HIQA conducted a risk-based announced inspection of Cork University Hospital (CUH) on 25 and 26 July 2023. The hospital was found to be compliant or substantially compliant with three national standards, partially compliant with six national standards and non-compliant with two national standards assessed during inspection. While there was evidence of progress and commitment by CUH’s hospital management to achieve efficiencies and improvement in the hospital’s emergency department, further substantive improvements are needed to ensure compliance with the national standards in the short, medium and long term.

HIQA found CUH had corporate and clinical governance arrangements in place, but these were being revised and implemented at the time of inspection. Hospital management should ensure that the restructured governance structures provide sufficient and effective oversight of the quality and safety of the healthcare services provided, including complaints management. Improvements were also required to ensure best practice infection prevention and control guidance and standards was applied in areas visited on the days of inspection.

CUH was particularly challenged with limited availability of suitable beds in the community which impacted on the ability to transfer patients from the hospital. This resulted in a number of patients experiencing a delay in their transfer of care and contributed to congestion in CUH’s emergency department (ED).

Following HIQA’s last inspection in June 2022, CUH’s ED had additional consultant and junior doctor staffing in emergency medicine, and the previous shortfall identified in nursing staffing had improved. This uplift in medical and nursing staff had enabled some operational and clinical efficiencies to be achieved, as evident in some improvements in patient experience times.

An announced inspection of Ennis Hospital on 17 and 18 May 2023 found the hospital to be compliant or substantially compliant with 10 national standards and partially compliant with one national standard assessed during inspection. The partially-compliant finding related to the physical environment in which care was provided, in particular, due to the older infrastructure of the medical assessment unit.

While findings related to the physical environment require attention from hospital management, HIQA found generally good levels of compliance in the wider hospital and inpatient clinical areas visited on inspection. On the day of inspection, the hospital’s medical assessment unit and local injury unit were functioning well and were compliant with HSE targets related to patient experience times. People who spoke with HIQA inspectors were positive about their experience of receiving care in the hospital and were very complimentary of staff. 

On this unannounced inspection of the ED on 6 July 2023, HIQA found the Mater University Hospital to be substantially compliant with three national standards and partially compliant with one national standard. The hospital’s ED was observed to be clean and well maintained on the day of inspection. Patients who spoke with inspectors on the day of inspection were complimentary about staff. On the day of inspection, there was a reliance on agency staff to ensure adequate staffing levels were maintained in the department, which is not sustainable in the long term.

From an operations perspective, the ED was functioning well. There was evidence that the executive management team was responsive and reactive to the issues impacting on performance in the emergency department. The hospital had a number of measures in place to support effective patient flow through the ED and wider hospital. Overall, there was evidence that hospital management and staff were aware of the need and availed of opportunities to respect and promote the dignity, privacy and autonomy of people receiving care in the ED. 

HIQA conducted an announced inspection of the National Maternity Hospital (NMH) on 30 and 31 May 2023 and found the hospital to be compliant with seven standards, substantially compliant with two standards and partially compliant with two standards.

The hospital was found to have effective formalised corporate and clinical governance for assuring the delivery of high-quality, safe and reliable healthcare with effective oversight from the hospital’s Board of Governors and Ireland East Hospital Group. This included effective systems to proactively identify, manage and minimise potential risk of harm to women and babies and act on opportunities to continually improve the quality, safety and reliability of the maternity services including management of complaints.

Areas identified for improvement included a staffing shortfall across all staff grades, in particular midwifery and nursing, as well as staff attendance and uptake of training. Hospital management should continue to progress with the short and medium-term infrastructural projects and plans to address the infrastructure challenges in NMH until the relocation to a purpose built hospital is progressed. Notwithstanding these areas for improvement, good overall compliance was found on inspection.

An unannounced inspection of Tipperary University Hospital ED on 9 August 2023. HIQA found the hospital to be substantially compliant in two national standards and partially compliant in two national standards. 

The hospital had defined corporate and clinical governance arrangements in place for assuring the delivery of high-quality, safe and reliable healthcare in the ED. Hospital management had good operational oversight of the ED and were responsive in their approach to addressing challenges within the department. Notwithstanding this, the mismatch between the demand on ED services and the capacity of the emergency department resulted in the hospital being in escalation for extensive periods of time. However, the ED was functioning effectively on the day of inspection, and patient experience times were among the better performing hospitals. The emergency department was overcrowded, and improvements were required to provide staff and patients with adequate facilities, including a clean utility room, additional permanent isolation facilities and further toilet and shower facilities for patients. 

Effective workforce arrangements were in place to support and promote the delivery of high-quality, safe and reliable healthcare. However, there were a number of vacancies across the majority of disciplines including consultant posts in emergency medicine and nursing staff. Furthermore, staff attendance at and uptake of mandatory and essential training required significant improvement.

An announced inspection of St Mary’s Hospital, Phoenix Park was carried out on 18 and 19 July 2023 to assess compliance with national standards from the National Standards for Safer Better Health. HIQA found the hospital to be compliant with four national standards, substantially compliant with five national standards and partially compliant with two national standards.

HIQA was satisfied that the hospital had formalised corporate and clinical governance arrangements in place for assuring the delivery of high-quality, safe and reliable healthcare. Systematic monitoring arrangements were in place at the hospital for identifying and acting on opportunities to continually improve the quality and safety of all services.

Staff promoted a person-centred approach to care and were observed by inspectors to be respectful and caring while maintaining patients’ dignity and privacy at all times. It was evident that hospital management was planning, organising and managing their staffing levels to support the provision of high-quality, safe healthcare. Notwithstanding this, there were a number of vacancies across all staff disciplines, most evident across health and social care professionals, which had the potential to impact on patient care and this must be addressed. 

The physical environment in the clinical areas inspected was observed to be generally clean and well maintained; however, the hospital continues to be challenged by the insufficient number of available isolation rooms.