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

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“extends its deepest sympathies to the parents and families of babies who died or were harmed at the Midland Regional Hospital, Portlaoise;

deeply regrets the manner in which they were treated by the health service in the aftermath of their loss;

commends the families who spoke out about their experiences for their strength and courage;

accepts fully:

— the findings and recommendations of the Report of the investigation into the safety, quality and standards of services provided by the Health Service Executive to patients in the Midland Regional Hospital, Portlaoise by the Health Information and Quality Authority (HIQA);

— that accountability within the health service must reflect patient safety and patient experience; and

— that patient safety is not just about staffing numbers, the status of institutions or levels of funding but depends much more on how services are governed, managed and delivered, and on training, risk management, audit, teamwork and quality assurance;

acknowledges that the Minister for Health has:

— visited Portlaoise and met with and listened to the families; and

— issued written direction to the Health Service Executive (HSE) seeking an urgent response to the needs of families regarding case reviews, counselling and immediate supports;

recognises that:

— the Government is committed to securing and further developing the role of the Midland Regional Hospital, Portlaoise;

— the Midland Regional Hospital, Portlaoise is now part of the Dublin Midlands Hospital Group and its future role will be determined in that context;

— any change to services at the hospital will be undertaken in a planned and orderly manner guided by what is best in terms of patient safety and outcomes;

— since the publication of the Chief Medical Officer’s report, HSE Midland Regional Hospital, Portlaoise Perinatal Deaths (2006-date), last year, much has been done to strengthen services at the hospital;

— new hospital management is in place, with significantly improved clinical governance and additional key clinical staff have been appointed;

— the HSE has agreed a Memorandum of Understanding with the Coombe Women & Infants University Hospital to provide the country’s first managed clinical maternity network within the Dublin Midlands Hospital Group; and

— the clinical governance shortcomings in the Portlaoise Hospital Maternity Services identified in the report, will be addressed through the link up with the Coombe Women & Infants University Hospital; and

supports the Minister for Health’s decision to:

— establish a National Women & Infants Health Programme in order to address and improve maternity services around the country;

— prioritise the publication of a new National Maternity Strategy in 2015;

— quickly establish an Oversight Group in the Department of Health, with representation from patients, to ensure the prompt implementation of the recommendations of the HIQA Report; and

— strengthen the Department of Health’s monitoring and oversight role in relation to patient safety.”

I thank Deputies Kelleher, Browne, Calleary, Niall Collins, Cowen, Dooley, Sean Fleming, Keaveney, Kirk, Kitt, Martin, Moynihan, McConalogue, Michael McGrath, McGuinness, Ó Cuív, O'Dea, Ó Fearghaíl, Smith and Troy for giving me the opportunity to address these issues.

I begin once again by recognising the fortitude and courage of families who shared their stories and have given us the opportunity to improve things for the future, by learning from the past. Two weeks ago, in a hotel room in Portlaoise, a group of over 100 people shared their experiences with my officials, the Chief Medical Officer, my advisers and me. It was a harrowing experience but an invaluable education for us all. It is important to understand that there were many different perspectives and differences of opinion in the room that night, ranging from people who never again want to set foot in Portlaoise hospital to others who had been back subsequently as patients and had many good things to say about it.

I heard for myself how difficult it can be for patients when things have gone wrong and how hard it is to get even basic information sometimes. Quite rightly, people want to know what happened and why. They want to know that all that can be done will be done to ensure it does not happen again. Often the truth was not forthcoming even when it was known and all that could have been done to learn from mistakes was not done soon enough. Trust breaks down at the very point at which patients and their families need it most and are at their most vulnerable.

I am sorry that patients, in their greatest need, did not receive what anyone in those circumstances should expect - honesty, respect, care and compassion. Families and patients were treated very badly. While inadequate staffing levels and expertise form part of the context, this was not a resource issue alone. It costs nothing to care. Families and patients needed help and needed to know that their loss mattered. They needed comfort, information and follow-up, but did not get these things.

Honesty also costs nothing. If anything, it saves lives and money in the long run.

