First, I raise the matter of the death of a baby in Cavan General Hospital which was reported this morning. I extend my sincere sympathy to the family involved and hope the review under way will get to the truth of what happened and bring clarity to the matter for them. I raise this matter in the context of the fact that two infants died in the same hospital in 2014 and another in November 2012. Last May the then Minister for Health, Deputy James Reilly, announced in a press release that he would instruct HIQA to review and pay particular attention to maternity services at Cavan General Hospital and said the use of an external agency was essential to bring objectivity to the review. However, it now appears that no formal order was made to instruct HIQA to investigate the unit and no review was carried out. Will the Taoiseach explain why that is the case?

In its report on Portlaoise hospital HIQA stated in its recommendation:

The Department of Health must now develop a national maternity services strategy for Ireland, as specified in recommendation N7 of the Authority's October 2013 Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients, including pregnant women at risk of clinical deterioration, including those provided in University Hospital Galway, and reflected in the care and treatment provided to Savita Halappanaver.

The report the Minister received on 7 April on Portlaoise hospital goes on to state the development of this strategy does not appear to have progressed substantially in the intervening period and that as a result of the investigation, the investigators believe such a strategy must be supported by a nationally mandated maternity care service. Will the Taoiseach tell us what is happening? A year ago the Minister announced that HIQA would investigate maternity services at Cavan General Hospital but no order was issued to HIQA and nothing happened. Over two years ago, following Savita Halappanaver's untimely death, a national maternity strategy was ordered but nothing happened until HIQA's report landed on the desk of the Minister two weeks ago. Two weeks later a steering group was announced. This raises a fundamental question. At the highest level, arising from HIQA's investigations, the Department and the Government were asked to conduct a national review of the safety of maternity services but that did not happen. Will the Taoiseach explain why that is the case?

First, it is my duty, with everybody else, to sympathise following the latest personal tragedy involving the death of a baby at Cavan General Hospital yesterday evening. I sympathise with the parents of the dead baby. This is the fourth baby to die at Cavan General Hospital in the past few years and clearly it is traumatic. The HSE is investigating the background and cause of this death and I do not wish to comment further until the facts about what happened are known.

HIQA's report on Portlaoise hospital has implications for maternity services throughout the country. With regard to Cavan General Hospital, I understand that, following the death of the third baby in May 2014, the then Minister for Health, Deputy James Reilly, wrote to HIQA on 14 May, requesting it to prioritise the monitoring of the maternity unit at Cavan General Hospital against the national standards to ensure safer and better health care, as part of the overall response to the Chief Medical Officer's report on maternity services in Portlaoise. HIQA subsequently sought a detailed report on the three cases involved and it was provided by the HSE.

In recognition of the wider implications of the national issues in maternity services highlighted in the Chief Medical Officer's report and as reflected in the terms of reference for the investigation at Portlaoise hospital, HIQA has started a focused programme of monitoring of compliance against the national standards to ensure safer and better health care across maternity services nationally. The programme includes the maternity services provided at Cavan General Hospital. That work has started and will be completed by the end of the year. Today representatives of HIQA are attending the Joint Committee on Health and Children, where I am sure this matter will be discussed in further detail by the representatives.

Because of his concerns about maternity services, the Minister for Health, Deputy Leo Varadkar, who is in Portlaoise General Hospital today to meet the bereaved parents of the babies who lost their lives and staff has decided to establish a national women's and infants' health programme to address and improve maternity services across the country. The programme will provide for a cross-sectoral framework for governance, integration and leadership to drive reform and standardise health care services across the 19 maternity units in the country.

It is clear that the then Minister did not order a probe as such at Cavan General Hospital. The Taoiseach used the phrase to "prioritise monitoring" at Cavan General Hospital, but the press announcement at the time indicated that the then Minister had ordered HIQA to probe the death of the baby at the hospital.

On the national maternity services strategy, in 2013 HIQA conducted a major report on the Savita Halappanaver case. As the Taoiseach will recall, it was a major issue at the time and there was huge controversy surrounding the case. It was clear back then that there was a need for a national maternity strategy to be developed. We then had the inquiry in Portlaoise by HIQA and one of its conclusions was that the Minister and the Department of Health had not followed through on a key recommendation made in the Savita Halappanaver inquiry. HIQA's report on Portlaoise hospital went on to state it had found the fact that it had not happened unacceptable, indicating: "The Authority considers the delay in developing and publishing a national maternity strategy unacceptable." The report was published in April, after the report on Portlaoise hospital.

