Ms Phil Ní Sheaghdha:

I will take that question. Following on from the Portlaoise inquiry there was a recommendation that each of the 19 units would have a director of midwifery. Up to that point, many of the hospitals outside of the three Dublin stand-alone hospitals and the Cork co-located hospital did not have directors of midwifery. Directors of midwifery were appointed during those negotiations. We asked the HSE to implement the same structure that exists in the group structure. In that structure, there is a group CEO, a head of financial services and a group director of nursing. We asked that the same status be afforded to maternity services and that a group director of midwifery would be appointed. As Ms Dunne said earlier, it helps with reinforcing recruitment retention, policy, good practice and all the things that have been confirmed as benefiting the service from a leadership point of view.

A question was asked about whether co-location has assisted recruitment and retention. The only example we can look to is the Cork model. Right now the general and maternity services are equally as bad. One of the benefits is that a closer postgraduate education can be encouraged. Neonatology and ICU services can work more closely together and look at training modules that assist both.

We have a huge shortage of midwives in neonatology units. That again comes back to an increasing requirement. With reference to what Dr. Boylan said about the authority, currently, if one could describe our services as anything, it is that one has hospital groups which have the stand alone maternity services within each group which also has a separate governance structure. Likewise, one has general hospitals, voluntary hospitals with separate governance structures. One has multiplicities of governance structures and it is very difficult to see where the authority lies. Our members would say regularly that we have all the responsibility but none of the authority and authority is the key. We need to know who is in charge and who is making the decision and whether they have fiscal control. One of the big criticisms that directors of midwifery bring forward is that, in many instances, they do not. They have all the risk responsibility but none of the authority to fire, to hire, to recruit and to make the service better.