Topical Issue Debate

Hospital Services

There are five speakers on the first issue and they will have two minutes each. I call Deputy Creighton first.

I wish to thank the Ceann Comhairle for an opportunity to speak on this matter. I also wish to thank the Minister for Health, Deputy Reilly, for participating in this debate. I welcome his announcement to the media yesterday that he will proceed with an independent HIQA inquiry into the deaths of babies in Portlaoise Hospital. The families concerned and a cross-section of Deputies have been calling for such an inquiry.

After the tragic death of Savita Halappanavar and the HIQA report that was conducted into her death, the HSE's national director of quality and patient safety said that there would need to be a clear analysis of where staffing does not match demand. He promised that he would address that matter. On Sunday, the Minister for Transport, Tourism and Sport, Deputy Varadkar, appeared on The Week in Politics programme and stated that Ireland is a very safe place in which to have a baby. He also said that Ireland does much better in this regard compared to England or Scotland. I want to believe that that is the case but I have to be honest and say that after meeting with the parents of one of the Portlaoise babies, baby Mark Molloy, I am deeply concerned that this is not the case. I am concerned by what the Molloys have indicated to me privately, as well as by what was revealed in the Prime Time documentary last week. Furthermore, very little has been done since the last HIQA report into the Halappanavar case when Dr. Crowley assured the public that these issues would be addressed.

Baby Mark Molloy's death, as well as the deaths of baby Nathan, baby Joshua and other unnamed babies - whose information we do not have and whose parents have not been made privy to it - were not reported by the clinicians at Portlaoise Hospital to the national perinatal epidemiology centre in UCC.

On the Order of Business earlier today I raised with the Taoiseach the fact that the independent research centre is used to advise the Minister for Health, the HSE and the public on the standard of maternity care.

Information is not being provided to that centre, however, so how can we have confidence in the information that is being provided?

I thank the Ceann Comhairle for allowing a brief debate on this matter. This has been a very sad time for mothers and families, particularly in the midlands area. Serious deficiencies have been exposed, including disturbing failures at a senior level in HSE management. The worst aspect was a failure to put the patient first. An apology in these circumstances is not sufficient. I am asking the Minister to ensure that due process is essential and that Portlaoise Hospital is not made a scapegoat in this issue. There is an urgent need on the Minister's part to restore confidence in the quality of maternity services at Portlaoise hospital. It is a busy hospital covering a large catchment area with 2,200 babies being born there every year. We have seen a big population increase in County Laois. I want the Minister to ensure that we have a thorough examination of all practices and procedures.

This must include staffing levels, accommodation and implementation of national and, if necessary, international protocols. There should be ongoing training and development of a professional nature. I want the Minister to indicate now the specific measures the HSE is undertaking to ensure high-quality service to expectant mothers in the midlands area. I acknowledge the hard work of the midwives, doctors and those concerned at the hospital. They are under pressure. My constituents want the highest standards in the midlands. Why are these standards being denied? We have had a number of debates about the hospital. Unfortunately, the predecessors of the Minister neglected to take appropriate action, as has been said in recent days. I want to see strategies and quality of care. We cannot allow the lessons of the documentary television programme of last week to go unheeded.

Deputy Stanley is not present so we will move on to Deputy Fleming.

When I saw the "Prime Time" programme last Thursday night, I was saddened and shocked. It was all news to me. I was not aware of any of the four cases in which babies died at Portlaoise hospital. I had not heard about it and I did not know the families involved. Our hearts went out to those parents and they have our deepest sympathy and support. Yesterday I had the privilege of meeting two of the finest people I have ever met, Róisín and Mark Molloy, and they talked about the death of their baby, Mark. We also touched on the issue of the other baby, Joshua, whose name we know. I do not know the other children.

Róisín Molloy said that this was about one issue: equality of care for people in the maternity unit in Portlaoise compared to treatment available in other maternity units. There are 2,500 births per annum at the unit, but certain basic equipment should have been in place. I cannot say for certain but it is possible that such equipment would have reduced or prevented the risk of death for baby Mark. We will never know. The parents and staff in Portlaoise hospital are entitled to have basic equipment which is available in other units. We need to restore confidence in the unit.

