HSE and Hiqa must ensure it's safe to give birth in all Irish maternity units
In whose interest is it that there is an ugly spat between the HSE and the health watchdog Hiqa?
This unprecedented stand-off culminated over two weeks ago with a HSE threat to injunct the publication of a draft Hiqa report.
The story has its origins in an RTE Investigations Unit programme in January 2014 which exposed of the deaths of four healthy babies in Portlaoise hospital between the years 2006 and 2013.
Each of the babies died during or shortly after labour. The hospital investigated the babies' deaths, yet failed to tell the families about the investigations and their findings.
The then-health minister Dr James Reilly acted promptly, asking the Chief Medical Officer, Dr Tony Holohan, to carry out a preliminary analysis as to what was going on in Portlaoise maternity unit.
Published within weeks of the television programme, Dr Holohan concluded that "families and patients were treated in a poor, and at times appalling, manner"; information was withheld from families for no justifiable reason; that the deaths may have been prevented if the hospital had acted upon its own enquiries into the earlier deaths; and critically that the Portlaoise maternity service "cannot be regarded as safe or sustainable".
Measures were recommended and put in place to make Portlaoise maternity services safe. Hiqa was asked to carry out a statutory investigation into "safety, quality and standards of services" provided in Portlaoise, as well as assessing standards in all Irish maternity units.
This very public row between Hiqa and the HSE is centred upon the process of the Hiqa investigation into Portlaoise and certain findings in the draft report.
After six months of Hiqa investigations into Portlaoise and four months of writing up and verifying findings, the draft Hiqa report was sent to the HSE's Director General, Tony O'Brien, on February 2 last.
Mr O'Brien was given two weeks to respond. He replied that the time given was "unreasonable and impracticable". He said the findings in the draft report would shatter confidence in the HSE, he raised serious concerns over Hiqa not keeping with "fair procedures" in their investigation, and how some findings "imply a reckless endangerment of patients".
Hiqa is adamant it is following the same procedures as all other investigations and that these are fair. Mr O'Brien sought a meeting with Hiqa. Hiqa refused - why would they meet with the very body they were investigating? More long, legal, robust letters followed, Hiqa extended the deadline.
In a letter dated March 13 to Hiqa CEO Phelim Quinn Mr O'Brien stated his concerns, claiming the report is "unfair, lacks context, balance, specificity… fails to give reasons for its findings… is in breach of fair procedures".
At the end of the letter, he admits to taking the "extraordinary step" of taking legal proceedings to injunct the publication of the report.
On request of the HSE, Chief Medical Officer Dr Holohan intervened and called a meeting of both parties. They met on the neutral territory of the Department of Health on March 19. The outcome of the meeting is that more time was given to the HSE so that a comprehensive response can be drafted.
Only a handful of people in the HSE and Hiqa have the report. For once, it is not been leaked. The only reasonable explanation for that is that, very unusually, it is in no one's interest to leak the report.
The HSE took the most unusual step of publishing its forthright letters to Hiqa late on March 23 after significant media coverage that day on the very public squabble between the HSE and Hiqa.
Given the nature of the enquiry and what is already known from the report of the Chief Medical Officer into Portlaoise, the report is inevitably going to be very critical of staff and management in the hospital and the HSE.
It is also expected that, similar to the Hiqa report into the death of Savita Halappanavar, there will be serious criticisms in the Portlaoise report of a health system that has failed to learn from the mistakes of its past.
The HSE has a litany of new procedures, processes and people in place to ensure lessons are learnt, but little proof to date that they are resulting in real change. The turnover of people as the acute hospitals' national director is likely to be identified as a contributory factor.
There is an assumption that the exceptional line of attack made by HSE chief Mr O'Brien is simply the HSE resorting to denial and obfuscation. This is understandable given the litany of cases in Irish health system history where denial was the default position for those responsible and or on the frontline.
However, it emerged last week that no staff midwife in Portlaoise was interviewed for the Hiqa investigation and that senior HSE staff who are seriously implicated in the report have not been given what is considered fair procedure or a right of reply.
The only thing that really matters is that the Hiqa report shines a light on the poor care in Portlaoise hospital and that we learn from such cases so other families do not experience such tragedies in Portlaoise or any other Irish hospital.
Too many Irish women and their babies have died in Irish maternity units. There are no doubt many more near misses and incidents of poor care in Irish hospitals that do not result in loss of life, but may have life-long consequences that we do not even hear about.
In order for the public to regain confidence in Portlaoise and all maternity services, Hiqa needs to get their report right, to go through due process in their investigation.
The HSE and Hiqa need to solely concentrate on putting their energy into identifying and learning from the mistakes of the past and present.
The only real public interest is that Hiqa and the HSE end their ugly spat and work to make sure all hospitals in Ireland are safe places to give birth in.