John Crown (Independent) | Oireachtas source

I thank Mr. Quinn for his hard work on the report and for his presentation today. I mean no intrinsic disrespect when I say that the core recommendations seem to boil down to one group of administrative oversight, investigative staff in HIQA commenting on the generally inadequate administrative responses of another group of administrative staff, that is, the HSE and the staff on the ground in Portlaoise hospital. On the role of clinicians, the lack of a clinical lead is highlighted - again, the lack of a clinician who is identified as having an essentially administrative role in the running of the department. Mr. Quinn will be aware of the data presented some time ago by Dr. Michael Turner, who is the HSE lead in obstetrical care, which showed that Ireland is at the very bottom of a league table of obstetricians per head of population. The question has to be asked, how many of the problems that arose in Portlaoise or other hospitals would have arisen if an adequate cohort of fully trained specialists were available to provide the care?

Does the HIQA report provide a figure for how many obstetricians occupy posts in Ireland? How many posts are empty? How many of the occupied posts are occupied by locums? What is the average duration of a locum's appointment in the system?

It is bad enough if there are far too few senior specialists in an institution - all kinds of pathologies happen as a result of that. One of them is that far too much work is devolved to trainee doctors. The report refers repeatedly to situations with non-consultant hospital doctors. With respect, unless HIQA is taking on a role in medical education, the presence or absence of one or a million junior doctors in any hospital should be a subject of monumental irrelevance, because they are trainees. They are there to train. They are not there as service providers. The fact that we depend on them so heavily, not just in this hospital but in much larger hospitals, for the provision of routine healthcare service, is an indictment of the way that we have structured our hospital system. I know the answer to some of these questions. We have a very small number of obstetricians and we have an unusually large number of locums. I worked in two fine medical institutions in the United States and one in London before I came back to Ireland. There were never locums because the units were sufficiently large, muscular and well-staffed that they could absorb somebody going sick, having a family crisis, or having paternity or maternity leave without the necessity of bringing in locums. That is the way a good well-run system should be.

There should be enough people in place to provide cover for each other and continuity of care. That is no disrespect to the individual locums, many of whom are fine people who are good solid medical graduates and well trained. However, the very act of being temporary in a job means there will be an issue with the continuity of care that is delivered.

A number of other questions arise. Has the authority made any recommendation that there is or is not a special care baby unit in Portlaoise hospital? How many neonatologists are there in Ireland, how many are in Portlaoise hospital and how many are in that hospital group? Another question must be asked of all of us in this room, and obviously this is a fight in which I have had a dog recently. Would anybody want their child to be born in a hospital where a neonatal intensive care unit or a neonatologist specialist paediatrician was not available should they be necessary or unless one had the certainty that there was a well trained, experienced obstetrician available should something unforeseen and catastrophic occur in the course of a pregnancy?

I probably sound a little subdued because, at this stage, my morale is shot on this issue. I returned to this country 22 years ago and 21 years ago, after a respectable period of silence, I started pointing out the incredible deficiencies I saw not only in the cancer service but also in the health service in general. I see little effort or little attention being paid to fixing the fundamental problems we have. With no disrespect to the witnesses, there is a heavy emphasis in these recommendations on administrative efficiencies, on the need to appoint more people to essentially bureaucratic and administrative positions and on the need to set up new agencies. These are very subsidiary priorities in a system which is so starved of specialists that catastrophes such as those we have seen will continue to occur while we are talking about it. Good Lord, was there ever a country that found itself so much in the glare of the international spotlight for deficiencies in its obstetric services as this country - I will not personalise it - after the very well-known tragedy that occurred several years ago? To think that we are still scratching our heads and trying to work out how to get the administration in place is very depressing.