There will be broad welcome for a package of patient safety initiatives announced by Minister for Health Leo Varadkar yesterday. Although some of the proposals had been highlighted previously, the renewed focus on this important aspect of healthcare is timely, as the echoes of the Halappanavar and Portlaoise cases continue to dent confidence in our public health system.
The creation of a National Advisory Council for Patient Safety to provide advice on patient-safety issues and publish reports prompted by specific safety information is a modification on a previous undertaking to establish a Patient Safety Agency. Instead the new advisory council will oversee the work of a separate National Patient Safety Office to be established within the Department of Health. While the development is an improvement on previous proposals to set up a patient safety body within the Health Service Executive, putting in place a statutory body similar to the Health Information and Quality Authority (Hiqa) would have copper fastened its independence.
The creation of a national patient advocacy service was the first recommendation in last year’s report by Hiqa into baby deaths in Portlaoise hospital’s maternity unit. Parents reported how their experiences were not consistently listened to or learned from. The Minister’s commitment to set up an independent advocacy service for patients must not be delayed by bureaucracy.
It is estimated that about 10 per cent of hospital admissions are associated with an adverse outcome for patients; about half of these are preventable. A significant percentage are attributable to medication errors, an area that will be the subject of a future patient safety campaign.
On the legislative front, the Health Information & Patient Safety Bill will make it mandatory to report events which result in death or serious harm; it will also extend Hiqa’s remit on setting standards and carrying out investigations to private hospitals and high risk activities in cosmetic surgery clinics. However not formalising the licensing of private hospitals and clinics in this Bill is a missed opportunity.
An open disclosure project has been initiated in the health service: it includes expressing regret for what has happened, keeping the patient informed, and providing feedback on investigations and the steps taken to prevent a recurrence of the adverse event. The announcement of legislative support to underpin open disclosure is welcome. But there is no mention of duty of candour legislation which would underpin the duty of professionals to maintain a relationship of trust with patients by placing their needs above the reputation of any organisation.
Patient safety is linked to resource provision. A commitment to reassess bed capacity in the context of patient safety would further enhance the suite of measures announced by the Minister.