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Dáil Éireann debate -
Tuesday, 26 May 2015

Vol. 879 No. 2

Midland Regional Hospital: Motion [Private Members]

I move:

“That Dáil Éireann:

extends its deepest sympathies to the parents and families of babies that died at the Midland Regional Hospital, Portlaoise;

deplores the manner in which they were treated by the Health Service Executive (HSE) in the aftermath of their loss;

notes:

— the publication of the recent Report of the investigation into the safety, quality and standards of services provided by the Health Service Executive to patients in the Midland Regional Hospital, Portlaoise by the Health Information and Quality Authority, HIQA; and

— the findings in the Report which point to consistent failures by the HSE at a national, regional and local level to decisively address numerous clinical governance and management issues;

acknowledges that the Government agreed and confirmed that the Midland Regional Hospital, Portlaoise be a model-3 hospital in 2011;

condemns:

— the withholding and concealment of information from parents and patients; and

— the decisions by the Minister for Health and the Department of Health not to allocate funding allowing the Midland Regional Hospital, Portlaoise to be funded as a model-3 hospital;

further notes the HIQA finding that services at the Midland Regional Hospital, Portlaoise were neither governed, resourced nor equipped to provide the level of care expected of a model-3 hospital; and

calls for:

— patient safety to be put first and for the Midland Regional Hospital, Portlaoise to be resourced in a manner commensurate with its status as a model-3 hospital;

— further improvements in the governance structure of the hospital to ensure patient safety in all areas of the hospital; and

— the recommendations of the HIQA report to be immediately implemented to ensure that risks and deficiencies identified are addressed at both local and national level to ensure the delivery of safe and consistent patient care.”

I am sharing time with Deputy Fleming and Deputy Keaveney, with 15 minutes, ten minutes and 15 minutes, respectively.

The motion condemns the withholding and concealment of information from the families. The Minister referred publicly to these families being lied to, a very serious charge and something that needs to be addressed. At the end of the day behind all of our debates, statistics, reports, data and statements as well as press statements from the HSE, the Department of Health, the Minister and others are families who have had bereavements and who were treated in an appalling fashion locally, regionally and nationally by the HSE.

We heard the testimony of Róisín and Mark Molloy last week as well as from Ollie Kelly and Amy Delahunt whose babies died in the maternity unit in Portlaoise hospital. The Minister heard first-hand from many families and individuals who had terrible experiences in Portlaoise. What I found having listened to the families was that they do not want people simply to issue statements saying that action will be taken. They want accountability and they want to ensure that this does not happen again. They want commitments to the effect that everything will be done to ensure safe practice for maternity services in Portlaoise hospital and broadly across all maternity services in the country. There was a noble statement from the families who came before the health committee as well as many of the other families affected.

That is why we have tabled this motion. Over many years, many people sitting on the other side of the House from all sides and none have said they would act now and that enough was enough. Watersheds have often been mentioned. We have crossed the Rubicon on many occasions. The problem is that we are still in the Po Valley and we are still waiting for the implementation of many of the recommendations made by HIQA in previous reports. These have been outlined in the report itself. We have had investigations on many occasions, for example, in the context of Ennis and Savita Halappanavar in Galway. We had reports into the misreading of mammograms.

The one common thread in all of them is that the implementation of the recommendations has been very poor.

In many cases, there have been appalling efforts by policy makers, those who provide the resources and those who implement the policy of the Government. That is not good enough. We have to keep this matter to the fore to ensure we strive for greater standards than currently exist. Our maternity services are reasonably good but they are not excellent. There are still shortcomings, including in terms of resourcing and the attitude of the HSE when something goes wrong. We talk of open disclosure, accountability and many such things, yet when something goes wrong families are very often left dealing not only with the associated bereavement and trauma but also with the bureaucracy and callousness of the system when they try to gain access to information and find out the truth. Very often, an adversarial approach is taken until the families go to the steps of the court, where a settlement is made. There is never any admission of liability on the part of the HSE so the facts cannot ever come out.

We still do not have proper perinatal pathology services. That is wholly inadequate in this day and age. If a baby dies immediately post partum or pre partum, or just before or after labour, we do not have proper perinatal pathology services in place to carry out an investigation into what happened and share the information with other maternity services throughout the country. We must examine this also. I do not believe this is a recommendation in the report but it must be considered.

I have tried in this debate to focus on the problems. There is one problem that we must accept and address. Very often politicians play politics with health and health care. For many years, including before the last election, there was no doubt that people ran around the countryside making outlandish promises, pretending they could deliver on things although knowing full well they could not or, perhaps even worse, having no notion of implementing their promises. That is very distasteful when we discuss health services. In the context of the Ennis report, for example, posters were put up in counties stating people would die if the recommendations were implemented. The problem in the context of Portlaoise hospital itself was that it was recommended that it not be a level 3 hospital anymore. This was in the Ennis report and the Mallow hospital report but there was political interference at some level. To this day, I do not know who made the final decision.

Last week at the meeting of the health committee, Mr. O'Brien was quite clear. I asked him about this twice and twice he was concise and pointed in his approach. I learned a policy decision was made at political level and that the HSE was obligated to implement it but there were no resources made available. Somebody somewhere decided, against the best recommendations available in the context of the Ennis hospital report, that Portlaoise hospital would be maintained as a level 3 hospital. Great emphasis was put on this political decision by the previous Minister, Deputy James Reilly, who said he would retain the hospital as a level 3 hospital and that HIQA could be dismissed to a certain extent. However, the problem was that there were no resources to follow the political decision, and the HSE was consequently left trying to pick up the pieces and pretending to the people of the midlands that they had a level 3 hospital. That is very serious.

Dr. Chris Fitzpatrick, who was Master of the Coombe Women and Infants University Hospital for a number of years, spoke last week. In 2011, he presented a report to the Department of Health. As far as I can ascertain, he presented it to the Minister and later to the CEO of the HSE. The report pointed out the inadequacies of the service in both Portlaoise and Mullingar hospitals. Dr. Fitzpatrick was highlighting safety issues in 2011. He presented the report to the Minister himself, from what I can gather, and subsequently met the then CEO the HSE to outline his genuine fears for patients. Nothing was acted upon. Despite this, there is a consistent pretence from those in charge in the Department of Health, at political level, and the HSE that they were not aware of this. The bottom line is that they were; everybody was aware and alarm bells were ringing loudly from Portlaoise. Nobody in the Department of Health or HSE headquarters was willing to listen and act on those alarm bells. When we hear of systems failures and red flags being raised that were not acted on, we should note the bottom line is that people failed to do their jobs, act and address the inadequacies and deficiencies in the maternity services in Portlaoise.

I have to agree with the Minister's statement that a lack of resources can never be blamed for the lack of compassion and basic humanity. That is true. There is no doubt that the manner in which some of the families were treated was disgusting. They were ignored in their time of bereavement and tragedy, and their treatment was cold and callous in many ways. They made an effort to try to extract information week in, week out, including by repeated e-mails and telephone calls. Telephone calls were ignored for many months. The bottom line is that the system was hoping the families would go away, or meekly go somewhere else and stop annoying HSE management. However, the families' tenacity and bravery ensured we are now discussing this issue in this forum. Last week, the families were adamant about what occurred. I asked them whether, if they had not pursued the matter to the level they did, we would be any wiser, and the pretence would still be continuing. I refer to the pretence that there is a level 3 hospital in Portlaoise, that it is fully safe, that management is working towards staffing it adequately and that any family that has any difficulty is being treated humanely, compassionately and with a degree of dignity and respect. The bottom line, however, is that management did not bank on Róisín Molloy saying when she went home after her baby died that enough was enough and that she could not allow this to happen to any other family. For that, we should all be grateful.

