Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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I call Deputy Catherine Murphy. I understand that Deputy Murphy is sharing time with Deputies Finian McGrath, Richard Boyd Barrett, Thomas Pringle and Michael Fitzmaurice. Is that agreed? Agreed.

Catherine Murphy (Kildare North, Independent)
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What happened at Portlaoise hospital was absolutely wrong and I agree that it was not all down to resources. I listened with absolute horror one morning on my way to the Houses to a mother on KFM radio station who described a heartless incident where her dead baby was brought to her in a tin box with a cloth over it. She had queried during her pregnancy if everything was all right, but when her baby was born it had catastrophic deformities. Those assurances made it much more difficult to come to terms with the baby's death. The families involved need to know the truth and must be facilitated to know it and we must stop codding ourselves about maternity services. Dr. Rhona Mahony has said that in the past decade Holles Street Hospital had seen a sharp increase in activity without the corresponding increase in staff. I just use it as an example. Writing in the hospital's clinical report for 2013, she highlighted severe shortages of consultants and midwives at the hospital. She said the UK had three to four times the number of consultants in obstetrics compared to Ireland and went on to say the hospital was overexposed in terms of the volume and complexity of cases. She said doctors and midwives found themselves in an extremely challenging environment. She pointed out that complications could be unpredictable and severe.

We already know through an article written by Nicola Anderson that Irish women spend on average just two days in hospital after giving birth, which is approximately half the time most other European women spend in a maternity unit. More and more, their experience resembles a conveyor belt. As women in Ireland on average give birth later, we are far more likely to see complications. I talked recently to an obstetrician who told me how terrified they all are of litigation. They have that spectre hanging over them, which influences every decision they make. We must pay attention to what is happening now. It is getting to a point where we could see a repeat of this. It will be a resources issue then.

Finian McGrath (Dublin North Central, Independent)
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I thank the Chair for the opportunity to speak on this very important debate on the Midland Regional Hospital in Portlaoise. Before I go into the details of the debate, it is important to recognise that it is families that are involved here. It is babies, mothers, fathers and extended families. I extend my deepest sympathy to all the parents and families of babies who died at that hospital and note the terrible way they were treated by the HSE after their loss. My heart goes out to them, but they need more than sympathy. They need our practical support. Concealing information should never be an option. We must always improve our game to ensure we comply with best international medical practice.

I deplore the decisions of Ministers and the Department of Health not to allow the Midland Regional Hospital to be funded as a model 3 hospital. HIQA found that services at the Midland Regional Hospital, Portlaoise, were not governed, resourced or equipped to provide the level of care expected of a model 3 hospital. That is the bottom line. The Minister must wake up, fund the services and stop hanging around. Like Beaumont Hospital in my own constituency, this hospital needs our support. At Beaumont Hospital, they need 80 to 100 beds to be opened to end the crisis in accident and emergency. Last week, I met the management and staff of Beaumont Hospital who are doing an excellent job against the odds. They showed us their frontline services and the accident and emergency unit where people were on trolleys and chairs. Not one of our two local Ministers bothered to attend that day, which was a total disgrace.

Tonight, we need to do three practical things on the motion. Patient safety must be put first and the Midland Regional Hospital must be properly resourced. Further improvements must be made in the governance structure of the Midland Regional Hospital. The recommendations of the HIQA report must be implemented immediately to ensure the risks and deficiencies identified are addressed at local and national level to ensure the delivery of safe and consistent patient care.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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It would be difficult to overstate just how terrible was the tragedy and suffering inflicted on these families. After tragic situations occurred due to a lack of resources or a failure to have adequate patient safety, it appears that staff, under pressure from management, tried to cover up matters and prevent people from expressing any complaint about what had happened to them. It is horrendous. It is particularly worrying that frontline staff in Portlaoise had been making complaints consistently about the lack of patient safety, lack of resources and so on, but these were ignored. We then had tragedies occur followed by attempts to cover them up. One must ask what the hell is going on in Portlaoise, because side by side with this situation we find the matter, about which I did not get to ask this morning, which is the discovery in the Tusla office in the town of hundreds of unidentified child protection files on neglected and abused children. The figure has now risen to 1,200 and a report that was supposed to come back on what happened with these files has not come back so we do not know exactly what is going on. It looks like an absolutely disastrous situation in Portlaoise and one wonders if this is being replicated elsewhere in the system. Is it not ultimately the slashing of resources across the health service which has led to these terrible situations?

Thomas Pringle (Donegal South West, Independent)
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I take the opportunity to send my condolences to the families who have suffered so much with the loss of their babies' lives. I recognise the commitment of the families in seeking answers and justice on behalf of their children and other families. They have fought tirelessly against a health system that would not listen and which would not act. The treatment they received after their already traumatic experiences was abominable and it is only thanks to their perseverance that we may be on the road to a more accountable and safe health service. I welcome that the motion is a call for action from the Government and a demand that it addresses the serious inadequacies in our health system once and for all and holds itself and its agencies directly accountable to the families who suffered gravely from this neglect.

I also take the opportunity this evening to discuss the ongoing problem of access to antenatal health services in my own county, Donegal, particularly with the closure of the Dungloe antenatal clinic. The clinic has been closed since November 2014 due to a consultant going on sick leave. The post has not been filled since and access to antenatal services has been confined to Letterkenny Hospital. The clinic's catchment stretches from Fintown to Dunfanaghy and the wider Rosses area and includes offshore islands such as Arranmore. Patients have had to travel to Letterkenny to avail of antenatal services as a result of the closure. This is taking place in a constituency in which public transport is poor to non-existent and the journey to Letterkenny can take three to four hours. It is even more difficult for rural communities to adapt to sudden changes like this.

I recognise the hard work of GAN, the campaign group on the issue, which has fought very hard to have the antenatal clinic reinstated in Dungloe. The group feels there is a very real lack of urgency on the issue and a lack of understanding about the health needs of people in rural Donegal. The usual picture is emerging for families attempting to face a large bureaucratic institution, the HSE, with long stretches of time spent waiting to hear back from it or to receive any correspondence. Protest after protest has been organised to generate a response and, eventually, meetings have taken place with the HSE from which little action or positive news has resulted. While there is a review pending to determine if services will be reinstated, families are still no closer to getting anywhere.

These families continue to seek a solution to this ongoing issue and feel not much has been done. I call on the Government to proactively respond to the urgent needs of all families around this country.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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Deputy Michael Fitzmaurice has two minutes.

Michael Fitzmaurice (Roscommon-South Leitrim, Independent)
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I am grateful for the opportunity to speak on this matter. First of all, we offer our condolences to the parents who have lost their babies, be it in Portlaoise hospital or any other hospital around the country. It is a harrowing time when something goes wrong for the parents. Down my part of the country in Ballinasloe, this issue has come into the limelight as well. When we do an inquiry into all of this and find out what is going wrong, we need to be upfront with parents, explain everything and be transparent and ensure that we rectify the issue and put in the resources.

