Dr. Rhona Mahony:

On the resource issue, the fertility rate in Ireland is approximately 14 per 1,000, which is at the upper limit of European fertility norms. Yet we have the lowest number of obstetricians in the OECD, comprising some 140 to 150 whole-time equivalent posts. By any reasonable international standard, that number should be at least twice if not three times as large. In terms of midwifery services, last year we conducted a national study called Birthrate Plus which identified that Ireland's complement of midwives is 140 short, including a shortfall of 25 in my own hospital. That is a very serious deficit. The problem, however, is not confined to a shortfall in staffing provision. We also have a huge problem recruiting and retaining staff, which is a major issue, particularly outside Dublin. In fact, it is a global problem which exists across a range of countries and represents a real risk over the next ten to 20 years. We have just done a survey of doctors in training which found that very few of them want to work outside Dublin. Already, there are units outside the capital with very high locum dependency and experiencing great difficulties in attracting obstetricians. On the midwifery side, we have a particular problem recruiting midwives who are trained to scan and midwives or nurses qualified to work in theatre and in neonatal units. Again, these are very specialised areas and one cannot just go to market. These are people who trained for a long time and have very good skill levels.

On the one hand, then, there are these difficulties with resources and the fact the units are all very busy. Professor Malone and I each work in units delivering almost 9,000 babies per year. Arising out of that resourcing issue is a related problem.

Last year, the State paid €1.6 billion settling medical negligence claims. Some 60% of that was in obstetrics although internationally our outcomes compare favourably. Our health budget is approximately €13 billion. We do not have a direct budget for obstetrics but I estimate that it is not more than €1 billion. It is likely that we are now paying more money to settle medical negligence claims than we are using, despite the deficit, to resource our service in the first place.

I believe there is a need to decriminalise. A complex medical decision is being made and I am not aware of any other area of medicine where people are charged with making complex medical decisions under the shadow of a custodial sentence of 14 years. We had an opportunity in the Protection of Life During Pregnancy Act to decriminalise but we did not take that opportunity, which is a pity. I support the Royal College of Surgeons in Ireland's statement that medical procedures pertaining to women in pregnancy should be treated with the same regulation as any medical procedure and not in a criminal context.

On training, first we have a problem recruiting trainees to do obstetrics because it is such a high-risk area. It is a punitive area in Ireland in which to practise. People are becoming increasingly fearful of practising obstetrics in this country, which does not make women safer. We need to support the clinicians at the coal face who are delivering difficult care. Our primary aim when training young doctors and midwives is that they will be good clinicians and that their primary objective will be to provide good, sound clinical care.

On the strain in the UK, this year on International Women's Day, the Royal College of Obstetricians and Gynaecologists held a meeting dealing with issues surrounding termination of pregnancy. I was at the meeting. Much of it focused on the resource issues in the UK, which is also struggling to recruit doctors. It is a big issue for it too.