THE ANNOUNCEMENT by the Health Information and Quality Authority (Hiqa) of an investigation into the standards of patient care at Mallow General Hospital has been clouded in confusion. Unlike a previous investigation into the similar-sized Ennis General, prompted by specific instances of patient mismanagement, so far no individual breaches of patient safety have been revealed by Hiqa or the Health Service Executive (HSE). Indeed nursing, medical and political representatives from the hospital’s north Cork catchment area have been uniform in their praise of the facility.
However, it is unlikely that the board of Hiqa would have authorised the inquiry at Mallow unless it had been furnished with evidence to warrant doing so. And while there is undoubtedly concern at the slow progress in reconfiguring services at the hospital in line with national recommendations made in the report on Ennis, focusing on the Mallow unit over and above other smaller hospitals such as Roscommon or Bantry could not be justified in the absence of specific examples where patient safety had been compromised.
That argument will not allay public suspicions that the move is about cutting costs across the health service, with patient safety an effective cover for a need to reduce spending on public services. At a local level understandably, there is an emotional attachment to local hospitals where family members have been well cared for over the years.
Yet patient safety must be assessed on objective rather than subjective criteria. In an age of evidence-based medicine it would not be right that a person attending a Cork city teaching hospital could access a standard of care superior to that enjoyed by a patient with exactly the same condition at Mallow hospital. Both may return home well, but the urban patient may have had access to superior technology and expertise making it less likely that an episode of the same illness will recur.
Like the streamlining of cancer services carried out under Prof Tom Keane, achieving a uniform standard of care in other areas of medicine and surgery in the Republic will mean complex treatments cannot be provided in all hospitals. A network of large regional units will form the central spine of secondary care across the State, with smaller hospitals acting as spokes. The aim must be for them to provide high-quality care under the direction of larger facilities.
It is clearly unacceptable for the HSE to fudge this transformation programme. Hiqa says it believes the HSE has failed to undertake the necessary review of surgical, critical care and emergency services recommended in a 2009 Hiqa report. According to a recent letter from Hiqa chief executive Dr Tracey Cooper, it has been unable to ascertain to what extent its recommendations have been implemented by the HSE.
The HSE is playing a dangerous game. It appears to want to “bounce” Hiqa into making difficult decisions for it. At the same time it is starving the health service inspectorate of information it is statutorily obliged to provide. It is time for Mary Harney to intervene.