Staff face sanctions
HSE boss’s vow to sort out issues at Portlaoise
STAFF could face sanctions over failings highlighted in a da mni n g report into standards of care at Portlaoise Hospital.
The HSE’s director general added there would be a ‘thorough review’ into a ‘significant lack of compassion’ shown to patients at the facility’s maternity unit to see if ‘there is anybody who shouldn’t be in the service’.
A report published on Friday by the Health Information Quality Authority found that eight newborn babies died in the scandal-hit Midland Regional Hospital.
Management at every level in the HSE was aware of patient safety risks at the hospital but failed to act on them, HIQA found.
Among the most shocking findings reported was how some of the grieving parents were handed their deceased newborns in a metal box, with one infant ‘squeezed in’.
The report found that while exist-
External reviewer to be brought in
ing facilities in the maternity department had undergone some refurbishment and essential renovations, ‘major inadequacies remained in its infrastructure, presenting an inherent risk to patient safety’.
Yesterday Tony O’Brien, director general of the HSE, said the report highlighted issues of accountability and resources, adding they now need to look at ‘accountability for things which did or didn’t happen’.
Mr O’Brien told RTÉ’s This Week programme: ‘One of the things I am going to do is bring in an external reviewer in accordance with our disciplinary procedure to look at issues of escalation of concern.
‘There were many issues escalated, they didn’t always find their way to the right decision-making levels and I need to look at that.’
In its report, HIQA detailed a litany of failings. The watchdog said the lack of quality of care and infrastructure in the hospital – including issues raised in several reviews and reports going back to 2006 – was putting patient safety at risk.
Most striking was the bereaved mothers and fathers’ harrowing accounts of their treatment, with two couples telling how they received the remains of their newborns in metal boxes delivered to them on a wheelchair covered with a white sheet.
In one case, the box was not big enough and the dead baby boy was squeezed in, HIQA revealed. Another bereft mother told how she was reprimanded for crying ‘as it would upset other mothers’ in the ward.
Yesterday Mr O’Brien said issues around what appeared to be a ‘significant lack of compassion’ needed to be examined.
He added: ‘Many of the issues which arise in Portlaoise aren’t just about the quality of clinical care but about the human and compassionate care that was or was not provided.
‘It is important – starting in the maternity unit in Portlaoise, then wider hospital and other maternity hospitals – that we have a thorough review of the issues that contributed to what appears to be a significant lack of compassion.
‘What we do about it and whether there is in fact anybody in the service who shouldn’t be in the service.’
He cl aimed very si gnificant resources are now going into the hospital such as additional consultant posts to strengthen departments including medicine, paediatric and emergency medicine.
He added: ‘Following the example that’s been set in the Dublin Mid-
‘Significant lack of compassion’
lands Hospital Group, we will be forming clinical networks linking those smaller maternity hospitals with larger ones in all cases. That’s another recommendation f rom HIQA that we’re happy to accept.’ A HSE spokesman last night said: ‘As clearly stated at the press briefing on Friday, a great deal of the findings in the report pertain to the period before the director general (Tony O’Brien) took up his position. He took up this position with a view to making a range of changes to the HSE. Since that time he has been addressing many of these issues, putting in place new structures and changing governance arrangements.
‘This work is well under way and the director general will continue to make these important changes and implement the recommendations of the HIQA report.’
EVEN if you accept the assurance of HSE boss Tony O’Brien that no effort is being spared with Portlaoise Hospital and making it fit for purpose, it is hard not to be cynical. For how many times have we heard the same sort of promises in the aftermath of a hospital scandal?
The narrative plays out along such familiar well-worn lines.
A series of damning reports is published into how lives were lost needlessly in some awful rundown hospital or why X-rays were misread and patients misdiagnosed with cancer when they should have been given the all- clear. Outside experts agree that they have never seen such shabby standards and appalling systems failures.
Patient representative groups and local politicians throw their hands up in despair and there’s lots of talk about resources, or specifically about lack of same.
Very occasionally a maverick doctor or radiologist is named and shamed. I’m thinking of Dr Michael Neary in Drogheda, deservedly struck off the medical register for his appetite for pointlessly extracting women’s wombs.
The HSE makes the same assurance that lessons have been learned and the same determination to change culture and management is expressed. And no one takes any responsibility.
Amid all the careful choreography surrounding press statements and media appearances and, more importantly, the anguished parade of patients and their families with their heartbreaking stories from the front so to speak, not one well-paid hospital chief executive or general manager ever falls on their sword.
No- one in the health service or among their political masters tells those responsible that they deserve to lose their job over a scandal that has caused so much suffering.
In Portlaoise, eight babies were lost during or just after childbirth, some of their parents treated brutally and scarred by tragedy. One deceased baby was squashed into a metal box. Another bereaved mother was told to stop crying as she was upsetting others in her ward.
