Dáil debates

Wednesday, 3 May 2017

Maternity Services: Motion [Private Members]

 

6:45 pm

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael) | Oireachtas source

6 o’clock

I move amendment No. 1:

1. To delete all words after “Dáil Éireann” and substitute the following:

“notes:— that Irish maternity services compare favourably with those in other countries in terms of safety and patient outcomes;

— the publication, in January 2016, of Ireland’s first National Maternity Strategy (the Strategy), which demonstrates a new and enhanced focus on maternity care at both policy and service delivery level and will fundamentally change how maternity care is delivered, improve the risk profile of the entire service and benefit the approximately 80,000 families who access it each year;

— the establishment of the National Women and Infants Health Programme to lead the management, organisation and delivery of maternity, gynaecology and neonatal services, strengthening such services by bringing together work that is currently undertaken across primary, community and acute care;

— the development of Maternity Networks to strengthen the operational resilience of smaller units such that they can provide safe quality services;

— the establishment of a new National Patient Safety Office (NPSO), located in the Department of Health, to prioritise work in this area and to work on a range of initiatives, including new legislation, the establishment of a national patient advocacy service, the measurement of patient experience, the introduction of a patient safety surveillance system and extending the clinical effectiveness agenda;

— the monthly publication of Maternity Patient Safety Statements by each maternity hospital/unit, as recommended by the Chief Medical Officer in his 2014 report on perinatal deaths in Portlaoise;

— the development of the Health Information and Quality Authority (HIQA) National Standards for Safer Better Maternity Services, which set out the key elements that a maternity service should strive to attain in order to promote the provision of safe and high quality services;

— the implementation of the Maternal and Newborn Clinical Management System, and the introduction of the electronic health record for mothers and babies which marks a very significant development in the delivery of maternity care and will support better, safer clinical decision-making and a more connected health service delivering improved health outcomes;

— the 2016 allocation of an additional €3 million for maternity services, as well as the increased funding of €6.8 million being provided in 2017, to allow for the continued implementation of the Strategy;

— the growing maternity workforce and the falling number of births, both of which are giving rise to improved staff to birth ratios;

— the highest ever number of consultant obstetrician/gynaecologists employed in Ireland at 142 Whole Time Equivalent (WTE), an increase of 26 WTEs since December 2010;

— the 1,583 midwife WTEs employed, and the recruitment of an additional 100 midwives in 2016, the allocation of which to individual maternity hospitals/units was informed by the needs identified by Birth Rate Plus, an evidence-based workforce planning tool;

— that one of the priority aims of the Health Service Executive (HSE) National Service Plan 2017, is the design and development of perinatal mental health services capacity;

— that anomaly scans are available in all Hospital Groups and the Strategy recommends that all women must have equal access to standardised ultrasound services;

— the publication of the HSE’s National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death, and the development of specialist bereavement teams;

— the very substantial implementation of the recommendations relating to children with life-limiting conditions contained in the Report on End of Life and Palliative Care in Ireland by the Joint Committee on Health and Children in 2014;

— the range of services provided for infants with life-limiting conditions and complex medical needs; and

— that these developments represent key building blocks in the provision of high quality maternity services;

endorses:

— the proposed new model of maternity care set out in the Strategy, consisting of three care pathways – supported, assisted and specialised, meaning every woman will be able to access the right level of care, from the right professional, at the right time and in the right place, based on her needs;

— the Strategy’s recommendation that services should be woman-centred, and provide integrated, team-based care, while increasing choice to women and ensuring safety;

— the Strategy’s intention for a partnership approach to be taken, with women to be encouraged to maintain regular contact with maternity services throughout pregnancy and following birth, have access to all necessary information, all of which will be underpinned by the principles of informed consent;

— the intention to relocate all four stand alone maternity hospitals with adult acute hospitals and plans to build a world-class maternity facility, namely the National Maternity Hospital at Elm Park, which will have clinical, operational and financial independence without religious, ethnic or other distinction, and the submission in March 2017, of the strategic infrastructure planning application for the hospital to An Bord Pleanála;

— the Minister for Health’s intention to meet with both hospitals and consider further the legal mechanisms necessary to absolutely protect the State’s considerable investment in the hospital, and to report to Government and the Oireachtas on this project at the end of May 2017, including on the issue of ownership of the new facility;

— the plan for the National Women and Infants Health Programme to oversee the implementation of the National Maternity Standards for Safer Better Maternity Services and for HIQA to, in time, develop an appropriate monitoring programme in relation to these standards once they have been embedded in the healthcare system;

