Martin Daly criticises governance at Porto Yonkla maternity unit
Martin Daly addressed a committee about safety and governance problems at the maternity unit in Porto Yonkla Hospital, urging implementation of recommendations from the Walker report and the later Coulter Smith review. He said he wanted only the safe delivery of babies and criticised confusion in local management, the ending of joint governance in 2024, and failures in communication with GPs.
He raised serious concerns about how the maternity unit has been managed, saying joint governance recommended by the Walker report was dispensed with in 2024 and that previous governance arrangements were neither fully implemented nor sustained.
He outlined problems with the intended joint clinical director post - described as a 50% post split between sites - saying the planned three-day/two-day alternation never materialised. He said interview processes twice failed to appoint in the first round, that a later appointment followed a second process, and that a two-year rolling contract was split between two people. He also raised questions about backfill at UHG and complained the post felt like a box-ticking exercise.
He acknowledged adverse events in the unit and said patients with underlying high-risk medical issues should be managed in a specialist unit. He insisted nothing should stay the same and pressed for the resources identified by Walker and by Coulter Smith seven years later to secure safe care for the 1200 or 1300 women who continue to deliver in Port Yonkla Hospital.
He criticised communications around the escalation of risk, saying GPs were initially excluded from the original communications pack and that decisions had been made unilaterally. He said a draft risk-criteria was reviewed with the NWIP and GPs gave strong feedback, but that initial messaging to local GPs had been mishandled.
He asked for clearer answers on governance and said he would have expected the regional clinical director for obstetrics and the associate clinical director to attend the session. He repeatedly demanded that the Walker and Coulter Smith recommendations be enacted and resourced to restore confidence in the Porto Yonkla maternity service.
Governance concerns
He raised serious concerns about how the maternity unit has been managed, saying joint governance recommended by the Walker report was dispensed with in 2024 and that previous governance arrangements were neither fully implemented nor sustained.
Clinical director post and appointments
He outlined problems with the intended joint clinical director post - described as a 50% post split between sites - saying the planned three-day/two-day alternation never materialised. He said interview processes twice failed to appoint in the first round, that a later appointment followed a second process, and that a two-year rolling contract was split between two people. He also raised questions about backfill at UHG and complained the post felt like a box-ticking exercise.
Safety and high-risk pregnancies
He acknowledged adverse events in the unit and said patients with underlying high-risk medical issues should be managed in a specialist unit. He insisted nothing should stay the same and pressed for the resources identified by Walker and by Coulter Smith seven years later to secure safe care for the 1200 or 1300 women who continue to deliver in Port Yonkla Hospital.
Communication with GPs
He criticised communications around the escalation of risk, saying GPs were initially excluded from the original communications pack and that decisions had been made unilaterally. He said a draft risk-criteria was reviewed with the NWIP and GPs gave strong feedback, but that initial messaging to local GPs had been mishandled.
Requests to the committee and next steps
He asked for clearer answers on governance and said he would have expected the regional clinical director for obstetrics and the associate clinical director to attend the session. He repeatedly demanded that the Walker and Coulter Smith recommendations be enacted and resourced to restore confidence in the Porto Yonkla maternity service.
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Transcript
Thank you Mr Gloucester and your team for coming here today and thank you to the committee for indulging my request to have you come here today to discuss the issues around because there is no doubt that there is serious disquiet about what has happened in the maternity unit in Porto Yonkla Hospital and I want to put it on record I have no interest other than the safe delivery of babies at maternity hospital in Porto Yonkla and unfortunately there's been a sense in the debate that any time there's been a challenge around this locally that in some way we are advocating less than safe practice in the maternity unit I want to put that on record we're all on the same page on that in relation to that and I have to say there's been utter confusion in terms of how this has been managed I'm looking here today I don't see the regional clinical director for obstetrics here for HSE West Northwest I do think that that would have been helpful I don't see the associate clinical director for the unit here I think that would have been helpful I'm also going to get into that because one of the things that Coulter Smith seven years on from the Walker report identified was the governance issues and when Walker made the recommendations around joint governance there was a very clear pathway that there was to be a post with three days and two days alternate weeks shared with the maternity unit in Porto Yonkla hospital that never happened the person who did it it's not their fault but their work wasn't backfilled in UHG so they spent an average six hours there and you get the feeling from talking to people it was a box ticking exercise and then at some point in 2024 a decision was made that joint governance would be dispensed with now if it's a recommendation in the Walker report and of course I've been told Walker was fully implemented which isn't true because why do all the same issues arise again in 2025 or if it was implemented it certainly wasn't sustained but I want to know why the governance that was recommended by Walker not fully supported obviously was dispensed with in 2024 an interview process was held and I understand the first interview process no one could be appointed as associate clinical director and that a second interview process had to be held and at that point someone who wasn't appointed in