Latest news with #Portiuncula
Irish Times
12-07-2025
- Health
- Irish Times
Portiuncula hospital is not safe for women giving birth
What does the latest report on serious problems in maternity services at Portiuncula University Hospital tell us? In my view, it provides irrefutable evidence that the systemic issues flagged in the 2018 Walker report have not been effectively addressed. That report warned that 'without fundamental changes in process and training', the tragic incidents investigated would happen again. This latest report , which reviews five adverse perinatal outcomes, demonstrates that the measures put in place after 2018 have failed. 'It is disappointing,' the authors observe with some understatement, 'that the clinical issues identified previously in 2018 have recurred.' Taken together, the two reports make an unanswerable case that safe maternity services are no longer viable at Portiuncula. While there is scope for antenatal clinics to continue, the unit is no longer fit for purpose for women to give birth there. The latest report documents in the starkest terms the factors that make this conclusion inescapable. READ MORE The first issue is the number of deliveries each year. The report is clear that a maternity unit of 'such size cannot provide the full range of maternity and newborn services'. That is a clear red flag. [ Families at centre of Portiuncula review call into question viability of service Opens in new window ] The most recent figures show that around 1,400 babies are born at Portiuncula each year. Critically, however, the extraordinarily high Caesarean section rate of 42 per cent in 2024 (double the rate of Scandinavia) means that nearly 600 babies were delivered surgically. In practical terms, this amounts to 50 sections per month, around 12 per week, thus not quite two per day. Some of these would have been scheduled, some would have been emergencies. Vaginal births numbered just over 800 last year – that is, around 67 per month, or two to three per day. Since vaginal deliveries occur over 24 hours, daily numbers are typically variable, so that Portiuncula would have experienced some days with perhaps five or six deliveries, while other days there may have been none. These numbers are not conducive to maintaining the skills and experience of the obstetric and midwifery staff. This is a risk factor for mothers and their infants. The HSE's proposed solution – to move high risk pregnancies to Galway – would simply further reduce the skill set of the clinical staff, so is not a viable solution to the problems. Furthermore, the staffing profile at Portiuncula reveals major issues of concern. While five consultant obstetricians for 1,400 births may appear satisfactory on paper, the new report reveals that one consultant is on long-term sick leave, one does not cover night duty, and at least one other works part-time only. This has led to a highly unsatisfactory reliance on locum consultants to cover out-of-hours deliveries and emergency Caesarean sections, especially at weekends. On paper the box is ticked for consultant cover at the hospital. In practice, however, the locums may have flown into Ireland just for the weekend. Many will never have worked in the unit before, or indeed in Ireland, and may never have met any of the permanent staff in the hospital, including midwives (some of whom may themselves be temporary agency staff). The locum will be unfamiliar with local work practices, management protocols and methods of communication among staff. Indeed, the report even identified poor mobile phone coverage making it difficult to contact the on-call consultant. At the end of the weekend, the locums often depart without appropriate handover to permanent consultant staff. This is not a sustainable model of maternity care. A second major issue is governance. I have written many times about the value of the mastership model in obstetric care which places a doctor at the heart of management in the three Dublin maternity hospitals. For seven years, an elected consultant obstetrician has both authority and accountability. While the master works in a collegial manner with midwifery and lay management, he or she is in overall charge. This is critical because, as experience tells us, a lay manager – no matter how well-intentioned – can never fully understand the intricacies of obstetric care, with the 24 hours a day, 365 days a year relentless nature of the delivery of safe care to women, where unexpected emergencies arise at any hour of the day or night, on any day of the week. The master has the ultimate responsibility for how the hospital operates and, crucially, has the authority to both allocate often limited resources and implement changes for the benefit of patient care. By contrast at Portiuncula, the role of clinical director created after the Walker report was not given appropriate executive authority. The new report is clear: the holder has no regulatory or budgetary control. Requests for enhancement in services are routed through the hospital's lay general manager and then through the line management structure in the HSE. This is simply toothless, and as the failure to improve services over the last seven years clearly shows, the system is failing women and their babies. With the publication of the new Portiuncula report the HSE asserts its commitment to ' implementing the 34 recommendations ' made. But that commitment was made seven years ago: measures were put in place, but the problems persist. Concrete actions promised, such as the provision of additional theatre space for emergency Caesarean sections, have made no progress. What the Portiuncula situation tells us clearly is that the smaller maternity units in Ireland are no longer able to deliver appropriate and safe levels of maternity and neonatal care. I absolutely concur with the latest report's conclusion that there should be a review of the way maternity services are delivered across the country. [ Maternity services across Ireland should be reviewed, expert group urges following Portiuncula report Opens in new window ] The safety of mothers and their babies must be put ahead of local interests where necessary. This will likely mean the closure of smaller units around the country and the transfer of care to larger maternity centres. This essential reform will require support – and not obstruction – from political leaders. The status quo is no longer a viable option. Dr Peter Boylan is former master of the National Maternity Hospital and former chairman of the Institute of Obstetricians and Gynaecologists
Irish Times
09-07-2025
- Health
- Irish Times
Portiuncula review: How can the same issues occur at the same hospital again?