There is one other thing we need to do for expectant mothers in all of these different hospitals. We need to ensure that we put out the word that a lot of children are born in this country and for many there are no problems. People should not be frightened. My children were born in Ballinasloe hospital, where we got a great service. However, there is pressure on front-line services. These people, be they consultants or nurses, are working flat out. They deserve great credit. We need to learn from the mistakes and we need to be transparent. However, we need to make sure that whatever resources are required are put in to these hospitals for the children of the future that will be born in them.

There is one other thing I wish to say about the general health services and I have a request for the Minister of State. We have a major problem in Roscommon and east Galway in respect of mental health services. Money is being sent back to the Minister of State's Department. I am not laying the blame at her table. However, I spent three hours one night trying to get a person who was going to commit suicide into a hospital. That person had to be driven to Dublin. Senior people in the west of Ireland, in the area of Roscommon and east Galway, are basically giving the two fingers to the ordinary people. What is going on is intolerable. There are parts of the country, not far from there, where there is a very good mental health service. Will the Minister of State look into this issue as well? What is going on in our area cannot go on any longer. I was promised a meeting with those people and got an e-mail saying they could not meet us. They never recognised us after that point. That is not good enough for a public representative. They should be answerable. Will the Minister of State call them to order?

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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Deputy Liam Twomey has five minutes.

Liam Twomey (Wexford, Fine Gael)
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First and foremost, our sympathies are with the parents of these children and those experiencing many other regrettable outcomes that are happening in our health services every day, unfortunately. Resources make a difference, but for years we have failed to take on board issues around governance, how we manage our health service and how we deliver our health services. All too often, I have sat in this House for the past 12 years and watched as hundreds of millions were poured into our health services, but nothing was ever done to tackle the clear problems in terms of how we delivered health services and how they were managed.

This applies not just to health staff such as doctors and nurses. It applies, in particular, to management as well. There are issues around how we are training young doctors. We have loads of young doctors but we are missing out completely in how we manage our postgraduate training of doctors. Therefore, many of them are leaving this country in their droves. We have issues around how we manage risk in our health services. All too often, when there is a crisis like this, and we are hearing it in the House again tonight, people look for a lynching rather than accept that these sort of things happen. We need to have a proper culture in respect of how we manage these matters.

In the airline industry, a person can make a mistake and no one looks to fire that person from the job. The industry wants the person to come clean on it and to talk about it in order to ensure that the same mistakes are not repeated in some other airline and planes do not keep falling out of the sky until someone cops on to what is going on. We do not have that culture in this country. We have a culture of blaming people too quickly. We need to change radically the way we approach these things.

There are big issues around the way teams work in our hospitals. Sometimes they just do not function at all and there is little communication in what should be a streamlined service, but that is not happening. One of the best results I have seen coming out of this report so far is the Minister saying he will link Portlaoise hospital with the Coombe hospital. This is the first time someone is saying we need to streamline how we deliver services. Deputy Kelleher is now in the Chamber, but when I was here first, the report published by Fianna Fáil was the Hanly report. The Hanly report was very much about closing down these types of services, taking out what they described as small hospitals and having super hospitals, possibly based in Dublin, Cork and Galway.

Billy Kelleher (Cork North Central, Fianna Fail)
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That is not true.

Liam Twomey (Wexford, Fine Gael)
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Unfortunately that sort of thinking stayed in the HSE for more than a decade, but it was not an overt policy. Therefore, hospitals such as Portlaoise hospital were being starved of funding but no one quite knew what was the management policy that was being implemented. It was, therefore, only a matter of time before a crisis like this was going to happen. This is a much more proper approach to health services. We are linking hospitals such as Portlaoise hospital with tertiary teaching hospitals such as the Coombe hospital. We are hoping the high standards of training and governance in a hospital such as the Coombe hospital will come back down to a hospital such as Portlaoise hospital and we can continue to provide the type of care that mothers need in Portlaoise, that is close to their doors and safe and dependable for expectant mothers.

This needs to be done not just in maternity services. This needs to be done in paediatric services and surgical services. To some degree, it has happened over the past number of years in surgical services as a result of how we have managed the cancer treatment services. The new cancer treatment programme rationalised where a person could have surgery for major cancers down to eight centres. Some people feel this should still be reduced to five centres. This means that a lot of major surgery was concentrated into large centres, where people were directly referred from their small hospital for major surgery but other minor procedures were safely and carefully done in the smaller hospitals. This made the smaller hospitals viable.

I am sure Deputy Fitzmaurice realises that there has been a lot of aggravation about Roscommon hospital, but the first people who reported the safety issues at Roscommon hospital were the consultants there. They stated clearly that it was unsafe to practise medicine at Roscommon General Hospital at the time.

Michael Fitzmaurice (Roscommon-South Leitrim, Independent)
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Because they were not given the resources.

Liam Twomey (Wexford, Fine Gael)
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That is where Deputy Fitzmaurice is wrong.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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Please allow Deputy Twomey to speak uninterrupted.

Liam Twomey (Wexford, Fine Gael)
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It is not always about resources. We cannot be doing brain surgery in Roscommon.

Michael Fitzmaurice (Roscommon-South Leitrim, Independent)
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I never said brain surgery.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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Please Deputy.

Liam Twomey (Wexford, Fine Gael)
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We cannot be doing major bowel surgery in Roscommon. However, we can safely do other procedures such as what is happening at present. There are no complaints from the consultants or the doctors who are working in Roscommon now, because they know this is-----

Michael Fitzmaurice (Roscommon-South Leitrim, Independent)
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Deputy Twomey should read the paper from last week.

Liam Twomey (Wexford, Fine Gael)
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-----the way medicine should be practised. It was the consultants at Roscommon hospital who reported their own hospital to HIQA.

Michael Fitzmaurice (Roscommon-South Leitrim, Independent)
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Read Dr. McMullen's reply in the paper.

Liam Twomey (Wexford, Fine Gael)
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Deputy Fitzmaurice should read it properly and understand properly what is happening. He would learn an awful lot from it.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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I thank Deputy Twomey.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Taoiseach obviously did not read it so when he made the promise that he would keep it open.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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Deputy Kelleher-----

Liam Twomey (Wexford, Fine Gael)
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What is that?

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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-----please allow Deputy Twomey to finish.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Taoiseach obviously did not read it so when he made the promise to keep it open.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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Through the Chair, please.

Liam Twomey (Wexford, Fine Gael)
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But, Deputy, he has kept it open-----

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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I call Deputy Jerry Buttimer.

Liam Twomey (Wexford, Fine Gael)
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-----and it is actually functioning better.

Michael Fitzmaurice (Roscommon-South Leitrim, Independent)
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Accident and emergency.

