ANALYSIS:Promise to legislate for robust hospital licensing system is welcome, but much more is needed, writes DR MUIRIS HOUSTON
WHEN THE report of the Commission on Patient Safety and Quality was published last August, the question of whether the Government would adequately fund the recommendations remained unanswered.
Yesterday’s announcement of the implementation of some of the patient-safety initiatives has provided partial answers; the licensing system for health service institutions will be self-financing, with providers paying a licence fee to cover the administration and inspection regime’s costs.
For patients availing of private hospital care, it will mean a substantial rise in health insurance premiums. As we know from the Health Information and Quality Authority’s (Hiqa) inspection of nursing homes, licensing is expensive. Ultimately, it will be the consumer who will pay for improved patient safety.
For the struggling public health system, Minister for Health Mary Harney has indicated the cost of licensing will come from existing revenues. An implementation steering group will be asked to “develop and submit implementation costings and proposals for how, and over what timescale, these could be funded by better use and reallocation of existing resources”.
If this means redirecting funds from the HSE’s bloated administration it will be a good thing. But if resources are redirected from frontline patient care then the cost of the licensing system could actually endanger patient safety by removing vital resources from those in need.
However, the commitment to legislate for a robust licensing system in both public and private hospitals must be welcomed. To make a real difference, the law must give Hiqa, the licensing agency, the power to close a hospital or an individual unit within a healthcare institution.
Apart from the licensing issue, we need a major cultural change throughout the health system – one that freely acknowledges medical error, openly communicates mistakes to patients and their families, and is committed to learning from errors in a blame-free way.
While licensing may take some time to implement due to the complex nature of the legislation, other recommendations made by the patient-safety commission can be implemented without delay.
A mandatory system of adverse event reporting will be facilitated by the protected disclosures provision of the 2007 Health Act, due to come into effect next month. In practice, this will facilitate whistle-blowing by offering employees both legal and employment protection. It should significantly improve the communication of medical error.
Following the revelations of various cancer scandals in the past two years, the new protocol in the Department of Health for dealing with all communications to it about patient safety issues is welcome. If properly implemented, the protocol should put an end to the buck-passing we have seen in recent years between the Department of Health and the HSE.
Deirdre Madden and her commission produced an excellent report last year and it is important that it be followed up by definitive action. Yesterday’s announcement is a start, but much remains to be done.