Regina Doherty (Meath East, Fine Gael) | Oireachtas source

I do not have time for a chat as I have so many questions. I thank the witnesses for attending the meeting. Regarding the report issued on Friday, how does it differ from the original draft report the authority had issued to the Minister and the HSE? Did it differ substantially arising from the threat of legal action?

Second, the first recommendation is probably the weightiest, notwithstanding all of the other deficiencies. The authority talks about immediately setting up, between now and next May, an independent patient advocacy service. How does the authority understand the word "independent"? How does it envisage it running? The authority has challenged the HSE to establish it. That is a contradiction in terms in my book. This relates back to the authority's investigation team. The response of the patient safety director and his team in the HSE in the last two years to doing their job with regard to patient advocacy has been to fund and finance the establishment of Patients for Patient Safety Ireland under the leadership of a lady called Margaret Murphy who, coincidentally, was on the authority's investigation team. How was the authority's investigation team selected? I assume the authority did not find any conflict of interest because Ms Murphy is on the team but did any conflict arise before she was part of the independent investigation team, since she is on the HSE's payroll?

When the authority went to Portlaoise was it made aware of the HSE's internal patient safety culture survey which it conducted in Portlaoise last year? If the authority was, what were the findings of it? What were the recommendations of the HSE's internal review and were any of them implemented? Has the authority any thoughts as to why the HSE in Portlaoise is not using the clinical indemnity STARS database to log adverse events and report incidents, as most other clinical practices do with regard to best practice in collating data? Does the authority think it odd that, aside from Portlaoise, the HSE's patient safety agency and directorate has not conducted even one independent survey of the patients' experience, views or anything else, other than establishing Patients for Patient Safety Ireland, in over two years? In fact, as far back as 2013 it actively starved the people who were responsible, on behalf of the State, for providing independent patient surveys on patient experience and data collection, because it could not control and manipulate the data, as there was no direct connection for it.

I have two further questions, Chairman. Two matters scream for attention but they are not highlighted in the authority's report, although they were highlighted in the CMO's report. The CMO's report highlighted the fact that the 24-7 emergency services being operated in Portlaoise only have a consultant on site four days per week for six hours. What happens in the accident and emergency department for the other three days and for all of the hours there is no consultant present? When the authority went to Portlaoise to carry out its investigation why did it not immediately recommend that the 24 hour service in Portlaoise should be closed or properly manned with immediate effect? Perhaps the personnel were put in place between the CMO's report being issued in February and the authority issuing its report.

As a result of the CMO's report an additional 16 midwives were added to the staff, which is extremely welcome given the low morale and the outcomes in Portlaoise in recent years. There are 19 places in this country where one can have a baby. What is the proportional ratio of midwives to births in each of the other 18 locations and do they come up to standard as to what should be in place? If not, what are we doing about it at national level?

Finally, a question was raised today in the Chamber. There was a really tragic incident in Cavan yesterday. There was a query regarding whether HIQA was asked-----