Below is the full text of the letter from Minister for Health Mary Harney to Pat McGrath, chairman of the Health Information and Quality Authority, ordering a review of services at Ennis General Hospital.
Dear Pat
I have been considering ow best to address the serious issues arising from the recent cases of the late Ms. Anne Moriarty and the late Ms. Edel Kelly following their treatment in Ennis General Hospital.
The expert clinical advice available to me is that a clinical review of other patients treated in Ennis would not be warranted. I am also conscious that, in the context of future lessons for cancer services, breast cancer services have now been transferred from the Hospital to a designated specialist centre.
However, I feel it is important to have a wider examination of the operation of Ennis General Hospital, which would look at the approach there to issues relating to diagnosis and treatment of patients, including the governance arrangements for quality and safety, and to communications both within the hospital and with patients. I believe that there may be lessons to be learned both for Ennis General Hospital itself and for the wider acute hospital system.
I am very conscious that the Health Service Executive has been working for some time to reconfigure services in the Mid Western region. It has been engaging with clinicians and other health professionals in the region to agree on a practical, patient-centred plan for reorganising services between Limerick Regional, Ennis, Nenagh and St. John’s Hospital.
The clinicians in the region have been working very positively and have shown strong leadership towards this end. I am aware that the HSE has placed a particular emphasis on integrating A&E services, with clear roles for all four hospitals as part of a well defined emergency care network.
I am also aware that HIQA has been reviewing documentation relating to the cases of Ms. Moriarty and Ms. Kelly and that it is formulating its own views on the question of carrying out an appropriate investigation or review.
In finalising the best approach to any review, I believe that we should take account of the valuable work recently done by the report of the Commission on Patient Safety, Building a Culture of Patient Safety(July 2008) which deals with critical areas such as governance, leadership and accountability.
The resources available to the HSE are of course an important element in the provision of services. I am conscious of the requirement on the HSE to use available resources in the most beneficial, effective and efficient manner (section 7 (1) of the Health Act 2004 ) and of the requirement on HIQA to have regard, in performing its functions, to the resources available to the HSE (section 8 (2)(c) of the Health Act 2007).
With all of these factors in mind I am now requesting the Health Information and Quality Authority, under section 9(2) of the Health Act 2007, to review the arrangements for providing services at Ennis General Hospital with particular reference to the diagnosis and follow-up of patients and the communication systems in place within the Hospital for both patients and staff. The review would include how these arrangements work in the Emergency Department.
I think it would be particularly helpful if any of the conclusions or recommendations were applicable to other acute hospitals also.
My officials would be happy to discuss formal terms of reference and a timescale for the review with the Chief Executive Officer. I would envisage the review being completed within a period of three months.
Yours sincerely
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Mary Harney TD