Current situation 'no longer sustainable': Portiuncula maternity report

A summary of the external review reports into the care provided to five women who gave birth at Portiuncula University Hospital, published by the HSE recently, concluded that "the current situation does not meet the expectations of parents, increases clinical risk, and is no longer sustainable."

The summary report by the review team also highlight a number of recommendations from the review team, including that the provision of additional theatre space for emergency caesarean sections be addressed immediately. It also called for this, and a special care baby unit, to be on the same floor level as the labour ward, to facilitate prompt access.

It also called for maternal and/or fetal assessment unit be developed to address the issue of the labour ward being used as an assessment area for patients over 20 weeks, but not in labour.

The review team also strongly recommended that the hospital's internal communication system is simplified and made more efficient, reducing the clinical risks associated with having two systems in place.

It highlighted that "mobile phone coverage in the area around the hospital does not appear to be consistently functional, and there have been situations where the staff were unable to contact the appropriate consultant on call, when assistance or advice was required."

"This is not a safe or satisfactory arrangement and needs to be resolved as a matter of urgency," it said.

It further highlighted the need for solutions to address additional clinical risk associated with the increasing number of patients from different countries, where the patient's first language is not English, who now access maternity services,

It said a reliance on locum cover at the hospital maternity service was "not sustainable" and "detrimental to the quality of service provided to patients and to the training of junior staff, and is frustrating for the midwifery staff".

The review team also strongly recommended that the way maternity services are delivered in the country be reviewed.

It said a unit of the size of Portiuncula delivering 1400 babies annually "cannot provide the full range of maternity and newborn services".

"It is clear that units of this size find it difficult to attract permanent members of medical staff and rely heavily on locum consultants.

"It is operationally challenging and there are significant clinical risks in providing maternity services in this way... It is not possible to train midwives and doctors to an acceptable level of competence with such little on call clinical exposure.

It said the issues addressed in the report are ones that could plausibly arise in other similar sized maternity units.

"If obstetric care is to be provided in a hospital, then the full range of support services should be available, provided by staff with the appropriate skill set and training to allow them to keep up their own clinical skills and to train junior doctors, nursing and midwifery staff."

It said: "Unless the issues and concerns identified in this report are addressed with long term sustainable solutions, there is a high risk that these or similar issues will re occur."

It also acknowledged that despite the issues and limitations identified in this review process, there is a cohort of staff delivering care at Portiuncula "who have been making considerable efforts to provide the best quality service they can within these limitations".