The report recommends that a steering group be set up to address and assess maternity services in the State. The Minister announced this when he saw the draft report. He has stated there are now more obstetricians, midwives and other health professionals in the maternity services, in addition to a dropping birth rate. That is a given, but we are still way off the ratios required to ensure we have the safest maternity services that possibly can be provided in this country. Therefore, we have a lot of work to do in this regard.

This motion effectively calls for patient safety to be put first and for the Midland Regional Hospital, Portlaoise, to be resourced in a manner commensurate with its status as a level 3 hospital. We must stop the pretence. We are now talking about the Coombe hospital interacting with the hospitals in Portlaoise and Mullingar, as recommended by the previous Master of the Coombe, Dr. Fitzpatrick. Dr. Fitzpatrick said there should be some level of oversight and co-operation between the Coombe, Portlaoise and Mullingar hospitals. In fact, most of the recommendations and observations he and others made at the time in question were compiled and included in the CMO's report of 2013 on foot of the Molloys, Amy Delahunt, Oliver Kelly and others coming forward and the pressure that was put on in the context of the "Prime Time" programme. There were people who were not calling for the sun, moon and stars but who were simply begging for help to ensure that the services would be made as safe as possible.

Political accountability required. The previous Minister for Health made political decisions that need to be explained. I cannot ask him to explain so I must now ask the current Minister to explain why Portlaoise was picked out of the ten hospitals that were named in the Ennis hospital report.

Why was it singled out for special treatment in terms of retention of level 3 status but no resources provided for it because it is critically important? If one allows political interference in terms of who gets health care and where health care is provided, if something goes wrong, that person should be held accountable. There is no point in the Minister or me pretending that it was done for other than political reasons because all the experts recommended that it should be included in the list of ten hospitals. I could accept if the recommendation had been different and if the former Minister had followed through but the fact that he single-handedly boasted he was going to retain it but did not fund it at the level at which it should have been funded is simply unacceptable.

We are calling for the recommendations to be implemented and for the resourcing to be put in place to ensure the standards and safety in the Midland Regional Hospital in Portlaoise are maintained; that when alarm bells ring, people act; and that when they do not act, we do not consistently blame systems failures because of the inability of individuals to carry out their basic duties locally, regionally and nationally. There are still many questions to be answered and many people still have an obligation to come forward and explain their role in the unfortunate and tragic circumstances that unfolded in Portlaoise over many years.

It is a shocking thing to lose a child. We all hope to end our days without having to endure such an awful loss. I offer my sympathies to the parents of the babies who died in the Midland Regional Hospital in Portlaoise. I also offer my sympathies to their wider families and friends. Parents suffering such a tragedy deserve to be treated with sensitivity and respect. They also deserve to know the truth, however uncomfortable that may be to the hospital, the HSE, the Department of Health or this House.

Their treatment after the loss of their babies was deplorable, made all the worse by the Government's delay in publishing reports into the incident. The Minister engaged in foot dragging. He did not face the truth when he had it. The serious management and clinical governance failures identified in the report added insult to injury. Often in tragedies such as this, some small comfort can be got from giving an individual who is grieving the opportunity to protect somebody who may become vulnerable because of the failures of the system and to prevent another family from having to endure that kind of pain. The actions and inaction of the Minister and his Department, the Cabinet and the HSE robbed the families involved of that opportunity.

Thanks to political interference relating to the Minister for Foreign Affairs and Trade, the midland hospital was told that it would retain its level 3 status. However, this was status without the appropriate level of resources. It might have looked good in the local print media but we see that level 3 status was provided without the resources required to ensure successful delivery of services. We now know that the hospital was not governed, resourced or equipped safely to deliver the level of clinical services required of a level 3 hospital. We now know it was simply a fiction and a failure to deliver to match what the Government announced. The Government has now been found out. This House must stop playing with people's well-being and lives for the sake of political expediency. Providing level 3 status without the resources was expedient and cannot be repeated and the Government ought to apologise for it. Aside from the risks associated with political interference to protect status without providing resources, it has damaged trust and created cynicism about politics. People in that community are raising questions about the role of the HSE and politics and they have every right to be cynical.

The HSE is conducting reviews of maternity services throughout the country. It is akin to Animal Farm in that all reviews are equal but some are more equal than others. I wish to raise the case of one hospital that is receiving some attention, namely, Portiuncula Hospital in Ballinasloe. It was unfairly treated regarding the leaking of information. It may not be of interest to the Government electorally but it is of interest to the people of Ballinasloe because they depend on it, including the accident and emergency department. This community has experienced the closure of a psychiatric inpatient service following a review similar to the one taking place across the country. We were told we would have a better psychiatric service in the context of the centralisation of services at University Hospital Galway, UHG. We now know that staff at UHG are taking industrial action as a consequence of serious issues at that unit. Nurses are expressing concerns about the workload. Unfortunately, their concerns, like those of front-line staff at the Midland Regional Hospital, were ignored. Management is looking at lack of resources on the front line, as happened in Portlaoise. Front-line services are not being progressed to a satisfactory and safe level. This has not been helped by staff shortages and an underspend where resources were sent back to the Exchequer. These shortages are compounding incapacity on the front line and a failure to deliver and protect the most vulnerable people. When the current Minister for Health was appointed, there was great hope that he would address that situation. The physical structure of the psychiatric unit in GUH is leaking, creaking and subsiding. The ceiling is falling in and the unit has poor toilets. This is in contrast to the unit at St. Brigid's Hospital in Ballinasloe which is the only ligature-free facility in this country but which is lying idle. It is political interference. This is what happened in Ballinasloe and Portlaoise. This is disgraceful and is indicative of this Government's failure in this area and the roll out of primary care in particular.

I fear the Minister will hesitate to intervene directly with the resources that are required. We need to ensure that women across this country can have faith and confidence in maternity services. It is little wonder those protesting against the closure of maternity services across the country such as the maternity unit in Portiuncula do not trust the HSE because their experience has been pretty awful in respect of how the HSE rolls out its reviews, given the damage that has been done and the public relations disaster presented by the midlands hospital. I am sure the Minister will agree that patient safety will be prioritised and this will be supported by this side of the House. We need to see a review of management and management practices. I am surprised that we have not ensured the greatest form of contemporary governance to address the situation at that facility. Most importantly, the HSE must be made to understand that it must take responsibility for improvements, accepting criticism and delivering a modern public service in the context of maternity services.

Senior managers have to become accountable, report back and accept liability, blame and responsibility.

I welcome the opportunity to speak on this issue and thank my party colleague, Deputy Kelleher, for tabling the Private Members' motion on behalf of the Fianna Fáil Party. The main points of our motion are as follows:

Dáil Éireann:

extends its deepest sympathies to the parents and families of babies that died at the Midland Regional Hospital, Portlaoise; condemns the withholding and concealment of information from parents and patients; calls for patient safety to be put first and for the Midland Regional Hospital to be resourced in a manner commensurate with its status as a model-3 hospital; and [for] the recommendations of the HIQA report to be immediately implemented.

We chose to use our three hours of Private Members' time this week to raise this issue at the highest level in our national Parliament so that we can get some clear answers as to what went on within the HSE that allowed this situation to continue for so long. There have been promises to do something but very little has happened. There has been some action but it is insufficient. The HSE is now involved in a dispute over who should be involved in the review of the situation. Top management in the HSE is a closed shop and it does not want the truth to come out. It has prevented the truth from emerging for years and it is the culture among those at senior level in the HSE to protect the organisation first.