Jerry Buttimer (Cork South Central, Fine Gael)
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I welcome the Minister and thank Deputy Kelleher for putting the motion to the House during Private Members' time tonight. Deputy Twomey is right. It is not all about resources. The Portlaoise case shows that human decency and compassion was lacking at one level and accountability was lacking at another level. Tonight we stand here to remember the families and to pay tribute to them for their bravery and courage. It is extraordinary that we are still here despite the fact that we are spending billions on our health service. At that most difficult time of when a parent loses a child, they should be treated with compassion by the hospital, Health Service Executive and staff. Thankfully, in the majority of cases, it happens, but on the occasion it does not happen, it is unacceptable and its legacy is to be found in the report by HIQA.

This is a tome of a report and it is shameful. It is regrettable that we speak about this tonight, because if one was to look at the report, and I challenge Deputy Fitzmaurice who preaches about good and new politics, to look at the report, on page 57, which states: "A good safety culture is certainly an important foundation of a safe organisation and is founded on the individual attitudes and values of everyone in the organisation."

However, a strong safety culture did not exist in Portlaoise. This is not necessarily about resources, it is about management, accountability and the delivery of a service by us, as people. It is clear that at times this was not available or was not being operated by the persons involved.

Equally, I am pleased that the Joint Committee on Health and Children met officials from HIQA and the HSE and, more important, provided an opportunity for the strong and courageous families to come in, speak and engage with the committee, of which I am privileged to be a member. If we listen to what HIQA said to the committee and its independent view on what happened and if we explore the recommendations made by the authority, then we will see that what occurred should never be repeated.

The independent report was commissioned in the interests of what our health system should be about: the patients and their families, past, present and future. Their concerns and the concerns of the families as well as the safety of the patients must be paramount. We must ensure that risks are minimised and compassion guaranteed when families are faced with the most difficult of circumstances. If one were to listen to the account of HIQA one would suggest that patient safety was not treated as a priority. That is a significant concern. It must not simply be a concern, we must ensure it is a priority.

The HIQA report raised number of fundamental issues around governance, accountability, hospital standards, resources and how we allocate money. I am pleased that the Minister for Health, Deputy Varadkar, and the Minister of State, Deputy Lynch, have been unequivocal in saying that the recommendations must be implemented in full. If we are to get anything out of this report, it should be to have the eight recommendations implemented to enable us to monitor our health system in a clear and cogent way. Equally, we must put in place a mechanism to monitor the implementation of recommendations in the HIQA investigation reports.

Prior to the investigation by HIQA and the publication of its report the previous Minister put in place a series of reforms, along with the Minister of State, Deputy Lynch, to ensure that we would never be back here again. These included putting new management in place. As Deputy Twomey said, the hospital in Portlaoise is part of the Dublin Midlands Hospital Group. Clinical governance is to be addressed by a memorandum of understanding between the Coombe Women and Infants University Hospital and the HSE to provide the first managed clinical maternity network within the Dublin Midlands Hospital Group. The Government is committed to securing and further developing the role of Midland Hospital, Portlaoise, something that was ignored in the past even though the constituency had a former Minister for Health, Taoiseach and Minister for Finance.

This is about people. It is about ensuring that we learn from the past and put in place a maternity service that is going to have women and the babies that are born at the centre of what we do. If we do anything in terms of improving governance, integration and leadership, we will see reform and a standardisation of care across all maternity hospitals. That is why we owe a debt of gratitude to the families, a debt that must be repaid by implementing in full the recommendations. The focus must be about putting things right such that we can ensure patient safety will never be compromised and is a priority.

Regina Doherty (Meath East, Fine Gael)
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Last Tuesday the Oireachtas Joint Committee on Health and Children heard the experiences of two families whose babies died in Midland Regional Hospital, Portlaoise. I believe we owe them a great debt. They described how they courageously fought against a system for many years which was supposed to support them and care about them and their experiences as well as learn by those experiences to ensure that no other family would go through what they went through. The recent HIQA report into the investigation of the quality, safety and procedures in Midland Regional Hospital demonstrates what happens when the health service fails patients. In this instance, not only are we seeing the evidence of a failure in terms of clinical services provided but also a deep failure in the lack of support and answers provided to patients, a lack of clear and consistent policies in respect of how patients can make a complaint and ensure that they will be heard, and that actions will arise from their complaints.

This morning an investigation by the Ombudsman, Peter Tyndall, found that people are afraid to complain about the care and treatment they receive in hospitals because they are concerned about the repercussions for themselves and their loved ones. The investigation also found that people do not complain because they do not believe it will make any difference. The Ombudsman's report, Learning to Get Better, was published today. He carried out the investigation because he was concerned that his office was not receiving the amount of complaints that the health care system should be generating. The recommendations he made this morning are similar to the recommendations made by HIQA some weeks ago arising from its investigation into Portlaoise.

I believe this moment holds the possibility of real change in our health service and with it the safety and quality that will restore the trust of the people. The recommendation by HIQA to establish an independent safety advocacy service is a starting point. This agency must above all be truly independent of the HSE and must have a direct reporting relationship to the Minister for Health. It is essential that this agency is set up in an honest, inclusive and transparent way to enable trust to be restored for patients and the public. Failure to do so will cause irreparable damage. Currently, Ireland has a fragmented poorly co-ordinated ad hocpublic health care advocacy service, one that often sees those advocating for change being funded by the HSE and, therefore, controlled by them. This practice cannot continue. Advocacy must be funded differently if we are to ensure that patients have an accessible and equitable advocacy service.

The people need the integrated agencies currently representing patients and the public to leverage a stronger organised voice and streamline their work with the Government's plans. We need an agency that will provide a unified voice for patients, carers, family members and the public and to engage in dialogue with our health services. We need an agency that provides a single easy-access point for public concerns and complaints about the public health service, one that will ensure transparency, restore public trust and educate our stakeholders to achieve safe, high-quality health care for everyone in Ireland.

Feedback is the best way to learn if we are doing things well. However, in Ireland we see feedback, specifically, complaints, as a negative for some reason. We do not see the value of learning from it or the value in learning from an adverse event because it can prevent another tragedy occurring. The last independent patient survey of experiences in the Irish health services highlighted that almost four in ten patients did not feel encouraged to voice their opinion about the services they received. Over six in ten were unaware of how to complain. Many who wanted to make a complaint failed to do so because the system is not set up in a way that makes it easy to provide feedback. The Ombudsman report from today bears that out.

Litigation is often the route forced on patients and family members. Often they simply want answers, assurances that it will not happen again, someone to take responsibility or, sometimes, simply for those responsible in the service to say sorry. Patients should not have to go to court or to the media to get these answers. There are other ways that we can promote trust, including by ensuring that patients have clearly-defined rights to services, the right to choose the hospital they attend, the right to seek a second opinion and the right to access their own records. We say that patients have these entitlements in Ireland but often the choice of hospital attended is decided by someone other than the patient. If a patient seeks a second opinion in this country she is often made to feel intimidated or viewed as an awkward patient. Despite evidence showing that working collaboratively with patients at the point of writing patient records has so many benefits, patients generally only have access to their records if they make a formal request. We have a habit of talking the talk in Ireland, but open disclosure is an example of where we do not walk the walk.

