A ‘deeply concerning’ report on gynaecology services at Letterkenny University Hospital has found that continued staffing issues pose a risk to patient safety.
The Health Information and Quality Authority has said that further improvements are needed in the governance and management of services at LUH to ensure the quality of the services and safety of women accessing those services.
A review was carried out of governance arrangements at the hospital in a follow-up to an external review of services at LUH, commissioned in 2019. The review found “unsatisfactory” care in the treatment of women with endometrial cancer. In six cases over a nine-year period where women suffered suspected or delayed diagnosis of endometrial cancer, it was found that there was a common theme of delay.
A Targeted Assurance Review by HIQA, published yesterday, found that while LUH received significant resources – funding and staffing – to make improvements to gynaecology services, weaknesses in governance structures and processes at the hospital and of oversight quality assurance mechanisms at Saolta Group levels remain.
HIQA’s review found that the hospital continues to struggle to recruit and retain medical, nursing and midwifery, and administrative staff which remains a risk to patient safety.
HIQA’s Director of Healthcare Regulation, Sean Egan, said: “Despite the number of initiatives and measures introduced by Saolta Group since 2018, HIQA was not assured that there were sufficient and effective governance and oversight arrangements in place to assure the quality and safety of gynaecology services, which posed a risk to women using the services. Strong and effective governance, leadership and management is needed at the hospital and hospital group to ensure and promote high-quality, safe and reliable services and establish and sustain a culture of patient safety.”
The review found that a new ambulatory (outpatient) gynaecology service at the hospital was not fully established and was working at only 50% of its potential capacity.
Mr Egan continued: “While some measures introduced at the hospital had brought about improvements, such as a new ambulatory (outpatient) gynaecology service, revised procedures for the review and triage of referrals and a decline in waiting lists numbers for women trying to access gynaecology services, these must be sustained in the long term so that women who use and depend on the service can be confident about its quality and safety. If this is not achieved, the HSE should hold Saolta Group to account.”
Sinn Fein TD Padraig Mac Lochlainn has said this week’s report was “deeply concerning for the women of Donegal at three different levels”.
Deputy MacLochlainn has called on the Tánaiste to intervene with the Minister for Health on the issues of governance, recruitment and outpatient services at LUH.
Management at LUH and Saolta group have welcomed the report and acknowledged that further implementation of the recommendations remain.
“It is essential that women accessing gynaecology services are assured that the service is safe and this remains the upmost priority for LUH and the Saolta Group. All the findings and recommendations of the HIQA Targeted Assurance review will be reviewed and addressed by the Saolta Group over the coming weeks,” said a statement from Saolta.
“The Saolta Group has been progressing implementation of the Price Report recommendations through an Implementation Group convened in September 2020 and significant progress has been made. This Group will remain in place and will continue to oversee implementation of the recommendations and service improvements to ensure all are fully implemented and to assure sustainability of the improvements.
“A Special Measures Team, comprising an external Consultant Obstetrician / Gynaecologist and Senior Manager from the Saolta Group were put in place to support and oversee the implementation plan to address the recommendations in the Price report. This ensured that clear pathways and processes were in place in LUH to ensure that all women presenting with possible endometrial cancer were seen, investigated and managed in a timely way to ensure the best outcome for them.
“An action plan following the withdrawal of the special measures team remains live and continues to drive activity on site to implement recommendations.
“Both LUH and the Saolta Group will continue the ongoing work to address all areas identified for improvement. The safety and welfare of our patients remains central to all that we do.
“We particularly acknowledge the ongoing efforts of staff to implement the wide range of recommendations throughout the Covid-19 pandemic and significant demands placed on all hospital services as a result.
“A significant number of recommendations included in the Price Report have been implemented within the past nine months despite the challenges of Covid and the cyber-attack. Changes were required across all aspects of the gynaecology service and this required significant leadership and work from all in LUH in collaboration with the Managed Clinical and Academic Network (MCAN) whilst also managing high levels of Covid in Donegal. This work continues and both LUH and the Saolta group are focused on implementing the outstanding recommendations.”