Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I join the Chairman in welcoming our panellists and thank Dr. Coulter-Smith and Dr. Sheehan for their presentations and for circulating the broad text of their contributions earlier. I have a number of questions although none is directed at any of the witnesses in particular. As they are comfortable, they might please respond.

On adverse outcomes, the accepted but unacceptable situation is to deny and defend. Do the witnesses, in their respective positions, believe a change of approach is needed to this disposition, which is very much in situ? Do they believe that not only their profession and the provision of maternity services but the broader public interest would be better served by an acknowledge and apologise approach? Do they and their colleagues believe they have a role to play in bringing about a change in the approach of the State Claims Agency in this respect? I think we all recognise that if one were to act individually, as I have urged, the State Claims Agency would go ballistic, as it were.

I will direct a specific question on inquiries and investigations to Dr. Coulter-Smith. My personal noting of inquiries and investigations is that they are mainly carried out by senior consultants and practitioners engaged by the HSE or hospital management. These people are the busiest of our practitioners. They are people such as Dr. Coulter-Smith, who is himself the master of a maternity hospital. As he is so busy, the consequence of having him on a panel set up to carry out an investigation in another hospital on a particular adverse outcome would be that there would be an inordinate delay in the conduct of the process and the publication of a report and recommendations. In my constituency of Cavan we have one maternity hospital. Currently, five maternity related reports are awaited. It is not the fault of those panellists that in one particular instance we are almost at the three-year mark and still waiting for something to enter the public arena.

I wonder if Dr. Coulter-Smith is engaged in such work. If he is, how many is he currently involved in and how many over the seven years of his holding the position of master of the Rotunda would he have been directly involved in? Does he think that is appropriate? Is that good use of his time? Would the process be better served by more available clinicians - I do know at what point in their service that could even be viewed as right - or perhaps retirees? I would be interested genuinely in knowing what his views are in relation to that. I would add that knowing some of the perils concerned and knowing some of the excellent staff in these maternity settings, including in Cavan, I can affirm the pain and hurt, not only of families but of those who provide such excellent service beyond the line of duty, at the delay in having the facts established. It is a terrible disservice to excellent doctors, nurses and support staff in the maternity settings. We need speedy address of these matters.

I note and welcome Dr. Coulter-Smith's remarks regarding the need for legislation that would provide for interventions in cases of fatal foetal abnormalities where such an intervention is the wish of the pregnant woman.

In relation to models of care, Dr. Sharon Sheehan referred to community midwifery services largely confined to the Dublin hospitals. Is it the case that in the Coombe and the Rotunda that women do not have the choice between consultant-led, medically-led birthing opportunities and midwifery-led ones? They do not exist in either of the two major hospital. Indeed, my understanding is that they are only in two maternity settings across the State and both of them are in the RCSI region, close to my domicile.

The Chair might bear with me for one moment. On staffing levels, I agree with the point Dr. Sheehan made and thank her for so much of what she included in her contribution today. We talk here in terms of the lifting of the recruitment embargo and we note the failure of the bring-them-home campaign - I do not see a big flood coming home - but Dr. Sheehan stated that the lifting of the moratorium in HSE hospitals has resulted in the movement of staff away. Could she explain that moratorium reference and the impact of it? I am a little puzzled. I enjoyed the point about there being no waiting lists and that clinics cannot be cancelled nor wards closed. How true that is. It is a pity it did not apply in all settings across the health services.