BACKGROUND:The Hayes inquiry found shortages of staff and management issues lay behind problems
DUBLIN’S TALLAGHT hospital was at the centre of an investigation last year into how nearly 58,000 X-rays went unreported at the hospital between 2006 and 2009.
The inquiry, chaired by Dr Maurice Hayes, also examined how 3,498 GP letters dating to 2002 were not processed properly. Shortages of staff and weaknesses in hospital management and governance systems were at the root of these problems, the inquiry found.
But even before that report was published last November, the hospital had itself commissioned a review of management systems from PricewaterhouseCoopers. It recommended the size of the hospital board be reduced from 23 to a more manageable 8-12 people. Hayes concurred with this. The second last line in the Hayes report said “there have been enough reviews and reports: what has been lacking is action and a sense of direction”.
More than a year since the hospital received the PwC document, and at least eight months on from the Hayes report, the old board is still in place. A smaller “transitional board” with 12 members meets monthly, but the final say on key matters ultimately rests with the larger, more unwieldy board, which meets every quarter.
Now the Health Information and Quality Authority, the health service safety watchdog, is to subject the hospital to another investigation – this time focusing on its emergency department.
Undoubtedly, if the authority went into any overcrowded emergency department in the State – of which there are several – it could come out with a damning report. What seems to have prompted it to investigate Tallaght’s emergency department is the failure of the hospital to respond adequately to its concerns about the way risk was being managed, as well as comments from a coroner last week when he said the hospital sounded “dangerous”. It won’t be surprising if the authority reiterates concerns already aired on the size of the hospital board.
Concerns about the emergency department had been conveyed to the authority by at least one of the consultants in the unit, Dr James Gray, who told an inquest last week into the death of a patient in the department of “appallingly poor standards of sanitation” on corridors where up to 59 patients, including those with TB, have been located at any one time.
Many staff are working flat out to ensure patients are treated appropriately every day in the hospital, but lack of inpatient beds is an obvious factor in such logjams, as is the lack of an out-of-hours GP service in the Tallaght area. The hospital dealt with more than 74,000 emergency presentations last year compared to between 42,000 and 48,000 at the other four main Dublin hospitals.
It’s argued the hospital, which has just recruited Eilish Hardiman as chief executive, is under-resourced to deal with high patient numbers.
At a time of economic restraint there will be fears a hard-hitting authority report could be all that is needed to force the closure of one of Dublin city’s six emergency departments, which is often said to be too many for the population of one million. Tallaght, which has lost cancer services and is about to lose its children’s hospital, will be worried.