Dr. Chris Fitzpatrick:

I wish to preface my opening statement by saying that it is opportune and important that we are meeting on a day when The Irish Timesonce again highlights on its front page the serious problems in our maternity services with the publication of yet another report that appears to tell us what we already knew about our problems, including the slow pace of change over a considerable period and the need to act decisively now. Mr. Paul Cullen quotes the HSE's response to Mr. David Flory's report, in that it provides "important insights" into quality standards in safety. With the greatest respect, we have the accumulated wisdom of more than ten years of reports and reviews, but a paralysis in terms of meaningful action.

I wish to offer my sympathies to all who have suffered loss or serious injury in our maternity services. As a doctor, I am only too well aware of the harrowing consequences that adverse outcomes have on mothers, fathers, babies and families. I thank the committee for giving me the opportunity to share with it some of my experiences of working in the Irish maternity service over many years.

As a clinician who has worked as a consultant in a busy tertiary referral women and infants university hospital for almost 20 years, seven of which were as master, I cannot overemphasise the importance of the responsibility that politicians, most particularly those in government, have for the planning, resourcing, provision and regulation of effective health services on a national basis. In the context and ethos of open disclosure, clinicians have a responsibility to explain and apologise to patients and their families honestly and transparently when their care falls short of appropriate clinical standards. Although health service managers are now being investigated in respect of their individual and corporate performances, even the most rudimentary root cause analysis will reveal, in the context of the Irish maternity service, that critical strategic decisions made on prioritisation and funding at the highest levels of political authority have had a significant impact on clinical outcomes in hospitals. Often, hospitals have been run into the ground by chronic underinvestment over many years.

It is important that what I have stated should not in any way be interpreted or misconstrued to excuse poor individual professional performance or negligent clinical care. If we are to gain a full understanding of what went wrong, however, it is important to scrutinise why a service that is designated to look after our most precious and vulnerable resource - mothers and babies - never became a political priority until such time as a series of adverse clinical outcomes hit the headlines of our newspapers and news bulletins on successive occasions in the recent past. During the boom years, there was little, if any, investment directed into maternity services and when the bust happened, they were exposed to systematic cutbacks while absorbing unprecedented levels of clinical activity, complexity and demographic change. The fact that the overall clinical outcomes for mothers and babies in this country still indicate, by international comparison, a high level of clinical performance is a testament to the dedication and professionalism of clinical and support staff, local managers and other health care officials, who often felt, and were at many times, abandoned by the political system over successive Administrations. Despite the overall reassurance of our national clinical results, there were outcomes that undoubtedly should not have happened and near misses that turned out better than expected.

The succession of problems that has come to the attention of the public in recent years and that has been the subject of simultaneous and sequential investigations has arisen in a particular context. The warning signs were there for a long time and were raised by many within the system. Unfortunately, they were mainly ignored and, when acknowledged, merely became the subject of reviews and reports, which often cost considerable amounts of money and, when completed, were mostly not implemented in any meaningful sense.

In 2011, as master of the Coombe Women & Infants University Hospital, I established and chaired a multidisciplinary team of clinicians and health care managers from the Coombe, Portlaoise and Mullingar hospitals. Having highlighted a number of significant clinical risks across this network of hospitals, we identified a number of important posts that were required to manage these risks.

Conscious of budgetary constraints, we developed a comprehensively funded innovative strategy that involved piloting these posts with strict performance indicators as well as a long-term savings potential. Despite several modifications of the proposal and presentations at the highest levels of authority and at a national forum, there was no response. These risks were also highlighted in the risk register of the hospital that was submitted to the HSE on numerous occasions over this period. It is noteworthy that this model of tertiary and secondary hospitals, working in close co-operation, emerged some years later as the appropriate strategic response to certain clinical incidents that occurred in Portlaoise Hospital and also as the model for the alignment of maternity services within hospital groups. It is the model that have been endorsed by the Flory report. It is also of concern that many of the risks highlighted in the 2011 tri-hospital submission are still present throughout the country.

If the current maternity strategy is to have any credibility, and if it is to bring about a sea-change in the way that maternity services are funded, organised and run in this country, then it must be more than a cut and paste exercise of generalisations, as many previous reports have been. It must have specifics in regard to models of care, staffing levels and infrastructural development. To do this it must have a methodology of implementation and a ring-fenced budget. Most importantly, it must be a political priority with a life expectancy beyond the next election.

The national cancer control programme is an example of how political prioritisation improves clinical outcomes. Accordingly, I believe that the Minister for Health should establish a national women and infants programme in order to drive change and clinical excellence. He must act decisively to restore confidence in this service otherwise there will be more critical incidents, more traumatised mothers, fathers, babies and families, while ever fewer school leavers and graduates will choose to become midwives or obstetricians in this country.