Martin Daly presses on Walker report, Port Yonkila failures

I want to first acknowledge your bona fides in the matter of the maternity unit at Port Yonkila Hospital. You have acted at all times on advice in what you felt is the best interest of the safety of mothers and babies in the region. However, I want to ask you why the Walker report of 2018 was not implemented and why it wasn't implemented, and if you would make a statement on the matter. Thank you. Thank you, Deputy, and thank you for your ongoing concern driven first by patient safety in Port Yonkila Hospital, which I greatly appreciate, and it is a very important focus to have. As you are aware, the Walker report came from a review commission by the then-Celta group in 2014, following a number of serious maternity cases at Port Yonkila in maternity services from 2004 to 2014. It covered 18 cases, was published in 2018, making 154 recommendations. The HSE has advised my department that all 154 recommendations were independently verified is implemented both by HICWA and by an independent national HSE team, but HICWA has verified that. On one of the recommendations related to the integrated clinical director model, with one clinical director covering Port Yonkila and University Hospital Galway, and that was in place from November 2021 until June 2024, but it 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, and the model didn't lend itself to the consistent on-the-ground leadership, and as a result gaps in governance emerged. Following prolonged consideration, the HSE reverted to having the model of a clinical director on both sides from August 2024. So all 154 were implemented, and that is one where it just didn't work, and they reverted back to having two clinical directors as opposed to one overseeing the complete group. The HSE West and North West has an established clinical network which includes PUH and UHG. That network supports PUH in all aspects of clinical maternity care, and joint processes have been in place since that time. Although changes were made in Port Yonkila following the Walker review, frankly, similar issues have emerged in Port Yonkila University Hospital, as you are aware, which is incredibly disappointing for us, but is of life-changing significance to the women whom it impacts and their babies. There are 12 reviews ongoing, which are at various stages of progress. Seven have completed. There are 52 recommendations arising from those seven reviews to date, and work to implement many of those recommendations is already in place. Mr. David. I want to acknowledge that the mothers and babies have experienced adverse, sometimes catastrophic events, and there are a small number of women, but that makes it no less. I worked with you on Port Yonkila maternity on the premise that the Walker report has been delivered, and it manifestly has not been delivered. And I do not believe the HIC report. Last week at the Health Committee, the CEO of the HSE, Mr. Bernard Gloucester, said that the Walker report had not been fully implemented. And that's the reality, because all of the same issues that arose in 2018 have arisen in 2025. Professor Sam Couto-Smith has identified that in his report, and he has couched it in language that isn't very obvious, but it's clear in what he is saying, and it's nuanced. All the same issues around governance, training, human resources. So we have a unit that was essentially set up not to function at risk. And that one hospital, two sides, I don't agree. Who made the decision that it wasn't working? Because a lot of the issues seem to have arisen from the time it stopped. Mr. Minister. Well, Deputy, I don't know how else to say it to you, but HICWA have verified that all of the recommendations were implemented. So perhaps we should arrange an opportunity for the Deputy to engage with HICWA as to their assessment. They are the independent regulator, and HICWA advised that they were implemented. There was one recommendation of 154 that didn't work, and that they moved it backwards. But the issues that have arised in Port Yoncula should not have arisen. They should not have happened, because the recommendations of the Walker report were implemented, and yet they arose again. I asked myself the same questions, and I have asked that of the hospital management, and I have asked through the reviews. How is it that the same issues, which are not of resources, but are of management, culture, communication and responsiveness to women, frankly, many of whom I have met and sat with and heard the particular personal experiences of their case and what happened to them and what happened to their babies? It is very, very 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, that the independent regulator has confirmed as having been implemented, and one recommendation having been walked back and tried to place what happened to those women at the foot of that single recommendation being changed, we are not in a good space. Well, we are not in a good space, because the maternity unit in Porto Yoncle Hospital is in trouble. So, for example, it was recommended by Walker that there would be seven consultant obstetricians, it never happened. There were five at the most, three full-time, one on managed leave, one on managed sick leave, and there was never the full compliment, someone second-guessed Walker. So, Walker wasn't implemented. In relation to infrastructure, such as having a theatre on the labour ward, that didn't happen. Who walked back the idea of the one hospital, two sites, and why? I want to know why. Have you got confidence in the clinical director regionally, and the associate clinical director who's been appointed recently? Are they the people who brought us to this juncture, and have you confidence that they're going to deliver us out of it? I was on a meeting with GPs last night, with the clinical team, and all I'm seeing is confusion, shambles. One of the clinical directors said there was no evidence base of moving older women, and women who were high multiple from Porto Yoncle Hospital. They decided not to move diabetes at the last moment, and they've also decided that GPs wouldn't risk stratify. They don't know what's going on, there is no clinical leadership, and I want the minister to make a statement on that. Minister? The Deputy is aware that there is an external management team put in place since January precisely to try to supervise, to assess, and to make some of the improvements that need to have been improved. There has been some infrastructural works and changes, some of which should have been done before the EMT arrived, and that have now been completed. For example, a four bay MDAU, a dedicated early pregnancy unit, all of that was in train, should have happened before the external management team arrived, has now happened. The EMT, and nobody else, nobody else, but the EMT identified a bungalow adjacent to the hospital that has now been converted to a dedicated maternity OPD, with six dedicated maternity clinical rooms, five days a week from the end of September. That bungalow had been acquired before the EMT commencing, but it was for a totally different purpose, and they have progressed that now as a maternity OPD. It should not be the case that we need an external management team in Port Juncula. The patient safety issues have been very, 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. Thank you, Minister. Deputy. Deputy. Deputy. Deputy.