Given the tragic nature of events in the maternity unit of Portlaoise hospital over many years, it came as no surprise that the word “accountability” appeared 212 times in a subsequent report.
That report on baby deaths at Portlaoise was hailed by Minister for Health Leo Varadkar as a “watershed” moment for maternity services in Ireland. The investigation by the Health Information and Quality Authority (Hiqa) could not be “just another report”, he warned.
Nearly a year on, there is no talk of accountability. The report made sweeping criticisms of the Health Service Executive and its staff for the repeated failures of care in the unit, and the failure to learn from those mistakes. Uniquely, it found fault not just with staff at the coalface – the doctors and nurses whose substandard care contributed to the tragic events – but also with managers up the line.
NHS team
For the first time, it seemed, the buck wasn’t going to stop at the bottom. Managers, whose job it is to manage effectively and safely, would be judged on their performance, and appropriate action taken. A team of senior ex-National Health Service executives was drafted in from the UK to review the Hiqa report and establish whether individual managers had a case to answer.
The investigators were given a time frame of 12 weeks, but almost nine months later, nothing has been heard of their work. Neither the Minister nor the Dublin Midlands Hospital Group, which runs Portlaoise hospital, can shed any light on progress. The HSE has parried questions from The Irish Times on the issue for weeks now.
Progress has been made in other areas. Extra staff have been appointed to the maternity unit, which is effectively being run from the Coombe hospital in Dublin. Reports into individual baby deaths have been published, and apologies issued to parents.
Reports awaited
Yet the issue of accountability sticks in the HSE throat. Two reports due from the UK investigators are still awaited. The first was into possible disciplinary action against the clinical staff responsible for the care of the women and babies – 83 families and their stories formed the basis of the Hiqa report.
Ultimately, some cases may wend their way to the professional regulators – the Medical Council for doctors and the Nursing and Midwifery Board of Ireland for midwives. This process moves slowly, and not always in public: over three years after the death of Savita Halappanavar, none of the staff who treated her has appeared before a public disciplinary hearing, and it is not certain any ever will. Something similar can be expected in relation to Portlaoise.
The second report, to establish whether any manager in the HSE has a case to answer for, is the real cause of the delay. This is no surprise, given the aversion within senior HSE circles to any suggestion of direct responsibility for what happened.
Let us not forget that HSE director general Tony O'Brien threatened to injunct Hiqa when he saw its draft report on Portlaoise and its criticisms of senior managers. After The Irish Times published the report, O'Brien claimed it vilified the HSE, was unfair to staff, lacked context and failed to substantiate findings.
The threat of legal proceedings was withdrawn – after all, the report had been leaked – but the hostility to its findings remains. The HSE may have gone abroad to find people to review the matter but it retained firm control of the process, including the setting of terms of reference. As little as possible has been said.
Meanwhile, the independent patient safety service promised by the Minister after the Portlaoise scandal will not be independent. Many women who suffered adverse events in Portlaoise and other maternity units are struggling to get an independent assessment of what happened. It hardly sounds like accountability.
