Patient safety not on agenda at management meetings
A senior member of the team which investigated Portlaoise Hospital said he has rarely seen a health body as "poorly organised" as the Health Service Executive (HSE).
Martin Turner, governance expert on the Hiqa team which carried out the Portlaoise probe, said: "I think there has been poor leadership in the HSE.
"If somebody is asked where Portlaoise is going to be in five or 10 years time I am not sure anybody is capable of answering that question."
Mr Turner, a former chief executive of the NHS in Wales, added: "Quality and health and safety are normally number one on the agenda of organisations I have been involved in."
He insisted it was not possible to say that Portlaoise Hospital was safe, despite improvements. It is still a work in progress.
There are particular concerns about the ability to carry out complex surgery in the hospital because of the low volume of patients needed for expertise.
The intensive care infrastructure is not fit for purpose and there is a lack of resources in its diagnostic imaging service to ensure patients get their X-rays and scans on time.
In the maternity unit the team found that while it could safely deal with the majority of women there, staff had an inability to risk assess patients who needed transfer to a larger hospital.
Portlaoise had been left to operate in isolation and was in "limbo" with no senior managers "on the floor".
Patient safety was not a standing item on its meetings' agenda. Midwives were working with insufficient supervision.
The State Claims Agency highlighted concerns about incidents in the maternity services in 2007 but an independent review was not carried out by the HSE.
Hiqa reports into similar hospitals in Ennis in 2009 and Mallow in 2011 had recommendations which were not followed up by Portlaoise. In March last year a review of surgery highlighted concerns.
The team concluded that the tragic deaths of five babies at the hospital may have been prevented if actions were taken.
Responding to the report HSE chief Tony O'Brien, who took over in summer 2010, said: "I wish to emphasise that any failings relating to the past either have been or are being rectified and that Portlaoise Hospital is now on a path to being an excellent hospital as part of a wider hospital group.
"The HSE has already taken objective steps to improve the quality and safety of services in Portlaoise over the past two years.
"The HSE is confident that it provides a safe level of service to its patients in the midlands."
The HSE, however, said that many of the comments and findings of the Hiqa report were presented from an overly simplistic viewpoint that demonstrated a refusal to acknowledge the exceptional challenges it faced trying to maintain and manage health services throughout a period of unprecedented budgetary cutbacks.
The HSE would needs more resources in order to make all services as safe and sustainable as they can possibly be.
However, it worked within financial and employment constraints, it said.