The many HIQA reports to date are a clear indication that the HSE is not functioning for the benefit of patients or the organisation's staff. It is time for the silos to come down, for egos to be left at home and to put the patients truly at the centre of care rather than simply pay them lip service. I believe it is the very least we owe the parents whose babies died on our watch and who explained their stories and experiences so eloquently last Tuesday.

Mary Mitchell O'Connor (Dún Laoghaire, Fine Gael)
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Last week, I had the privilege of hearing in the Joint Committee on Health and Children from the families who lost their precious innocent babies at the Midland Regional Hospital, Portlaoise. We have had many different groups present at the health committee but last Tuesday was probably the most harrowing day we ever had. As a mother, my heart went out to them. I can only imagine the trauma and pain that they went through and continue to go through.

At the same time, I understand there can be human error and that things happen that should not. However, I got the feeling last Thursday that nobody wanted to blame anyone in particular. One parent, Mr. Mark Molloy, said to us that when he was asked to present to the committee, the first question he asked was what would happen next. That is my question to the Minister of State tonight. What will be done to ensure such tragedies never happen again so parents such as Amy Delahunt, the Delahunt family and the Molloys will not have to sit before our health committee and plead with us to do something to fix our maternity units.

I fully understand that, as with any job, things happen and go wrong, but staff and management should be able to put up their hands and acknowledge the mistakes that have been made. We need an open disclosure policy. We should not drag parents and patients through the courts. Parents told us last week that they have to use the freedom of information regime to get answers. These families have been treated appallingly. What is really sad is that there are many other families who have been treated just as badly.

What were the people on the management committees in the hospital in Portlaoise doing? Blame can be attributed but change must be implemented. We cannot stand here and lament the awful tragedies without making real change to ensure they never happen again. When a woman goes into hospital to have a baby, she is so vulnerable and expects the best service. She needs that service. Many of the staff serving or working in the hospital are all well paid; this is not voluntary work. We really need to do something, not state platitudes. I look forward to hearing the Minister of State's reply.

Catherine Byrne (Dublin South Central, Fine Gael)
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What has happened in Portlaoise hospital is unacceptable and beyond belief. I read the HIQA report in full with a heavy heart. It shocked and upset me and even made me really angry. How on earth was this allowed to happen? The HSE not only failed parents who lost their new babies due to negligence and mismanagement but caused great trauma and sadness for families, which they will bear for the rest of their lives. Their strength and courage during this whole process is to be applauded. Speaking out to highlight what happened to them has resulted in the publication of the report and the putting in place of proper procedures. However, it will still be very difficult for parents to have faith in the maternity hospital in Portlaoise, but faith we must give them.

This damning HIQA report pulls no punches. It shows that some staff at the hospital dealt with parents immediately after the death of their babies without a shred of humanity or dignity, or even respect. Parents received no explanations; they were denied the truth of what actually happened to them and their babies. What should have been a very happy time turned into a nightmare. Those people who were supposedly working in the care profession at the hospital did very little at times to help.

The most shocking point of all is this did not happen just once but time and again, yet nobody did anything. There was a complete failure to act on the part of staff. It is difficult to comprehend that this could happen in any hospital.

The Minister has stated parents were treated in an appalling manner after the death of their babies. He also said he is ashamed of how patients were treated in Portlaoise hospital. I share his sentiments but I know he is committed to improving standards and developing better maternity services. He has made it his priority to have the planned national maternity strategy published by the end of this year. A proposed patient advocacy service, independent from the HSE, is also a priority for him.

A steering group is to be established to oversee the implementation of eight recommendations set out by HIQA its report. Changes have begun to be made at the hospital. For some, this is happening too late, but change is needed and must result in better, safer, more reliable maternity services in Portlaoise and throughout the country.

Sometimes in life we are faced with many different crosses, not always of our making. At times, it can be hard to make sense of them. Our hearts go out to all those parents who lost babies in Portlaoise hospital. The courage they have shown by opening the door on their tragic loss has made it possible for the parents of the future not to suffer the same sadness. They are the heroes of this report. They have had to fight long and hard over many years to get answers, not only for themselves but especially for others.

I have read many reports as a Member of this House, one more tragic than the next. As a member of the health committee, I have listened to people's stories about the health services that have failed them. I have been moved by the raw emotion of the young and old telling their stories. On reading the HIQA report, I ask myself how one human being could treat another as described. It is imperative that all of us in this House treat one another with dignity, respect and compassion. It should be the same outside.

Tonight across the country, doctors, nurses, health care workers and staff in hospitals are saving lives, healing people and caring for the dying, often under tremendous pressure. Most of them treat their patients with humanity. It is said that where there is a loss there is a new beginning. The parents in question deserve a new beginning. The hospital in Portlaoise deserves a new beginning also. The Government must support the parents and the staff of the health service. Most of all, we must support one another in making sure we have a health service that is the envy not only of our little country but also of the rest of Europe and the rest of the world.

Michael Kitt (Galway East, Fianna Fail)
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I commend Deputy Billy Kelleher on tabling this motion. It is important and gives us an opportunity to discuss a very serious matter. I extend sympathy to the families who lost babies at Midland Regional Hospital, Portlaoise. I deplore the manner in which the families were treated by the HSE in the aftermath of their loss. There was certainly a lack of decency and compassion for the families.

The HSE must act swiftly to implement the recommendations of the HIQA investigation into services at Portlaoise hospital. I am not one to expect a Minister to micro-manage every hospital but I believe the current Minister should outline practical policies and fight for a good budget. I was heartened to hear that Mr. Tony O'Brien, the director general of the HSE, commented that he would be negotiating a good budget. He talked about conducting business in a different way and about taking a much more robust approach. That is important because we are talking about a level 3 hospital for which sufficient resources are not available.

If we really believe in the importance of the patient and patient safety, we should have a patient safety authority established. This has been long promised. It is important to have HIQA incorporated into any new structure. There has been talk of a patient safety agency or patient advocacy agency. Irrespective of which, we are told it will not be in the service plan. If, as we all agree, patient safety is important, we must reflect on the fact that it will be another year before we have a body that will deal with it.

We have an opportunity for public consultation. I would like to see public consultation on the provision of maternity services right across the country. The west-north hospital group has ongoing reviews. These are important because they afford an opportunity to determine the conditions in the maternity units.

We are waiting for the review of maternity units at Portiuncula Hospital in Ballinasloe which is an excellent hospital and one I know well, Castlebar, Sligo Letterkenny and Galway. University College Hospital, Galway is a level 4 hospital and a centre of excellence. However, many members of staff talk about the workload, while constituents talk about the extent of the inadequacies in the public health care system because of the shortage of staff. I refer, in particular, to the stroke unit at University College Hospital, Galway where there is difficulty with the level of nursing care because of the shortage of staff. The Minister of State knows that nursing staff in the psychiatric unit in the hospital have threatened industrial action. This is a level 4 hospital and it is certainly time resources were also made available there.

