Varadkar and HSE clash over Savita plan
Series of internal memos reveal how lessons were not learned from baby deaths or misdiagnosis cases
Health Minister Leo Varadkar has bluntly admitted that the Health Service Executive (HSE) has failed to prioritise patient safety or fully learned the lessons of baby deaths and tragic cases of misdiagnosis.
Internal memos reveal fractious behind-the-scenes wrangles between the minister's officials and the HSE over the follow-up to the death of Savita Halappanavar.
The Department of Health was still in the dark about who in the HSE was responsible for providing reports on implementing the crucial safety recommendations announced last October as a result of the Halappanavar tragedy - nearly two years after her death.
And the minister also expressed a lack of confidence in the HSE's attitude to openness about scandals like the Portlaoise Hospital affair.
Mr Varadkar now appears mired in the same turf wars with the HSE as his predecessor Dr James Reilly.
It comes as he seeks €1bn for next year's health budget - again a similar trend to Dr Reilly's tortuous time in the department.
The documents show Mr Varadkar supporting scathing criticism of the HSE's failure to fully prioritise patient safety and notify senior officials of risks, including the death of a baby.
For six months, the HSE ignored an instruction to provide monthly updates to the Department of Health on developments in tackling safety issues in Portlaoise Hospital.
Highly-charged letters and emails obtained by the Irish Independent reveal:
The HSE failed to notify the department about the death of a baby born in Mullingar Hospital.
The HSE reneged on a pledge to provide monthly updates on safety in Portlaoise Hospital.
It was still unclear last October who was responsible for providing progress reports on recommendations arising out of the 2012 death of Savita Halappanavar in Galway University Hospital.
The scandal of the Áras Attracta care home is also raised in the correspondence.
In one memo to the minister in December, the Department of Health's chief medical officer Dr Tony Holohan says: "Notwithstanding statements in public to the contrary, the HSE simply does not, in my view, accord the issue of patient safety and the implementation of learning from previous errors/incidents/priorities the importance required."
He said the essential problem was at governance and accountability level - " a theme of every Hiqa report".
Mr Varadkar replied by email, saying: "I think that sums things up well."
The December memo related mainly to a proposed briefing for the minister on conditions in Portlaoise Hospital as the publication of the patient-safety watchdog Hiqa's investigation into the hospital neared.
When it was published in May, it blamed failures at all levels of the HSE for problems at the hospital, where five babies died in simliar circumstances.
Throughout much of last year, the department was struggling to get information from the HSE about various hospitals.
Another memo refers to a new case of miscarriage misdiagnosis at Portlaoise and also comments from Hiqa that a recent site visit to the hospital shows that things were "worse".
The memo came after a series of exasperated letters from the Department of Health to the HSE during 2014 over the latter's failure to provide reassurances on patient safety.
It emerged that the HSE did not tell the Department of Health or Hiqa about a baby death in the National Maternity Hospital after transfer from Mullingar Hospital in August.
This is despite a 2008 agreement that patient incidents with a national profile should be notified to the department.
The HSE's national director of acute hospitals, Dr Tony O'Connell, who has since returned to Australia, had limited knowledge of the case, according to the department.
News of the case prompted a strong letter to the HSE, saying specific concerns about Mullingar maternity services had been raised in the past and there was a need for reassurance to see if it raised wider issues that needed to be investigated.
The department's internal note to Mr Varadkar in October complained that the HSE was not being open about incidents.
It said: "In recent times a number of high-priority incidents have become the focus of media attention. The department has not been advised of these cases in an appropriate and timely manner."
Correspondence also shows that an instruction that the HSE provide monthly updates to the Department of Health on developments in tackling safety issues in Portlaoise Hospital was not followed through.
It submitted no reports from the spring of last year until October, despite public concerns.
And the quality of its progress report from the HSE on the actions taken to implement the recommendations of Dr Holohan's own highly critical inquiry into Portlaoise in February 2014 was also not up to standard.
The department said it did not have access to any analysis of what impact the new measures the HSE put in place were actually having.
In October, Mr Varadkar's officials also wrote to the HSE, outlining "very significant concerns" about the lack of progress reports on how the HSE was implementing the recommendations arising out inquiries into the death of Ms Halappanvar in Galway Hospital in 2012.
The department's patient safety unit said the new structures in the HSE were designed to provide reassurance on the implementation of a number of recent reports that related to maternity services.
"Unfortunately, the initial experience of using these new arrangements to seek reassurance from the HSE on matters relating to patient safety matters has given cause for concern," the letter said.
A spokesman for Mr Varadkar told the Irish Independent that patient safety had been his priority since moving to the department and he was committed to implementing recommendations of various reports.
"It's important to acknowledge that the vast majority of patients have a very positive experience, but this should not give rise to complacency. Unfortunately, too many instances from the past show that this has not always been the case," he said.