Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

To the best of my knowledge the terms of reference have not been yet decided. I welcome the Deputy's suggestions as to what might be in them. The inquiry will be independent and will be led by people who are outside the Saolta hospital group and it will also include a patients' advocate.

The reason some of the families were informed through the media was due to the fact that it was leaked to the media. I do not know who was responsible for that leak but it is very regrettable because the hospital and the other authorities should have been given time to contact the families, but sometimes things are just too good a story for them to avoid publication. I know that at least one media outlet decided not to break the story in deference to the families' wishes but, unfortunately, others did not take that approach.

In regard to the therapeutic cooling, it is important to bear in mind that while the rate of therapeutic cooling was higher in Portiuncula than in Galway, it was not outside the international range of norms and it was not that in itself that created concerns. It was the subsequent review of the cases that threw up concerns.

On staff ratios, I do not know offhand what the midwife to birth ratios are in Portiuncula or whether they are very different from other hospitals or larger hospitals. However, one aspect needs to be pointed out. In medicine and in midwifery the more cases one sees, the better, and then one is more used to seeing a difficult case when it arises. If a centre, and I not speaking particularly about Portiuncula, has 1,500 or 2,000 births, which is probably five or six a day or two or three in each shift, one is less likely to know what to do when that one in 700 cases arises. Sometimes having more staff does not necessarily make services better. What we need are senior staff and we have a difficulty getting and retaining senior staff, particularly at registrar and senior house officer, SHO, level, in smaller centres. That is a reality we face across the country. We need to be honest with people about that and the difficulties that can arise from that. When one looks at inquest reports from maternal deaths and neonatal deaths, the deciding factor is not that the staff were too busy to do their jobs, it is that they made a mistake in reading a cardiotocography, CTG, or detecting a foetal heartbeat or something else. That can often be down to lack of experience and lack of case volume rather than there not being enough staff. Certainly, what I can say, and I will be straight about this, is that there are no plans to discontinue maternity services in Portiuncula. That is not part of this Government's agenda.

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