Sir, – Optics aside, it is difficult to see the value of an external review by an accountancy firm on issues of patient safety ("Savita hospital review finds 'reasonable compliance'", December 5th). The central issue in the Savita tragedy was poor medical management of a sick patient. Unfortunately, the inevitability of such poor outcomes remains the case in the vast majority of Irish hospitals.
The reasons for this have been clearly identified and reported in The Irish Times over the last few months. First, the grossly inadequate provision of intensive-care units and critical-care beds has never been addressed. All the so-called "early warning systems" can hope to achieve is to underline this fact on a daily basis. If the alarms keep going off, people stop listening.
Second, as stated by the recently departed head of Health Information and Quality Authority, while there are pockets of excellence in Irish healthcare, there are no clear standards of care and we do not know how many patients are being killed or harmed (her words not mine) because it is not being measured. Finally, the total lack of accountability of HSE management for poor clinical outcomes is appalling.
Where I work now, there is no public vs private nonsense. Patients are treated free at the point of care on an as-needed basis. Each person has a unique patient identifier; care is provided by consultants or the institution doesn’t get paid; I am responsible for every clinical decision I make, and there is a permanent electronic record of diagnostic tests, consultation letters and other reports. If a patient has an adverse outcome, all providers involved must attend the relevant morbidity and mortality meeting, which are held routinely. – Yours, etc,
Dr PAUL MacMULLAN,
Clinical Assistant
Professor Division
of Rheumatology,
University of Calgary,
Alberta, Canada.