Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I thank all the witnesses for their presentations. It is worth noting that despite a ratio of live births to consultants of 1,000:3.95 our outcomes are comparable with the best in the world. I am mindful, however, that there is always the straw that breaks the camel's back. A large number of people have put a great deal of work into this strategy and it is excellent. One could possibly be excited by this strategy. I am possibly as excited as I will ever be about a strategy having spending a good deal of time in the maternity services in recent years.

All of us are born at some stage so we all have skin in the game. When we refer to good outcomes in births, we want a 100% success rate because a catastrophic event at a birth can change the course of the lives of those affected forever. It is probably the most tragic thing that can happen in the life of any family.

I will repeat Deputy O'Reilly's question. I cannot understand how gynaecology was not included in this report. Can someone identify why that is the case? Is there any historical reason for leaving gynaecology out of the strategy? I cannot see how the two could be separated.

The master model seems to be a no-brainer. It seems to have worked for the past 200 years, as one of the witnesses has said already.

One commendable point from the strategy is the lean team structure. This is something other areas of the health service could examine. The key is to have an identifiable accountable clinician at the top and there should be a clear chain of command. The master model is something we have to develop. It is great that we have the appointment of 19 midwives in train, but it seems the master model is the only way forward.

It was interesting to hear that the first maternity services to be cut are those not protected by independent governance. We all need to work to ensure that they are ring-fenced or protected.

Without going too much into the detail, will whoever is best placed outline for the committee the impacts of poor gynaecological services on the every day lives of women? One example relates to having to wait for two years for a procedure. What effect can that have on quality of life of those affected? Perhaps it is something people are not comfortable talking about. My experience is that this would have a serious impact on the day-to-day life of any woman who has to wait for a long time for such a procedure.

Professor Kenny referred to fundamental inequity within our service. Can she offer a personal view on why it exists? Why have we ended up in a situation whereby our maternity services or the associated plans are simply not up to scratch, notwithstanding the outcomes?

Can the deputation outline the position on sonography? Reference was made to an unacceptable level of risk because of deficiencies in sonography services. Can the deputation provide some detail on this to the committee not only regarding the unborn child, but the issues that might materialise if there is no 22 week scan? What effect does this risk have on the outcomes? I assume that following a 22 week scan those involved know what they are dealing with and can plan to mitigate any adverse event. Let us take this to its natural conclusion. If there is no 20, 21 or 22 week scan, what is the domino effect? At the end point, the birth, could we end up with outcomes that are not ideal? Does it put the clinician in a position that is far from ideal if she does not know what she is dealing with at birth? Is there any barrier other than resources? Is it a question of buying machines and getting people to operate them?

Is there any ethical or political barrier to the roll out of detailed scans at 20 weeks? I am simply putting the question out there. Is there any such reason? Perhaps there might be some historical reason that the maximum amount of information might not be made available to the mother of an unborn child. Is there anecdotal evidence on this point? What is the proportion of women who are pregnant and who do not get the 22 week scan as a matter of routine? How many of these people go and pay for a scan? What I am getting at is whether this is a class issue. If people cannot afford to pay, is there a reason? The cost was €160 the last time I had a scan, but perhaps it is €200 now. Are poorer people not getting a 22 week scan? Let us take this to its natural conclusion. Are such women disadvantaged because of their social circumstances? Will the deputation give me some indication of whether their experience in practice?