James Reilly (Dublin North, Fine Gael) | Oireachtas source

I thank the members for their contributions. Nobody here does not wish to have this problem fixed. In the past there was a sense that when hospitals became unsafe, reports were carried out to confirm the fact that they were unsafe, and to use that to close them down. That will not be the case here. This report will be used to fix the service.

Deputy Kelleher raised a number of issues. Some of his questions are better directed towards Dr. Holohan, such as what are the other organisations alluded to in respect of having information. I am acutely concerned about the issue of bringing concerns and patients' concerns to the fore. That is the reason I wish to set up a patient safety agency this year, in order that people will have a patients' champion and advocate who is clearly on their side to pursue their issue, whether it is something dreadful and tragic as happened in Portlaoise or just a small matter. It will be there to support the patient, to pursue their issue with them and to direct them how best to get satisfaction. I have stated on the record many times that what most patients want, in my experience, is an acknowledgement that something went wrong, an apology for what went wrong and an assurance that it will not happen again because things will change. That is at the root of the problem in Portlaoise. Reports were produced and recommendations were made, but they were ignored.

That brings me to a broader point, which the report addresses. It is the fact we do not have an outside monitoring system for the implementation of recommendations of various reports throughout the country. One of the recommendations in the report is that HIQA should engage in such a monitoring process. The patient safety statement and patient surveillance will aid that. What Deputy Kelleher alluded to and what Dr. Holohan discovered is that the information was available if one went looking for it in different places, but nobody was collating it and putting it together in order that they could see there might be a problem and it should be checked. What we are depending upon is the bravery and tenacity of parents in this case or somebody in the hospital to put up their hand. That is not a good system. We must have a monitoring system whereby we can objectively identify something. It is like a fire alarm. It might be nothing or it might be something really serious, but we must have a system in place that alerts us to it.

I welcome open disclosure. We opened a conference on it and it is running on a pilot basis. Dr. Holohan was there that day with the HSE. There is great acceptance of this throughout the system and people see the value of it.

The Deputy mentioned the GP contract and the line that is being interpreted by GPs with some concern about what they see as a gagging clause. I wish to put it on the record that, as Minister for Health, I would not preside over a situation where people could not voice their concerns. However, I am equally aware that many employers have a line in their contracts which ask people not to bring the organisation into disrepute. That is more about behaviour, not about not voicing one's concerns. I point out that the wording in that area can be changed in order that it does what it is supposed to do, which is remind people of their responsibility to the organisation in terms of not bringing it into disrepute, but by no means does it infer that they are gagged or cannot speak out if they are concerned about what they see as wrong, unsafe or any other concern.

In these situations a balancing act is required. On the one hand we must hold to account individuals who have failed in their duty. On the other hand we do not wish to have a witch hunt. We certainly do not want the morale of the staff in Portlaoise, many of whom are excellent people, to be further damaged. We must support them to grow and give of themselves, in a way they had always intended, to the local people. All the parents were very clear with me.

They did not want the service closed but made safe and I support their wish 100%. That is what the report is about.

I regret that some people feel the report is a whitewash, but I do not think it is. If one listens to the parents - and I have listened to one on the radio who made it very clear - they had all of their concerns written down and when they read through the report they were able to tick every box because each concern had been addressed. Notwithstanding the cynicism that sometimes surrounds this House, we listened, we heard and we took things on board. As I said in my opening remarks, we must ensure that we do not fail parents and patients again by not ensuring that the lessons learned here are learned not just in Portlaoise but right throughout the health service. That is what HIQA monitoring will ensure.

Members also asked about local complaints procedures, and Dr. Holohan will address the matter in a more cogent way than I could, but I will simply say that people do get frustrated. Most hospitals have a complaints officer. If people do not get satisfaction they will resort to the law, because that is the only way for them to get satisfaction. What the parents had to endure was shocking; there is no other way put it. It is astonishing that one must go to court to get one's notes. We now have an opportunity to change the culture completely. I am at pains to point out that this is our health service - everybody's - and it behoves us all to be engaged and to change it to one that we would want for ourselves. Tony O'Brien sent a letter to staff two weeks ago and made it clear to them that people should be treated with respect and compassion in the same way they would want their loved ones to be treated. Deputy Catherine Byrne mentioned - and I agree with her - that it must be key, and everybody here is in agreement about that issue.

Deputy Ó Caoláin raised the issue of staffing levels. In response to his query and that of Senator Crown, nobody is saying that staffing levels might not have had an impact in this case. We are saying that it does not explain it all. It does not explain, when there was nobody else in that unit on a given night, how the failures occurred; it does not explain the culture and attitude. What was done was unacceptable at a human level and we must change that. Nobody here would disagree with my wish.

I shall pass a few specific questions to Dr. Holohan. I have addressed the issue of the early warning signs and HIQA reporting and monitoring. Dr. Holohan can talk about the approved complement of the HSE, because I do not have that information to hand. The workforce planning will be finished by the end of the second quarter of this year. The plan will inform all of the national maternity strategy, as will other reports that are available to us.

Obviously everybody is very concerned about the perinatal death statistics if they are not accurate. We have found that to be the case and so we will improve the situation. We must have evidence in order to make proper decisions on health care, and information technology will help. However, information technology is only as good as the information that is fed into it. There was the old acronym GIGO, which means "garbage in, garbage out". We must ensure that information is collected properly.

Deputy Healy raised the issue of nursing concerns and staffing levels, which will be addressed by Dr. Holohan. Senator Colm Burke talked about low staffing levels and wondered whether that was still the case. He asked for the ratio of consultants to patients and deliveries, and asked what were the normal or internationally recommended ratios and how much managerial change has taken place since 2005. Perhaps the HSE will address these matters.

Obviously the coroner delays are of great concern. We want to see changes in the coroner's approach. Sometimes we do not need to legislate but we must outline definitions, and there must be a willingness to change. My view is very clear: there should be an inquest in respect of any baby that dies once labour begins. This will deal with what some parents felt was an attempt to label deaths as stillbirths so that they would not require an inquest. There has been a huge breach of trust at so many different levels here. We will rebuild the trust. We will turn Portlaoise into an exemplary hospital over the next number of years.

I have already addressed the issues raised by Deputy Catherine Byrne. She did mention that patients should be treated with compassion, kindness, care and safety. No amount of kindness and compassion can make up for incompetence.

I will let Dr. Holohan deal with Senator Crown's assertions. Deputy Neville asked the pertinent question of whether this is happening elsewhere. I want to be assured that it is not happening elsewhere but I cannot be assured of that at the moment. That is why we are reviewing other maternity hospitals of a similar size, and all maternity hospitals, to ensure that the recommendations that came out of the tragic death of Savita Halappanavar will be and are being implemented. I cannot be sure that this has happened. With no disrespect to the HSE or the people who work in hospitals, it is not good enough for us to just accept it when a hospital says it is doing something and that is the end of it. We must satisfy ourselves that hospitals are doing what they say they are, and so we must have outside monitoring. A question was asked about whether something triggered this case. Back in 2005 it was a cultural thing that seemed to grow at the hospital. I will ask the chief medical officer to address the remainder of the questions.