John Crown (Independent) | Oireachtas source

I am at this stage officially despondent about any attempts to reform the health system or about meaningful practical actions to improve the service for patients taking place on foot of administrative reports. Forgive me if I sound browbeaten at this stage. I have been harping for 22 years since I came back to this country about the absolutely mediocre health system. People talk about it being a Third World service, but anybody who has worked in a Third World hospital will know it is not. However, we have a strictly mediocre health system and obstetrics is the tip of the spear. This is all to do with the way the service is run and the absolute treacle-like ability of the bureaucracy to thwart any attempt to fix things.

In Ireland, the number of obstetricians per 100,000 people is 4.8; the next lowest in Europe is the Netherlands, which has a lower birth rate, at 7.6.; Turkey, 9.1; Poland 13.5; and Switzerland, 17. It is a question of cause and effect. Appalling cancer survival figures came out last week, and for all the guff we have heard about our brilliant attempt to tackle the cancer problem, we are just one notch ahead of the British, who are by far the worst of the western countries. We set our bar low and compare ourselves to a British yardstick. The British health system is also strictly mediocre and, in quality terms, pales in comparison to the other good socialised medical systems of Europe, the German, Scandinavian, Belgian and French. It is bad on all the metrics. However, we insist on bringing over British administrators to do our inspections.

I do not know why I am even bothering to speak. At the time of the Savita Halappanavar tragedy, I pointed out that the region with the fewest obstetricians, in the country with the fewest obstetricians in the OECD, could expect disasters related to insufficient senior, on-site presence, 24 hours with continuity of care of senior specialists, and too much delegation to trainees. I said it then, I say it now, and I see no evidence that it will change.

Ireland has no excellent obstetric centres. I say it very advisedly. Some five months ago, my beautiful wife gave me a beautiful son, who was delivered with wonderful skill by the obstetric staff of the National Maternity Hospital, Holles Street, and the great backup of the midwifery and other staff. However, given the hospital's facilities, we cannot call it a centre of excellence. It does not have a full ICU. There is limited surgical backup for other surgical emergencies that occur. It does not have the full range of medical specialties on site, such that very sick adult patients have to be sent to other institutions. This is not the way to do modern obstetrics. While we can delude ourselves all we want about being the best in the world, we are not. We set the bar very low. I mean no disrespect to my obstetric colleagues, who do a heroic job and are incredibly well trained. We probably have the best trained cohort of obstetricians of any country in the western world, most of whom have trained in international centres of excellence. Dr. Peter McParland, who delivered my baby, James, is a wonderful, internationally reputed obstetrician, but look at the circumstances in which he is forced to work and the backup he has. Maybe the Department is prepared to fix it, maybe there is going to be a road to Damascus moment for the health service. I do not see it coming.