— the prioritisation by the National Women and Infants Health Programme of the provision of anomaly scans, to ensure that women will have equal access to standardised ultrasound services;

— the agreement reached recently, following engagement between the Departments of Health and Public Expenditure and Reform, the HSE, INMO and SIPTU nursing unions on a number of specific measures to attract nursing and midwifery graduates and to retain nurses and midwives;

— the resultant commitment given under that agreement to deliver the 2017 funded nursing and midwifery workforce plan, including 1,208 additional posts, 96 of which are additional midwives to support the implementation of the Strategy;

— the commencement of work by the NPSO on a Patient Safety Complaints and Advocacy Policy, the development of which will be informed by public consultation; and

— the intention to fully implement the recommendations of the November 2016 Evaluation of the Children’s Palliative Care Programme, to further improve the supports and services available both to children with life-limiting conditions and palliative care needs and their families; and

supports the commitment, as set out in the Programme for a Partnership Government and in the developments outlined above, to implement the National Maternity Strategy, which will be carried out on a phased basis over the lifetime of the Strategy and will ensure the provision of a safe and high quality maternity service for women and babies.”

I thank Deputies for giving me the opportunity to speak about our maternity services. I acknowledge the constructive nature of the Fianna Fáil amendment, in particular its focus on the legal mechanisms necessary to complete the new national maternity hospital at the St. Vincent's campus.

Too frequently maternity services make the headlines for the wrong reasons. While any one loss or negative experience is one too many, in particular for the individuals and families concerned, it would be remiss and irresponsible of us not to acknowledge that Irish maternity services compare favourably with those of other countries in terms of safety and outcomes. Of course, there is always room for improvement and to learn from past mistakes.

When it comes to maternity care, we not only know what we need to improve but we already know how we are going to do it. To that end, Ireland's first ever national maternity strategy was published in January 2016. It maps out the future for maternity and neonatal care to ensure that it will be safe, standardised, of high quality and offer an enhanced experienced and more choice to women and their families. This strategy has been broadly welcomed and I have no doubt it was enriched by the more than 1,300 voices which contribute to its development.

Starting with this strategy, 2016 was a landmark year for maternity services. In August I launched the HSE national standards for bereavement care following pregnancy loss and perinatal death and in December HIQA's national standards for safer and better maternity services were published. These developments, when taken together, represent key building blocks to facilitate the provision of a consistently safe and high quality maternity service.

The development and publication of the national maternity strategy demonstrates a new and enhanced focus in this country on maternity care at policy and service delivery level. I firmly believe that the strategy will fundamentally change how maternity care is delivered, improving the risk profile of the entire service in the process to the benefit of the approximately 80,000 families who access it every year. The proposed new model of maternity care set out in the strategy consists of three care pathways: supported, assisted and specialised. Such an approach means that every woman will be able to access the right level of care from the right professional at the right time and in the right place, based on her needs.

It recommends that services should be woman-centred and provide integrated team-based care. It aims to increase choice for women at a very special, individual and private time for them and their families, while also crucially ensuring that services are safe. The strategy outlines that a partnership approach should be taken, with women to be encouraged to maintain regular contact with maternity services throughout pregnancy and following birth and have access to all necessary information, all of which will be underpinned by the principle of informed consent.

Safety is the first and overriding principle. Integral to this are guidelines to assess and place women in the appropriate risk category which will ensure that their care is managed in line with best evidence. To this end, the strategy underlines that this new model of care will be underpinned by evidence-based guidelines which will provide the necessary patient safety assurances and help to ensure consistency and practice across the country. The national clinical effectiveness committee has commenced the development of a national clinical guideline in this regard.

The strategy also supports the implementation of the HIQA national standards for safer and better maternity services. The standards will provide a framework for maternity service providers to ensure that they are meeting the needs of women, their babies and their partners and that a consistent service is delivered across the country.

For most people, pregnancy and birth is a joyous life event. Sadly, however, many families suffer a pregnancy related bereavement. The strategy recognises the importance of improving and standardising bereavement care throughout maternity services. The HSE national standards for bereavement care following pregnancy loss and perinatal death will ensure that clinical and counselling services will be in place to support women and their families in all pregnancy loss situations from early diagnosis from early pregnancy loss to perinatal death, as well as situations where there is a diagnosis of foetal anomaly that may be life-limiting or fatal. I trust that they will ensure that all families who have the terrible experience of a pregnancy related bereavement will receive the care and compassion they need.