There should be an independent HIQA inquiry and it should engage with the families. No HSE or Department of Health review is acceptable. Senior people in the Department of Health and the HSE were involved in cover-ups and denial for several years. People with knowledge or those who were made aware of it should step aside and take no part in any inquiry. The question to be asked by HIQA is whether this has happened in other maternity units. It took "Prime Time" to highlight this. We all need to know whether this is the case. It appears the HSE felt that if it denied it and covered up for long enough the parents would go away. That is not true of Mark and Róisín and they are to be commended on that.

The most disgusting aspect of the debacle is that the parents were told their innocent baby was stillborn when the baby was born alive. How can any health professional stand over this? Not only does it have major implications for how the birth is treated from a legal perspective, but far more importantly, it has far-reaching consequences for the mother, who will naturally question herself. Was it her fault that the baby was stillborn? Did she have a knock at some stage during the previous 40 weeks? This doubt delays the grieving process and the mother's ability to come to terms with the loss of her baby. This has an impact on her partner and any other children she may have. If that was not bad enough, in the case of little Mark Molloy, the way the truth was actively concealed from the parents is inhumane. This went right to the top of HSE. In the initial six weeks, phone calls to the hospital were not returned until a third party intervened. Two years on, the desktop review of the death of baby Mark has not been released to the family even though they have tried to obtain it under the Freedom of Information Act.

There is a litany of such examples throughout this case and others. This is not confined to Portlaoise but is systemic throughout the health service. A number of orthodontists in the west have been referred to the Dental Council for fitting used braces to children's mouths. These are braces that should have been destroyed, but no child in receipt of these braces has yet been contacted. I could go on and give other examples. We need mandatory medical disclosures to patients where something goes wrong and we should not rely on decisions being made behind legal closed doors that allow for risky practices to continue. Baby Mark, baby Nathan, baby Joshua and the other innocent baby deserve that.

I extend my sympathy to the families and relatives of those involved in this case and other similar cases. I also acknowledge the hard-working staff in the maternity units in hospitals around the country. This is causing a lot of grief, particularly to those in Portlaoise hospital.

The Minister should not have to be here today. Why is the Minister in the Chamber? He is here because we have a flawed system, one that includes a policy of silence and obstruction. We are dealing not with the Charles Dickens era but with the post-Celtic-tiger era, yet our institutions have learned nothing. The Minister should not have to be here because the issue should have been dealt with by the HSE in the first instance. Notwithstanding the tragic circumstances, the family should have received satisfaction on the day.

I have three questions I would like the Minister to answer. When did he first become aware of the issue? The most disturbing aspect of the programme was the HSE representative speaking about Portlaoise having a relatively good record. How many similar cases exist around the country, where families are going through the same difficulties with other maternity units? Will the Minister give a commitment to publish a list of all child deaths during childbirth over the past ten years and the hospitals in which they occurred? Many of these happen for reasons beyond anyone's control, but it is important to realise the extent of the issue. It is terrible to come in here after every crisis. There was a hullabaloo about the CRC and top-ups but newspapers wrote that the Department of Health was aware of it two years ago. We do not deal with these issues. The policy of silence, frustration and obstruction has us in the Chamber today. When did the Minister become aware of the issue? Are there similar cases out there? Will the Minister commit to publishing a list of all child deaths in hospitals over the past ten years?

I extend my sympathies to the families. I thank the Deputies for raising these matters and for affording me the opportunity to place my concerns on the record of the House. I, like everyone else who watched the programme, was deeply disturbed by what I saw. At the weekend, I met three of the families involved to offer my sympathies personally and to hear their individual stories. The meetings were very constructive, and I am indebted to the families for speaking to me in such an open and honest manner.

