Dr. Chris Fitzpatrick:

I thank Senator John Crown for his comments. I absolutely agree with him, there is no acceptable level of maternal or perinatal morbidity or mortality. My ambition for the country is that rather than being “the best little country in which to do business” it should be the best country in the world in which to have a baby, both in terms of maternal safety and paediatric outcomes. There is the capacity to achieve this.

I hope the Minister for Health, Deputy Leo Varadkar, is in the same mould as the Minister for Finance, Deputy Michael Noonan, and a person who is able to make up his mind about what needs to be done. I agree absolutely that there is a critical need to appoint more consultants. The problem is that in my day when one went for a consultant interview, there were 20 people being interviewed against me, now there might be only one. We have lost a generation of graduates who competed, who wanted and were inspired to work in obstetrics, went away and got the best jobs and pursued fellowships in North America, Australia and Britain and came back here to work. Some of them have not taken up the speciality and some of them do not want to come back for a variety of reasons. There is demoralisation about what they see here.

There are things that can be done immediately: we should clear deficits in order that voluntary hospitals would not be under a financial burden. Most of the creativity in the health service has happened in the voluntary sector. With the greatest of respect, if the three Dublin hospitals had been run by the HSE during the years of austerity, they would not be standing today because having people give of their expertise in a voluntary capacity to try to make a hospital work was hugely advantageous to us. The deficits need to be cleared. We need to appoint consultants in Portlaoise, the Coombe Hospital and the Rotunda Hopsital and all other units. That will take time because there are not necessarily the people available and we need to appoint the best people. We do not only need obstetricians. Neonatologists are run off their feet looking after babies with the highest risk in the country of dying, serious morbidity and mortality. They are grossly understaffed. On top of this, we need perinatal psychiatrists. We passed legislation on the protection of life in pregnancy and emphasised the importance of dealing with the issue of suicide. We do not have enough perinatal psychiatrists to deal with the referrals we are seeing. A sign of the disconnectedness in one person being in charge is that we do not have a mother and baby home in the State to look after mothers with a serious mental illness in pregnancy or afterwards. We cannot accommodate them appropriately.

In respect of the cancer programme, we do not want to create a bureaucracy. The appointment of critical staff is far more important. I agree with Deputy Catherine Byrne that it is possible to have a system that is overburdened with management. It needs to be at a level of priority that perhaps only comes with that type of designated programme.

On the sustainability of Portlaoise hospital, by international standards, there are many units in the developed world which deliver 2,000 babies very effectively. It cannot be a stand-alone facility, it needs to be networked into a tertiary hospital. Cross-institutional appointments, cross-institutional training, cross-institutional audit, cross-institutional research and dedicated transfer pathways would work extremely well.

Approximately 15% of cerebral palsy is due to intrapartum events. In the other 85% of cases, we are not certain in the context of the aetiology. Obviously, there is a strong obstetric factor to it but 15% of instances of cerebral palsy occur during pregnancy. The unfortunate scenarios that we see at present - the Kafkaesque-type scenarios - where parents and children are dragged through the courts in order that they might obtain adequate compensation is something most of us find absolutely reprehensible. In terms of open disclosure, if something goes wrong then this could be clearly identified. There are opportunities to mediate and to try to deal with the issue very early on at source. Parents are often forced to go to court in order to secure the long-term well-being of their children because there is nothing else. In terms of children who have a long-term disability from neurological injury or other conditions, one need only to speak to people at the Jack and Jill Foundation to find out what level of care is available in the community. These families need to have the security of long-term care for their children. That will not necessarily remove from them their right to go to court in relation to litigation if something happened that should not have happened. I agree with Senator Crown that the more consultants and the better-trained individuals one has looking after mothers and babies, particularly at critical periods, the better will be the outcomes.

Deputy Catherine Byrne asked about locating the new national children's hospital at James's Hospital. We are fully supportive of this proposal. My only regret is that it did not submit an application for a maternity hospital at the time. Given the delays relating to the last decision, there would have been plenty of opportunity to submit such an application. The nightmare scenario would be that planning permission to build a children's hospital will be granted and then for some reason there will be a problem with having the tri-located entity. I hope the project proceeds. In terms of the Coombe, I hope we will relocate on to the St. James's campus. I think there was a once-in-a-lifetime opportunity, given the delays, to actually put the whole package together. The Deputy is correct - the Coombe Hospital needs to be redeveloped. We need a new hospital. The Rotunda needs a new hospital. This is a reflection of how non-partisan are obstetricians. I am doing my best, working on the project team to relocate the National Maternity Hospital on St. Vincent's Hospital. Our loyalty is to patients, not to institutions. Those days of trying to promote one's institution, at the expense of another institution, are gone. The three Dublin hospitals work very well together as a network in terms of a joint committee. We also work with the hospitals with which we are networked, in our case, Portlaoise hospital.

The Coombe, the Rotunda and Limerick need a national maternity hospital. We need interim development. The things that need to be fixed must be fixed now, namely, in the context that the hospitals will be rebuilt. That is why I am appealing to the Minister. If there is one message to come out of this, it is to appoint the consultants, the obstetricians, the midwives, the neonatologists, the perinatal psychiatrists, the perinatal pathologists and deal with the equipment and the infrastructural issues that need to be dealt with in the short-term, build the hospitals and then look at community care. There is a way of doing it and we do not need to wait for a programme to tell us what we all know.