Portiuncula review: How can the same issues occur at the same hospital again?
Portiuncula hospital
– particularly around governance, communication, the presence of consultants and training and reliance on locum consultants.
Seven years later, the public would be forgiven for wondering if this is Groundhog Day, as another review at the Ballinasloe hospital highlights strikingly familiar concerns.
'Unfortunately, although changes were made following the 2018 review, many of the same scenarios have been identified by this 2024 review process,' a review summary noted.
On Wednesday, the Health Service Executive published a summary report of five external reviews into the care provided to women and their babies at the Ballinasloe hospital.
READ MORE
The reviews were commissioned after five cases of
neonatal encephalopathy
(NE) requiring therapeutic hypothermia (known as neonatal cooling) were identified in a close time period. NE is an impairment of neurological function.
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Maternity services across Ireland should be reviewed, expert group urges following Portiuncula report
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Adding to this, a further five reviews are under way, while two more reviews are due to begin imminently.
In the summary, the review team laid out four common themes of concern: communication, governance, clinical care, leadership and clinical governance and infrastructure.
For anyone who consistently follows health news, the terms will be familiar. Time and time again, they are touted as the reason why things go wrong in our health service.
But how can the same issues occur at the same hospital again? Steps were taken to improve things. One of the recommendations in the 2018 report was to improve clinical governance. Consequently, the responsibility for maternity services was given to a new clinical director from the hospital group.
Wednesday's report notes, however, that while this might have seemed a 'positive move', the position has no executive oversight, no regulatory or budgetary control and their role is 'purely oversight and advisory'.
'There have been a number of changes in recent years to the governance structures of HSE hospitals from health boards to hospital groups to regional groups,' the report said.
'The further the distance between the key decision makers and the clinical coalface, the more likely it is that decisions will be significantly delayed and based more on financial merit than clinical need.'
As such, the review team has recommended that clinicians take up leadership roles, and reliance on locum consultants is reduced.
The review team also noted the two communication systems in place, which they said should be simplified to make it more efficient and to reduce the 'clinical risks'.
Furthermore, the report said there were situations in which staff were unable to contact the consultant on call due to mobile phone coverage problems.
'This is not a safe or satisfactory arrangement and needs to be resolved as a matter of urgency,' the report added.
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What is HIE? The condition affecting newborns has led to reviews in Portiuncula hospital
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The hospital's maternity unit is small, delivering 1,400 babies annually. Consequently, the review team cited difficulty in its ability to provide the 'full range' of maternity and newborn services and to attract permanent staff members.
'It is operationally challenging and there are significant clinical risks in providing maternity services in this way,' it said.
In conclusion, it found 'the current situation does not meet the expectations of parents, increases clinical risk, and is no longer sustainable'.
That statement is stark, but the more alarming finding is the review team stating the issues arising in the report are ones that 'could plausibly arise in other similar sized maternity units'.
As such, the team 'strongly recommends' that there is an opportunity to review the way maternity services are delivered across the State.
Such a finding will do little to reassure expectant parents of the safety of the maternity system. If anything, it will leave them with more questions than they had before.
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Irish Times
4 hours ago
- Irish Times
How eating disorders are changing: ‘I'm not the stereotype. I'm a man, I'm plus-sized'
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These challenges, he says, all came from the same place: a desire to be able to exert control. He is now five years sober. 'When I got sober, it was like I was in a house that was on fire. Sobriety put the fire out, but now I'm standing in rubble and I have to build the house again,' he was when he seriously sought help for his eating disorder. 'In April 2020 I got sober for the last time. A year after that, in 2021, I had a year of sobriety under my belt. My 30s were knocking on my door and I thought, I cannot live like this forever and the only person who can change this was me.' One difficulty he found when seeking help, he says, was the questioning attitude and scepticism he faced by some healthcare professionals because he doesn't fit the common eating-disorder stereotype: a young woman or teenager with anorexia. 'I am the opposite of the stereotype in that I'm a man, I'm plus-sized, I wasn't restricting food,' he adds. 'There is all this messaging around fatness or plus-sized people that if you're fat it's a moral failing or you're lazy or you don't care about how you look. But that's just not true.' William Dwyer Joyce: 'I am the opposite of the stereotype.' Photograph: Dara Mac Dónaill This stereotype is beginning to change, according to Laura Casey, director of services at Lois Bridges, an eating disorder treatment centre in Sutton, north Co Dublin. The number of young men seeking help at the centre has increased in recent years, she notes. Casey attributes this rise to the increasing gym culture seen online – in which men are constantly fed images of bodybuilders with very little body fat – combined with the masculine tendency of men to keep their feelings to themselves. 'But when they do go and reach out, they're not heard the same. Their voices can be dismissed a bit easier,' she says. 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When it comes to certain foods, some people with this diagnosiscan have a panic attack or feel like they're choking. 'They can only eat yoghurts and drinks,' she adds. Awareness of eating disorders has increased since the Covid-19 pandemic, when there was a rise in the number of referrals for treatment to HSE eating-disorder teams, who provide specialist treatment. HSE data shows there were 894 referrals to such teams last year, a 33 per cent increase on 2023. There was also a 24 per cent rise in accepted referrals, where patients proceed to treatment after an initial consultation. A total of 562 patients were assessed last year, of which 90 per cent were female and 59 per cent were children under the age of 18. One-third were teenagers aged between 15 and 17. Still, the service also saw the number of adults accessing treatment increase by 51 per cent. 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What did I do to deserve this?' Trying to find somewhere to go is something many patients experience. Alicia Woods, clinical nurse specialist at Lois Bridges, says the centre is a private facility, but they receive 'phone calls everyday of the week from people who don't have private health insurance'. 'We treat a range of eating disorders. And in terms of age, we've treated from 18 up to people in their early 70s,' she says. 'The majority of older people with eating disorders have had it their whole life but they just haven't had the information, education or support to seek help. Some people do develop it later in life.' Though Woods says the reasons why individuals develop eating disorders are complex and nuanced, she believes social media is playing a role. 'Body positivity was such a thing, but now we've gone back almost 20 years. 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She says: 'It doesn't just take one go. People often feel guilty when they have to go back. But it's such a complex illness.' The Tallaght woman is four years in 'proper recovery', but she says for her that doesn't mean the eating disorder is 'completely gone', but just now she has the 'resilience' to acknowledge and challenge those urges when they arise. She writes poetry to help her cope. She looks at inspirational quotes hung up on her wall. 'Sometimes I wish I could wake up, go about the day, not having all of these overwhelming feelings – the eating disorder and mental health [difficulties]. But it doesn't work that way. It can be frustrating. But it's about findings ways to deal with it.' Bodywhys (The Eating Disorders Association of Ireland) – – (01) 210 7906 – alex@
The Journal
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Irish Times
14 hours ago
- Irish Times
Boy who suffered catastrophic injuries after fall at park settles case with €3.3m interim payment
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