Louis O'Hara (Galway East, Sinn Fein)
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I will say at the outset that it is a disgrace that the Minister, Deputy Carroll MacNeill, is not here. The downgrading of maternity services at Portiuncula University Hospital is a huge issue that is causing enormous stress and worry for families in my constituency and beyond. She is accountable for this and should have the decency and courage to come in here tonight to take questions. It is deeply disrespectful to all those impacted by this.

Fundamentally, this issue comes down to the health and well-being of mothers and children and ensuring the best possible outcomes for them. The consequence for mothers in my constituency in east Galway is they will have to travel to University Hospital Galway, UHG, to access maternity care. Many mothers who would otherwise have a short trip into Portiuncula could face an hour or more, depending on traffic, travelling to UHG, that is, to a hospital with limited parking and a maternity unit that is already stretched as it is. It is not acceptable to expect high-risk patients to have to travel long distances for essential care and sometimes emergency care. It is causing huge stress and worry for families and is a decision that does not appear to have been fully thought through in terms of the consequences.

Moving these mothers from Portiuncula was not one of the recommendations from the summary review and there are serious concerns with the transparency around this whole process and how this decision was arrived at. The review highlighted a number of issues and many of those issues were the same as those highlighted in the 2018 Walker report. HSE management, however, has insisted those recommendations were implemented in full, while Bernard Gloster has said they were not. I wanted to ask the Minister to outline her position on this but she is not here.

The bottom line is the hospital should have the resources, staffing and infrastructure to be in a position to provide top-class maternity services and mothers in the local community should expect no less than that. The staff at the hospital are fantastic and do their very best but they need the support from the Government and the HSE to address the issues. When something goes wrong, the answer should not be to downgrade the service but to make the necessary improvements.

It is not the Minister of State's Department but I wish to ask if this decision will be revisited and if the Department will commit to a roadmap for restoration of full maternity services at Portiuncula.

Claire Kerrane (Roscommon-Galway, Sinn Fein)
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I agree with my colleague that the Minister for Health should be here tonight to stand over a decision she has made. She should be here to answer our questions. The Minister for Health should be here to tell us why pregnant women in our region are going to be forced to travel to access maternity care and have their babies. She should be here tonight to tell us why she and the HSE have made a decision that essentially means we have issues here, we are going to do reviews, we are going to implement the recommendations and then we are not going to restore at any point in the future, full maternity services at Portiuncula.

In 2018, the Walker report followed an independent external review of maternity services at Portiuncula, which was then published. A total of 154 recommendations followed and those recommendations were not implemented. Seven years later, we have some of the very same issues identified again. The response of the HSE was to not let it fix this or let it do whatever it had to do to make this safe and support women in this region. Instead, the response of the HSE was that it has implemented the Walker report. It was to pretend it had implemented it in full and to tell us repeatedly it had implemented it in full. Just last week, I received a letter from the hospital manager who stated all 154 recommendations had been implemented and independently verified as implemented by both HIQA and an independent national HSE team. On the very same day, Bernard Gloster told the health committee that to be clear, it would be not reconcilable for him or someone to say the Walker report was implemented in full. He said that on the same day.

I have come here tonight to ask why, in the case of Portiuncula, a decision was made not to bother to do everything necessary to ensure women across a number of counties in our region get the care they deserve at Portiuncula Hospital.

Alan Dillon (Mayo, Fine Gael)
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I thank both Deputies for raising this important matter around concerns relating to the delivery of maternity services at Portiuncula University Hospital. I am taking this on behalf of the Minister, Deputy Carroll MacNeill, who is unavoidably absent today.

The safety and quality of our maternity services are of critical importance to the women and families who use them, as well as to the Government. I understand recent developments at Portiuncula may undoubtedly cause concern and worry for many women and families who attend or plan to attend services at the Portiuncula maternity unit. However, steps are being taken to support the unit and to ensure the safety of women attending maternity services across the region. There are 12 external reviews related to maternity care at Portiuncula, which are at various stages of progress. Seven of these reviews have now been completed. The individual review reports were shared with the relevant families in July 2025. The HSE has engaged individually with each family to discuss the findings of these reviews, address their questions and outline the next steps. The Minister for Health has previously met some of the families concerned and has asked Portiuncula to provide the families affected with whatever support they need. The HSE has set up an information line for women booked with the maternity unit to contact if they have any further queries.

