Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I wish to clarify for the Deputy that actions have been taken to assure the safety of maternity services in Portlaoise. I do not think anybody waited for a report to do this. As the Deputy will be aware, actions have been ongoing for the best part of a year. The ones that may take a few months to complete include the establishment of an independent patient advocacy service which might have to be put out to tender. Legal status for the hospital groups will also take a few months to achieve.

We need greater personal accountability in the health service. It is not good enough to talk about a systems failure, which is an inadequate excuse. We need greater personal accountability. We also need to acknowledge where there are failures in the system. As things stand, two referrals have been made to the Medical Council concerning two doctors. There have been two referrals to the Nursing and Midwifery Board of Ireland concerning two nurses. There is an internal disciplinary process for HSE managers, although what is under consideration is appointing somebody from overseas to undertake disciplinary investigations of managers in the HSE because people may not have faith in an internal HSE disciplinary procedure. The point the Taoiseach made was that there were external disciplinary procedures for nurses, midwives and doctors but only internal procedures for managers.

It is important to point out that it is certainly not all about resources. Today I looked at hospital budgets. For example, the budget for the hospital in Portlaoise is within 10% of the budget for Naas hospital which covers a much bigger catchment area. Therefore, it is not all about budgets. Services were understaffed in certain areas, but to make them safe and bring them up to specialist standard, often no amount of resources will be enough because an adequate case load is needed to ensure clinicians are not de-skilled. One also needs to be able to attract specialists and senior staff, which is sometimes difficult. Up to now, where it has not been possible to attract specialists and senior staff, we have staffed services with expensive, often transient and not always very well qualified, locums and agency staff. That is happening all over the country. In the coming months and years we will need to consider seriously whether services that cannot attract specialists and senior staff should continue, not just in Portlaoise but also in many other hospitals all over the country. We need to face up to this issue.

The national maternity strategy group has been asked to report by October or November this year. One of the actions mentioned in the HIQA report is that a director of midwifery be appointed as midwifery services leader in every maternity unit. That will be done by the HSE. Notwithstanding the enormous financial pressure the State has been under and despite tough time, the number of midwives employed in the public health service is now 1,425. When the Government took office, it was 1,178. The number of consultant obstetricians and gynaecologists is at a record high. Despite the cutbacks made in recent years, therefore, we now have record numbers of midwives and consultants, even though the birth rate is falling. This shows that the Government takes the matter much more seriously than previous Governments, but we still have a long way to go.

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