It is clear now from the trenchant criticisms levelled at the Health Service Executive, as revealed in The Irish Times on Tuesday, why that organisation was so unhappy with the draft report prepared by the State's health watchdog into Portlaoise hospital.
The Health Information and Quality Authority (Hiqa), in its draft report, places much of the blame for the failings at Portlaoise on all levels of the health service. In essence, it says the HSE knew about the problems but was too inert, indecisive and sluggish to do anything decisive about them.
If confirmed in a final version of the report, these criticisms could spell the death knell for the HSE and for its senior leaders, who would in the normal course be expected to shoulder ultimate responsibility for any shortcomings. As the draft makes clear, the problems at Portlaoise could have been averted if the recommendations of many previous reports were properly implemented. Once again, it seems the health service is unable to learn from its mistakes.
The draft report also raises serious questions for the politicians who resisted downgrading services at Portlaoise – required to make the hospital safer – but failed to ensure the HSE was given the funding needed to improve services. Effectively, this meant local people got a 24-hour hospital funded at the level of an 8am to 8pm facility.
It is important to note that HSE director general Tony O'Brien contends the draft report is unfair, lacks specific details, is inaccurate in some respects and fails to give reasons for its findings. This is why he threatened last month to take legal proceedings to prevent the draft report being published.
Changes
The HSE has submitted detailed responses to the draft material it has been provided with, and these may result in changes being made before the final report is published. It says the hospital is currently operating safely.
Yet it is also important to remember why this report was commissioned. Five women lost their babies after giving birth in the maternity unit at Portlaoise. The reasons for the deaths were similar in each case and arose from failures of care. A subsequent report found the service was unsafe and the women were treated appallingly. It suggested similar problems could exist elsewhere in the health service.
The draft makes clear there was an awareness of problems at Portlaoise within the health service for many years – almost a decade. Hiqa is also clear that these problems are not confined to the maternity unit, which featured in last year's Prime Time programme on the baby deaths; the emergency department, surgery and acute services are also identified as problem areas.
Separate from Hiqa’s investigation, a HSE review last year said there wasn’t enough patient throughput for surgery to be carried out safely and recommended an end to 24-hour emergency department services. That review was never published.
Redesignation
As the draft report highlights, back in 2011, the HSE was planning to redesignate 10 hospitals, including Portlaoise, as small “model-2” facilities. This would inevitably result in emergency services being downgraded, as happened in Roscommon, to the chagrin of the local population. The last thing the Government needed was another local hospital action group campaign.
In the event, the Government intervened, the list was cut to nine, and Portlaoise was removed. The then Minister for Health James Reilly linked the decision to the fact the hospital had maternity and paediatric units. However, nothing was done to increase its funding to the level required for a level-3 facility, as Hiqa points out.
The row over Portlaoise gets to the core of the problems our health service. In some areas, the safety of patients is being endangered, whether through sub-standard practices and treatment or understaffing.
The problems are not confined to Portlaoise, as at least one senior HSE manager told Hiqa. Yet the issues are not being tackled effectively for a variety of reasons – managerial, political and financial.