As a priority, we must establish exactly what happened. I have therefore asked the Chief Medical Officer to provide me with a report on the issue as quickly as possible. He will have the support of the chief nursing officer in compiling his report. I have assured the families that the process will be transparent, that they will be involved and that they will have the opportunity to see the report in advance of its release. The findings of the Chief Medical Officer's report will inform the terms of reference of any subsequent HIQA review into this issue. There will be such a review.

My Department is working on the development of a new maternity strategy, which I hope will be finalised by the end of the year.

The strategy will ensure that our services are fit for purpose into the future and in accordance with best available national and international evidence. The Chief Medical Officer's report will inform that strategy, as well as the need for any wider review by HIQA.

It is important to recognise that this issue is of significant concern to pregnant women across the country. I want to be clear and reassure women that Ireland is a safe country in which to have a baby. Compared to neighbouring countries, we have low rates of perinatal deaths, and this rate continues to fall. The perinatal mortality rate is estimated at 5.9 per 1,000 live births and stillbirths in 2012, which is a decline of 31% since 2003. I know this is very little consolation to the families that have lost babies and I know from speaking to the families that they are concerned about how these figures are collected. I have instructed my Department to carry out an audit on the figures and how they are collected in individual hospitals. Nevertheless, these rates are encouraging and I am determined that there will be continuous improvement.

Patient safety is a priority for me. My officials meet representatives of the HSE each month to discuss the service plan, and patient safety is a standing item on that agenda. I have also written to the chairman of HIQA to ensure that his patient safety priorities are included in the monitoring programme against the National Standards for Safer Better Healthcare. My Department is also leading the development of a code of governance which will clearly set out employers' responsibilities in achieving optimal safety culture, governance and performance. I have instructed the national clinical effectiveness committee to commission and quality-assure four priority national guidelines on sepsis, clinical handover, maternal early warning score and paediatric early warning score. The House might also be interested to note that in November 2013 I launched a national policy on open disclosure, developed jointly by the HSE and the State claims agency, designed to ensure an open, consistent approach to communicating with patients when things go wrong in health care. Roll-out of the policy across all health and social services has now commenced.

We cannot undo the loss that the families have suffered, but we can ensure that we learn the lessons we should learn from such events. I want to assure the families that we will do so. I can assure the House that I am determined that a thorough review will be undertaken and that any actions deemed necessary will also be taken.

I thank the Minister for his reaction, although he has not addressed any of the questions raised by Deputy Timmins. I appreciate that statistically our low rate of perinatal deaths compares well with other OECD countries and other parts of the European Union. What I have learned from my discussions with the families involved is that there are inaccurate figures, which must be of grave concern to the Minister because deaths of babies have essentially not been reported, collated or acknowledged. As Roisín Molloy indicated yesterday, these amount to babies "missing" from our national statistics, which is unacceptable. I appeal to the Minister to consider the possibility of putting a mandatory requirement in place so that hospitals cannot have the choice of opting in or out of reporting such deaths, as it should be mandatory. The policy of open disclosure appears to be working extremely well in parts of the United States of America but this should not simply be a policy aspiration and instead should be put in a legislative framework so that it must be implemented by the HSE and all maternity units around the country.

I thank the Minister for his reply and wish the report well. I want the Minister to ensure it is thorough and adequate. I refer to the Minister's speech to the all-Ireland midwifery conference of 17 October 2013. At an early date, if not today, the Minister should stitch into the record of the House the target for planning as evidenced by the speech, as it is important.

Will the Minister assure me and the House that there is a plan for the hospital in Portlaoise? Before last week's programme was aired, the HSE blamed the increasing population for pressures on the hospital, and that is evidence that there is an absence of a plan or strategy for the facility. I have raised the issue with the Minister before in the House and as a local Deputy I cannot stand over a position in which there is no plan or strategy for this hospital. I would like the Minister to address that matter. This is a regional hospital in the midlands in which 2,250 babies were born in a year. We want assurances and commitments from the Government that the HSE, and the Minister will ensure the delivery of high-quality care in the midlands area.

