Seán Fleming (Laois-Offaly, Fianna Fail) | Oireachtas source

I welcome the opportunity to speak on this issue and thank my party colleague, Deputy Kelleher, for tabling the Private Member's motion on behalf of the Fianna Fáil Party. The main points of our motion are as follows:

Dáil Éireann:

extends its deepest sympathies to the parents and families of babies that died at the Midland Regional Hospital, Portlaoise; condemns the withholding and concealment of information from parents and patients; calls for patient safety to be put first and for the Midland Regional Hospital to be resourced in a manner commensurate with its status as a model-3 hospital; and [for] the recommendations of the HIQA report to be immediately implemented.

We chose to use our three hours of Private Member's time this week to raise this issue at the highest level in our national Parliament so that we can get some clear answers as to what went on within the HSE that allowed this situation to continue for so long. There have been promises to do something but very little has happened. There has been some action but it is insufficient. The HSE is now involved in a dispute over who should be involved in the review of the situation. Top management in the HSE is a closed shop and it does not want the truth to come out. It has prevented the truth from emerging for years and it is the culture among those at senior level in the HSE to protect the organisation first.

Patient safety must come first in all cases and adequate management procedures must be in place to ensure this. The Minister for Health must provide adequate resources, staffing and funding to bring this about. Staff numbers in the hospital must be brought up to an adequate level to ensure patient safety at all costs. The new arrangements between Portlaoise and the Coombe Hospital are very welcome. I fully support those developments because I do not think Portlaoise can be left as a standalone maternity hospital.

Portlaoise hospital is approximately 45 or 50 minutes from Dublin and we must have an honest discussion about it. I was born and reared in County Laois and am very familiar with the hospital. Indeed, everyone in Laois is familiar with the way health services are configured in the region. We all know, for example, that a person involved in a serious car accident goes straight to the hospital in Tullamore and does not go to Portlaoise and the same is true for patients with ear, nose or throat issues. If someone has a stroke, for example, an ambulance will take him or her straight to Naas hospital. Patients go to where the service can be best provided.There are some dedicated services in Portlaoise hospital and they should be run properly. We have a very large maternity unit there, with well over 2,000 births in most years and the next nearest maternity unit is quite a distance away. We have a very important and good paediatric unit in Portlaoise as well as one of the busiest accident and emergency units for a town of its size. There are well over 30,000 visits to the accident and emergency unit every year. There may be a dispute about the exact figure but it is of that range. Surgical procedures are carried out in the hospital but they are not of the most serious nature. To be honest, most people in Laois would not want to go into the hospital in Portlaoise for a serious, complex or complicated surgical procedure unless there was no other option.

We are close enough to St. James' Hospital and the other hospitals in Dublin. I regularly make representations on behalf of constituents waiting for hospital procedures to be carried out and often the replies come from St. James' Hospital. Laois is not isolated and Portlaoise hospital does not just provide a service for Laois. Some health services are provided in Laois but many are provided outside the county. I should also mention that there is a substantial psychiatric unit in the hospital in Portlaoise. There is no maternity unit in the neighbouring counties of Tipperary, Kildare, Offaly or Carlow so the unit in Portlaoise covers a wide geographic area. The facilities are not just for County Laois. All those attending the maternity unit expect proper facilities to be in place and rightly so. We are all agreed that it is not possible to provide every service in every hospital but where services are meant to be provided, they should be provided in a safe manner.

My party colleagues have already made reference to the issue of political accountability. I heard it directly from the Minister's predecessor, the former Minister Deputy James Reilly, that Portlaoise would be a model three hospital but the necessary funding was not provided. That said, I accept that it is not all about funding. It is also about patient care, a caring attitude, management systems, complaints procedures and so forth. The Ombudsman's office has undertaken a detailed study to ascertain why so many complaints in respect of the health services are brought to that office. The main finding of the research study was that people were afraid to complain directly. Families who are not happy with services or treatment do not want to complain in case it will have an adverse impact on the care their loved ones receive. Added to that, complaints procedures are unclear even when people do want to complain. Complaints procedures may be there in theory or may be published in a manual somewhere, but they are not clearly available and accessible to the general public. These findings are based on research from the Ombudsman's office which I saw earlier today.

Why are we having this debate today? We are having it because in January 2014, RTE broadcast the "Prime Time" special investigation into the death of four babies over a six year period in the Midland Regional Hospital in Portlaoise. The babies were alive at the onset of labour but died either during labour or within seven days of birth. It should not take a television programme from RTE for us to discuss this issue today. Why was that RTE programme made? While I am not a member of the Joint Oireachtas Committee on Health and Children, I attended the meeting last week to listen to the parents and to HIQA representatives. Róisín and Mark Molloy told the story of the death of their baby, Mark and Amy Delahunt and Ollie Kelly told the story of their child, Mary Kate. Róisín said that people in the HSE said she was a crazy woman because she just would not let it go. That is the reason we are here. She would not let it go. Most people in her situation would have let it go and accepted what they were being told, following a review and an inquiry but she would not. She said that she was described as a "crazy woman" but one could not meet a more reasonable woman, as I am sure the Minister knows, having met her in Portlaoise recently. She is a very reasonable woman and patients such as Róisín Molloy should not have to fight and be considered crazy in order to get the truth. We must thank her, on behalf of everyone who uses that facility, for ensuring that it will be safer in the future. HIQA has said that it cannot say it is safe today, the HSE says it is safe and the Minister has said that it is safer than it ever was and maybe all three viewpoints are correct.

