Alan Kelly (Tipperary, Labour) | Oireachtas source

I welcome all our guests to this session. In the next session, representatives of the HSE will be before us, so if the witnesses want to prompt anything to me and my colleagues, I am sure we will be able to facilitate that for the second session. I apologise for being late; I also had to attend a meeting of the Committee of Public Accounts. A number of us have two committees on at the same time.

I am very supportive of the strategy and I was one of the people who asked that the witnesses be brought before the committee. I accept the criticism regarding gynaecological services but, in principle, the strategy is a very good one. My issue is not with the strategy rather to get the witnesses' realistic views as to whether it can be implemented. I am giving them an opportunity to give us their considered views because they are the experts in this area and because we will hear the alternative views of Mr. Liam Woods after the break.

There is a huge capital requirement regarding this strategy and I want to see it happen. It needs to happen and it needs to be a priority for this and future Governments because it will take that amount of time. I am open to the suggestion of alternative funding models to ensure we bring this about as quickly as possible. Do the witnesses support that view? I note the commentary regarding funding and women's health being first to be cut from a capital point of view with all the competing priorities. Realistically, given all that is going on, I cannot say with certainty that it will be guaranteed that the capital requirements will be put forward to ensure that the strategy is implemented as swiftly as possible. We will therefore need to consider alternative models. Would the witnesses support that? For instance, in the past few years, my wife and I have used the services in Limerick under the excellent service provided by Dr. Gerry Burke. The building is falling down but the service is excellent. I want to see the design phase of the new unit in Limerick happen, but €3 million is envisaged this year just to design it. I have seen neither sight nor sound of this. I ask the witnesses' opinions in this regard.

The second issue is one which is sometimes underestimated, namely, mental health issues. While recognised in the strategy, I am concerned about how much progress is being made in appointing consultant psychiatrists and teams with a particular interest in perinatal mental health. What funding is being provided in this regard? Have the witnesses seen any changes? Is it improving? Is it disimproving? From evidence I have heard and seen, and which has been brought to my attention, unfortunately, I understand it is the latter. I ask the witnesses for their views in this regard.

Ultrasound was mentioned.

I do not want to go over previous questions because they have been comprehensive in their answers. I have huge concerns about equal access to ultrasound across the country. In their reply this time round, they might outline why, and where geographically, there are differentials in the availability of ultrasound for women in the hospital groups.

I am very much taken by Dr. Boylan's comment on the mastership governance model. I fully agree it has worked for a couple of hundred years. More have an issue with the term than with the ideology behind it which is correct. The master is the captain of the team and the person leading. Given Dr. Boylan placed such emphasis on it, has he a concern that there will be a different model put in place? If so, Dr. Boylan might express his concern so that we can tease it out with others coming in later.

I am very much taken by the contributions of both Marys, in particular, Ms Leahy, on the midwife-to-staff ratios. It is clear that where there is good guidance, for want of a better word, there is a greater chance that more students will come through. Why is this the case? Are there geographical issues or issues in relation to certain hospital groups which Ms Leahy might outline to us, and is this down to personal good management or are there other issues? Is it down to the fact that in some areas there is contagion because of the issues in a specific hospital or hospital group? I want to tease that out more because it is an important issue for us.

The strategy envisages a doubling of consultant obstetricians over the next ten years. Have any of the witnesses, in the past year or so, because the strategy is now a year in place, seen locally of any extra funding being provided to implement this? I presume the answer is, "No". It points to the fact that this strategy is all very well on paper but it is not being implemented.

I am sorry for all the questions. My final one relates to community midwifery and funding in this area. I have seen evidence in some areas where it is working well and in others where there are gaps in funding which means the service available differentiates. Could we have a little more information on the areas where the latter is the case where there may be problems rather than where there is a certain standard? Those are my questions.