Dr. Susan O'Reilly:

I am the recently appointed group CEO of the Dublin Midlands Group having previously been the lead for the cancer control programme in the country. It has been my observation since taking up this role that the major benefit that the groups can deliver will be clinical networks where we can strengthen services in smaller services and integrate a number of services with the larger ones. This is the way of the future.

I have had a lot of learning as a consequence of having Portlaoise and The Coombe as our two maternity centres within our network. Portlaoise has been, of course, in the eye of the storm. One of the challenges for all of us, including the staff there, is to ensure the provision of safe and compassionate care to patients. We are endeavouring to plan for the future. We also have to deal with the review of the past and be fair to people who have had either serious adverse events or concerns or deaths that need to be evaluated. All of these things are going on simultaneously.

Although I do not always agree with Senator Crown, I agree with him in this circumstance. One of my biggest concerns is recruitment and retention of high quality permanent staff, whether it be in consultant posts, junior hospital doctor posts, which preferentially should be training posts, midwifery, nursing, quasi-safety manager posts or a whole panoply of allied health staff. We have to get there incrementally, coming out of one of the worst possible recessions and a blunt instrument of a moratorium that has constrained management in terms of planning for the future. We are now in a position whereby resources will begin to improve but getting the staff back is going to be biggest challenge.

From my observation, it has been very helpful to be able to recruit nurses and midwives on permanent posts or term contracts rather than agency staff. I could not agree more that this is better than having a revolving door of people from agencies, whom, even if good people, because they are new to the site and the patients, make hand-overs very difficult. That is not an ideal solution, rather it is a very expensive and somewhat disjointed band-aid for the circumstances that arise in clinical care. From my observation, it has been reasonably straightforward to recruit a good cohort of midwives into Portlaoise Hospital.

It is somewhat attractive, the cost of living is lower once one gets outside the big cities and people have been very willing to come. It is harder to recruit obstetricians, so although the component-----