Failures ‘cannot be explained away’ by poor staffing levels

Inadequate staffing levels in maternity units cannot "explain away" the failure to provide basic care to Savita Halappanavar, Minister for Health James Reilly has said.

Dr Reilly was responding yesterday to calls for an immediate increase in the number of consultants and midwives across the State’s 19 maternity units in light of the findings of the Health Information and Quality Authority investigation into Ms Halappanavar’s death.

The health watchdog’s report, which was published on Wednesday, said: “The HSE must review its workforce arrangements for maternity services nationally to ensure maternity teams are made up of sufficient numbers of staff with the right mix of skills and deployed effectively both during core and on-call hours.”

Dr Reilly, speaking to journalists in Dublin yesterday, said a national review of maternity services now being established would examine whether staff were “in the right place”.

'Tragic circumstances'
"No staffing issue can explain away the lack of basic clinical care that took place in the tragic circumstances surrounding Savita Halappanavar," he said.

“I’m not saying we don’t need more staff. I believe we will, but I do believe we have an opportunity to change the model of care as well . . .We need to change the way we’re working and that’s a much broader issue than the tragic case.”

Describing the labour ward as a “critical high-risk area for the pregnant patient”, the report says: “This area must involve direct supervision and care by hospital consultant staff and have 24-hours-a-day, seven-days-a-week senior midwifery cover”.

It points out that the 2003 Hanly report concluded there would need to be 191 consultant obstetrician gynaecologists in the State by 2013. At the end of last year, according to the HSE, there were 126. A 2006 report recommended that by 2016 there should be one consultant obstetrician-gynaecologist per 350 births.

According to the authority's report, in Dublin and mid-Leinster there were 41 consultants and 22,445 births last year, or one consultant per 547 births. In Dublin North East there were 27 consultants and 14,551 births last year, or one per 538. In the HSE South region, there were 17,740 births last year and 31 consultants, or one per 572, and in HSE West, there were 15,606 births and 27 consultants, or one per 578 births.

'Appalling indictment'
Dr Reilly agreed with the characterisation by clinical director of the National Maternity Hospital, Dr Peter Boylan, of Ms Halappanavar's death as an "appalling indictment of the State's care for patients".

Dr Reilly said: “It is an appalling indictment. But the rationale behind it now needs to be looked at and no amount of staffing can explain away the failure to care for the patient, to do basic things like taking blood pressure, measuring pulse rates, failure to recognise a patient is deteriorating, failing to recognise infection might be the real issue here, failure to follow up a blood test. Staffing [levels] can’t explain that.”

He said he wanted staffing levels looked at “across the system” and said he wanted “an appropriate level of staffing to an appropriate level of care”.

The Hiqa report pointed to 13 “missed opportunities” that, had they been identified and acted upon, could have resulted in a different outcome for Ms Halappanavar, who died in University Hospital Galway last October.