Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

The Deputy will follow me with five minutes, that is correct.

The Private Members' business before us this evening deals with the harrowing and deeply upsetting cases that we have heard of over the past number of weeks and also relates to other cases going back, in some instances, years and decades.

Táthar tar éis go leor cainte a dhéanamh le tamall ar imeachtaí ospidéal Phort Laoise. Bun agus barr an scéil ná gur tugadh cúram nach raibh ar chaighdeán sách ard agus go bhfuair leanaí óga bás. Ní féidir leis an Rialtas é sin a athrú, ach bhí ar chumas an HSE a chinntiú nach dtarlódh sé. Anois caithfidh an Rialtas a chinntiú nach dtarlóidh a leithéid riamh arís - leanaí óga ag fáil bháis de bharr easpa foirne agus maoinithe agus ansin go gcaithfí go dona le tuismitheoirí na leanaí seo.

I welcome this Private Members' business and the opportunity to speak on these cases, and particularly on the response of the Health Service Executive, HSE. This is something that has been grossly inadequate and, if some of the utterances reported are true, grossly insensitive and uncaring. When I commented recently on the publication by HIQA of its report into HSE oversight of services in the Midland Regional Hospital, Portlaoise, at the outset I commended HIQA’s determination to publish the report despite unprecedented pressures from senior HSE management. I was also conscious that at the heart of this report are the tragic outcomes suffered by some families, including those who lost longed-for and much-loved newborns. I again extend my deepest sympathies, and the sympathies of my colleagues in Sinn Féin, to the parents and families of all babies that have died in all hospitals across the State.

The HIQA report arises from experiences of poor care and bad outcomes highlighted by patients and families, some identified following the broadcast of the RTE "Prime Time" programme in January 2014. It is clear from the report that over a sustained period the HSE at all levels failed to adequately deal with issues relating to clinical governance and management. That this has affected negatively the quality and safety of services in Portlaoise hospital is an indictment of the HSE and of the Department of Health and Minister of the day. Most shocking were the testimonies of lies told to parents and reports that they had felt they were hated by those who were employed in oversight and caring roles.

The report tells us that there were many reasons the HSE should have maintained very close oversight of services at Portlaoise hospital, including local and national HSE inquiries into significant service failures. It is evident that while clinical reviews were carried out, findings and recommendations were not acted on or implemented. It was also found that the hospital was operating as a level 3 hospital, one which provides the full range of acute services, but that these services were not resourced nor equipped to an adequate level. It also appears that senior HSE managers were focused mainly on controlling budgets.

Money won out over patient safety. That is the bottom line. During Leaders' Questions in September 2011, the Taoiseach stated, “I can confirm, on behalf of the Minister for Health, that there is absolutely no intention of reducing Portlaoise from level 3 to level 2”. In reality, this happened in all but name. The funding did not allow it to function as a level 3 hospital. The spotlight has since descended onto maternity services and many areas of confusion still remain. The HSE published, in 2013, a report into the death of Savita Halappanavar mentioning the fact that many previous reports and recommendations, if implemented, might have led to a different outcome in her case. Despite this, we now see that even some of these recommendations were not implemented. The national maternity strategy recommended is still not in place and only this month was a steering group appointed. What is the timeline for the strategy and how many meetings has the steering group held?

Statistics in this area are unreliable. The National Perinatal Epidemiology Centre, NPEC, was not informed of a number of deaths of babies. Not only was it a tragedy for the parents but for all other prospective parents too, given that nothing was learned or changed following their passing. The data collection system must be improved. Regrettably, we can no longer trust the oft repeated claim that Irish hospitals are among the safest in the world. Some have asked questions as to why HIQA has not named the individuals involved in its report. My understanding is that HIQA is not in a position to do this legally. This could be changed, however. Although such a change would bring a level of transparency to health delivery that might unnerve some who work in the upper echelons of the organisation, it should be examined. There is also the issue that HIQA does not yet have the legal authority to license hospitals.

In the NHS in Britain, up to 19 infants and mothers died at the University Hospitals of Morecambe Bay between 2004 and 2013. An independent investigation found that of these, 11 babies would have survived, if they had received the right care. An inquiry into the cases was led by Dr. Bill Kirkup, a former associate chief medical officer of the NHS. He interviewed more than 100 NHS officials, regulators and health workers, including the former chief executive of the NHS. Six staff face disciplinary hearings in front of the Nursing and Midwifery Council later this year, and others were suspended. In light of this, will the HSE review incorporate senior management in its terms of address? With the HSE drawing up the terms of reference, can we be totally sure that this review will have full scope to perform a full and proper investigation?

We still have the major challenge of over reliance on locum doctors. The Minister has told us that this reliance will be reduced. Will he tell us what progress has been made? One in six posts recently advertised attracted no applicants and we know from surveying doctors who have emigrated that poor working conditions at home were critical factors in driving them from our shores. Tony O’Brien has stated that, given that the HSE is held to account, as it should be, the organisation will take a more robust approach to the budgetary requests of the Minister. We must not forget that the HSE had requested, and was refused, additional funding over recent years. The fact that funding requests will be clearly linked with risk is to be welcome and will remove the Minister's hollow excuses of being powerless and limited by funding. This will allow an appraisal of risk and solutions for the most risky areas of the health services. The Government can then decide to address these risks. Simply put, if the HSE is not given adequate funds, how can it provide an adequate and safe service?

There are also concerns relating to the HSE investigation under way after the death of yet another newborn at Cavan General Hospital. Is this investigation under way and when will it conclude and report? While we do not know the full facts of this most recent incident, I must reflect that there are real concerns across the dependent catchment of Cavan, Monaghan and the adjoining counties. I do so most especially because no report, findings or set of recommendations has been published into any of the previous three incidents, including that of the death of baby Jamie Flynn in November 2012.

Systems failures, underresourcing and, most important, the provision of adequate trained staff, are all matters raised when these tragic outcomes are discussed. But we do not yet have the full facts, the full truth. We have no findings. We have no recommendations. The Minister must ensure that these cases are addressed as a priority and that the promised reports into previous incidents are published and the recommendations implemented. The HIQA report on Portlaoise recommended that “an independent patient advocacy service” be established. A patient safety authority should be the priority. Such a body would be able to enforce the standards laid out, investigated and reported on by HIQA. It is clear that while HIQA can make sound recommendations, they often fall on deaf ears. A patient safety authority would be able to ensure the implementation of recommendations arising from HIQA reports. Evidently, things are not working, and such a body could ensure quality and standards are kept, as they must be, across all health delivery settings throughout the State.

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