Patience wearing thin on safety guarantees

  • Niall Hunter, Editor


The fall-out from yet another patient treatment scandal has again shown the disconnect between the health service that exists in the group mindset of those running it and the public perception of how safe and quality-driven that service really is.

To read through all the verbiage in HSE documents and on its website about its commitment to patient safety and quality care, you could be forgiven for thinking that treatment scandals had been consigned to history.

The latest scandal, revealed, once again, through the media (is the HSE only capable of apologising for something that previously remained secret?) involves the unexpected and probably avoidable neonatal deaths of four infants at the maternity unit in Portlaoise Hospital.

Familiar themes run through the 'politics of the latest atrocity'. Potentially preventable adverse incident(s) occur at a hospital, are investigated , treatment and service deficits are identified, guidelines for better clincial practice are issued and ignored, further similar events occur, families express concern through the media.

The authorities then find out that the media has uncovered something that was previously hidden from public view, a proper investigation is promised and, of course we are assured that this type of thing doesn't happen very often. 

Then the great and the good 'move to reassure' the public that services are, most of the time, pretty safe. And, of course, we get the inevitable helpline.

We are also told that it's all a learning process and hospitals can learn from their mistakes. One can only imagine the dismay that such statements must induce among the victims of health service scandals in recent years as they witness the plight of the latest victims.

As the details of the scandal unfold, we see the familiar lack of transparency and poor communication between the HSE/hospital authorities and the families of the victims. In this case, the lack of proper communication bordered on contempt. And don't take our word for it - this is pretty much the view of the Minister for Health.

Two families involved weren't even informed for some time of the investigations into their children's deaths.

The following has been repeated time and time again after each succeeding patient treatment scandal and the ensuing Government and HSE assurances about safety. You could almost set it to music at this stage:

Assurances that services are safe most of the time are irrelevant, and indeed almost insulting to the public if there is little or no evidence of structures being put in place to ensure that the health service is as safe as possible and that incidents caused by errors of omission, commission, resourcing, downright negligence or a combination of all of these are kept to a minimum.

Otherwise you are running a supposedly safe service on a wing and a prayer.

This appears to be so mind-blowingly self-evident that it has passed over the heads of those running the HSE and holding senior posts in its institutions. Do they ever actually read HIQA reports? There are quite a lot of these at this stage, often repeating the same themes of care failures and poor safety and quality structures.

To put it at its most brutally tabloid - if the health service is so safe most of the time and everyone is constantly 'learning' about how to avoid mishaps and how to communicate with victims in their aftermath, why do all these scandals just keep on happening? In the Portlaoise case, one of the babies' deaths occurred as recently as 2012.

Slightly insulting too are post-hoc apologies about what happened and how it was handled, or not handled as they case may be.

In the Portlaoise case, the time for the HSE and the hospital to apologise was after the incidents occurred and internal reviews found deficits in the level of care provided. The time for learning was after recommendations for practice improvements were drawn up in the wake of the deaths.

The time for saying sorry and doing something about what went wrong was well before the media uncovered the scandal.

There are indications that this latest scandal may have been partly due to a lack of resources provided to Portlaoise Hospital.

How significantly this contributed to the adverse incidents remains to be seen - we may have to wait for the Department of Health Chief Medical Officer's report to get the full picture.

Conscientious staff were in recent years warning of risks to patients due to lack of staffing but that doesn't necessarily mean the four Portlaoise deaths can be directly linked to a shortage of staff.

The evidence that has emerged to date in the RTE documentary indicates care failures at crucial stages of treatment.

When treatment scandals emerge, confidence in our health system is shaken, whatever the undoubted skill and dedication of most staff working in the service.

However, the public is now understandably worried about the level of safeguards in place to prevent avoidable patient harm in our maternity services. Over the past few years we have had the missed miscarriage controversy, the Savita Halappanavar scandal and now the Portlaoise infant deaths.

While we are assured that the maternity service is safe, people now need a better guarantee of this.

For a start, we could do with more transparency. Portlaoise is one of seven maternity units in the country that do not publish an annual report with their clinical results.

Despite recent assurances about hospital safety records following infant deaths at Portlaoise and Mount Carmel hospitals, the national perinatal mortality figures do not name maternity units so that the public can compare their clinical results.

If the public isn't informed about the detailed clinical outcomes from every maternity unit in the country, how can the HSE and professional bodies be sure that their message about safe maternity care will be believed by everyone?

The public needs to be told what the infant death rates are, along with details of deaths that occur, in every maternity unit in the country.

In the meantime, we await the report of the Chief Medical Officer into the Portlaoise deaths. This may well need to be followed up by another independent HIQA inquiry.

And the planned national review of maternity services, called for by HIQA after the Halappanavar case, cannot come quickly enough.

Such reviews will undoubtedly make numerous recommendations on providing safer, better care. Ultimately, these recommendations will have little effect unless we have a proper enforcement regime.

Health Minister James Reilly has promised a hospital licensing system, whereby hospitals which do not meet specific standards will face sanctions, including, presumably, potentially losing their licence to treat patients.

The Minister has talked about such a system for some time - he needs to act on it now.

Public in the dark on maternity safety





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