X-Rays in Tallaght hospital
- Thread starter Sunny
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I have to say it is staggering. There was complete systematic failure and for that, the Minister has to take responsiblity. It wasn't a simple case of x-rays not being read. There was a cover up and an inadequate repsonse by the body who report directly into her. Sorry Mary Harney but its time to go.
From HIQA's own website:
We are an independent Authority, with broad ranging functions and powers reporting to the Minister for Health.
We have been set up to drive quality, safety, accountability and the best use of resources in our health and social care services, whether delivered by public, voluntary or private bodies.
We will set the standards for delivering health and social care services and we will continuously inspect to ensure that these standards are being met.
We will take action if there's a risk to the safety of any person using our health services.
This is obviously not the case. They wrote letters asking for reports. Thats not taking action.
As for the former CEO of the hospital, there should be a criminal investigation. Supposed he retired on a pension of tens of thousands of euro and could not care less.
[broken link removed]
I have to say it is staggering. There was complete systematic failure and for that, the Minister has to take responsiblity. It wasn't a simple case of x-rays not being read. There was a cover up and an inadequate repsonse by the body who report directly into her. Sorry Mary Harney but its time to go.
From HIQA's own website:
We are an independent Authority, with broad ranging functions and powers reporting to the Minister for Health.
We have been set up to drive quality, safety, accountability and the best use of resources in our health and social care services, whether delivered by public, voluntary or private bodies.
We will set the standards for delivering health and social care services and we will continuously inspect to ensure that these standards are being met.
We will take action if there's a risk to the safety of any person using our health services.
This is obviously not the case. They wrote letters asking for reports. Thats not taking action.
As for the former CEO of the hospital, there should be a criminal investigation. Supposed he retired on a pension of tens of thousands of euro and could not care less.
The FDA (Food and Drug Administration) in the USA has the power to execute search warrants, make arrests, carry firearms and gather evidence, just like any other federal law enforcement agency.
People have been known to vomit because of worry during FDA audits; they know that they could not just lose their job but lose their liberty as well.
The HIQA has the power to write strongly worded letters.
This is yet another example of the states utter inability to regulate anything.
Not correct, there are 470 people employed in the Dept of Health and this will fall further in line McCarthy report recommendations.
Correct me if I'm wrong, but doesn't a doctor request an Xray for a patient? Surely the doctor in question is ultimately the person responsible for the patient's care and should be the one following up to ensure that the Xrays were read?
From the HIQA website, under “National Standards for the prevention and control of Healthcare Associated Infections”;
"Planning implementation
All facilities should identify a named person responsible and accountable for leading the implementation of these standards. This person should be the chief executive/general manager/lead clinician and where relevant this person should report progress to the board or management committee of the facility/service on a regular basis."
Then, under “Monitoring” we get;
"There are a number of international and national audit/assessment tools(11;20;21) available that can be adapted by all health and social care services to support the process of evaluating their compliance against the National Standards. The Authority will expect to see effective internal monitoring and reporting systems for the key aspects of the National Standards proportionate to the scale and complexity of the services. This does not mean measuring everything all the time, but rather developing a portfolio of qualitative and quantitative measures to provide adequate assurance of compliance for the board, governing body or responsible clinician for the service.
Given these standards are intended to set a direction of improvement in quality and safety for patients, an important aspect of monitoring will be assessing progress against planned implementation milestones.
From publication of the National Standards, there will be a six-month adjustment period to allow all services to consider the local implications of the National Standards and develop implementation plans. During this period, the Authority will engage with the HSE and other stakeholders to discuss the nature and scope of internal monitoring processes.
Following this period, the Authority will undertake a baseline assessment exercise that will focus on the findings of the internal gap analysis, the development of plans and how priority safety areas have been addressed. This exercise will be predominantly a self-assessment process. The self-assessments will be followed up in more detail in 2010. The detailed nature of the follow-up process will be communicated to services well in advance of any visits programme. However, unannounced visits will be part of the Authority’s approach."
So there’s lots of aspiration but despite the title, there is no standard in place.
Where’s the hospitals quality manual?
Where are the procedures derived from the quality manual?
Where are their internal audits?
What outside party audits them?
All of the above have been in place in small manufacturing businesses supplying medical device manufacturers since the late 1980’s. Why is it that Irish Hospitals don’t seem to have them?
An organisations quality manual should be a public document. Many companies have them available to download from their website. We give outs to our customers, our customers give their to us. It helps a customer to understand what procedures their supplier has in place and what to look for during a quality audit. It also helps a supplier understand what their customers’ expectations are.
Where can I download Tallaght Hospital’s Quality Manual?
"Planning implementation
All facilities should identify a named person responsible and accountable for leading the implementation of these standards. This person should be the chief executive/general manager/lead clinician and where relevant this person should report progress to the board or management committee of the facility/service on a regular basis."
Then, under “Monitoring” we get;
"There are a number of international and national audit/assessment tools(11;20;21) available that can be adapted by all health and social care services to support the process of evaluating their compliance against the National Standards. The Authority will expect to see effective internal monitoring and reporting systems for the key aspects of the National Standards proportionate to the scale and complexity of the services. This does not mean measuring everything all the time, but rather developing a portfolio of qualitative and quantitative measures to provide adequate assurance of compliance for the board, governing body or responsible clinician for the service.
Given these standards are intended to set a direction of improvement in quality and safety for patients, an important aspect of monitoring will be assessing progress against planned implementation milestones.
From publication of the National Standards, there will be a six-month adjustment period to allow all services to consider the local implications of the National Standards and develop implementation plans. During this period, the Authority will engage with the HSE and other stakeholders to discuss the nature and scope of internal monitoring processes.
