Alan Kelly (Tipperary, Labour) | Oireachtas source

I thank the witnesses for attending to discuss this critical topic. We heard some very good presentations earlier from the Irish Nurses and Midwives Organisation, INMO, and the Institute of Obstetricians and Gynaecologists. I would go as far as to say they were some of the best I have heard during my time in public office. I hope that our current witnesses were listening in or that they will at least have a copy of them. I accept that there are variations of views on stories etc. but I took an awful lot from our earlier session and I would encourage the witnesses to reflect on the transcript of it.

My questions for the witnesses are based on similar questions I put earlier to the representatives of the INMO and the Institute of Obstetricians and Gynaecologists, because I think it is good to hear both sets of views, and a few additional questions. While there are questions around a gynaecology strategy etc., I am a huge supporter of this strategy. By and large, it is a very good strategy but I do not believe it will be implemented because I do not think the necessary funding is available. I am also not convinced the will to implement it exists. It is a ten year strategy and we are now one year into it. What has happened, aside from the few jobs which I understand were advertised in the not too distant past? There are four politicians here today. We know the areas that have to be prioritised in terms of the funding streams. Has there been any thinking outside of the box in regard to funding this strategy? I am not convinced that it will be funded directly from the Exchequer over the next nine years. Is there an alternative strategy in place in regard to funding? For example, has consideration been given to how funding could be raised through other mechanisms? I am concerned that this strategy will not be implemented within ten years.

I was born in the maternity hospital in Limerick, as were my children. The service there, under the guidance of Dr. Gerry Burke, who has since moved on, was and is still the best I have ever seen but the building on the Ennis Road in Limerick is falling down. I understand that service is to be moved on campus at University Hospital Limerick, in respect of which €3 million is required for the design phase, but that this project is already behind schedule. That is just one example. In terms of capital funding of the strategy, from where will that funding come? Are alternative mechanisms of funding being sought because we cannot wait for it? What progress is being made on the strategy? For example, is it being positively received by consultants, psychiatrists and teams with special interest in peri-natal mental health? The evidence we heard earlier in terms of the statistics in regard to these areas was shocking.

We also had a discussion earlier on the services being provided to women, including ultrasound services and the requirement for a clinical decision to be made in regard to the provision of a second scan. Worryingly, we heard from Professor Louise Kenny that this is not safe and that because second scans are only carried out at 20 22 weeks in a low percentage of cases critical issues are missed. What is being done to address this issue and, more important, are sufficient numbers of people being trained in this area to ensure an increase in that percentage? We also heard from Ms Mary Leahy of the INMO that a number of years ago the percentage in this regard was 70% but that it is 50% now. In regard to governance plans, Dr. Peter Boylan made a comprehensive case for the mastership governance model, with which I agree. Unfortunately, this does not apply across the country. Why can it not be standardised? Will it be standardised? We heard earlier from Professor Louise Kenny that the budget for the maternity unit at CUH is being transferred to other clinical areas? Why can this budget not be ring-fenced? What is the plan in terms of governance going forward?

In regard to obstetricians and gynaecologists, it is proposed in the strategy to double the number of consultant obstetricians over the next ten years. Is this possible?

Obviously, this cannot be done in one go and must be planned. One year into the plan, I presume funding is in place for the recruitment of these staff. I ask the witnesses to set out for each budgetary area what is being done and provide evidence of same.

On the recruitment of midwifery personnel, the committee heard clear evidence on staff to patient ratios. The safe ratio is 29.5:1. Are plans in place to reach this ratio and, if so, when will it be achieved? The current figures are causing grave concerns, as we heard from previous witnesses.

On the implementation of the maternity plan, while I am aware that people are working on the plan, I have not seen its impact or any evidence to suggest a dedicated funding model is in place or a dedicated task force has been set up to oversee its implementation by the Health Service Executive and Department. Will the witnesses alleviate my concerns in this regard because all the evidence suggests none of this is happening? In many cases, the ratios are moving in the wrong direction.