EXPECTANT MOTHERS attending three hospitals in the northeast are being put at risk because of a shortage of consultant obstetricians, the clinical director of women’s and children’s services in the region has said.
Dr Alan Finan, in a letter to the network manager for hospitals in the region, said there were about 4,000 women a year giving birth at Our Lady of Lourdes Hospital, Drogheda, giving a ratio of approximately one consultant to 570 deliveries. He cited the recommended ratio, which is one consultant to 350 deliveries.
He noted that various reports, including one into the death of Tania McCabe in March 2007 after she gave birth to twins, one of whom also died, have recommended that the staffing ratios be improved but this has not happened.
In his letter on July 15th last to Willie Rattigan, he said there was an “urgent” need to address consultant obstetrician staffing levels in the Louth/Meath hospital group. The three hospitals in this group are Drogheda, Dundalk and Navan hospitals.
He pointed out that the fact that antenatal clinics, gynaecology clinics and gynaecology day services are provided across the three hospitals, means the seven consultant obstetricians in the hospital group “are spread far too thinly across three sites and this is leading to significant gaps in service and increased risk”.
He also said locum cover for planned consultant leave is not provided but antenatal clinics must go on, so currently the antenatal clinics are staffed by NCHDs (non consultant doctors or junior doctors) during periods of consultant leave. “This is a completely unacceptable situation,” he said.
He went on to say it was “not sustainable or safe to continue to prop up the service” with locums when consultants are on leave and called for consideration to be given to the immediate appointment of an eighth consultant obstetrician. The HSE said the decision to seek an additional consultant must be taken in the context of overall service pressures existing in the region.
“Clearly the HSE has to prioritise the areas most in need. Even when the regional priorities are decided, a case still must be made to the national body responsible for approving the appointment of additional consultant posts. Dublin North East is currently considering requests for a number of additional consultant posts, in various medical specialities,” it said.
Dr Finan told The Irish Times he didn’t believe the shortage of consultant obstetricians in the region was “a critical safety issue” but there were gaps that needed to be “tightened up”. He said the HSE was now considering his proposal. He stressed that the recommended ratio of one consultant obstetrician to 350 deliveries was a “gold standard” from the UK but many other Irish hospitals did not comply with it. He said some had “worse” ratios than Louth/Meath and some had better.
“The fact is the Irish health service, by any standard, is understaffed from a consultant point of view and the HSE accept that and would like to have a consultant delivered rather that a consultant-led service,” he said.
Dr Finan also confirmed the extent of consultant obstetric staffing in the Lourdes hospital had not changed since the report into the death of Ms McCabe (34).
A report into her death found short-staffing at the hospital compromised the care she received.
Meanwhile, midwifery staffing levels have improved since the Lourdes hospital inquiry report in 2006 and were now at “close to recommended levels”, Dr Finan said. That report examined the high level of Caesarean hysterectomies carried out there over a 25-year period by the now-struck off obstetrician Michael Neary.