Dr. Colm Henry:

There are a wealth of data, not just from the HSE but also the Department, which reports on individual conditions, individual mortality and compares hospitals. The Department of Health has this year, for the fourth year running, published the national healthcare quality reporting system, NHQRS, which reports mortality from strokes, overall hospital mortality and overall mortality for myocardial infarction, or heart attack, and other metrics such as access to cancer services. The caveat is written very strongly in the foreword and the introduction that we are not comparing like with like. A stroke specialist carrying out a thrombectomy, in which a clot is removed from the patient, is going to attract more complex and difficult cases. A neurosurgery unit will attract cases from other hospitals which deal with less complex cases.

When we are looking at quality of healthcare, adverse events are one important component, but there is much more to it. We have to look at access as well. Every month we discuss performance management at our hospital groups, looking at access to cancer clinics and healthcare associated infections. We look at patterns between hospitals and, in some cases, patterns between practitioners. Our governance structure is set up so that the first port of call is management at local level, meaning the hospital and the hospital group, which are best placed to interpret the data and to put in place improvement plans where they believe they are needed. We are confident that it happens in an ongoing quality improvement cycle.