the findings and recommendations concerning Portlaoise Hospital across its clinical services will not fall on deaf ears. The HSE is a bureaucratic monolith which has endured much criticism since its establishment back in 2004, yet little appears to ever change at an organisational level.
Until such time as there is a level of individual responsibility, there will be the ever present risk of important recommendations going ignored.
Individuals working within the healthcare system must accept responsibility for their actions and this is one of the reasons why many patient advocates have been calling for a legal duty of candour to be introduced along the lines of that which is now law in the UK.
The Minister for Health Leo Varadkar himself noted not long after he took office that not owning up to an error was to his mind akin to "a hit and run". Hiqa has recommended that the HSE assign responsibility and accountability to named person/persons for implementing recommen-dations and actions contained in internal and external reviews and investigation reports. "Responsibility" and "accountability" are two words that don't always sit easy with the HSE.
Michael Boylan is a solicitor with Augustus Cullen Law who acted for one of the families whose baby died in Portlaoise.