Some say it is a scandal that no action followed the Savita Halappanaver inquiry.

The e-mail from which I quoted yesterday from the national incident management team stated there were numerous sad and serious cases in all sites across the country. Was Cavan one of those sites? It seems people at the higher levels of the Department of Health, the Government and the HSE were all aware that there were serious safety issues. The same applies to the case of Savita Halappanavar but, for some reason, for two years inactivity seems to have been the order of the day in establishing the national review. Why was it not established after the 2013 report?

My understanding is that the Minister wrote to HIQA on 14 May requesting that the authority prioritise the monitoring of the maternity unit in Cavan against the national standards for safe and better health care as part of the overall response to the chief medical officer's report into Portlaoise maternity services. HIQA includes Cavan in its response and as part of a national analysis of the standards that apply in the 19 maternity units around the country.

The Deputy recalls the tragedy of Mrs. Halappanavar and the number of reports that were produced following her death in Galway. The HIQA report on Portlaoise was damning in its findings and it is the first time management has been the subject of a report on its competence, or incompetence as the case may be. That report, with its eight recommendations for both the Department of Health and the HSE, has been accepted in full by both bodies and will be implemented in full. In fact the work has already started.

In 2013 HIQA said there should be a national strategy.

The opportunity will arise today, at the Oireachtas committee hearing which HIQA will attend, to deal with matters arising in the report.

It said it should happen in 2013. The Portlaoise inquiry stated it was unacceptable. Why did it not happen?

We are over time and Deputy Adams and other speakers are waiting. I ask the Deputy to allow the Taoiseach to finish.

We need to focus on maternity services so that every expectant mother can look forward to giving birth in a maternity unit where the highest standards apply.

Bring in the Minister.

I do not have the medical details of the tragedy in Cavan last night or what was the cause of the death of the little baby but I assume the investigation currently ongoing will bring it to light very quickly.

What we need to discuss today is why the HSE and the Department of Health have not acted on recommendations made by regulatory bodies such as HIQA.

The tragic death of a baby in Cavan General Hospital raises further concerns about maternity services but I do not want to make any judgment about this tragedy because I do not know what happened. I extend my sympathy to the parents of the child, the family and others who have suffered such dreadful loss. This news comes on the back of last week's publication of the HIQA report on the safety of services in the Midland Regional Hospital. I ask the Taoiseach to listen to this quotation from the report: "HIQA found that the hospital was not governed, resourced or equipped to provide 24-hour, 7-day acute surgery, accident and emergency and maternity services". The national incident management team has also said that it is aware of other "numerous sad and serious cases at all HSE sites". HIQA goes on to make the point that if the findings of previous HIQA recommendations had been implemented the risks to patients would have been vastly reduced. This is not the first time that HIQA has made this point. It made the point directly with the HSE and with the Department of Health.

I have raised this matter many times with the Taoiseach in this Chamber and I have given him a letter from HIQA enumerating its concerns. The charge from HIQA and the NIMT could not be more serious. The harsh reality is that these recommendations are being continuously ignored and have been ignored for a long time by the HSE and the Department of Health. That is the nub of this problem.

Does the Taoiseach accept that the HSE is obliged to take prompt action to implement recommendations made by regulatory bodies such as HIQA? If so, why did it not do this? Does he accept also that this is the explicit responsibility of the Department of Health and the Minister for Health? Can he explain why the HSE, the Department of Health and the Minister failed to act on these recommendations? There is bound to be an explanation. Could the Dáil and the public be given it?

I accept that the imperative now is to implement the recommendations arising from the HIQA report into the situation at Portlaoise. They have been accepted by the Department of Health and the HSE and will have implications for other hospitals in terms of demonstrating that the standards of competence and service available in the 19 maternity units around the country are of the highest order.

The decision made by the Government to transfer the health Vote into the Department of Health, so that the Minister is responsible and accountable, gives a much greater opportunity to determine where moneys are spent to ensure the adequacy of staffing and resources. The grouping of hospitals is also much better than having individual hospital entities around the country competing, as they did for so many years, for their own set of services and having to make their case each year. The fact that difficult choices were not faced up to for very many years has led to a range of services that, in some cases, have proven not to be of the highest standard. When Professor O'Higgins proposed centres of excellence for cancer a great deal of anxiety was expressed and there were public marches on the proposal. However those people, particularly women and families, who have had the traumatic experience of having to go to a centre of excellence for cancer treatment have found that outcomes are much more specific and relevant and it has proven that the decision to put the patient at the centre of the strategy was right. It means a lot to women who have gone through the trauma of breast cancer to see the capacity in a centre of excellence for the highest level of expertise and treatment.

