Lack of information means HIQA can't assure safety of maternity services

“Young patients don’t just die,” said Nuala Lucas of HIQA yesterday as she spoke of deficiencies in staffing, knowledge, guidelines and protocol.

IRELAND’S HEALTHCARE WATCHDOG has said it cannot stand over the absolute safety and quality of maternity care because of a lack of information.

HIQA says it gathers statistics but that problems arise when dealing with maternal morbidity and sickness rates.

“We are saying that with the lack of information, it is very hard to absolutely give assurance on the quality and safety of services,” said Phelim Quinn, director of regulation.

“That is a key deficit in the system.”

He was speaking at the launch of a report into the death of Savita Halappanavar at University Hospital Galway last October.

“No doctor, nurse or healthcare worker will stand by and let their patient die,” Dr Nuala Lucas, a consulstant anesthetist, said when asked to comment on Praveen Halappanavar’s remarks that his wife was ‘left to die’ in her hospital bed.

“But if you don’t have the correct knowledge, guidelines and protocols in place…then things like this are going to happen,” she continued.

The authority’s chief executive Dr Tracey Cooper also noted that the 31-year-old dentist was treated on a “very busy” gynaecology ward even though she was a deteriorating obstetric patient.

The reality is that the staff…were not equipped around the knowledge of sepsis.

University Hospital Galway was one of 14 hospitals to not report full implementation of the recommendations of a 2007 report into the ‘strikingly similar’ case of Tania and Zach McCabe in Our Lady of Lourdes Hospital, Drogheda.

Although the hospital does have guidelines in place for the management of sepsis, they were not in use on St Monica’s Ward where Savita was treated.

The HIQA team behind the report believe that the outcome for the Galway resident could have been different.

“Young patients don’t just die,” said Dr Lucas. “They generally become ill and start down a slippery slope. You have opportunities to reverse that…that is what early-warning scores are all about. It is about picking up a patient before they become critical.”

One of the 32 recommendations to the HSE from the watchdog advises the hospital group to consider making appropriate referrals to the relevant professional regulatory bodies about the actions, omissions and practices of the medical staff involved in the care of Savita Halappanavar.

Quinn explained that HIQA wants an “open and just” system of care and part of that would be referrals when there are significant failures.

He noted that the referrals may have already taken place following the HSE investigation and inquest but that his body had also forwarded a copy of their recommendations to highlight concerns.

It is up to each individual body then, he said, to examine and assess if those concerns and actions meet the threshold to alter fitness to practice.

Lucas also outlined her worries about inadequate staffing levels in hospitals, noting that there was a wider picture than just one-on-one care.

Having a sufficient number of consultants will improve a hospital’s services as a whole, including clinical care, education, training, nurse management and local guidelines, she said.

The HSE has been called on to review its workforce arrangements for maternity services nationally to ensure there are adequate numbers of staff with the right mix of skills, deployed effectively both during core and on-call hours.

Speaking after the publication of the report and recommendations last night, Health Minister James Reilly said that patients safety must be paramount and confirmed that the issue will be given attention in the next HSE service plan.

“This tragedy should not have happened,” he said. “The untimely death of Savita Halappanavar on 28th October last year was a shocking wake-up call to the whole healthcare system about how failures in patients’ care can sometimes have extreme consequences.”

He has outlined a five-point priority plan which includes moving towards a culture of patient safety, creating a code of conduct for employers, monitoring the progress of the 34 recommendations, developing a strategic plan for maternity services and mandating clinical guidelines for sepsis and clinical handover.

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