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HSE Statement

The HSE welcomes the publication today of the “Review of progress made at the Midland Regional Hospital, Portlaoise, in implementing recommendations following HIQA’s investigation” by HIQA.

The HSE wishes to acknowledge the commitment and dedication of both the patients and the staff of the Hospital in bringing about significant changes to ensure better and safer Maternity Services in Portlaoise Hospital.

The report sets out the progress made to date in addressing the recommendations of the HIQA report.  While challenges remain, HIQA notes that maternity services at the hospital are now being provided in a much safer and sustainable way with; 

  • Significant improvements in corporate and clinical governance, and management structures at the hospital;
  • Improvement in maternity services and the benefit of developing the Coombe Women and Infants University Hospital and MRHP clinical network partnership;
  • Close working relationships between the hospitals in the DMHG and improved integration of services that have helped in addressing the deficiencies noted by HIQA in May 2015.

The progress made over the course of the past 18 months is due to investment, recruitment, and in particular the commitment of local clinical, management and support staff.

The HSE established a National Implementation Group to implement the HIQA recommendations for all Maternity Units and Acute Hospitals under the chairmanship of the National Director, Acute Hospital Services.  This has seen extensive investment in recruitment of clinical staff, strengthened risk management and improved work practices across all maternity services.  In addition there has been a comprehensive review of structures and processes for managing risk in general acute services.

In 2016 the HSE Service plan provided €3 million for investment in maternity services including the recruitment of an additional 100 midwives nationally. Progress is being made in ensuring that all 19 maternity units have a Director of Midwifery in place with 13 appointed to date. 

In Portlaoise Hospital, since 2012 there has been an 18% increase in staffing levels across maternity, paediatric, medicine and emergency services.

With specific reference to maternity services there are now six funded obstetrics and gynaecological posts, four of which are joint appointments with the Coombe Women and Infants University Hospital.  20 additional midwives were approved for the Group in accordance with recommendations of Birth Rate Plus and are in place.  A clinical network for obstetrics has been established for the Group led by the Coombe that includes Portlaoise.  A clinical lead for Integration of Obstetric services was appointed in 2015.

The HSE acknowledges that significant challenges remain at Portlaoise Hospital, in relation to general acute services, particularly in the Emergency Department and Critical Care.  Despite investment a key challenge is the recruitment and retention of clinical staff.

In order to address the immediate risk issues identified through the HIQA and other review processes, a number of actions have been taken : 

  • Trauma bypass protocol which means that orthopaedic trauma is directed to other appropriate hospitals 
  • The development of a Medical Assessment Unit which is expected to open next year and
      • The appointment of additional consultants including in Emergency and General Medicine.  In order to strengthen clinical supervision in the ED  the hospital  is proceeding with recruiting an additional emergency medicine consultant to extend  out of hours supervision
      • Strengthening of risk management and quality structures at the hospital to ensure early identification of and active management and intervention in risk issues
  • Cessation of Complex Surgery at the hospital with effect from August 2015 because of the small numbers of cases being undertaken.  The Dublin Midlands Hospital Group is committed to ensuring that consultant surgeons refer directly to consultants in appropriate hospitals within the Group (St. James Hospital, Tallaght Hospital, and the Midlands Regional Hospital Tullamore).  It has confirmed this patient transfer policy is fully operational and is under continuous review to ensure consistent compliance with the protocols in terms of transferring patients to other hospitals. 

In compliance with HIQA’s May 2015 report, the Dublin Midlands Hospital Group, in collaboration with the Acute Hospitals Division of the HSE, National Clinical Programme leaders and the National Ambulance Service, has developed a draft Action Plan for hospital services in the midlands.  This Plan has now been submitted to the Department of Health for consideration.

In relation to maternity services significant progress has also been made at the national level.

 

·         The RSCI Hospital Group has a clinical network in place incorporating Drogheda, Cavan and the Rotunda Hospital.  Saolta Hospital Group already has a Women and Childrens Directorate and the clinical network will be developed as part of the Groups 5 year strategy.  The South South West Hospital Group has appointed a Clinical Lead for Obstetrics.

  • The National Bereavement Guidelines following Perinatal Death and Baby Loss were launched this year. These new standards clearly define the care parents and families can expect to receive following a pregnancy loss or perinatal death. The standards will be implemented and applied across the health service in all appropriate hospitals and settings.  
  •  Publication of monthly maternity safety statements by each unit providing information on key metrics relating to Maternity Services
  •  The Interim Programme Director has been appointed for the Women and Infants Programme and the Clinical Director post has been readvertised.

Other national initiatives completed or underway to date to address HIQA recommendations include the completion of the HSE Midwifery Planning Report, adoption of the maternity early warning and clinical handover systems, completion of an Annual Clinical Audit Plan and the development of a national complaints process.  Each Hospital has a complaints officer and each Hospital Group has a person responsible for complaints.  Plans are also progressing to publish Hospital Patient Safety Statements and to commence patient safety culture surveys.

 

 

 

Last updated on: 05 / 12 / 2016