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From €160m shining jewel to shambles ... so what's gone wrong at Tallaght?

It started so promisingly on June 21, 1998. A shiny new hospital at Tallaght opened its doors to patients, replacing the old Adelaide, Meath and Harcourt Street hospitals. It was, and still is, Dublin's newest hospital, costing €160m to build.

Fast forward to last week. The health safety watchdog HIQA tells the under-pressure and scandal-ridden Tallaght Hospital that it must stop putting A&E patients on trolleys in corridors as this practice is endangering their safety.

Where did it all go wrong?

The hospital's official potted history admits the amalgamation of the three old hospitals into Tallaght was a challenge, bringing different traditions, including the Protestant tradition of the Adelaide, into one institution.







Death

In the beginning, it all seemed to be going reasonably well, but trouble set in early on, with the resignation of the Tallaght's CEO seven months after the hospital opened.

Tallaght appears to have been hitting the headlines for all the wrong reasons ever since.

It is now undergoing a HIQA probe into the safety of its A&E services.

This was after the Dublin County Coroner, commenting on the death of a patient in an A&E corridor, said Tallaght "sounded like a dangerous place".

Tallaght is also under scrutiny at present over how patient medical reports sent abroad for transcription may have fallen into the wrong hands as a result of a major data security breach.

Before these controversies, Tallaght was only just recovering from another scandal.

Last year it was revealed that 58,000 X-rays going back a number of years went unreported by radiologists and nearly 3,500 GP referral letters were unprocessed.

Tallaght is not a 'bad' hospital. Those who work there do their best to provide what is usually a good service for the people of Tallaght and it environs.

Yet since its birth 13 years ago, Tallaght has been beset by funding and staffing shortages, by the fact that it has had to struggle with the other major Dublin hospitals for resourcing and perhaps, most importantly, by a dysfunctional management and governance culture.

You can complain all you like about resourcing, pressure on services and funding, but managers are paid to manage and boards of governors are tasked with overseeing management.

If this system is flawed, then problems arise. Those involved in management and governance may do their best, but the recent controversies have shown that there are serious problems in the culture at Tallaght which remain unresolved.

Basically, those looking after the hospital are not learning very quickly from previous mistakes.

The Hayes report into last year's X-ray scandal referred to problems with the 'culture, structure and style' of the hospital.

This essentially means that if a hospital gets off on the wrong foot and things are done in a less than efficient way from the beginning, that inefficiency can continue.

The Hayes review called for a major revamp of the Tallaght board and of management. Since the X-ray scandal, we have been told that things are improving. Certainly, efforts were made to steady the ship. And to be fair to Tallaght, it does seem to lose out to other major hospitals when the resources cake is being sliced up. But all hospitals have resourcing issues. Perhaps things will get better at Tallaght and the high hopes expressed back in 1998 will finally be realised.

But it shouldn't take the politics of the latest scandal to improve patient safety and services.

Niall Hunter is Editor of irishhealth.com


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