Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I thank the two masters for their presentations. Reference has been made to the fact that in recent years there has been some high-profile and tragic incidents in our maternity services. There is always the concern, in reacting to such adverse events, that we have a very short-term response and no strategy that flows from it. We have a knee-jerk reaction rather than putting in place a proper strategy that would deal not just with an adverse event but which would also bring forward better maternity services. In that context, it was mentioned that we have 19 maternity units in the country serving a population of 4.5 million. Whatever way it is calculated, 50,000 to 75,000 births will probably be the going rate for the next number of years. As the population ages, there probably will also be a drop in birth rates. We should bear all that in mind as well as the fact that when, as I always say, medicine and politics meet, seldom there is a good outcome. That is often the difficulty in this country. We consistently politicise our health services. If a decision is made by a Government or Minister, the medical professionals become political. We do not seem to have proper discourse or debate about what is right for the patient.

When talking to professionals of all hues, colours and backgrounds, I find that sometimes the patients' concerns are very much secondary. The professionals and politicians sometimes put their own profession and concerns ahead of those of patients. It is not done in an underhand way; it is often just the nature of the beast. Between now and the publication of the review of the maternity services, which is urgently required, are we capable of coming up with a blueprint and planning our health services and maternity services in the short and medium term?

Dr. Coulter-Smith and others referred to community-led midwifery and maternity services. To many that means the local maternity hospital is closing down and getting those discussions going in communities can be very difficult. It was said that approximately 4,000 to 5,000 births per annum is the best ratio to maintain competence, continuing professional development and medical expertise, but many hospitals have fewer than 4,000 births. There will be many around this table and elsewhere whose maternity hospital in their constituency or region has only 3,000 births, which means closure. When developing a strategy, we need to come at it purely from the point of view of patients. I mean that with respect to everyone in this room. We have made this point in debates on foot of tragic circumstances that have received national and international attention, yet the system trundles on. We need to follow through on commitments we make. I am not putting questions but making points because many important people are here today.

When we talk about reviews, restructuring and reconfiguration of maternity services, it is normally done as a pretext to a downgrading of services. We should be honest about that fact. Over the history of our health services, when we have spoken about reconfiguration and amalgamation, they have often been a result of cuts to capital projects, funding and current expenditure. However, we not have a huge opportunity to get maternity services right.

At the end of that Second Stage speech, Chairman, for which I apologise, I have a couple of questions. We often compare ourselves to the UK when we look at statistics and best practice in maternity services, and rightly so, but given the geography and size of our dispersed population and the fact we have one large city and pretty much after that small regional towns, apart obviously from the city in Cork as well, for fear I would forget it, where else could we look? Where else should we look to get a blueprint for the building of good community care, midwifery-led services and high-end centres of excellence attached to tertiary hospitals? Where else should we look for a blueprint to do all the things we need to do?