David Cullinane
Question:76. Deputy David Cullinane asked the Minister for Health if she will consider an independent public inquiry into scandals at Children’s Health Ireland; and if she will make a statement on the matter. [52528/25]
Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions
Public Inquiries
My first question relates to the need for a public inquiry into spinal surgeries for children with scoliosis and spina bifida at CHI. I note the Minister met Harvey Morrison Sherratt's family with the Tánaiste recently and it seems a commitment was given to an inquiry. Will the Minister inform the House as to what form that inquiry will take and what her view of the timeframe will be in the terms of reference?
I thank the Deputy. He is correct. On Monday, the Tánaiste and I met with the parents of Harvey Morrison Sherratt, along with other advocates who were there to support the family. The Tánaiste and I listened carefully to what his parents said. It must have been a particularly difficult time, as all of this period has been for them, but also recognising it has been two months since the death of their little boy. At the meeting, it was agreed that we would work in partnership on the structure of an inquiry into spina bifida and complex scoliosis services at CHI. As the Deputy will be aware, there are a number of different models of inquiry and investigation. I have committed to scoping out the different models that are possible and the pros and cons of each of those models, while recognising that some of them have limitations, and to presenting that back to the parents and the advocates. It is important we would have a follow-up meeting when they have had the opportunity to reflect on that therefore it is my intention to write to them within two weeks and then to meet them a week after that. I have a little bit of work to do on that yet. The inquiry will be part of the wider reflection on paediatric services in CHI. The Deputy and the House will be aware that there is an important audit going on into waiting list equity or equity of access to the waiting lists in some of these services. It is important to say that. There is also the CHI oversight improvement steering group which is working regularly and oversees the implementation of the range of different reports of which the House is already aware, including the HIQA review. It will also oversee upcoming reports, including the Nayagam review, and a range of other measures.
There are different models but it is important that this is an inquiry. That is what families are looking for. Obviously, there are different types of inquiries. We have seen in the past where inquiries were promised and they end up being reviews and investigations, very similar to the Nayagam review which is ongoing and still has not been published. This inquiry has to be comprehensive. It has establish all of the facts. It has to look at the full range of services and it has to achieve accountability, wherever that lands us; whether that is political, within CHI or governance. We know that this is not just about surgeries. They are vital. Children were failed in relation to not getting surgeries on time. We know that. Far too many children were waiting. However, there are also issues regarding urology services, pre-care, aftercare and all of that. That has to form part of any review. It is really important for all of those children in the first instance that that inquiry happens, but it is equally important that we also invest in services and ensure in the here and now that children are getting timely access to care.
Yes, it would be my intention, irrespective of the form of investigation or inquiry, that it would be comprehensive in the way the Deputy has outlined, that it would be transparent and that it would be an inquiry that is also capable of making recommendations, as the parents and advocates have looked for. As he will be aware, in some forms of inquiry where information is presented during the inquiry, it can never be used in other proceedings. I am very conscious, for example, of a comparable model in relation to Limerick where there are disciplinary proceedings happening. That has never happened in the health service before.
The Frank Clarke report did not step over that, but a different form of inquiry would have stepped over that and precluded some of those disciplinary proceedings continuing. That is the balance I am trying to strike. Again, this is for a discussion with the advocates and with the person who will, ultimately, be in charge of this. It will be intended to have a senior legal figure and a clinical leader of this inquiry. It is very important that we get their perspectives as well on what is likely to work, what is going to be the right timeframe, what is capable of being comprehensive, and not precluding other proceedings that may be appropriate.
