A new report published today by the Health Information and Quality Authority has identified progress in the way in which services within the University of Limerick Hospitals group are being governed and organised. However, it also highlights a number of patient safety risks in the hospital group which must be addressed as a priority.

The Authority’s Report of the review of the governance arrangements as reflected in the safety, quality and standards of services at UL Hospitals found a clear willingness to change and improve services for the public, but that the absence of a statutory governance framework is hindering the development of strong governance and patient safety functions. 

HIQA’s Director of Regulation Phelim Quinn said, “Since the findings in 2009 of HIQA’s investigation into the quality and safety of hospital services in Ennis Hospital, there has been an extensive and positive journey of reconfiguration and reorganisation in the catchment area covered by UL Hospitals. Substantial governance and operational changes have occurred and these have the potential to improve services for patients. If such reorganisation can be supported and safely sustained, it would reflect the governance and accountability approaches previously recommended by the Authority and as advocated in the move to set up independent hospital trusts in Ireland.”

The governance review is part of HIQA’s proactive programme of work seeking assurance on the quality and safety of services against the National Standards for Safer Better Healthcare. It wasconducted with the cooperation of staff from the six hospitals in the hospital group, and focused on risks previously identified by HIQA as part of its interaction with the hospital group.

The review highlights a number of patient safety risks in the hospital group which must be addressed as a priority. The single most significant risk identified by the HIQA review was the serious delays and risks for patients and staff due to persistent overcrowding in the Emergency Department of University Hospital Limerick in Dooradoyle (previously known as the Mid-Western Regional Hospital, Limerick), the only site within the hospital group that was providing emergency department and critical care services.

Phelim Quinn went on to say: “HIQA believes the conditions experienced by patients attending the Emergency Department in University Hospital Limerick are unacceptable. The Department was overcrowded and not fit for purpose; this resulted in significant compromises in maintaining adequate levels of environmental cleanliness, and increased risk of Healthcare Associated Infections, impeded access to patients for care and observation, and severely reduced patients’ privacy and dignity.

“Other risks identified within the Emergency Department were delays in the admission of children to wards, while being accommodated in adult surroundings. This was despite the fact that a new children’s area had been developed but remained unopened. At the same time, staff in all the region’s local injuries units reported under-utilisation of their services. During the review, HIQA raised these risk issues at local and national HSE level.”

The Authority also noted that there were delays in transferring patients from the Emergency Department to the Intensive Care Unit and or High Dependency Unit and that the absence of a single clinical governance structure for the management of the Intensive Care and High Dependency Units contributed to this.

The report identifies a number of specific actions requiring high priority by UL Hospitals that also require the support of the HSE nationally. These actions are aimed at reducing both actual and potential risks to the quality and safety of services associated with overcrowding in the Emergency Department.

The hospital group’s corporate and clinical governance structures are in the early stages of development. The Authority recognises and acknowledges the change process that has been undertaken and the commitment of staff to achieving this. However, the review identified gaps in some of the group’s assurance processes which must be addressed as a priority. These include lack of a statutory framework for combined governance of the group, routine monitoring of patient experience arising out of quality and patient safety audits conducted, complaints management, risk reports, and compliance with Healthcare Associated Infection targets.

Phelim Quinn concluded, “Nonetheless, UL Hospitals staff who were met by HIQA are committed to providing good safe care and to improving the services. The momentum witnessed locally must now continue and be supported by the HSE nationally in order to ensure patients in the region continue to receive safer, better care. This report – and specifically the risk areas identified as requiring action – must now be reviewed by UL Hospitals and the HSE nationally and reported on in a quality improvement plan. It is imperative that the findings of such reviews are used to inform the ongoing reorganisation of acute hospital services across the country. Therefore, in the interests of the system-wide dissemination of learnings from such reviews, all public hospitals must consider the findings from this report and benchmark their own services against the progress and challenges reported on in this report.”

ENDS

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement

01 8147480 / 086 2447623 mwhelan@hiqa.ie

Notes to the Editor: 

• This report is the culmination of a long-standing interaction between the Authority, the Health Service Executive (HSE) and the group of hospitals previously known as the Mid-Western Regional Hospital Group that has subsequently become known as UL Hospitals.
• The Authority has previously had a special reporting framework with the Mid-Western Regional Hospital, Limerick since 2011. This engagement was grounded in a concern by the Authority about the effectiveness of the general and clinical governance arrangements in place.
• Substantial governance and operational changes that have been undertaken at UL Hospitals included the appointment of a Board of management, a Chairperson of the Board, a group Chief Executive Officer (CEO), an Executive Management Team and a clinical directorate structure. Board engagement with hospital staff and external stakeholders was a positive manifestation of the changes that had been undertaken.