Ms Phil Ní Sheaghdha:

I will concentrate on the issues generally that have been asked about staffing. It is very important to give some raw data in respect of the numbers. For example, there were 1,445 staff midwives employed in the public health service in Ireland at the end of December 2017. That was a reduction of 16 on the number employed in December 2016. That tells us two things. First, it tells us we are not training enough midwives and, second, we have an inability to retain them.

We train midwives in this country in two different ways. We have a direct entry midwifery programme and we have a postgraduate higher diploma in midwifery for general nurses who want to change career and become midwives. That programme has not met the target numbers for the past two years. In other words, the applications are down. It is a very good programme and it allows nurses who wish to train and work as midwives while training to qualify and thereafter register as midwives. Deputy O’Reilly asked what we can do in the short term.

We know the problem is that the pay rates are too low for nurses in general and for midwives particularly. Deputy Kelleher asked if it was the litigious nature of the job. There is no doubt that the pressure on midwives and the public appetite to get somebody to blame have most certainly not helped retention.

Dr Boylan made a very important comment. Nurses and midwives work very well with their colleagues, obstetricians, gynaecologists, etc. There is a lot of co-operation in the area of midwifery particularly. As a profession, it is very independent in its practice. That is why we welcomed the strategy so much, particularly in respect of developing services in the community. In many jurisdictions, these services are delivered by midwives. Our disappointment centres around the midwifery-led units. We still have two; one in Our Lady of Lourdes and one in Cavan. The feedback from the women who attend is very positive yet the development has not progressed beyond what was there when we last met the committee.

As to where we get midwives from when we cannot recruit and retain our own, the most recent figures from the nursing and midwifery board, An Bord Altranais, show us that the general service relies on recruitment from non-EU countries, particularly India and the Philippines, to make up its numbers. That is not the case for midwifery as the qualifications do not transfer. We have to concentrate on what we are doing at home to a greater extent, as we cannot rely on non-EU recruitment. We have some EU recruitment, particularly from Portugal and Italy. We recruited and registered 19 in 2015, according to the last statistics. That has gone up slightly but, of course, there is an issue with language. That has to be taken into account.

We have two possible remedies. If for example, I want to do the postgraduate diploma in midwifery in Limerick but there is not a place there, I will go to the Coombe or the Rotunda. However, I will not then be offered employment in Limerick. It is bureaucracy. There is a very simple remedy. The circular needs to be amended to ensure that whoever sponsors me employs me once I qualify as a midwife. That requires me to relocate. The good thing about the postgraduate programme is that the students are usually more mature people. They have done their initial qualification as a registered general nurse and are therefore more likely to stay. They are obviously very interested in changing career and becoming midwives. We have to work harder at making it attractive, to ensure that people do train as midwives after qualifying as general nurses and that it is not an expense on them. They should not have to maintain two locations from a living perspective and should not have to do their second qualification away from their base. Many of the postgraduates are currently dropping out and the numbers are not being met this year. Very disappointingly, we have not even filled half the places that are available. The remedies are there; we just need to focus on them. The strategy will not be implemented unless we get enough of our own training as midwives.

Likewise, on the undergraduate programme for direct entry midwives not all the places are being filled. Again, we have to ask why and we have to make sure that students are supported in clinical practice. It is very intimidating, particularly in hospitals that are not maternity only, for student midwives who are training and are being rotated into a general site. They need clinical facilitators and clinical practice co-ordinators to make sure they are confident while learning. Unfortunately, the numbers are very low. The general population of midwives is very low.

Midwives also avail of maternity leave themselves and we know replacement posts for maternity leave are just not happening across the service. There is a deficit of about 3% in the workforce as a result. Those on maternity leave are counted as part of the numbers as if they were at work even though they are not. Those are some of the issues that were raised.