Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses and thank them for their presentations. I must be repetitive because all our questions are of equal importance. I will re-emphasis and maybe get more detail, particularly from Professor Kenny, on the issue of the 20th week scan not available to everybody. Is it purely a clinical decision as to who gets the scan? At what stage is the clinical decision primarily bases on whether or not there is funding available? In other words, if an obstetrician decides that every case is clinically required, will every scan be provided? Professor Kenny can answer that in the overall context but it is an important issue. Professor Kenny stated quite clearly that this is putting the lives of both mother and child at risk and I am trying to work out the ethical side of that in terms of making a decision primarily based on the fact that they ration because they are told there is no funding available. I wonder where that falls in the issue of the efficacy of the decision-making process, not only of the doctors but, primarily, of management.

At what stage is the optimum time for a scan to identify most challenges that could come about in terms of both the fetal development or implications for the woman's health? Is 20 weeks critically important or could it be at 15 weeks or 14 weeks? At what stage is it best to do the scan? The reason I ask is Deputy O'Connell raised issues about whether or not there is resistance to scans and the sharing of that information based on religious ethos. I ask whether or not that is the case in any of the maternity services.

Recruitment and retention is an issue, both in midwifery services and also in obstetrics and gynaecology. Let us be honest, we talk about career pathways and the work environment, but I assume the remunerative package is a big issue. There is no point in us beating about the bush here. The remunerative package is clearly an issue as well. There is plenty of evidence that consultants are not even looking at contracts in this country anymore because, although there are other issues, of the remunerative package. They might elaborate on that as well.

The strategy states that all pregnant women need a certain level of support, but some need more specialised care, and it proposes an integrated care model that encompasses all the necessary safety nets in line with patient safety principles, which delivers care at the lowest level of complexity, yet has the capacity and the ability to provide specialised and complex care, quickly, as required. It also recommends that dedicated emergency obstetric teams be provided in each maternity unit, and that a maternal retrieval service should be available alongside the existing neonatal retrieval service. I assume that is an aspiration and it is not happening in practice in every one of the 19 maternity centres. It goes back to what Dr. Boylan stated about governance and a master-led governance structure. Dr. Boylan stated in his presentation that he wished to see the mastership model of governance applied in every unit but I assume he means in every hospital group as opposed to every unit. At what stage are we in terms of assessing whether or not all the maternity units will be able to deliver safe maternity services according to the strategy outlined or are we merely pretending and trying to avoid difficult political decisions about maternity services in the time ahead in some of the maternity units?

The issue of the capital programme follows on from the previous point. If we are to talk about recruitment and retention and expending the services, we need a lot of capital investment, merely to stand still. I note there are some amalgamations here in Dublin but across the country many of the facilities are poor.

Women's health and home birthing is an issue that was prevalent and campaigned about for a number of years. The campaigning element of home birthing has dissipated to a certain extent. Do we have the capacity to deliver a safe home birthing service for those who want it? Is there an issue about stating that service is available when deep down we know that we do not have the capacity to deliver it? There is an ethical question there, and a patient safety question as well.

With regard to the issue of women's health and well-being, a key component of the strategy recommends the health and well-being approach to give babies the best start and improve women's health. I presume it is referring to women's health in advance of pregnancy, during pregnancy and post-natal. How far down the road have we got on that because the statistics show us that obesity, diabetes, smoking and poor diet lead to poor health outcomes? How far down the road have we got in providing proper services and educational programmes for women of conception age?