Madam, – The decision by the Health Information and Quality Authority (Hiqa) to carry out an investigation of Mallow hospital is strange. In the absence of a statement to the contrary by Hiqa, it appears no formal complaints have been made against Mallow hospital; indeed quite the opposite. The people of north Munster, including the medical and nursing staff of Mallow hospital, appear to be satisfied that the hospital is providing a service which is safe. Some have suggested the real motive behind the investigation is a plan to remove services or close the hospital.
Hiqa, one of the few beacons of light in a bureaucratic, dysfunctional and secretive health service, is an independent body with statutory powers to carry out investigations where it believes patient safety is or may be compromised. However, the fact Hiqa reports directly to the Minister for Health, and not the Oireachtas, is not reassuring, and therein lies the problem. People are not convinced that this investigation is about safety, but about finance and politics. Should the people in north Munster be worried? Perhaps they should, because the more serious risks to patient safety are far removed from Mallow.
I have a vested interest in our health service because it fails to provide a safe neurosurgical service. My wife died in 2005, because of very serious individual, and above all, systemic failures. Nuala collapsed and stopped breathing as a result of a subarachnoid haemorrhage, caused by a ruptured brain aneurysm. She was resuscitated at home and was unconscious on admission to Tallaght hospital. Despite several requests for Nuala to be transferred to Beaumont Hospital for emergency treatment to secure the ruptured aneurysm, treatment was delayed. She regained consciousness, but five days later suffered a second more devastating bleed, before being offered treatment in Beaumont Hospital. The second haemorrhage was predictable and preventable. Her life could have been saved by early intervention.
In 2000, the Society of British Neurological Surgeons issued minimum safety guidelines for neurosurgery which included standards on consultant numbers, work load, waiting times, bed numbers and bed occupancy. In 2006, Beaumont Hospital commissioned its own report Safe Neurosurgery in Ireland in which the hospital confirmed it had failed all but one of the above minimum safety guidelines. Safe Neurosurgery in Ireland was not published, but Beaumont reluctantly released the report following a Freedom of Information request. Since the Beaumont neurosurgical “Centre of Excellence” was established in 1986, when two smaller neurosurgical units in St Vincent’s Hospital and the Richmond Hospital were closed, the number of consultant neurosurgeons in Beaumont Hospital had not increased in 20 years.
As a consequence, the hospital requested funding from the HSE to increase the number of consultant neurosurgeons from six to 11 and satisfy one of the minimum safety guidelines. The hospital did not receive all the funding it needed and while some improvements have been made since 2006, the service is still not safe. Despite several requests to Hiqa to confirm that the neurosurgical service is now safe, there is silence. The very serious risk to patient safety, where patients are denied or delayed treatment in the neurosurgical centre, should not be underestimated.
Each year as many as 300 people in Ireland suffer a ruptured brain aneurysm causing subarachnoid haemorrhaging. Almost 150 do not survive the journey to hospital and the lives of those who survive continue to be at risk, until the ruptured aneurysm is secured. Access to emergency treatment, which can only be delivered in a neurosurgical centre, is very much a lottery and is not guaranteed.
The only concession from Hiqa, to date, is confirmation that guidelines, just developed, are being piloted and this may bring consistency and transparency when neurosurgeons are deciding which patients will be accepted for treatment. While very welcome and long overdue, guidelines will not overcome the serious leadership and resource deficits.
Meanwhile, requests for an independent external review of the neurosurgical service, to assess the risk to public safety, have been ignored. Instead, Hiqa suggests that Beaumont Hospital should commission an outside consultant to carry out a review of the hospital’s own failures. This, of course, is absurd and unacceptable.
The decision to carry out an investigation in Mallow and not deal with the more serious crisis in neurosurgery is puzzling. The Health Information and Quality Authority is duty bound to inform the public on matters which compromise patient safety. To date it has not answered. We need to know if the neurosurgical service is safe. We also need an accurate assessment of the risks associated with failing to meet minimum safety standards.
The closure of local hospitals or departments within hospitals in favour of large centres may reduce costs, but large centres do not become “centres of excellence” without leadership and resources. Meanwhile, patient safety is seriously compromised. – Yours, etc,