Mr. Liam Woods:

I thank the committee for the invitation to attend the meeting. I am joined today by Dr. Peter McKenna, Mr. Kilian McGrane and Ms Angela Dunne from the national women and infants health programme and by Ms Janice Donlon, who is with the sexual health and crisis pregnancy programme.

In my submission to the committee I have addressed the points raised by the committee in correspondence with the HSE. With regard to improvements being made to counselling and support facilities for pregnant women both during pregnancy, perinatal mental health features strongly in the national maternity strategy recognising the potential impact it has on the mother, baby and the wider family. The national women and infants health programme implementation plan sets out a series of actions aimed at identifying at risk women, and ensuring that they get the appropriate support throughout their pregnancy and during the postnatal phase. These actions include the appointment of clinical midwife specialists in each of the 19 maternity hospitals or units, to support and train midwives in identifying and supporting at risk women and the recruitment of additional perinatal psychiatrists, so that each maternity network has a minimum of one perinatal psychiatrist. In line with the perinatal mental health model developed by the HSE’s mental health directorate, a hub and spoke model will exist within each maternity network, with the psychiatrist based in the tertiary facility accepting referrals from individuals units, and supported as required by local liaison psychiatry. Another implementation action is the training of all staff working in maternity hospitals or units to identify women at risk at booking appointments, or throughout their maternity journey, and in particular those with a mental health history.

While these developments are resource dependent, the implementation process will commence with the launch of the HSE’s implementation plan for the national maternity strategy. Perinatal mental health is a significant priority for the programme. The actions in the implementation plan will focus on providing the necessary support and counselling to women who are showing signs of stress and anxiety at the lower end of the spectrum, as well as those who have an underlying history of mental illness in the higher risk categories. The pathway for women will depend on the risk classification from their assessment. The model of care for perinatal mental health is being launched today by the mental health division of the HSE and we will arrange for information to be provided to the committee on its content. I have copies of the printed document from that session which I will provide to the clerk if that is helpful for committee members.

The model of care is based on the maternity networks recommended in the national maternity strategy. This means the specialist perinatal mental health services will be aligned to hospital groups and developed in a hub and spoke format so all 19 maternity services are included in the model. An allocation €1 million has been made in 2017 to start three specialist perinatal hubs in Galway, Cork and Limerick hospitals and to expand the small existing teams in the Dublin based maternity hospitals - the Coombe, the National Maternity Hospital and the Rotunda. A further €2 million has been allocated for 2018 to complete each of these six hub teams. The model of care recommends the establishment of a national mother and baby unit. This will require further investment.

In August 2016, the HSE launched the national standards for bereavement care following pregnancy loss and perinatal death. These standards set out the care that families can expect following a maternity related bereavement. An implementation team has been established and a clinical lead and programme manager have been appointed. The implementation team are visiting all 19 units to support the implementation of the standards. In 2016, resources were secured to appoint a clinical midwife specialist in bereavement to all maternity hospitals and units that did not already have one. Recruitment to fill these important posts is currently under way.

The provision of services and supports to women and their families experiencing a crisis pregnancy is part of the remit of the sexual health and crisis pregnancy programme, which is one of a number of national programmes led by the health and well-being division of the HSE. My colleagues, Janice Donlon and Helen Deely, made a presentation to the committee on the work of the programme on 15 November 2017, and Ms Donlon is here today to provide any further inputs the committee may require. The programme presented on the current provision of counselling services in Ireland as funded by them and the range of supports available to women both during a crisis pregnancy and following termination.

The members will be aware from the presentation that the HSE programme currently funds 15 individual crisis pregnancy counselling services, which operate out of 40 plus locations nationwide to provide free crisis pregnancy counselling. These services are in a mix of rural and urban locations. Details of these crisis pregnancy counselling services can be found on www.positiveoptions.ie. Crisis pregnancy counselling and the provision of information on all three options - parenting, adoption and abortion - is provided under the legal framework of Regulation of Information (Services Outside the State for Termination of Pregnancies) Act 1995.

The Act sets out how information about legal abortion services outside Ireland may be given to individuals or groups in Ireland.

All women should have the same standard of obstetrical care, including early scanning and testing. That was the subject of the committee's second question to us. The national maternity strategy, Creating a Better Future Together, sets out the roadmap for ensuring that all women can access standardised high-quality, safe care regardless of location. The HSE has developed and published an implementation plan for the national maternity strategy which seeks to address the current regional variations in provision of anomaly scanning as part of the overall approach. The implementation plan will be overseen by the HSE's national women and infants health programme, NWIHP. The HSE's maternity services will be managed through maternity networks, with larger tertiary centres working collaboratively with smaller regional centres.

The provision of a dating ultrasound in the late first trimester, 12-14 weeks, followed by a detailed foetal anomaly scan at 20-22 weeks is a recognised component of good antenatal care. Currently only seven maternity hospitals or units offer 100% of women access to anomaly scans, and five units do not offer any access. As part of the implementation plan for the national maternity strategy, the NWIHP has identified the need for an additional 52 sonographers to support the provision of both dating and anomaly scanning in all 19 maternity hospitals or units. In 2018 the priority will be on improving access for anomaly scanning, and funding for approximately 40 additional sonographers, subject to the approval of the HSE's national service plan for 2018, will be provided. Sonographers are a difficult grade to recruit, and if suitably qualified personnel are not available, existing staff will be trained to develop the required capacity. While this will take time, the recruitment of the additional staff will improve access. Further consideration should be given to who will fund and carry out terminations of pregnancy in Ireland. That was the final query. In the first instance this will be a policy matter for the Department of Health in the event of any changes in the legislation being passed in the future, following which the HSE may be invited to submit additional service proposals for funding through the HSE's annual service plan and Estimates processes.

This concludes my opening statement and with my colleagues we will endeavour to answer any questions the committee may have.