Money and staff did not tackle problems at Portlaoise hospital says HIQA

Hiqa finds that investment in the hospital has not reduced risks

Midlands Regional Hospital Portlaoise

By Conor Ganly conor.ganly@leinsterexpress.ie @laoisnews

Changes have been made to general hospital services, including A&E in Portlaoise, but not enough to convince Hiqa that the hospital is equipped for the variety of sick patients that present.

The 2014 Investigation Report concluded that Portlaoise Hospital was notadequately resourced or structured to provide the undifferentiated care that it was charged with providing. Although Portlaoise Hospital was regarded as a model 3 hospital, it was not resourced as such and was trying to deliver clinical services without the appropriate funding and staffing.

The Hiqa Review says the most significant change that had taken place in the general services was the cessation of complex surgery at the hospital since 4 August 2015.

“With the exception of complex surgery stopping at Portlaoise hospital, only limited changes to general services at the hospital had taken place. As a consequence many of the risks to patients attending general services to the hospital, which had been identified during the original investigation, remain.”

A 24-7 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 still operates.

Hiqa found this is done in “the knowledge that it cannot safely and effectively treat some of them and that these sicker patients will require transfer to a more appropriate hospital.”

While an A&E consultant is now based at the hospital four days a week, alongside two that travel from Tullamore, this review identified continuing staffing issues.

It continues to be staffed by a team of medical and surgical NCHDs (junior doctors) as opposed to emergency medicine NCHDs - this is not unique to Portlaoise.

In 2015, 24,979 adults presented and 11,265 children attended the A&E. Nearly 90% are not classed as serious.

Staff reported A&E risks as: lack of consultant cover at weekends and after 5pm; split between medical and surgical teams; inadequate nursing skill mix due to redeployment.

The greatest concern was the transient nature of the NCHD.

There had been little change to the Intensive Care Unit at Portlaoise Hospital, and the Hiqa Review Team found that it still did not meet the minimum requirements for critical care.

“The Hiqa Portlaoise Investigation Team was not assured that critical care services were sustainable in Portlaoise hospital and this situation has remained unchanged at the time of this Review.

Since the 2014 investigation, there have been improvements to the consultant medical and radiology staffing.

In addition, the hospital has received funding for and has constructed a 10 bed modern medical assessment unit on site. The Dublin Midlands Hospital Group identified the opening of this new Medical Assessment Unit as one of its priority actions for completion by the end of 2016.

Hiqa found that the hospital's budget has risen from almost €45million in 2012 in 2012 to €51.7 this year.

The increases are largely on staff costs many of whom work in medical and emergency services.

When it was originally ivestigated the hospital had 552 full time posts employing 600 people.

In May this year it had 650 posts equating to 740 on staff.