Martin Daly: Walker report still unimplemented at Port Yonkele

Minister, I want to discuss a matter of profound importance for women and families across the West. The ongoing failure to fully implement the recommendations of the 218 Walker report into maternity services in Porto Yonkla University Hospital. And firstly, I want to acknowledge the families who've suffered devastating outcomes. Their experiences must be acknowledged. I also want to recognise that the midwives, the doctors, the nurses and other health staff that work in that unit under extraordinary pressure in an organisationally dysfunctional system. This discussion is not about blame. It's 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 HICWA had reviewed it in 2019. And Walker was all about clear governance, modern infrastructure, robust communications and continuous training. Yet seven years later, many of those recommendations remain unfilled. Now, I spoke to people at the highest level in the HSC and I also have looked to see what HICWA report the Minister was referring to. And there was a HICWA review in 2019, but it was part of a normal natural audit of all maternity units in 2019. To my knowledge, there has not been a specific HICWA review of the implementation of the Walker report of 2018. And this has been the implementation of Walker and the non-implementation was also confirmed to me at the Health Committee three weeks ago by the CEO of the HSC, Mr. Bernard Gloucester, who said that it was patently clear, given the points I'd raised to him about the deficiencies in the management of the maternity unit in Port Yonkla Hospital, that Walker had not been implemented. Now, there's been some rowing back from that position. Now, I'm being told that Walker was implemented, but it wasn't sustained. So I'm really confused. And the people in Bannesloe, the people in East Galway and Roscommon, and in the wider region that Porter Yonkla Maternity Unit serves, are also confused. Because all of the same issues arise again. Issues around staffing, around consultant staffing. We were promised under Walker there would be seven obstetricians. At no given time in that 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 of time. Issues around infrastructure, issues around having a gynaecological theatre on the labour ward. Issues around training, stuff like CTG training, cardiotochograph training, which is basic training, ongoing training for staff. All of these issues were identified in Walker, and again identified in 2025 by the Coulter-Smith report. And we have to recognise there are 12 cases under review by Coulter-Smith and that Coulter-Smith has reported in seven of those reviews. And I will await the outcome of the other five reviews. But I also have to ask the question, is the clinical leadership that led us, who were supposed to implement Walker, are they the same clinical leadership that are going to lead us out of this? There was a policy under Walker of one hospital, two sites. That was discarded in July 2024. There has been no good reason given why that joint governance was discarded. I want to know why it was discarded, because 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, two days, another week, alternative weeks. That never happened. Six hours. Their work wasn't backfilled in Galway, so they couldn't commit to it. So that wasn't the implementation of Walker. So, so I'll thank you, Minister. Thank you, Deputy Minister Butler. Thank you very much, Deputy, and thank you for raising this really important issue. And I welcome the opportunity to discuss the delivery of maternity services at Port Yonkele University Hospital. There were 12 external reviews related to maternity care at Port Yonkele. Seven of these reviews have now been completed. And I understand the very natural worry that developments at Port Yonkele may be causing for many women and families who attend or who had planned to attend Port Yonkele maternity hospital. And I also want to acknowledge and to support those women who may have had devastating outcomes as a result of their care. And I've just put on the record of the Dáil that there are perinatal mental health supports. It's one of the things I'm very proud of having rolled out across all maternity hospitals over the last six years, across all 19 maternity hospitals. And these perinatal mental health supports are very important, especially for first-time mothers, mothers who might be nervous, mothers who might have mental health conditions, but just women who might have anxiety as well. And it's really important that they're 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 Port Yonkele. The team reports directly to the HSE West and Northwest regional management, and is responsible for managing and supporting all aspects of maternity, gynaecology and neonatal services at Port Yonkele. This team will continue to oversee the work and services provided at the hospital. The maternity unit at Port Yonkele has been fully supported in this regard. The safety and quality of our maternity services is priority. 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 Port Yonkele 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 arriving 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, but I do take on board what you have said in relation to the 2018 Walker report. Some of them may be implemented but not sustained. You are quite right. This is all about governance and accountability. This is not a blame game. This is to support the staff that are carrying out 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 Port Yonkele 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 high risk pregnancies within the regional maternity network. This approach has been 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 Port Yonkele, while GPs have also been advised and may refer women to Port Yonkele University Hospital for assessment of the appropriate pathway of care. These changes mean that women in rural communities who previously attended Port Yonkele 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 expected mothers and their families. The HSE West-Northwest, 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. Minister, I thank you for your answer. I want to deal quickly with the transfer. The transfer of high risk cases, yes, there was already a pre-existing system for women who had underlying medical conditions to be transferred either to Galway or to Dublin. The suggestion was initially that all women with diabetes, gestational diabetes or pre-existing diabetes would be transferred. That's not happening now because there's no capacity in UHG. So we're either implementing this policy on the basis of safety or we're applying it on the basis of capacity. You raise 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 can't travel, the women with the least education and there are pockets of severe deprivation around Bannislaw in the East Galway and South Roscommon Hospital. We're going to have these ladies not presenting for antenatal care, presenting late at delivery units in Port Youngclown because that's the closest place to them. They need accessible, high quality and safe care. We need Walker implemented. It's clear to me all the issues around training, communication and governance were promised but they were incompletely or inconsistently applied. And so we're in denial here when people are standing up and telling me that Walker was implemented when it patently wasn't implemented. So the people in Bannislaw deserve the implementation of Walker and the recommendations of the Coulter-Smith report. But what's really important, what we're forgetting here, that even with the movement of maybe 200 cases to UHG or to Galway for high risk cases, with the diabetic ladies and ladies who develop diabetes during pregnancy being maintained in Bannislaw, we need a safe, high quality service in the maternity unit, in Bannislaw. And we also need, and I'm going to implore this because this is not just management, I'm asking the department that there are issues around inter-professional and intra-professional relationships within that department which need to be managed very, very closely because people have a professional responsibility to collaborate to produce a high quality service. Thank you very much Deputy for raising this issue and I just, on the outset I want to acknowledge and appreciate your knowledge of a situation that's on your doorstep, that in some cases there may be patients that you have worked with previously and I do accept your passion in relation to that and you're absolutely right. It is, we have to prioritise patient safety not only at Port Juncalá, 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 other similar countries and international safety metrics. While most women experience a straightforward pregnancy and delivery, sometimes things go wrong. When they do, the health service must do all it can to establish what happened, support these women, their babies and their families to the greatest extent possible and try to prevent it from happening again. But I hear you in relation to capacity issues at University Hospital Galway and I also hear you when you speak about that women who might be from a deprived area whose financial situation mightn't be good and asking people to travel an additional journey for the safety of them and their babies, which is understood, but it can put them at a financial risk and 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 you're speaking specifically about Port Juncalá today and I just will give you a commitment here on the floor, the doll that I will speak to the Minister today in relation to the issues that you have raised, because it's a difficult time for many, many women. I think you have to go through pregnancy to understand that and you know, people need to be reassured that they're going to get the best care for them and their babies and I know that's what the staff are trying to do, but I do acknowledge the issues that you have raised here today. Thank you Minister.