Some four years after the tragic death of Savita Halappanavar in University Hospital Galway, there are real concerns about the pace of reform in the State's maternity services.
It has emerged that two senior experts in midwifery specifically recruited to implement improvements in maternity care in the west of Ireland have resigned just two years after taking up their posts.
Director of midwifery with the Saolta University Hospital Group, Dawn Johnston, who brought high-level experience from Britain's NHS, and NUI Galway professor of midwifery Declan Devane, who was on a half-time secondment with the HSE, have resigned. Both were among the authors of the national maternity strategy, published earlier this year.
Ms Halappanavar was admitted to the Galway maternity unit when she began to miscarry. She and her husband asked for, but were refused, a termination and she died a week later, on October 28th 2012, following the onset of sepsis.
Her death triggered a number of major reports, including one from health watchdog Hiqa outlining recommendations designed to improve maternity care. According to Saolta, 22 of these recommendations have been implemented with work ongoing on a further 12.
However, within the Saolta group, completion of an investigation into a series of baby deaths at Portiuncula hospital in Ballinasloe, Co Galway has been repeatedly delayed.
And a national geographic inequity in the availability of 20-week foetal anomaly scans persists – a potentially dangerous omission for women unable to access them. It is just one indicator of the variable quality of maternity services in the country’s 19 obstetric units.
The resignation of the two senior Saolta staff raises serious questions about the level of progress made locally and nationally. While a myriad of factors are involved in implementing recommendations, there must now be real concern about unresolved midwifery issues that may have contributed to the premature resignations.
Their decision does not augur well for future patient safety and the management of clinical risk.