More than a week after the publication of a highly critical report on maternity services at Portlaoise hospital, there has been much outpouring of emotion but little clarity about who is responsible for this scandal.
Far from an increased focus on accountability, we are seeing a tendency on the part of some to ensure that whatever blame is being apportioned is assigned elsewhere.
Understaffing and austerity have also been cited, understandably given the tribulations of the health budget in recent years, though they are not an excuse for what happened. Neither do they explain the basic failings in using equipment and drugs that contributed to some of the baby deaths.
HSE director general Tony O'Brien is certain to face a grilling when he appears before the Oireachtas health committee today over the failures identified at all levels of his organisation in the Health Information and Quality Authority (Hiqa) report on Portlaoise.
O’Brien has disclaimed personal responsibility on the basis that most of the deaths occurred before he assumed the top job in the HSE.
Before becoming director general, he was a senior executive in the health service for many years .
He is one of a number of senior executives mentioned in the 2011 application for funding by the Coombe, Portlaoise and Mullingar hospitals, which went unheeded, as reported by The Irish Times today.
But according to the HSE, Mr O’Brien was no longer working in HSE clinical programmes by the time this application was submitted. He had moved on to work in the special delivery unit in the Department of Health in September 2011.
Beneath the level of director general, there have been many changes in personnel among senior HSE managers in recent years. The level of responsibility senior managers are required to carry, vis-a-vis what they are paid, is evidently out of kilter, especially when there are lucrative and less onerous opportunities in the private sector or overseas.
Some of these managers sounded their own alarm bells, such as the ex-director of acute hospitals, Ian Carter, who led a review of Portlaoise hospital and last year recommended the closure of its emergency department.
The HSE's response was to not publish the review and, when it was leaked by The Irish Times, to downplay its findings.
It maintained that any decision about downgrading the hospital had to come from politicians.
All of the managers, from the top down, would have had to work within the straitjacket of the Government’s spending restrictions during the years of the bust. O’Brien maintains the HSE was forced to implement measures such as the 30 per cent cut in consultant salaries introduced in 2012, which has proved so disastrous in terms of retaining and recruiting skilled staff.
Minister for Health Leo Varadkar has been very active since Hiqa published its report, meeting families and deploring the treatment they received in the hospital.
Once again, the Minister has been seen to be energetic and empathetic, though his response hardly cuts to the core of the issue. It is indeed deplorable that staff lacked compassion in dealing with bereaved mothers but if the standard of care they received was better, they would never have found themselves in this tragic and vulnerable position.
National strategy
Varadkar boasted yesterday how he had "already" appointed the steering group to devise a national maternity strategy, when this strategy was called for two years ago in the report into the death of Savita Halappanavar.
His department’s announcement about the steering group was made just days before the publication of Hiqa’s report on Portlaoise.
Meanwhile, it has emerged that his department killed off the HSE’s plans to create a patient safety authority, which was promised in the programme for government – ostensibly over concerns about its independence. This is now back on the table since Hiqa recommended the creation of an independent patient advocacy body.
None of this to-ing and fro-ing gives much reason for confidence about the implementation of the Hiqa report. But Hiqa, too, hasn’t helped matters by calling for accountability without specifying exactly where that accountability should lie.
This article was amended on May 19th, 2015.