I thank the Minister for his reply and acknowledge the fact that he has met the families concerned. From the tone of his reply it genuinely appears he has a deep personal interest in dealing with this case. The four baby deaths cannot be undone, as the Minister indicated, and the families can now grieve properly as they begin to know what happened. Perhaps the deaths will not be in vain if some good comes from the system changing for the better so as to benefit other families and expectant mothers. That is really all that can be achieved at this stage.

I want the Minister to support the maternity unit in Portlaoise with whatever resources and equipment are required for the staff on the front line. I will not overly labour the point but it is ironic that around the day of the programme's airing, the Department issued the 2014 budget for the Portlaoise hospital, cutting it by €2.76 million. That was announced within hours of the programme airing on television. That is not the proper response, although I will not play party politics.

I have some little concerns about the Minister's comments. The Chief Medical Officer is to complete a report, as is HIQA, and the Department is leading the development of a code of governance. The national clinical effectiveness committee is to consider another issue and there was also mention of a national policy launch on open disclosure. Everybody seems to be doing something, but perhaps the Minister can take personal charge of the process. When everybody is doing something, nobody is held responsible at the end of the day. We want to learn from this.

I acknowledge that the Minister met the families and he is to be commended on that. I have three sets of questions. Why did we have to wait until yesterday for foetal blood sampling to be introduced at the sister hospital at Mullingar? With regard to the questions from Deputy Timmins, how many similar reviews have been performed in other hospitals and have the parents of the babies in question been informed of the reviews? Which maternity hospitals have implemented the HSE open disclosure policy and when will all maternity hospitals have an open disclosure policy in place? Does the Minister intend to put that open disclosure policy on a statutory footing? Legislative change drives social change, as we have seen with drink-driving and smoking, and there should be a cultural shift within the medical profession in that regard. Legislation is needed.

Historically, when there is a difficulty in this country, the political establishment and institutions have morphed together to conspire against the citizen. That is something I have noticed more in the past couple of months as I reflect on issues. We seem to lose track of why we were elected and how we are here to represent the people rather than conspire with institutions in silence.

There is an unrelated issue which involves other legislation. I listened to a woman this morning who had a child on 19 June 1987 at Holles Street hospital. That was one year before Ray Houghton scored the goal against England and not long after Band Aid; it was not the time of Charles Dickens. The child was handed to a social worker, but that woman cannot find any record of the child or any details whatever. This was in the National Maternity Hospital at Holles Street. It is completely unacceptable.

I will come back to the three issues I raised earlier, particularly the list of perinatal deaths across the board, when the Minister first became aware of the issue and whether there are other similar issues evident. With regard to the implementation of reports, there were 27 recommendations following the tragic death of Tanya McCabe, and when HIQA investigated the Savita Halappanavar case it found that many hospitals had not implemented those recommendations. I have tabled questions on that issue over a period.

In recent correspondence the HSE has requested all hospitals to undertake a self-assessment against a HIQA recommendation resulting from the Galway case, with reference to the recommendations made in the report on the death of Tanya McCabe. It is unclear from the letter whether they have all been implemented, but I do not believe they have been. Will the Minister tell us at some stage whether all maternity hospitals have implemented the 27 recommendations, in addition to the ones made following the Galway case?

I call on the Minister who has just two minutes in which to respond.

It will not be possible to answer all of the questions asked in two minutes.

Patient safety has been my priority. It is the priority in the national service plan for the HSE. We have made available specific funding to address the recommendations made in the HIQA report on the death of Savita Halappanavar and have had monthly updates. A recent update shows that great progress has been made in implementing all of the recommendations. I have asked the HSE to bring forward the patient safety agency on an administrative basis so as to get it up and running as quickly as possible.

With regard to Portlaoise hospital, the issue will be fully investigated. We will use this matter to address and fix the problems in the hospital, not to downgrade it. The plan for the hospital will be created by the new hospital group. The clinical treatment questions must be addressed and answered. What was very disturbing was the way in which patients' families had been dealt with by the hospital and the HSE. That has to change and will. If ever there was a case that demonstrated the need for a patient safety agency, this is it.

I thank Roisin and Mark, Shauna and Joey, and Natasha for taking the time to tell me their stories and raise their concerns. They will be addressed in full.