Part of the problem here is that we have had almost a decade of failure and broken promises, some of which it must be said were political promises, and in more recent times a lack of transparency from Children's Health Ireland. Those very same families the Minister has met, and those parents and advocates she would meet, have been screaming from the rooftops about governance failures at CHI for many years. Many of their children are part of what is called the Dickson report, and I know that CHI has given a reason as to why it feels that report cannot be published. I have said there is absolutely no reason the contents of that report cannot be shared with the families whose children were part of that. There is a reference to what are called "orphan" children, who are children that fell through the cracks and were not getting the appropriate care. They were not under the appropriate consultant, be it a urologist or orthopaedic surgeon, and they simply fell through the cracks. These are children with spina bifida and scoliosis who at the time were waiting for procedures. I believe that trust is at an all time low. Trust is on the floor for many of these parents and there is an awful lot of work to do to repair and restore that trust. This is why I appeal to the Minister to make sure that whatever inquiry is put in place is the most robust it can be to get answers to the questions that need to be answered and, as important, to actually put the services in so that no other child has to wait as long as Harvey, and far too many other children, did.
Again, I agree with the Deputy. On the Dickson report I will provide a note to Deputies on this. There is a follow-up process with those families. I do not have the details to hand but I would like to provide that information to them.
Deputy Cullinane is absolutely right about developing services now. An inquiry should not prohibit or preclude that. He will be aware that I have strengthened very considerably the board of CHI with appointments most recently, and in particular with Fergus Finlay who is a very strong advocate in this space, and who I know will be a very strong advocate on the board and hold CHI very strongly to account, especially in relation to spinal services. As I said at yesterday's health committee meeting, I am really not satisfied with this year's performance. I cannot account for the reduction in the number of families travelling abroad. It is not clear to me how that is being offered to them, at what stage it is being offered to them or the breadth with which it is being offered. I am pleased that the adolescent complex surgeries have begun in the Mater. This is after a period when they were being paid for and not being done. Since July it has now been agreed that these will be done, and I am trying to see what options I have, domestically and internationally, that go beyond what we currently have to see how we can do more. I will report back to the House on that. I do not have an answer on that yet.
Cancer Services
Marie Sherlock
Question:77. Deputy Marie Sherlock asked the Minister for Health to account for the dramatic drop over the past eight years in breast cancer patients with an identified B5 or C5 receiving surgical intervention within the 20-working day target - with surgery identified as the first treatment; and if she will make a statement on the matter. [52489/25]
From the Department's hospital productivity dashboard, we know that the specialty that has seen the largest increase in waiting times over the past three years has been breast surgery. From parliamentary questions we have asked, we are aware that for breast cancer patients for whom surgery is the first treatment there is a HSE commitment to treatment within 20 days. Over the past eight years there has been a sustained and dramatic drop in meeting that target. In 2017, just over 10% did not get timely treatment but that number is now at 40% of all the women. We want to hear from the Minister how she will account for these failings and what actions are being taken by the Department.
The Government is of course, as is everybody else, committed to improving cancer care, ensuring better prevention, maintaining improvements in cancer survival rates, and timely access to treatments. The national cancer control programme, NCCP, has a number of metrics for breast cancer services. They are consistently reviewed to guide service advancements and to make improvements.
Since 2017 the total number of patients annually receiving this type of surgery increased by 10% to well over 1,500 in 2023. Over this period the percentage of patients seen within the recommended 20 days has decreased from 84% to 60%. The time to surgery can be influenced by a number of factors, including imaging and inpatient capacity, as well as the individual circumstances of the patient. The HSE is working on several initiatives to improve surgical capacity, including consideration of imaging and inpatient capacity in several cancer centres. Waiting times for radiology and diagnostic services are very seriously recognised as an issue.
The NCCP has produced a range of guidelines aimed at ensuring standardised access to cancer services across the country. These will, I hope, reduce variation in the management of patients and will lead to more appropriate referrals and management of patients within cancer services.
The Deputy will already be aware of the scale of the investment into the national cancer strategy since 2017. Significant improvements have been made with regard to breast cancer in recent years, in line with the overall objectives of the national cancer strategy. We do need to see a good deal more, as the Deputy will be aware.
