Alice-Mary Higgins (Independent) | Oireachtas source

Overall, we welcome the strategy and our questions concern its implementation. The National Women's Council worked with the HSE around some of the consultation on this. One of the strong desires among women was for choice and options. That is set out to an extent in respect of the supported care options as well as assisted and specialised care. The strategy seems to envisage side-by-side facilities, such as birthing centres, which would allow people access their preferred option but also to move smoothly to another option. Are those birthing centres in place? Has there been progress in the 19 centres towards having those side by side facilities? What is the witnesses' estimated timeline for those options being available? Other resources might be put in place to support how people make those choices and how decisions are made on people moving between them. It is a different approach but it is not enough that it be theoretical. It needs resources. What is happening to ensure that is happening and working smoothly?

One of the key points that came from the witnesses' consultations for the strategy was that one of the key desires was for midwife-led procedures where there was a low risk. We have heard in great detail about the problems in midwife recruitment. The witnesses spoke - with regard to the strategy and its implementation - about some of the problems they have encountered in recruiting people at the highest level. It is clear, however, that those problems exist throughout the system, although their impact around the country is uneven in nature. The moratorium has been mentioned. Has anything been learned from that because it seemed to create pockets of great deficiency in certain areas of care? Have the gaps in care that came about been analysed?

Recruitment and retention of midwives has been mentioned but there is also a concern about those involved in midwifery or who want to move into the area being released to pursue professional development opportunities. There is also a question of mentorship and progression. Directors of midwifery are now being recruited and there are student and entry levels but there is a large gap in the middle. There is also a problem of reward. The wages are very low. The only option for progression is to move into management. What is being done to ensure a pathway for progression for practising midwives to allow them to become advanced midwifery professionals? Will such a pathway be put in place? If it is, that might help resolve the problem relating to mentorship. There is a great shortage of mentors. There need to be increments and incentives for people to climb the ladder and remain involved in midwifery.

I imagine what we would like to hear is what the timelines on recruitment are in terms of the medium-term timeline. We do not want to simply hear that each year, depending on what comes through in the budget, the recruitment list will be drawn up. We want to know about the five and ten year plans for recruitment, in particular in terms of replacement. We have heard that 350 nurses and midwives are leaving the system annually and if we are looking to recruit approximately 100 nurses per year then we will not even be standing still. I know the question has been asked so I will not elaborate further about how it will be done.

Another area of key concern is neonatal care. I understand we do not have adequate training facilities and courses in this country and that in many cases people are going abroad to study neonatal care. There is a question of the gap in neonatal care, which is one that suffered from the moratorium. Could the witnesses discuss what is happening in that particular area which is important? That relates to the wider area of postnatal care. In the plan we discuss a lot about women's health and well-being but currently there are only three part-time perinatal psychologists in the country. Reference is made in the plan to the Coombe hospital but I understand there is a huge shortfall in the west, despite this being an extremely high-risk time in terms of mental health.

In terms of breastfeeding within the strategy, it was mentioned that all 19 units participated in the World Health Organization's baby friendly health initiative but only nine units were designated, which meant less than half of the units met the standards for the WHO.

The main point that came across in the earlier discussion was the lack of gynaecology. Why was that area left out of the terms of reference? What is happening in terms of a gynaecology strategy, and what will happen in the interim, in particular in postnatal care to ensure gynaecological services are provided? That is a crucial point which has come through. I agree with those who said the National Treatment Purchase Fund is not an adequate response to what is a predictable and should be a manageable issue.

We have heard about the mastership model in terms of governance structures but the key thing we have consistently heard is the importance of dedicated specific resources. It is important, for example, that we are not seeing it merged with acute adult care but that dedicated resources, dedicated theatre access and dedicated budgets are provided, including the capacity to strategise and think for the long term. We would like to see what models are being considered in terms of leadership and dedicated, separate resources. One of the key things in that regard is sonography and scanning. That is something on which we really need to see action this year. It is noticeable that where there is a different governance structure such as the mastership structure it has been prioritised. I would appreciate the thoughts of witnesses on the following: if we do intensify and improve governance structures, have clearer structures and resources, do they believe it would assist in dealing with the gaps and problems that have been experienced with recruitment?

This is a ten-year strategy. Care, consent and choice were crucial points in the strategy. Over the course of the ten-year strategy, however, we are likely to see legislative change on areas such as the eight amendment. I know that is key, and that it has been highlighted by groups such as AIMS Ireland, which has worked on and welcomed the strategy, while accepting there are gaps in terms of choice and consent. Do the witnesses consider the strategy is capable of responding to such changes as may arise because if there is legislative change that would require different resourcing and measures which means it will have to be flexible in that regard?