Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses and thank them for the publication of the report. When speaking about this report, we must be mindful that it came about because of the very tragic circumstances that arose for at least five families involving the maternity services in Portlaoise and elsewhere.

In 2008 there was an investigation carried out into the misdiagnosis of breast cancer in Portlaoise. Is it within HIQA's remit to monitor, visit, or assess a hospital? Were alarm bells ever raised in the period prior to the Minister's request for HIQA to carry out an investigation under the 2007 Act? The 2008 investigation showed difficulties in governance and patient safety. Will Mr. Quinn clarify whether or not HIQA engaged with the hospital in these areas?

The report is damning. We cannot assess it any other way. It calls into question accountability and commitments in terms of basic governance and patient safety, not only in the context of maternity services but right across the spectrum of services provided at the hospital. Mr. Quinn has said that there must be a designated, named person in the hospital who is responsible for patient safety. Did Mr. Quinn find in his investigation that there was a complete absence of accountability in terms of people's roles and responsibilities?

From reading the report and the executive summary, it seems that there was very little emphasis put on patient safety at local, regional and national level, right throughout the HSE. Red flags were being raised on a continual basis and some people would say that there were alarm bells ringing everywhere, yet there seemed to be inactivity or an inability to understand the seriousness of the situation. Was the weakness at local or national level or was there just weakness across the whole system right to the top in terms of understanding the deficiencies in the hospital itself? Will Mr. Quinn provide clarity on that?

The chief medical officer's report was also damning. It spurred some activity in terms of addressing some of the deficiencies but, again, this seemed to be quite lethargic, in spite of the recommendations made in the report and the findings made before HIQA began its investigation under the 2007 Act. It seems that there is quite a distance to go, even on the recommendations that were outlined in that report, which was published over a year ago. There is still no lead clinical obstetrician or proper safety governance in place. At present, HIQA cannot say with 100% certainty that all services are being operated in a safe manner in Portlaoise. That is clearly something that gives rise to concern. I do not want to fuel fear or concern but I believe that the public have an entitlement to believe that when they engage with the HSE, as its stated mission is to provide safe care, that they receive this, at the very least. That does not seem to have been part of the culture at Portlaoise. Serious deficiencies were exposed in 2008 in the breast cancer misdiagnosis but there were concerns from as early as 2004 about the lack of resources in the maternity and midwifery services, and about the lack of consultant leads, not only in maternity but throughout the hospital.

Mr. Quinn has referred to the State Claims Agency, and the report indicates that it corresponded with the HSE. Did it express concerns about the number of claims coming from the hospital? Were those claims in relation to maternity services or were there other claims coming from Portlaoise hospital? In that correspondence, does the State Claims Agency outline that something should be done to address the number of claims? Was the hospital informed that it was out of kilter with other hospitals of similar size?

I have asked a lot of questions but there is a lot in this report.