Ms Marie O'Shea:

The dating of the pregnancy is from the first date of the last menstrual cycle. People can sometimes be quite slow in realising they are pregnant for various reasons. It might be that they have an irregular menstrual cycle. There are various different reasons and they are set out in the report. The Act states that a person can access termination of pregnancy services where the pregnancy does not exceed 12 weeks. People who present at a later stage to the GP, presenting at nine weeks plus six days, have to be referred to a hospital for a termination of pregnancy to be managed there. A person may present at week 11, and I am told by GPs that this more often affects more disadvantaged groups in society and, as I said, people who do not realise they are pregnant until later for medical reasons, and will need an ultrasound scan to date the pregnancy. Someone with an irregular cycle may not be able to date their pregnancy from the first date of the last period, for instance, and may need to be sent for an ultrasound. In some parts of the country, that works very well. In other parts of the country, the pathway is less reliable. It can work well in some of the private services but sometimes they do not. For example, it may be that the GP makes the choice to make a referral and the referral is not responded to. The GP follows up and is told the sonographer or radiologist is not there and another appointment is made. The time moves on and the clock ticks down and by the time the person has dated their pregnancy, they may be at a stage where, because of the three-day wait or simply because of the delay in assessing the time of the pregnancy, they have timed out.

There is a quotation in the report from a primary care provider where a person presented late in the first trimester. The provider was trying to arrange a hospital appointment for that person. As this service does not warrant the hospital running a service every single day of the week - even in the larger hospitals it may be two days a week - a difficulty in making a referral to a hospital for a person to be seen may result in the person also timing out. If there are public holidays, Christmas time for instance, between the first visit and the mandatory three-day wait so that the mandatory three-day wait is extended, that can exacerbate the problem.