FURTHER IMPROVEMENTS ARE needed in the governance and management of gynaecology services at Letterkenny University Hospital to ensure the quality of the services and safety of women accessing those services, the health watchdog has said. 

The Health Information and Quality Authority (Hiqa) statement today comes following a review of the governance arrangements of the services at the hospital, Saolta University Health Care Group and national HSE level. 

Concerns about gynaecology services at Letterkenny University Hospital were first raised in 2018. 

This led to an external review being carried out, the Price report, which found “unsatisfactory” care in the treatment of women with endometrial cancer and that there was a common theme of delay. 

Hiqa carried out its review to see if all recommendations from the Price report were being implemented. 

The watchdog’s review found that the hospital failed to meet national HSE and Saolta Group guidance and timelines for the review, testing and diagnosis of some women referred with post-menopausal bleeding. 

It found that Saolta Group failed to identify cases where non-adherence to timelines had occurred. 

Hiqa said this was a significant concern and raised it with the hospital group. 

The review also found that the hospital continues to struggle to recruit and retain medical, nursing and midwifery, and administrative staff. Hiqa said this remains a risk to patient safety. 

Hiqa added that the transition to a new outpatient gynaecology service was welcome. However, it added the expected number of women that could be managed in this service at the hospital fell short of that estimated by national HSE. 

It found the outpatient gynaecology service at the hospital was not fully established and was working at only 50% of its potential capacity. 

“Despite the number of initiatives and measures introduced by Saolta Group since 2018, Hiqa was not assured that there was sufficient and effective governance and oversight arrangements in place to assure the quality and safety of gynaecology services, which posed a risk to women using the services,” Hiqa’s director of healthcare regulation Sean Egan said. 

“Strong and effective governance, leadership and management is needed at the hospital and hospital group to ensure and promote high-quality, safe and reliable services and establish and sustain a culture of patient safety,” Egan said. 

“While some measures introduced at the hospital had brought about improvements, such as a new ambulatory (outpatient) gynaecology services, revised procedures for the review and triage of referrals and a decline in waiting list numbers for women trying to access gynaecology services, these must be sustained in the long term so that women who use and depend on the service can be confident about its quality and safety,” he said. 

“If this is not achieved, the HSE should hold Saolta Group to account.”

Hiqa’s review took place between April and September of this year and involved an on-site inspection at the hospital, interviews with key personnel at the hospital, hospital group and national HSE level, a documentation review and a survey of women to establish their experiences and views of using the gynaecology services. 

Hospital response

In a statement this morning, Saolta Group welcomed the publication of Hiqa’s review. 

“It is essential that women accessing gynaecology services are assured that the service is safe and this remains the upmost priority for LUH and the Saolta Group,” it said.

The statement said that all the findings and recommendations of the Hiqa review will be reviewed and addressed by the Saolta Group over the coming weeks.

“The hospital and Saolta Group acknowledge that further implementation of the recommendations remain,” it said. 

The statement noted that the Saolta Group has been progressing implementation of the Price report recommendations through an implementation group convened in September 2020, adding that “significant progress has been made”. 

It said this group will remain in place and will continue to oversee implementation of the recommendations and service implements. 

“Both LUH and the Saolta Group will continue the ongoing work to address all areas identified for improvement. The safety and welfare of our patients remains central to all that we do,” the statement said. 

“We particularly acknowledge the ongoing efforts of staff to implement the wide range of recommendations throughout the Covid-19 pandemic and significant demands placed on all hospital services as a result.”