Patient safety must come first in all cases and adequate management procedures must be in place to ensure this. The Minister for Health must provide adequate resources, staffing and funding to bring this about. Staff numbers in the hospital must be brought up to an adequate level to ensure patient safety at all costs. The new arrangements between Portlaoise and the Coombe hospital are very welcome. I fully support those developments because I do not think Portlaoise can be left as a standalone maternity hospital.

Portlaoise hospital is approximately 45 or 50 minutes from Dublin and we must have an honest discussion about it. I was born and reared in County Laois and am very familiar with the hospital. Indeed, everyone in Laois is familiar with the way health services are configured in the region. We all know, for example, that a person involved in a serious car accident goes straight to the hospital in Tullamore and does not go to Portlaoise and the same is true for patients with ear, nose or throat issues. If someone has a stroke, for example, an ambulance will take him or her straight to Naas hospital. Patients go to where the service can be best provided. There are some dedicated services in Portlaoise hospital and they should be run properly. We have a very large maternity unit there, with well over 2,000 births in most years and the next nearest maternity unit is quite a distance away. We have a very important and good paediatric unit in Portlaoise as well as one of the busiest accident and emergency units for a town of its size. There are well over 30,000 visits to the accident and emergency unit every year. There may be a dispute about the exact figure but it is of that range. Surgical procedures are carried out in the hospital but they are not of the most serious nature. To be honest, most people in Laois would not want to go into the hospital in Portlaoise for a serious, complex or complicated surgical procedure unless there was no other option.

We are close enough to St. James's Hospital and the other hospitals in Dublin. I regularly make representations on behalf of constituents waiting for hospital procedures to be carried out and often the replies come from St. James's Hospital. Laois is not isolated and Portlaoise hospital does not just provide a service for Laois. Some health services are provided in Laois but many are provided outside the county. I should also mention that there is a substantial psychiatric unit in the hospital in Portlaoise. There is no maternity unit in the neighbouring counties of Tipperary, Kildare, Offaly or Carlow so the unit in Portlaoise covers a wide geographic area. The facilities are not just for County Laois. All those attending the maternity unit expect proper facilities to be in place and rightly so. We are all agreed that it is not possible to provide every service in every hospital but where services are meant to be provided, they should be provided in a safe manner.

My party colleagues have already made reference to the issue of political accountability. I heard it directly from the Minister's predecessor, the former health Minister, Deputy James Reilly, that Portlaoise would be a model 3 hospital but the necessary funding was not provided. That said, I accept that it is not all about funding. It is also about patient care, a caring attitude, management systems, complaints procedures and so forth. The Ombudsman's office has undertaken a detailed study to ascertain why so many complaints in respect of the health services are brought to that office. The main finding of the research study was that people were afraid to complain directly. Families who are not happy with services or treatment do not want to complain in case it will have an adverse impact on the care their loved ones receive. Added to that, complaints procedures are unclear even when people do want to complain. Complaints procedures may be there in theory or may be published in a manual somewhere, but they are not clearly available and accessible to the general public. These findings are based on research from the Ombudsman's office which I saw earlier today.

Why are we having this debate today? We are having it because in January 2014, RTE broadcast the "Prime Time" special investigation into the death of four babies over a six year period in the Midland Regional Hospital in Portlaoise. The babies were alive at the onset of labour but died either during labour or within seven days of birth. It should not take a television programme from RTE for us to discuss this issue today. Why was that RTE programme made?

While I am not a member of the Joint Oireachtas Committee on Health and Children, I attended the meeting last week to listen to the parents and to HIQA representatives. Róisín and Mark Molloy told the story of the death of their baby, Mark and Amy Delahunt and Ollie Kelly told the story of their child, Mary Kate. Róisín said that people in the HSE said she was a crazy woman because she just would not let it go. That is the reason we are here. She would not let it go. Most people in her situation would have let it go and accepted what they were being told, following a review and an inquiry but she would not. She said that she was described as a "crazy woman" but one could not meet a more reasonable woman, as I am sure the Minister knows, having met her in Portlaoise recently. She is a very reasonable woman and patients such as Róisín Molloy should not have to fight and be considered crazy in order to get the truth. We must thank her, on behalf of everyone who uses that facility, for ensuring that it will be safer in the future. HIQA has said that it cannot say it is safe today, the HSE says it is safe and the Minister has said that it is safer than it ever was and maybe all three viewpoints are correct.

All I want is safety because I have heard from medical personnel on the ground that expectant mothers in Laois are nervous about going to Portlaoise. Why would they not be nervous, given what has gone on there? This is affecting people's confidence in the services in Portlaoise and that must be put right. The Coombe hospital must do whatever is necessary to improve the services in Portlaoise and restore confidence. If complex cases present and patients must be transferred from Portlaoise to the Coombe, then so be it. I am not a medical person but I assume such cases can be identified and procedures put in place to deal with them properly. Complex cases should be sent to the Coombe hospital. Expectant mothers who are due to give birth in Portlaoise want to know that the system there is safe.

In some of the cases at the centre of this debate, babies were wrongly classified as still-born, even though they were actually born alive. This was concealed by the HSE, by senior and middle management and many other people for a long time. Does the Minister know whether that is a criminal offence? Is it a criminal offence to conceal a death or record it incorrectly? It could be argued that An Garda Síochána should investigate whether criminal negligence was involved here. It is fine to have HIQA investigating such matters but sometimes a visit from members of An Garda Síochána can make senior public servants sit up more than any admonishment from their superiors, including from a Minister. Deputies will remember the incident in Bray a number of years ago when two firemen lost their lives.

It was only when the county manager was arrested for dereliction of his duties - I do not know the exact details of the case - that the management of local authorities sat up and ensured they had proper health and safety regimes in place regarding the fire service. Had the Garda not arrested the county manager on that occasion we would have carried on as normal. I think the fear of God - if I am allowed to use God's name in this House - needs to be put into the senior management in the HSE.

Based on my experience as a Deputy, I do not have confidence in the HSE to resolve this issue. I have been dealing with the HSE for 20 years in my public life. The culture in the HSE back to the old health board days is first and foremost to protect the organisation. That culture is endemic in the HSE and it will take somebody from outside to shake it up and not just at political level. It would take an organisation like the Garda to follow that up.

We have had many broken promises. We have spoken about a patient safety authority and we have not seen that coming to pass. There are many unanswered questions. This is all about patient safety. Patient safety comes first, second, third and fourth, and everything else comes down the line.

In this situation people want the truth. In any cases I have dealt with when something went wrong in Portlaoise or other hospitals in recent years, all people wanted was the truth. They can move on with their lives when they get the truth. I know of expectant mothers who were taken from Portlaoise and were diverted to Naas, half way to Dublin, because their lives were in danger. However, they were never told what happened. They have told me: "I don't want to sue them. I just want the truth so that I've ease of mind." All people want is the truth and honesty. They can cope with difficulties. Life is full of tragedies, as we all know. However, people can cope with a tragedy if they know the truth. However, if there is a double injustice on top of that with people holding back the truth, it is a very serious issue.

How many members of HSE senior management, who knew of the concealment of those deaths, got promotions over the years? I am sure some of them did and we need a review of how senior people can get promoted, not just within the Department of Health and the HSE, but in the public service. I am aware of cases in other agencies where people were involved in very serious cases that resulted in major litigation. Those officials applied for a job at a higher grade in another region. None of that gets recorded on the application form and they meet all the requirements on paper, but there is no reference to their previous experience or cases they were involved in where there was serious maladministration. Those issues need to be highlighted.

