Despite substantial improvements to maternity services and management Portlaoise hospital is at a ‘critical juncture’ because of a lack of change in the general hospital services and an absence of a plan for its future, according to a new report.
The Health Information and Quality Authority (HIQA), the health service watchdog, has just completed a follow-up report to its 2014 statutory investigation carried out after the deaths of babies at the hospital.
It has found “significant improvements in the corporate and clinical arrangements”. The hospital now has senior management team with a clear focus on ‘quality and safety”.
Maternity has improved and is safer on many levels but this is tempered by the finding by HIQA that full integration with the Coombe Women and Infants University Hospital is some way off and there is a lack of a commitment to invest in the unit. Staffing remains below what it should be.
While the HSE has acted on the management side and the involvement of the Coombe has ensured progress in maternity, there appears to have been little done to upgrade the rest of services at the hospital to a Category 3 level.
The HSE is spending extra money but the ‘status quo’ remains in medical and surgical services including A&E, HIQA has found.
HIQA says that while extra cash is being spent and more staff work at the hospital there is an overall reliance on agency and temporary staff.
It finds little substantial change in general and medical services. It concludes that the A&E cannot “safely and effectively” treat sicker patients. It says arrangements at the A&E are “unsustainable”. It says HIQA is “not assured” that Intensive Care Unit services are “sustainable”.
The watchdog continues to have substantial concerns over the future. It references the plan drawn up by the HSE which has not been agreed by the Minister of Health.
“The HIQA review team believes that Portlaoise hospital has now reached a critical juncture.
“The status quo is not an acceptable long term situation from a patient safety point of view, and the ongoing uncertainty that results from the lack of a long term plan is damaging for the hospital and impacts on current service sustainability.
“A decision on what general medical and surgical services that hospital can, or might safely sustainably provide with service design, needs to be urgently made in the best interests of patients,” it said.
In particular it says the “receipt of undifferentiated patients” should be addressed in the short term.
In 2014 HIQA carried out a root and branch review of services and found shortcomings in many areas. The watchdog also was extremely critical of the HSE’’s role in the maternity problems and the overall running and role of the hospital.
It made national and local recommendations. Some of the national recommendations have been implemented others not.