Mr. Kilian McGrane:

It deals with education and development. I cannot remember its exact title. We will come back to the committee with the specifics. Our colleagues in general midwifery and through the institute would identify if there are requirements for change. We would have a role in that but it is not our area of responsibility.

The Deputy also spoke about risk factors. I think we are all very aware of the points raised by Dr. Boylan about on-call and weekends. I totally agree that they need to be addressed.

Dr. McKenna spoke about hypoxia and the risk factors and this is our focus of attention. We mentioned in our opening address our draft instant management framework that sets out a process by which we would hope to standardise even the reviews of these cases. This would have a number of advantages, including the lessons that would be disseminated. It would be the responsibility of the programme to ensure that lessons from an incident in an individual location would be disseminated nationally. That responsibility falls with us.

In terms of the adequacy of the programme's resources to discharge its responsibilities, there are two separate elements. Each individual hospital is accountable for what it delivers. We spoke about the mastership. The masters are responsible for the services provided in their institution. The programme could not possibly do that remotely. At the moment, we have the resources that we have been given. We could probably have spent a little more but not a hell of a lot more. We sought in the region of €14 million for development funding for the programme. That is a full-year cost. If we got €7 million, that is probably the very most we could have spent in a year. Colleagues in both the institute and the INMO have highlighted the recruitment challenges. Therefore, the sum of €4.55 million is probably not far off the maximum we could have expended in a year in terms of staffing levels. We are satisfied with what we have. It will be up to us to demonstrate that it is used effectively in order to attract additional funding next year.

I note Deputy O'Connell's point about "person" rather than "woman". She mentioned the issue about terminations, which was outside our control. If there is a repeal and legislation is passed, it will be up to us to size its implications for the service, subject to there being a surgical impact. The risk is that there would be an impact on gynaecology waiting lists if surgical procedures are required.

The midwifery led unit, MLU, has been addressed, as has foetal folic acid.

I appreciate Deputy O'Connell's point that we should get them now if we are short 100 consultants. The proposal of both the institute and the clinical care programme was that we would invest in ten consultants a year for ten years. We could stretch to nine this year although we would like to have had more. As Dr. Boylan said, whether we would have got them is not 100% certain. It is a positive message to say that we are investing in maternity services and it is to be hoped that that will attract more people into the training programme.

We have covered the on-call issue.

Deputy O'Connell responded to Ms Dunne's observations about the public confidence. Our experience is that public confidence gets hit regularly. We have regular adverse media coverage. As recently as last Monday, it was on the foetal monitor issue. We then get feedback from the institutions stating that women are coming in and asking whether the monitors are safe. We know there are challenges with cardiotocography, CTG, interpretation but that is not an issue that is specific to the monitor; it is a training and development issue. We are very concerned about that public trust and confidence. We want women to avail of the supported care pathway. We do not want them to feel they must have multiple scans outside of what is required and access to an obstetrician every time they come in because their confidence in the service is impacted. That is a big concern from our perspective.

I fully accept what Deputy O'Connell said about anomaly scanning, both the challenge for staffing and the upskilling. The number of 28 is what the system said we need and hopefully we will get most of them this year. Some of them will come in on a training programme which could take up to 18 months. That is why we are saying it is likely to be the end of next year before we have everything that is required.

On the mastership, and Dr. Boylan has related to this as well, as the voluntary hospitals in Dublin are individual institutions, they are not part of the HSE. They therefore can appoint a chief executive officer, CEO, or, in their case, a master who reports to the board. In a HSE context, it is different. There is only one CEO or director general and currently there is not a board but a directorate. As I said, the South/South West group appointed an executive clinical director and that kind of model would work very well.

I acknowledge what Deputy O'Connell said about budgets. We have to be careful though. In a stand-alone unit, the budget needs to be separated but if it is part of a large general hospital such as that in Wexford, Mullingar or Kilkenny, it takes 4% or 5% of the gross budget. If we start pulling those budgets out, the maternity directorate within it would then be responsible for portering, cleaning etc. In a hospital of that size, it may not be feasible. We therefore have to come up with a hybrid which does exactly the same, that is, it protects the resource, which is our key bit. We cannot come up with something that is not workable in a unit that has maybe 1,500 births in a very busy hospital. There is a collegiality aspect. Radiology, pathology and all of the other facets have to work together. We do not want to break something that works but, at the same time, we want to respect that governance and protect the resources that go in.

We accept the point Deputy O'Connell made about co-location. I will not comment on the issue of men outside with prolapsed anything but I take the point that we take the gynaecology issue seriously.