Following this period, the Authority will undertake a baseline assessment exercise that will focus on the findings of the internal gap analysis, the development of plans and how priority safety areas have been addressed. This exercise will be predominantly a self-assessment process. The self-assessments will be followed up in more detail in 2010. The detailed nature of the follow-up process will be communicated to services well in advance of any visits programme. However, unannounced visits will be part of the Authority’s approach."
So there’s lots of aspiration but despite the title, there is no standard in place.
Where’s the hospitals quality manual?
Where are the procedures derived from the quality manual?
Where are their internal audits?
What outside party audits them?
All of the above have been in place in small manufacturing businesses supplying medical device manufacturers since the late 1980’s. Why is it that Irish Hospitals don’t seem to have them?
An organisations quality manual should be a public document. Many companies have them available to download from their website. We give outs to our customers, our customers give their to us. It helps a customer to understand what procedures their supplier has in place and what to look for during a quality audit. It also helps a supplier understand what their customers’ expectations are.
Where can I download Tallaght Hospital’s Quality Manual?
If a cardiologist requests x-rays it is on the understanding that they will be viewed by one of the well paid and under-worked Radiologists in the hospital in question. The same applies of a GP sends a patient to a cardiologist; they expects the cardiologist to make a diagnosis based on the results of the tests they carry out rather than just sending the test results to the Go for them to look at. That’s why there are specialties, so that people can become experts in particular areas. Reading x-rays is a specialist area.
I agree, but from the patient's perspective, they deal with their doctor - surely it is the doctor's responsibility to ensure that the X rays are performed, read so he can provide the results to the patient?
Good question, I don't know the answer but GP's don't have any special access to hospital management.
From todays [broken link removed] (In relation to GP letters);
"Following a review, it is understood it was found an incoming letter from a GP had to pass through more than 20 separate stages before the hospital sent an appointment to the patient who had been referred. The hospital has now streamlined the process to three steps."
Purple, what is your problem with the public service and those who really provide it (the front line public servants)?
Tallaght Hospital should have 18 Radiologists for the volume of work it deals with. It has in reality 7 full time Radiologists dealing with more than 200,000 examinations per year. The recommended number of examinations for the staff they have is 11,000.
Radiologists are claiming that they sent 40 letters to management highlighting the problems but nothing was done.
So Purple, please give it a rest bashing the front line public servants
Thank you.
Most public servants do an good job, many do an excellent job (there are far more good than bad). I do have a problem with very highly paid public servants who obstruct reform, work short hours and, while being accountable to management, that management has no real sanction if they are unhappy with the quality of service their employee is providing.
If consultants were really concerned about lack of numbers then they wouldn’t look to get paid so much as they know that the more they get paid the fewer of them the state can afford to employ.
That said the real problem is a structural one where boards of hospitals are cumbersome and there is no clear lines of responsibility. I go back to my earlier point about oversight and auditing; where’s the independent regulatory body, where are the international best practice standards based processes for them to audit against and where are the sanctions (i.e. suspension, arrest and prosecution) that they can take against those found to be in breach of those standards?
By the way, most consultants make most of their money from private work.
I think that private GPs have been the ones banging the drums here trying to get x-rays seen. The doctor is A&E is probably less likely to bang the same drum as he is probably in closer contact to the consltant and also works for the same employer. This is just my hunch though
I totally agree with you on both points
Oversight agencies were created with certain functions and powers (the majority of them by our good friends in Government at the moment) but unless they are given the powers they need to fully carry out their functions they really are only as good as newspapers reporting on the story.
I did an essay only last week on the Garda Ombudsman who invesitgated an allegation of serious breach of discipline by a senior Garda in relation to the Rossport protests and made recommendations that disciplinary action be taken but the Gardai threw it out stating that it found “no breach of discipline”
So really what was the point of the investigation by the Garda Ombudsman, only to highlight the problem?
If the gov had the balls they would appoint an audit committee from somewhere like France which has a good health care system to conduct quick, narrow audits of key HSE key functions and publish these findings publicly. HSE audits are close to worthless imo as they are self-protecting.
My wife went for an x-ray a couple of weeks back down the country, she was given her referal letter by her GP, went over to the local health centre the next day and had her xray there and got a txt from her doctor a few days later telling her it was all clear. She was a public patient so there are parts of the country where the health service seems to be working in a far more efficient manner then Tallaght
There are a whole pile of issues around Tallaght. It was reported in the news last night for example that Tallaght was handling twice as many private patients as the recommnded norm. As for the board, you can't run anything with a board of 22 people, that becomes more about crowd control then achieving anything. It was also reported on the news that the HSE have an option to have a director on the hospital board, but never took it up
There are a whole pile of issues around Tallaght. It was reported in the news last night for example that Tallaght was handling twice as many private patients as the recommnded norm. As for the board, you can't run anything with a board of 22 people, that becomes more about crowd control then achieving anything. It was also reported on the news that the HSE have an option to have a director on the hospital board, but never took it up
An auditor can only audit based on the procedures that are in place. Their function is to make sure that an organisation is doing what it says it does.
What procedures are in place?
What system are those procedures based on?
What internationally recognised standards are the systems derived from?
Where are the procedures?
Where is the management structure flow-chart that assigns responsibility?
Who is the quality manager?
Where are the internal audit records?
Do the internal audit records assign responsibility for each process (note the person being audited)?
What sanctions are in place which can be imposed on those who fail audits?
Is there a clear one-step line of command between the person who fails the audit and the person who can sanction them?
What sanctions can be taken by the auditor against a manager who fails to take corrective actions resulting from non-conformances issued during internal or external audits?
Every small company in Ireland that is ISO9001:2008 compliant can answer all of the above.
Is it too much to ask that a multi-billion euro organisation should do the same?
