Further improvements in the governance and management of gynaecology services at Letterkenny University Hospital are needed in order to safeguard women, the Health Information and Quality Authority (HIQA) has said.

It undertook a review of governance arrangements at the hospital after concerns were raised about the quality and safety of the gynaecology services available.

This followed an independent review of services at the hospital, which found that diagnoses of endometrial cancer were commonly delayed. This review, which was led by consultant gynaecologist, Dr John Price, looked at the cases of eight women who had reportedly experienced a delay in diagnosis.

That report found that major improvements needed to be made at the hospital. The HIQA review was carried out to determine if these improvements had been made.

According to HIQA’s director of healthcare regulation, Sean Egan, a number of women and families had raised concerns with HIQA about gynaecology services at the hospital “over the past few years”.

“Our priority in this review was to examine the effectiveness and sustainability of measures introduced to improve the quality and safety of gynaecology services for women and provide them with assurances about the service.

“We extend our deepest sympathies to the families of those who experienced a delay in diagnosis of endometrial cancer and those who died with the disease,” Mr Egan said.

HIQA found that while the hospital had received significant resources, funding and staffing 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”.

“Despite the number of initiatives and measures introduced by Saolta Group 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.

“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,” Mr Egan commented.

He said that while some measures introduced had brought about improvements at the hospital, such as a new ambulatory (outpatient) gynaecology service and revised procedures for the review and triage of referrals, “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,” Mr Egan insisted.

The 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.

Furthermore, Saolta Group failed to identify cases where non-adherence to timelines had occurred. This was of significant concern to HIQA and was raised with the hospital group.

The review also noted that the hospital continues to struggle to recruit and retain medical, nursing and midwifery staff, as well as administrative staff, and this poses a risk to patient safety.

Mr Egan noted that many of the challenges in staffing and waiting lists in Ireland’s gynaecology services identified over 15 years ago “continue to challenge service provision today”.

“To improve these services, the HSE must continue to rollout the new ambulatory (outpatient) gynaecology model and progress the development of a set of key performance indicators for gynaecology services to standardise and enable comparative benchmarking of the quality of services for all women, and prevent future service failures like we have seen in Letterkenny University Hospital,” he said.

HIQA’s review took place between April and September 2021 and involved an on-site inspection, interviews with key personnel and a survey of women to establish their experiences and views of gynaecology services at the hospital.

The full review is available to read here.