I acknowledge Deputy O'Reilly's loss and the issue she raised as well.

Sentiment score: -0.05

I want to discuss a matter of profound importance for women and families across the west, namely the ongoing failure to fully implement the recommendations of the 2018 Walker report into maternity services at Portiuncula University Hospital. I acknowledge the families who have suffered devastating outcomes. Their experiences must be acknowledged. I also recognise that the midwives, doctors, nurses and other health staff who work in the unit under extraordinary pressure in an organisationally dysfunctional system. This discussion is not about blame, it is about governance, accountability and leadership. On the floor of the Dáil two weeks ago, the Minister for Health informed me that the Walker report was implemented and that HIQA had reviewed it in 2019. Walker was all about clear governance, modern infrastructure, robust communications and continuous training, yet seven years later many of those recommendations remain unfulfilled. I spoke to people at the highest level in the HSE and I have also looked to see what HIQA report the Minister referred to. There was a HIQA review in 2019 but it was part of a normal, natural audit of all maternity units in that year. To my knowledge, there has not been a specific HIQA review of the implementation of the Walker report of 2018. The non-implementation of the Walker report was also confirmed to me at the health committee three weeks ago by the CEO of the HSE, Mr. Bernard Gloster, who said that it was patently clear, given the points I raised with him about the deficiencies in the management of the maternity unit at Portiuncula hospital, that the Walker report had not been implemented. There has been some rowing back from that position, and I am now being told that the Walker report was implemented but was not sustained. I am really confused, as are the people in Ballinasloe, east Galway and Roscommon and in the wider region Portiuncula maternity unit serves. All of the same issues arise again, such as staffing and consultant staffing. We were promised following the Walker report that there would be seven obstetricians but at no given time in the intervening period were there even four obstetricians. There were three full-time obstetricians sharing on-call care. There was one on managed sick leave and one on managed leave over that period. Issues around infrastructure, having a gynaecological theatre on the labour ward, training such as cardiotocography, CTG, which is basic training, and ongoing training for staff. All of these issues were identified in the Walker report and again identified in 2025 by the Coulter-Smith report. We have to recognise that there are 12 cases under review by Coulter-Smith and that he has reported in seven of those reviews. I will await the outcome of the other five reviews. Is the clinical leadership that was supposed to implement the Walker report the same one that is going to lead us out of this? There was a policy under Walker of one hospital on two sites. That was discarded in July 2024. No good reason was given as to why that joint governance was discarded. I want to know why it was discarded, particularly as the idea was good. There was no full commitment to it. The associate clinical director was to come from Galway on three days one week and two days another week for six hours on alternate weeks. That never happened because the work was not backfilled in Galway so they could not commit to it. That was not the implementation of the Walker report.

Sentiment score: -0.02

I thank the Minister of State for her answer. I will deal quickly with the transfer. On the transfer of high-risk cases, there was already a pre-existing system for women who had underlying medical conditions to be transferred either to Galway or to Dublin. The initial suggestion was that all women with diabetes, gestational diabetes or pre-existing diabetes would be transferred. That is not happening now because there is no capacity in UHG. We are either implementing this policy on the basis of safety or we are applying it on the basis of capacity. The Minister of State raised the issue about women having to travel to Galway. The women who will be most affected by this are the women with the least resources, the women who cannot travel, the women with the least education. There are pockets of severe deprivation around Ballinasloe and the east Galway and south Roscommon area. We will have these ladies not presenting for antenatal care and presenting late at the delivery unit at Portiuncula because that is the closest place to them. They need accessible high-quality and safe care. We need the recommendations from the Walker report to be implemented. It is clear to me that all the issues around training, communication and governance were promised but they were incompletely or inconsistently applied. We are in denial here. People have told me that the recommendations from the Walker report were implemented when they patently were not implemented. The people in Ballinasloe deserve the implementation of the recommendations from the Walker report and also the implementation of the recommendations of the Coulter Smith report. What is really important and what we are forgetting here is that even with the movement of maybe 200 high-risk cases to University Hospital Galway, given that the diabetic ladies and ladies who developed diabetes during pregnancy are being maintained in Ballinasloe we need a safe high-quality service in the maternity unit in Ballinasloe. I implore for this to happen because this is not just about management. There are issues around interprofessional and intra-professional relationships within the department which need to be managed very closely because people have a professional responsibility to collaborate to produce a high-quality service.

Sentiment score: 0.10