There has been too much official ducking and diving because of a highly critical report by the Health Information and Quality Authority (Hiqa) concerning standards of care and administrative oversight at the Midland Regional Hospital in Portlaoise. Evading personal responsibility for mistakes and failures has become too common among health service employees. That is why Hiqa was established as the State's health watchdog to identify bad practices, improve standards and reassure the public that their interests were being upheld.
A draft report on Portlaoise hospital, however, brought thundering denunciation from management of the Health Service Executive (HSE) and threats of a High Court action to prevent its publication. HSE director general Tony O'Brien complained of 250 adverse findings that affected senior people in the HSE, the Department of Health and the State Claims Agency. Soothing noises from Taoiseach Enda Kenny and appeals for mediation between the parties suggested the outcome might be a watered-down fudge. That, however, has not happened. Hiqa appears to be standing its ground.
Comparisons with the Garda Siochána are hard to avoid. In both cases, a traditional immunity from critical scrutiny and accountability is gradually being stripped away. The Garda Siochána Ombudsman Commission and the Garda Inspectorate were established to improve the quality of policing and to investigate bad practices and wrongdoing. They are deeply resented within the force. Hiqa finds itself in much the same position as it develops its role as health watchdog.
Tensions are to be expected in such circumstances but there should be no question about the Government's position when disagreements arise. Unless there is convincing evidence of prejudice or inappropriate conclusions, it should encourage transparency and accountability. In this instance, such a decision is likely to involve political baggage. In spite of complaints on safety grounds, former minister for health James Reilly intervened in 2012 to preserve the status of the hospital. The necessary funding was not, however, put in place by the HSE.
A tug-of-war exists between conflicting objectives. Hiqa’s responsibility is to ensure safe, high quality healthcare. But local communities are determined to retain existing services and place undue pressure on politicians and the HSE. The quality of services at Portlaoise hospital reflected some of those tensions. Shortcomings at the hospital were found to arise from passivity amongst senior managers; poor reporting relationships; regular changes in corporate structures and inadequate funding. Findings like this should promote a necessary reconfiguration of acute hospital services and improved accountability. Publish and be damned.