Mr. Kilian McGrane:

In Portiuncula, a number of babies were referred for cooling. It was picked up within the Saolta hospital group towards the end of 2014 after six babies had been referred. It is very hard to know, considering international evidence, what is the tipping point. The Deputy has made very valid points. We were here in February and spoke about the need to implement serious incident management forums for maternity services only. Had they been in place in the Saolta hospital group at the time, there is a very good chance that some of these issues would have been picked up earlier. There was a comprehensive review carried out by Saolta long before Professor Walker's report was commenced. It identified almost all of the issues, and Professor Walker's report confirms that point. Most of those things have been implemented at this stage or are in the process of being implemented.

The core point the Deputy is making is absolutely valid. We need specific focus on maternity services in terms of incident reviews, but the broader issue is the governance of maternity services, which involves the maternity networks. We are absolutely committed to achieving that. It is being progressed in the Saolta group, which is moving from what it currently has to what it is describing as clinical business units. It is the same concept; a clinically managed network that ensures that the smaller units do not operate in isolation but rather work in collaboration with the bigger units. One of the developments Saolta has come up with is the creation of an integrated unit between the site at University Hospital Galway and the Ballinasloe site. On Deputy O'Connell's point about the safety of the unit, safety is one of the core elements. Professor Walker was at pains last week to stress that developments on the Portiucula site are significantly different, and that for normal risk women - I appreciate that it is very hard to define a normal risk woman - Portiuncula is appropriate and safe. Professor Walker appeared before the committee last week. We have done many of the things we needed to do in the last period.

The core point made is very valid about how we trigger something before it becomes a major issue. We have the tools available to us, and we need to make sure they are fully implemented.