Mr. Liam Woods:

Maternity services are delivered in 19 hospitals, of which five are stand-alone maternity hospitals. There were 67,347 births in 2014 and it is projected there will be 65,473 for 2015. Since 2012, there have been several reports on maternity services and lessons have been learned, informing how maternity services are now delivered. In line with the HSE accountability framework 2015, the acute hospital division has established governance and management arrangements to support the ongoing monitoring and measuring of the implementation of recommendations from all reports.

The imminent maternity strategy will provide the platform for how maternity services are delivered to have a world class maternity service. Since 2014, a number of maternity staff have been recruited who will improve maternity care, including additional midwives to Portiuncula Hospital, Midland Regional Hospital, Portlaoise, Midland Regional Hospital, Mullingar and Wexford General Hospital. A maternity anti-microbial pharmacist has been put in place in each hospitals group. Funding for six additional obstetricians in 2015 for Midland Regional Hospital, Mullingar, Midland Regional Hospital, Portlaoise, Wexford Hospital, Waterford University Hospital, Letterkenny General Hospital and Sligo General Hospital has been made available and these posts are currently being progressed. The requirement for additional midwifery staffing nationally will be informed by the outcome of the HSE commissioned national midwifery workforce planning review, Birthrate Plus, and the 2016 Estimates has made provision for additional midwifery staff as an immediate requirement.

Clinical networks are an important element of our strategy for increasing evidence-based practice and improving models of care. Hospitals groups provide better opportunities for building effective networks to provide direct support which goes beyond oversight and planning and into direct hands of responsibility for solving problems. Planning commenced at the beginning of 2015 for the integration of the Coombe Women and Infants University Hospital and the women and infant service in Midland Regional Hospital, Portlaoise. The process of establishing the first clinical network is a model which will provide a framework for all groups. This hub-and-spoke model of obstetrics is intended to deliver the Coombe services on two sites according to agreed pathways and policies. In March 2015, the Coombe board and the HSE Dublin Midlands Hospitals Group signed a memorandum of understanding to achieve this goal, contingent on well-planned integration. A senior obstetrician from the Coombe was appointed as the director of integration and is on site in Portlaoise. The Coombe-Portlaoise implementation planning is proceeding well. There have been joint multidisciplinary workshops defining the pathways according to HSE national policies and the Health Information and Quality Authority, HIQA, better health care standards. Recommendations from the ongoing maternity strategy will be integrated. My colleague, Dr. Susan O’Reilly, can provide further detail and answer any questions.

In addition, Wexford General Hospital and Midland Regional Hospital, Mullingar are developing closer links with the National Maternity Hospital, Holles Street, as part of the Ireland East Hospitals Group. These links will strengthen clinical governance arrangements and will involve the review of maternity services medical manpower needs. The RCSI Hospitals Group has appointed a clinical director for women’s and children services who is leading on the development of the maternity clinical network to include Cavan General Hospital and Our Lady of Lourdes Hospital. My colleague, Dr. Alan Finan, can answer any questions on this. In the South-South West Hospitals Group, a review of maternity services is under way which includes the establishment of a maternity clinical network with Cork University Maternity Hospital as the hub.

The Saolta University Health Care Group has in place a clinical director and group director of midwifery for women and children’s directorate across the group and the clinical network is being established. To support the networks, the national neonatal transport programme is now a 24-7 service for the retrieval, stabilisation and transfer of critically ill neonates up to the age of six weeks from maternity units outside of Dublin to one of the neonatal intensive care or paediatric intensive care units in one of the children hospitals.

The establishment of managed clinical networks will promote consistency and quality of service throughout the care pathway. The HSE considers more needs to be done at a national level to ensure appropriate oversight and clinical leadership and to drive necessary reform and reconfiguration in maternity services. Looking to the system for precedents of successful organisational reform, the National Cancer Control Programme stands as a model which has significantly improved cancer services and patient outcomes.

A programmatic approach to maternity services will underpin the provision of quality and safe, patient-centred, sustainable maternity care. The programme will provide the necessary governance, integration and leadership to drive reform and standardise care across all units. Such a dedicated structure will also ensure learning from adverse incidents is applied in a comprehensive and consistent manner and promote a national approach to consistent, evidenced-based practice in maternity care. This approach will support staff and enhance the opportunity for optimal clinical outcomes for mother and baby through the integration of the best research evidence, clinical expertise and patient values into the decision-making process for patient care.

A charter for maternity care is being developed in partnership with the clinical programme for obstetrics and gynaecology. The charter will outline a set of principles which describe what matters to women and their partners when engaging with and using maternity services. It aims to inform and empower women to actively look after their own health and the health of the unborn baby, while influencing the quality of maternity care. The work will be completed once the maternity strategy is finalised as the key components of the strategy need to be reflected in the charter.

The MN-CMS is an electronic health record, EHR, for all women and babies who access the maternity services in Ireland. This system will provide accurate and up-to-date information to all those involved in the care of mothers and babies in maternity units. The vision is to continue to develop the system to meet the ongoing changes within maternity services and to work closely with other national systems and initiatives to capture and provide key information. This system, when implemented, will provide a seamless, complete and reliable source of all the information clinicians require to quickly and accurately make care decisions for the health and well-being of mothers and babies within Ireland. Phase 1 of this project is focused on the initial roll-out to the following four hospitals in 2016: Cork University Hospital; the Rotunda Hospital; Kerry General Hospital; and the National Maternity Hospital. This system will then be deployed to the remaining 15 maternity hospitals from 2016 onwards.

Moving on to the Irish maternity patient safety statement, a key concern for patients is that they receive safe and appropriate care. The CMO Portlaoise report sets out the requirement for a maternity patient safety statement. The maternity patient safety statement will provide up-to-date information for management and clinicians in maternity units on key patient safety issues. It will have the advantage of creating a source of information that is much more accessible and transparent for the purposes of external scrutiny, including by the public. The information within the statement will support local and hospital group management to identify trends, to target quality improvement measures and support ongoing risk assessment. It is expected these statements will be published online on a monthly basis commencing with August 2015 data published in early October 2015.

As you may be aware, Chair, yesterday the HSE published on its website two reports that were undertaken as part of our internal review of maternity services by David Flory. We can also address those, if required by the committee, or refer to them at a future date. That concludes my opening statement and I look forward to taking members' questions.