Mallow probe may speed up HSE South reorganisation

Catherine Shanahan says the HSE was as surprised as anyone by move to investigate Cork hospital

ANY number of opinions have been aired in recent days over the fate of Mallow General Hospital (MGH) and why it is that the health watchdog has decided to probe its patient care.

There are those who believe it is a collaborative effort between the discredited Health Service Executive (HSE) and the Health Information and Quality Authority (HIQA) to quickly justify removal of certain services from the north Cork hospital and speed up the HSE South’s plodding reconfiguration plan.

This opinion is held by those who regard HIQA as the HSE’s military wing.

HIQA is an independent health watchdog.

According to HIQA, the HSE was no less surprised than any of the staff or patients of MGH that it was to be the subject of a probe.

Prof Richard Greene, clinical director of the Cork University Hospital Group (which includes MGH), was equally flummoxed. He had no knowledge of any complaints made against the hospital and, as clinical director, he would expect to be in the loop.

But the fact is, anyone can approach HIQA directly with a complaint and if it is serious enough, and HIQA verifies that the complaint stands up, it can launch an investigation without any reference to the HSE.

The conspiracy theorists who believe HIQA is doing the HSE’s dirty work may not appreciate how much work has so far gone in to reconfiguring hospital services in the South and how many within the HSE regard the timing of this investigation with dismay.

The HSE has been working on the reconfiguration process for some time and claims it was already busy implementing some of the recommendations HIQA last year outlined as necessary to provide a safe and quality service to acutely ill patients in small, standalone hospitals.

The announcement of this investigation may cause some of those currently co-operating with the reconfiguration process to withdraw pending the outcome of the HIQA investigation.

It has already led some to question what the HIQA agenda really is, particularly as it failed to make any reference in its press release announcing the investigation to the fact that it had received a patient/patient complaint(s).

When it investigated Ennis General Hospital in April 2009, everyone understood why. Two women had been given a cancer misdiagnosis.

Ann Moriarty was twice erroneously given the all-clear for breast cancer at Ennis and once at St James’s Hospital in Dublin. She died of breast cancer in April 2008.

Edel Kelly, a 26-year-old mother-of-two, died in June 2008 after the failure by Ennis General Hospital to diagnose her breast cancer in 2006.

This time around we must take HIQA at face value. What happened in Ennis post-HIQA may also be a pointer to what could be on the cards for MGH.

Since April 2009, Ennis has lost 24-hour emergency care, acute surgery and thousands of patients to the MidWest Regional Hospital in Limerick, the main tertiary centre in the midwest. It was deemed unsafe to provide paediatric and maternity care.

It will also lose its six coronary and intensive care beds by the end of 2011 when a new critical care unit comes on stream in Limerick as part of the midwest reconfiguration plan.

The positives are that it has acquired an acute medical assessment unit that treats patients who would otherwise have gone to the emergency department and it has an upgraded ambulance service.

Similar improvements are in train in the HSE South.

In response to the HIQA announcement of its investigation and its criticism of the HSE for failing to improve quality and safety of patient care in hospitals like Mallow, the HSE said many of the issues identified at MGH had already been addressed.

As part of reconfiguration of services in the South, cancer services have transferred to Cork University Hospital; ENT paediatric inpatient and daycase admissions have been transferred to the South Infirmary Victoria Hospital which is now the regional centre for ENT; bypass protocols for critically ill patients are in place with the ambulance service to CUH.

The HSE said there was “clear evidence that referrals of medical patients are effectively streamlined by GPs to MGH or CUH, with the more unwell patients being admitted to CUH”.

A strict no-refusal policy for the transfer of critically ill patients from MGH to CUH is being formalised.

The HSE is also planning the introduction of an Advanced Paramedic service in north Cork by March 2011 to support the transition of the current surgical service to day surgery only.

MGH will continue to have a 24/7, 365 days a year service for patients with appropriate general medical emergencies needing urgent admission.

This service will be available at an Acute Medicine Unit (AMU). The HSE says it is committed to all of the above. It argues that re-organising the services will ultimately improve patient care. It was well along the road to convincing others to buy into these plans when HIQA stepped in. They may had done the HSE a favour by speeding up the re-organisation process up, but that was not part of their plan.

As a HIQA spokesperson said: “If we receive information that raises our concerns in relation to the safety and quality of patient care, we can’t say to patients in Mallow to wait for another year before we investigate until the reconfiguration process is complete. Our job is to ensure safety of care for patients in the here and now.”