Dr. Peter McKenna:

Benign gynaecology is not prioritised in many hospitals and if there are pressures on beds it will be cancelled. There are no dedicated day theatres or day beds in many hospitals. It is one of the specialties with the largest waiting lists and unless it is resourced properly colleagues will not have access either to outpatient or theatre facilities. There are imaginative ways in which it can be addressed but it has not had the priority within hospitals which it has needed.

The 19 centres deliver more than 1,000 babies and that is a lot by international standards. The four big hospitals deliver between 8,000 and 9,000 and that is massive by European standards. One cannot say any of the units is too small by international standards. Our remit is not to close units but to comment on their safety and we have no concerns as regards the smaller units. It may become more difficult to staff them and the posts may become less attractive but that is a separate issue from the question of closing one over safety issues.

Another issue is patient complexity. Patients are getting older, which is happening through demographics and postponing families. Patients are getting larger, which is happening at an alarming rate and which causes increased morbidity. More patients benefit from assisted reproduction and an increasing proportion of women are having their first baby as families get smaller. These factors all feed into increased complexity. The population is becoming more complex from the point of view of maternity and Dr. Boylan will comment on this.

Money is an issue in consultant recruitment but so is workload and quite a lot of work in maternity services could be on an on-call basis.

If someone works in a smaller unit, they may be on a four-person team. That is committing that person to a lifetime of on call after holidays of one in three. The question of compensation or inducement is very clear but, similarly, there is also the issue that should anything go wrong, the individual has the regulatory authorities and the press to answer to. It is not very attractive, as the committee can well imagine, for somebody who has set out on professional pathway to find themselves the object of adverse attention in the press. It is measure of incentive and the fact that elements of the job may not be very attractive but I am sure Dr. Boylan will have a similar viewpoint.