Both the Midland Regional Hospital and Portiuncula Hospital serve the midlands. Portiuncula Hospital also serves the west and the mid-west. Some of the challenges in it are similar to those faced by the Midland Regional Hospital, particularly the issue of resources, replacing staff, the need for extra staff and buildings. I can tell the Minister of State that the last official opening of a building I attended in Portiuncula Hospital was when Mary Harney as Minister for Health opened a special baby care unit. The hospital has made submissions for buildings and I hope they will be looked on favourably by the HSE and the Department. I know that there are other concerns about the recommendations in respect of maternity services in other locations such as Tralee, Cavan, Clonmel, Kilkenny, Monaghan, Wexford, Portlaoise and Drogheda. That is why public consultation is important. We need to have that process completed before any action is taken. The HSE should outline the real agenda in the health service. I have seen reports that reviews are being carried out at 19 maternity units across the country in order to provide assurance that the recommendations made in a number of recent high profile reports are being fully implemented. This is the important point. We know that corrective measures to address quality of care issues should be implemented, but it is important that implementation is ongoing. Similarly, I have also seen reports that additional training has been provided for all maternity staff and additional senior supervision has been provided for for both medical and midwifery staff. However, I have not seen any reports stating extra staff will be provided, particularly in areas in which there are significant pressures.

I would like to have a full debate on the infrastructure of maternity services, particularly the infrastructure we need to meet the needs of the country in the coming years. In particular, I would like to have a discussion about the greater role community midwifery services could play and the urgent need for greater numbers of consultant obstetricians. If we had obstetricians who led services as a priority in maternity hospitals, we would be doing a very good day's work. We know that there are proposals in Dublin to relocate maternity hospitals to more suitable locations, but let us also look at the people who live outside Dublin because we must provide high quality health and maternity services for them. If we ensure current maternity services are protected, we will be doing a good job, but we should enhance rather than downgrade them. It is a very important issue around the country, as the Minister knows. I hope we can investigate those areas that are doing well and provide the investment needed to support them. It is true to say we have very good staff in hospitals who work very hard, but there are huge pressures, as the Minister knows. This is the area in which I would like to see him lay down his overall policy and, in conjunction with the HSE, fight for a good budget in order that the resources required can be made available.

Charlie McConalogue (Donegal North East, Fianna Fail)
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I join my colleagues in supporting the motion brought forward by Deputy Billy Kelleher. We have heard the testimony of the parents who, unfortunately, suffered one of the most difficult things any family or person has to suffer, namely, the loss of a young child. We must sympathise with them and also pay credit to the families concerned for continuing to push to get answers. That is what has led us here and to HIQA's investigation which finally delivered some of the answers. I hope we can see the lessons learned and ensure other families will not have to experience similar things in the future. It is important that we recognise the work of "Prime Time" in working with the families through its investigation unit and bringing this issue to public attention.

The families who lost children and their testimony and bravery are at the centre of this debate. That bravery was displayed at the Oireachtas Joint Committee on Health and Children. It is important that we keep this at the centre of the debate and use it as our inspiration to ensure the very clear mistakes made in the handling of this issue and how it was allowed to develop will be addressed and that the Midland Regional Hospital will be properly resourced in order that it can have a safe maternity unit. It is also important that lessons are learned about how we provide health services, particularly maternity services, throughout the rest of the country.

Last week Mark and Róisín Molloy, the parents of Mark who died on 24 January 2012, moments after delivery at the Midland Regional Hospital in Portlaoise, spoke to the Oireachtas Joint Committee on Health and Children. The Minister knows that they recounted how in the past three and a half years they had fought very hard against continuous opposition to get the answer to a very simple question: how did it happen and how did their young boy die? They had to use the Freedom of Information Act to receive additional information to get answers. Despite being informed by the hospital obstetric and midwifery management team that the death of a healthy baby during childbirth was extremely rare, it became apparent to them very early on that they were not the only family whose healthy child had died in these circumstances at the hands of the maternity unit at the Midland Regional Hospital and nationally. Mark and Róisín detailed a litany of correspondence and meetings during which they had worked to get the full story about the death of their baby. It is important to read some of their testimony here to reflect this. Mark told the committee:

The HSE was aware at local, regional and national level that this was an unsafe unit. Members saw from the schedule that I went through that we had been screaming about this for 18 months through meetings and so on but the HSE did nothing about it. The HIQA report reflected a dysfunctionality in various management levels, particularly regionally. We met various people who seemed almost unaware of the HSE's policies and procedures in the investigation of an adverse event such as our baby's death. They genuinely seemed not to know how to handle this investigation in accordance with their procedures.

It is important to note that we met officials at every level, to whom we believed we were bringing new information in regard to what was happening at each level below. We met management, who told us there were no policies or procedures in place which allowed for an investigation into Mark's death. Our response to that was, "Oh my God" because we knew that was not true. We then raised at regional level local management's opinion in regard to its carrying out an investigation into Mark's death. We knew fairly soon into the process that people were only paying lip-service to us.

That was the experience of Mark and Róisín Molloy and unfortunately that was not an isolated experience. Indeed, Mark informed the committee that at a meeting with the Minister for Health, Deputy Varadkar in Portlaoise "there were 120 people in the room. Person after person told stories of their baby's death or cerebral palsy injury or horrific injuries that mothers were left with. This is not a figures game but the figure is far in excess of five baby deaths". People spoke of incidents as far back as 1986.

Our heart goes out to them tonight but we must look at how this situation came about. The Government cannot ignore the fact that the designation of Portlaoise as a level three unit without ensuring that the resources were in place so that it could operate to that standard was important in the context of the service at Portlaoise being unsafe. There is a lesson here in terms of how the Government has been dealing with our health service in general. The Government has a key role to play because it provides the resources to the HSE to enable it to carry out its functions. However, it cannot force the HSE to implement a service plan which the executive regularly indicates it cannot provide without the necessary resources and then absolve itself, at a political level, of responsibility for services on the hospital floor being unsafe.

It is essential that the HIQA report recommendations are implemented. It is also key that we do not see a media-management approach adopted with regard to our health service when horror stories are revealed or even in the face of the day-to-day stories of excessively long waiting lists for treatment which Deputies deal with every day. We need to see real change and real investment in our health services because that is what is required. I welcome the fact that the Minister for Health, Deputy Varadkar met the parents and heard their stories himself. His approach, at a human level, is an improvement on that of his predecessor, Deputy Reilly. That said, however, we are not seeing anything change within our health services or in what people are experiencing on the ground. It is long past time for improvements in that regard.

