Professor Louise Kenny:

I will respond first to the questions around anatomy scanning. By way of clarification, the purpose of the minimal ultrasound schedule is to accurately date the pregnancy, diagnose multiple pregnancy and to plan for the management of multiple pregnancy in the first trimester and potentially to screen for abnormality. The 20-week scan is all about screening for structural abnormalities. As obstetricians, we recommend universal availability of those scans. I should emphasise, however, that women are autonomous beings and uptake of these scans is optional. In our experience, uptake is pretty much close to 100% but some women, for whatever reason, decide not to take one or both scans, as is their right.

It was brought to our attention immediately before this meeting that in response to Parliamentary Question No. 254 - Ref. No. 5055/17 - from Deputy Sean Sherlock regarding data around the availability of the anatomy scan and on when it will be universally available across the country Mr. McGrane responded that the HSE does not have that data. We have provided the data to the committee today and we are happy to share it with Mr. McGrane. We note that Mr. McGrane also states in the response that the implementation group will meet in the third quarter of this year to plan for what is required for universal anatomy scanning and that these requirements will be factored into the 2018 Estimates process, which by my estimation means that the earliest we will see any movement in this area will be 2019. Following on from that, we have provided data that show that 23,000 women in this country will not receive scans this year, next year and, possibly, in 2019. The background congenital abnormality rate is approximately 1% and so based on a very simple equation there will be 230 missed cases of congenital abnormality every year until this is fixed, some of which will be very significant. Following on from that, what are the professional and personal consequences? Women and their families are at the heart of everything we do and how personally and professionally we cope with this is secondary to the affect it has on a family. Some women have come forward in recent weeks to highlight this issue, some of whom have shared their stories with the media. Their tragic experiences have been well documented. These women have joined a campaign on social media to try to remedy this situation.

I would like to share a personal anecdote of a mother who delivered a baby by emergency cesarean section because her baby's abnormality had not been diagnosed pre-natally and therefore we could not plan for an elective delivery. The baby had an unusual condition of the heart, hypoplastic left heart syndrome. Under ordinary circumstances, we recommend that these babies are delivered in Dublin so that they can be immediately transferred to Crumlin hospital for corrective heart surgery. This baby was transferred ex utero in an ambulance and unfortunately died shortly after reaching Dublin. That may have been the case no matter what but that baby died 230 miles away from its mother, who never got to see or hold the baby during that time. I have no doubt that that will be carried with her and her family for the rest of her life.

With regard to the mastership model, Dr. Boylan, who will elaborate further on this point later, and I are convinced that one of the four most important issues in terms of address of all of the issues we have spoken about during this meeting and previously is governance. If we had independent clinical and executive governance, whether through the mastership model or an empowered clinical director, which are the same thing in most units and across other jurisdictions, we could start to fix most of these problems immediately and fix most of them in a short timeframe. As I outlined, we could probably fix the issue around anatomy scans in our own unit in about six months but we do not have the freedom to operate to do so.

On the issue of catastrophic incidents without scanning in terms of home birth and the domino scheme, we have prioritised women who are taking part in the domino scheme and our home birth service in Cork for anatomy scans. They do have anatomy scans for that specific reason. I agree that that is essential for women who are planning to deliver in areas remote from a hospital. With regard to post-natal mental health, a mother who develops significant post-natal mental ill-health such as, for example, puerperal psychosis, is separated from her baby and often by many hundreds of miles. This is fundamentally bad for clinical care and outcomes.

When a mother is separated from her baby, the issue that has led to that separation in the first place is compounded. The ethos of a mother and baby mental health unit is to keep mothers with their infants during those critical weeks as they are on the pathway to recovery. The absence of them is another facet of unequal care in Ireland for women in 2017.