Portiuncula downgrade ‘will see hundreds turned away’ from maternity unit

By Jessica Thompson

Roscommon councillors have warned that the removal of maternity care for high-risk pregnancies at Portiuncula University Hospital in Ballinasloe poses serious risks for women and families across the region.

At the September meeting of Roscommon County Council, Cllr Valerie Duffy tabled a motion calling for the local authority to write to the Taoiseach, the Minister for Health and the HSE, “to request them to reconsider the removal of care and maternity services for high-risk pregnant women” at the hospital.

She also sought the council “to request a timeline for the reinstatement of all services, and to ensure that full resources are allocated to maintain and improve the quality of maternity care at the hospital.”

The decision to move all the care of high-risk pregnancies out of Portiuncula University Hospital was made earlier this year after five external reviews into maternity care at the facility identified ongoing safety issues.

“This means now that up to 25% of women are being transferred away from Portiuncula University Hospital, given their need for specialist services - somewhere between 200 and 300 women per year,” said Cllr Duffy.

“Women will need to travel longer distances for care as a result. An external management team has been placed in Portiuncula University Hospital to work with and support the hospital management team in implementing the findings from the reviews. Over 50 recommendations have been made with some welcome investments and implementation.

“Behind each review is a family, a woman and her child. I completely recognise that women and their babies must be safely cared for and the highest standards should be in place. I sympathise with the mothers and families who are the basis for these hospital reviews and I hope that they are getting the support that they need,” she added.

Since the start of 2024, seven babies born at Portiuncula were diagnosed with hypoxic ischaemic encephalopathy (HIE) – a dangerous reduction of oxygen or blood supply to the brain. Six of those infants required neonatal cooling treatment. Reviews are also underway into two stillbirths in 2023.

The HSE said a “well-established pathway” already existed for the transfer of high-risk pregnancies to Galway University Hospital (GUH), and that this will now be expanded to include women with conditions such as obesity, significant medical disease, previous baby loss, or maternal age concerns, along with those likely to deliver before 35 weeks.

Councillors across the chamber expressed alarm at the consequences for women in Roscommon and neighbouring counties, who may now face longer journeys to Galway or Mullingar for care.

Cllr Emer Kelly was quick to support the motion, stating that two reports were carried out and “in neither report did it suggest the removal of services from Portiuncula University Hospital”.

“Removing services or moving high-risk pregnancies from Portiuncula to an even busier hospital in Galway or Mullingar, where they're already under-resourced, is not the answer in this case,” she said.

“Portiuncula serves a wide range of cross-county regions from Galway, Roscommon, Westmeath, Longford, Leitrim, Tipperary, Offaly... and it’s unacceptable that we’re watching this happen. GPs are unaware of where is the most appropriate place to refer women to, so this in itself is causing unsafe care.

“The increased travel time for women is increasing the risk and it’s going to in turn lead to more high-risk pregnancies and there’s no way to document who is or isn’t a high-risk pregnancy.”

Several members drew parallels with past losses of services, with Cllr Valerie Byrne warning that it’s “just a replica of what happened with the hospital out here in Roscommon with the A&E”.

“We used to have maternity here in Roscommon and it's gone. It's gone to Ballinasloe and now it's going to go to Galway or wherever else,” she said.

Others stressed that safety must remain central, with Cllr Dominick Connolly stating that there would be no point reopening the services if there is no personnel “to carry out the procedures safely”.

Cllr John Keogh also urged caution, disputing that there was no recommendation to remove high-risk pregnancy care entirely, and citing the Walker report from 2018 and the more recent Sam Coulter-Smith report which found that, although many recommendations from the Walker report had been implemented, there were still a lot of the same issues arising.

“So, there's no question but that there are issues that need to be addressed here. The question is can they be addressed and how quickly can they be done? But I would urge caution in relation to calls to simply put back in place a service that may not necessarily be in the best interests of the women that would be going into that service,” said Cllr Keogh.

Cllr Laurence Fallon argued that removing high-risk cases could fatally undermine the unit’s viability.

“They have removed high-risk mothers but what is a high-risk mother? In my opinion every mother is a high risk until the baby is safely delivered, and the mother is safe, but you can't go into a hospital assuming that somebody isn't a high risk,” he said.

“By their own admission numbers will be down from 1300 to 950 within 12 months. If another half of that is concerned about the safety it'll be down to 450 and then we close it fully. It's very simple as I see it.

“You either create a safe service or you close it down. It can't continue the way it is now. You won't get the staff,” he concluded.

The motion passed, with agreement that the council’s letter should also be circulated to all local authorities in Portiuncula’s catchment area