Dr. Susan O'Reilly:

I am the new CEO of a very new hospital group, the Dublin midlands hospital group. I was appointed in November 2014. The HIQA review of the hospital concluded in mid-October 2014, so I arrived after that. Subsequently, I met HIQA to brief it on governance changes in particular. I recruited my small management team. We are a small, focused group. Its members came on board in March and April. We lead the development and integration of clinical networks across seven hospitals, those being, St. James's, Tallaght, the Coombe, the St. Luke's radiation oncology network and the three midlands hospitals of Naas, Portlaoise and Tullamore.

One of my first actions after arriving was to assess the situation based on some of the feedback from a variety of reports, for example, from the HSE and the Chief Medical Officer, and on listening to and learning from Dr. Colm Henry, clinical adviser in the national clinical programme, and five of his national clinical leads for acute services. Dr. Henry may comment on that process in due course.

My first change was to clear up clinical governance within the midlands hospitals, particularly Portlaoise, so that there was no risk whatsoever of any physician being confused about to whom he or she reported. In January, my next act was to appoint a new management structure for Portlaoise and to mimic it across the other midlands hospitals. This change led to having a general management level individual who was the lead for all operations in the hospital, with clinical leads reporting to that person for operations and the professional leads - nursing and clinical director - reporting to my group's individuals in those roles who were their professional practice and strategy advisers.

Operations remain the responsibility of the hospital, with which we have maintained and developed a close working relationship.

While we are dealing with the topic of maternity services, I will be more than happy to address other areas in due course.

In respect of maternity services, even before my appointment, there had been substantial change, some of which was outlined by Mr. O'Brien. The appointments of a general manager and a director of midwifery have been enormously successful in beginning the process of changing the culture within the hospital. Cultural change takes time to develop. Staff must feel supported. A balance must be struck between identifying staff who are significantly and consistently under-performing and who should, perhaps, undergo a fitness to practise or disciplinary process and those staff who may have made a clinical judgment call that in retrospect was not right.

The families who presented to the committee have suffered terrible losses and rightly complained about how they were treated. Often, clinical staff, in particular nursing, midwifery and allied health staff, are afraid to be open because they are afraid of the shame and the blame. It is our job to balance ensuring appropriate discipline for under-performance with appropriate support and open disclosure. These two elements can sometimes counter-balance each other and it takes a while for that culture to evolve. The new director of midwifery, the new clinical lead appointed last year prior to my appointment and the new manager began that change. We are investing in quality and safety complaints management and elements of patient engagement. To date, 16 additional permanent midwifery staff have been appointed, bringing total staff numbers to 72. Another obstetrician has also been recruited, bringing the total number of obstetric staff to four. More particularly, the memorandum of understanding with the board of the Coombe hospital, the infant and maternity hospital, was signed by me and the board chairperson in March. The process of the Coombe hospital taking over the governance and management of a Coombe hospital on two sites, in Portlaoise and the Coombe, is under way.

A director of clinical integration from the Coombe hospital went on-site over one month ago. The role of the director of clinical integration who is a senior obstetrician is to integrate and standardise clinical pathways and policies across the groups. In the interim, there has been progressive and completed work on ensuring appropriate training for midwives in CTG, cardiac monitoring for the foetus-baby during pregnancy and delivery. There has been consistent development and implementation of policies for the safe use of the drug oxytocin and considerable investment in the restructuring of maternity services in that there are now shift leads to whom midwives delivering babies can go, as well as the medical staff. We also have a bereavement support midwife, breast-feeding support, midwifery education support and a number of other structural changes that give confidence to midwives who are in the field delivering babies and working with the medical staff that they have a structure to support them in their education, development and training.

There have been substantial improvements to date at Portlaoise hospital. Although born out of tragedy in terms of the Chief Medical Officer's report and the "Prime Time" programme, we have landed in a good place. We must thank the families for their pursuit of and engagement with excellence. We are achieving consistent and safe services today which will continue to get better as we move towards the new networked model of the Coombe hospital on two sites.