The Health Information and Quality Authority has said that 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 HIQA statement follows a review of governance arrangements at the hospital, the Saolta University Healthcare Group and national Health Service Executive level.

The watchdog undertook the review in a follow-up to an independent review of services at LUH, which had found "unsatisfactory" care in the treatment of women with endometrial cancer, finding that there was a common theme of delay.

The Price report examined the cases of eight women reported to have experienced a delayed diagnosis of endometrial cancer, including those of the two women who had subsequently died.

It found that there was significant scope for improving the governance and management of gynaecology services both at the hospital and more widely at Saolta Group level.

The HIQA review was carried out into see if recommendations made in the Price Report had been carried out.

Among the recommendations made were that the hospital should review its referral and triage system for gynaecology patients and build its capacity and capability for inpatient, day case and planned procedures and review how the hospital manages waiting lists.

The HIQA review found that some measures introduced at the hospital had brought about improvements, such as a new outpatient gynaecology service, a reduction in waiting lists for women accessing gynaecology services, which it said was commendable; and revised procedures for the review and triage of referrals.

But the review said these must be sustained in the long term so women can be confident about its quality and safety.

The authority noted that prior to, and over the course of its review, the health service was working to manage and deal with the unprecedented impact of the Covid-19 global pandemic and that LUH was one of the most
affected hospitals impacted by the virus.

"This inevitably had an impact on the progress of implementation of the Price report's recommendations."

HIQA said the hospital had received significant resources, including funding and staffing to improve the gynaecology service, but weaknesses in governance structures and processes at the hospital, and oversight quality assurance mechanisms at the Saolta University Healthcare Group remain.

However, it noted that the Saolta University Healthcare Group had committed "to implementing corrective actions to address the weaknesses in the governance and quality assurance mechanisms" and "the recent implementation of these actions should provide additional confidence for women using the gynaecology services at Letterkenny University Hospital that the governance and management issues HIQA identified are being actively addressed".

Essential women know services are safe - SUHG

The Saolta University Health Care Group has welcomed the publication of the HIQA review and its finding that "some important changes and initiatives had been introduced to improve efficiencies and the quality, safety and reliability of gynaecology services at the hospital."

In a statement, it said 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."

The Group said the HIQA report noted the marked reduction in the waiting list in LUH for general gynaecology services," especially when compared with national waiting lists since mid-2020".

It said that additional resourcing has enabled the scheduling of additional general gynaecology clinics which assisted in the reduction of the waiting lists.

"Over 65 additional clinics have been implemented since last autumn which has reduced the waiting list from 1600 this time last year, to 569. This reduction has been achieved despite the constraints placed upon the hospital due to COVID-19 and the cyber attack. Three additional clinics are scheduled per fortnight to further address the waiting list."

The Saolta Group said it has been progressing implementation of the Price report recommendations and both LUH and the Saolta Group will continue the ongoing work to address all areas identified for improvement, with the Managed Clinical and Academic Network (MCAN) while also managing high levels of Covid-19 in Donegal.

This work continues and both LUH and the Saolta group are focused on implementing the outstanding recommendations.

IPA has concerns over some aspects of review findings

The Irish Patients' Association has welcomed the HIQA report but said its concerned about its comment that "…... If sustainable improvements in the governance structures and processes at hospital level and quality assurance mechanisms at Saolta Group level are not achieved with this further external independent intervention, then the Saolta Group need to be held to account by the HSE"

In a statement, the IPA asked: "How many reports are needed to resolve these issues? While the HIQA report clearly calls for accountability if progress is lacking, the HSE itself should review its own processes so that the HSE may need to be held to account".

In a national context, the IPA said that "the Price report stated that we need assurances that what happened to women in Letterkenny Hospital was not an outlier nationally".

At a meeting with Minister for Health Stephen Donnelly last November, the IPA said it informed him that the HSE has conducted a review of the application of guidelines for assessing women with Post-Menopausal Bleeding and the situation of waiting lists nationally and it now asks the minister " if your department received this will you be publishing this report?"

Stephen McMahon of the IPA said that in the HIQA review, " we learn that that report is still not complete" and he said that the HSE should "issue an interim report to assure the Women of Ireland that their Maternity and Gynaecological services are safe and work to best practices."