The HSE has advised that work to implement the recommendations arising from the reviews is in progress through the work of the Portiuncula external management team and the regional women’s and children’s managed clinical and academic network. An implementation team has been established to ensure the implementation of the recommendations arising from all reviews and to progress any further changes required over the coming months. There are currently 52 recommendations being implemented, arising from the seven reviews completed to date. This implementation team will also oversee the transfer of care for an expanded group of women with higher-risk pregnancies from Portiuncula to University Hospital Galway or the hospital of their choice. This is in line with well-established pathways already in place for the transfer of care of complex or higher-risk pregnancies within the regional maternity network. This approach has now been broadened to include women with a wide range of clinical factors known to contribute to higher-risk pregnancies. The HSE has communicated this to the women and families booked at Portiuncula, as well as their GPs. The HSE has advised the Department that ongoing engagement is happening with GPs with a briefing session being held this week.

The reconfiguration of maternity services in Portiuncula University Hospital to move higher-risk pregnancies off the site will mean some women in rural communities who previously attended Portiuncula will now need to travel to University Hospital Galway or other units for certain aspects of their maternity care. It is acknowledged these changes may create additional travel demands for expectant mothers and their families. HSE west and north-west, through the work of the implementation team, will consider what contingencies and supports can reasonably be put in place to assist women affected.

A highly experienced external management team was put in place in January 2025 to oversee and manage maternity services at Portiuncula.

This work will continue to progress over the coming months, with close monitoring and engagement within both the HSE and the Department of Health. This will include ensuring that sufficient capacity and resources are in place across the HSE west and north-west region.

Louis O'Hara (Galway East, Sinn Fein)
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Everybody understands that safety is paramount here and that we need to ensure the well-being of mothers and children, but forcing women in high-risk pregnancies to travel long distances is not appropriate. In the Minister of State's view, is that safe? Why would women not be given the choice as to where they can access maternity care? This will place further pressure on other maternity services and it is a downgrading of the maternity services at Portiuncula. The view among people locally, and I agree with them, is that there is an agenda here to remove services from the hospital by stealth and to centralise services. If previous recommendations had been implemented in full and proper resourcing, staffing and oversight put in place, we would not be in this position. The Government must make the necessary investments to support maternity care in Portiuncula and ensure we have a top-class maternity service there. That should be the Government's approach rather than seeking to downgrade services at this hospital. The Minister needs to answer questions about this issue as soon as possible.

Claire Kerrane (Roscommon-Galway, Sinn Fein)
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I thank the Minister of State for his reply. Of course, the bottom line here is that if you seek an external independent report, get the recommendations, fail to implement those recommendations, and then see the same issues arise again, it is not exactly rocket science to know how that has happened. We, as elected representatives, have been misled. On a really important report in relation to the birth of children at a hospital, a report that is that important, we were misled in terms of the recommendations not being implemented. We need to hear urgently on the floor of the Dáil from the Minister for Health. I stand to be corrected but, as far as I am concerned, she has not said a word on this matter in this House. I wrote to her over two weeks ago seeking a meeting for all of us, as Oireachtas Members across parties, to sit down and meet with her to ensure we can put across to her the worry and the stress at what should be the happiest time for women in their lives. I cannot put across to the Minister of State the stress this has put on women and their families. The Minister should have been here tonight to answer those questions and answer those women.

Alan Dillon (Mayo, Fine Gael)
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Again, I thank the Deputies for raising this important matter. I am sure they will understand that the Government and the Minister for Health are very much committed to ensuring that all women and families receive the highest standard of care, both at Portiuncula and across all maternity services nationally. The Minister and her Department officials will continue to work closely with the HSE, the clinical leads and families to ensure that the necessary improvements are delivered and sustained.

Pregnancy in Ireland is predominantly a safe experience with good outcomes. Ireland compares well with other similar countries on international standards. However, considering that the future direction of maternity services and their development will require extensive evidence-based assessment, of which the review of the implementation here is an important provision, I will relay the concerns the Deputies have raised back to the Minister. Through ongoing communication and a management plan, which is currently in place for Portiuncula University Hospital by the HSE, the Department of Health will continue to engage regarding all patient safety incidents to ensure they are being managed in line with the HSE incident management framework but also that the work being delivered through the programme for Government commitment in developing an extensive national maternity strategy is developed and that the new strategy will include wider policy issues arising from the Portiuncula review and its recommendations.