Robert Troy (Longford-Westmeath, Fianna Fail)
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I welcome the opportunity to speak in this debate tonight and compliment my party colleague Deputy Kelleher on tabling the motion before us. I wish to start by offering my deepest sympathies to the families who have suffered the loss of a loved one. It is appalling that not only did they have to suffer that loss but they also had to deal with an unforgivable manner on the part of the HSE. The loss of a child was bad enough but was exacerbated by the fact that they had to fight tooth and nail to get the truth from the HSE. We have to remember that the HSE is an arm of the State. Not only did it fail in the context of the delivery of these children but it added insult to injury by the manner in which it dealt with their parents. There was a complete lack of compassion, respect or understanding. Were it not for the determination and drive of these parents, assisted by RTE, we might not have been any wiser this evening.

A report into a child's death in 2008 acknowledged that there was a failure to recognise that the baby was in distress during labour and that staff went on to administer the wrong drugs. The recommendations made on foot of that report to improve safety were never implemented. That lack of implementation had devastating consequences for families who came after, up to and including the loss of life. Previous speakers have singled out Mark and Róisín Molloy for the manner in which they pursued their baby's case vigorously over the last few years. They shared their harrowing experiences with us in the Dáil and with the wider public in the interest of ensuring that similar events never happen again.

The Government must acknowledge that wrong was done and must ensure that all maternity services are adequately resourced and fit for purpose. It is simply not good enough to designate a maternity unit as a grade three service if adequate resources are not provided for that unit. That is neither practicable nor safe. I do not want to get political because this is not an issue for political point making but how could the Government stand over the scenario in Portlaoise hospital? How could it say that it was a model three hospital when the resources were not in place to justify that status? Why did that happen? Was it for political reasons? Was it done as a result of the fallout from events at Roscommon hospital?

A review of all of our maternity services must be carried out now to ensure that expectant mothers can have the confidence that when they present to a maternity hospital, wherever it is located, they will get a premium level of service. Furthermore, as well as political accountability, we must also see accountability at a senior level within the HSE because senior staff of the executive were aware, every step of the way, of what was going on in the hospital at Portlaoise. With that accountability should come responsibility and consequences for those who did not act in the interests of patient safety. Unfortunately, the only people for whom there have been consequences to date are the families who lost their loved ones and that is simply not good enough.

John Browne (Wexford, Fianna Fail)
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I compliment Deputy Kelleher on tabling the motion and giving us an opportunity to debate the issues, particularly with regard to the maternity services in Portlaoise. It is important at the outset to extend our sincerest sympathy to the families who lost children in such terrible circumstances. When we all watched the "Prime Time" investigation into the deaths of four babies over a six year period at the Midland Regional Hospital, Portlaoise, we were horrified. That programme highlighted, in no small way, the problems that beset the hospital in Portlaoise. It highlighted the need for change, decisive action, extra staff and also the need to deal with the issues that had arisen over a number of years. It pointed out very clearly that the hospital and the HSE had failed to implement recommendations arising from previous investigations which may have saved the babies' lives.

The programme also stated that neither the hospital nor the HSE informed the bereaved families that an investigation had taken place in their case or that a report had been produced until many years later.

One mother only found out about the investigation and report five years after her baby had died. In a statement, the HSE and the hospital have apologised and accept responsibility for what happened. They have promised to act on certain recommendations, particularly the recommendations HIQA proposed to deal with the problems at the hospital at Portlaoise.

Last week we heard a compelling account from Mark and Róisín Molloy, parents of Mark, who died on 24 January 2012, of the problems they faced over a long period of time in trying to get answers or any type of information on what happened to their child. They now know, at this very late stage, of the situation at the time. However, they were put through the hoops at a very difficult time. This is a family that was grieving and had to endure the sad loss of a child. Every roadblock possible was put in their way preventing them from getting information on the reasons their child had died. Mark and Róisín Molloy had a litany of correspondence and meetings during which they tried to get the full story but always found it very difficult and did not find the answers they wanted.

I compliment the Minister, Deputy Varadkar, on attending the meeting in Portlaoise. He listened to the families in a room of 120 people. He must have been very concerned over the stories of the difficulties the families had faced. I am sure the Minister will act on what he has heard to ensure such a situation does not recur. It is important that he would do that. I am sure the Minister of State, Deputy Kathleen Lynch, and he will ensure that the difficulties these families faced in the past will not be repeated.

It is important to implement HIQA's recommendations as quickly as possible. It produced a shocking report, which exposes the chronically weak levels of oversight and inaction by the HSE nationally, regionally and locally. It failed to deliver safe clinical services and put patients' lives at risk. What is worse is that management was well aware of the risks posed by these unsafe practices but failed to take any decisive action to rectify the situation. HSE bosses allowed Portlaoise hospital to continue to operate on a 24/7 basis despite a series of safety and quality of care issues which were never acted upon. They also failed to resource the hospital sufficiently and to ensure that the governance arrangements in place could safely deliver services to patients.

The Government and the HSE in many ways ignored alarm bells about the safety risks which were being highlighted at the hospital and patients suffered as a result. It is disgraceful that the HSE failed in its duty to exercise any meaningful oversight of services despite repeated warnings. Patients across the midlands have every right to feel angry and concerned at the findings in the HIQA report. However, we are where we are and it is now important that the HIQA report be acted on as quickly as possible. The Minister should work in conjunction with the hospital in Portlaoise to deal with the problems and risks in order to ensure that adequate staff are in place in future to deal with such issues.

It is important to highlight that expectant women will not find this situation in every hospital. We have some maternity hospitals that are providing an excellent service. It is generally agreed that Wexford maternity hospital is the best and safest place for births in the country. At one stage it was suggested that Wexford maternity hospital would close and that Waterford would become a centre of excellence for the south east. Cross-party political pressure resisted this and we now have a state-of-the-art maternity hospital at Wexford General Hospital. It is one of the safest places for births in the country.

There is considerable talk about reviewing the maternity services and perhaps closing down some of the hospitals. The people of Wexford, Wicklow and the south east region in general are very happy to have a maternity hospital based in Wexford. We have a population of 140,000 with Wicklow not far behind. That hospital is servicing the needs of expectant mothers and families in that area.

It is increasingly clear that our national maternity infrastructure is under strain and needs serious review and investment. We need a proper debate and Deputy Kelleher's motion tonight has started the debate. It is important that this debate continues on whether the existing infrastructure is sufficient to meet the needs of the country over coming years. This debate needs to include a discussion about what greater role community midwifery can play, the urgent need for greater numbers of consultant obstetricians and what level of investment in the physical infrastructure is actually needed.

Ireland has one of the lowest ratios of obstetricians to patients in the OECD and there is a need for investment in maternity and neonatal services across the country as a matter of urgency. I hope the Minister, Deputy Varadkar, in October's budget will have money made available to ensure that the problems in Portlaoise and Galway are never repeated. Adequate money needs to be made available to provide the services.