One of the things that concerned me most last week was what Mr. Tony O'Brien said. I am not taking a cheap shot at Mr. Tony O'Brien. I call it lazy politics to call for his head. He is not the sole problem. One would have to go through 50 people below him to frighten the people down the line. Every time there is a problem in an organisation, if the head changes, it does not affect the people down the line. Because he is so far up, it counts for nothing. That is the lazy approach.

When he was asked about training last week, he said it would cost €13 million to send everybody on a day's training and €65 million for seven days. However, he did not say that the HSE pays out about €90 million every year to the State Claims Agency. This is one of the problems I have encountered in the Committee of Public Accounts. When we ask HSE officials about the €90 million, or whatever the figure is that is paid out on medical negligence cases annually, they say that once a case comes in it is over to the State Claims Agency to fight it. So the HSE washes its hands and is just told to send the cheque. It is disengaged from the process and does not seem to learn. Then things are issued without admission of liability. There is an endless budget at that end - to pay for negligence - but there is no budget for proper training in the HSE. Mr. Tony O'Brien should reconfigure his mentality on that issue. The HSE spending more on training will result in less spent on medical negligence down the road. That needs to happen.

I appeal to the Minister on behalf of all expectant mothers going into maternity units. Portlaoise hospital is not unique; it is no better and maybe no worse. Some people would say the statistics in terms of the outcomes are better in Portlaoise hospital than in hospitals in other counties. There was definitely serious maladministration in how people were dealt with. They were not dealt with nicely on the day and were not dealt with nicely in the follow-up. They met senior management up along the line. Everyone said: "You're an isolated case. Go away. You're almost a crank. Go home and just accept the fate."

However, were it not for Ms Róisín Molloy and the other parents, we would not be here. If nothing else the death of her baby, Mark, and the deaths of the other children will not have been in vain, although that is no comfort to the parents concerned. I hope some good comes out of this, but it does not bring closure for the families who will always have to carry this legacy.

My final plea to the Minister is to ensure patient safety is first, second, third and fourth, and everything else follows.

I call the Minister for Health, Deputy Varadkar, who is sharing time with Deputy John Paul Phelan.

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“extends its deepest sympathies to the parents and families of babies who died or were harmed at the Midland Regional Hospital, Portlaoise;

deeply regrets the manner in which they were treated by the health service in the aftermath of their loss;

commends the families who spoke out about their experiences for their strength and courage;

accepts fully:

— the findings and recommendations of the Report of the investigation into the safety, quality and standards of services provided by the Health Service Executive to patients in the Midland Regional Hospital, Portlaoise by the Health Information and Quality Authority (HIQA);

— that accountability within the health service must reflect patient safety and patient experience; and

— that patient safety is not just about staffing numbers, the status of institutions or levels of funding but depends much more on how services are governed, managed and delivered, and on training, risk management, audit, teamwork and quality assurance;

acknowledges that the Minister for Health has:

— visited Portlaoise and met with and listened to the families; and

— issued written direction to the Health Service Executive (HSE) seeking an urgent response to the needs of families regarding case reviews, counselling and immediate supports;

recognises that:

— the Government is committed to securing and further developing the role of the Midland Regional Hospital, Portlaoise;

— the Midland Regional Hospital, Portlaoise is now part of the Dublin Midlands Hospital Group and its future role will be determined in that context;

— any change to services at the hospital will be undertaken in a planned and orderly manner guided by what is best in terms of patient safety and outcomes;

— since the publication of the Chief Medical Officer’s report, HSE Midland Regional Hospital, Portlaoise Perinatal Deaths (2006-date), last year, much has been done to strengthen services at the hospital;

— new hospital management is in place, with significantly improved clinical governance and additional key clinical staff have been appointed;

— the HSE has agreed a Memorandum of Understanding with the Coombe Women & Infants University Hospital to provide the country’s first managed clinical maternity network within the Dublin Midlands Hospital Group; and

— the clinical governance shortcomings in the Portlaoise Hospital Maternity Services identified in the report, will be addressed through the link up with the Coombe Women & Infants University Hospital; and

supports the Minister for Health’s decision to:

— establish a National Women & Infants Health Programme in order to address and improve maternity services around the country;

— prioritise the publication of a new National Maternity Strategy in 2015;

— quickly establish an Oversight Group in the Department of Health, with representation from patients, to ensure the prompt implementation of the recommendations of the HIQA Report; and

— strengthen the Department of Health’s monitoring and oversight role in relation to patient safety.”

I thank Deputies Kelleher, Browne, Calleary, Niall Collins, Cowen, Dooley, Sean Fleming, Keaveney, Kirk, Kitt, Martin, Moynihan, McConalogue, Michael McGrath, McGuinness, Ó Cuív, O'Dea, Ó Fearghaíl, Smith and Troy for giving me the opportunity to address these issues.

I begin once again by recognising the fortitude and courage of families who shared their stories and have given us the opportunity to improve things for the future, by learning from the past. Two weeks ago, in a hotel room in Portlaoise, a group of over 100 people shared their experiences with my officials, the Chief Medical Officer, my advisers and me. It was a harrowing experience but an invaluable education for us all. It is important to understand that there were many different perspectives and differences of opinion in the room that night, ranging from people who never again want to set foot in Portlaoise hospital to others who had been back subsequently as patients and had many good things to say about it.

I heard for myself how difficult it can be for patients when things have gone wrong and how hard it is to get even basic information sometimes. Quite rightly, people want to know what happened and why. They want to know that all that can be done will be done to ensure it does not happen again. Often the truth was not forthcoming even when it was known and all that could have been done to learn from mistakes was not done soon enough. Trust breaks down at the very point at which patients and their families need it most and are at their most vulnerable.

I am sorry that patients, in their greatest need, did not receive what anyone in those circumstances should expect - honesty, respect, care and compassion. Families and patients were treated very badly. While inadequate staffing levels and expertise form part of the context, this was not a resource issue alone. It costs nothing to care. Families and patients needed help and needed to know that their loss mattered. They needed comfort, information and follow-up, but did not get these things.

Honesty also costs nothing. If anything, it saves lives and money in the long run.

What is clear, above all else, is that what the patients and families at the centre of what happened in Portlaoise hospital wanted, and still want, is to ensure that other families do not go through what they experienced. They are giving us the chance to learn from what happened to them and to change how we do things. I hope that this brings them some consolation in the future. I should, of course, recognise that the number of patients and families who have had a bad experience in Portlaoise hospital extends beyond the families who lost newborn babies in recent years and beyond the maternity unit. We should remember that in our contributions. We should remember also that many patients speak well of Portlaoise hospital, based on their own experiences.

It should be remembered that in Ireland, every year, there are about 12 maternal deaths and about 450 perinatal deaths. These include stillbirths, newborn deaths and intrapartum deaths, which are, of course, much more rare. Each one is a human tragedy and a loss but these mortality rates are at, or below, the average for the developed world, and the vast majority occur for natural or biological reasons and not as a result of poor standards of medical or midwifery care, let alone negligence. While our maternity services have their shortcomings, there is little evidence to support the view that they are unsafe or that they compare poorly with other countries. This is unfair to front line staff and causes unnecessary worry for pregnant women and their partners and families. This is a serious issue that should be debated in this House, but not with a view to political point-scoring or grandstanding, and I ask the Opposition to give that some thought.

