Report finds improvements to LUH gynaecology services needed

A report into gynaecology services at Letterkenny University Hospital has found that further governance and management improvements are needed to safeguard women.

Following a series of concerns about the quality and safety of gynaecology services at the hospital, HIQA undertook a review of the governance arrangements of the services at the hospital, Saolta University Health Care Group and national HSE level.

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

The hospital also 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.

Furthermore, Saolta failed to identify cases where non-adherence to timelines occurred.

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

The transition to a new outpatient gynaecology service has been welcomed; however, it was found to not be fully established and working at 50% of its potential capacity.

HIQA's Director of Healthcare Regulation, Sean Egan, has warned that the HSE should hold Saolta to account if the measures introduced to improve the service, are not sustained.

The full report can be accessed here

In response, the Saolta University Healthcare Group has acknowledged that further implementation of the recommendations are needed.

In a statement, the hospital group says along with Letterkenny University Hospital, it will continue the ongoing work to address all areas identified for improvement and that the safety and welfare of patients remains central to all they do.

Statement from Saolta University Healthcare Group in full:

Saolta University Health Care Group has welcomed the publication by the Health Information Quality Authority (HIQA) of its Targeted Assurance Review relating to the gynaecology services in Letterkenny University Hospital.

The targeted assurance review of governance arrangements for gynaecology services at Letterkenny University Hospital was conducted over a six-month period from April to September 2021.

It was carried out further to an external review of Gynaecology Services in LUH which was commissioned by the Chief Clinical Director in the Saolta Group in November 2019.

This review, undertaken by Dr John Price, Consultant Gynaecologist, Belfast, Anne Kelly retired Director of Nursing and Midwifery and Gareth Cliffford, Quality and Patient Safety Office, HSE, was finalised in August 2020.

Following on from this the HIQA review sought to ensure all recommendations from the Price report are being implemented. The review included an on-site inspection of the service; interviews with key personnel at hospital, hospital group and national HSE level; and a review of documentation. The Saolta University Health Care Group and Letterkenny University Hospital co-operated fully with HIQA as they determined and confirmed the level of progress made in implementing recommendations of the independent 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. 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 Saolta University Health Care Group welcome the finding in the HIQA report that “some important changes and initiatives had been introduced to improve efficiencies and the quality, safety and reliability of gynaecology services at the hospital.”

It also welcomes that the 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.

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

The hospital and Saolta group acknowledge that further implementation of the recommendations remain.

The Saolta Group has been progressing implementation of the Price Report recommendations through an Implementation Group convened in September 2020 and significant progress has been made. This Group will remain in place and will continue to oversee implementation of the recommendations and service improvements to ensure all are fully implemented and to assure sustainability of the improvements.

A Special Measures Team, comprising an external Consultant Obstetrician / Gynaecologist and Senior Manager from the Saolta Group were put in place to support and oversee the implementation plan to address the recommendations in the Price report. This ensured that clear pathways and processes were in place in LUH to ensure that all women presenting with possible endometrial cancer were seen, investigated and managed in a timely way to ensure the best outcome for them.

An action plan following the withdrawal of the special measures team remains live and continues to drive activity on site to implement recommendations.

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. 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.

A significant number of recommendations included in the Price Report have been implemented within the past nine months despite the challenges of Covid and the cyber-attack. Changes were required across all aspects of the gynaecology service and this required significant leadership and work from all in LUH in collaboration with the Managed Clinical and Academic Network (MCAN) whilst also managing high levels of Covid in Donegal. This work continues and both LUH and the Saolta group are focused on implementing the outstanding recommendations.

A significant number of improvements to the Gynaecology Service at LUH have been implemented on foot of the Price Report. These include:

  • Increased Gynaecology Outpatient Clinics – 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.
  • Waiting time for urgent cases has decreased – the waiting list for urgent cases (time-critical or quality of life impacting) has continued to drop. The current inpatient list is down from 144 to 115; and the Day Case Waiting List has decreased from over 200 to 135 patients. Appointments are prioritised based on clinical urgency and length of wait.
  • Access to Surgery – a dedicated maternity theatre opened on a phased basis on 17 December and since 06 April it is fully operational Monday to Friday. Two new full time consultant anaesthetists and one part time role have been appointed along with nursing and support staff.
  • Additional Gynaecology Inpatient Operating Sessions have been introduced – historically there have been two lists per week; there are currently five lists. The process to recruit a consultant gynaecologist is underway.
  • LUH Ambulatory Gynaecology Service - Funding was received from National Women & Infants Health Programme for the development and implementation of an Ambulatory Gynaecology Service in LUH. This unit opened in late Q1 2021. To date the Ambulatory Gynae Service has seen and treated 379 women.
  • Gynaecology Outpatient Facilities - construction completed at Gate Lodge area of the hospital to extend the clinical space to facilitate the additional number of patients being seen.
  • Key Additional Staff – a candidate advanced nurse practitioner and business manager appointed; additional administrative, support and clinical staff for Ambulatory Gynaecology Clinic and theatres as referenced above.