Wednesday 11 December 2019

A health system unfit for purpose

The revelations from Tallaght Hospital over the past week have been deeply shocking. It is still not clear whether the management at the hospital was so dysfunctional that it had no idea of the scale of the problems it faced.

But it is abundantly clear that the hospital had no concept of its duty of care to its patients. System failures no doubt played their part in the accumulation of thousands of X-rays that were not read by a consultant radiologist and the thousands of referral letters that were ignored, but there can be no excuse for the way in which the hospital responded to these crises.

Its management displayed an unbelievable lack of urgency in rooting out the cause and extent of its problems once they were formally alerted to them by Prof Tom O'Dowd, a GP. Even the intervention of the Health Information and Quality Authority failed to shake hospital management out of its complacency and it has taken almost a year for the hospital to admit the true scale of its problems.

An independent review will now determine precisely what went wrong at what should be an efficient, modern hospital and there will have to be severe consequences for those who contributed to its failings. The worry for the Irish public, however, is not just Tallaght Hospital, but the entire health system.

A series of scandals in recent years has shattered confidence in the Health Service Executive: there is no sense of accountability or responsibility within the system, and no assurance that the HSE or the Department of Health are providing rigorous oversight. From the very basic issue of hygiene, where far too many hospitals fail to reach an acceptable standard of excellence, to the specific problems of misread and unread X-rays, there emerges a picture of a health service that is not fit for purpose.

That may be too harsh a verdict -- there are many areas of excellence within the service and there has been impressive progress in the delivery of cancer care in the recent past -- but the overall impression if of a vital area of the public sector being let down by its own management.

Mary Harney, the Minister for Health, cannot escape responsibility simply because the day-to-day management of the health service is delegated to the HSE. As minister, she sets the standards to which the HSE must aspire and she bears ultimate responsibility for systemic failure. In particular, she must impose a culture of accountability and responsibility which responds urgently to issues of patient welfare.

That culture does not exist and in its place there is a culture of blame referral and denial. Ms Harney cannot be blamed for individual cases of management failure, but she cannot avoid responsibility for a system that does not know how to cope. Her tenure at the Department of Health has not been a success, despite the early promise and energy that she brought to the role. Long overdue reform of the service has been frustrated by union intransigence and management failure and it seems that Ms Harney's appetite for transformation has been fading. Her absence in New Zealand for an extended St Patrick's Day junket exacerbated the Tallaght crisis, but her presence would not have averted it.

As well as the inquiry into Tallaght Hospital's shortcomings it is vital that the public is reassured that no similar failings are taking place in other hospitals across the State. As a matter of urgency the HSE needs to clarify that referral letters and X-rays are being dealt with expeditiously and that management throughout the health service is focused on the needs of patients.

Sunday Independent

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