HSE denies Portiuncula downgrade plan, as timeline for return unclear

By Rebekah O'Reilly

The Health Service Executive (HSE) Chief Executive Officer Bernard Gloster has said there was “no view” to downgrade maternity services at Portiuncula University Hospital (PUH).

Mr Gloster told the Oireachtas Committee on Health recently that there is no clear timeline for the full return of maternity services to the unit, as reviews and improvements under the National Women and Infants Health Programme are ongoing.

A detailed debate was held at the committee on Wednesday, December 17, as part of a wider discussion on Ireland’s 19 maternity units across six clinical networks.

Addressing the committee, Mr Gloster said based on relevant benchmarks, there are “no significant concerns arising from safety indicators across 18 of the units,” with Portiuncula identified as an outlier.

He stressed, that maternity care is a high-risk specialty where poor outcomes can occur in any unit and that each case must be “taken seriously, examined transparently, reported, and responded to.”

According to Mr Gloster, trend analysis led to significant concern regarding Portiuncula. The care provided to 12 women and their infants has been reviewed or is currently under review. To date, seven external reviews have been completed and shared with families, with a further five reviews ongoing.

He outlined that in 2023, two cases of intrauterine death at Portiuncula Hospital led to reviews that raised concerns about aspects of care that may have impacted outcomes. In 2024, five babies were referred for therapeutic hypothermia to treat neonatal hypoxic–ischaemic encephalopathy, representing a rate of 3.82 per 1,000 births at Portiuncula, compared with a national rate of 1.24 per 1,000 births based on the Irish Maternity Indicator System (IMIS).

All five of these cases were reviewed by an external team led by Professor Sam Coulter Smith, which produced individual reports and an overarching summary. A further five external reviews into care provided between October 2024 and July 2025 are ongoing, with all reviews expected to be completed by the first quarter of 2026.

To manage risk and provide assurance on safety, an external management team, comprising a consultant obstetrician, a director of midwifery and a general manager, was appointed in January 2025 to oversee maternity services at Portiuncula. Mr Gloster said the team remains in place, providing “additional supervision, oversight, and governance.”

All seven completed reviews have been shared with families, and meetings have been offered with the regional director and regional director for midwifery. Three families have taken up this offer to date, and a dedicated liaison officer remains in contact to ensure access to counselling and healthcare supports.

The completed reviews generated 52 recommendations across five broad themes: clinical care, multidisciplinary staff training, multidisciplinary team communication, communication with women and partners, and post-adverse event follow-up.

Professor Coulter Smith’s overarching summary identified four common themes: communication, governance, clinical care leadership, and clinical governance and infrastructure. Mr Gloster said comprehensive quality improvement plans have been developed and are being implemented, with progress tracked and reported.

He also noted that, given the history of previous reports and the findings of the Walker Report, a separate 2018 reivew of maternity care at Portiuncula, there must be “significant caution” regarding the range of pregnancies booked at Portiuncula. In July 2025, it was announced that women in higher-risk categories would be transferred to University Hospital Galway or another unit of their choice.

From October 28, 2025, Portiuncula will no longer book women in defined higher-risk categories, with capacity and operational impacts being risk-assessed.

Restoration Of Services

Mr Gloster said the aim of the changes to Portiuncula is to ensure a smooth, safe, and sustainable maternity services.

He acknowledged the concerns of women, families, and staff, apologised for past shortcomings, and emphasised that 2025 service decisions were necessary and evidence-based.

"I particularly acknowledge the women and their partners whose story has been and remains the subject of these case reviews. To them, I apologise on behalf of the health service," Mr Gloster said.

"When we see accelerated risk and repeated poor outcomes we have to take the right decisions, notwithstanding that they are uncomfortable for so many. I am satisfied that the decisions taken in 2025 in respect of Portiuncula are necessary and proportionate to the evidence."

When asked by Galway East TD Albert Dolan whether there was a focus on improving the situation to a point that high risk pregnancies can return to Portiuncula, Mr Gloster said there is “a continued focus” to improve the services at the hospital.

“There is an absolute focus on bringing Portiuncula to the best level that it can be brought to, including reducing dependence on locums and increasing the capability of the availability of specialists who operate in Portiuncula.”

Seeking clarity on a timeline for the restoration of services to Portiuncula, Senator Gareth Scahill asked whether it would be a phased restoration.

