Dr. Susan O'Reilly:

It is multi-factorial. One of the issues for midwifery is having the positions ready at the times people are coming out of the programmes and not making the role so unattractive because of all the difficulties and emotional experience for staff in dealing with tragic events for patients and some of the fallout from that. There is a huge morale issue around recruitment into midwifery. However, we have been very successful in Portlaoise in this regard.

Obstetricians and junior hospital doctors are looking for a career path that will sustain them and there are multiple elements involved. They have to be working in a collegial environment in a good location, so facilities matter. They have to be well supported, with access to the resources they need to do the job well. They need to feel that they will be compensated at a rate comparative to some of the other circumstances, and often to have opportunities for research teaching and other elements of care. Therefore, it is very much multi-factorial.

In terms of where we have gone since the HIQA report on Portlaoise - and, in fact, well before that - there is a clinical network between Portlaoise and the Coombe, which had already begun to evolve some time ago. This network operates well. Women with complex medical problems will be referred to the Coombe from Portlaoise. Women who are in premature labour or at risk of premature labour are referred for an opinion. They may or may not choose to deliver them there. We have infant transportation for children who need intensive care and that works extremely well on a 24-7 basis throughout the country. That network certainly works well.

As regards the journey we are on now with the Coombe, we are in the process of doing a legal integration of governance and management where the hospital will run its services on two sites. To that end, there has been a huge amount of work done. First of all, we have been approved for more recruitment of obstetricians and neonatologists. However, we have been very careful to plan to advertise these as joint appointments next January. The next cohort of trainees will become available 180 days later. The sense was that if we advertised as Portlaoise posts on their own, they would not be as attractive as joint posts. We also planned the timing to match the output of people coming along. There are two obstetrical posts which will be joint and two neonatal posts which will be joint. These will be advertised in January as a result of both the timing issue and the likelihood of success.

There is a director of clinical integration on site - Dr. Michael O'Connell from the Coombe - who has worked out all of the clinical pathways through a series of workshops with both hospitals across the entire spectrum of maternity, delivery, outpatients, neonatology and dealing with grief and bereavement. These will now go out to patients as well as staff to say "Was my journey like that in these hospitals and has it worked for me? Can I give input?". That work is ongoing.

We have been examining how we build an integrated information technology between the two hospitals. The Coombe has an old one, Portlaoise has none. We need that for clinical audit, to see how we are doing every step along the way. There is clinical audit but it should be automated to make sure we know what is going on. The direction of travel is that I anticipate that at some point in 2016 we will have formal governance and management from the Coombe. Building success, however, must be based on these steps along the way. Management is critical: there is a need for clinical leadership, a lead obstetrician, a strong general manager for the service and there must be quality and safety. There must also be complaints management within the system. Joint reviews of adverse events that are noted and integration with Mr. Patrick Lynch's programme to ensure we are very careful to evaluate why, for example, a baby died. Sometimes a death is not preventable, while on other occasions it might be.

It is really important that we engage with patients. I know that Mr. Woods is setting up a programme of patient engagement for the groups that we can roll out across the country and Portlaoise will be one of the lead groups there.

I would be happy to take any further questions on any of those elements.