Dr. Peter Boylan:

The Institute of Obstetricians and Gynaecologists welcomes the opportunity to engage with the committee in respect of the implementation plan for the national maternity strategy. The plan has 77 recommendations and 236 specific actions. While all of the recommendations are welcome, I will concentrate on those which the institute considers the most important.

Under the health and well-being strategic priority the commitment to prioritise the recruitment of consultant perinatal psychiatrists and multi-disciplinary team members is essential. There are currently only three perinatal psychiatrists in the country, only one of whom is full time, and all three are in the Dublin area. Women are badly served in this respect.

Under the safety and quality strategic priority, the continued development of national clinical guidelines and the emphasis on audit, using the Irish maternity indicator system, IMIS, data set, should improve the standard of care to women in pregnancy. There is a long tradition of audit in the Dublin maternity hospitals. A lot of work has been already done in the area of guideline development under the leadership of Professor Michael Turner, clinical lead in obstetrics and gynaecology. The involvement of the national women and infants health programme in this area is welcome.

There is a well-recognised deficiency at national level in access to ultrasound services. The institute regards correcting this as a high priority. Under the model of care strategic priority it is critical that the development of the three pathways concept and associated changes does not cause divisions between midwives and doctors. Midwives and doctors working in the Irish health service have a long tradition of working co-operatively together. Such is not always the case in other developed nations, sometimes with tragic results. Teamwork and mutual respect are in the best interests of women. Teamwork also refers to other health care professionals, such as pharmacists, etc.

Development of special services such as early pregnancy assessment units, neonatal screening programmes, perineal clinics and perinatal pathology services will require substantial increases in staff numbers. Under the governance and workforce strategic priority the institute welcomes the repeated emphasis on the importance of audit in maintaining patient safety and quality. The institute strongly supports clinical leadership in governance of the developing maternity networks within each group. The maternity lead should be a senior clinician with both authority for implementation of the plan under discussion here today and accountability for the success, or otherwise, of implementation. Without authority, however, the lead should not be held accountable. The mastership model, as operated by the three Dublin hospitals, but with adaptation, could serve as a model for governance in this respect.

The deficiency in medical staff numbers is a cause of serious concern. It is well known that many consultant jobs are so unattractive that no applications are received. This is a major change from a decade ago and requires urgent and realistic action by the State.

Benign gynaecology gets no mention in the national maternity strategy and we regard this is a serious deficiency which needs to be addressed. I would add that having listened to Mr. McGrane's presentation that a lot of the issues are being addressed and what he said is welcomed by the institute.