Mr. Kilian McGrane:

I thank the committee for the invitation to attend the meeting. I am joined by my colleagues, Ms Angela Dunne, director of midwifery, and Dr. Peter McKenna, the clinical director.

The national women and infants' health programme was established in January 2017. The programme has responsibility for maternity services, benign gynaecology and neonatology. The focus in 2017 was on building relationships around the 19 maternity hospitals, working with the hospital groups to establish maternity networks and developing an implementation plan for the national maternity strategy. The implementation plan was completed in the summer of 2017 and launched by the Minister for Health in October 2017. The plan has over 230 specific actions designed to achieve the four strategic priorities of the strategy and specifically to address the 77 recommendations in the strategy. The programme has identified three priorities areas within the 230 actions for attention in 2018. These are anomaly scanning, the model of care and quality and safety. The programme was allocated €4.55 million in development funding for 2018 to address the actions in the implementation plan and that funding is being targeted in the following areas.

With regard to anomaly scanning, each hospital group has been asked to identify how many additional ultra-sonographers are required to ensure that 100% of women presenting at each maternity unit can be offered an anomaly scan. Hospital groups are being allocated funding in line with their requirements. In addition, the programme is working with the maternity networks to ensure foetal medicine expertise is available to support ultra-sonographers when an anomaly is identified. Given the challenges with recruitment and training, it is likely to be at least 18 months before we can achieve 100% access, but the 2018 investment will make tangible improvements.

The model of care is about providing women with informed choice regarding the care pathway they choose for their pregnancy. The specialised and assisted models are well established, and the programme is focusing on implementing the supported care pathway. In 2018, 52 additional midwives have been approved to support the further roll-out of the supported care pathway and to start the process of providing women with improved access to ante-natal and post-natal care closer to their homes. The programme acknowledges that there will be challenges with recruitment, but implementing the model of care will provide midwives will greater choice about how they can best practise their profession.

The programme recognises that while we develop the model of care and increase access for women to the supported care pathway, we also must build public confidence in our maternity services. How we deal with adverse incidents is critical to maintaining the trust and confidence of the general public and, in turn, will encourage women to access the supported care pathway. The programme has provided each maternity network with funding to support a quality and safety manager for women and infants. These posts will be central to the establishment within each network of a women and infants only serious incident management forum. The forum will ensure that all incidents for all maternity hospitals within the network are reviewed by a multidisciplinary team, which includes midwives, obstetricians, neonatologists, anaesthetists and risk management. This level of scrutiny and support will ensure units do not review incidents in isolation. The programme has also developed a draft incident management framework for maternity services. This process, which is aligned to the development of the serious incident management forum, will focus on a small number of very severe adverse events and seek to ensure that a similar methodology is used in investigating and reporting on these events. By focusing on the more extreme events in a systematic manner we aim to reduce the occurrence of these events through improved quality, better reviews and sharing of learning.

I will outline how the €4.55 million allocated in budget 2018 is being used. We will fund nine additional obstetrician-gynaecologist posts. We have engaged with the hospital groups to identify the areas of need and we hope this is the first step in adding the additional 100 posts identified by the Institute of Obstetrics and Gynaecology and the HSE's clinical care programme. We also aim to fund three perinatal pathologists as part of that process. We have approved the appointment of an additional 28 ultra-sonographers to support access to anomaly scanning. In addition to the 52 registered midwives for the model of care, we have approved an additional 15 clinical midwife specialists in mental health, to align with the specialist model launched in November 2017. We have allocated 12 health and social care professionals to support the health and well-being approach to maternity services and to address identified need within the system. We acknowledge that outside of the large centres the availability of health and social care professionals is quite limited. We have also allocated resources to each hospital group to establish their maternity networks, and a small amount of resource to support the phase one sites that are live on the maternal newborn clinical management system. In total, the €4.55 million will support approximately 150 additional whole-time equivalents.

Finally, the programme acknowledges the importance of having a dedicated unit to focus on women and infants' issues and that we received significant development funding in 2018. Our ambition is to ensure that the four strategic priorities of the national maternity strategy are delivered and that we continue to build trust and confidence in the general public for our maternity service. We know that this will take investment over a number of budgets, but our goal is to ensure that every normal risk woman can access the same range of services with the same level of quality, regardless of her location. This concludes my opening statement. I and my colleagues will endeavour to answer any questions.