The GP who exposed the x-ray and referral letter scandal at Dublin's Tallaght Hospital last year has said those running the hospital have not done enough to improve how it is governed and managed despite calls for action on this from review groups.
Prof Tom O'Dowd, who is also head of the Department of General Practice at TCD, was speaking following the recent announcement of yet another inquiry into the hospital, this time into emergency department (ED) care.
He noted that the safety body HIQA, in announcing the ED inquiry, indicated that there had been a failure at management and governance level in Tallaght to deal with this issue.
Prof O'Dowd queried why this was the case when assurances were given last year that there would be improvements in oversight in the wake of the x-ray and referral letter scandal, in which x-rays went unreported and referral letters unprocessed.
He said in spite of recommendations in the Hayes review nine months ago and in a management consultants' report more than a year ago, Tallaght had not appointed a smaller permanent management board and had still failed to appoint a GP to its board.
"Basically, they still have the same board structure and have not responded to the need to have a GP representative on its board of management."
While stressing that staff at the hospital had responded to many of the problems there and that 'things have improved enormously', he said these improvements had not extended to management and governance at Tallaght.
"There is a sense here of ignoring the fact that this is public money we are talking about. There is a need for public accountability and that seems to have been ignored. None of our hospitals can afford to ignore the talents and perspectives of the community they serve."
"Also, if hospitals want to advocate effectively for more appropriate resources, having local GPs on board will only increase their voice and make it more difficult to ignore'"
Prof O'Dowd felt there was a 'lack of civility' in relationships between many hospitals and local GPs, and GPs needed to be given a much bigger say in how hospitals are run.
He said this was particularly important in view of reforms planned in how care will be delivered in future, with a greater emphasis on treatment in the community.
Prof O'Dowd said it was vital that Tallaght appoint a local GP representative to its board now, and that GP representatives be included on other hospital boards and on the board of the HSE.
He said it was important that a GP be included on the board so that the hospital could respond properly to the needs of the local community.
Prof O'Dowd said local GPs had expressed an interest in joining the smaller transitional board appointed last
October and had written to the hospital about this.
As far as he was aware, this request had not been responded to.
He said he felt that following the x-ray scandal, individual staff at the hospital had taken on board the lessons to be learned, but real change had been resisted by those governing and managing the hospital.
Prof O'Dowd felt those governing Tallaght were not happy with his 'whistleblowing' which led to exposure of the x-ray scandal last year.
"Individual consultants at Tallaght have told me they admired what I did but I cannot say the governance of the hospital was very happy. They almost feel it (exposure of the scandal) shouldn't have been done."
Prof O'Dowd said management at hospitals like Tallaght and elsewhere seemed to want to serve the governance of the hospital rather than local communities.
"Until GPs get onto the boards and are respected and earn respect, then that situation is going to continue and we will continue to have problems with hospital services."
Prof O'Dowd said the ED crisis was not unique to Tallaght and was emblematic of the wider problems across primary care and hospital care and how they interacted. "I would never expect emergency departments to be able to cope while the system is configured as it is."
Tallaght Hospital's permanent board is due to end its term of office on July 31. The hospital has indicated that after that date, it will appoint a smaller permanent board and will consider including GP and local community representatives on it.
Meanwhile, the membership of the HIQA review team for the Tallaght emergency department services probe has yet to be announced.
Discussions on this topic are now closed.