Portiuncula's maternity issues were 'cultural', says HSE chief

The top official in the HSE has suggested that the issues which led to the downgrading of maternity services at Portiuncula Hospital this year were "cultural" rather than a consequence of a lack of resources,

The transfer of high-risk maternity care from the hospital earlier this year was raised when Bernard Gloster, the chief executive of the HSE, appeared before the Oireachtas Public Accounts Committee last month.

Galway East TD Albert Dolan told Mr Gloster there had been "huge hurt and upset" over the handling of the downgrading of maternity services at the hospital.

Deputy Dolan noted that the Health Minister, Jennifer Carroll MacNeill, had said there were "other level 3 hospitals with maternity services in the country at a similar resource level" that were performing very well, and he asked: "Is it a resource issue in Portiuncula or is it a culture issue?"

"I certainly do not think it is a resource issue," replied Mr Gloster. "We had a review carried out of all the individual recent cases, some of them very harrowing in their outcomes.

"Fundamentally, we have moved higher risk pregnancies from being booked at Portiuncula to being booked in other units. That is about 20% of the workload of deliveries in Portiuncula.

"That has to be the case in the face of the evidence until such time as we are satisfied that something has been identified that could change," stated Mr Gloster.

The HSE chief was then asked if he was seeing any improvements at Portiuncula that might lead to a full restoration of maternity care.

"For higher risk pregnancies, I could not say that right now," he said.

Responding to the remarks, Roscommon-Galway Fianna Fáil TD, Dr Martin Daly, said characterising the situation as a cultural matter was deeply unfair to hospital staff and misleading to the public.

"Of course culture plays a role in any organisation, but that is not what has put Portiuncula in difficulty," Dr Daly said. "The problems here are rooted in leadership, governance, and delivery.

"The Walker Report in 2018 set out what needed to change — an obstetric theatre beside the labour ward, reliable communication systems, and adequate consultant staffing. Seven years later, many of those recommendations remain incomplete.

"There are only three whole-time equivalent obstetricians, less than half of what is required, and the service continues to rely heavily on locum cover.

“That is clearly a resource and planning issue."

Deputies Dolan and Daly said the priority now must be the immediate and full implementation of the recommendations from both the Walker Report and the Sam Coulter Smith Report, with clear timelines, transparency, and accountability.

"This is about restoring confidence through action," Dr Daly said. "The solutions are known. The reports exist. What is missing is sustained delivery.

Meanwhile, Sinn Féin TD Claire Kerrane was critical of a written response she received from the HSE to a question she asked about whether a risk assessment was carried out in advance of the decision to transfer high-risk maternity cases from Portiuncula.

The HSE's response referred to a regional implementation group which was put in place to "oversee the implementation of all recommendations made by review teams in relation to maternity services at Portiuncula University Hospital."

It said this implementation group "will address... the completion of a risk assessment of the impact of this transfer of women for Portiuncula University Hospital, Galway University Hospital and other maternity units, and develop plans on how to mitigate this risk."

Commenting on this response, Deputy Kerrane said: "Not only have the HSE not bothered to carry out any risk assessment on the impact of transferring women for Portiuncula, University Hospital Galway or anywhere else, they haven’t developed plans on how to mitigate said risks - which haven’t even been identified yet.

"This is appalling and not good enough for women and their babies," the Roscommon - Galway TD added.

Local councillor Dr Evelyn Parsons, of the Portiuncula Maternity Alliance group, accused the HSE of resisting public scrutiny of its decisions.

She raised the matter after the executive of the HSE's Regional Health Forum West put on record that it did not support a unanimously agreed motion from elected members calling on the Health Minister to attend the forum in order to answer questions on Portiuncula.

She said while the executive cannot block councillors' agreed motions from going forward, their stated position raised serious concerns.