Health Services

I thank the Ceann Comhairle for allowing me to raise this issue.

The Ombudsman found that the HSE had discriminated against a mother and her child who had attention deficit hyperactivity disorder, ADHD, and criticised the failure of the executive to ensure a uniform approach to the administration of the long-term illness card scheme. In his first major finding since taking over in December the new Ombudsman, Mr. Peter Tyndall, ordered the HSE to pay the mother of a child who had lodged a complaint €3,000 to refund the costs she had incurred in purchasing medicines. He also made a ruling in regard to children in general concerning the long-term illness card benefit for those with ADHD. He found that a child with ADHD and autism had been discriminated against on the basis of geography. The child's mother took the case to the Ombudsman, complaining that her son was being discriminated against because he lived in Wexford. She maintained that if he had lived elsewhere, she would have received a card.

Is the Deputy talking about Lyme disease?

No, I am talking about ADHD. I submitted the topic. There is confusion because I believed we were to deal with the topic I submitted on ADHD.

Can the Minister deal with that matter?

I will leave it.

If the Deputy withdraws the matter, I will make sure he gets to raise it again.

I will come back again.

Absolutely. I will make sure that happens. I apologise.

Would the Deputy like the answer on Lyme disease now?

Did the Deputy submit a topic on Lyme disease?

I did, but I then submitted one on ADHD.

We will address it on another day.

Harbours and Piers Funding

I thank the Minister of State for attending. The flooding in the past week or ten days has caused problems in every county, including Wexford. Courtown Harbour and Marshmeadows in New Ross have both been affected. We are dealing today with Courtown Harbour. The Courtown Harbour and Pier Association has been in touch with me about the problems caused by storms in recent weeks. It states the pier at the back strand and boulders have been swept into the channel and that silting has occurred at the entrance, with the result that fishermen cannot put out to sea. As the Minister will be aware, coming from the south-east, Courtown is very dependent on tourism and fishing. In recent years, despite repeated requests and efforts by Wexford County Council to secure funding to upgrade the harbour at Courtown, nothing has happened to date. Numerous surveys have been carried out, the latest of which was by a company called Malachy Walsh & Partners Consulting Engineers. It proposed solutions, but solutions cannot be effected unless there is sufficient money available.

The piers are in a dangerous state of disrepair and there are massive holes where the concrete facing on the front of both piers has fallen off. The pylons are rusted and some have fallen off. At one stage, some of them were sticking out at the mouth of the harbour, causing problems for fishermen trying to gain access. A large hole appeared in the south pier recently, with the result that seawater from the back beach was flowing through into the channel. The storm caused massive damage to the coastline and it is a miracle that the piers are still standing.

As I stated, countless surveys have been carried out of the piers, but no recommendation has been implemented. There have been numerous meetings and numerous Ministers have visited - Mr. Seán Kelly, MEP, visited recently - but the locals believe they are being fobbed off and not getting any concrete answer or funding to solve the problem.

As well as being a fishing harbour with five fishing trawlers, the harbour depends very much on tourism. There are leisure boats and yachts. Many other types of boat use the harbour regularly. However, because of the silting they are unable to gain access. The yachting club made an application to Wexford County Council to drain the harbour to carry out some necessary works, but it seems this did not happen because the club was told it could not do so for health and safety reasons. The club was willing to put up half the money, which would have benefited all the people using the harbour. Perhaps the Minister of State will respond on how this problem can be addressed. If organisations are prepared to put up money, surely the Government and the council should reciprocate by putting forward money.

As the Minister of State knows, fishermen are very dependent on the weather. In recent years, however, even when the weather was good, they have been unable to gain access to the sea to fish because of the silting of the harbour. Whelk fishing is very important to Courtown Harbour, but, as I stated, the fishermen are finding it very difficult to fish.

I thank the Minister of State for attending. I ask him to have discussions with Wexford County Council which I am sure will be only too willing to propose a solution if he can find the necessary money to put it into effect. I ask him to consider making funding available as soon as possible.

