Dr. Chris Fitzpatrick:

That had already been brought to the attention of the Department of Health. The issues pertaining to Portlaoise hospital and the solution were brought to the attention of the highest level of authority in the Department and the HSE in one week in September 2011. Three years later the model that was ignored and sidelined is, in fact, the one that suddenly was magicked up at a time when critical incidents were publicised in the newspapers.

Bereaved parents need to know that there is a different narrative regarding clinicians and health care managers over a consistent period of time. I have the greatest of respect for the many managers I worked with in the HSE, as well as officials in the Department, who came to the assistance of hospitals and did their best to squeeze out what resources were available. Knowledge of what to do was there in advance, but it was not a political priority. It frustrated many when they came forward with an idea. We went with a creative idea. We also know that investing in women and infant services is not only the right thing to do, but it is also the correct medical thing to do. Investment will improve outcomes, quality of care, experience and save money not just in terms of the €60 million we pay out every year in obstetric litigation but also in terms of the care of children who, unfortunately, sustain serious adverse cerebral events in pregnancy or labour. It saves money and makes sense to make that type of investment, but it did not happen.

I would take a leaf out of the Minister's book. He went on the airwaves after incidents had been reported in the media regarding Portlaoise hospital and said he felt ashamed, as a Minister and a doctor, that patients had not been treated with compassion and respect. As a health care clinician who advocated consistently at the highest level of authority in the HSE and the Department, I felt ashamed of how politicians and the political system had treated maternity services. Women and infants are our most valuable and precious resource, but they were treated with a lack of compassion, respect and care.

We are not slow learners but are slow in action, and I hope that at this stage of our experience we will do something now. Action speaks louder than words. Announcing new hospitals is fantastic; it is futuristic at present. I spent two years of my time building an imaginary hospital in Tallaght that never actually happened. I would like the Minister to do a number of things. First, he should clear the deficits of hospitals that are taking responsibility for the HSE services that are now being transferred into them. Across those hospitals, we need to deal with critical staff requirements, equipment requirements and capital developments that need to be done now. If the Coombe Women and Infants University Hospital is to be relocated on to the St. James's campus in five or ten years, certain things need to be done now. If the Rotunda Hospital is moving to Connolly Hospital Blanchardstown, certain things need to be done now. However, that does not sound as appealing in the run-up to an election as a promise to spend €150 million building a new hospital.

Senator Burke asked what happened between 2003 and 2010. In consultant appointments, we fell far behind other specialties. That happened because decisions were made. It was not as though jobs were not going into the equivalent of the consultant appointments unit there, but other jobs were being prioritised. I know from my involvement that in 2005, the old Eastern Regional Health Authority published a report on the three Dublin hospitals and addressed critical manpower issues in terms of consultant appointments, midwifery-neonatal appointments, etc., but none of those were addressed. From 2005 up to the present, submissions were made for posts. Maternity services were not being prioritised. In addition, our morbidity and mortality figures stacked up in international terms. So at a very superficial level we seemed to be doing all right, but in fact we were not.

On top of that, we had the tsunami of deliveries. In Dublin the hospitals are up to 9,000 or 10,000 deliveries while being resourced to deliver about 3,500 fewer babies. We were skating on thin ice. We were constantly appealing for additional resources. We had the chaos of voluntary redundancy schemes and early retirement schemes. Our revenue was cut back every year. We had the collapse of the private sector and patients coming in from private hospitals with no insurance, accessing care, as they are entitled to do and as we wanted to provide. We had huge issues in terms of interpretation services. The hospitals were providing interpretation services that they found themselves, rather than doing it centrally.

A member mentioned gynaecology, which is very important. The cancer programme has had a significant impact on gynaecology services. The hospitals have importantly prioritised women's cancer, and the results and services are better. The patients with benign disease, among whom will be some patients with cancer, are coming into the maternity hospitals. So the Coombe Women and Infants University Hospital would inherit a very significant cohort of benign gynaecology from St. James's Hospital, and we are not resourced to do that. In addition, the emergency rooms we provide in the standalone maternity hospitals are not resourced as emergency departments. So we do not form part of the audit of trolleys - and there are no trolleys. However, we are not resourced. We are providing emergency gynaecology services and elective gynaecology services out of a budget that is stretched beyond belief in terms of obstetric services.

The use of agency staff is not an issue in Dublin, in that all the consultants and non-consultant hospital doctors in the Coombe Women and Infants University Hospital are non-agency people. They all have standard HSE appointments. Outside Dublin, it is a major issue. It is also an issue in regard to training and networking. In terms of consistency of care, it is not possible to run a hospital on agency staff where the people dropping into and out of the hospital do not necessarily have loyalty to it. There is no continuity of care, and a patient sees whomever is in carrying the bleeper at the time. The way to address that is through networking of hospitals, cross-hospital appointments, and also the provision by the universities that are part of the groups of academic leadership and an academic context, as has been the case recently, so that someone working in a small hospital will get valuable training and will also get exposure to an appropriate academic context.

I believe that about 15% to 20% of women and babies in hospital at any one time have come through referral from other units. The money does not follow the patient at present. In one sense, the HSE managers who are responsible for the income and expenditure of hospitals might be asking why the hospitals are overspending. It may be because we have taken four babies from another hospital, including babies weighing less than 1,500 g, which cost a phenomenal amount of money because of the resources they require.

I addressed this issue at the highest level of authority in the HSE and the Department of Health and asked for more support in this regard. That transfer of funding needs to happen. There are issues the Minister can address that would give a major impetus and really drive the momentum for change in the maternity services.