Mr. Kilian McGrane:

Deputy Kelleher raised the scans at 12 and 22 weeks. It is a matter of both personnel and infrastructure but is predominantly a personnel issue. Through the maternity networks, we have identified that an additional 28 ultrasonographers are required to deliver anomaly scanning to 100% of women. More sonographers are required to ensure that dating and anomaly scans are provided for all women. We have put the investment in this year. There was ring-fenced money for anomaly scanning in the budget and that investment is going out this week into the system. We know there will be a challenge in getting the number of people needed. Over the course of the last year, in a number of locations, they have already started to upskill midwives if there is a difficulty recruiting sonographers. That is specialised training. The issue is almost exclusively personnel and it is twofold.

The stenographer carries out the ultrasound and does the counselling with the woman in the clinic, while foetal medicine expertise is required if an anomaly is identified.

My colleagues will comment on safe systems. I was asked about the 19 units. To date we have had no safety concerns with any of the 19 units but my colleagues will talk about them from a clinical perspective. Deputy Kelly asked about populating the women and infants team. It is a seven-person team, made up of the three of us sitting here and another four sitting in the Gallery. We have a person to deal with quality and safety, another who has a business intelligence background and two who do general project management support. We will hopefully have two or three more and a recruitment process is under way, although this is not slowing us down.

I was asked for an update on perinatal mental health. A programme was launched in November last year by the HSE mental health directorate under Dr. Margot Wrigley, which is a specialised programme for perinatal mental health. It had €1 million in funding in 2017 to address issues such as psychiatry, and it has €2 million for 2018. The team will put in the specialist posts in perinatal psychiatry, psychology, specialist nurses and social work, and the programme will then move onto clinical midwife specialists in mental health, who will support midwives on the ground to ensure the care pathways are in place. The launch and the ring-fenced funding announcement were very welcome.

Two former masters are sitting here so I will be careful about what I have to say about the mastership. The mastership model works very well in the Dublin voluntaries and they have boards. There will be challenges for us in moving the model into a HSE-run environment. The best example is in the south-south west group, where Professor John Higgins has been appointed as the executive clinical director for the maternity network. It is a work in progress and we can learn a lot from the Dublin maternity hospitals but we need that level of clinical leadership. The model in the Dublin maternities is unique to Ireland, has worked very well and has served the system extremely well so we need to find out how to adapt it in other areas.

I was also asked about capital and making up for lost time. The national maternity hospital is moving ahead as planned. We identified Limerick as the next highest priority behind the national maternity hospital, because of risk factors with the blood bank. The other two Dublin maternities are also on the list and we hope the announcement will mean an acceleration in the ability to draw down funding. Ms Dunne will talk about community midwifery. The Birthrate Plus report was launched in 2016, which was an analysis of what the appropriate midwife to births staffing ratio was at the time, based on a 2014 audit. It recommended a 35:1 ratio but said we need to get to 29:1 when we implement the model of care. We agree fully with the INMO in this respect so there is a significant journey to travel. We will support 75 additional midwives with investment this year, which is a positive first step though there is a considerable distance to travel beyond that.

Deputy Kelly also asked about the doubling of consultants. The nine we will get this year is a good start though we would have liked more. I am not sure if Dr. Boylan thinks we could have got more. We hope that the 100 that were identified will be recruited over the course of the next ten years. Deputy O'Reilly asked about recruitment and retention and my colleagues will respond to that. We have the same challenges as Deputy O'Reilly in that the issue of anomalies in scanning comes up repeatedly. There are seven units which provide 100% access, seven units which provide partial access, usually where clinically indicated, and five where there is no access. The clinical indication does not always come from a scan and it could, for example, be age-related because in some locations this will apply to women who are older than 36 or 38. We have worked with all of these and some have made progress already, to move beyond where they were this time last year. The south-south west area has a very good plan which it hopes to implement whereby all its sites would be able to provide 100% access this year. I will not commit the area to a timeframe because recruitment will be a rate-limiting factor.