Martin Daly (Roscommon-Galway, Fianna Fail)
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81. To ask the Minister for Health the reason the recommendations of the Walker report have not been implemented; the current status of their implementation; and if she will make a statement on the matter. [52819/25]

Martin Daly (Roscommon-Galway, Fianna Fail)
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I acknowledge the Minister's bona fides in the matter of the maternity unit in Portiuncula hospital. She has acted at all times on advice in what she felt is the best interest of the safety of mothers and babies in the region. However, I want to ask her why the Walker report of 2018 was not implemented and if she will make a statement on the matter.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Deputy for his ongoing concern, driven first by patient safety in Portiuncula hospital, which I greatly appreciate. It is an important focus. As the Deputy is aware, the Walker report came from a review commissioned by the then Saolta Group in 2014 following a number of serious maternity cases at Portiuncula maternity services from 2004 to 2014. It covered 18 cases and was published in 2018, making 154 recommendations. The HSE has advised my Department that all 154 recommendations were independently verified as implemented by both HIQA and an independent national HSE team. HIQA has verified that.

One of the recommendations related to the integrated clinical director model, with one clinical director covering Portiuncula hospital and University Hospital Galway. That was in place from November 2021 until June 2024 but was recognised by both sides, I understand, as a challenge from the outset. There were elements of risk due to the distance between the two units and the associated split of the clinical director's time. The model did not lend itself to consistent on-the-ground leadership, and as a result gaps in governance emerged. Following prolonged consideration, the HSE reverted to having a clinical director on both sites from August 2024. All 154 recommendations were implemented and that is one which just did not work and the HSE reverted to having two clinical directors as opposed to one overseeing the complete group.

HSE West and North-West has an established clinical network which includes Portiuncula hospital and University Hospital Galway. The network supports Portiuncula hospital in all aspects of clinical maternity care and joint processes have been in place since 2018. Although changes were made in Portiuncula hospital following the Walker review, frankly, similar issues have emerged in Portiuncula hospital, as the Deputy is aware, which is incredibly disappointing for us, but is of life-changing significance to the women whom it impacts and their babies. Twelve reviews are ongoing, which are at various stages of progress. Seven have been completed. Fifty-two recommendations have arisen from these seven reviews to date. Work to implement many of those recommendations is already in place.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I acknowledge the mothers and babies who have experienced, at birth, sometimes catastrophic events. It is a small number of women but that makes it no less. I worked with the Minister on Portiuncula maternity unit on the premise that the Walker report had been delivered, but it manifestly has not been delivered. I do not believe the HIQA report. Last week, at the health committee, the CEO of the HSE, Mr. Bernard Gloster, said that the Walker report had not been fully implemented. That is the reality because all of the same issues that arose in 2018 have arisen in 2025. Professor Sam Coulter-Smith identified that in his report and he has couched it in language that is not obvious, but it is clear what he is saying and it is nuanced. All the same issues with governance, training and human resources exist. We have a unit that was essentially set up to function at risk. On the idea of one hospital, two sites, I do not agree that it was not working. Who made the decision that it was not working? Many issues seem to have arisen from the time it stopped.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I do not know how else to say it to the Deputy but HIQA has verified that all of the recommendations were implemented. Perhaps we should arrange an opportunity for the Deputy to engage with HIQA about its assessment. It is the independent regulator and HIQA advised that they were implemented. One recommendation of 154 did not work and it was moved backwards. The issues that arose in Portiuncula hospital should not have arisen. They should not have happened, because the recommendations of the Walker report were implemented, yet they arose again. I ask myself the same questions. I have asked that of hospital management and I have asked through the reviews.

How is it that the same issues, which are not of resources but of management, culture, communication and responsiveness to women, frankly, are occurring? I have met many of these women. I have sat with them and heard the particular experiences of their cases and what happened to them and their babies. It is difficult to accept that those cases should have happened in circumstances where the Walker report was implemented. If we are going to have a political dialogue about a report that has been implemented, which the independent regulator has confirmed as having been implemented, with one recommendation having been walked back, and try to place what happened to those women at the foot of that single recommendation being changed, we are not in a good space.

Martin Daly (Roscommon-Galway, Fianna Fail)
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We are not in a good space because the maternity unit in Portiuncula hospital is in trouble. For example, it was recommended by the Walker report that there be seven consultant obstetricians. It never happened. There were five at the most: three full-time, one on managed leave and one on managed sick leave. There was never a full complement. Someone second-guessed the Walker report, so it was never implemented. Regarding infrastructure, the recommendation of a theatre in the labour ward did not happen. Who walked back the idea of one hospital, two sites, and why? I want to know why. Does the Minister have confidence in the clinical director regionally and the associate clinical director who was recently appointed? Are they the people who brought us to this juncture? Does the Minister have confidence that they will deliver us from it?

I was at a meeting with GPs last night with the clinical team. All I am seeing is confusion and shambles. One of the clinical directors said there was no evidence base for moving older women and women who were high-risk from Portiuncula hospital. They decided not to move people with diabetes at the last moment. They also decided that GPs would not risk stratify. They do not know what is going on. There is no clinical leadership and I want the Minister to make a statement on that.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The Deputy is aware that an external management team, EMT, was put in place in January precisely to try to supervise, assess and make some of the improvements that are needed. There have been some infrastructural works and changes, some of which should have been done before the external management team arrived, which have now been completed, for example a four-bay maternity day assessment unit, MDAU, and a dedicated early pregnancy unit. All of that was in train and should have happened before the external management team arrived. It has now happened. The EMT, and nobody else but the EMT, identified a bungalow adjacent to the hospital that has now been converted to a dedicated maternity outpatient department with six dedicated maternity clinical rooms five days a week from the end of September. That bungalow had been acquired before the EMT commenced but it was for a totally different purpose. It has progressed that as a maternity outpatient department.

11 o’clock

It should not be the case that we need an external management team in Portiuncula hospital. The patient safety issues have been very significant. I have acted on clinical advice to me that it is not safe for high-risk women to give birth there until the changes that are necessary have been made and sustained in a way that can give confidence to everybody.