New standards vital to ending debacles in health service

ANALYSIS:The benchmarks are a first step towards a licensing system for the Irish healthcare system

FOLLOWING THE many health service failures visited upon us in the last decade, yesterday’s publication of the National Standards for Safer Better Healthcare by the Health Information and Quality Authority (Hiqa) is reminiscent of flood defences being completed after many years of recurrent breaches and costly clean-ups.

The health service in the Republic was essentially flying blind pending implementation of these standards. Individual health professionals have attempted to do their best for patients in a porous health service where systems were either non-existent or liable to crumble at the slightest sign of pressure.

Now we have 45 standards with legislative teeth; in the words of Hiqa chief executive Dr Tracey Cooper, “the standards provide, for the first time, a national and consistent approach to improving safety, quality and reliability in our health service”.

It’s worth looking at the new standards through the prism of recent critical events in the health system. A year-long inquiry has been held into the running of Tallaght hospital’s emergency department after an inquest into the death of a patient, Thomas Walsh, in a corridor while waiting for a bed in March 2011. This found he was the victim of an abdication of responsibility for his care while he was being transferred from one part of the health system to another.

Standard 2.4 states: “An identified healthcare professional has overall responsibility and accountability for a service user’s care during an episode of care.” In practice this means you can expect to receive safe and co-ordinated care when being looked after by more than one healthcare professional; when you move between different services, such as when your GP refers you to a hospital for further care; or when you move within or between hospitals and services.

So, with Standard 2.4 in place, there is no doubt as to who is responsible for a patient who has been admitted to hospital but who is waiting in the emergency department for a free bed. It is up to every hospital to decide how this works in practice, but with no room for fudge or obfuscation.

In the case of Ann Moriarty, a breast cancer patient at Ennis hospital, a 2009 report found that abnormal blood test results, strongly suggestive of recurring breast cancer, were filed in her chart without being acted on.

Standard 2.6 comes into play here, namely: “The people providing your healthcare have the necessary skills and experience to provide safe care for you as they regularly care for people with the same or similar condition; the service only delivers those services that it knows it can deliver safely and effectively; and if the service where you are currently receiving care is unable to meet your healthcare needs, you will be supported to access a different service that can provide the necessary care.”

The Hayes inquiry into unreported X-rays in Tallaght hospital found evidence of 57,921 unreported X-ray films going back to 2003. This reflected a hospital’s under-resourced radiology department operating to a curtailed budget. Under Standard 7.1, hospitals are expected to make “arrangements to manage financial performance and evaluate its impact on the quality and safety of services, in particular any deterioration in performance”.

What about occasions when, despite strong governance and clinical performance, something goes wrong? Healthcare providers will be expected to “model” such scenarios so they respond quickly to possible risks and train those working in the service to know what to do if something goes wrong during the care of a patient. After an adverse outcome, there is a commitment to look at what happened, and how, with the aim of trying to prevent it happening again.

The standards are a first step towards a licensing system for the Irish healthcare system, public and private. While Hiqa’s remit does not currently cover private healthcare, officials from this sector were involved in developing the standards. It is expected private healthcare providers will voluntarily adopt them before proposed statutory licensing. The standards apply to all healthcare services (excluding mental health), including hospital care, ambulance services, community care, primary care and general practice.

In coming months, education of the standards for healthcare providers will be the main focus. From early next year, hospitals and clinics can expect inspection visits to assess compliance. Any health service debacles will be judged by how closely or otherwise those concerned adhered to the new standards.

Let’s hope at a political level there will be an appetite to hold accountable those at the highest level for any future failure to implement these vital standards.

Dr Muiris Houston is health analyst for The Irish Times