Wednesday, 1 April 2015

Compensation costs, accountability, and listening to women.

On Monday, March 30th 2015, the Irish Times ran an article "Childbirth malpractice cost HSE €67m over five years" by Ciarán D'Arcy in which new figures were revealed from the HSE that nearly €67 million has been paid out to families in compensation for medical malpractice for birth procedures in the past 5 years.

The article states: "The increase in birth-specific payouts in 2013 reflects an overall spike that year, in which HSE hospitals spent over €50 million compensating patients and members of the public. This compares to €26 million in 2012, and €32 million last year, according to figures obtained through Freedom of Information legislation. As an organisation, the HSE has spent about €367 million in compensation payments for more than 2,000 cases over the last decade."

What is omitted from this discussion is the human voice of those touched by these cases. The experiences and lives of families affected.The people behind the HSE's compensation figures.


One woman provided a powerful comment following the posting of this article:

"If these so called 'medical professionals' did their jobs properly in the first place then there wouldn't be babies born with severe brain damage which is life changing for them and their families! If these so called midwives and doctors were held accountable for their actions and were not let free to do it again there would be less children born with brain damage. We as parents have not come in for some kind of 'windfall' as is quoted in the article and also said at a medical conference by the head of the States Claims Agency! It is NOT about money. Our children's lives have been ruined. Do these people have children? Do they know what they are going to say at their childs funeral? I do."

This woman and others, should be at the very heart of this conversation. Her experience. Her child. They are not a number on a list of pay-outs nor the words in a court brief.

Another notable absence in this discussion is recognition of a culture within our maternity services which fails to deliver accountability and best practice standards to women and babies.

Have individual clinician's practices been reviewed following these cases?
Have any clinicians been suspended or required to re-train as a result of adverse outcomes?
Are these cases open and transparent so that women can make informed decisions?
Have there been investigations into routine clinical practices which do not meet best practice standards?

The reader quoted above also posted on the AIMS Ireland page, that she,

 "would love to see a change but unless a legal duty of candour is brought in nothing will."

The reluctance of medical professionals and the State Claims Agency (in spite of their media spin) to bring in 'open disclosure' in the case of adverse events means no apologies and no clear and helpful information for those who have suffered, and continue to be profoundly affected, by these significant events.


What is a grave concern to AIMS Ireland is the number of failures at national level identified in numerous reports which include timely access to maternity services, inadequate staffing levels for safe care, a maternity care model that hasn’t been revised in 59 years despite numerous national and international reports and recommendations, a lack of accountability and governance, and a strategic review of maternity services in which women's voices have not been included in the consultation process.

Ireland is a nation of numerous reports and recommendations. Report , after report, after report come to the same conclusions with absolutely no preventative action from the HSE or Department of Health to implement best practice standards and individualised care in Irish maternity care options. There is a fundamental failing to identify and act on local and individual clinical practice;  all necessary to ensure full accountability.

Silencing Experiences

As a nation, we have a comprehensive failure to listen to women and those at the centre of the issue. The HSE have claimed 'unverified accounts' within the most recent HIQA report. How can our Irish health services be accountable when a woman's/family's first person account is considered 'unverified' in the eyes of the HSE?

 This is a reoccurring complaint to AIMS Ireland – women do not feel their experiences, concerns, and the implications of their birth are acknowledged or listened to.

Women are told what their experiences were, rather than being asked.
Women are spoken for by politicians, health care providers, and other 'experts'.
Women are told what they are feeling.
Women's stories, choices, and concerns are silenced.

Women also referenced  'not being listened to' in the AIMS Ireland 2014 survey, "What Matters to You" in which nearly 3,ooo women took part who had birthed in Ireland over the past 5 years. This trend is highlighted in the following graph including women's comments.


Change of Culture

A change of culture is desperately needed from the top to the bottom in Irish maternity services with a focus on high quality, evidenced clinical practice and accountability for failures in clinical safety. The experiences and voices of those using the services, those living with the consequences of their birth, those at the very centre of the issue, must be consulted as equal and worthy partners in the process.  #listentowomen

Full article on compensation costs here:

What Matters to YOU 2014 - AIMS Ireland survey available to read here - next batch of results due out in April:

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