The HIQA report into governance and related issues at Portlaoise general hospital has been published. It makes for shocking reading, presents an appalling vista in terms of what happened at that hospital and raises a range of issues in terms of patient safety and the needless loss of the lives of five young children and perhaps others of whom we are not aware. The report is an extraordinary tribute to the perseverance and persistence of parents who faced obstruction after obstruction in their search for the truth. Despite the latest attempt by the HSE to suppress this report, we witnessed its publication last week.

It is evident from the report that patient safety was not a priority and that there were failures at local, regional and national level in regard to this issue. What is extraordinary is the extent of the repeated warnings which time and again were not acted upon. This morning I received a copy of an e-mail received by one of the parents involved. This e-mail reveals systemic weaknesses and awareness of those weaknesses by senior people within the HSE. Alarmingly, these weaknesses were identified not just in Portlaoise, but in almost every other site across the country. This e-mail was sent by the chair of the national incident management team, NIMT, to the director of patient safety. In essence, he said that he knows the director is aware that the high rates of harm alluded to are reflective of what is occurring in other jurisdictions also and that the NIMT is aware of numerous sad and serious cases occurring at all HSE sites.

I will repeat that: "The NIMT is aware of numerous sad and serious cases occurring at all HSE sites". This was known at a very senior level within the HSE. Was the then Minister aware of the numerous sad and serious cases at the time? Was the Government aware of what has essentially been revealed as a systemic patient safety issue? I have repeatedly asked in the Dáil when the national patient safety authority would be established but I have received no reply.

Portlaoise was a band 3 hospital, which was confirmed by the Minister at an Oireachtas committee meeting in 2011 and which means it was to be a 24-hour, 7-day, acute surgery, accident and emergency and maternity hospital. As we know from the HIQA report the investigation team found that the hospital was neither governed, resourced nor equipped to safely deliver this level of clinical services. Furthermore, in 2012 and 2013 the HSE had specifically identified clinical risks associated with surgery and emergency medicine, going as far as to say that surgical services at the hospital should cease. Given that all this was known and given the decision of the Government to make it a band 3 hospital, why were the necessary resources for a band 3 hospital not allocated? Why was the requisite funding that would have gone to other, similar level hospitals, not given?

Given what we now know from the report that very senior people were aware of the systemic safety issues in Portlaoise, how does the Minister for Health ensure proper accountability and responsibility for the needless loss of so many young lives? What steps does the Minister intend to take so that we will get accountability? That is the least the families and parents in this situation deserve.

I thank Deputy Martin for his question. I am sure that on a matter as serious and sensitive as this, nobody wants to make political point-scoring the objective of their questions. I know that is not what Deputy Martin is doing. For the families of the five little babies who are no longer with us, Katelyn Keenan-McCarthy, Nathan Molyneaux, Joshua Keyes, Mary Kate Kelly and Mark Molloy, it is obviously a tragedy. The persistence and dedication of the parents in following this through has brought about a situation where the HIQA report has been made and published. It is not the first HIQA report - there have been seven on various sensitive issues in the past number of years, such as on the misdiagnosis of breast cancer several years ago and on warnings about inadequacies in maternity services going back as far as 2006. There will always be occasions when adverse incidents unfortunately arise in hospitals. That is not confined to this country but happens in hospitals all over the world. It is imperative that actions are taken to minimise that risk and to learn fully from errors where errors occur.

I recognise the courage and dedication of the families involved in persisting and following through on this until the HIQA report was published. The publication of the report is welcome and its eight recommendations are all accepted. This will drive much needed improvements in Portlaoise and will have implications for the standards of local, regional and national services not just in maternity but in other sectors. The very least the families who have spoken out here deserve is that the tragic legacy of what happened will be dealt with so that, in so far as is humanly possible, it should never happen again.

I agree with Deputy Martin that this report raises issues of grave concern. The fact that patients in their greatest hour of need were not treated with compassion, respect and dignity is an indictment of the health service in some locations. The fact that, at HSE corporate level, patient safety is not given the highest priority is disturbing to put it mildly. It is a fact that there are accountability and disciplinary procedures in respect of doctors and nurses but not in respect of management and that is why this report is lengthy and complicated and one on whose content the Minister for Health has to reflect very carefully. At the very least a comprehensive response is required to ensure that a culture of patient safety is evident in the health service as a matter of absolute priority and it is not just a service that pays lip-service to patients and their requirements but one where the patient and the patient's needs are at its centre.

The Minister is engaging directly with the HSE directorate to ensure that the very serious findings of this report are addressed and, in accepting the eight recommendations of the report, that they are fully implemented and that other issues arising from it are dealt with appropriately. Deputy Martin asked about resources and one would expect that. It is not all about resources but it is in part about resources. I have dealt with many health issues over the years and for many years there has been a failure to address fundamental questions about the nature, the structure and the kind of service we need for our people nationwide. The Minister will have to bear this in mind as he looks at national, regional and local services.

