Mr. Liam Woods:

Yes, it reflects in recruitment generally. We are having difficulty recruiting and retaining staff. Some of Senator Colm Burke's points on staff experience come to bear there, both in recruitment and retention. We face significant challenges in these areas.

The implementation of the recommendations of these and previous reports was raised. It is my responsibility to report to the Department of Health and the chief medical officer on the recommendations of the Portlaoise report. I have a process under way to do it, we are working on it and the recommendations are being implemented on the ground across the country. We can discuss it in more detail another time if it is helpful. We also have recommendations on the back of the two reports we have just been discussing that need to be implemented locally. Those reports are being used by all the hospitals and groups to review what may be required across the 19 units. This assessment will come back to me. We have a process in place for it. We have examined all previous HIQA recommendations - there are more than 270 - to be sure we are implementing them effectively, where required. The HSE has a process under way at a detailed level to cover it.

Touching on Deputy Ó Caoláin's point, we also have requests directly from parents to publish reports in certain instances and we are seeking ways to do it. We will be happy to report further on it. The timing of reports is an issue for us. As the number of inquiries, investigations or reviews we have to undertake grows, there is a challenge in the system regarding capacity to provide speedy reports. While it is a requirement and is part of what we must do, it is also a concern for us. We are seeking ways to accelerate it and Mr. Lynch may talk about it later. We recognise that faster access to senior clinical review may help in certain circumstances without any lengthy delays, and we are evaluating it.

Regarding stress on staff, I am aware of cases in which midwives who have attended a coroner's court have struggled to return to work. There have been cases in the High Court. Obstetrics is an area of high litigation. The committee is aware from previous dialogue that more than 50% of claims dealt with by the State Claims Agency are related to obstetrics. It is very litigious and very demanding and stressful on staff. Our staff surveys indicate that there is a high degree of stress. Actions that have been taken previously in that regard would relate to use of employee assistance programmes at a local level. There is a wider challenge to us to say how we support people and what revised national policies we might need to put in place for it, given that there are issues, both before and after incidents, with which we need to support our staff.

Practice in this regard varies across the country. There are good examples of this support being in place but there are also deficits.

I referred to the obstetrician numbers. I will ask Mr. Lynch to address the Ombudsman report and complaints to that office. I will then ask Dr. Finan to answer the specific questions on Cavan.