A lack of stringent control
Our Lady of Lourdes Hospital in Drogheda is once again in the news. This time it doesn’t arise from overcrowded emergency services or the use of inappropriate medical procedures but from poor administrative practices. Casual agency staff, lacking Garda and medical clearance and without proper training, have been employed. Not just that: the cost of agency staff there is the highest in the State.
Excuses might be made for this situation on the grounds that the hospital has been under such enormous pressure, in terms of overcrowding and nursing shortages, that shortcuts were needed to avoid a collapse in services. It is true that Our Lady of Lourdes accident and emergency service has become a bottleneck, with nursing unions demanding that more hospital beds be opened, along with additional staff. That does not, however, excuse poor administrative practices involving the recruitment of outside agency personnel without adequate scrutiny.
The fact that this is an internal Health Service Executive audit is also significant. As an organisation that reacts badly to criticism and tends to be economical with the truth, the formal recognition of a range of weaknesses and failings in the administration of public hospitals is to be welcomed. Findings, in relation to potential conflicts of interests and special financial arrangements, could be regarded as self-serving. But they send a useful signal that more transparent arrangements will be required in future.
All public hospitals and regions are included but the audit findings are encapsulated in a judgment that found “a lack of stringent control”. There is little new there. When the HSE was established, it was forced to find jobs for all former health board staff, no matter whether they were effective or incompetent managers. It also became apparent that individual health boards had been operating their own ranges of pay levels and perks for medical and clerical staff. The job of establishing common pay levels and allowances for all hospitals continues.
Hospitals are complex organisations that require constant monitoring and attention on both a financial and medical level. Reductions in State funding, recruitment restrictions and public demand for better services have piled on the pressure. An additional, but necessary, challenge has come from the State’s health watchdog, Hiqua, which reports on hospital hygiene and the delivery of quality medical care.
The days when ministers and health executives could dismiss poor practices and inept management as “systemic” and carry on, are fading. Accountability is beginning to mean something. This audit of hospital services has identified poor management, extensive waste and potential fraud. The next step will involve doing something about it.