Ms Mary Dunnion:

The need for staffing was certainly identified by the hospital. Members of the investigation team identified that the rise in maternity rates was a national issue; it was happening in all maternity hospitals across the country. We do know, however, that in terms of recruitment, the response was slow. Even if posts were sanctioned, it took a long time to recruit staff. This, coupled with the rate of staff leaving, meant that the hospital was on the back foot in the context of staff numbers.