I welcome the publication of the HIQA report. As the House will know, it follows on from the 2014 report by the chief medical officer into perinatal deaths at Portlaoise hospital. The report is critical of the hospital and the HSE at regional and national level. I believe that the criticism is justified and I am disappointed that our health service was found to be so lacking in compassion and care, two core values of the service we strive to deliver. I accept in full the findings, and all eight recommendations, of the report. I want to ensure it is a watershed report that brings about real change and helps to drive much needed improvements in Portlaoise hospital, and by extension, all hospitals. I have written to the HSE director general indicating that a specific targeted local response must be put in place immediately, including the provision of counselling and other supports to the families and former patients. I have asked that a senior midwife or nurse from outside the hospital be assigned to act as a service liaison to enable an assessment of counselling or other requirements these families and former patients may have and to ensure the early provision of such services. I have also indicated that a local senior community-based manager should be assigned to act as a liaison to facilitate an early and effective response to specific issues they raised regarding difficulties accessing services locally. I am mindful, too, of the need to provide some answers to the families and former patients regarding their care, where possible, so I have emphasised the importance of a speedy completion of the individual case reviews. I expect a weekly progress report from the HSE regarding its response on the ground and the first such report is due this week.

One critical issue for me to deal with at the outset is that of resources. I have heard many people rush to judgment to say that a lack of resources explains what happened in Portlaoise hospital and adverse incidents elsewhere. They often do so before knowing the full facts, or even any of the facts. The Opposition in its motion this evening, and some others, have been cynical in the speed and superficiality of their response in this regard. I can only assume that some of these comments were made by people who have not fully read or understood what HIQA had to say about Portlaoise hospital.

At the meeting with the families and former patients, I did not hear many complaints about a lack of resources. In general, I did not hear that staff were run off their feet. I did hear that there were some infrastructural deficits and staff shortages but mostly I heard of patients being treated with indifference, a lack of compassion and empathy, a cold shoulder and a deaf ear. It is a report with profound patient safety implications. I have heard its message and I understand it. This House needs to understand it, too. A service does not become safe simply because it has a certain ratio of doctors or nurses, has been given a particular designation or status or because it has a particular location or size. That is not it at all. Safe services are those in which patients are treated with clinical competence and human kindness, in which people and families are listened to, in which staff are honest and open with patients about what they can and cannot do for them, and above all, are honest and open when things go wrong. Safe services are services where staff work as a team; communicate well with each other as well as with patients; where adverse events, complaints and serious incidents are reported, analysed and responded to as opportunities to learn and improve. They are services where audits are done regularly to show up any anomalies or differences with comparable centres. They are services in which staff being adequately trained is a given. They are services in which saying that patient safety is the top priority is not rhetoric but something real. Management teams and boards of such organisations listen to and learn from the experiences, good and bad, of their patients and staff. This has to be the standard we expect of every service, regardless of how small, where it is, what type of services it provides, its budget, status or classification.

Improvements have been, and continue to be, made at Portlaoise hospital. New management and governance structures, clinical and operational, are in place. Appointments have been made to key posts of concern in maternity and general services. This includes additional consultants sanctioned in anaesthetics, surgery, emergency medicine, paediatrics and obstetrics. Sixteen additional midwives have been appointed and approval has been given for further midwifery posts, to include shift leaders, as well as posts in diabetics and ultra-sonography. There is now a risk manager on site. A director of midwifery has been seconded from the Coombe and all emergency department patients are now under the care of a named consultant. Ambulance bypass protocols are in place.

Structural change has begun. Governance of the maternity service will transfer to the Coombe following on from a memorandum of understanding agreed with that hospital. This will become the country's first managed clinical maternity network: the first of many, I expect. This is a very significant development which will address the clinical governance and oversight shortcomings identified in the report. It will also ensure that women in Portlaoise hospital receive the same high quality maternity care experienced by women attending the Coombe. Capital investment will be required but will have to be subject to prioritisation, as in the case of all such developments around the country.

I know that questions have arisen about the future of Portlaoise hospital in light of this and previous reports. I can assure the House that the future of Portlaoise hospital is as a constituent acute hospital within the Dublin Midlands Hospital Group. The concepts of model 2, model 3 and model 4 are now largely obsolete because of the hospital groups and every hospital has a unique role within their group. I do not believe it was ever a good idea to try to classify or categorise hospitals crudely into four groups. When one considers that Bantry and Navan hospitals are in the same group and that the Mater and Cork University Hospital are in another, one can instantly see the enormous differences between those institutions, not to mention their geography. Any change to services in the hospital will be undertaken in a planned and orderly manner, guided by what is best in terms of patient safety and outcomes. This will take account of existing patient flows, demands in other hospitals and the need to develop particular services at Portlaoise hospital that are part of the overall service reorganisation in the group. We will need to ensure that any services currently provided by the hospital, which are not viable, are discontinued and we need to assure that viable services are safe and adequately resourced. Every hospital in the Dublin midlands group, large and small, will play a key role within the group. I am confident that these changes will make Portlaoise hospital a better, busier and safer hospital in the years to come.

The establishment of hospital groups is one of the most radical modernisations of acute care since the foundation of the State and is a key building block in delivering our programme for Government commitments on health reform. Hospital groups provide the optimum configuration for hospital services, for high quality, safe patient care in a cost effective manner. As hospitals move to working as part of a group, services will be reviewed and evaluated to ensure the delivery of high-quality, safe patient care which results in better outcomes for patients. In the context of the Dublin Midlands Hospital Group, relationships among Portlaoise and Tullamore, Tallaght, Naas and St. James' hospitals are being further developed, particularly in emergency medicine, critical care, ICU, surgery and bed capacity.

Maternity services in all parts of the country will be subject to review and evaluation this year, as part of the development of the national maternity strategy, which is now under way. The strategy will map the future of maternity services to ensure that women in Ireland have access to safe, high quality maternity care, in a setting most appropriate to their needs. I have established the national maternity strategy steering group to advise on the strategy. The group, which has wide representation across stakeholder groups, had its second meeting this week. It is intended to publish the new strategy later this year. Developing the strategy gives us the opportunity to take stock of current services and identify how we can improve the quality and safety of care provided to women and babies. The strategy will ensure that our maternity services are developed and improved in line with best available national and international evidence. Among those on the steering group are two of the mothers who lost babies in Portlaoise hospital, Shauna Keyes and Róisín Molloy. I want to thank them in particular this evening for agreeing to serve on the group and provide their insights.

I have also decided to establish a national women and infants health programme to address and improve maternity services across the country. The programme will span the delivery of maternity services across primary, acute and community care. Modelled on the highly successful National Cancer Programme, it will provide the leadership and have the authority to deliver the strategy and to drive reform and standardise care across all 19 maternity units.

As stated by other speakers, Ireland has a relatively low ratio of staff per birth in its maternity services. However, the number of obstetricians and midwives is increasing. In 2015, we have 123 whole-time equivalent consultant obstetricians as compared with 116 in 2011 when this Government came into office. Midwife numbers have increased significantly, from 1,189 whole-time equivalents in 2011 to 1,424 in 2015.

This ongoing increase in staffing happened at a time when the country was facing a financial emergency. This is significant and shows that the Government and the HSE protected maternity services in the toughest financial environment. It is disappointing but true to form that the Opposition has chosen to ignore this. Now that the economy is growing again we can do better.

On a point of information, I did not ignore it. The Minister is responding with a prepared script and should acknowledge what I have said.

The Deputy is correct. He did refer to it, but a Deputy who spoke after him took a different view.

Now that the economy is growing again, we can do better. Increasing staff numbers, coupled with a falling birth rate, mean that, although there is a way to go to reach OECD or international levels of staffing, the situation is improving and will continue to improve.