In 2018, a publication, known as the Walker report, highlighted significant issues with maternity services at Portiuncula hospital – particularly around governance, communication, the presence of consultants and training and reliance on locum consultants. Seven years later, the public would be forgiven for wondering if this is Groundhog Day, as another review at the Ballinasloe hospital highlights strikingly familiar concerns. 'Unfortunately, although changes were made following the 2018 review, many of the same scenarios have been identified by this 2024 review process,' a review summary noted. On Wednesday, the Health Service Executive published a summary report of five external reviews into the care provided to women and their babies at the Ballinasloe hospital. READ MORE The reviews were commissioned after five cases of neonatal encephalopathy (NE) requiring therapeutic hypothermia (known as neonatal cooling) were identified in a close time period. NE is an impairment of neurological function. [ Maternity services across Ireland should be reviewed, expert group urges following Portiuncula report Opens in new window ] Adding to this, a further five reviews are under way, while two more reviews are due to begin imminently. In the summary, the review team laid out four common themes of concern: communication, governance, clinical care, leadership and clinical governance and infrastructure. For anyone who consistently follows health news, the terms will be familiar. Time and time again, they are touted as the reason why things go wrong in our health service. But how can the same issues occur at the same hospital again? Steps were taken to improve things. One of the recommendations in the 2018 report was to improve clinical governance. Consequently, the responsibility for maternity services was given to a new clinical director from the hospital group. Wednesday's report notes, however, that while this might have seemed a 'positive move', the position has no executive oversight, no regulatory or budgetary control and their role is 'purely oversight and advisory'. 'There have been a number of changes in recent years to the governance structures of HSE hospitals from health boards to hospital groups to regional groups,' the report said. 'The further the distance between the key decision makers and the clinical coalface, the more likely it is that decisions will be significantly delayed and based more on financial merit than clinical need.' As such, the review team has recommended that clinicians take up leadership roles, and reliance on locum consultants is reduced. The review team also noted the two communication systems in place, which they said should be simplified to make it more efficient and to reduce the 'clinical risks'. Furthermore, the report said there were situations in which staff were unable to contact the consultant on call due to mobile phone coverage problems. 'This is not a safe or satisfactory arrangement and needs to be resolved as a matter of urgency,' the report added. [ What is HIE? The condition affecting newborns has led to reviews in Portiuncula hospital Opens in new window ] The hospital's maternity unit is small, delivering 1,400 babies annually. Consequently, the review team cited difficulty in its ability to provide the 'full range' of maternity and newborn services and to attract permanent staff members. 'It is operationally challenging and there are significant clinical risks in providing maternity services in this way,' it said. In conclusion, it found 'the current situation does not meet the expectations of parents, increases clinical risk, and is no longer sustainable'. That statement is stark, but the more alarming finding is the review team stating the issues arising in the report are ones that 'could plausibly arise in other similar sized maternity units'. As such, the team 'strongly recommends' that there is an opportunity to review the way maternity services are delivered across the State. Such a finding will do little to reassure expectant parents of the safety of the maternity system. If anything, it will leave them with more questions than they had before.
Irish Times
18-05-2025
- Health
- Irish Times
Oireachtas health committee must hear from HSE on Portiuncula maternity services, says Opposition
The Oireachtas health committee will need to examine and hear from Health Service Executive officials about maternity services at Portiuncula University Hospital in Co Galway , Opposition TDs have said. The Irish Times revealed last week that a further external review into maternity care at the Ballinasloe hospital has begun following the death of a baby in recent weeks. It is the 10th review to take place into the care given to women and babies at the hospital. The new Oireachtas health committee will meet for the first time on Wednesday. Sinn Féin 's health spokesperson David Cullinane said it is 'important that all of the reviews are completed and that maternity services are safe at Portiuncula'. READ MORE 'This is an important issue of patient safety, and the Oireachtas health committee will need to examine it.' Labour 's health spokesperson Marie Sherlock said the committee 'needs to hear from the HSE as to the status of those reviews'. 'Questions need to be asked now about what exactly is going on here,' she said. 'The delay in the reporting of the reviews and the addition of yet another review could certainly prompt a crisis of confidence in services at Portiuncula, which we don't want to see happen,' she said. [ Death of baby at Portiuncula Hospital leads to new review Opens in new window ] Ms Sherlock said she was 'really taken aback' when she heard 'yet another review' had to be initiated. 'Ultimately, confidence in our maternity services right across the country depends on people being updated as to what's happening when there have been successive issues in one particular maternity unit.' Nine external reviews were announced in January, after six babies delivered in 2024 and one in 2025 had hypoxic-ischaemic encephalopathy (HIE) – a reduction in the supply of blood or oxygen to a baby's brain before, during or after birth. Six of these babies were referred for neonatal therapeutic hypothermia known as neonatal cooling. Two stillbirths occurred at the hospital in 2023, the circumstances of which are also being reviewed externally. An external management team remains in place at the hospital to oversee all elements of maternity and neonatal care. Stephen McMahon, chairman of the Irish Patients Association , a patient advocacy group, said that, with 10 reviews ongoing at the hospital, the matter needs to be 'independently investigated up to and beyond the board of the HSE'. Mr McMahon said the association would like to know if there have been any formal interim reports or updates on the process. A spokesperson for Minister for Health Jennifer Carroll MacNeill said she is 'very aware of the very sad death of a baby who was recently born at Portiuncula University Hospital and that an external review has commenced'. 'She extends her deepest condolences to the family at this devastating time,' the spokesperson said. The Minister understands a number of other external reviews ongoing at the hospital are expected to be completed 'soon', the spokesperson said, adding that these reports will be shared with the families and other stakeholders, including the Minister, once complete.
