Dr. Susan O'Reilly:

There was a question about access to theatres, relating to page 93 of the HIQA report. The issue here was less about access to theatres than access to a surgical team if there were two consecutive urgent or emergency caesarean sections. There are two theatres in Portlaoise. The bulk of the work in the theatres is obstetrical and the issue that arose is what would happen out of hours, at night or on the weekend, if two mothers required an urgent caesarean section. This only occurs perhaps twice or three times a year, because the theatre space is there. Last autumn, Portlaoise put in place a back-up clinical team, so it can have the additional doctors and midwifery staff on call and two simultaneous caesarean sections can be carried out should the occasion arise. That issue has been addressed.

Moving to the broader questions about guarantees regarding the disrespectful or lack of compassionate behaviour towards the mothers or parents involved where a baby has been lost through a stillbirth or a neonatal death, I can give the committee my absolute commitment for the two maternity services within our group, comprising Portlaoise hospital and the Coombe, that engagement with the family will happen immediately. It must. In my clinical practice, and I am a medical oncologist cancer specialist, and also in cancer leadership in Canada and in this country, I learned the lesson many years ago that one is only making the families or the patient increasingly miserable, angry and hurt if one does not engage immediately. One is doing no favours if staff back-off from the situation, perhaps out of their own anxieties or distress. That engagement must be there and it must be compassionate. One must have bereavement support for patients and psychological support where needed. It absolutely must be provided. I make my personal commitment on that.

One can never guarantee that babies' lives will not be lost. The committee has heard Professor Greene talk about the small numbers of babies that are documented as dying around childbirth, but the issue is how one deals with it. It is absolutely critical that we adopt and implement fully the open disclosure and also the patient support. It is still an excruciating experience, but the one message I have heard most frequently from all of the parents involved is that they do not want their child's death to be in vain and that they want to see change. I believe change is happening and will continue to happen.

In general terms, I cannot comment on the history of what took place in individual situations in 2012 and 2013. I was heading the cancer control programme then and I only got engaged in the hospital group leadership in November 2014. I cannot say anything relevant to that because I do not have that historical data. Perhaps Dr. Crowley and Mr. O'Brien could comment if necessary.

Again, I will not address the HSE approach to audit, advocacy, risk and complaints. However, as I already mentioned, we have a very effective complaints process and complaints officer in Portlaoise now. Complaints are almost all resolved within the 30 days required. An advocacy programme is beginning and we have a very highly skilled individual on site who will begin her work at Portlaoise but will roll it out for the other hospital groups as well under Liam Woods's leadership. We are doing clinical audit. We are not auditing absolutely everything, but we are auditing that we have the full engagement of the maternity staff in using all of the early warning requirements to monitor patient progress. That is carefully audited. The risk management processes have up-scaled substantially. Risks are being managed, documented, reviewed and recorded.

As an aside, I have taken over commissioning some of the investigations that were already ongoing. I agree that some of them have taken too long. I also agree that part of the issue is that it is not easy to have obstetricians or other clinicians volunteer their time to do this work on top of their day job. They also require indemnification from their professional bodies and a number of other structures to be put in place. However, I can certainly commit regarding any of the reviews I have taken into my office that if anybody gets in touch with my office we engage right away and if reports are to go out we are endeavouring to get to the end of the road. There are still some legacy delays that I am endeavouring to manage at present and some communications, but that is ongoing. That includes some of the work being done by Dr. Peter Boylan and his team in respect of maternity complaints.

Walk-arounds are happening. The culture of safety is embedded in the maternity services at Portlaoise hospital and also is in progress in the general hospital services. In regard to the operation of continuous cardiotocographic machines, CTGs, all midwives receive the required training as part of their electronic module. Each new member of staff is signed up to attend a workshop, with workshops being held approximately every two months. Staff are mandated to undertake the electronic training and, in addition, shift supervisors and the director of midwifery will supervise, engage and continue to instruct. Learning does not just involve a single e-module or workshop; it is a continuous, lifelong clinical improvement project. It is important to state we now have people well trained at the midwifery and junior hospital doctor level and that we intend to sustain this. In addition, we have staff trained in ultrasound technology to a higher degree than was previously the case.

I hope I have covered all of the questions addressed to me by members.