For the past two decades we have seen some very significant improvements in cancer care in this country but there is a very real and very well-founded concern now that cancer care outcomes may regress if the current trend in the delays in care continue. We have an excellent framework in terms of the deadlines that have been set down within the NCCP with a 95% target of ten working days for an urgent referral and 20 days for where surgery is required. We know, however, that this is so patchy, as the Minister herself acknowledged, across hospitals and indeed will be missed by the majority of hospitals. We heard from the Irish Cancer Society this morning that 3,600 women this year are not seen within the ten-day target. All of us here have had people come to us really distressed because they are told they need an urgent appointment and then they are given an appointment, such as in one case that I was dealing with, of seven weeks later. The reality of course is that this is one part of the cancer care process. I understand that the conversion rate from breast screening to diagnosis is about 8%.
The five-year net survival rates for breast cancer grew from 71% in the 1990s to 87.5% for the 2019 to 2022 period. We are going in the right direction. The Deputy is absolutely right to highlight it. We have had more people through the system and demand is increasing year on year. More than 56,000 patients were seen in clinics in 2024, up from 50,000 in 2019.
From my analysis, the single biggest issue, although there are many, is the timely access to MRI as a diagnostic tool. From the data I have, the reason for being out of target, say in 2022, was that imaging was at about 30%. It is now at 41%. We need to focus all of our efforts on access to imaging, the way in which our imaging technology is being used, the consistency, the hours that it is being used and the commitment of hospital staff to do that at all times and days of the week. As part of the productivity we were speaking about, this is an example of why that matters so much. Access to imaging, as far as I can see at the moment, really is the most challenging part.
I very much share the Minister's concern but I know, for example, that there is an MRI scanner in a major hospital for which they cannot get access to the post because there has been a suppressed post. I can talk to her afterwards about this.
There is also the reality of the very significant inequality for some women out there. Research published this year by the National Cancer Registry Ireland shows that 41% of women from deprived backgrounds have a much higher risk of death within five years of diagnosis compared with those from more affluent backgrounds and 24% have a higher risk of being diagnosed with late stage disease. We have had 4,000 diagnoses in 2022. One in seven of us women will get breast cancer in our lifetime. These wrinkles within the hospital system are down to the equipment that is not being properly optimised because of suppressed positions, and the delayed response to business cases by the HSE for breast surgeons. These are very real issues.
I would be very grateful for the specifics of what the Deputy is asserting. I will check that out. It is very much the opposite to what we are trying to do. Considering the number of vacancies we are desperately trying to fill, I would be very concerned about that. I would appreciate if the Deputy could help me out with more information on that.
Several cancer centres have plans for additional theatre and inpatient capacity specifically for cancer and inpatient care because the theatre access is so important. Part of what will help with this is completion of the surgical hubs nationally, which will alleviate some pressure on our acute theatre capacity by moving lower complexity procedures, obviously since it is surgical hubs. Aligned to that is the theatre utilisation project, which is changing start times of theatres and maximising the flow and capacity within that. As I said, if there is a particular issue in a hospital I would be very glad to know about it.
Capital Expenditure Programme
David Cullinane
Question:78. Deputy David Cullinane asked the Minister for Health if she is confident that sufficient capital funding has been provided for in the national development plan to deliver elective centres, 3,000 additional acute inpatient beds, digital transformation, and the entirety of health infrastructure commitments made by the Government; and if she will make a statement on the matter. [52529/25]
Capital funding in health is really important. This capital allocation is one of the most important because it is linked to many of the big projects that are about reform of the health service. It is about more hospital beds and the 3,000 beds that were promised by the Minister's predecessor before the local elections last year. Elective hospitals have to be built, which is really important in following on from those surgical hubs and separating scheduled from unscheduled care.
We have the new National Maternity Hospital. We need to develop Galway. I know there are plans for other acute hospitals in my own constituency in Waterford. I will get to those projects as well. I do not believe the capital funding is there to deliver on all of those projects so the question is: which projects are not going to be delivered because of the capital funding that is allocated up to 2030?
I thank the Deputy. As he is aware, the programme for Government will set out a review of the national development plan as a key priority. Through the NDP review, we are prioritising critical economic growth but also the health infrastructure we need to have, which the Deputy has articulated.
The substantially enhanced NDP provision for the health sector of €9.25 billion will support the delivery of equitable, accessible and high-quality healthcare across Ireland. We have seen a number of examples of that happening so far but there is quite a lot of work to do, such as the new surgical hub at Mount Carmel, the HSE health app and the 96-bed ward block in UHL. That is what has happened so far. As the Deputy and I both know, we have to drive further ahead.
