Ms Mary Dunnion:

It was sad to listen to patients' experiences. It is good to know that controls have now been put in place in Portlaoise hospital to provide that if a woman has that tragic event, a single room will be provided where she can be managed and cared for. A bereavement counselling service has be put in place in the hospital which will help in that situation, but that facility and that service were not provided until those tragic events came to the fore.

We were asked whether Portlaoise hospital was safe. I do not think anybody can say that any hospital is safe, because risk is inherent in all clinical services. When we looked at maternity services we relied very much on our obstetric experts, and Professor Jimmy Walker was the main expert. He would have said that the majority of patients going through the maternity services in Portlaoise hospital are safe because they are normal healthy ladies expecting a baby and delivering a baby, and that the concern arises where there are patients with risk. As my colleague outlined, we need to be able to transfer that patient in the right time and manner to another hospital. We see the memorandum of understanding, that network with the Coombe hospital, as being the essential determinant of that.

It will not get rid of all risks, as there is always risk in hospitals.

In the context of critical service provision, by virtue of its layout, the intensive care unit is not conducive to providing a service to the level one would expect in 2015. There is no confidentiality or privacy for people. It is a poor facility. The anaesthetists who are primarily in charge of a ventilated patient do excellent work. In Portlaoise hospital they moved patients very quickly when they needed to do so, but the question is whether the service can continue in that way. From the point of view of HIQA's investigation, the answer is no. The infrastructure is not good and the clinical staff would identify that they need to get the pathways right. The recommendation about having hospital groups is not about diminishing the role of any hospital but ensuring the pathway for patients is safe. The same applies to surgical services. There were just not enough major cases in Portlaoise hospital to ensure the surgeon remained competent. It is not a matter of questioning his ability. It is like anything else - the more often one does something, the better one becomes at it. The hospital did not have a sufficient volume of cases. It dealt with 6,000 surgical cases per year, but only 49 of these were major. It is a tiny number of cases to ensure sustainable delivery of the service. These were not the findings of the investigation team only; they were also the findings of the HSE which reviewed the service and made the same findings. Therefore, in the context of accountability, the issues were known and it was a source of huge concern for our investigation team that they had remained unaddressed. That was the position as we had found it and reported accordingly.