Dr. John Monaghan:

On Deputy Conway's question about smaller hospitals and specialists, most hospitals probably have between three and five physicians, that is, medical people, who would generally cover one specialty each. The commonest arrangement might be to have an endocrinologist, a cardiologist, a gastroenterologist and, perhaps, a respiratory physician. Roscommon Hospital, which is near Ballinasloe, has a respiratory physician but there is not one in Portiuncula. There is a cardiologist in Portiuncula Hospital. That would be the arrangement. In the case of a serious medical problem, such as a woman with a major heart disease, a local assessment would decide the severity. There are many patients with mild cardiac disease being managed in local hospitals, and then the move to transfer them would be made. I do not think there has ever been a problem with referral or obtaining expertise. I referred earlier to the cancer problem, which I thought was different from cardiology. One finds cardiology expertise in Galway and Cork, and specific skills would not be required for the management of pregnant women. If surgery were required, it would not be that much different. I do not know if that is helpful on the specialist question.

I was asked about maternal deaths. There has always been a difference, as is well known, between Ireland and the United Kingdom. The question was whether this was because of abortion. I am not suggesting it is because of abortion, but I suggest that if abortion was a significant factor in the improvement of maternal health, the figures should be better in the United Kingdom than they are in Ireland, especially given that a very large number of terminations are done in UK. I suggest that the results should be better in the UK than they are here if medically mandated abortion improves women's health.

A related issue which I have studied slightly myself is the problem with recruitment into obstetrics and gynaecology in the United Kingdom for the last 35 years. The matter is well written up in the reports of the Royal College of Obstetricians and Gynaecologists. Another study which was published in the British Journal of Obstetrics and Gynaecology showed that recruitment into obstetrics and gynaecology was highest in Northern Ireland and lowest in places like Leeds and Oxford. Certainly, Dr. Jim Clinch, who was one of the doctors who was keen to come today but could not, is of the opinion that if an abortion culture becomes widespread, it seriously affects recruitment into obstetrics and gynaecology. That would have been my experience. I worked in the NHS for three and half years in total. Certainly, in my time in the north of England, I used to speak to medical students and ask them if they would consider a career in obstetrics and gynaecology. During the two years I was in the north of England, no student said he or she was interested in a career in obstetrics and gynaecology. When asked the reasons, fear of being sued and a hard-working rota were cited, but the single biggest factor was that students did not like the abortion culture, not for particularly ethical reasons but because it was distasteful to them.

I was asked about psychiatrists as qualified doctors. I cannot second guess psychiatric expertise, but I do not think psychiatric expertise around the country is different to the expertise in the city. Much is made of the availability of perinatal psychiatrists and I am not sure that is as important as has been stated.