Dr. Peter Boylan:

One does get continuity because a lot of doctors just want to stay in the public system because it is more comfortable and less challenging in terms of generating one's own income and so on. All of the midwives are also providing continuity of care and that team work is really important in that there is continuity of care that way. It is a concern. One would not allow a consultant to have one session a week in the public service.

One would have to have a minimum amount to make it realistic.

Linked in with that, reference was made to the master shift system, which works extremely well in the single stand-alone maternity hospitals. The model of the south-south-west system that was mentioned, of which Professor John Higgins is the executive clinical director, is one that needs to be developed for all the networks, but it is really important that maternity services, including gynaecology, have separate governance and separate budgets, just like the cancer strategy. A separate budget is critical. What happened in Cork is a classic example of where that can go wrong; the budget for maternity services was eaten into by the general hospital. As Dr. McKenna said, the first thing to get sacrificed is gynaecology; women's health care gets sacrificed first when there is a push. A separate budget and co-location of the maternity hospitals with the general hospitals is critical, as opposed to integration because then they get sucked into all of the problems one gets in the general hospitals. When a crisis arises in the emergency department and patients are on trolleys, where do they go? They go to a gynaecology ward. What gets cancelled? Gynaecology. Obviously, one cannot cancel obstetrics.

Benign gynaecology has been dealt with. Regarding perinatal mental health services, we have heard that those are being improved and that is critical. With respect to the capital plan, the development of the new hospitals is welcomed but co-location rather than integration is a critical factor as well as having separate governance and separate budgets.

I mentioned in my opening statement the importance of midwives and doctors working together as teams. It is critical we do not lose the tremendous co-operation and teamwork we have had between midwives and doctors in the Irish health service down the years. There is a terrible tendency to look to the UK and say what they are doing is good and, therefore, we will do it. It is not always good. It has had very serious problems in its maternity services. We do not want to repeat the mistakes of separating out midwifery and obstetric care. There are both the same. All obstetricians are midwives and are proud to be midwives but they are also looking after more complicated cases. It is essential they work together and that we do not lose sight of that.