Mr. Jim Lawless:

Corporate and clinical governance is poor. There is no clear separation of roles and responsibilities for patient safety between the Health Information and Quality Authority, HIQA, the investigating authority, and the Health Service Executive, HSE, which funds health care. In 2012, out of 238 SAH, subarachnoid haemorrhage, patients who were diagnosed, 138 were treated but 100 were denied treatment. There is no information on the outcome for these patients. If poor grade patients were to be admitted to the National Hospital for Neurology and Neurosurgery, London, 53% could expect a good recovery.
We need to know the outcome for SAH patients who were denied neurosurgical treatment between 2011 and 2013. This information is available in Beaumont Hospital because the neurosurgical centre is required to provide a patient management plan for each SAH patient referred for treatment. Letters are sent from the centre to each referring hospital, so the records are in place. There is a culture of secrecy and denial, however. The statement by Beaumont Hospital to The Irish Timesthat appropriate protocols were in place to ensure SAH patients receive emergency neurosurgical treatment was misleading. HIQA claims the HSE is responsible for the safety of patients who require treatment. However, the HSE relies on assurances from Beaumont Hospital that the neurosurgical centre can provide access to treatment but assurances from Beaumont Hospital are not reliable.
My written submission makes 13 recommendations which I urge the joint committee to carefully consider, approve and recommend for action to the Minister for Health. I particularly recommend an increase in the number of neurosurgical intensive care beds in line with the recommendations from Towards Excellence in Critical Care and review the corporate and clinical governance standards at HIQA and the HSE. I also recommend the urgent review of mortality and morbidity for SAH patients denied treatment between 2011 and 2013. One small change, which would not incur any costs, relates to the interhospital transfer of critically ill patients. This should have the same urgency as a 999 emergency call. There was one case where it took three and a half hours to transfer a patient from one hospital to another.