Martin Daly (Roscommon-Galway, Fianna Fail)

I welcome Mr. Watt and Mr. Gloster. I will start with a critical situation in my area, which is Portiuncula University Hospital maternity services in Ballinasloe. The only thing we should be concerned about is the safety and welfare of women and children. That is the fundamental issue. Many things, though, make up that safety. There is deep concern in the Ballinasloe area that the maternity service has been essentially undermined. I can understand that the Minister for Health's decision is based on the best medical advice she is getting through the Department of Health and the HSE. I have to ask the question that many people in east Galway, Roscommon and the west midlands and right down into Clare and north Tipperary, are asking: how did we come to this? I have asked a series of questions on the Walker report from 2018. How all the same issues can arise in 2025 in the Coulter-Smith report that were identified in 2018? I have been told by the HSE that the Walker report was implemented in full. I can take one recommendation from the report, which was for seven obstetricians to be on staff. That has never happened. There were three before the Walker report. That was elevated to five, but my information is that there were three full-time people, one on sick leave and one with a managed contract. The figure of seven was never reached. I understand that after that the HSE and HIQA decided that six was enough. We are told the Walker report was instituted, but it is clear it was not.

There is a range of issues. There is the concept of one hospital and two sites, where there would be collaboration between University Hospital Galway, UHG, and Portiuncula maternity services. For some reason, in a bland statement, it has been said HSE West and North West decided that arrangement was not working and it broke down in June 2024. I would like to know why it was not working. Was enough energy put into it? Was there enough commitment to that concept?

In relation to training, there was a tick box regarding training on cardiotocograph, CTG, reading and monitoring during delivery. All of this was supposed to happen on foot of the Walker report. How have we arrived back at the same situation in 2025, where the Coulter-Smith report identifies all the same issues again?

On internal communications, the bleep system was not working. Is that the fault of the staff? Is it the fault of obstetricians or midwives? They are being scapegoated in Ballinasloe for what has happened there.

With regard to not having proper mobile phone services and coverage in the hospital, who is to blame for that? This is outrageous stuff.

I also have here figures from 2024. There were five stillbirths or early life deaths. Each case was very unfortunate. There were 11 in UHG. Part of the issue in Portiuncula there is that we have a situation where the HSE's own regional executive officer, Tony Canavan, at one of the Saolta meetings, identified that it is impossible to predict intrauterine death in most cases. If might be possible to reduce and mitigate the risk for it, but in Portiuncula hospital, for example, one of the cases was an ambulance turn for a woman already attending UHG maternity services but, unfortunately, suffered a bleed and had to be brought as an emergency case to Portiuncula hospital. Are we now saying that ambulance will not go there? It is recognised that her life was saved by Portiuncula maternity services, even though the baby was lost. An abruption on site in the hospital could not save a baby. Is the hospital being held accountable for that as well?

I also come back to physical infrastructure. There is a 42% Caesarean section rate. There is not a gynaecological surgical ward on the labour ward in Portiuncula hospital. Is that the fault of the staff? Is it the fault of the obstetricians? Is it the fault of the midwives?

I want to be careful with my time because I would like the witnesses to give me an answer. This is not personal, but we have a situation where a critical service in my area is not being fully supported. I want to know why the resources and the same level of scrutiny is not being paid to the situation to support it and make it safe.