The NDP settlement recognises that there are certain key programme for Government priorities in health that will progress to statutory approval towards the latter part of the current NDP. In relation to shovel-ready projects, I have assurance from the Minister for Public Expenditure, Infrastructure, Public Service Reform and Digitalisation and his Department that they will be priorities for funding in the post-2030 NDP. The basic point is that if we get something to shovel-ready, we will be making the case to central Government for the funding to be enabled for that.
The Minister for public expenditure and reform has also confirmed that should there be underspends evident in the overall NDP allocation, the first allocation for that will go to the Department of Health. We have a programme of funding for the next five years. We have a challenge to meet that and get those to construction phase. Where we get something else to shovel-ready, I will be going to the Minister for public expenditure and reform looking for unspent allocation in other NDP programmes, the first call on that and indeed the first round of funding. My challenge is, frankly, getting things to shovel-ready stage. I am confident of the funding for electronic health and for the infrastructure projects we have. Our bigger difficulty is getting them to shovel-ready.
I do not believe that is the biggest challenge at all. It is a challenge, of course, to get projects ready and obviously they have to go through planning processes and there are other processes as well. I met with senior officials in the Department before the last general election. What they set out to us was an ask of about €13.5 billion up to 2030. What was achieved was €9.5 billion. Even looking at some of the costs, we know there is at least €1 billion, at a minimum, needed for digital transformation. We have to finish out the children's hospital which, it is estimated, will require about €300 million in addition to the current €9.5 billion allocated. The surgical hubs have to be paid for. Primary and community care facilities were estimated to be €270 million. On the 3,000 hospital beds, they average out at about €1 million each. That is €3 billion alone for those beds. Half of those beds, in my mind, will not be delivered and we will see who is right and who is wrong as all of this plays out. The new National Maternity Hospital is at a minimum of €900 million, at best, and then we are into the elective hospitals. We know from the preliminary business cases they are about €1 billion at a minimum for those four. When you add all of that up, it is well over €13 billion. It does not add up. Then the question is: what projects are not going to be delivered?
The question is around what is capable of being delivered to absolute completion within the next five years and how we balance and manage that. I do not think it is a question of right or wrong. Both the Deputy and I want to see the infrastructure delivered immediately if possible but we both live in the real world where we have to go through planning and procurement processes. There is a slowness in doing that, unfortunately - in the Government and the public sector doing that - which does not challenge the private sector in the same way. It is very frustrating but we both want to see the projects delivered.
I now have a capital envelope the size of which we have not had in health. There was an underspend on capital investment for a very long time in health, with significant additional funding on the current side. That was fine and necessary but there has been an underspend. I have secured a large capital portion of the NDP and the additional programme that is there. I have the assurance that where I get something to shovel-ready, I will get the funding for that and I would welcome the Deputy's support when I get to that point.
Despite all of the best efforts of people who will work in this space, even if they get them to shovel-ready, I have already outlined and done the maths. I have met with the Department. I know the money simply is not there to do all of these projects. It is a case of who is right or who is wrong when it comes to the funding. I would accept that the Minister wants as much as possible to be done, as I do, but it does come down to money. It is a case of "show me the money". If the money is there, we can do these projects. If the money is not there, whether they are shovel-ready or not, they simply will not proceed. We have seen health projects stalled.
We can all give examples in our own constituencies. I have dealt with the bigger State-wide projects. In my own constituency of Waterford, we need to deliver 24-7 cardiology care, which the Minister committed to. We need to invest in the adult mental health unit. There is a need for a PET scanner. There are loads of projects right across each individual hospital that will also have to be funded. They have to be taken into account when you look at all the bigger projects as well. I believe - and it is my analysis based on the discussions I have had with the Department and the HSE - that there is a funding shortfall in regard to capital. I fear that some of those big reforms, especially the elective hospitals, simply will not happen as quickly as they should because the money will not be there.