The casual indifference shown to bereft mothers – which, unlike some of the other problems thrown up by the HIQA report, cannot be explained by a simple lack of resources alone – didn’t even prompt the movers and shakers in our health service to seek out the hospital boss and ask him or her to do the honourable thing and step down. On RTÉ’s Marian Finucane Show yesterday junior health minister Kathleen Lynch made all the right noises about the catastrophe at Portlaoise.
Yet when pressed about who was accountable for the hazardous lack of training and communications at the hospital’s maternity wing, she predictably had no light at all to shed on the matter. Her first priority on hearing of any hospital crisis she said was to consider the patients who are currently under the hospital’s care and to satisfy herself that their lives or health are not at unnecessary risk. Then she looks to the past and what might have gone awry.
Although some new managers have been installed at Portlaoise since the scale of the scandal first emerged, how can the Health Minister, the HSE boss and the various senior managers sitting behind their desks in Dublin plan for reforms in Portlaoise without first holding someone to account?
If no one is hauled over the coals for turning a blind eye to evidence of poor and dangerous practice – the verdict of the earlier inquiry held by the former chief medical officer at the Department of Health, Dr Tony Holohan into the Midland Regional Hospital – then how can we know for sure that this alarming behaviour has ceased?
Portlaoise is only one of several HSE scandals uncovered by RTÉ’s investigations unit over the years. Three elderly and vulnerable patients were abused in Áras Attracta in Co. Mayo yet the manager of the Swinford home did not resign.
Protected
No one stepped down after the death of Savita Halappanavar and the countless reports which exposed a series of missed opportunities for saving her young life.
Nine of the 30 medics involved in her case were subjected to a mild form of disciplinary action and their anonymity protected. Some had informal counselling about what to do in a patient crisis, others got a warning.
But no one took ultimate responsibility for the hospital’s failure to provide the pregnant dentist with the most basic elements of patient care. We don’t even know if they got so much as a slap on the wrist.
What is it about accountability that the public service finds so anathema?
In the real world people take the rap for failure all the time.
Most of the banking chiefs stood down in the wake of the economic collapse.
They are giving their side of the story now at the Banking Inquiry and they are familiar to us, almost household names.
Similarly the charity bosses lost the cloak of anonymity when they had to justify in public their often eye-watering salaries and pension arrangements.
We know who is responsible for the debacle that is Irish Water. We know the identity of those at the wheel in most areas of public interest and have the power to make them account for their decisions. Often they vig- orously defend their actions and survive despite some reputational damage: but at least they are made to make that case.
Others like Patrick Neary, who was so hopeless as Financial Regulator, may have retired just in time – but at least the whole country knows who they are and what they did or didn’t do. Our hospitals and the HSE are however utterly faceless institutions.
Apart from a handful of media-friendly hospital consultants, the masters of the maternity hospitals and, of course, Tony O’Brien, who succeeded Cathal Magee and Professor Brendan Drumm as the HSE’s public face, we don’t know the people who are responsible for spending the gargantuan multi-billion euro health budget.
After RTÉ’s Prime Time went undercover to investigate a selection of creches, one staff member was immediately sacked and at least three others were suspended.
Deirdre Kelly, the director of Links Creche and Montessori which featured in the exposé, is now facing trial under child protection laws. The prosecution has been brought by Tusla, the Child and Family Agency, as a result of the documentary.
In private business, the rules are different. If creches like Links or Giraffe want to survive the fallout from public exposure, they must convince parents and prospective parents that they have turned over a new leaf. Firing and suspending staff is the start of that process.
Why is it not the same in our health service? Tony O’Brien wants to persuade us that Portlaoise is a safe hospital and that if a pregnant woman pitches up there next week, she is guaranteed the best possible delivery for her baby.
But his assurance would have a lot more credibility if we knew who was the new face at the top of the hospital – and what had happened to the old ones.
Sacking people is an unpleasant business because very often mishaps are caused by a complex interplay of forces. That at least is what most leaders say when their head is on the block.
But good leaders also know that they should be removed if they are grossly incompetent or negligent and if, as in the case of hospitals, terrible tragedies occur on their ‘watch’.
Holding managers to account is a way of safeguarding institutions, of incentivising future leaders to do better and generating the healing power of catharsis for staff.
We have excellent nursing staff – and today’s story about the generous perks offered by the NHS to entice Irish nurses to England shows the high esteem in which they are held.
The reputation of our hospital doctors is also second to none. Indeed it is perhaps our misfortune that they have so little difficulty finding work in Australia or the US.
Other than in rare cases of medical incompetence or malpractice, the blame for scandal cannot be laid at their door. But when no one is found accountable when things go drastically wrong as in Portlaoise, doctors and nurses suffer guilt by association and become even more demoralised by the health service.
Who can blame them? The chronic underfunding of the health service may be alleviated as the economy improves but as long as public outcry is the sole deterrent against bad practice, it will remain dysfunctional.