I am no wiser at the end of the Taoiseach's reply. My opening question raised a very serious issue, revealed in the e-mail of December 2012 from the national incident management team to the director of patient safety. It states that, "The NIMT is aware of numerous sad and serious cases occurring at all HSE sites". Will the Taoiseach ask the Minister for Health to come before the Dáil and elaborate on that e-mail? To what does it refer? What are the systemic risks in sites across the country? The public and parents are fed up of waiting three years to get answers, as they had to in the case of the HIQA report. These are very serious issues.

I am not raising the issue of funding, as one might do. It was HIQA which raised it. I quoted earlier from the Health Information and Quality Authority report, which states, "the hospital is neither governed, resourced nor equipped to safely deliver this level of clinical services". Furthermore, the HSE itself, in 2012 and 2013, had specifically identified clinical risks associated with surgery and emergency medicine, going as far as to say that surgical services at the hospital should cease. At the time of the publication of this report, however, the hospital continues to deliver those services.

In 2011, a Government intervention specified categorically that it was to be at this level at Bantry General Hospital. However, there was no follow-through in terms of resources, governance or equipment to deliver the level of clinical services it would mean. This core question must be answered. What happened? To what degree were the risks suppressed and why? People at a very high level are commenting on the numerous sad cases all over the country. Is it all being kept subterranean? Were it not for the parents of the five babies concerned, we would never have had the HIQA report. The e-mail was written five months before Mary Kate Kelly died and before the Portiuncula cases happened. It is time, not to give the pat or formulaic reply as tends to happen on such occasions, but to use the HIQA report as a catalyst for coming clean on what is happening and calling it appropriately and properly, which has not been done to date.

The Taoiseach seems to be saying, as the Minister has said, that there will be no accountability on the management side. It is not the classic tragedy. These deaths should not have happened and could have been prevented had people acted on the concerns identified here. Regarding prior consideration of these issues the e-mail states, "on this basis a decision was made not to initiate a service safety review". The following question was put in the e-mail: "Do you now think that a service safety review or a specific review of the overall performance of this service is required?" These are the people responsible for safety in the hospital and across the system. They seem to be at sixes and sevens about what to do next. This would have also gone elsewhere and others must have known about the very serious concerns that were being raised. Was the Government aware of how serious the situation was in 2011 and 2012? It is time the Minister came before the House to make a statement on the issue, on this e-mail and the HIQA report and to take questions from Members of the House on Portlaoise and other hospitals.

I have not seen the e-mail to which the Deputy referred. I would like to read it before I comment, as the Minister would. When the Deputy speaks of bands and categories of hospitals, he is reverting to the sort of system we had for so many years.

The Taoiseach's Minister said it in 2011.

Could I finish? The old system of hospitals A, B, C, D, E and F, and their facilities and services always led to tension between different regions for their individual hospitals. The establishment of the hospital grouping system allows for contracts to the group and much greater engagement between hospitals, medical personnel and the services they provide.

The Taoiseach is missing the point. The accident and emergency consultant contacted us this morning.

For example, in the new hospital grouping, the Coombe Women and Infants University Hospital is associated with the Midland Regional Hospital, Portlaoise, and this speaks for itself. The HIQA report clearly points out that much has been done in the last period. As the Deputy knows, all eight of the recommendations will be fulfilled. New management is in place in Portlaoise and a memorandum of understanding has been signed with the Coombe to establish the country's first managed clinical maternity network in the Dublin midlands hospitals group, which is important. The quality and patient safety position in the hospital has been filled; risk management has been strengthened; on-site incident reporting has been introduced; 16 additional midwives are in place to reduce the ratio of midwives per baby born; and approval has been given for further midwifery posts to include shift leaders in delivery and posts in diabetics and ultrasonography. The director of midwifery in place is seconded from the Coombe; a training and needs analysis was undertaken and a training plan has been developed with Athlone Institute of Technology; all midwifery staff have attended cardiotocography, CTG, training, which is important; guidelines are in place for oxytocin administration; and a programme of diagnosis and treatment for neonatal hip dysplasia has been implemented. The national mandatory reporting of serious patient safety events is in place; an improved patient satisfaction survey completed in 2014 indicated that patients were much happier with the quality of the maternity services they receive in Portlaoise; the maternity service has developed a multidisciplinary communications guideline; and a mandatory multidisciplinary customer care workshop was provided. The Deputy might comment on whether he agrees with the view that the Portlaoise emergency department should be closed at 8 p.m. I do not agree.

I agree with what is right for patient safety.

I take the Deputy's suggestion that this should be the start of a new conversation about how we structure our health system and the services we provide. The Minister will come before the House at 5 p.m. and will have no difficulty indicating his intention and that of his Department to follow through on the implementation of the eight recommendations made by HIQA in this very grave and serious report. If, out of the tragedy of the loss of these five little babies, and outside analysis, our national, regional and local services are improved, it can be a good thing for everybody concerned. We must have a system that puts patient care and needs at the centre, and not one that pays lip service to it.