Abject failure of HSE to carry out basic elements of patient care exposed

ANALYSIS:ANY HOPES that the significant management failures revealed by the Fitzgerald inquiry into the Portlaoise breast cancer debacle were of a limited nature have been dashed following the publication yesterday of the Health Information and Quality Authority (HIQA) report into symptomatic breast services.

Taken in conjunction with the deficiencies in private medical care illustrated by the Barrington's Hospital report, it is clear why public confidence in the Republic's cancer services is at an all-time low. Yet again, the abject failure of the HSE to carry out basic elements of patient care has been exposed. Not alone was the clinical care of Rebecca O'Malley suboptimal, but the HSE's response to its original mistake was to prevaricate. According to HIQA, no one within the Midwestern Regional Hospital (MWRH), Limerick or Cork University Hospital (CUH) took the lead in responding to Ms O'Malley's well-founded concerns.

Shortfalls in communication are known to compromise patient safety; the report found that communication between senior management and front-line staff was poor. "The shortcomings in communication were unacceptable and exaggerated the levels of anxiety and distress that Rebecca O'Malley and her family were already experiencing", it notes. Amazingly, even though the system knew it had made a potentially life-threatening error, it did not have the capacity to respond quickly and sensitively to the patient.

As a result, Rebecca O'Malley was obliged to take the lead in the investigation: it took her five letters and a total of five months just to get the results of an external review of her original biopsy specimens.

She finally got an apology from CUH, where the sample taken in the MWRH was analysed, only after senior managers in Cork University Hospital wrote to the HSE chief executive's office asking permission to escalate the organisation's national complaints policy to the next level to facilitate an apology.

In many ways, this particular incident sums up all that is wrong with the HSE. It shows an organisation that limits decision- making to a single central authority. It is one thing to have tight "head office" control over finances; by over-centralising decision-making, however, the HSE has emasculated regional managers to the point where front-line services are compromised.

The HIQA investigators, led by Dr Michael Durkin, who is responsible for the clinical governance of health services for five million people in the South West region in the UK, found a "collective lack of accountability, cohesion and focus on the needs of the patient". And one of their key recommendations is that a named individual at senior management level should be responsible and accountable for clinical governance.

Effective clinical governance is fundamental to providing safe healthcare. The problems unveiled by failures in Rebecca O'Malley's care are a clear message that patient safety is being compromised.

The O'Malley investigation must be examined in conjunction with both the Portlaoise and Barrington reports into breast cancer care. A common theme emerges: despite the existence of the O' Higgins guidelines on the management of symptomatic breast disease, ad-hoc and suboptimal care leading to missed diagnosis, unnecessary surgery and haphazard investigation is evident. In the interest of consistency, it is a pity that HIQA was not charged with investigating all three incidents.

The Minister for Health must now ensure HIQA's remit is extended to private hospitals.

The HSE is a sick organisation in need of constant policing. HIQA chief executive Dr Tracey Cooper says the authority expects the HSE to "performance manage" the implementation of the report's recommendations.

But the real hero of yesterday's report is Rebecca O'Malley. She could easily have melted away to recuperate from her breast cancer treatment.

To her immense credit she choose to highlight the deficiencies in our health service so that others might not suffer in the way she has.