What is clear, above all else, is that what the patients and families at the centre of what happened in Portlaoise hospital wanted, and still want, is to ensure that other families do not go through what they experienced. They are giving us the chance to learn from what happened to them and to change how we do things. I hope that this brings them some consolation in the future. I should, of course, recognise that the number of patients and families who have had a bad experience in Portlaoise hospital extends beyond the families who lost newborn babies in recent years and beyond the maternity unit. We should remember that in our contributions. We should remember also that many patients speak well of Portlaoise hospital, based on their own experiences.

It should be remembered that in Ireland, every year, there are about 12 maternal deaths and about 450 perinatal deaths. These include stillbirths, newborn deaths and intrapartum deaths, which are, of course, much more rare. Each one is a human tragedy and a loss but these mortality rates are at, or below, the average for the developed world, and the vast majority occur for natural or biological reasons and not as a result of poor standards of medical or midwifery care, let alone negligence. While our maternity services have their shortcomings, there is little evidence to support the view that they are unsafe or that they compare poorly with other countries. This is unfair to front line staff and causes unnecessary worry for pregnant women and their partners and families. This is a serious issue that should be debated in this House, but not with a view to political point-scoring or grandstanding, and I ask the Opposition to give that some thought.

I welcome the publication of the HIQA report. As the House will know, it follows on from the 2014 report by the chief medical officer into perinatal deaths at Portlaoise hospital. The report is critical of the hospital and the HSE at regional and national level. I believe that the criticism is justified and I am disappointed that our health service was found to be so lacking in compassion and care, two core values of the service we strive to deliver. I accept in full the findings, and all eight recommendations, of the report. I want to ensure it is a watershed report that brings about real change and helps to drive much needed improvements in Portlaoise hospital, and by extension, all hospitals. I have written to the HSE director general indicating that a specific targeted local response must be put in place immediately, including the provision of counselling and other supports to the families and former patients. I have asked that a senior midwife or nurse from outside the hospital be assigned to act as a service liaison to enable an assessment of counselling or other requirements these families and former patients may have and to ensure the early provision of such services. I have also indicated that a local senior community-based manager should be assigned to act as a liaison to facilitate an early and effective response to specific issues they raised regarding difficulties accessing services locally. I am mindful, too, of the need to provide some answers to the families and former patients regarding their care, where possible, so I have emphasised the importance of a speedy completion of the individual case reviews. I expect a weekly progress report from the HSE regarding its response on the ground and the first such report is due this week.

One critical issue for me to deal with at the outset is that of resources. I have heard many people rush to judgment to say that a lack of resources explains what happened in Portlaoise hospital and adverse incidents elsewhere. They often do so before knowing the full facts, or even any of the facts. The Opposition in its motion this evening, and some others, have been cynical in the speed and superficiality of their response in this regard. I can only assume that some of these comments were made by people who have not fully read or understood what HIQA had to say about Portlaoise hospital.

At the meeting with the families and former patients, I did not hear many complaints about a lack of resources. In general, I did not hear that staff were run off their feet. I did hear that there were some infrastructural deficits and staff shortages but mostly I heard of patients being treated with indifference, a lack of compassion and empathy, a cold shoulder and a deaf ear. It is a report with profound patient safety implications. I have heard its message and I understand it. This House needs to understand it, too. A service does not become safe simply because it has a certain ratio of doctors or nurses, has been given a particular designation or status or because it has a particular location or size. That is not it at all. Safe services are those in which patients are treated with clinical competence and human kindness, in which people and families are listened to, in which staff are honest and open with patients about what they can and cannot do for them, and above all, are honest and open when things go wrong. Safe services are services where staff work as a team; communicate well with each other as well as with patients; where adverse events, complaints and serious incidents are reported, analysed and responded to as opportunities to learn and improve. They are services where audits are done regularly to show up any anomalies or differences with comparable centres. They are services in which staff being adequately trained is a given. They are services in which saying that patient safety is the top priority is not rhetoric but something real. Management teams and boards of such organisations listen to and learn from the experiences, good and bad, of their patients and staff. This has to be the standard we expect of every service, regardless of how small, where it is, what type of services it provides, its budget, status or classification.