Spending cuts and freezes across the health service from 2008 onwards had an inevitable effect on services. However, this year an extra €2 million has been provided in the HSE national service plan 2015 to address current pressures in maternity services. It includes provision for the recruitment of additional obstetricians this year, over and above mentioned, midwives and other front-line staff.

As I outlined, the issues in Portlaoise are not directly or solely related to resources. Recent media reports have suggested Portlaoise hospital was in some way drastically underfunded compared to similar hospitals. In fact, the funding for it is broadly on a par with similar, formerly model 3 hospitals such as Portiuncula, Wexford and south Tipperary hospitals which all serve a similar sized population. The budgets for them in 2014 were as follows: Portlaoise hospital, €53.5 million; Portiuncula hospital, €54.9 million; Clonmel hospital, €51.4 million; and Wexford hospital, €52.9 million. In response to Deputy billy Kelleher's question earlier, the former Minister, Deputy James Reilly, explained that Portlaoise hospital was not included in the small hospitals framework because unlike the other then called "model 2 hospitals", it had maternity and paediatric services and anaesthetic services 24/7. Therefore, it was not comparable to other smaller hospitals.

There has been much commentary on accountability. As I am sure the House will agree, everyone involved in this matter has a right to a fair hearing in accordance with stated disciplinary procedures. HIQA does not name any individual and it is not in my power to effect summary dismissals or sanctions against persons who are not in my employment. I do not propose to comment further at this time, other than to say a number of staff have had complaints made to their professional regulatory bodies about their involvement in care in Portlaoise hospital. These complaints will be investigated in line with standard procedures and the law. In addition, the HSE is finalising an investigation in line with its code of governance and disciplinary procedures. This may result in disciplinary action being taken against some individuals in management positions.

A culture of patient safety needs to be embedded in the health service. We need a health service with the patient and his or her needs at its centre. I have a clear focus on patient safety and have ensured this has been made a priority within the HSE's annual service plan. My officials meet the HSE each month to discuss the service plan and patient safety is a standing item on the agenda. There are many facets to patient safety and several initiatives have the potential to drive significant change in the coming years. Leadership of this change, through governance and management, will be a key dimension. Guaranteeing better outcomes for patients is a fundamental principle of our health reform programme. We all continue to strive to ensure patients receive the best care possible when they need to access health and social care services. Recent reports show that we still face many challenges to ensure health and social care services are truly safe and the highest quality. I am, however, confident that implementation of the HIQA and chief medical officer's reports on Portlaoise hospital will ensure patient safety is everyone's priority and reassure patients that the services they access are of the highest quality and safe.

Before I became Minister for Health, there was a plan to create a patient advocacy agency as a sub-agency of the HSE. I strongly believe any new patient advocacy service should be independent of the HSE. That is why the HSE was told to remove the proposed agency from its service plan for 2015. My view has been supported by the recommendation made in the report on Portlaoise hospital. I plan to establish a fully independent national service before May 2016. The scope, role and functions of the service need to be considered, with the structural, governance and funding arrangements needed. My Department will consult widely on the best way to get the service up and running in the shortest possible timeframe.

Informed by HIQA reports on various hospital services and based on analysis and internal discussions on patient safety priorities, I intend to strengthen the patient safety role and functions of my Department. I will develop a significantly enhanced patient safety function in the Department, with a clear mandate for leadership, direction and oversight for national improvements in patient safety, clinical effectiveness and patient experience. This new function is in addition to other patient safety policy initiatives in progress, including legislative proposals for the further regulation of health care, patient safety provisions in the Health Information Bill and the recently completed work on the code of conduct for employers which clearly sets out employers' responsibilities in achieving an optimal safety culture, the governance and performance of the organisation.

My Department continues to progress the patient safety (licensing) Bill. However, as an interim step towards licensing, I will shortly bring a memo to the Government seeking approval to draft amendments to the 2007 Health Act. The amendments will seek to extend HIQA's remit to the private health care sector in the short term. I also intend to bring forward legislation to give effect to recommendations made by the Commission on Patient Safety and Quality Assurance to facilitate open disclosure of adverse events to patients. In the meantime, the HSE has begun to implement the national policy on open disclosure across all health and social services. The policy is designed to ensure an open, consistent approach to communicating with patients and their families when things go wrong in the provision of their health care.

The HIQA report on Portlaoise hospital called for a group to oversee implementation of the recommendations contained in the report. I have approved the composition and terms of reference of this group which will be chaired by the Chief Medical Officer and include senior officials from my Department, as well as patient representation. I have also written to the HSE director general, requesting a plan and a timetable to implement HIQA's recommendations. This plan will be used by the oversight group to monitor the HSE's progress on implementation. A named person in the HSE will have responsibility for reporting to the oversight group on behalf of the directorate on progress made on a monthly basis. The reports will be published quarterly. The House will be aware that for 2015 the Minister of State, Deputy Kathleen Lynch, and I will develop as a priority a mechanism to better monitor implementation by the HSE of the recommendations contained in previous HIQA reports. I will seek regular updates and intend to use it to drive a much improved commitment to implementation than we have seen in the past.

I want to finish by reassuring the House that I will do everything in my power to ensure the recommendations made in the report are implemented without delay. We cannot undo the loss families have suffered or the experiences patients have had, but we can ensure the lessons learned will not be ignored. I spoke about the bravery of those who had spoken out and believe there is some space for political bravery on the part of all of us here. We all have a responsibility to act as leaders, either nationally or in our constituencies, to ensure all decisions made in the health service are made on what is best in terms of patient access, safety and clinical outcomes, rather than giving in to vested, institutional or political interests. In the next few years as we implement the hospital groups we will need to consider reconfiguring and restructuring how services are delivered across them. There is a role for us all as public representatives to ensure we deliver the best health service possible, but we need to ensure that in doing so we do not approach reconfiguration through the "save our local hospital at all costs" approach; nor should it be about financial savings, rather, we need to view issues from the perspective of what is best for patients, see what services can be safely delivered in each hospital within a group and plan services accordingly.

I too express my sympathy to the families affected by the events covered in the reports we are discussing. I welcome the motion brought forward by Fianna Fáil which, in fairness, seeks to address the serious issues uncovered by the reports. I am not a parent and can only imagine the pain and hurt experienced by any parent who loses a child and his or her exasperation on learning about the substandard treatment and care dealt with in the reports.

Like many others, my interest was drawn to this issue by some of the media reports, particularly those following publication of the recent HIQA report which highlighted the basic lack of humanity demonstrated in a number of specific instances. The Minister has mentioned that investigations are under way and I do not want to get into them.

Everybody is entitled to fair procedure but I believe that patients in hospitals, particularly maternity hospitals, are entitled to be treated with a sense of dignity, respect and empathy, which at least in some of these cases appears to have been dramatically lacking. Perhaps it is symptomatic of a wider difficulty in Irish society that matters that do not directly affect ourselves or a failure in certain institutions, organisations and agencies of the State over the years to take responsibility where errors have occurred do not concern us. I hope that, arising from this discussion tonight, the investigations that are ongoing and the implementation of the recommendations that the Minister has outlined, these incidents will not occur again in the future.

I welcome the Minister's statement that the eight recommendations as they concern both the Department of Health and the HSE are to be implemented. Four relate specifically to the Department. The establishment of an independent patient advocacy service is something that has been spoken about previously. I welcome the fact that it will be acted upon. The development of a national maternity strategy is an issue that has been mentioned often in the past, and I welcome that it will now happen and that the recommendations of previous HIQA reports will be implemented.

