In 2018, a publication, known as the Walker report, highlighted significant issues with maternity services at Portiuncula hospital – particularly around governance, communication, the presence of consultants and training and reliance on locum consultants.
Seven years later, the public would be forgiven for wondering if this is Groundhog Day, as another review at the Ballinasloe hospital highlights strikingly familiar concerns.
“Unfortunately, although changes were made following the 2018 review, many of the same scenarios have been identified by this 2024 review process,” a review summary noted.
On Wednesday, the Health Service Executive published a summary report of five external reviews into the care provided to women and their babies at the Ballinasloe hospital.
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The reviews were commissioned after five cases of neonatal encephalopathy (NE) requiring therapeutic hypothermia (known as neonatal cooling) were identified in a close time period. NE is an impairment of neurological function.
Adding to this, a further five reviews are under way, while two more reviews are due to begin imminently.
On foot of the report published by the HSE on Wednesday, expectant mothers whose pregnancies are defined as being “higher risk” are to have their antenatal care moved from Portiuncula to other locations.
In the summary, the review team laid out four common themes of concern: communication, governance, clinical care, leadership and clinical governance and infrastructure.
For anyone who consistently follows health news, the terms will be familiar. Time and time again, they are touted as the reason why things go wrong in our health service.
But how can the same issues occur at the same hospital again? Steps were taken to improve things. One of the recommendations in the 2018 report was to improve clinical governance. Consequently, the responsibility for maternity services was given to a new clinical director from the hospital group.
Wednesday’s report notes, however, that while this might have seemed a “positive move”, the position has no executive oversight, no regulatory or budgetary control and their role is “purely oversight and advisory”.
“There have been a number of changes in recent years to the governance structures of HSE hospitals from health boards to hospital groups to regional groups,” the report said.
“The further the distance between the key decision makers and the clinical coalface, the more likely it is that decisions will be significantly delayed and based more on financial merit than clinical need.”
As such, the review team has recommended that clinicians take up leadership roles, and reliance on locum consultants is reduced.
The review team also noted the two communication systems in place, which they said should be simplified to make it more efficient and to reduce the “clinical risks”.
Furthermore, the report said there were situations in which staff were unable to contact the consultant on call due to mobile phone coverage problems.
“This is not a safe or satisfactory arrangement and needs to be resolved as a matter of urgency,” the report added.
The hospital’s maternity unit is small, delivering 1,400 babies annually. Consequently, the review team cited difficulty in its ability to provide the “full range” of maternity and newborn services and to attract permanent staff members.
“It is operationally challenging and there are significant clinical risks in providing maternity services in this way,” it said.
In conclusion, it found “the current situation does not meet the expectations of parents, increases clinical risk, and is no longer sustainable”.
That statement is stark, but the more alarming finding is the review team stating the issues arising in the report are ones that “could plausibly arise in other similar sized maternity units”.
As such, the team “strongly recommends” that there is an opportunity to review the way maternity services are delivered across the State.
Such a finding will do little to reassure expectant parents of the safety of the maternity system. If anything, it will leave them with more questions than they had before.
