A preliminary report by the Health Information and Quality Authority (Hiqa) on standards of care at the Midland Regional Hospital in Portlaoise is damning. But health professionals are particularly shocked. For the first time, blame is being apportioned for medical and management failures. The time-worn, public service excuses of "systemic failure" and "a dysfunctional system" have been abandoned. Personal accountability and liability have made an appearance.
Threats of legal action immediately followed as the HSE attempted to prevent publication of the report. The draft document has placed some of the blame for shortcomings at the hospital on senior management in the HSE. A lack of clear reporting relationships; passivity among senior managers and constant changes in corporate structures were identified as contributory factors. There was also the question of an inappropriate level of funding. HSE director general Tony O'Brien spoke of 250 adverse findings or inferences being made that affected senior people in the HSE, the Department of Health and the State Claims Agency. It was a scattergun response in defence of anonymity. It should not surprise. So many managerial and medical failures have been quietly buried in recent years that it appears almost normal.
The HSE has a reputation for being economical with the truth; for withholding data and for defending medical cases to the door of the High Court. It finds itself in an invidious position, under intense pressure to maintain or improve services at a time of reductions in staff and funding. That, however, does not excuse inept management. Too many well-paid and incompetent executives have been employed for too many years within this unwieldy organisation.
For decades, there has been a tendency for ministers and senior public servants to hide behind each other’s skirts, none of them accepting responsibility for administrative misjudgments or service failures. Until that changes, personal accountability will mean little. If adequate services cannot be delivered because of inadequate funding, senior executives should not pretend otherwise.
For the HSE, blaming the messenger is not the way forward. Hiqa was instructed to investigate what went wrong at the hospital after an initial report into baby deaths there found services to be unsafe. Efforts to prevent publication of its findings are unacceptable because they signal an unwillingness to undertake fundamental reform. Tensions between the two organisations are understandable because of conflicting responsibilities. In a system marked by successive failures and dramatically different standards of care, however, the State’s health watchdog should be encouraged to bark.