All I want is safety because I have heard from medical personnel on the ground that expectant mothers in Laois are nervous about going to Portlaoise. Why would they not be nervous, given what has gone on there? This is affecting people's confidence in the services in Portlaoise and that must be put right. The Coombe Hospital must do whatever is necessary to improve the services in Portlaoise and restore confidence. If complex cases present and patients must be transferred from Portlaoise to the Coombe, then so be it. I am not a medical person but I assume such cases can be identified and procedures put in place to deal with them properly. Complex cases should be sent to the Coombe Hospital. Expectant mothers who are due to give birth in Portlaoise want to know that the system there is safe.

In some of the cases at the centre of this debate, babies were wrongly classified as still born, even though they were actually born alive. This was concealed by the HSE, by senior and middle management and many other people for a long time. Does the Minister know whether that is a criminal offence? Is it a criminal offence to conceal a death or record it incorrectly? It could be argued that An Garda Síochána should investigate whether criminal negligence was involved here. It is fine to have HIQA investigating such matters but sometimes a visit from members of An Garda Síochána can make senior public servants sit up more than any admonishment from their superiors, including from a Minister. Deputies will remember the incident in Bray a number of years ago when two firemen lost their lives.

It was only when the county manager was arrested for dereliction of his duties - I do not know the exact details of the case - that the management of local authorities sat up and ensured they had proper health and safety regimes in place regarding the fire service. Had the Garda not arrested the county manager on that occasion we would have carried on as normal. I think the fear of God - if I am allowed to use God's name in this House - needs to be put into the senior management in the HSE.

Based on my experience as a Deputy, I do not have confidence in the HSE to resolve this issue. I have been dealing with the HSE for 20 years in my public life. The culture in the HSE back to the old health board days is first and foremost to protect the organisation. That culture is endemic in the HSE and it will take somebody from outside to shake it up and not just at political level. It would take an organisation like the Garda to follow that up.

We have had many broken promises. We have spoken about a patient safety authority and we have not seen that coming to pass. There are many unanswered questions. This is all about patient safety. Patient safety comes first, second, third and fourth, and everything else comes down the line.

In this situation people want the truth. In any cases I have dealt with when something went wrong in Portlaoise or other hospitals in recent years, all people wanted was the truth. They can move on with their lives when they get the truth. I know of expectant mothers who were taken from Portlaoise and were diverted to Naas, half way to Dublin, because their lives were in danger. However, they were never told what happened. They have told me, "I don't want to sue them. I just want the truth so that I've ease of mind." All people want is the truth and honesty. They can cope with difficulties. Life is full of tragedies, as we all know. However, people can cope with a tragedy if they know the truth. However, if there is a double injustice on top of that with people holding back the truth, it is a very serious issue.

How many members of HSE senior management, who knew of the concealment of those deaths, got promotions over the years? I am sure some of them did and we need a review of how senior people can get promoted, not just within the Department of Health and the HSE, but in the public service. I am aware of cases in other agencies where people were involved in very serious cases that resulted in major litigation. Those officials applied for a job at a higher grade in another region. None of that gets recorded on the application form and they meet all the requirements on paper, but there is no reference to their previous experience or cases they were involved in where there was serious maladministration. Those issues need to be highlighted.

One of the things that concerned me most last week was what Mr. Tony O'Brien said. I am not taking a cheap shot at Mr. Tony O'Brien. I call it lazy politics to call for his head. He is not the sole problem. One would have to go through 50 people below him to frighten the people down the line. Every time there is a problem in an organisation, if the head changes, it does not affect the people down the line. Because he is so far up, it counts for nothing. That is the lazy approach.

When he was asked about training last week, he said it would cost €13 million to send everybody on a day's training and €65 million for seven days. However, he did not say that the HSE pays out about €90 million every year to the State Claims Agency. This is one of the problems and I have encountered in the Committee of Public Accounts. When we ask HSE officials about the €90 million, or whatever the figure is, paid out on medical negligence cases annually, they say that once a case comes in it is over to the HSE to fight it. So the HSE washes its hands and is just told to send the cheque. It is disengaged from the process and does not seem to learn. Then things are issued without admission of liability. There is an endless budget at that end - to pay for negligence - but there is no budget for proper training in the HSE. Mr. Tony O'Brien should reconfigure his mentality on that issue. The HSE spending more on training will result in less spent on medical negligence down the road. That needs to happen.

I appeal to the Minister on behalf of all expectant mothers going into maternity units. Portlaoise hospital is not unique; it is no better and maybe no worse. Some people would say the statistics in terms of the outcomes are better in Portlaoise hospital than in hospitals in other counties. There was definitely serious maladministration in how people were dealt with. They were not dealt with nicely on the day and were not dealt with nicely in the follow-up. They met senior management up along the line. Everyone said, "You're an isolated case. Go away. You're almost a crank. Go home and just accept the fate."

However, were it not for Ms Róisín Molloy and the other parents, we would not be here. If nothing else the death of her baby, Mark, and the deaths of the other children will not have been in vain, although that is no comfort to the parents concerned. I hope some good comes out of this, but it does not bring closure for the families who will always have to carry this legacy.

My final plea to the Minister is to ensure patient safety is first, second, third and fourth, and everything else follows.

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