Slow response to Halappanavar report

Only one of the State's 39 hospitals ranked "excellent" for its implementation of recommendations made on foot of the death of Savita Halappanavar, according to an internal HSE report earlier this year.

Six out of 10 hospitals gave themselves the lowest score for their implementation of the recommendations made by the HSE and Health Information and Quality Authority (Hiqa), the progress report states.

The report, obtained under Freedom of Information, dates from last April, seven months after publication of the Hiqa report.

University Hospital Galway

University Hospital Galway, where Ms Halappanavar died almost two years ago, scored the two lowest grades for its implementation of each of the 34 recommendations, according to the report. For 31 of the recommendations, UHG gave itself the lowest category mark, “emerging improvement”, under the self-assessment tool designed to check the progress of hospitals in implementing the report findings.

It gave a “continuing improvement” mark for three other recommendations but no marks in the two highest categories, “sustained improvement” and “excellence” in respect of any of the recommendations.

A spokesman for UHG said yesterday significant work had taken place since then, with many recommendations implemented.

“This is a self-assessment process and we do not see it as a negative if we have marked ourselves hard. It shows that we are intent on driving improvements and the nature of the Hiqa recommendations is that they require constant vigilance and review.”

Staff have been trained in a national early-warning score system for monitoring pregnant women and in the detection of sepsis in pregnancy, he said.

A revised risk-management structure has been implemented in the hospital group with electronic reporting of complaints, incidents, near misses and claims.

Ms Halappanavar died in UHG in October 2012 after multiple care shortcomings at the hospital. She was 17 weeks pregnant and miscarrying.

All hospitals

The assessments in the progress report apply not just to maternity units, which were the focus of a Hiqa report, but to all hospitals generally.

The National Maternity Hospital said it had achieved "excellence" on four recommendations, and "sustained improvement" on 12 recommendations, the highest score in the report.

The UHG spokesman said consultant Ernst and Young had been commissioned to carry out an independent review of progress in implementing the recommendations after a 12-month period.

Patient safety

Their report will be presented to the November board meeting of the West/North-West Hospital Group, which will be held in public.

“Patient safety is paramount for us all in the hospital group and we are determined that we will have learned from the three investigations that took place.

“We are taking all action necessary to ensure the safety and welfare of all pregnant women and all other patients attending not just UHG but all the other six hospitals in the group.”