Concerns over future of Portiuncula maternity services

Concerns have been raised over the future of maternity services at Portiuncula University Hospital in Ballinasloe following a decision to transfer the care of high-risk pregnancies elsewhere.

The move by the HSE, on foot of five external reviews into the care provided to women and their babies at the hospital, has sparked fears that maternity services at the hospital, the main location for women in the wider Athlone region, are being downgraded.

It's understood up to 300 expectant mothers a year could now be cared for elsewhere, representing more than 20% of the annual number of births at the hospital.

READ: Summary of external reports

This has prompted a strong political reaction, with Sinn Féin Roscommon Galway TD Claire Kerrane calling on the Minister for Health to instruct the HSE to “prepare and publish an urgent roadmap to the full restoration of maternity services” at Portiuncula.

South Roscommon Fine Gael councillor Valerie Duffy said she was “deeply concerned” with the confirmation that no high-risk mothers can have babies in Portiuncula Hospital in the long-term.

“This has potentially huge knock on issues for Portiuncula Hospital and for the women who currently avail of its services,” she said.

Independent Ireland also warned against any downgrading of maternity services at Portiuncula University Hospital, saying proposed changes would leave some mothers from communities across East Galway, South Roscommon, Ballinasloe and surrounding rural communities exposed and unsupported.

Athlone Independent Ireland councillor Paul Hogan said the recommendations of the five reviews, and others in the future, could “amount to the death of a much-needed community- based maternity service by 1,000 cuts.”

The party's Roscommon Galway TD Michael Fitzmaurice said the plan amounted to “a slow dismantling of core maternity services under the guise of reform.”

"The reality is this — maternity services in Portiuncula are being quietly gutted," he said.

"This is a hospital that has served this region for generations. Obviously, there have been tragedies in the past and safety of the mother and baby is the paramount consideration. But you don’t solve past failings by moving care out of reach for future families. What’s needed is investment, not retreat."

Since a previous report into maternity services at the hospital in 2018, some high-risk pregnancies are already being transferred to Galway University Hospital (GUH).

The HSE said this would now be expanded to other groups of higher-risk women whose care will be transferred to GUH or the hospital of their choice, in the coming months.

These could include those with a 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.

The HSE action came following the completion of the first five external reports, with a further seven underway or due to commence.

Last January, external experts were appointed to oversee maternity services at the hospital and the HSE announced individual external reviews were underway into the maternity care provided to nine women who gave birth there since late 2023.

It said, since the start of 2024, seven babies were born with hypoxic ischaemic encephalopathy (HIE) (the reduction in the supply of blood or oxygen to a baby’s brain before, during, or after birth).

Six of those babies were referred for neonatal hypothermic treatment, also referred to as neonatal cooling.

At the time, the HSE said the incidence of HIE, resulting in referral for neonatal cooling treatment, was "significantly higher than that observed nationally or internationally for a similar time frame."

Reviews were also taking place into the care provided in the cases of two stillbirths which occurred at the hospital in 2023.

A further three births, since January of this year, are now also subject to the review process.

The HSE last week said the five external review reports had been shared with the families and it would now offer to meet individually with them to discuss the findings, answer any questions and lay out the next steps.

The HSE said work on implementing the recommendations of the five reviews was already well advanced.

It said the external team now in charge had made "significant improvements in clinical governance, operational processes, patient care pathways, and multidisciplinary team collaboration."

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 Pat Nash, Regional Clinical Director, HSE West and North West said: "We are fully committed to implementing the recommendations laid out in the five reviews and will take all steps necessary to ensure we are providing the best care possible to the women and babies receiving care at our hospital."

Meanwhile, responding to reports that the care of up to 300 mothers could now be transferred from Portiuncula, Cllr Paul Hogan said: "This would push many women further away from accessible, safe maternity care. It would mean that some mothers from Athlone, Ballinasloe, Ferbane, and dozens of rural communities would now be forced to travel to Galway, or elsewhere."

He also questioned the logic behind reducing care in Portiuncula when other hospitals are already under pressure: "If services are to be transferred to Galway, Mullingar or other facilities, are those hospitals getting extra staff, extra beds, extra consultants? Because without that, we’re just shifting risk and stress from one place to another. It makes no sense — clinically or logistically."

Cllr Valerie Duffy said she recognised that women and their babies must be safely cared for and the highest standards should be in place.

"Everything should and must be done to ensure the highest standards and procedures are in place in Portiuncula Hospital and that the maternity services there continue, for everyone - all women regardless of their pregnancy status," she said.

However, she added that here fear was that "an initial downgrading will lead to a bigger shift as women and their families who are not at high risk move elsewhere just in case their pregnancy status changes."

Deputy Claire Kerrane said in her correspondence to the Minister for Health last week she had also asked that there are conversations (not letters) with all expectant mothers booked into Portiuncula to give them an opportunity to ask questions and provide clarity on their care.

She also sought information on what preparation has been done in other hospitals which will accept additional transfers from Portiuncula

She asked the minister to seek a full review of maternity services under the remit of the HSE West & North-West

"Expectant mothers, families, the wonderful maternity staff at Portiuncula and the public deserve to hear a commitment to maternity services at Portiuncula from the HSE," Deputy Kerrane added.

An online petition to 'Save Maternity Services at Portiuncula Hospital' has also been established with some 1,200 signatories at the time of going to press.

The petition states: "We are deeply concerned about the proposed changes to maternity services at Portiuncula Hospital.

“We believe that the current plans, which involve diverting high-risk patients to other facilities, pose a significant threat to the health and well-being of mothers and babies in the region. This petition calls for the immediate reconsideration of these plans and the preservation of comprehensive maternity services at Portiuncula Hospital."