I particularly urge the Minister to act on the fourth recommendation on his Department to expedite the necessary legal framework for hospital groups. This is a new initiative introduced by his predecessor, to some degree of controversy at the time. We were told at the time that it would take a period of months for the new networks to bed down and become effective. I urge the Minister to act as soon as he can with regard to implementing that necessary legal framework.

I do not want to correct Deputy Fleming because I do not think he was trying to mislead the House but I understand there are maternity services in South Tipperary General Hospital in Clonmel. He said earlier that there were no maternity services in Tipperary. There is no doubt that Portlaoise General Hospital covers a much wider hinterland than just Portlaoise and its county of Laois. Deputy Fleming mentioned a lack of maternity services for many years in Carlow, and likewise in Offaly and other parts of the midlands region. That is why it is important that the final four recommendations regarding the HSE, which I will not read - the Minister read them into the record - would be implemented to ensure that parents such as those involved in this tragedy in Portlaoise would never have to face such situations again.

It is important that the Minister placed on the record of the House the fact that the primary issue in regard to Portlaoise does not appear to have been specifically one of resource but more in terms of the care given to the patients, the families, the parents and the children who died. Basic human dignity is not something that the law in general is particularly good at addressing. There might have been an old Irish belief that areas like that did not particularly need to be legislated or regulated for, but the stories that have emanated in this instance about these situations from the general hospital in Portlaoise would indicate that the contrary is the case.

I welcome the fact that the Minister has decided to establish a national women and infants health programme to address and improve maternity services. The provision of maternity services across the country is a very emotive issue, and I welcome the fact that the Minister has indicated that will happen now.

On a personal level I want to express my sympathy to the families concerned and to join with the Minister in thanking those two parents he named who are taking part in the implementation group to try to ensure that the difficulties that have been exposed in this instance never happen again. As a Deputy from a neighbouring constituency I would have to say that most of the stories I have heard about treatment and care in Portlaoise General Hospital over the years have been positive. However, to say that in this particular instance the stories that have emanated from there are unsatisfactory is an understatement. The basic lack of humanity in some of these instances was staggering, and I hope we never have to revisit it again.

I call Deputy Caoimhghín Ó Caoláin who has ten minutes. I understand he is sharing his time with Deputy Brian Stanley.

The Deputy will follow me with five minutes, that is correct.

The Private Members' business before us this evening deals with the harrowing and deeply upsetting cases that we have heard of over the past number of weeks and also relates to other cases going back, in some instances, years and decades.

Táthar tar éis go leor cainte a dhéanamh le tamall ar imeachtaí ospidéal Phort Laoise. Bun agus barr an scéil ná gur tugadh cúram nach raibh ar chaighdeán sách ard agus go bhfuair leanaí óga bás. Ní féidir leis an Rialtas é sin a athrú, ach bhí sé ar chumas an HSE a chinntiú nach dtarlódh sé. Anois caithfidh an Rialtas a chinntiú nach dtarlóidh a leithéid riamh arís - leanaí óga ag fáil bháis de bharr easpa foirne agus maoinithe agus ansin go gcaithfí go dona le tuismitheoirí na leanaí seo.

I welcome this Private Members' business and the opportunity to speak on these cases, and particularly on the response of the Health Service Executive, HSE. This is something that has been grossly inadequate and, if some of the utterances reported are true, grossly insensitive and uncaring. When I commented recently on the publication by HIQA of its report into HSE oversight of services in the Midland Regional Hospital, Portlaoise, at the outset I commended HIQA’s determination to publish the report despite unprecedented pressures from senior HSE management. I was also conscious that at the heart of this report are the tragic outcomes suffered by some families, including those who lost longed-for and much-loved newborns. I again extend my deepest sympathies, and the sympathies of my colleagues in Sinn Féin, to the parents and families of all babies that have died in all hospitals across the State.

The HIQA report arises from experiences of poor care and bad outcomes highlighted by patients and families, some identified following the broadcast of the RTE "Prime Time" programme in January 2014. It is clear from the report that over a sustained period the HSE at all levels failed to adequately deal with issues relating to clinical governance and management. That this has affected negatively the quality and safety of services in Portlaoise hospital is an indictment of the HSE and of the Department of Health and Minister of the day. Most shocking were the testimonies of lies told to parents and reports that they had felt they were hated by those who were employed in oversight and caring roles.

The report tells us that there were many reasons the HSE should have maintained very close oversight of services at Portlaoise hospital, including local and national HSE inquiries into significant service failures. It is evident that while clinical reviews were carried out, findings and recommendations were not acted on or implemented. It was also found that the hospital was operating as a level 3 hospital, one which provides the full range of acute services, but that these services were not resourced nor equipped to an adequate level. It also appears that senior HSE managers were focused mainly on controlling budgets.

Money won out over patient safety. That is the bottom line. During Leaders' Questions in September 2011, the Taoiseach stated, “I can confirm, on behalf of the Minister for Health, that there is absolutely no intention of reducing Portlaoise from level 3 to level 2”. In reality, this happened in all but name. The funding did not allow it to function as a level 3 hospital. The spotlight has since descended onto maternity services and many areas of confusion still remain. The HSE published, in 2013, a report into the death of Savita Halappanavar mentioning the fact that many previous reports and recommendations, if implemented, might have led to a different outcome in her case. Despite this, we now see that even some of these recommendations were not implemented. The national maternity strategy recommended is still not in place and only this month was a steering group appointed. What is the timeline for the strategy and how many meetings has the steering group held?

Statistics in this area are unreliable. The National Perinatal Epidemiology Centre, NPEC, was not informed of a number of deaths of babies. Not only was it a tragedy for the parents but for all other prospective parents too, given that nothing was learned or changed following their passing. The data collection system must be improved. Regrettably, we can no longer trust the oft repeated claim that Irish hospitals are among the safest in the world. Some have asked questions as to why HIQA has not named the individuals involved in its report. My understanding is that HIQA is not in a position to do this legally. This could be changed, however. Although such a change would bring a level of transparency to health delivery that might unnerve some who work in the upper echelons of the organisation, it should be examined. There is also the issue that HIQA does not yet have the legal authority to license hospitals.

In the NHS in Britain, up to 19 infants and mothers died at the University Hospitals of Morecambe Bay between 2004 and 2013. An independent investigation found that of these, 11 babies would have survived if they had received the right care. An inquiry into the cases was led by Dr. Bill Kirkup, a former associate chief medical officer of the NHS. He interviewed more than 100 NHS officials, regulators and health workers, including the former chief executive of the NHS. Six staff face disciplinary hearings in front of the Nursing and Midwifery Council later this year, and others were suspended. In light of this, will the HSE review incorporate senior management in its terms of address? With the HSE drawing up the terms of reference, can we be totally sure that this review will have full scope to perform a full and proper investigation?

We still have the major challenge of over reliance on locum doctors. The Minister has told us that this reliance will be reduced. Will he tell us what progress has been made? One in six posts recently advertised attracted no applicants and we know from surveying doctors who have emigrated that poor working conditions at home were critical factors in driving them from our shores. Tony O’Brien has stated that, given that the HSE is held to account, as it should be, the organisation will take a more robust approach to the budgetary requests of the Minister. We must not forget that the HSE had requested, and was refused, additional funding over recent years. The fact that funding requests will be clearly linked with risk is to be welcome and will remove the Minister's hollow excuses of being powerless and limited by funding. This will allow an appraisal of risk and solutions for the most risky areas of the health services. The Government can then decide to address these risks. Simply put, if the HSE is not given adequate funds, how can it provide an adequate and safe service?