The provision of accessible, safe and high-quality obstetrician-led maternity services to all mothers and babies, regardless of where they live must be a core objective of public health policy. We need to bear that in mind with the budget in October. Rather than downgrade services we should focus on attracting the necessary number of qualified consultant obstetricians to facilitate an accessible, safe, high-quality maternity service to all existing maternity centres nationally and to promote obstetrics as a career option among our medical professionals in order to achieve this and in order to overcome the challenges that our obligations under the working time directive present.

This is the first of many debates on this issue in coming months. It is important to make the funds and staff available to ensure we do not have a repeat of what happened in Portlaoise. I accept we will always have human error and difficulties in that area.

As the Minister of State, Deputy Kathleen Lynch, is on duty, the Ceann Comhairle might allow me a minute to say that the Waterford child and adolescent mental health services have suspended taking new referrals for the foreseeable future. This will seriously affect the services in the south east generally, including in my county. The Minister of State might not be aware of this because there was only a news flash this evening about it. It seems that the HSE has failed or refused to appoint a permanent psychiatric consultant to deal with such issues. When the Minister of State arrives in her office tomorrow she might check out the situation and have the problem dealt with or otherwise the young people in the south east will suffer greatly because of a lack of service.

Kathleen Lynch (Cork North Central, Labour)
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I reassure the Deputy that I was not waiting for a news flash; I have already started dealing with the issue. It is not a failure; it is simply an inability to find a suitable person. CAMHS consultants are quite rare, as Deputy Kelleher and I know from the Cork situation. However, we have already started on that. I always try to be ahead of the posse.

I am deeply saddened that our health service failed so many families in Portlaoise. As Minister of State, I stand with the Minister, Deputy Varadkar, in insisting that our services be improved. Along with many of the speakers yesterday evening and tonight, I recognise the courage and tenacity of the families who came forward to share their stories. They must have been very difficult stories to tell. I do not believe there is anybody here who is a parent who does not recognise the hurt of losing a long awaited and wanted baby.

This time, the opportunity will not be missed. Last night, the Minister, Deputy Varadkar, outlined the measures we are taking on the HIQA Portlaoise report. I do not propose to repeat all of those tonight. However, I applaud the Minister for his swift action to ensure that the families get the services they need on the ground. We need to minimise, in so far as we can, the difficulties that some of the families continue to endure.

At a national level, our priority must be excellent, safe care with a view to achieving the best possible outcomes. Patient safety must be at the core of everything we do and we must work tirelessly to embed a patient safety culture throughout our health service. The lack of compassion in care in the hospital was a clear and disturbing feature of the report. This must, and will be, addressed without delay. Just as patients need medical and nursing staff for their clinical abilities they need them to show that they care and support them. I find it difficult to understand how we got to where we are. How did the health service lose its capacity to care? I do not subscribe to the view that a lack of resources was the issue.

Last night, it was claimed that alarm bells sounded about Portlaoise in 2006 and 2011. I am not in a position to comment on the action or inaction of the previous Government but I can contextualise funding requests in 2011. At that time the country was in the middle of a financial crisis and funding shortfalls were identified across the board. Many clinicians came looking to the Minister and the Department for funding, claiming their specialty had the greatest need. The reality is that real clinical leadership is demonstrated by working to mitigate any risk within available resources and using the mechanisms within the HSE to seek the additional funding required. The HSE then has the responsibility to consider competing demands and to prioritise funding requests accordingly.

Whether Portlaoise hospital was a model 2 or 3 hospital is a smokescreen. The categorisation of hospitals was, if anything, a bit simplistic. In any event, with the move to hospital groups, hospital models are now obsolete. Within the Dublin Midlands Hospital Group, there is a very bright future for Portlaoise hospital. There are bound to be service changes as we move to provide services across the Dublin midlands group. What people need are safe services, and thus they will travel to the hospital where that service is best provided. It is clear that we need to ensure that services in Portlaoise that are not viable are discontinued, and that viable and safe services are resourced, but we must do this in a planned and ordered way. We must also listen better to the voice of the patient.

The Ombudsman today published, Learning to Get Better,which investigated how public hospitals handle patient complaints. This report and the HIQA Portlaoise report show that the health service has not been responsive enough to patients who have had bad experiences. The HSE's complaints management and resolution processes need improvement, in particular about learning from complaints.

I wish to reassure the House that we will do everything in our power to ensure that the recommendations of the HIQA report are implemented without delay. We owe that to all the families who bravely came forward in an effort to ensure that no more families would endure the pain that they experienced. Several speakers tonight asked what has been done in the interim. While I do not propose to list all that has been done it is important to mention that 16 additional midwives have been recruited, including shift leaders in delivery. A director of midwifery, which I believe is essential in any maternity service, has been seconded to Portlaoise from the Coombe. A training needs analysis was also undertaken and a training plan has been developed with Athlone Institute of Technology. Some 100% of midwifery staff have attended CGT training. Guidelines are in place and the type of governance that is necessary to ensure a safe delivery of care is also being put in place.

Having just read again Deputy Kelleher's motion and the Government's counter-motion, I see very little between us.

Billy Kelleher (Cork North Central, Fianna Fail)
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I welcome the contributions from all sides of the House. I read the Minister's speech again this morning, in which he mentioned that we should not play politics with this issue. I certainly was very reluctant to go down the political route without first having listened to the testimonies of the families and read the indepth reports of the CMO and HIQA but I would be failing in my duties if I did not bring this matter to the floor of the Dáil to ensure we had a proper discourse and debate on the issue of our maternity services in Portlaoise and, to say the very least, the appalling failure of systems and, perhaps, of individuals as well.

Many of the families, including Amy Delahunt, Ollie Kelly and Mark and Róisín Molloy, told us of their experiences. Last week, I asked Róisín Molloy at the health committee about treatment by the HSE and if it had changed. Her response was: "We were treated with complete disdain. They hated us." I wrote down those words as she expressed them, which were a damning indictment of individuals within the system. I am always reluctant to point the finger at individuals but we cannot always hide behind systems failures. Staff, particularly those in senior management posts, must share in responsibility. This is not about witch-hunting or scapegoating. That is certainly not the motivation of the families. I have met with the Molloys, Ollie Kelly and Amy Delahunt and I have spoken to others as well. They are not interested in witch-hunting. What they want is an element of accountability for the purpose of ensuring that this does not happen again. Unfortunately, it has happened again in the context of HSE local management and administrators and regional management and administrators and so on informing families that this was a once-off and that it had not happened before and would not happen again. The unfortunate reality is that it was happening all too often in the context of Portlaoise hospital.

If we are to learn anything from this very tragic saga it is that we need to have a system in place that can access information, collate it and ensure that people who failed in their duties or ability to manage are identified early. Within any system, a weak individual will weaken the entire system. This, unfortunately, in my view, is the case in the context of the HIQA report, throughout which is highlighted the failure in governance across Portlaoise hospital, including at regional and national management level. The HIQA report states on page 135:

During this investigation, the Authority found that Portlaoise Hospital and the Health Service Executive (HSE) at local, regional and national level were aware for many years of numerous patient safety risks in the hospital but failed to act decisively to reduce these risks.

