Time for clinicians to be masters at Cork’s maternity hospital

It is unprecedented for consultants to write to hospital management in terms as stark as those expressed by CUMH doctors over gynaecology services, writes Peter Boylan

Time for clinicians to be masters at Cork’s maternity hospital

THERE are many well documented failures in Irish maternity services, which include gynaecology.

The failure to respond to the needs of the more than 4,000 women, some of whom may well have cancer and all of whom need to be seen by gynaecologists in a timely fashion, waiting for appointments at Cork University Maternity Hospital (CUMH) is the latest to be brought to public attention, this time by responsible journalism unearthing the concerns of the consultant staff at CUMH expressed in letters to management over a considerable period of time.

In my experience, it is unprecedented for a group of consultants to write to hospital management in terms as stark as those expressed by the CUMH doctors regarding the failure to address the serious deficits in gynaecology services at their hospital.

They have communicated their concerns regarding patient safety to the CEO of CUMH, Tony McNamara who is also CEO of Cork University Hospital (CUH), on numerous occasions, to no avail.

The failures at management level now pose potentially very serious risks to the health of the women served by the hospital. There is a real possibility of cancers going undiagnosed as a result. This is unacceptable in 2016.

The problems at CUMH are a good illustration of why maternity services should not be integrated with general hospitals. There have been many, well documented, adverse incidents in our maternity services in the past few years, almost all of which occurred in hospitals where the governance of maternity services came under that of a general hospital.

The National Maternity Strategy, launched earlier this year, was developed in response to these tragedies and specifically endorses the clinical and corporate governance structures of the three Dublin Maternity Hospitals, which are managed under the mastership system, which the National Maternity Strategy states “demonstrates a sound governance model, operating with clear lines of accountability and responsibility”.

The National Maternity Strategy was introduced by Leo Varadkar after widespread consultation with women, midwives, and doctors and has been endorsed by his successor, Simon Harris. It is, therefore, state policy with regard to maternity services, and has been welcomed by all relevant stakeholders.

What is the mastership model of maternity hospital governance? It is a system started in the Rotunda over 250 years ago, and subsequently adopted by both the Coombe and National Maternity Hospitals because it works.

The master is a doctor, an obstetrician/gynaecologist, who is responsible for running the hospital for a fixed period of seven years, during which he or she functions as both a clinician and CEO.

An administrative manager and director of midwifery support the master, and the master reports to the board of the hospital. The position carries authority, and also accountability, for both clinical and corporate governance. The buck stops on the master’s desk. There are clear lines of communication and everyone in the hospital knows who is ultimately responsible for the work of the hospital.

Implementation of the National Maternity Strategy will see this model of clinical and corporate governance introduced across all maternity units in the country. It will mean that budgets for women’s health care will be ring-fenced, and managed by a doctor who will have both authority and accountability for how the service is run.

The advantage of having a doctor as “captain of the ship” is that they are at the coalface of obstetrics and gynaecology. They understand the core business of the hospital and can respond effectively to the clinical needs of pregnant women and women with gynaecological problems.

A CEO who is not a doctor, no matter how well-intentioned, can never have as good an understanding of the core business.

It is clear that the current governance model at CUMH is not working in patients’ best interests. A suggestion that the current system is “an exemplar as to how obstetric services might integrate with general services” is seriously wide of the mark.

Dangerously long waiting lists, failure to open a second operating theatre, failure to seek additional consultant appointments, and an apparent withholding of millions of euro which the consultant group say should have been made available to CUMH do not suggest that the integration of CUMH with CUH is a success, least of all for the women for whom the hospital was built.

The consultants have stated that they “will not take responsibility for adverse health outcomes arising from a well-documented chronic lack of investment in the gynaecology service, which has resulted in longest waiting times for outpatient assessment and inpatient treatment nationally”. This is a woeful state of affairs.

The situation in Cork is of national importance. It provides a golden opportunity for Mr Harris to implement, without delay, a key element of the National Maternity Strategy — the Mastership model of governance — in order to solve the problems in Cork.

Failure by Minister Harris to act would call into question the State’s commitment to the National Maternity Strategy and would represent an abandonment of concern for the welfare of women in this country. The situation demands ministerial intervention.

Dr Peter Boylan is chair of the Institute of Obstetricians and Gynaecologists

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