There is no barrier to them in the context of the funding side of it. The bigger issue is the planning side but we will work through it together.
I had the good fortune to be in Waterford, a really excellently run hospital. I was in the cath labs and got to see the different theatre configuration, which, of course, has been delivered. It is the case that the cardiologists have been recruited and that was confirmed to me by the hospital management and the IHA management so we will see that commitment delivered. The current funding was put beside it.
That is for 8 a.m. to 8 p.m., not 24-7.
There was a recruitment process, and there you go. I stood, as I am sure the Deputy has done, and his party colleagues were there with me, outside the pretty magnificent surgical hub that is being completed there. We would very much like to see that. If anybody is going to run that well, I am confident that Waterford will do it. Those projects are being delivered and I look forward to seeing the physical transformation of that hospital as much as every other hospital with the ongoing capital investment that has happened and continues to happen, and the major projects, such as the one in the Deputy's own constituency, which is being delivered in front of his constituents' eyes.
Cancer Services
Pádraig Rice
Question:79. Deputy Pádraig Rice asked the Minister for Health the steps she is taking to address the serious deficits in staffing and equipment in public radiation therapy services; if she will instruct the HSE to offer all radiation therapy graduates employment; and if she will make a statement on the matter. [52861/25]
I wish to ask the Minister about cancer services. Over 50% of cancer patients require radiation therapy at some point in their care. It is routinely used to treat the most common types of cancer such as breast, cervical and lung cancers. It is the cornerstone of modern cancer treatment and yet, it is neglected. We have ageing machines. In other areas, newer machines have no staff to operate them. Qualified radiation therapists cannot get jobs and there are shocking levels of outsourcing to the private sector. As of July, €17 million has been spent this year alone contracting-out radiation therapy. What action will the Minister take to address deficits in both staffing and equipment?
I thank the Deputy. The Government is obviously committed to improving cancer care generally. As the Deputy is aware, a total of €105 million has been invested in the strategy since 2017, including €23 million in budget 2025.
Under the national plan for radiation oncology, state-of-the-art radiation oncology centres have opened in Cork and Galway in 2019 and 2023, respectively, which was €120 million capital investment. In Dublin, the St. Luke's Radiation Oncology Network, which includes St. James's and Beaumont Hospitals, were developed under phase 1 of the national plan in 2010. The design of the phase 1 facilities made provision for future expansion for phase 2, which is now under way at Beaumont Hospital as a priority.
On staffing, I wish to acknowledge the incredibly important role of radiation therapists in the provision of cancer services in this country. There are currently 220 radiation therapists in Ireland, an increase of over 20% since 2020. While recruitment for radiation therapists is challenging globally, radiation therapist staffing vacancies in the HSE have improved from 30% in 2024 to about 15% to 22% at present. It is not fully staffed but it is going in the right direction, notwithstanding a challenging global environment.
There are currently 40 radiation therapy student places available annually across Trinity College, Dublin and University College, Cork. In the last six years, the radiation therapy training programme has grown by 32% and more than 20 additional specialty training posts have been established in the last three years. The national radiation therapist review, completed in 2024, provides a strategic review of the profession in Ireland and recommendations are being progressed by the HSE. The review recommended the development of new advanced practice radiation therapist roles and those posts are expected to be advertised in the coming weeks. To maintain improvements, NSP 2025 included 5.5 radiation therapy posts and six advanced practice radiation therapists.
First, on machinery, I accept there is a replacement programme under way for St. Luke's but why are machines breaking down before action is taken? The internationally accepted lifespan for a treatment machine is ten years but in St. Luke's, Rathgar, they have two machines that are 15 years old and another two that are almost 17 years old. They are limited to using three machines at a time. This means that a quarter of the capacity in Rathgar is being lost. Why? It is to mitigate breakdowns. These machines need to be replaced every ten years. It is entirely predictable, so why is there not a national programme in place to support a ten-year replacement programme? This ad hoc replacement of antiquated machines coming too late in the day is compromising patient safety. Nationally, 35% of machines are already 15 years old, with two more approaching 17 years old. Some 40% of machines will require replacement in the next five years and overall, 75% of the machines will require replacement now or within five years.
