Dr. Peter Boylan:

I thank the Chairman and members of the committee. The Institute of Obstetricians and Gynaecologists fully endorses everything Ms Leahy has said in respect of the role of midwives. We are fully supportive of what she has said. The institute also welcomes the national maternity strategy and hopes it will be implemented. There are three areas which the institute is particularly keen to see implemented without further delay. First, we wish to see the mastership model of governance applied nationwide, with each unit having its own separate budget and governance structure. This model has been in operation in the three Dublin maternity hospitals for more than 200 years. It is a tried and tested model that works. A clinician is effectively the chief executive officer, CEO, and is assisted by a director of midwifery and a general manager who has the appropriate financial and clerical support. The master is ultimately responsible for the quality and safety of the service and is therefore accountable. With that accountability goes authority to operate the service in the best interests of patients, that is, women and children. There is an identifiable person who is answerable for the quality of the service. Experience in the UK has shown that the further away from the patient the governance structure is, the more there is emphasis on financial outcomes and less on clinical outcomes. The current governance model, whereby maternity units around the country are integrated into the general hospitals, is a failure and recent problems in Cork and Portlaoise are good examples of this. This failure has been demonstrated repeatedly over the past several years by well-documented tragedies. There is no budgetary protection for maternity services, including gynaecology, and so they are the first to suffer cutbacks in our hospitals.

Second, we wish to see all units have access to expert ultrasonography services for all pregnant women. At the moment there is a huge variation in availability of ultrasound for pregnant women around the country. This has serious implications for the quality of care which can be given to women in pregnancy.

Third, we wish to see an increase in consultant numbers to bring us up to internationally accepted norms.

It is well recognised and accepted that the number of specialist obstetrician-gynaecologists in Ireland is the lowest in the developed world. There is a need for an additional 100 consultants to bring us to an acceptable level.

There are other elements of the strategy which the institute would like to see developed, such as more community-delivered antenatal care closer to women’s homes. Learning from experience in the UK, it is essential that obstetricians and midwives work together as a team and not separately. Finally, there is no mention of gynaecological services in the national maternity strategy. This is a serious deficiency. A national gynaecology strategy needs to be developed.