Midland Regional Hospital spared HSE downgrade after Reilly intervention, says Hiqa

Midland Regional Hospital, Portlaoise, was removed from a list of hospitals chosen by the Health Service Executive to be downgraded from operating as a 24-hour facility after an Oireachtas committee was told this was not Government policy, according to the draft report by the Health Information and Quality Authority (Hiqa).

However, the draft report says the hospital was neither resourced nor equipped to safely deliver the higher level of clinical services.

Hiqa says its inspectors found a number of examples of how Portlaoise was not resourced to safely provide services at the higher level set out under Government policy.

In 2010, the HSE identified 10 hospitals nationwide, including Portlaoise, to become “Model-2” centres. Such hospitals provide day surgery, some acute medical services, care for minor injuries, diagnostic services as well as specialist rehabilitation and palliative care.

However, the report says in July 2011 the Oireachtas health committee identified that Government policy “determined” Portlaoise was a “Model-3” hospital as it provided maternity and paediatric services.

Model-3 hospitals deal with all types of patients with any degree of seriousness of illness and provide acute medical and surgical services as well as critical care on a 24/7 basis.

Former minister for health James Reilly told the Oireachtas committee meeting it was "not Government policy" to remodel Portlaoise as a Model-2 hospital, according to the official transcript of the proceedings.

Reassurance

Fine Gael colleague and local TD Charlie Flanagan, though not a member of the committee, demanded the HSE provide reassurance this would not be happening.

Mr Flanagan told the committee Portlaoise hospital had performed 42,000 procedures in its emergency department the previous year (2010). He demanded to know where these people would go if the hospital was downgraded.

He also questioned where the 2,500 births taking place at Portlaoise would take place if 24-hour services at the hospital were removed “given that the recent trolley count shows 1,145 people are on trolleys in Mullingar hospital for six months of the year and more than 1,000 in Tullamore hospital”.

The draft Hiqa report also says while the HSE had originally wanted 10 hospitals including Portlaoise designated as Model-2 centres, when the Department of Health set out its framework for smaller hospitals in May 2013, only nine centres were included.

Portlaoise had been dropped from the list.

The draft report argues whatever the rationale for the decision to designate Portlaoise as Model-3, changes should have been put in place to ensure that its structures and resources were sufficient to allow it provide the more sophisticated level of care such as 24-hour, seven-day acute medical, surgical and critical care.

The draft says subsequently, as part of further HSE reforms, it was recommended Portlaoise should be incorporated into a cluster of larger and smaller hospitals known as the Dublin/ midlands group.

Stand-alone care

However, the formation of the group is still at an early stage and in the interim Portlaoise continues to provide stand-alone, single-hospital type of care, it says. At the time of its investigation, Hiqa concludes, there was “no clear vision of the services that Portlaoise hospital could and would safely provide into the future”.

It says Hiqa inspectors found the hospital lacked formal systems to ensure close clinical co-operation, communication and integrated systems of clinical governance between it and a larger training hospital.

HSE director general Tony O’Brien has told staff the Hiqa draft report contains some factual inaccuracies, lacks context and balance and fails to give reasons for, or substantiate, certain findings.

The HSE has identified concerns over the standard of acute clinical services or 24- hour emergency care in 10 smaller hospitals. The names of these hospitals came into the public domain in April 2011 as part of Hiqa’s report into Mallow hospital, although they did not receive significant media attention at the time.