Is it possible the HSE is beginning to change for the better?

Is it possible that the huge ship that is the Health Service Executive (HSE) is beginning to turn? I may well be premature in this attribution, but I have long maintained that the dysfunctional culture, endemic in the organisation, would only change if led from the top.

And there are a couple of straws in the wind that suggest this may actually be happening.

This time last year I wrote how, hitherto, one could make an argument that once admitted to an acute hospital, the care you received would be of an acceptable standard. However, by January 2023, that was no longer the case.

The canary in the national public hospital coal mine is University Hospital Limerick (UHL). Unprecedented warning signs about UHL had been flashing for some time. In June 2022, the Health Information and Quality Authority (Hiqa) issued a damning assessment of patient care at the hospital’s emergency department. In a report following an inspection visit, the State’s health watchdog found that the “overcrowded and understaffed” department posed a significant risk to the provision of safe, patient-centred care.

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Later that summer, 14 hospital consultants at UHL wrote to the hospital chief executive to voice their “deep concern” about the safety of patients attending the hospital emergency department. Seventeen hospital registrars added their voices of alarm.

As this unsafe hospital environment continued to worsen, a 16-year-old, Aoife Johnston, presented to UHL’s emergency department on December 19th, 2022. After waiting 12 hours for treatment, she died from bacterial meningitis and associated sepsis.

Her death was the subject of an internal HSE report, which was given to its chief executive Bernard Gloster last month.

This report found there was a 12-hour delay in caring for the teenager’s developing sepsis. Overcrowding was endemic in the hospital’s emergency department and there was “little apparent understanding” of the risks this posed, the internal report by two non-UHL doctors found. There were insufficient ED nursing and medical staff to adequately monitor patients and a high turnover of staff, leading to “low experience levels and low situational awareness”.

In the past, health service chiefs would have used such a report to kick the broader issues into touch. Significantly, on this occasion, Gloster asked former chief justice Mr Justice Frank Clarke to carry out an independent investigation into Aoife Johnston’s death and the governance of the hospital. The results of this independent inquiry are expected within weeks.

In an RTÉ interview last week, Gloster declined to express confidence in the management of UHL at the time of Aoife Johnston’s death. Asked if he had confidence in the management of the hospital, Gloster said he was satisfied with the arrangements that were now in place and the additional assurance provided by his recent appointment of regional executive officer Sandra Broderick, to whom UHL management must now report.

“It is very important that there is accountability, but equally I will not commit my staff to trial by social media or summary justice or populism,” he told RTÉ Radio 1′s This Week programme.

However, it seems clear that Gloster intends to use the Justice Clarke report to identify individuals where accountability is found to be an issue. This is new ground for a HSE chief executive and is welcome.

For too long, health service managers have escaped accountability when patients have suffered and died as a result of dysfunctional structures. It is time they were answerable to a professional standards body akin to Corú, the Medical Council, and the Nursing and Midwifery Board of Ireland.

Are these developments an early sign that the health service may be about to move beyond its broken magic roundabout phase?

Since its inception, the poor culture within the HSE means it continues to make the same mistakes over and over.

And while only time will tell, I sincerely hope my sense of straws of change is not premature.

• Dr Muiris Houston is a medical journalist, health analyst and Irish Times contributor