Statement by board and management of Tallaght hospital following the publication of the Hiqa report:
The Interim Board and CEO of Tallaght Hospital appointed in December 2011 today accepted the recommendations of the HIQA Investigation into the quality, safety, and governance of care provided for adult patients requiring acute admission at the Hospital.
The CEO of Tallaght Hospital, Eilísh Hardiman, said the HIQA findings were both serious and far reaching.
She expressed her acceptance without reservation of the Report’s recommendations specifically relating to Tallaght Hospital and pointed out that positive progress had been made in recent months which would assist in the implementation of HIQA’s recommendations.
Ms Hardiman said “The safety, welfare and wellbeing of patients are key priorities for this Hospital. We firstly remember that a patient and a family were at the heart of this investigation and they are in our thoughts today. I have met with that family and have assured them that the HIQA Report recommendations will be fully implemented.
I want to state that Tallaght Hospital accepts the recommendations of the HIQA Report in their totality and without exception. We will fully implement its recommendations and we are already well on the way to doing so. This Report has highlighted many of the issues which also came to my attention when I took up the role of Chief Executive last August. As well as governance and management issues, it highlights concerns around how the Hospital delivered patient care and the need for cultural change in all these areas.
I am heartened today to be able to report that the urgent patient care issues have already been addressed as part of a major change programme underway at Tallaght Hospital in the 11 months since the inquiry was initiated. While there is still some way to go, patients are receiving improved care, in a more dignified way and are being seen more quickly at Tallaght Hospital Emergency Department (ED). ED trolley waiting times are down by 60% for admitted patients. We don’t accommodate patients on trolleys in the corridor of our Emergency Department. A new Medical Assessment Unit (MAU) is in place, with all patients now being seen within one hour by a senior clinician, with 8 in 10 of these patients treated within 6 hours.
We have restructured the senior management team at Tallaght Hospital to include the four Clinical Directors on the Executive Management Team. We have made several new management appointments including the appointment of a Director a new role as Director of Quality, Safety and Risk Management. We have also appointed a new Director of Finance.
We cannot consider the HIQA Report in isolation of the serious legacy financial challenge facing Tallaght Hospital today. However, we are already showing in this financial year that there is still scope to do things more efficiently and more effectively and are making positive progress in that regard. We are reducing ED waiting times and we are working much better at ensuring that only those in need of hospital treatment occupy a hospital bed.
Staff
I want to emphasise today that notwithstanding the serious issues arising, the HIQA Report cites multiple examples of the dedication and excellent care provided by the clinicians and staff at the Hospital and testified to by patients.
It is a matter of record that since 2009 concerns about the safety, dignity and privacy of patients were raised repeatedly and in writing, by Emergency Medicine Consultants and other senior nursing staff to senior management, the Hospital Board and the Medical Board. Emergency Department (ED) staff members were correct to have done this. It is, to say the least, highly regrettable that these concerns were not appropriately responded to by Hospital management and Board at that time in that the ED corridor remained in place. I can understand how the Emergency Medicine Consultants then felt compelled to notify external bodies such as HIQA and the Health and Safety Authority (HSA) of their concerns for patient safety and other issues relating to staff welfare and health and safety.
My message today is that we are more responsive to staff concerns and complaints at Tallaght Hospital. We want all our staff to feel confident that they can raise any patient safety concern in confidence with Hospital management, secure in the knowledge that their concerns will be fully listened to and acted upon promptly and without prejudice.
Governance
The Chairman of the new Interim Board of Tallaght Hospital, Sir Keith Pearson, also acknowledged the serious concerns surrounding the former governance structures of the Hospital. He added that since inception last December, the Interim Board had worked to address key patient and governance issues at the Hospital.
“This Report rightly identified the need for a new system of governance at Tallaght Hospital.
It is unequivocal in stating that the Board of the Hospital did not function in an effective way or have the necessary arrangements in place to adequately govern the Hospital.
However I am confident that this is no longer the case.
I have worked extensively in the past 6 months with the newly appointed Board Directors, the new CEO and her management team to address the structural and governance shortcomings which have been identified by HIQA.
The new Interim Board was put in place to address and improve amongst other things, patient safety and the patients' experience in using Tallaght Hospital and to overhaul the overall governance of the Hospital.
High performing hospitals have clear lines of accountability where the key roles, responsibilities and remits are clearly understood by all.
Significant progress has already been made in this regard – the new Interim Board was appointed last December with a clear remit from the Minister for Health to implement contemporary governance in Tallaght Hospital. The HIQA Report recommends that the Hospital Charter be replaced by new legislation. We have a new CEO in place since last autumn and new members to the Management team all of which has strengthened the executive management function and improved the governance structures at the Hospital. We have also worked externally and very closely with the Minister, his Department, the SDU, the HSE, to address these serious issues over the past 6 months. We have also worked positively with the Archbishop and the Foundations to re-define our relationship.
I would like to emphasise that Tallaght Hospital is a good hospital and it functions very well in addressing the acute medical needs of its catchment population of almost half a million people living in the greater Dublin area.
The hospital also plays a key role within the national hospital infrastructure network and I believe the changes now being put in place will ensure that it will continue to improve further in the months and years to come.”
Financial
The Report raises various shortcomings in the governance as a result of which 2 specific issues are identified as a cause of concern.
The HIQA report makes reference to a previous consultancy agreement with external management consultants. At its first meeting the Interim Board was made aware of this consultancy arrangement which totalled €1.8 million. The Interim Board was concerned about the previous governance of the procurement process and commissioned an independent external report. The Interim Board advised the C&AG, HIQA and the HSE of an external review it has commissioned and once due process has been completed and advice sought on what action should be taken the report will be shared.
Robust procedures are now in place to ensure that the Hospital’s procurement policy is strictly adhered to in all cases. Adherence to this is overseen by the Interim Board’s Audit Committee which has specific skills, competencies and expertise in this area.
The HIQA reports states that it was not made clear how decisions were made at previous Board or Committee level in relation to the appointment or remuneration of senior executive managers and makes reference to additional remuneration. By way of explanation, the new Interim Board was made aware of a previous practice whereby an external payroll facility was adopted to supplement senior pay.
We have established that this amounted to €739,000 over a five year period to five individuals (2005-2010). The supplementary payroll ceased in 2010 with remaining contractual payments moved to the hospital payroll. As of today that obligation amounts to an ongoing €35,000 per annum. To ensure that the Hospital does not incur further financial liability it cannot comment on the individual arrangements pertaining to this scheme. The Interim Board commissioned an external review and advised the C&AG, HIQA and the HSE. Once due process has been completed and advice sought on next steps, it will be shared.