Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

As I did last week, I welcome the publication of Dr. Holohan's report. At the outset, it is important to say that this is not a presumption - I am certain that it is the case that what we all want to see is a safe, highest standard maternity service for women who need that service, not only at Portlaoise, but at all maternity units throughout the country. Anything that helps to ensure that is the case and guarantees it to women is welcome. It is very sad, however, that we have had to see all of this focus and light shone on failures and inconsistencies as a result of tragic outcomes. That is always very sad indeed.

I would welcome and highlight many parts of Dr. Holohan's report, but I have to ask a question. It does not anywhere in any serious way reflect on staffing levels at the Midland Regional Hospital's maternity service. It does not focus on the fact that maternity-midwifery staff had highlighted back in 2006 the serious understaffing at the Portlaoise hospital maternity service, PHMS. Why is that the case? While even the Minister acknowledged in his address this morning that failures were identified at both local and national levels, there is no doubt but that there is a failure at national level to heed the concerns of front-line maternity-midwifery staff, and those working with them in obstetrics, over a series of years and a series of Governments. We cannot simply focus in on failures of individuals or the hospital system to the exclusion of a failure to not only address a problem highlighted a number of years ago, but one that has been compounded over the period since by a continual drain on staffing provision and resourcing.

The Minister stated that had the data obtained been collated and examined it would have pointed to there being a good reason to suspect an ongoing problem with outcomes of care. The Minister also stated that birth rates had risen very quickly over a short period. How does that sit with concerns in relation to staffing levels having been raised as far back as 2006? There clearly was a cry from staff in that regard? I do not believe it is sufficient to say, as Ms McGuinness did in her concluding remarks, that in the event the HSE's review establishes that certain actions may be warranted, appropriate disciplinary action would be taken. I do not for one moment excuse any failures of the highest conduct and behaviour on the part of our hospital staff at any location. Nothing excuses it. We cannot look at this in isolation and say that is the problem while ignoring the elephant in the room, which at the end of the day must be the fact that there was inadequate staff provision. That point has been made point after time.

The INMO response to the report highlights a factual position. It is not a case of the INMO doing its business representing its members, which job it does very well, rather it is a fact of life that we have a midwife to births ratio at the Portlaoise site of 1 to 55. The recommended ratio is 1 to 29.5 births. The INMO has called for the immediate recruitment of 33 additional midwives at the Portlaoise hospital site. I would like the Minister to comment on those points and would welcome his reaction to the INMO position in relation to the need for 33 new staff. The Minister in an exchange between us in the Dáil on 13 February on this issue stated that the hospital had approval to recruit additional midwives up to the approved complement. Will he advise what that complement is? While I put that question to the Minister on the day in question he did not respond. When did approval to recruit additional midwives issue and what is the approved complement? Does it come close to the identified need of 33 additional midwives at Portlaoise hospital?

The Minister spoke in his contribution of the commencement of a midwifery workload and workforce review by the HSE. Can he advise what the timeframe is for that review and when the report will present? I note that the Health Information and Quality Authority, HIQA, is to undertake an immediate investigation of Portlaoise hospital maternity services and to report by the end of the year. Why in this instance is a timeframe of up to nine months provided when no timeframe is set out in respect of the HSE review? The Minister has indicated that a planned development of a national maternity service strategy will be delivered this year. I am trying to put each of these pieces of the jigsaw into some order. Is it possible that a national maternity strategy would be delivered in advance of some of these reviews and reports or does the Minister see it as a natural lead of one informing the other? I would welcome if the Minister could clarify that situation.

In relation to the inconsistencies referred to by the Minister in relation to perinatal data collection, will he outline exactly what inconsistencies have now been identified that have given rise to an under-reporting of perinatal deaths across this State?