The Health Information and Quality Authority has today published the report of its investigation into the quality, safety and governance of the care provided by the Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, for patients in the Emergency Department and those requiring acute admission to the Hospital.

Commenting on the publication of the investigation report, HIQA Chief Executive Tracey Cooper said: “The findings of this investigation reflect a history of longstanding challenges in leadership, governance, performance and management at Board and Executive level of the Hospital, and a failure of the State to hold the Hospital, which was in receipt of significant amounts of State funds, effectively to account for the quality and safety of services it provided.”

“These challenges resulted in the persistent, and generally accepted, tolerance of patients lying on trolleys in corridors for long periods of time with a lack of clarity as to who was accountable for patients. This puts patients at risk, is not acceptable and should not be tolerated in any hospital in Ireland.”

During the course of the investigation, the performance of all hospitals providing emergency department services nationally over a 24-hour hour period in August 2011 was also analysed. This identified some significant concerns in relation to the waiting time for patients in some hospitals and the quality of the data and the amount of absent information with which to manage the performance of an emergency department.

The investigation also found that the Board of the Hospital did not have adequate arrangements in place to direct and govern the Hospital, nor did it function in a sufficiently effective way to assure itself that the Hospital was providing safe care to patients – including patients receiving care in the Emergency Department.

Also, the Charter that established the Hospital is not in line with modern corporate governance principles. Despite a number of attempts to address governance problems at the Hospital, and a number of improvement reviews having been undertaken, sufficient action was not taken by the Hospital itself or the Health Service Executive to address these issues. 

During the investigation, information came to the attention of the Authority regarding the awarding of a contract that raised serious concerns about the effectiveness of the governance arrangements for financial management, transparency and contract control in the Hospital. These arrangements are essential in an organisationin receipt of significant public funds and raises questions about the transparency of the use of taxpayers’ money.

“Every day there are patients who receive good, safe care at Tallaght Hospital and there are patients who could receive safer and better care. The Hospital has made significant changes and improvements in the way that it is led, governed and managed since the commencement of the investigation with a strengthened leadership and management team and the establishment of an interim Board that is more fit-for-purpose to govern and direct the Hospital,” Tracey Cooper said.  

The challenges for this Hospital, and all other acute hospitals in Ireland, will be to drive, inject and embed strong patient-centred leadership in order to establish and sustain a strong culture of patient safety throughout the Hospital.

“Healthcare is far too important to be run, managed and governed in a way that does not reflect a high performance, high quality and high delivery mindset. Ignoring persistent poor performance in the quality, safety and timeliness of patient care and financial management should no longer be acceptable and must change.”

“The Authority believes that given the substantial amount of public money that is entrusted to health and social care service providers in Ireland, of which Tallaght Hospital is one, there should be a robust mechanism in place to oversee the recruitment, appointment, performance management and replacement of board members, chairpersons, chief executives and other executives and it has made recommendations to address these gaps.”

The findings and the 76 recommendations from this investigation focus on the improvements required in Tallaght Hospital, and in similar hospitals nationally, as well as the changes necessary to improve the accountability of the health system by the State and modernise the way in which we run our health system in Ireland. 

They include recommendations to improve the acute care for patients in emergency departments nationally, the effective management of patient admissions and discharges and access to diagnostic tests. There are also recommendations on strengthening the arrangements to hold chief executives and chairpersons to account for the delivery and quality of the service and a requirement for existing boards and executives of all health and social care service providers in receipt of State funds to assess themselves against the relevant recommendations within the report and tomodernisethe constitutional basis, composition and competency of such boards.

“Following on from this investigation, the Authority recommends that the Department of Health establishes a clearly defined ‘Operating Framework’ for the State that establishes the key levers and drivers for the effective oversight, governance and delivery of a high quality, safe and reliable health and social care system which is designed to deliver the most accessible service in the most cost and clinically effective way for our population.”

Also, a Special Measures Framework should be established to actively address circumstances in which substantial and persistent poor performance of the board and/or executive management of a service provider in receipt of State funds occurs.

“This Framework should contain the provisions for the Minister for Health to intervene where there is evidence that a hospital or health and social care provider is not performing one or more of its functions adequately or where there are significant failings in the way it is being run.” 

Following the approval by the Minister for Health of the National Standards for Safer Better Healthcare, and the subsequent commencement of a monitoringprogrammeagainst the Standards, the Authority will monitor service providers against the implementation of these recommendations as part of that process.

“These Standards will be the first step towards the introduction of a licensing system in the Irish healthcare system. The establishment of a licensing system in Ireland will accelerate the requirement for these recommendations to be implemented by all service providers.”

“It is crucial that in Tallaght Hospital, and in all healthcare providers, the behavioursand practices that result in unacceptable care for patients are simply not tolerated. We must make a choice to actively drive our health system, from patient to policymaker, and to ensure that a culture of patient safety, openness, accountability and improvement is led, managed and embedded into our services,” Tracey Cooper concluded.

Ends

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement, HIQA
01 814 7481/ 086 244 7623, mwhelan@hiqa.ie

Notes to the Editor: 

• The full Investigation Report, along with the Executive Summary and Recommendations are available to download from www.hiqa.ie
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