Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I thank the witnesses for their attendance. We have been given a comprehensive overview of the reality as it is experienced by those working in the maternity services. There are probably people present who could give the perspective of those who have availed of the maternity services. The only conclusion I can draw from this is that the HSE is not in any way, shape or form serious about implementing the maternity strategy or prioritising women's health. It gives me no pleasure to say that.

My first question relates to the provision of an anomaly scan at between 20 and 22 weeks of pregnancy. When I asked the Minister about this issue in October 2016, he referred my question to the HSE which subsequently advised me that this scan is routinely offered and available to patients. In December, it revised the reply it provided in October, which is relatively quick for the HSE, and informed me that the scan is available. The truth is that a postcode lottery applies. If a woman is lucky enough to live in Dublin and is attending one of the three maternity hospitals in the capital, she will be offered the scan as a matter of routine.

The need for this scan was brought home to me when I met a young mother from County Kerry. While I will not mention the woman's name, I have no doubt the HSE witnesses will be familiar with her case. She gave birth to a beautiful baby girl suffering from hypoplastic left heart syndrome. I hope I pronounced the condition correctly. If the mother had undergone the scan, she would have known what was coming, could have made plans and would have been able to travel to Dublin and have her family around her. Instead, her child travelled to Dublin in an a ambulance while she stayed in hospital in Kerry. I spoke to her and it is clear that her suffering was made immeasurably worse by the fact she was not prepared for what happened.

According to Professor Kenny, women are exposed to an unacceptable level of risk by not having these scans available. The woman to whom I referred wrote to the Minister in September 2016 seeking a meeting. She received an acknowledgement of her letter and when I followed up the matter, I was advised that the Minister was open to meeting individuals but was very busy and had asked the newly appointed director of the HSE's national women and infants health programme to meet the woman to discuss the issue. When I contacted her this morning, she informed me she had not had any communication from the HSE. While I understand the director's appointment is recent, it cannot be beyond the HSE to arrange a meeting with a woman who has suffered greatly and is seeking a meeting. I expect it to do so as a matter of priority.

This case highlights the issue of the anomaly scan at 20 weeks. Does the HSE have plans to roll out this scan throughout the country for all pregnant women, including those who may be watching proceedings or may read the transcript of the meeting? Women want to know whether they will be able to access the types of services that would be considered basic in many other jurisdictions. In this jurisdiction, this service appears to be something of a luxury and the subject of a postcode lottery, which is not right. If the HSE has a strategy, will its representatives set out how the staff who will carry out these scans will be recruited and retained?

Recruitment is one thing, and we all know the HSE has a problem in this area, but it also has a problem with retention, one which is caused by working conditions, wages and poor access to educational opportunities. As we heard from Mary Leahy of the INMO and Professor Boylan and Professor Kenny, there is a shortage of trained health care professionals in the system. Midwives are graduating and entering private sector industries that have nothing to do with health care.

This brings me to the issue of clinical placement co-ordinators, CPCs. During the moratorium, which was introduced in the health service two years earlier than everywhere else in the public service, as I know only too well, many CPCs were redeployed in the system or back on to their tools, as one might say. This has left us with an unacceptable ratio of student midwives to clinical placement co-ordinators. Does Mr. Woods have a plan for recruiting more clinical placement co-ordinators? Has the HSE set a target for their recruitment? It must be remembered that midwives are central to the implementation of the maternity strategy because one cannot have a maternity strategy without the trained personnel to implement it. Without staff, a strategy is nothing more than words on a page, which is all the strategy is at the moment. We discussed recruitment and retention at length with those working at the coalface before the HSE representatives arrived. Does the HSE have a comprehensive plan in this area? We are short of midwives and we have problems with recruitment and retention. I would like the HSE witnesses to comment on those issues.

The National Treatment Purchase Fund was referred to. Professor Kenny, who we all agree knows what she is talking about, described the NTPF as not building long-term stability. We have experience with the NTPF and we know it will not work in the long term, even if it may have a short-term impact. I appreciate, however, that this will not prevent the HSE from utilising the fund again. Professor Kenny was asked about the €5 million being spent on the NTPF. She estimated that if the public health service had this money, it could open up theatres and operate on patients in public hospitals, which is where this work should be done. Does the HSE have a strategy to wean itself off the NTPF and begin the process of investing in hospitals and working towards implementing the maternity strategy?