Hospital unit where babies died still short of key staff

The maternity unit at Cavan General Hospital where a cluster of baby deaths is under investigation still remains understaffed and unable to carry out foetal anomaly scans.

A review ordered by the HSE also found strains in working relationships between consultant obstetricians and midwives, over- dependence on locums and a few key management personnel, and poor morale affecting medical judgement.

The review was carried out by a former senior executive with the NHS in Britain, David Flory, and followed concerns over the deaths of four babies in a two-and-a- half-year period since 2012.

Its focus was on the structures and procedures in place around patient safety, service quality and risk management rather than the deaths which are being examined separately.

Mr Flory said the cluster of deaths had “hit the place hard”. “There is a very bright and critical media spotlight on the hospital. This is impacting on the mood and morale of members of the maternity team and it was described how it is affecting clinical risk assessments and decisions”. One locum consultant was reported to have left the hospital as a result.

The unit was supposed to have four consultant obstetrician posts and there was a proposal for a fifth but only one was permanently filled. Two were filled by locums and the third locum who left had not been replaced.

“This is clearly inadequate both in terms of capacity and capability,” Mr Flory said.

He said the plans to provide foetal anomaly scans for expectant mothers at 20 weeks could not begin until all five consultant posts were filled. The mortality rate for babies during pregnancy and birth at the unit was below the national average.

However, Mr Flory said: “The services lack the level of resilience required to give confidence that high standards of care can be consistently maintained as and when key individuals come and go and when demand pressures spike.”

Senior management were praised, in particular the general manager, but Mr Flory said the team was “hugely dependent on a small number of key individuals working beyond what can reasonably be expected.”

The team was “not permanent and stable,” he said. The director of nursing was temporary, the clinical director in charge of women’s and children’s services was planning to stand down and there was “some suggestion the general manager was planning to move on”.

Midwives were also in short supply, working at a ratio of one for every 40 births . While the unit was aiming for a 1:37 ratio, nurses’ unions argue best practice requires no more than 1:30.

Dr Alan Finan, clinical director for women and children at the hospital, said the report’s findings would be acted on. “The management team are very conscious that there are a small number of families who have not had a positive experience of the maternity service in Cavan,” he said.

Mr Flory also reviewed maternity services at South Tipperary General Hospital which was not the subject of controversy but which was also found to be under-staffed and under-resourced.

“It reflects the hand-to- mouth existence experienced by the unit on a day-to- day basis. In these circumstances the individuals running the maternity unit do a remarkable job,” he said.