Varadkar and O’Brien’s biggest test: to deliver safe maternity services
My analysis of Portlaoise HIQA report in the Irish Independent on 16 May 2015
Five babies died in Portlaoise Hospital between 2006 and 2013. The maternity unit was unsafe, with insufficient frontline clinical staff, under-resourced to cope with the complexity of care required. Had lessons been learnt from previous HSE inquiries into Portlaoise and Hiqa reviews into Ennis and Mallow hospitals between 2007 and 2010, babies’ lives could have been saved.
The 208-page damning Hiqa report into Portlaoise found that the Intensive Care Unit was ‘not fit for purpose’, the Emergency Department and surgical services were unsafe, while medical services needed “significant restructuring and resourcing”.
Management and staff at Portlaoise Hospital, in the HSE regionally and nationally failed to act on adverse incidents and deaths.
To compound their tragedies, the families of the deceased babies were treated “inhumanely”. Each was given the impression that their baby’s death was a one-off.
Some of the deceased babies were presented in a “grossly inappropriate and extremely traumatising” manner.
One mother was presented with her dead baby in a tin box that was too small for it. Other families did not get to hold their dead children. Families were given bad news in corridors and not given any explanation for their babies’ deaths.
For seven hours this week, Minister Varadkar, Hiqa, and the HSE appeared before the Oireachtas health committee.
HSE DG Tony O’Brien and Leo Varadkar were keen to emphasise that services are now safe, new staff, management and governance structures are in place, that people will be held to account.
Just days before the publication of the Hiqa report, Minister Varadkar announced a group to oversee the development of a maternity strategy. First promised in the 2001, it was called for again in the 2013 Hiqa report into the death of Savita Halappanavar.
Minister Varadkar has said that the new maternity strategy will be produced by year-end, that some maternity services might have to close. Will any government really publish a report recommending the closure of some maternity units in the weeks and months in advance of a general election?
One of the central findings of the Hiqa report is that Portlaoise was resourced as a model 2 hospital, but was having to operate as a model 3 unit – which is a hospital with 24-hour surgery and critical care.
Model 2 hospitals are a “step down” from model 3 in that they do not provide 24/7 surgery, acute, critical care or emergency medicine.
Last Thursday, HIQA chief Phelim Quinn called for the political commitment to ensure that the eight HIQA recommendations are acted upon.
Chapter two of their report sets the scene, showing how Portlaoise Hospital was under pressure as far back as 2004. In 2007/08, a series of cancer-misdiagnosis scandals resulted in cancer services being removed from Portlaoise.
In 2009 and 2010, Hiqa published two reports into Ennis and Mallow after concerns about the safety of services in smaller hospitals. These reports told the HSE to apply the recommendations to all smaller hospitals.
In September 2010, the HSE produced a list of 10 hospitals to which these recommendations should be applied. Portlaoise was one of those.
In July 2011, the then HSE chief, Cathal Magee, appeared before the health committee, where TDs were given responses that listed Portlaoise as one of 10 hospitals to operate at model 2 level.
In a heated exchange between Fine Gael TD, Charlie Flanagan and Dr Garry Courtney, the HSE clinical lead for acute medicine, Charlie Flanagan looked for reassurance that Portlaoise would keep its 24/7 Emergency Department and maternity services.
Minister James Reilly intervened, reassuring Flanagan “that it is not Government policy that Portlaoise will be a model 2 hospital”.
And when the framework for smaller hospitals was published in May 2013, nine not 10 hospitals were listed, critically Portlaoise was not.
The Hiqa Portlaoise report is being cited as a watershed moment in Irish health services. It is an ignominy that it took the tragic deaths of so many healthy women and babies in our maternity units for this seminal moment to be reached.
Delivering safe, high quality maternity and infant services requires an end to cosy consensuses, institutional defensiveness and clientelism.
Seizing this opportunity to deliver safe maternity services is perhaps the biggest test facing both Minister Varadkar and Tony O’Brien. If they rise to this challenge, they could go down in history. If they do not, their positions are not tenable.