Dr. Meabh Ní Bhuinneain:

I am happy to answer the questions on the smaller units. I thank members for their favourable comments on the maternity service in the west at this time.

On the smaller units, which issue was dealt with at length this morning with Dr. McCaffrey, these services are in isolated areas and operate out of hours. Unfortunately, obstetrics tends to be busier out of hours than during normal working hours. There has been much change in this area over the past ten years as a result of the review of maternity services. There are now informal networks linking hospitals all around the country with the maternity units in each area. These networks are not formalised in every part of the country but they do afford a greater communication between tertiary specialists. Also, owing to mobile phones, the ability to contact colleagues out of hours is greater.

In terms of a consultant going off duty in a small unit leaving the duty of care with a locum, the substantive consultant has a duty to ensure that the locum is suitably qualified for the services. We have experienced huge difficulties staffing these units. However, for the purpose of today's discussion, if the substantive consultant is not adequately satisfied that the locum can perform all duties that might arise, he or she would not then be able to go fully off call. While the response time might not be the ten to 15 minutes for obstetrics which is often the case, the consultant will be responsive by phone and be able to return to the unit within 30 or 60 minutes, which in the type of situation we are discussing today is often the timeframe involved.

There is recognised urban drift of professionals and different working groups towards the urban centres, which is difficult in a country that does not focus on rural training and streaming in the context of the delivery of these services in the long term. In practice, it is possible in many situations of imminent risk to get second opinions and often to get a second pair of hands. It must be remembered that currently all the maternity units are sited in general hospitals outside the free-standing maternity units in Dublin so that there are specialties who have not been involved in this process, including general surgeons who attend emergencies and general physicians and anaesthetists with intensive care expertise who are part of teams on duty at weekends. The brief needs to be widened to include other medical practitioners who will of course be governed under the Medical Council provisions that will change in due course as the Government legislates on this issue.

The question was asked as to whether we are satisfied that with a consultant spread of 120 we have enough geographical spread. That will depend on what happens with reconfiguration. The reason we have sought regulation with the legislation is to ensure we can adapt to situations as they arise. If a unit suddenly loses some aspect of its acute service then the geographical spread might not be acceptable. We may have to regulate for this to adapt as time proceeds.