Ms Mary Dunnion:

Yes. The recommendation is that, irrespective of whether it involves a hospital or a group of hospitals, it publicly state the types of service it has been equipped and resourced to provide and what it can safely deliver.

In the context of the numbers of staff available in the maternity unit, additional staff have been put in place. This very action suggests staffing levels were inadequate. However, when the investigation team looked at staffing levels in the hospital, it was unable to ascertain what were the actual staffing levels in the maternity service or the general service because it was given a global figure for the whole hospital. We were not able to determine what were the staffing levels in different areas. More importantly, no one can tell us what the actual staffing levels in a maternity hospital should be. That is why in 2013 we emphasised the need for a maternity strategy to begin to identify what the staffing levels should be because in the absence of such a strategy, it is speculative. We know that the hospital was challenged to keep its staffing levels acceptable, as determined by it. There were several reasons for this. If a member of staff left, for example, it was almost impossible to obtain sanction to recruit. If sanction was given, it was a protracted process and took ages to get someone new into the system. As a consequence, the hospital was reliant on agency staff all of the time. That raises issues because different people are reporting for work, they have to learn the ropes, be supervised and so forth. There were resource issues at Portlaoise hospital which were not unidentified. In fact, the hospital had been identifying them continuously at a local level and had escalated them at regional and national level. They were then de-escalated regionally again. There is a plethora of documentation which shows this to be the case. All we know, to address the issues identified and make the maternity service safer, staffing numbers had to be increased. This was done in 2014.