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26/10/2021

Health watchdog finds need for further improvements in gynaecology services at Letterkenny University Hospital

Hiqa not assured sufficient and effective governance and oversight arrangements in place

Forty-five patients reported awaiting beds at Letterkenny University Hospital

Concerns about gynaecology services at the hospital were raised with Hiqa in 2018 following a delayed diagnosis of endometrial cancer

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, the States’s health watchdog has said.

The Health Information and Quality Authority (Hiqa) has published the report of a review of the governance arrangements of gynaecology services at the hospital, which is run by the Saolta group.

Concerns about gynaecology services at the hospital were raised with Hiqa in 2018 following a delayed diagnosis of endometrial cancer. Two women with delayed diagnosis subsequently passed away with endometrial cancer.

The delayed diagnoses led to an external review by Dr John Price that found 38 women waited longer than 100 days for their diagnosis or treatment.

Hiqa carried out a review to ensure all recommendations from the Price report were being implemented. 

It found that while the hospital received significant funding and staffing resources to make improvements to gynaecology services, weaknesses in governance structures and processes at the hospital and of oversight quality assurance mechanisms at Saolta Group levels remain.

Hiqa’s director of healthcare regulation, Sean Egan, said that despite the number of initiatives and measures introduced since 2018, “HIQA was not assured that there were 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”. 

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

“While some measures introduced at the hospital had brought about improvements, such as a new ambulatory (outpatient) gynaecology service, revised procedures for the review and triage of referrals and a decline in waiting lists 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. If this is not achieved, the HSE should hold Saolta Group to account.”

The review also 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 and the Saolta group failed to identify cases where non-adherence to timelines had occurred. 

The hospital continues to struggle to recruit and retain medical, nursing and midwifery, and administrative staff which the review says remains a risk to patient safety.

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

Saolta said it acknowledged that further implementation of the recommendations remain. In a statement on Thursday, it welcomed the publication of the report.

It said significant progress has been made in the implementation of the Price Report recommendations through an implementation group set up in September 2020.

“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. All the findings and recommendations of the HIQA Targeted Assurance review will be reviewed and addressed by the Saolta group over the coming weeks,” it said.

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