Michael McHale , 2025-07-09 14:24:00
External reviews of five cases found issues in communication, governance, clinical leadership and infrastructure
Patients with pregnancies deemed high risk will have their care moved away from Portiuncula University Hospital (PUH) after external reviews into five separate cases highlighted concerns around their care.
The reviews, which were commissioned after the hospital recorded seven incidents of hypoxic ischaemic encephalopathy (HIE) in 2024 and early 2025, resulting in six of those babies being referred for neonatal hypothermic treatment, also referred to as neonatal cooling.
Two stillbirths which occurred at the hospital in 2023 are also being reviewed externally. In total, seven reviews are yet to be published.
While each of these initial five reviews is individual, the review team prepared an overarching summary document which laid out four common themes of concern: communication; governance; clinical care, leadership and clinical governance; and infrastructure.
A previous review of maternity care in PUH – the Walker report – took place in 2018 which highlighted similar concerns around governance, training and consultant presence.
The Walker report also highlighted concerns in relation to reliance on locum consultants, communication and timely recognition of deteriorating clinical situations.
Although changes were made following the 2018 review, similar issues have been identified by the 2024 review process.
In a statement, HSE West and North West said it is committed to implementing the 34 recommendations contained in these five reviews. Some of this work has already begun through the work of the external management team and the Women’s & Children’s Network
Key among them is the transfer of cases involving high-risk pregnancies to other hospitals.
Factors which contribute to higher risk pregnancies include previous loss of a baby, history of significant medical disease, history of massive obstetric haemorrhage, obesity and maternal age. Women considered likely to deliver their baby before 35 weeks pregnancy will also have their care moved.
“While well-established pathways are already in place for the transfer of care for women with high-risk pregnancies to GUH (Galway University Hospital), considering the safety issues highlighted in these reviews, this implementation team will expand this to other groups of higher-risk women whose care will be transferred to GUH or the hospital of their choice,” the statement said.
According to the HSE, this work has enhanced structures for quality and patient safety oversight, training and education, mandatory training compliance and clinical performance monitoring.
“This has aligned the service more closely with national and regional standards. In addition, the external team oversee all consultant and registrar rotas in Obstetrics and Paediatrics,” its statement added.
Tony Canavan, Regional Executive Officer, HSE West and North West, said: “The management team appointed in January to oversee and manage maternity services in Portiuncula University Hospital (PUH) remains in place and are working on a programme of improvements, many of which relate to the recommendations. Our focus remains on ensuring the safety and wellbeing of women and their babies.”
An implementation team with key stakeholders is now being set up to further progress the recommendations and any further changes required over the coming months.
Dr Cliona Murphy, of the HSE National Women’s and Infants Programme said: “The National Women and Infants Health Programme welcome the publication of the five reviews today. We note that some of the commentary in the summary report relates to the challenges that are faced by the regional maternity services. Currently all maternity services are managed through maternity networks, and the specific issues raised in the summary of the five reviews will form part of the considerations for the successor to the National Maternity Strategy, which is set out in the Programme for Government.”