Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I join you, a Chathaoirligh, in welcoming Mr. Liam Woods and his co-panellists. I thank him for his opening statement. I am going to address the issues, largely from a more parochial point of view, and I give notice to Dr. Finan that I will concentrate more on the Flory report, as published yesterday, and on how it reflects on Cavan General Hospital. I ask his indulgence in that respect because it is of considerable importance to the people who have entrusted me with the responsibility to represent them here. It gives me great comfort and assurance to reflect on the positive report that has been published by David Flory. It is most welcome that we had sight of the report in advance of today's engagement with our guests.

I wish to reflect on a number of points from the report. Mr. Flory makes some general statements, not just in respect of Cavan or Clonmel - that will be of interest to my colleague, Deputy Seamus Healy - but he also makes a number of very important points. He refers, for example, to cuts and the fact that they are still having a significant impact on day-to-day service delivery. We are all - people who work at the coalface and those of us who are in roles of political responsibility - are very conscious of that.

Mr. Flory also reflects, very correctly, on the fact that the absence of a clear and understood strategy for maternity services has given rise to speculation and suspicion and creates a negative environment that absorbs the energy which, in his words, "can be better used focussing on day to day service delivery. I recognise that to be the case and I welcome that it is spelt out in clear and unequivocal terms.

In the context of other matters, there is a perception about smaller units. I suppose Clonmel would fall into that category and Cavan, at which there were approximately 1,800 births last year, would also come into that general sense of scale. There is a shared perception that they are at the back of the queue when it comes to access to funding for capital works. We have had that suspicion reflected before the committee previously. We have known it with regard to other situations, namely, that someone, somewhere is planning to downgrade the sites or, even worse, to recommend closure. There is no such recommendation in this report. If anything, this is a report that substantively supports the retention and development of these sites. I hope that message would come clearly from today’s meeting. There needs to be a scotching of that fear. People should not be concerned about group relationships, as in any way undermining or impacting deleteriously in relation to existing provision.

In terms of Cavan in particular, and knowing many of the personalities involved, it is only right to reflect what Mr. Flory speaks of, namely, that it is a much greater number but, in terms of the core management of the hospital, he speaks of a small number of key individuals working beyond their contractual commitments and carrying a much broader range of responsibilities than their job titles entail. There has been a change of personnel at the hospital and the general manager with whom Mr. Flory engaged has moved on to other responsibilities. It is only fair that it would be reflected here this morning Mr. Flory's statement to the effect that Bridget Clarke sets a tone by her example of leadership, which is based on care and compassion. Ms Clarke deserves to have that highlighted in the public arena because it is absolutely the case.

The other post to which Mr. Flory refers is the clinical director with responsibility for women and children’s services. I understand that is Dr. Finan. Mr. Flory says of Ms Clarke and Dr. Finan that they are both are highly capable and that senior colleagues in the hospital have great confidence in them. As a service user in the Cavan and Monaghan area, as father of five children and as someone who has had the occasion to present before Dr. Finan - in his capacity as a paediatrician - I acknowledge that is absolutely the case and I would even add much more to it. I thank him for the professionalism and courtesy he always displays. I know that to be the shared experience of those who have presented for his professional advice and intervention through the years. I wish Dr. Finan well. Staff going beyond the call of duty is something which Mr. Flory reports. Again, that comment is deserved because it is absolutely and unquestionably the case.

There is much more in this report to which I could refer. However, I wish to get to a couple of critical points because the backdrop to all of this is the series of very unfortunate, adverse outcomes in respect of births which date back to November 2012. The reports on those cases have not yet been presented. That has in its own way given rise to increased upset and concern in the absence of clarity. I hope that where reports are available for publication, the greater number would be so published. I understand, however, that parents in any given situation may be reticent about such a course. A number of the parents concerned wish that the reports would be published and I support them in that. It would be a critical part of the journey to the restoration of full confidence across the board and the scotching of any concerns that may obtain.

I note that a number of initiatives have been taken at Cavan General Hospital to address what were perceived as areas that required further attention. I would like to ask a number of questions of Dr. Finan, if I may. Do we have strict compliance now with the national obstetric programme of clinical guidelines?

We had a practice development officer appointed last month, as of 21 September. Is that appointment RCSI Hospital Group-based or is it dedicated to Cavan hospital?

I also note that, in the preparation of the budgetary requirements for 2016, Cavan General Hospital has sought a number of additional posts, including an increase in the number of consultant obstetricians at the hospital. We currently have four approved, of which there are only three filled. In fact, only one is permanently filled. I understand two are locums. Perhaps the officials can clarify that. However, we have three, where we should have four, trying to provide cover 24 hours a day, seven days a week. It is not tenable. What is the position with regard to the filling of the fourth vacancy? I note that the hospital is seeking approval for the appointment of a fifth consultant obstetrician in 2016, which the birth numbers would justify and which is most important. I also note that there is an application for an increased number of midwifery posts included in the proposals for the estimate for 2016.

There was much public concern - I will conclude on this, and I appreciate the Chair's indulgence - that the first report on the tragic outcome in November 2012 was suppressed by a decision of the High Court. Of course there were recommendations, but the entirety of the report, by the decision of the courts, was suppressed. It is important that there is public realisation that whatever may have been entailed in the recommendations would have been picked up in any event from a number of other reports and from the general exercise in the preparation of that report, and would have been acted upon. Could the officials comment? Have the published reports - including HIQA's Galway report and HIQA's Portlaoise report, which are in the public domain - informed improvements in Cavan General Hospital? Will the witnesses avail of the opportunity to outline some of the improvements and the additional steps that have been taken in order to ensure that, where it is at all humanly possible, we will not see a further tragic adverse outcome in the maternity services at Cavan General Hospital?

I will conclude with this one remark. My youngest was born in Cavan General Hospital. At my age, I am not in the business of intending to return with my wife to Cavan General Hospital, but I would say to those whom I know so well across the dependent population that I would have no hesitation in using its services in the future.