I thank the Deputy for raising this issue. The Department of Agriculture, Food and the Marine is responsible for six fishery harbour centres located in Howth, Dunmore East, Castletownbere, Dingle, Rossaveel and Killybegs. The centres provide essential services and facilities for the fishing industry around the coastline.

The Department also has responsibility for North Harbour at Cape Clear Island and for maintaining a range of small harbours, piers, lights and beacons around the coast, in accordance with the 1902 Act.

Repairs to local authority-owned piers and harbours and other coastal defences remain, in the first instance, the responsibility of the relevant local authority. Courtown Harbour is therefore the responsibility of Wexford County Council. That said, myself and the Minister for Agriculture, Food and the Marine, Deputy Coveney, are acutely aware of the ferocity of the recent storms combined with the exceptionally high tides which have resulted in widespread damage to vital public infrastructure including various small local authority piers and harbours and various navigational lights and beacons around the coast. We are also concerned, in particular, at the impact this damage may have on our fishing industry.

The Minister is working closely with his Cabinet colleagues in evaluating the overall extent of the damage. The Department of Agriculture, Food and Marine is represented on the National Co-ordination Group on Severe Weather, convened to assess the impact of the storms on infrastructure and communities and to ensure a co-ordinated response by the relevant local authorities, Departments and agencies. The Government is anxious to deal with the totality of the impact of the storms and has asked local authorities to assess the damage in their areas and revert with their reports as soon as possible to enable a fully informed and co-ordinated response to the damage to our coastal communities as a result of the exceptionally bad storms. However, even now it is hard to completely determine the full extent of the damage. Inspections will have to continue when there are more favourable tides, to check the lower structural sections of some harbours. It should be noted that weather and tidal conditions over the coming days may not make things any easier.

The Minister will continue to assess the damage reports and the estimates of the cost of repair and expects a full and complete damage evaluation over the next few weeks. That information will be fed into the Government's overall consideration of the appropriate course of action. The Minister fully expects his Department to have a prominent role in the Government's co-ordinated response. He is confident that the damage caused to critical pier and harbour infrastructure can be addressed as comprehensively and quickly as possible and that the Department will play its part along with all other relevant Departments, local authorities and agencies to achieve this objective.

I thank the Minister of State for his reply but it does not signal any great hope for Courttown Harbour. I ask the Minister of State to consider visiting the harbour himself to see the current situation there. Courttown Harbour is not an issue just because of the recent storms. Problems have been ongoing at the harbour for the last two or three years because of silting. While I accept that this is chiefly a matter for Wexford County Council, the Department of Agriculture, Food and the Marine allocates some funding for small harbours and piers and I believe it is important that some funding be provided through that scheme. I ask the Minister of State to visit Courttown Harbour and to pass on a request to the Minister for the Environment, Community and Local Government, Deputy Hogan and the Minister of State at the Department of Finance, Deputy Hayes, to visit Marshmeadows in New Ross, where 500 people are currently employed. It is completely under water, causing grave concern in the area. A number of companies are located there, employing 500 people between them. Marshmeadows is very important to the economy of New Ross.

I ask that when the Minister of State is visiting Courtown Harbour he would bring some money with him for Wexford County Council to enable it to solve the problem there. As I said, the yacht club is prepared to put up half the money so I ask for a quid pro quo on that.

On the question of a visit by me or anybody else, I would not like to hype expectations in the area. The Cabinet discussed this matter yesterday. Local authorities have been asked to submit estimates on the cost of the damage done along the coast. I am very pleased to hear that an organisation in Deputy Browne's locality is prepared to put up some finance of its own to address the problem at Courtown Harbour. That should feed into the process involving the local authorities and I would be hopeful that the problem will be resolved.

The Government is fully aware of the problems in this regard. Deputy Hayes, who has responsibility for the OPW, has visited Limerick and Clare already. I will certainly ask that at least one Minister or Minister of State would visit Wexford and see the situation there at first hand.

Sitting suspended at 3.05 p.m. and resumed at 4.05 p.m.