ALISON O'CONNOR: Shambolic state of our maternity services and HSE makes me sick

HSE director general Tony O'Brien at a recent briefing following publication of report by HIQA into the safety, quality and standards of services in the Midland Regional Hospital, Portlaoise.

THE women of Ireland need to take part in a reproductive action, and by action I mean a stoppage. 

I propose a procreation strike that will continue until we have a national maternity strategy that ensures giving birth in Ireland is made as safe as is possible.

I have just waded through the excellent and shocking 200-plus page report from the Health Information and Quality Authority (Hiqa) into Portlaoise Hospital where five babies died in controversial circumstances.

I am left seething, not just at what went on in the Midland Regional Hospital, but at the ongoing failure by the Department of Health to put in place a national maternity strategy, currently and incredibly absent from our healthcare service.

The Portlaoise report examines all areas of the hospital and is a microcosm of everything that is wrong with the HSE to the point where you imagine that even with no experience of healthcare, anyone with a bit of intelligence and common sense could have gone in and done a better oversight job than what happened here over a number of years.

We also have the pitiful situation where one arm of the State, the State Claims Agency, as far back as 2007, attempted to raise the alarm with the HSE over the quality of the Portlaoise maternity services, and even offered to get an independent obstetric expert in, but were rebuffed.

But even more depressingly, the report highlights how this is not just relevant to Portlaoise, or the maternity unit there – this attitude and manner of going about their business abounds in the service. At the end of it all, you are left wondering if the HSE is in any way fit for purpose, or should its director general, Tony O’Brien, be considering his position? How has there not been an absolutely massive public and political outcry as a result of what this report has revealed? Is it a sign of how low our expectations are when it comes to the way our health service is run?

The Portlaoise probe was the seventh investigation of its kind by Hiqa since 2007 and, in all, they found significant deficiencies. The trend appears to be that they recommend certain actions to try and make the service safer for the patients of whichever hospital is under scrutiny, but the HSE largely fail to act on them. The executive may eventually, as we see in Portlaoise, put some recommendations in place, very belatedly, but only because there is a metaphorical gun to their head.

There are so many quotable lines from the Hiqa report but one of my favourites regarding the overall approach of the HSE is where it states that evidence gathered during the course of the investigation showed that, until late 2014, patient safety issues “were not a standing agenda item for discussion at meetings of the health service directorate, the highest level of management within the HSE”.


Such is the level of disconnection that we are told that, following the RTÉ Prime Time investigation in January 2014 into baby deaths in the Portlaoise unit, there was no evidence that “key senior HSE managers” had visited the hospital in the immediate aftermath of the broadcast to assess the situation in the hospital’s emergency services. This shows a breathtaking level of disengagement — that, even for the sake of the optics, such visits had not taken place following a television programme that contained such shocking information.

What kept running through my head as I read the report, especially the bits which concentrated on the maternity services, was how we’ve been fed the line (and swallowed it) that we have one of the best maternity services in the world.

Our maternity services are shambolic at best. In hospitals such as Portlaoise, there are a myriad of problems, from the management of high-risk pregnant women to the brutal manner in which parents were dealt with after the death of a baby. Cavan Hospital is back in the news with the tragic death of a baby this week. We shall never forget Savita. We have big maternity hospitals such as the National Maternity Hospital, Holles St, the Rotunda, and the Coombe that are voluntary hospitals, run by boards, and appear to operate to a very high level of safety and efficiency.

But anyone who has visited any of them recently will immediately notice that these buildings are long, long past their sell-by dates and usually chaotically, dangerously busy. If a company tried manufacturing products in these buildings, even nuts and bolts, they would be shut down by the Health and Safety Authority. But they are acceptable for Irish women to give birth in. Isn’t it funny how whenever we have a controversy over abortion in this country, we are told how giving birth is such a magnificent thing to do and that babies are so precious?

I could never quite work out the disconnect between that and the lack of resources afforded the very places where women are expected to go and make their exceptionally valuable contribution to society. Given what we now know about the shambolic state of our national maternity services, I would suggest anti-abortion groups might consider picketing some of our maternity hospitals in respect of the protection of human life.

So we have 19 maternity units operating across the State, a number clearly on a wing and a prayer. The birth rate in Ireland increased by approximately 30% from 2000 to 2012, with the greatest increase between 2005 and 2007, and the greatest number of births recorded in 2009. As we learned from the Hiqa report, we do not have a national maternity strategy, even though one was first recommended 14 years ago, nor do we have nationally mandated maternity standards. There aren’t enough midwives, there aren’t enough obstetricians, and because of the absence of comprehensive information gathering systems we can’t properly assess or compare what goes on in these units.

As the Hiqa report states the purpose of such a strategy should be to agree and implement standard, consistent, “modern-day models” of maternity care in order to ensure that all pregnant women have choice and access to the right level of safe care and support on a 24-hour basis.

One senior HSE manager told the investigation team that what went on in Portlaoise was not surprising and “will very likely reoccur elsewhere in the system”. The real surprise, given the manner in which the system is currently run, is that we do no see more maternal mortalities.

Of course it is not all down to the HSE; there has been so much politics over the years with hospitals such as Portlaoise, and we are likely to see even more of it in the run up to the general election. There is also the issue of health service funding.

So, nine days before the Hiqa report was published Health Minister Leo Varadkar announced a steering group to “advise on the development of a national maternity strategy”. It is to finish it’s work by the end of the year. The biggest shock of all would be to have an actual strategy put in place by 2016. Like I said at the start it will take more than words to bring it about.

At the end of it all, you are left wondering if the HSE is in any way fit for purpose


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