Until such time as we see that change in attitude, with people at senior level being held accountable, we will not change the system because, regardless of what we think, the motivation to change will not be present and the herd mentality will prevail. We talk about groupthink, but we know where it got us. We had groupthink in this Chamber, the Central Bank and many other places and know where we ended up. Groupthink or group protection in these areas could cause huge difficulties.

When we read the report on Portlaoise hospital and listen to the contributions from some sides of the House, it is clear that those contributing have not read the full report if they say this is not about resources. It is about resources. On page 135 of the report a failure to act decisively to reduce risks in the context of management is reported. On page 138 it speaks about general hospital services and states diagnostic imaging services were significantly underresourced and that the hospital did not have a strong clinical governance structure. Another point made is that the intensive care unit infrastructure was unfit for purpose. This, again, is a resource issue. Also, the report states general medical services in the hospital were not resourced or structured to effectively implement the recommendations of the HSE's acute medicine programme. Many pages of the document refer to the fact that the hospital was under-resourced.

At the heart of this issue also is the fact that the small hospitals framework, on foot of the Mallow and Ennis hospital reports, made recommendations that were applied in Portlaoise hospital. We cannot pretend or deny that inside this House, or somewhere else, a decision was made to exempt or remove Portlaoise hospital from the small hospitals framework, which effectively pointed out that there were deficiencies in these hospitals and that they would not have the capacity or the clinical governance structures in place or the throughput of patients to ensure safe practice in all areas. Clearly, there were difficulties. The report states the hospital was not structured to provide safe surgery, "as there are insufficient, acute and elective surgical presentations to ensure surgeons maintain the necessary competence and expertise". This is the reason Portlaoise hospital was mentioned in the original small hospitals framework because it did not have the required throughput of patients, yet a decision was made somewhere-----

Kathleen Lynch (Cork North Central, Labour)
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The framework is based on resources.

Billy Kelleher (Cork North Central, Fianna Fail)
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Yes, but somewhere along the line the decision was made to take Portlaoise hospital out of the small hospital framework, even though it had been included for that specific reason. Four year later we find that HIQA's report makes the very same recommendation made previously in the context of the Mallow and Ennis hospitals reports which fed into the small hospitals framework. The Minister, Deputy Leo Varadkar, said last night that the concept of level 2 and level 3 hospitals was an outdated assessment of what a hospital was. That may well be the case now, but at the time that concept was the benchmark in terms of the number of clinical presentations, the number of procedures carried out and the competence and expertise that could be maintained within a hospital facility because of the numbers of patients presenting. All of this was known when the issue of moving Portlaoise hospital out of the small hospitals framework and exempting it arose. Let us be clear that it was exempted from the framework with political fanfare and that there was significant backslapping at committees and in this Chamber. However, when we read the report, we see that the difficulty was that the hospital was not being resourced as a level 3 hospital. That is stated clearly in the report. In the context of resourcing alone, the hospital should not have been maintained at level 3 because of the difficulties in it. The HSE lacked a clear strategy or vision for the hospital. It was regarded by the HSE as a model 3 hospital, one that could provide acute services for patients presenting with all manner of injuries and illnesses, including life support. However, HIQA's investigation found that it was not being funded, equipped or resourced to provide this range of services. The authority's investigation found a number of examples of how the hospital was not being resourced to safely provide services at the level that would be expected of a model 3 hospital. This led to unacceptable ongoing risks for patients attending the hospital, on which I elaborated previously. These reasons, the backslapping and the accolades attributed to some people for maintaining Portlaoise hospital as a level 3 hospital make it clear that it was all a pretence from start to finish. There was no maintenance of level 3 hospital services. There was this pretence by senior hospital management and the HSE and at political level, but we find there were unsafe practices on a continual basis which knowingly happened in Portlaoise, in the general hospital as well as maternity services, and that nothing was done about it.

The Minister of State made reference to this issue in her contribution and I raised it last night. Dr. Chris Fitzpatrick, a former master of maternity services in the Coombe hospital, went to the Minister for Health in December 2011 and highlighted the problems in Portlaoise and Mullingar hospitals and begged for assistance and support. I have not seen the report on that matter, but I know that it is available. I know that every effort was made by the then master of the Coombe hospital to ensure something was done. He pointed out that we needed to do something in both hospitals. That happened in December 2011 and the following week Dr. Fitzpatrick went to the CEO of the HSE and repeated the same message but nothing happened.

I would like to find out and intend to find out by way of an FOI request what effort was made to relay this information to the front line and promise to do something at that level. People have referred to red flags, but as he families, many others and I have said in the context of the health committee's investigations into this issue and HIQA's report, it was no longer a matter of red flags. Alarm bells had been ringing everywhere for a number of years, but there was a complete failure to react at every level. Mr. O'Brien almost tried to absolve the HSE by virtue of the fact that Portlaoise hospital had been exempted from the small hospitals framework. He mentioned this quite intentionally. I asked him on a number of occasions when the HSE could respond to the policy direction of the Government and state it could not implement the policy because it would lead to unsafe practices. He said he could not do this, that the HSE was obliged to implement the stated policy. However, it was obliged to pretend that it was a policy that could deliver a safe service. Every one of us here who has read the report, every one who has gathered information or who has been in contact with the Department of Health, the previous and current Ministers for Health, the previous CEO of the HSE and the current director general of the HSE knows that they were all informed that there was a chronic problem with basic patient safety in Portlaoise, in the general hospital and maternity services.

We owe a lot to the families who have suffered so much. The least we should do is be honest about the fact that we did know about what was hapening but did nothing about it. We must implement the recommendations made in HIQA's report. They must be implemented expeditiously to ensure there is safe practice. We owe it to all expectant women, now and in the future, to ensure maternity services are put on guard in terms of patient safety and to ensure that the maternity review that has been announced will be fully supported. We must ensure the recommendations it will bring forward will be executed. We cannot allow a situation where there is even the slightest doubt that maternity services are not up to the highest international standards possible.

We have a continual debate in the Chamber about the pretence that there are realistic budgets. The Minister told us last December that he had achieved a realistic budget, but that budget is already a busted flush. We may as well accept now at the end of May that it is completely off target and out of kilter with what is happening in the health service.

The pretence that we will not have a huge budget deficit at the end of the year may as well be stopped tonight. We should accept that we have to reprioritise and refocus investment in health because the Minister has other problems besides patient safety. There are patients lying on trolleys, and more than 11,000 people in Waterford have been waiting to see a consultant on an outpatient basis for over a year. There are huge problems in the system, and at the same time we have to reprioritise patient safety. I ask the Minister of State to go back to the Minister for Health and the Departments of Finance and Public Expenditure and Reform and tell them that it cannot be done with what she has been given because it is not a realistic budget. I commend the motion to the House.