There are also concerns relating to the HSE investigation under way after the death of yet another newborn at Cavan General Hospital. Is this investigation under way and when will it conclude and report? While we do not know the full facts of this most recent incident, I must reflect that there are real concerns across the dependent catchment of Cavan, Monaghan and the adjoining counties. I do so most especially because no report, findings or set of recommendations has been published into any of the previous three incidents, including that of the death of baby Jamie Flynn in November 2012.

Systems failures, underresourcing and, most important, the provision of adequate trained staff, are all matters raised when these tragic outcomes are discussed. But we do not yet have the full facts, the full truth. We have no findings. We have no recommendations. The Minister must ensure that these cases are addressed as a priority and that the promised reports into previous incidents are published and the recommendations implemented. The HIQA report on Portlaoise recommended that “an independent patient advocacy service” be established. A patient safety authority should be the priority. Such a body would be able to enforce the standards laid out, investigated and reported on by HIQA. It is clear that while HIQA can make sound recommendations, they often fall on deaf ears. A patient safety authority would be able to ensure the implementation of recommendations arising from HIQA reports. Evidently, things are not working, and such a body could ensure quality and standards are kept, as they must be, across all health delivery settings throughout the State.

I welcome the opportunity to speak on this Private Members' motion. Portlaoise hospital is in the town in which I live and there have been major concerns. I express my disgust at the scandal of the disgraceful treatment of families who lost babies in Portlaoise and the way they were lied to and misled into believing their cases were isolated and that there were no similar incidents. The hospital has been under-resourced for years and no Government in recent years has set out a clear plan to secure the future and resource core services or to develop and maintain Portlaoise as a significant regional hospital. Were it not for the efforts of staff and pressure by people in the local community and political representatives, the services at the hospital would have been downgraded further a long time ago.

The HSE and the Department of Health cannot plead that they did not know what was happening in Portlaoise. In 2006, staff wrote to the then Minister for Health, Brian Cowen, to highlight the difficulties at the hospital including shortage of resources and inadequate facilities, and no action was taken. In 2007, the State Claims Agency brought the problems at Portlaoise to the Government's attention. Again, no action was taken. There have been many other whistleblowing incidents, including in 2012, when a midwife filed an incident report in which she described the treatment of a patient as "barbaric" and reported the doctor on call for negligence. The CEO of HIQA, Phelim Quinn, said "the hospital was allowed to struggle on despite a number of substantial governance and management issues over the quality and safety of services". Sufficient action was not taken at national, regional and local level to address this. We must put it behind us.

Following the publication of the HIQA report, it has been reported that at least six separate investigations are under way as a result of deaths of babies in the maternity unit. Among the main issues to be addressed are the lack of resources - physical, infrastructural and staffing - and unsafe practices as highlighted by staff members and HIQA. The Minister spent a long time in Portlaoise meeting people affected and staff at the hospital. The maternity services in Portlaoise serve a huge catchment area including all of Laois, south Kildare, north Tipperary and Offaly, and more than 2,000 babies were delivered there in one year. The accident and emergency unit is one of the busiest outside Dublin, as shown by the figures. This is due to the catchment area, the presence of the two prisons just across the road from the hospital and the fact that Portlaoise and County Laois have a number of busy arterial routes running through them, such as the N7, N8 and N80.

The statement during recent days by Mr. Tony O'Brien, director general of the HSE, that Portlaoise hospital is a "model two and a half" hospital and unsustainable highlights the failure of the HSE and Governments to date.

He went on to say the hospital's 24-7 emergency department and intensive care unit were unsustainable. An emergency department that is only open between 9 a.m. and 5 p.m. will not be acceptable to the people of Portlaoise, County Laois or the surrounding catchment area. They will have to be made sustainable.

I listened carefully to the Minister and while I accept that he is introducing measures aimed at making Portlaoise hospital safer, the Government and the HSE have a responsibility to set out a clear plan to turn it into a modern and fully developed regional hospital. That work must begin immediately. It is welcome that maternity services in Portlaoise have been grouped with those provided at the Coombe hospital. By moving between the Coombe hospital and Portlaoise, consultants will develop the caseload experience that will enable them to manage difficult cases. I am not a medical person, but I recognise that this is a sensible decision.

We will be holding the Minister to his commitment to implement in full all of the recommendations made in HIQA's report. Portlaoise hospital has to be resourced as a busy regional hospital. Adequate consultant cover must be provided for emergency, maternity, paediatric and other core services. The Minister referred to capital investment in infrastructure. HIQA was very clear in recommending that the long awaited new maternity unit be constructed. I recall raising this issue as a county councillor several years ago. Staff of the hospital have been calling for the development of the new unit for many years. I am aware that money is always an issue, but I urge the Minister to prioritise the project. In a recent visit to the hospital he stated he could not guarantee which services would be maintained. I ask him to guarantee the core services in the hospital, including the maternity unit and the 24-7 emergency department. The people of County Laois will tolerate nothing less. As a Deputy for the area, I want the hospital to be developed and improved in order that the safety of patients can be ensured.

I welcome the opportunity to speak to the motion. I offer my sympathy to the parents and families of the babies who died at Portlaoise hospital and commend the courage and tenacity of the families who brought this sad episode to the public's attention. I pay tribute, in particular, to Mark and Róisín Molloy and Amy Delahunt and Ollie Kelly who presented their case to the Joint Committee on Health and Children last Thursday.

Although I support the motion, it does not go far enough. While addressing the committee last Thursday, representatives of the families involved called on the Minister for Health to commence an independent investigation into the affair. Ms Delahunt stated:

Given this presentation, the Minister must initiate an investigation into all levels of HSE management relating to this scandal. This HSE management team is clearly incapable and cannot be trusted to implement the recommendations made in this or previous HIQA reports.

Such an investigation should go right to the top of the HSE. It must not be confined to front-line services which are understaffed, under-resourced and under-equipped. HIQA's report confirms the experiences of the families and describes the nightmares they faced. It is a damning indictment of the HSE right up to its most senior management. It notes that families were left believing there was a cover-up. They were encouraged to go down the legal route to ensure investigations would not take place. They were misled and perhaps even lied to by being informed that the incidents they had experienced had never happened previously, only to find out subsequently that a number of other families had had similar experiences. The report describes failures at local, regional and national level and a system that is dysfunctional. The system produced the opposite of the open disclosure we might have expected.

I read the report with a mixture of sadness, disappointment, frustration and anger. The lack of compassion and humanity identified in the report was particularly disturbing. It described a HSE which was not fit for purpose and which should be disbanded. The HSE should never have been established in the first place and I voted against its establishment when it was first proposed. The fact that it is not fit for purpose is made clear by the disastrous reconfiguration of services in the north east and the mid-west, as well as the huge problems in emergency departments, the 400,000 people awaiting outpatient appointments, the medical card debacle and the reconfiguration of mental health services in the south east. The Government and its predecessor cannot wash their hands of blame, Pontius Pilate-like, because one cannot cut the health budget by €4 billion and 11,000 staff and expect it to continue as heretofore. HIQA found that the hospital was not governed, resourced or equipped to provide the level of service expected from it. The chief executive of HIQA has stated the increasing pressure on maternity services at the hospital was highlighted as long ago as 2004 and that additional deficiencies in midwifery staffing levels were identified in a review carried out by the hospital in 2006. These issues were not substantively addressed until 2014, following publication of the Chief Medical Officer's report and after the damage had been done. The reductions in staffing and resources must be taken into account.

I commend Patient Focus for the help it gave to the families in Portlaoise. An independent patient advocacy authority must be established on a statutory basis because that is the only way patients will be properly advised and represented.

Debate adjourned.
The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Wednesday, 27 May 2015.
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