We need greater investment and we need a programme to replace these machines.
There are five public radiotherapy treatment centres with a total of 22 linear accelerators across the services. Galway has four, Cork has five and St. Luke's has 14 machines across the three sites in Dublin. The HSE also contracts radiation oncology services for public patients to centres in Waterford and Limerick and has a service-level agreement with the North West Cancer Centre in Altnagelvin to provide radiotherapy services for patients within a 90-minute road journey of Derry.
Under the National Plan for Radiation Oncology, NPRO, Ireland has developed state-of-the-art radiation oncology centres, as the Deputy is aware. I will look into the examples the Deputy has given relating to the management and replacement of different machines. I just need to spend more time doing that. I thank the Deputy for highlighting it.
Regarding staffing, Cork and Galway both have new builds and new machines, but not enough staff. St. Luke's network has a CT scanner with no staff, a skin cancer treatment service operating at reduced capacity because it has insufficient staff, and at the same time, we had 30 graduates in radiation therapy from Trinity College last year. Only ten of them secured posts in Ireland, a further ten left the profession, and ten more have no employment. Radiation therapy graduates need a guarantee of employment from the HSE. At the moment, we are just training them to leave the country, leave the profession or go to the private sector. We also have the ludicrous situation where radiation therapists hired by the HSE do not get incremental credit for previous service in the private sector. How can the Minister justify this policy where radiation therapists are so desperately needed? Why would they move from the private sector to take a pay cut? To address these staffing issues, we need two measures. We need a guarantee of graduate employment for those qualifying and we also need incremental credit for radiation therapists.
There are a couple of different things. Staffing vacancies have decreased considerably, from 30% in 2024 to 14% in Dublin, 15% in Galway and, I acknowledge, 22% in Cork. CORU has changed some of the registration requirements, which has brought Ireland closer to international standards, providing access to work in Ireland for more radiation therapists generally. We have funding allocated in 2025 for the development of advanced practice roles in radiotherapy, which, again, is an effort to help people to work at the absolute top of their profession, which is really important. Recruitment is ongoing for vacancies in radiotherapy services. We are actively looking for people to come and work in these services. We are trying to enhance the workforce through advanced practice opportunities and to really drive in that direction. We know how much people have to offer. We have the funding for the additional posts. We want people to come and work in this service. We are taking all of the steps we can to try to attract them. We cannot compel people to be in the public health system either.
Graduates are looking for jobs, Minister.
I have jobs.
Hospital Services
Martin Daly
Question:81. Deputy Martin Daly asked the Minister for Health the reason the recommendations of the Walker report have not been implemented; the current status of their implementation; and if she will make a statement on the matter. [52819/25]
I acknowledge the Minister's bona fides in the matter of the maternity unit in Portiuncula hospital. She has acted at all times on advice in what she felt is the best interest of the safety of mothers and babies in the region. However, I want to ask her why the Walker report of 2018 was not implemented and if she will make a statement on the matter.
I thank the Deputy for his ongoing concern, driven first by patient safety in Portiuncula hospital, which I greatly appreciate. It is an important focus. As the Deputy is aware, the Walker report came from a review commissioned by the then Saolta Group in 2014 following a number of serious maternity cases at Portiuncula maternity services from 2004 to 2014. It covered 18 cases and was published in 2018, making 154 recommendations. The HSE has advised my Department that all 154 recommendations were independently verified as implemented by both HIQA and an independent national HSE team. HIQA has verified that.
One of the recommendations related to the integrated clinical director model, with one clinical director covering Portiuncula hospital and University Hospital Galway. That was in place from November 2021 until June 2024 but 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. The model did not lend itself to consistent on-the-ground leadership, and as a result gaps in governance emerged. Following prolonged consideration, the HSE reverted to having a clinical director on both sites from August 2024. All 154 recommendations were implemented and that is one which just did not work and the HSE reverted to having two clinical directors as opposed to one overseeing the complete group.
