Jerry Buttimer (Fine Gael)
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I welcome the Minister of State, Deputy Calleary.

Barry Ward (Fine Gael)
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Gabhaim buíochas leis an Aire Stáit as ucht teacht isteach chun an nithe i dtosach suíonna seo a fhreagairt. This important issue affects families throughout the country. It relates to neonatology services, particularly in children's hospitals, and the provision of neonatal intensive care units, NICUs. We have a problem. There are NICUs in maternity hospitals, but where babies requiring surgical interventions or interventions in certain specialist areas are transferred to the four Children’s Health Ireland, CHI, hospitals in Dublin, there is no NICU available to them. They are going into what is called a paediatric intensive care unit, PICU. Although the professionals there are highly qualified, they do not have the specialist skills involved in neonatology, including neonatological intensive care.

We are discussing incredibly vulnerable children - the tiniest, most premature, sickest babies who are born in Ireland – who are most in need of highly specialist intervention. These are babies who sometimes weigh less than 0.5 kg and whose lives are very much in the balance. We are lucky to have people within our medical services who are highly qualified in making surgical interventions – what is called subspecialist intervention – to save these babies’ lives.

I read in The Irish Times that Dr. Ann Hickey has resigned from her position as clinical lead of neonatology services because she has repeatedly asked the Department and the HSE to provide an adequate number of qualified people and NICUs in children’s hospitals to serve these vulnerable patients. Those have not been provided, which I understand is why she has stepped down.

What I have outlined creates a major problem. It sets us behind every other EU country. We are not making these necessary facilities available. Worse, we hear all the time about how we are spending so much money on a state-of-the-art children’s hospital. That is welcome and there is physical provision within that for NICUs and the neonatology teams that would service these very vulnerable patients, but it will not be possible to set up such a team there once the hospital opens. It is something that needs to be in place already. That team could then transfer from the existing CHI infrastructure into the new children’s hospital. There is no such team, though. The people leading other teams are telling us that it is not there and that they will not have the capacity to transfer over to the new hospital. This means that, after the physical facilities have opened, it will take years before the personnel are in position to deliver the services that we need to save the lives of very premature and very ill children.

The consequence of this is that there are children being born today who have less of a chance of survival because the State – the Government or the HSE – is not providing the infrastructure we require to give them a fighting chance. That is unforgivable, as we have the means to do it. This is about an investment in human capital. We need to put the neonatological nurses and consultants in place. I am told that approximately 15 consultants and 80 nurses would be required. It is not a massive investment, but the return on it for the families and tiny children involved is huge. This country has such a good record of low-mortality birth rates. It would be a terrible shame and a massive tragedy for the individual families concerned if we did not maintain that record and ensure that every child born with a difficulty had every chance of surviving.

Dara Calleary (Mayo, Fianna Fail)
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I thank Senator Ward for raising this issue, which I am taking on behalf of the team in the Department of Health, who are dealing with Question Time in the Dáil at the moment.

I agree with the Senator that newborn infants are some of the most vulnerable patients within our health system. For any parent, having a child who is unwell and requires medical care is devastating, particularly at that time. Ensuring good continuity of care for newborns is vital to having the best medical outcomes. The Government has been investing significantly in care for all newborns. I am delighted that, in the past month, further funding has been announced by the Minister for Health to develop four new postnatal hubs. These hubs are delivering vital structured care in the community for women and infants in the first weeks after birth.For some infants, more intensive medical intervention and support is required from birth. Through funding for the national maternity strategy, work is ongoing to train more clinical staff in neonatal resuscitation and a set of national neonatal resuscitation training standards will be published this year. Over 3,200 staff in our health services have undertaken neonatal resuscitation advanced provider training.

As the Senator noted, for infants requiring high levels of medical care, there are 19 neonatal intensive care units, NICUs, across the maternity services in Ireland. There are four level 3 units based at the maternity hospitals for infants with more complex needs, with regional NICUs in Limerick and Galway.

In 2022, CHI opened a new high dependency neonatal unit in Crumlin, as part of its plan to develop a new and highly specialised NICU in the new children’s hospital. Young babies with surgical or complex medical needs are transferred to CHI from neonatal units throughout the country and on admission through the emergency department. The service includes six neonatal high-dependency beds for babies with additional care needs. Together with six well-established neonatal high-dependency beds in Temple Street, this provides specialised cots for a particularly vulnerable group of patients. Funding for an additional 26.5 staff was provided for in 2023 for the neonatology service, with a full year cost of €2.6 million. This was to enhance the service in preparation for the establishment of the NICU in the new children’s hospital. These posts include consultant neonatologists, nurse practitioners, staff nurses and other clinical staff.

To support our medical staff to deliver better continuity of care, we are directing significant investment to eHealth. Through the national maternity strategy, a full electronic health record, EHR, is being rolled out across maternity and neonatal services. An EHR makes it easier for all clinicians to access patient information that is instant, consistent and up to date. It enables more information to be gathered more quickly on how services are operating. Phase 2 roll-out of the maternity and newborn clinical management system will extend this EHR to University Maternity Hospital Limerick and the Coombe. This work is currently under way. This expansion will mean that all stand-alone maternity hospitals have this EHR. It will therefore cover 70% of births nationally, and 60.5% of neonatal intensive care activity.

There has been significant medical progress in the care and lifesaving treatments that can be provided to newborns. I am glad that this Government is supporting clinicians and the wider health system to deliver better outcomes for infants and their families.

Barry Ward (Fine Gael)
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I accept entirely the bona fides of the Minister and the Minister of State. Having listened to what the Minister of State has said, I do not think there is an understanding within the Department of the urgency of this matter. It is not enough to make reference to an investment of a full-year cost of €2.6 million “to enhance the service in preparation for the establishment of the NICU in the new children’s hospital”. It must be in place now. The NICUs must be operational now with the staff complement of specialist nurses, specialist doctors and consultants because that is the team that has to transfer wholesale to the new hospital. It will not be enough to build it up when the new hospital opens. It must be there now. I am calling on the Minister to prioritise investment in the human resources, staffing and facilities that are needed to have those NICUs in place so they can hit the ground running. It is not enough when the hospital opens to say “Great, we will use the facilities that are there to build up a team”. That team has to be in place now.

The reason I say I do not think it is understood here is that I have read what has been said in the papers by the people who work in this area. They do not feel it is there. It is not there and it needs to be if we are to serve all the children of the nation.

Dara Calleary (Mayo, Fianna Fail)
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I would point out that funding was put in place for 2023 to start establishing the teams. So the Minister and the Department of Health have put the funding in place. It is now a matter for the HSE and CHI. They have the funding. There should not be anything stopping them from putting those teams in place. I agree that this should be done now. The teams should be in place before the move. The funding is there. I think HSE and CHI should be driving it on.