The Deputy also said nothing had happened in respect of Portlaoise. On Leaders' Questions yesterday I dealt with the measures put in place in Portlaoise in the past 12 months, such as the new management and the memorandum of understanding signed with the Coombe Women and Infants University Hospital. Portlaoise is now part of the midlands strategy in terms of maternity services and is linked with the Coombe. An equality and patient safety position for maternity services has been filled, risk management has been strengthened, there are 16 additional midwives in place and a director of midwifery has been appointed. As I said yesterday, the recommendations of the recent HIQA report are all accepted. The training that was put in place had a full attendance from midwifery staff.

As I said, the Minister for Health, Deputy Varadkar, is in Portlaoise today meeting the parents who have lost babies so tragically and also the hospital personnel. The bluntness of the HIQA report brings into stark focus the inadequacies of a system that has grown over the years and that must be adjusted so that people can feel comfortable and happy that our maternity units have the safest standards possible for expectant mothers to give birth to their babies.

I hope the steps the Minister is taking regarding Portlaoise hospital are adequate and I wish him well. However, the Taoiseach has avoided my question.

Surprise, surprise.

The Portlaoise report was not the first time we heard about these issues. My question was why the recommendations were not acted on. This is too serious an issue for us to play politics with. What is the point of HIQA? The Taoiseach may claim he did not know about the recommendations. I walked across the Chamber and handed him a letter from HIQA which detailed the recommendations it made in the Tallaght report. It made other recommendations regarding the Savita Halappanavar case, and they were not acted on. The Taoiseach has said the Government will act on them. We are being told the problems are being found in other hospitals, including Cavan General Hospital. Contrary to the Taoiseach's response to the earlier question about the Minister for Health and an investigation, although last May the Minister said he wanted a HIQA investigation into Cavan hospital in addition to the investigation into Portlaoise hospital that was ongoing, he never formally ordered the investigation and therefore there was no review. Why was there no review? Why did the Minister not act on his public statement and follow through, as was his responsibility?

I constantly make the case here that the Government's austerity policies are decimating the health services. Now, we can see the outworking of the dysfunctional approach which does not see health as a public service and an entitlement of citizens. One example is the fact that an extra 600 midwives are required and that the number of midwives available to pregnant women is dangerously low. How many more damning HIQA reports will be ignored? When will the Government publish legislation to extend the remit of HIQA, as the Minister promised? Will the Taoiseach take the opportunity to reassure people? People know the recommendations were not acted on. It is always better to give people what the Taoiseach has mentioned many times, namely, clarity and information. Will the Taoiseach take the opportunity to explain why the Minister, Department and HSE failed to implement HIQA's recommendations? None of the Ministers for Health involved in any of the HIQA reports disagreed with the recommendations. They all said they would act on them. However, they did not. The Dáil and the citizens, particularly pregnant women, deserve an explanation.

They do deserve an explanation. As I pointed out, many actions have been taken in Portlaoise. It is not good enough that for 50 years we have relied on reports that follow tragic incidents in hospitals, taken some actions to address the findings and moved on. The point of HIQA is that it is an independent authority that can walk into a hospital and analyse, investigate and assess any sector or service. The Minister is entitled to request that HIQA produce a report and he wrote to HIQA on 14 May 2014 requesting that it examine the maternity unit in Cavan hospital. HIQA has moved to carry out an analysis of all the maternity units in the country, including Cavan.

Will the Government act on it?

What about HIQA's 2013 report?

We will have more analysis.

Arising from the latest HIQA report on Portlaoise, there are eight clear recommendations, including to establish an independent patient advocacy service; ensure the recommendations of this and previous HIQA reports are implemented; develop a national maternity strategy; expedite the necessary legal framework for hospital groups to perform their governance and assurance functions; and four more recommendations for the HSE, including the appointment of a director of midwifery in all maternity units.

The Government ignored the last set of recommendations.

A director of midwifery has been appointed for Portlaoise hospital. The report is stark and disturbing and the recommendations are not only accepted, but will be implemented in full.

It is like the planning.

The eight babies who have passed on should have this legacy, which has been driven by the persistence of their parents.