Martin Daly demands answers on Bananaslo maternity safety failures

Welcome, Secretary-General Watt and CEO Gloucester. I'm going to start off because it is a situation that is critical in our area, which is Port Young Maternity Services in Bananaslo. I want to start off with the premise that the only thing that we should be concerned about is the safety and welfare of women and children. So that's the fundamental issue here. But there are many things that make up that safety. There is deep concern in the Bananaslo area that the maternity service has been essentially undermined. I can understand that the Minister's decision is based on the best medical advice she is getting through the Department of Health and the HSC. But I have to ask the question that many people in East Galway, the Midlands, West Midlands, right down to Clare, into North Tipperary, are asking, and Roscommon, are asking, how did we come to this? And I've asked a series of questions around the Walker Report 218, about how can all the same issues arise in 2025 in the Coulter-Smith Report that were identified in 2018. I've been told by the HSC that the Walker Report was implemented in full. I can take one particular recommendation, the Walker Report, was for seven obstetricians to be on staff. That has never happened. There were three before the Walker Report. It was elevated to five. But my information is that there were three full-time people, one on sick leave and one with managed contract. So the seven was never reached, I understand after that, that the HSC and Hickwood decided six was enough. But we've been told the Walker Report was instituted, it was clear it wasn't. A whole range of issues, the concept of one hospital, two sides, where there would be collaboration between UHG and Port Yonklin Maternity Services. For some reason, in a bland statement, it has been said that the HSC West, Northwest, decided that that arrangement wasn't working, and so it broke down in June 2024. I'd like to know why it wasn't working. Was there enough energy put into it? Was there enough commitment to that concept? In relation to training, I mean, I'm looking at the Walker Report and the tick box, but training around CTG reading, monitoring during delivery. All of this was supposed to happen in the Walker Report. How we arrived back at the same situation in 2025 when Coulter-Smith's report identifies all the same issues again. The internal communications, we had a bleep system that wasn't working. Is that the fault of staff? Is that the fault of obstetricians? Is that the fault of midwives? Because they are being scapegoated in Banneslow for what's happened here. In relation to not having proper mobile phone services and coverage in the hospital, who's to blame for that? I mean, this is outrageous stuff. I have here also figures from 2024. We have five stillbirths, or early life deaths. Very, very important for each case. In Galway, in UHG, there are 11. In Port de Uncler, five. Part of the Port de Uncler's issue is that you have a situation where your own REO, Tony Canavan, at one of the sail-to meetings, has identified that it is impossible to predict, in most cases, inter-uterine deaths. You might be able to reduce and mitigate the risk for it. But, for example, Port de Uncler Hospital, one of the figures was an ambulance turn for a woman who was already attending UHG maternity services, but suffered the bleed, unfortunately, and had to be brought as an emergency to Port de Uncler Hospital. Are we now saying that ambulance won't go there? It's recognised her life was saved by Port de Uncler maternity services, even though the baby was lost. An abruption on-site in the hospital couldn't save a baby. Are they being held accountable for that as well? We also come back to physical infrastructure. There's a 42% cesarean section rate. There isn't a gynaecology surgical ward on the labour ward in Port de Uncler Hospital. Is that the fault of staff? Is that the fault of the obstetricians? Is that the fault of midwives? I want to be careful with my time out, because I'd like you to give me an answer. This is not personal. But, you know, we have a situation now that a critical service in our area is not being fully supported. And I want to know why the resources and the same level of scrutiny now is being paid to the situation to support it, to make it safe. Thank you. Thanks for that, Deputy, and I'll let the clinical dimensions of it to Colm Henry, the Chief Clinical Officer, who's been heavily involved in aspects of this. I do want to take up, I think, one point you said, which I think is a very fair point to address. When somebody says the Walker report was fully implemented, I think you've clearly pointed to deficits between what Walker said and what subsequent incidents reported as having happened. The stark reality of it, from the perspective of where I sit, is that, firstly, the Walker report took several years to materialise. There does appear to have been some improvement in the rate and type of incidents occurring after the early implementation phase of that. And then there does appear to be, outside of the international norms, an unexplained deterioration again in 2023 and on into 2024. And in terms of the high-risk pregnancy decision, which I think is the core decision that you're talking about, I can assure you that that decision is made only on the basis of all of the clinical advice as to what is appropriate, what's applicable, and what's safe. And it certainly isn't being made in any blame context. And I do want to be fair to doctors and nurses working in Port Yonkola. The question of blame context hasn't risen, the question only of what is the best possible intervention that can be made in Port Yonkola and elsewhere to make it as safe as possible for the women attending there. I might just ask Dr. Henry to then address the clinical dimensions of the questions you're arising. But to be clear with you, it would be not reconcilable for me for someone to say the Walker report was fully implemented. That doesn't... The simple reality is you've pointed yourself, and we all know there are deficits that occurred post-Walker. That's very clear. Mr Jeremy, we just have a minute left. The action has taken definitely, certainly not intended to be a comment on, or any slight on the staff who are working very hard at Port Yonkola to deliver the service in what has been a very difficult year or two for them. They're more in response in terms of patient safety, of addressing those people we know are at high risk. We can't identify everybody who's going to have a difficult birth or complication, but we can identify those women based on the recommendations of the reports we have to date on the excessively high number of therapeutic hypothermias in Port Yonkola, and also based on the concerns of the external team that were put in there in January 25. And those actions include identification of women that we deem to be of higher risk with pregnancy, and ensuring that they are diverted either at booking from October 1st onwards, or building on the existing co-management with Galway, that they are diverted for the purpose of intrapartum delivery and management in Galway Hospital. They include women with a history of neonatal death or stillbirth, those with a significant medical illness, those with a pre-existing diabetes, those with a history of massive obstetric hemorrhage. So I just want to draw a distinction between any commentary on the staff, and in response to the work unit, as the CEO said, there has been enhancement of the services there, including, as the deputy says, six over six time-equivalent obstetricians, not all of whom are on the rota. And also a provision of midwives in excess of the birth plus ratio of 1 in 40 is 1 in 25. So it isn't a question of resources, it's a question of identifying those women who are at high risk pregnancy, whose needs and safety are best addressed in Galway. Thanks, Mr. Henry.