Ms Mary Leahy:

Thank you, Chairman, Deputies and Senators. I would like to introduce my colleagues. I am joined by Ms Phil Ní Sheaghdha, general secretary of the Irish Nurses and Midwives Association, INMO, who will give a detailed analysis, including figures, on recruitment and retention issues associated with midwifery, and Ms Mary Gorman who is a practicing midwife and member of the executive council of the INMO. I am first vice-president and a public health nurse and midwife as well.

In January 2017 the Irish Nurses and Midwives Organisation appeared before this committee and welcomed the launch of the country’s first National Maternity Strategy - Creating a Better Future Together 2016-2026. Our midwives section has particularly welcomed the recognition, within the strategy, of the need to give pregnant women appropriate and informed choices in respect of their care during pregnancy, supported by access to the correct level of care and support for their individual needs.

One year on, the progress in implementation is very slow. We have not developed any further midwifery-led units despite the positive feedback surrounding this model of care. Likewise, the development of community midwifery services remains at planning stage. Recommendation 41 of the strategy regarding hospital outreach community midwifery services was due to be fully implemented in the first quarter of 2018 but this has not occurred.

Arising from a recommendation of the report of maternity services in Portlaoise General Hospital, directors of midwifery have been appointed to all midwifery units, 19 in total. One important thing to note about these appointments is that the post of director of midwifery has a remit which spans both the maternity hospital and the adjoining community services in the context of implementing the maternity strategy. The INMO believes that the hospital group structure must provide for the same policy and governance at group level for midwifery services, as is the case for general services. Therefore, the appointment of group directors of midwifery are a necessary national driver for policy and governance changes. The implementation plan published in October 2017, which the INMO was briefed on, set out a plan for the establishment of a midwifery network within each group as a priority and stated specifically that by the second quarter of 2018 that a maternity network governance structure would be in place with a network manager, clinical lead, midwifery lead and quality and patient safety lead clearly identified.

Discussions have not taken place with the INMO yet in relation to the national governance model. The INMO believes that midwifery services would benefit from a national governance model like the way in which general hospital governance is enhanced by the national role of group directors of nursing. The INMO is becoming increasingly concerned at the slow pace of implementation of the strategy and with the low midwife to birth staffing ratios which continue to exist in this country. The accepted midwife to birth ratio, which arises from evidenced based practice, is one midwife to 29.5 births. The strategy committed to the introduction of this ratio over a number of years.

As part of the 2017 funded workforce plan the HSE committed to increasing the staff midwifery numbers from the December 2016 census figure by 96 whole-time equivalents, WTEs, at December 2017. The most recent figures presented to the INMO by the HSE in late January 2018 show that the overall number of staff midwives have actually fallen by 16 whole-time equivalents in December 2017. We have furnished these figures to the committee already. The reality is that our maternity services are severely understaffed and, from the experience of the INMO, there is a funding barrier to realistic workforce and manpower planning services at undergraduate level and continuing at post-graduate level in all aspects of planning. Midwifery is a profession which requires continuity of staffing levels and it is a concern that the highly pressurised environments in which midwives’ work do not lend themselves to retention of staff. The pay for midwives is modestly low for the responsibilities held. The Public Service Pay Commission is currently looking at the barriers to recruitment and retention in nursing and midwifery in Ireland and we have made a detailed submission to this body, demonstrating the fact that Ireland is currently the lowest paying country for nurses and midwives of the five main international recruiter competitors. Ireland is currently unable to retain or recruit sufficient numbers of nurses and midwives to continue to provide safe levels of care in the current models of care delivery. A major improvement in relation to pay and recruitment and retention planning is required to improve midwifery staffing levels and provide sufficient numbers for the expansion and development of services such as those envisaged by this strategy.

I thank members for their time today. We will be happy to answer any questions.