Martin Daly (Roscommon-Galway, Fianna Fail)
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I acknowledge Deputy O'Reilly's loss and the issue she raised as well.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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I thank Deputy Daly.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I want to discuss a matter of profound importance for women and families across the west, namely the ongoing failure to fully implement the recommendations of the 2018 Walker report into maternity services at Portiuncula University Hospital. I acknowledge the families who have suffered devastating outcomes. Their experiences must be acknowledged. I also recognise that the midwives, doctors, nurses and other health staff who work in the unit under extraordinary pressure in an organisationally dysfunctional system. This discussion is not about blame, it is about governance, accountability and leadership.

On the floor of the Dáil two weeks ago, the Minister for Health informed me that the Walker report was implemented and that HIQA had reviewed it in 2019. Walker was all about clear governance, modern infrastructure, robust communications and continuous training, yet seven years later many of those recommendations remain unfilled. I spoke to people at the highest level in the HSE and I have also looked to see what HIQA report the Minister referred to. There was a HIQA review in 2019 but it was part of a normal, natural audit of all maternity units in that year. To my knowledge, there has not been a specific HIQA review of the implementation of the Walker report of 2018.

The non-implementation of the Walker report was also confirmed to me at the health committee three weeks ago by the CEO of the HSE, Mr. Bernard Gloster, who said that it was patently clear, given the points I raised with him about the deficiencies in the management of the maternity unit at Portiuncula hospital, that the Walker report had not been implemented. There has been some rowing back from that position, and I am now being told that the Walker report was implemented but was not sustained. I am really confused, as are the people in Ballinasloe, east Galway and Roscommon and in the wider region Portiuncula maternity unit serves. All of the same issues arise again, such as staffing and consultant staffing. We were promised following the Walker report that there would be seven obstetricians but at no given time in the intervening period were there even four obstetricians. There were three full-time obstetricians sharing on-call care. There was one on managed sick leave and one on managed leave over that period.

Issues around infrastructure, having a gynaecological theatre on the labour ward, training such as cardiotocography, CTG, which is basic training, and ongoing training for staff. All of these issues were identified in the Walker report and again identified in 2025 by the Coulter-Smith report. We have to recognise that there are 12 cases under review by Coulter-Smith and that he has reported in seven of those reviews. I will await the outcome of the other five reviews.

Is the clinical leadership that was supposed to implement the Walker report the same one that is going to lead us out of this? There was a policy under Walker of one hospital on two sites. That was discarded in July 2024. No good reason was given as to why that joint governance was discarded. I want to know why it was discarded, particularly as the idea was good. There was no full commitment to it. The associate clinical director was to come from Galway on three days one week and two days another week for six hours on alternate weeks. That never happened because the work was not backfilled in Galway so they could not commit to it. That was not the implementation of the Walker report.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this important issue. I welcome the opportunity to discuss the delivery of maternity services at Portiuncula University Hospital. There are 12 external reviews related to maternity care at Portiuncula. Seven of these reviews have now been completed. I understand the very natural worry that developments in Portiuncula may be causing for many women and families who attend or who had planned to attend for Portiuncula maternity hospital. I also acknowledge and offer support to those women who may have had devastating outcomes as a result of their care. I am very proud of having rolled out perinatal mental health support across all 19 maternity hospitals over the last six years across. These perinatal mental health supports are very important especially for first-time mothers, mothers who might be who might be nervous, mothers who might have mental health conditions and women who just might have anxiety. It is really important for them to be aware that those supports are there.

In January 2025, a highly experienced external management team was put in place to oversee and manage maternity services in Portiuncula. The team reports directly to the HSE west and north-west regional management and is responsible for managing and supporting all aspects of maternity, gynaecology and neonatal services at Portiuncula. This team will continue to oversee the work and services provided at the hospital. The maternity unit at Portiuncula is being fully supported in this regard.

