The Health Information and Quality Authority (HIQA) has said further improvements are needed in the governance and management of gynaecology services at Letterkenny University Hospital to ensure the quality of the services and safety of women accessing those services.



Following a series of concerns about the quality and safety of gynaecology services at Letterkenny University Hospital, HIQA undertook a review of the governance arrangements of the services at the hospital, Saolta University Health Care Group (Saolta Group) and national HSE level.



HIQA’s Director of Healthcare Regulation, Sean Egan, said: “A number of women and families raised concerns with us about gynaecology services at the hospital over the past few years. Our priority in this review was to examine the effectiveness and sustainability of measures introduced to improve the quality and safety of gynaecology services for women, and provide them with assurances about the service. We extend our deepest sympathies to the families of those who experienced a delay in diagnosis of endometrial cancer and those who died with the disease.”



HIQA found that while the hospital received significant resources - funding and staffing - to make improvements to gynaecology services, weaknesses in governance structures and processes at the hospital and of oversight quality assurance mechanisms at Saolta Group levels remain.



Sean Egan, said: “Despite the number of initiatives and measures introduced by Saolta Group since 2018, HIQA was not assured that there were sufficient and effective governance and oversight arrangements in place to assure the quality and safety of gynaecology services, which posed a risk to women using the services. Strong and effective governance, leadership and management is needed at the hospital and hospital group to ensure and promote high-quality, safe and reliable services and establish and sustain a culture of patient safety.



“While some measures introduced at the hospital had brought about improvements, such as a new ambulatory (outpatient) gynaecology service, revised procedures for the review and triage of referrals and a decline in waiting lists numbers for women trying to access gynaecology services, these must be sustained in the long term so that women who use and depend on the service can be confident about its quality and safety. If this is not achieved, the HSE should hold Saolta Group to account.”



HIQA’s review also found that:

• The hospital failed to meet national HSE and Saolta Group guidance and timelines for the review, testing and diagnosis of some women referred with post-menopausal bleeding. Furthermore, Saolta Group failed to identify cases where non-adherence to timelines had occurred. This was of significant concern to HIQA and was raised with the hospital group.
• The hospital continues to struggle to recruit and retain medical, nursing and midwifery, and administrative staff which remains a risk to patient safety.
• The transition to a new ambulatory (outpatient) gynaecology service was welcome; however, the expected number of women that could be managed in this services at Letterkenny University Hospital fell short of that estimated by national HSE. The ambulatory gynaecology service at the hospital was not fully established and was working at only 50% of its potential capacity.

Sean Egan continued: “Many of the challenges in staffing and waiting lists in Ireland’s gynaecology services identified more than 15 years ago continue to challenge service provision today. To improve these services, the HSE must continue to rollout the new ambulatory (outpatient) gynaecology model and progress the development of a set of key performance indicators for gynaecology services to standardise and enable comparative benchmarking of the quality of services for all women, and prevent future service failures like we have seen in Letterkenny University Hospital.”



Read the report at the link from the top of the page



Ends.

For further information please contact:

Marty Whelan, Head of Communications and Stakeholder Engagement

(01) 8147480 / 085 805 5202 / mwhelan@hiqa.ie



Notes to the editor:

• This review was carried out under section 8(1)(c) of the Health Act 2007, which outlines HIQA’s powers to monitor compliance with nationally mandated standards and advise the Minister for Health and the HSE accordingly.
• HIQA’s review took place between April and September 2021 and involved an on-site inspection at the hospital; interviews with key personnel at hospital, hospital group and national HSE level; a documentation review and a survey of women to establish their experiences and views of using the gynaecology services.
• Concerns about gynaecology services at Letterkenny University Hospital were first raised in 2018. Following continued engagement by HIQA with the HSE, an external review into the totality of post-menopausal bleeding services within the gynaecology services at Letterkenny University Hospital was commissioned by the HSE in 2019.
• An external review, Letterkenny University Hospital: Review of the Gynaecology Service, with a particular focus on post-menopausal bleeding pathways was published in July 2020. HIQA followed up on the implementation of recommendations from this report during its review.