Another HSE scandal, another feeble reaction

In a passionate contribution to this week’s Dáil debate around GSOC bugging and garda whistleblowers, independent deputy Mick Wallace described our parliament in less than flattering terms and suggested that public cynicism about our political system is entirely justified.

Though Mr Wallace, by not paying VAT he had collected from customers to the exchequer, made his contribution to that cynicism, he would no doubt agree that yesterday’s report on the deaths of a number of babies at Portlaoise Hospital will add to the despair and cynicism provoked by yet another indication of poor, unprofessional and dangerous performance at an Irish hospital.

That this report was only, and at a very late stage, provoked by a highly commendable RTÉ investigation into the deaths of four infants at the hospital deepens that cynicism. Despite being made aware of the issue repeatedly by bereaved parents — “maternity services ... that are not safe or sustainable” — the HSE did not bother to investigate. However, the RTÉ report made it impossible not to do so. This self-serving evasion of responsibility and unacceptable stonewalling by the HSE was referred to by the Chief Medical Officer at the Department of Health, Tony Holohan, who found that the families were treated in a poor and, at times, “appalling” manner. Most alarmingly, he found that the evidence of poor, dangerous performance existed but was ignored. That terrible indictment comes so very soon after the damming report into the October 2012 death of Savita Halappanavar just adds to the alarm around under-performing, dangerous maternity services.

Minister for Health James Reilly’s response was entirely predictable. He has asked the HSE to look at other maternity services and said the report was “a watershed moment ... and would result in a change in patient safety”. Cultural, training, management and governance issues had to be addressed at the hospital, he promised.

Even if you accept that Dr Reilly means what he says it is hard not to be, yet again and dishearteningly, cynical. Time after time in situations like this the same assurances have been made, the same determination to change cultures and management structures has been expressed.

What Dr Reilly — or any of his ministerial colleagues or predecessors — did not do was respond in a way that reflects the relationship between performance and outcome that prevails in the real world. Even though four lives were needlessly lost, four families tragically bereaved, no one in our health service or among their political masters felt those responsible deserved to lose their job over this scandal. Someone may have been censured in that harmless, pointless, patronising public sector way — moved aside, relieved of responsibilities or, most laughably of all, suspended on full pay but, it seems, no meaningful, grown-up action was taken.

The recurrence after recurrence of scandals like this more than suggests that health service employees are immune to the kind of discipline that ensures good outcomes for patients. Until such time as a health worker can be fired without golden handshakes or an immediate pension then we can expect to have to read a report like yesterday’s year after year. This kind of response to this kind of failure is standard practice in the private sector. Yesterday’s report, and the Halappanavar one, show that it is time to introduce these measures across our health service. Now that would be real, meaningful change, Dr Reilly.