The Health Information and Quality Authority (HIQA) has today published its Review of progress made at the Midland Regional Hospital, Portlaoise, in implementing recommendations following HIQA’s investigation. The original HIQA investigation was initiated as a result of the negative experiences of a number of patients and their families in receipt of maternity services at Portlaoise Hospital. The Report of the investigation into the safety, quality and standards of services provided by the Health Service Executive to patients in the Midland Regional Hospital, Portlaoise, was published on 8 May 2015.

In light of the findings of the Portlaoise Investigation in 2015, HIQA made eight recommendations that must be implemented to ensure that risks and deficiencies identified are addressed at both local and national level to ensure the delivery of safe and consistent patient care. The Review published today, which began in April 2016, sought to evaluate the progress achieved at Portlaoise Hospital in implementing these recommendations.

Commenting on the publication of the review, HIQA’s Director of Regulation Mary Dunnion said “This Review was carried out in order to support the provision of safe and quality services at Portlaoise Hospital. While some progress has been made, significant risks remain and the future of the hospital is uncertain.”

“Those with responsibility for the ultimate decision making on the hospital’s future must determine the range of clinical services that Portlaoise Hospital can or could safely deliver. Making these decisions will require careful planning to avoid unintended knock-on impacts on other hospitals in the Dublin Midlands Hospital Group, neighbouring hospital groups, the National Ambulance Service and community services. Once the decision has been made, the plan should be implemented as quickly as can be safely achieved.”

 “The remaining risks at Portlaoise Hospital will only be fully addressed through the formulation and enactment of a clear strategic plan for the hospital that is agreed by those with responsibility for the ultimate decision making on the hospital’s future.”

“When the Portlaoise Investigation was published, HIQA noted that the findings and recommendations of previous inquiries and reviews had not been attended to. To minimize the risk to patient safety and improve service quality, it is essential that the findings of the Portlaoise Investigation and this Review are now addressed in full”.

The review found that maternity services at the hospital are now being provided in a safer and more sustainable way. This improvement has been facilitated by enhanced leadership, governance and management within the service, increased investment, and an improvement in the staff to birth ratio, which has been largely driven by a reduced number of births. Efforts to begin the process of integration with the Coombe Women and Infants University Hospital have also seen service quality and the safety of services enhanced at Portlaoise Hospital, but more remains to be done to progress this clinical network.

While some safeguards have been put in place, many of the risks identified during the investigation in 2015 relating to general services, including critical care and emergency services for undifferentiated* patients, remain unchanged. The most significant change in general services provided at the hospital since the investigation has been the cessation of complex surgery. Otherwise, however, only limited change to the provision of general services has occurred.

Mary Dunnion added “Despite the improvements to maternity services at Portlaoise Hospital, the lack of certainty around the provision of other clinical services at the hospital has led to difficulty in recruiting and retaining staff and an over-reliance on agency staff. The ongoing lack of certainty has a negative effect on staff recruitment, retention and morale, and further affects the sustainability of services.”

Portlaoise Hospital continues to provide a 24-hour, seven-days-a-week emergency service for undifferentiated adult and paediatric patients who may arrive at the hospital with any degree of seriousness or complexity of illness or injury. However, the governance arrangements in the Emergency Department remained largely unchanged and continue not to be in line with the HSE’s National Clinical Programme for Emergency Medicine.

The Intensive Care Unit still does not meet the minimum requirements for critical care as set out by the Joint Faculty of Intensive Care Medicine of Ireland. In 2015, the HIQA Portlaoise Investigation Team was not assured that critical care services were sustainable in Portlaoise Hospital, and this situation has remained unchanged.

Ends

* Undifferentiated patients are all types of patients with any degree of seriousness or severity of illness or injury.

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement, HIQA, 01 814 7480 / 086 2447 623, mwhelan@hiqa.ie

Notes to the Editor: 

The Review of progress made at the Midland Regional Hospital, Portlaoise, in implementing recommendations following HIQA’s investigation, which was carried out at the request of the Department of Health,can be found here.

The Report of the investigation into the safety, quality and standards of services provided by the Health Service Executive to patients in the Midland Regional Hospital, Portlaoise, published on 8 May 2015.

The Review was carried out by HIQA staff, who are authorized to monitor compliance with standards in accordance with section 70(1)(a) of the Health Act 2007 (the Act). In accordance with section 8(1)(c) of the Act, HIQA issued formal documentation and data requests to relevant organizations. The HIQA Review Team also obtained information through interview with individuals, including staff working in Portlaoise Hospital and HSE staff at regional and national level whose role related to aspects of the governance and quality and safety of services at Portlaoise Hospital. In addition, the HIQA Review Team visited Portlaoise Hospital in June 2016 to interview staff and review the environment and physical facilities. On completion of evidence gathering, HIQA evaluated the findings.

The HIQA Portlaoise Investigation Report contained eight recommendations that needed to be implemented to both improve the quality and safety of services at Portlaoise Hospital and progress the safety of maternity and other clinical services across the public acute hospital system. Of these, six were of relevance at a national or regional level and two were of relevance at a hospital group level or locally at Portlaoise Hospital.

Recommendations 1 to 4 from the investigation were of relevance to the Department of Health – the reported level of progress achieved with the implementation of these recommendations can be found on the Department of Health’s website. HIQA notes that progress nationally has been made with the publication of a National Maternity Services Strategy for Ireland. HIQA has also developed National Maternity Standards that support the implementation of this National Maternity Strategy. These national standards will be launched later this month. Full implementation of both the National Maternity Strategy and the national standards should be a priority for the HSE in order to drive improvement across all maternity units in Ireland.

Of the remaining two recommendations of national significance, Recommendation 5 called for the HSE to ensure the appointment of a director of midwifery before September 2015 in all statutory and voluntary maternity units and hospitals. At the time of writing, it was reported that seven permanent directors of midwifery were in post and one additional permanent post had an agreed start date in November 2016. Three units had temporary appointments, with plans in place to advertise and fill them on a permanent basis. Within eight units, permanent posts are currently being advertised or re-advertised but remained unfilled.

Recommendation 8 concerned the need for the HSE, the chief executive officer of each hospital group and the State Claims Agency to develop, agree and implement a memorandum of understanding between each party to ensure the timely sharing of actual and potential clinical risk information, analysis and trending data. The HIQA Review Team found that the HSE and the State Claims Agency have developed and agreed a Statement of Partnership between the two organisations and a Joint Governance Group had been established.

Recommendation 6 and Recommendation 7 were of relevance to all hospital groups within the HSE. This HIQA Review examined the implementation of these recommendations within Portlaoise Hospital and the Dublin Midlands Hospital Group.