The safety and quality of our maternity services are priorities. The steps that are being taken to support the unit are to ensure the safety of all women attending maternity services across the region. The HSE has advised that the work to implement recommendations arising from the reviews is in progress through 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 recommendations arising from all reviews are followed and to progress any changes required over the coming months. There are currently 52 recommendations, arising from the seven reviews completed to date. I take on board what the Deputy said about the 2018 Walker report. Some of them may be implemented but not sustained. He is quite right in saying this is all about governance and accountability. This is not a blame game. This is to support the staff who are supporting women and girls every day of the week to deliver their babies safely.

The implementation team will also oversee the transfer of care for women with higher risk pregnancies from Portiuncula to University Hospital Galway or the hospital of their choice. This is not a new approach. It is in line with the well-established pathways in place for the transfer of care of complex or higher risk pregnancies within the regional maternity network. This approach is being broadened to include women with a wider range of clinical factors known to contribute to higher risk pregnancies. The HSE has communicated this to the women and families booked at Portiuncula, while GPs have also been advised and may refer women to Portiuncula University Hospital for assessment of the appropriate pathway of care.

These changes mean that women in rural communities who previously attended Portiuncula may now need to travel to Galway, or another unit of their choice for their maternity care. This may result in additional travel demands for expectant mothers and their families. The HSE west and north-west, through the work of the implementation team, is considering additional supports to assist women affected to ensure a seamless transfer of care for women identified as having a higher risk pregnancy.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the Minister of State for her answer. I will deal quickly with the transfer. On the transfer of high-risk cases, there was already a pre-existing system for women who had underlying medical conditions to be transferred either to Galway or to Dublin. The initial suggestion was that all women with diabetes, gestational diabetes or pre-existing diabetes would be transferred. That is not happening now because there is no capacity in UHG. We are either implementing this policy on the basis of safety or we are applying it on the basis of capacity.

The Minister of State raised the issue about women having to travel to Galway. The women who will be most affected by this are the women with the least resources, the women who cannot travel, the women with the least education. There are pockets of severe deprivation around Ballinasloe and the east Galway and south Roscommon area. We will have these ladies not presenting for antenatal care and presenting late at the delivery unit at Portiuncula because that is the closest place to them. They need accessible high-quality and safe care.

We need the recommendations from the Walker report to be implemented. It is clear to me that all the issues around training, communication and governance were promised but they were incompletely or inconsistently applied. We are in denial here. People have told me that the recommendations from the Walker report were implemented when they patently were not implemented. The people in Ballinasloe deserve the implementation of the recommendations from the Walker report and also the implementation of the recommendations of the Coulter Smith report. What is really important and what we are forgetting here is that even with the movement of maybe 200 high-risk cases to University Hospital Galway, given that the diabetic ladies and ladies who developed diabetes during pregnancy are being maintained in Ballinasloe we need a safe high-quality service in the maternity unit in Ballinasloe.

I implore for this to happen because this is not just about management. There are issues around interprofessional and intra-professional relationships within the department which need to be managed very closely because people have a professional responsibility to collaborate to produce a high-quality service.

Mary Butler (Waterford, Fianna Fail)
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I again thank the Deputy for raising this issue. I acknowledge and appreciate his knowledge of the situation on his doorstep. In some cases they may be patients he has worked with previously. I accept his passion about that. He is absolutely right. We have to prioritise patient safety not only at Portiuncula but across all maternity units in Ireland. The Minister and the Department of Health are continuing to work closely with the external management team, the HSE clinical leaders 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 similar countries on international safety metrics. While most women experience straightforward pregnancy and delivery, sometimes things go wrong. When they do, the health service must do all it can to establish what happened and support these women, their babies and their families to the greatest extent possible, and try to prevent it from happening again. I hear what the Deputy said about capacity issues at University Hospital Galway. I also hear what he said that asking women, who might be from a deprived area and whose financial situation might not be good, to make an additional journey for the safety of them and their babies, which is understood, can put them at a financial risk. I will certainly raise that with the Minister.

There has been focused investment in the quality and safety pillar of the national maternity strategy but I know the Deputy is speaking specifically about Portiuncula today. I give him a commitment on the floor the Dáil that I will speak to the Minister today about the issues he has raised. It is a difficult time for many women - people need to go through pregnancy to understand that. People need to be reassured that they will get the best care for them and their babies and I know that is what the staff are trying to do. I acknowledge the issues the Deputy has raised here today.