Martin Daly on Porto Yonkla: risk, reforms and community concern
Martin Daly addressed concerns arising from maternity care at Porto Yonkla, accepting expert evidence on high-risk pregnancies while querying whether risk stratification would have altered outcomes in seven reviewed cases. He welcomed recent service improvements but expressed measured concern about leadership, training, communication and social deprivation affecting antenatal access.
Martin Daly told the committee he accepts Mr. Glaston's bona fides and accepts Dr. Lena Murphy's expert evidence in relation to high-risk pregnancies. He made clear he is not an obstetrician and was not questioning Dr. Murphy's expertise while stressing that some public and GP-facing information had been confused.
Daly asked whether risk stratification would have made any difference to the outcome of the first seven cases under review and sought Dr. Murphy's expert opinion on that point. He noted two of the cases involved gestational diabetes and that many reviewed cases were low risk, and raised the possibility that identifying a cohort at high risk for HIE might have warranted different mitigations given the unit's circumstances.
He welcomed changes introduced at Porto Yonkla, including the establishment of ambulatory gynae services, direct assessment without attendance at the labour ward, and a tender aimed at improving communications. Daly said he regretted that those improvements only followed the incidents under review and called for continued training and professional development to be monitored more closely.
Daly rejected conflating the HICWA audit of April 10-11, 2019 with a forensic review of the Walker report, accepting the audit as national but distinct. He said he was satisfied at the time of his decision that the external management team should remain in place, indicating there is further work before that team could withdraw and full assurance be reached.
Daly highlighted concerns about high levels of deprivation in Banasau Town and rural East Galway, measured by Pobl and Desch status, warning that socially high-risk women could fail to access antenatal care in Galway and present late to the maternity unit in Banasau. He said he would take that observation away for further consideration and acknowledged deficits in communication with GPs, which he said the committee should learn from.
Acceptance of expert evidence
Martin Daly told the committee he accepts Mr. Glaston's bona fides and accepts Dr. Lena Murphy's expert evidence in relation to high-risk pregnancies. He made clear he is not an obstetrician and was not questioning Dr. Murphy's expertise while stressing that some public and GP-facing information had been confused.
Questions on risk stratification and cases
Daly asked whether risk stratification would have made any difference to the outcome of the first seven cases under review and sought Dr. Murphy's expert opinion on that point. He noted two of the cases involved gestational diabetes and that many reviewed cases were low risk, and raised the possibility that identifying a cohort at high risk for HIE might have warranted different mitigations given the unit's circumstances.
Service changes at Porto Yonkla
He welcomed changes introduced at Porto Yonkla, including the establishment of ambulatory gynae services, direct assessment without attendance at the labour ward, and a tender aimed at improving communications. Daly said he regretted that those improvements only followed the incidents under review and called for continued training and professional development to be monitored more closely.
Leadership, audits and external oversight
Daly rejected conflating the HICWA audit of April 10-11, 2019 with a forensic review of the Walker report, accepting the audit as national but distinct. He said he was satisfied at the time of his decision that the external management team should remain in place, indicating there is further work before that team could withdraw and full assurance be reached.
Social deprivation and access to antenatal care
Daly highlighted concerns about high levels of deprivation in Banasau Town and rural East Galway, measured by Pobl and Desch status, warning that socially high-risk women could fail to access antenatal care in Galway and present late to the maternity unit in Banasau. He said he would take that observation away for further consideration and acknowledged deficits in communication with GPs, which he said the committee should learn from.
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Transcript
Could I say to the outset I fully accept Mr. Glaston's bona fides in this matter and I accept his explanation and it is your decision to bring your team with you on so I accept that without a reservation. I also would like to say that I accept Dr. Lena Murphy's expert evidence in relation to high-risk pregnancies. My point, Dr. Murphy, wasn't directed at you but was confused information that was being directed out to GPs and to the public. So I want to rest that. I accept your specialty qualifications. I'm not an obstetrician, so I want to make that absolutely clear and I'm not questioning your expertise. I suppose one of the things I just wanted to ask around the evidence in relation to the first seven cases, and this is asking your expert opinion again, do you feel that the risk stratification would have made any difference to the outcome of those seven reviews? Are you party to that type of information? So with regard to the individual cases, so the decision, the discussions around moving high-risk weren't directly about a specific case. There were two cases that had gestational diabetes and so that is one of the criteria we looked at. But in fact, it was more, and many of them were low-risk cases. But if you have a unit that is, you know, I would say struggling, where processes weren't where we'd like to see them, that actually, if we know there's a cohort of women who go into pregnancy with a high risk for HIE, that, you know, potentially we should be doing something to try and mitigate that risk in light of the circumstances in Porto Yonkla. So that was the reasoning, if you like. Yeah, well, thank you, and thank you very much for that. And I just also want to recognise some of the changes that have been implemented in Porto Yonkla. I'm sorry that it has taken this for this to happen, but the ambulatory gynae services has been established and there's a huge welcome for that. The direct assessment without having to go to the labour ward, that's very, very welcome. The tender for communications has gone in to improve the communication beliefs. I, for the life of me, can't understand why it took this to arise for that to happen. I mean, that's not just the maternity unit in Porto Yonkla hospital, it's the whole hospital. It should have happened before this. I am hoping that something as obvious as continued training and professional development will be monitored more closely. I mean, training comes up. I mean, training should be a no-brainer. It should be an integral part of professional development. I take issue around suggesting that the HICWA audit in April 10th and 11th of 2019 represented a review of the Walker report. It wasn't. And I just don't want that to be conflated. I'll accept that it was an audit. It was a national audit. But I think it's wrong to conflate that audit with a forensic review of Walker. So I just want to put that on the record, okay? And I accept you've said that, but I'm not attacking on that. I just want to say that. I will ask this question. There's just two pieces. I have very little time. Are you happy with the leadership and culture within the unit now that's going to bring us out of this? Because that is a question that's coming to me from the unit and professionals in the unit. And I'm going to own that because it's ultimately my responsibility. I'm happy at the point in time of my decision that the external management team remains in place. And you can take it from that that there's a way to go before that team could withdraw and that we could be fully satisfied with where we're at. And that's not a reflection on individual people. It's a reflection on the level of incident that led us to a very difficult decision and therefore the assurance that's required after that. So I'm happy with the arrangements that are in place today. Okay. And I accept that. And the last piece is more of a social issue rather than a medical issue. We have some of the worst or highest levels of deprivation in Banasau Town and rural deprivation in the East Galway area. I can't comment on Roscommon and things, but we have. And that's measured by Pobl and Desch status and that. That's accepted. There is significant concern that the very women that we would consider to be high risk by due of their social status and their risk factors will end up not making it to the antenatal care in Galway, will end up presenting late without any previous care to the maternity unit in Banasau. So that's a real concern and I think it's a legitimate concern. And I think on the basis of what you've just said and how you've articulated it, rather than me saying we're doing this, that or the other about it, that's an observation I hadn't heard and I want to take it away and seriously consider how I can help the region because I think it's a very valid point. And I certainly just wasn't minded to it. Can I just say before you finish, I appreciate it's gone red, whatever deficits occurred in the communication with the most important part of our health care system, which is our GPs, I take that for the bona fides with which you've given us and we'll certainly reflect on that and learn from that. I just wanted to say that any points I've made have not been personal. I am passionate about services in my area. All accepted. Thank you. All accepted. Thank you.