the first interview process was appointed in the second interview process and that a two-year rolling contract which would be the normal practice was then split between two people so I just want to know firstly and I suppose I direct this to you Mr Canavan is what happened with this governance issue? so you're quite right in saying that one of the recommendations from the Walker review was that we would have joint governance across the two sites one maternity service across Galway and Port Yonkla we did appoint a clinical director to fulfil that function but by agreement on both sites when it wasn't working we stood that arrangement down it wasn't working favourably for us seriously why wasn't it working? is it because there wasn't proper commitment? I can direct this as well to the clinical director Dr Nash but you know if it wasn't working why wasn't it? it sounds like there wasn't the due support given to the person in that post to carry out that function it was supposed to be a split post three days and two days alternate weeks and that didn't happen I'm on tight time so I just want an answer to that the post was a 50% clinical director like all posts and it was split between both sites and he did have backfill it was Galway based I'm told he didn't he did have backfill in Galway but it was split between both sites the feedback how many again how much commitment did that person give to Port Yonkla? did they give to Port Yonkla? did they give the three days and two days split? it was never going to be five days because he's 50% three days and two days split alternative it was never five days so you're saying that that wasn't the issue? it was agreed that he's a 50% clinical which is Galway based as an obstetrician and the other 50% was split between was that time given to Port Yonkla? he was in Port Yonkla every week he was there a day a week but that's not the question the question was was he give the three day and two day split? it was never going to be three days and two days so it didn't happen that's the answer but no that's the answer it didn't happen now in relation to and I'm conscious of the time in relation when all this broke we were told that high risk pregnancy no one no one ever disputes that people with underlying high risk medical issues should be managed in a specialist unit no one's disagreeing with that and I'm not here for the status quo adverse events happened in Port Yonkla Hospital and I want to acknowledge that for those mothers and their babies and their partners and the outcomes so I want to make that absolutely clear so nothing can stay the same okay all we're asking for is the resources that Walker identified and that Coulter Smith identified seven years later be put into place to make sure that the 1300 or 1200 or 1300 women who continue to deliver in Port Yonkla Hospital have a safe service that's why we're here today so the confusion in communication firstly GPs weren't included in the original communications pack decisions were being made unilaterally and that's a fact why did that happen? they were included they weren't they weren't I'm a GP in the area so I know that didn't happen it was laterally because there was a sense that there was going to be diktat sent out to GPs to stratify risk which isn't their job by the way no I suppose just the background to it is we met with the NWIP to look at what criteria were higher risk and once we had a draft criteria we met with GPs they fed back strongly to can I just say no no I'm going to say to you that it's factually incorrect because I know that Dr Annette Jennings was appointed to your implementation board laterally that's a fact so you can paint this any way you want to that is a fact and GPs are deeply unhappy in the way your team managed that I'm going to move on in the risk stratification of high risk all sorts of stuff was coming around we were getting out from the units and it was carried in the media that women who had existing diabetes who were pregnant and women who developed gestational diabetes were going to be part of the high risk group then suddenly they weren't part of the high risk group now the point I'm making here we're either doing this on the basis of safety or we're doing this on the basis of capacity so why did all that change? So the structure that we put in place to implement the changes involved representation both from Port Chunkley and from Galway and once the team started meeting in the middle of the year they were considering all of the various criteria and what was appropriate and what was the correct way forward and the decisions that they were making as we were progressing towards October implementation influenced that Finally, because I'm running out of time here and in relation to evidence base I was on one and the reason why I asked why the clinical director for obstetrics for West-Northwest isn't here is because he should be here because on a meeting with GPs about two months ago his exact words were that there is no evidence base for much of the moves of the high risk groups that have been identified in Mr Gloucester's document here today to move to Galway his exact words you were on the meeting, Dr Nash Okay, can I just talk today to assist you because that is a very expert specific question so can I just ask Dr Dean? Just briefly, we're over time so can we get a very brief answer Very serious question, Chair We're working back Deputy, you're over time Okay, fine So if you want an answer, we'll take a quick answer Thank you We'll take a quick answer if we can No Yeah, I can answer that So, women with a BMI more than 40 have an increased risk of cerebral palsy about three times more women aged more than 42 increased risk of stillbirth and perinatal mortality many, many studies showing all of this So why would the clinical director Deputy, you're out of order Deputy, you're out of order Well, I just want to know why would the clinical director come on it and say that there was no evidence base for the moment of this Deputy, we're trying to get an answer to your question That's a direct contradiction of what he said on the meeting Deputy, I'm fine Deputy, we're trying to get an answer to your question Just what has been done obviously was different to what has been done previously so I think it's in that context that those comments probably were made but the evidence and the literature is quite clear with regarding the high-risk women that we've identified because a lot of you aren't for a record for it