HSE West and North-West has an established clinical network which includes Portiuncula hospital and University Hospital Galway. The network supports Portiuncula hospital in all aspects of clinical maternity care and joint processes have been in place since 2018. Although changes were made in Portiuncula hospital following the Walker review, frankly, similar issues have emerged in Portiuncula hospital, as the Deputy is aware, which is incredibly disappointing for us, but is of life-changing significance to the women whom it impacts and their babies. Twelve reviews are ongoing, which are at various stages of progress. Seven have been completed. Fifty-two recommendations have arisen from these seven reviews to date. Work to implement many of those recommendations is already in place.
I acknowledge the mothers and babies who have experienced, at birth, sometimes catastrophic events. It is a small number of women but that makes it no less. I worked with the Minister on Portiuncula maternity unit on the premise that the Walker report had been delivered, but it manifestly has not been delivered. I do not believe the HIQA report. Last week, at the health committee, the CEO of the HSE, Mr. Bernard Gloster, said that the Walker report had not been fully implemented. That is the reality because all of the same issues that arose in 2018 have arisen in 2025. Professor Sam Coulter-Smith identified that in his report and he has couched it in language that is not obvious, but it is clear what he is saying and it is nuanced. All the same issues with governance, training and human resources exist. We have a unit that was essentially set up to function at risk. On the idea of one hospital, two sites, I do not agree that it was not working. Who made the decision that it was not working? Many issues seem to have arisen from the time it stopped.
I do not know how else to say it to the Deputy but HIQA has verified that all of the recommendations were implemented. Perhaps we should arrange an opportunity for the Deputy to engage with HIQA about its assessment. It is the independent regulator and HIQA advised that they were implemented. One recommendation of 154 did not work and it was moved backwards. The issues that arose in Portiuncula hospital should not have arisen. They should not have happened, because the recommendations of the Walker report were implemented, yet they arose again. I ask myself the same questions. I have asked that of hospital management and I have asked through the reviews.
How is it that the same issues, which are not of resources but of management, culture, communication and responsiveness to women, frankly, are occurring? I have met many of these women. I have sat with them and heard the particular experiences of their cases and what happened to them and their babies. It is 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, which the independent regulator has confirmed as having been implemented, with one recommendation having been walked back, and try to place what happened to those women at the foot of that single recommendation being changed, we are not in a good space.
We are not in a good space because the maternity unit in Portiuncula hospital is in trouble. For example, it was recommended by the Walker report that there be seven consultant obstetricians. It never happened. There were five at the most: three full-time, one on managed leave and one on managed sick leave. There was never a full complement. Someone second-guessed the Walker report, so it was never implemented. Regarding infrastructure, the recommendation of a theatre in the labour ward did not happen. Who walked back the idea of one hospital, two sites, and why? I want to know why. Does the Minister have confidence in the clinical director regionally and the associate clinical director who was recently appointed? Are they the people who brought us to this juncture? Does the Minister have confidence that they will deliver us from it?
I was at a meeting with GPs last night with the clinical team. All I am seeing is confusion and shambles. One of the clinical directors said there was no evidence base for moving older women and women who were high-risk from Portiuncula hospital. They decided not to move people with diabetes at the last moment. They also decided that GPs would not risk stratify. They do not know what is going on. There is no clinical leadership and I want the Minister to make a statement on that.
The Deputy is aware that an external management team, EMT, was put in place in January precisely to try to supervise, assess and make some of the improvements that are needed. There have been some infrastructural works and changes, some of which should have been done before the external management team arrived, which have now been completed, for example a four-bay maternity day assessment unit, MDAU, and a dedicated early pregnancy unit. All of that was in train and should have happened before the external management team arrived. It has now happened. The EMT, and nobody else but the EMT, identified a bungalow adjacent to the hospital that has now been converted to a dedicated maternity outpatient department with six dedicated maternity clinical rooms five days a week from the end of September. That bungalow had been acquired before the EMT commenced but it was for a totally different purpose. It has progressed that as a maternity outpatient department.
It should not be the case that we need an external management team in Portiuncula hospital. The patient safety issues have been 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.