Mr Gloster said he cannot put a timeline on it.

“I would hate to meet a woman on the streets of Ballinasloe in two years' time who would say to me 'You said',” he said, adding that restoration of services depends on assurances by The National Women and Infants Health Programme that the level of clinical service available, the sustainability of that and the implementation of the key recommendations of the various reports in a sustainable way are all present to reconsider the booking profile in Portiuncula.

“That is the timeline. It would be so wrong of me to say that to the Senator. It would just be wrong. I did not go into this decision with any view of Portiuncula or of downgrading anything. I would come back out of this decision as quickly in the same context.”

Local TDs Concerns

Roscommon–Galway TDs Martin Daly and Claire Kerrane raised strong concerns with the HSE over Portiuncula maternity service changes.

Referring to the Walker Report, a critical independent review of maternity services at Portiuncula University Hospital (PUH) led by Professor James Walker, Deputy Daly said recommendations on joint governance between Portiuncula and Galway were never properly implemented or sustained, despite repeated assurances from the HSE.

He said agreed arrangements for shared clinical leadership were inadequately resourced and later abandoned in 2024, and criticised what he described as a flawed recruitment process for senior posts.

Daly also added that the HSE handled communication with GPs poorly, and that there was inconsistent messaging around which women were classified as “high risk”, arguing this created confusion and undermined confidence in the decision-making process.

Deputy Kerrane said her central concern was whether the HSE intended to fully restore maternity services at Portiuncula once all review recommendations were implemented, rather than limiting the unit to low-risk births.

She noted that many of the recommendations arising from the external reviews, such as improvements in communication systems, access to interpreters and staff training, could be delivered quickly. Kerrane also highlighted the heavy reliance on locum consultants and asked whether joint consultant posts across hospital groups, used in other regions, could provide a more sustainable solution.

Both TDs raised concerns about the impact of diverting women to University Hospital Galway and Mullingar, citing travel distances, traffic congestion and staffing pressures, and sought confirmation that capacity and risk assessments had been carried out at receiving hospitals.

Responding, Chief Executive Officer of the HSE, Bernard Gloster, said the decision to redirect certain higher-risk pregnancies in 2025 was based solely on clinical evidence and safety considerations and would not have been taken if the conditions identified had not existed.

He said the Walker Report was “technically implemented” but not sustainable in practice, and stressed that future decisions on Portiuncula would depend on whether specialist staffing and governance arrangements could be delivered and maintained over time. He said no unit would be treated unfavourably because of past issues and that decisions could be revisited if conditions improved.

HSE officials confirmed that joint consultant posts had been approved and that University Hospital Galway had capacity to accommodate an additional 250 to 300 higher-risk births, though they acknowledged ongoing challenges in recruiting and retaining specialist staff without reliance on locums.

Mr Gloster concluded that as the maternity strategy progresses, it will contextualise Portiuncula in the rest of the 19 units.

“I can only say to the people of Ballinasloe and the people who use Portiuncula that I wish it were different. I am sorry it is not. However, I am absolutely clear that for the women who are booked to go there and continue to be booked to go there, I am very happy to recommend that they continue to go there. We are absolutely committed to the healthcare system in Portiuncula hospital.”

The joint committee is adjourned until Tuesday, January 13, 2026, when it will meet in private session.

Following the debate, Cllr Dr Evelyn Francis Parsons drew attention to the National Maternity Experience Survey 2025, published on Wednesday, December 10.

The survey, which invited women who gave birth in February and March 2025 to share their experiences, showed Portiuncula University Hospital to be among the strongest-performing maternity units in the country.

Of the 202 women invited to participate at Portiuncula, 99 responded, giving a response rate of 49%, above the national average of 42%. A total of 84% of respondents reported a good or very good overall experience, higher than the national average of 83%.

Cllr Parsons said the findings “sharply challenge the ongoing downgrading of services at PUH” and raise serious questions about the rationale for diverting women from the hospital.

The survey results show Portiuncula scoring above both national and Saolta Group averages across antenatal care, labour and birth, postnatal care, breastfeeding support, neonatal care and overall patient experience. In antenatal care, Portiuncula outperformed University Hospital Galway, with patients reporting strong communication, respect, dignity and confidence in care.