Patient body urges better health service governance

WEAK GOVERNANCE and poor working relationships between clinicians and management were compromising patient safety, Dr Deirdre Madden, chairwoman of the Commission on Patient Safety, has said.

Speaking at the annual conference of Irish Association of Directors of Nursing and Midwifery yesterday, Dr Madden said there was a need for a national network of patient advocates, facilities for patients to raise concerns at point of care and protection for whistleblowers.

Recent investigations and reports into the health service had revealed a lack of structured incident reporting, poor senior clinical leadership and an absence of consistent analysis of adverse events, she said.

A national mandatory reporting system for serious adverse events had to be established along with a voluntary system to deal with non-serious or near-miss incidents.

A senior clinical leader in each organisation should have delegated responsibility to report at board level and reviews of governance should take place on a regular basis, with a legal obligation to monitor safety arrangements.

There should be a greater involvement of patients in health policy development and in healthcare organisations. Any board of management should include lay people as well as health professionals, and all new and existing employees should receive training in patient safety. She said patient safety had to be based on “knowledgeable patients receiving safe and effective care from skilled professionals in appropriate environments with assessed outcomes”.

The powers of the Irish Medicines Board also needed strengthening to tackle the problem of unlicensed medicines, Dr Madden said. The conference also heard calls for better facilities for end-of-life care in hospitals.

Almost 80 per cent of people now die in hospitals, compared with less than 20 per cent a century ago, Helen Donovan of the Hospice Friendly Hospitals programme told the conference.

Longer life expectancy and the increased medicalisation of everyday life were among the factors that had resulted in this change, she said.

Those dying in hospital and their families often had poor experiences because of a lack of appropriate facilities.

One of the greatest difficulties for those dying in hospitals was a lack of privacy, she said. Only 15 per cent of beds in acute hospitals and 14 per cent in community hospitals were in single rooms.

Of the deaths that occurred in acute hospitals, 68 per cent were in hospital wards, 20 per cent in intensive care and 12 per cent in AE departments.