Improvements have been, and continue to be, made at Portlaoise hospital. New management and governance structures, clinical and operational, are in place. Appointments have been made to key posts of concern in maternity and general services. This includes additional consultants sanctioned in anaesthetics, surgery, emergency medicine, paediatrics and obstetrics. Sixteen additional midwives have been appointed and approval has been given for further midwifery posts, to include shift leaders, as well as posts in diabetics and ultra-sonography. There is now a risk manager on site. A director of midwifery has been seconded from the Coombe and all emergency department patients are now under the care of a named consultant. Ambulance bypass protocols are in place.

Structural change has begun. Governance of the maternity service will transfer to the Coombe following on from a memorandum of understanding agreed with that hospital. This will become the country's first managed clinical maternity network: the first of many, I expect. This is a very significant development which will address the clinical governance and oversight shortcomings identified in the report. It will also ensure that women in Portlaoise hospital receive the same high quality maternity care experienced by women attending the Coombe. Capital investment will be required but will have to be subject to prioritisation, as in the case of all such developments around the country.

I know that questions have arisen about the future of Portlaoise hospital in light of this and previous reports. I can assure the House that the future of Portlaoise hospital is as a constituent acute hospital within the Dublin Midlands Hospital Group. The concepts of model 2, model 3 and model 4 are now largely obsolete because of the hospital groups and every hospital has a unique role within their group. I do not believe it was ever a good idea to try to classify or categorise hospitals crudely into four groups. When one considers that Bantry and Navan hospitals are in the same group and that the Mater and Cork University Hospital are in another, one can instantly see the enormous differences between those institutions, not to mention their geography. Any change to services in the hospital will be undertaken in a planned and orderly manner, guided by what is best in terms of patient safety and outcomes. This will take account of existing patient flows, demands in other hospitals and the need to develop particular services at Portlaoise hospital that are part of the overall service reorganisation in the group. We will need to ensure that any services currently provided by the hospital, which are not viable, are discontinued and we need to assure that viable services are safe and adequately resourced. Every hospital in the Dublin midlands group, large and small, will play a key role within the group. I am confident that these changes will make Portlaoise hospital a better, busier and safer hospital in the years to come.

The establishment of hospital groups is one of the most radical modernisations of acute care since the foundation of the State and is a key building block in delivering our programme for Government commitments on health reform. Hospital groups provide the optimum configuration for hospital services, for high quality, safe patient care in a cost effective manner. As hospitals move to working as part of a group, services will be reviewed and evaluated to ensure the delivery of high-quality, safe patient care which results in better outcomes for patients. In the context of the Dublin Midlands Hospital Group, relationships among Portlaoise and Tullamore, Tallaght, Naas and St. James' hospitals are being further developed, particularly in emergency medicine, critical care, ICU, surgery and bed capacity.

Maternity services in all parts of the country will be subject to review and evaluation this year, as part of the development of the national maternity strategy, which is now under way. The strategy will map the future of maternity services to ensure that women in Ireland have access to safe, high quality maternity care, in a setting most appropriate to their needs. I have established the national maternity strategy steering group to advise on the strategy. The group, which has wide representation across stakeholder groups, had its second meeting this week. It is intended to publish the new strategy later this year. Developing the strategy gives us the opportunity to take stock of current services and identify how we can improve the quality and safety of care provided to women and babies. The strategy will ensure that our maternity services are developed and improved in line with best available national and international evidence. Among those on the steering group are two of the mothers who lost babies in Portlaoise hospital, Shauna Keyes and Róisín Molloy. I want to thank them in particular this evening for agreeing to serve on the group and provide their insights.

I have also decided to establish a national women and infants health programme to address and improve maternity services across the country. The programme will span the delivery of maternity services across primary, acute and community care. Modelled on the highly successful National Cancer Programme, it will provide the leadership and have the authority to deliver the strategy and to drive reform and standardise care across all 19 maternity units.

As stated by other speakers, Ireland has a relatively low ratio of staff per birth in its maternity services. However, the number of obstetricians and midwives is increasing. In 2015, we have 123 whole-time equivalent consultant obstetricians as compared with 116 in 2011 when this Government came into office. Midwife numbers have increased significantly, from 1,189 whole-time equivalents in 2011 to 1,424 in 2015.

This ongoing increase in staffing happened at a time when the country was facing a financial emergency. This is significant and shows that the Government and the HSE protected maternity services in the toughest financial environment. It is disappointing but true to form that the Opposition has chosen to ignore this. Now that the economy is growing again we can do better.

See this speech in context