ANALYSIS:THE PUBLICATION of a report by the Health Information and Quality Authority on the safety of care provided to patients requiring emergency admission to Tallaght hospital has ramifications that permeate well beyond that institution.
The patient safety watchdog conducted a year-long investigation into the running of the hospital’s emergency department after an inquest into the death of a patient, Thomas Walsh, who died in a corridor while waiting for a bed at Tallaght in March 2011.
Its findings are a damning indictment of the management of the hospital and may also trigger questions about the individual responsibility of health professionals working there.
The decision by the State’s chief medical officer, Dr Tony Holohan, to refer the report to both the Medical Council and
An Bord Altranais is a clear indication that he and others in the Department of Health believe certain individuals may have professional standards issues that require further investigation by regulatory bodies. And it is an unmistakeable signal to doctors and nurses in the wider health service that they have broadly defined responsibilities when it comes to patient care.
Explaining the chief medical officer’s decision, Minister for Health James Reilly said: “It is completely unacceptable that there was no clarity as to who was providing medical supervision of these patients.” As part of a system-wide response, Dr Reilly yesterday formally approved the Hiqa national standards for safer, better healthcare. These are designed to support the development of a safer health service, and specifically spell out the obligation on teams and individuals to safely transfer a person’s care from one part of the health system to another.
The standards recognise that error can never be fully eradicated from healthcare, but state that when a patient experiences an adverse outcome, hospitals must respond promptly. It acknowledges the need to support the patient throughout the response process.
There is an interesting standard in reference to budgetary issues. In it, hospitals, clinics and others are told they must consider the potential implications for quality and safety of care when they are asked to make savings in their allocated budget.
The report on Tallaght shows how governance problems extended to the highest levels of the HSE and the Department of Health. Hiqa highlights a failure of governance in the health system as a whole, in failing to hold one service provider to account for the performance, delivery and quality of its service. The report suggests that failure extends to other hospitals and healthcare institutions in the Republic.
It is clear that the days of constituting a hospital board of management to reflect the interests of staff and past traditions are over. For Tallaght, that poses challenges to its hospital charter; for other hospitals around the State, it means boards must operate according to proper governance standards now laid out by the patient-safety watchdog.
Like any good report, it has the potential to make the health service a safer place. Whether it achieves this aim now depends on the political will of the Minister for Health.