As I previously mentioned, a key pillar of the national maternity strategy is to ensure the safety of our services. Since December 2015, each maternity hospital has published a monthly maternity patient safety statement as recommended by the Chief Medical Officer in his 2014 report on perinatal deaths in Portlaoise. These statements contain information on metrics covering a range of clinical activities, major obstetric events, mode of delivery and clinical incidences. These statements are publicly available on the HSE website, ensuring transparency.

Now that a clear and comprehensive strategic and policy framework is in place, our intention must turn to implementation. To ensure that all of these plans translate into improved care and outcomes, we have put in place new structures which are dedicated to maternity care. To that end, the national women and infants health programme has been established within the HSE to lead the management, organisation and delivery of maternity, gynaecological and neonatal services, strengthening such services by bringing together work that is currently undertaken across primary, community and acute care.

The programme will also oversee the establishment of maternity networks in each hospital group, the development of which will strengthen the operational resilience of smaller units. This will result in a co-operative approach to service delivery which ensures that each hospital site within the network delivers care appropriate to the facilities and services available on that site. Any future development funding for maternity, gynaecological and neonatal services will now be ring-fenced and allocated through this programme. With its wide remit and dedicated expertise, it is envisaged that the programme will facilitate greater oversight and support for service providers and ensure the appropriate allocation and targeting of new resources.

The programme will draw up a detailed action plan that will inform the full implementation of the strategy. This work will include the identification of capital and revenue funding requirements which will, in turn, inform the annual Estimates process over the lifetime of the strategy. The implementation group has held its first meeting and I expect the action plan to be completed in the coming months.

In the interim, work to implement the strategy has already begun. In demonstration of the Government's commitment to the progressive development of maternity services, €3 million in development funding provided for majority services in 2016 was allocated in line with the strategy and included funding for additional staff, including 100 midwives, the development of specialist treatment teams and the implementation of the maternal and newborn clinical management system. Increased funding of €6.8 million has been provided for maternity services in 2017, which will allow for the continued implementation of the strategy.

While it must be noted that the growing maternity workforce and the falling number of births are giving rise to improved staff to birth ratios, the strategy acknowledges the need to increase further the maternity workforce. While the Private Members' motion points out that the overall number of obstetricians was one of the lowest in the OECD when last measured, significant recruitment has taken place since then. As of February 2017, a record number of obstetricians, that is 142 whole-time equivalents, were employed within our maternity services. This represents a rise of 25 since 2011 when the OECD data quoted in the motion was gathered, despite the decreasing number of births in the country since then. The Government is committed to building on this progress.

We have also increased the number of funded midwife posts, including the recruitment of an additional 100 midwives in 2016, the allocation of whom to individual maternity hospitals was informed by the needs identified by Birth Rate Plus, an evidence-based workforce planning tool. Currently, there are 1,583 whole-time equivalent midwives throughout the services. I have been assured that the maternity strategy will make Ireland a more attractive place for midwives to work.

During recent engagement between my Department, the Department of Public Expenditure and Reform, the HSE, the INMO and SIPTU nursing unions, agreement was reached on a number of specific measures to attract nursing and midwifery graduates back to Ireland and, indeed, to remain in Ireland. This commitment has put in place a funded workforce plan for nurses and midwives, including 1,208 additional posts, 96 of which are additional midwives to support the implementation of the maternity strategy.

I want to return to the issue of anomaly scans. While I accept that the provision of anomaly and dating scans is not uniform throughout the country, foetal anomaly scans are available in each hospital group. We are working and must work to improve this further. The national maternity strategy is very clear that all women must have equal access to standardised ultrasound services. This issue is a priority for the new programme, and as a first step clinical guidance on routine detailed scans at 20 weeks will be developed. In the meantime, the programme will work with the six hospital groups to increase access to anomaly scans for those units with limited availability.

In regard to co-location, the model of stand-alone maternity hospitals is not the norm internationally. Government policy is, therefore, to co-locate all remaining maternity hospitals with adult acute hospitals. Co-location of maternity services with adult services provides mothers with access to a full range of medical support. On 10 March, a planning application for the new national maternity hospital at St. Vincent's Healthcare Group was submitted to An Bord Pleanála. The remaining stand-alone maternity hospitals in the Coombe, the Rotunda and Limerick will relocate to the campuses of St. James's Hospital, Connolly Hospital and University Hospital Limerick, respectively.

Tri-location with paediatric services ensures immediate access to on-site paediatric services when foetal or neonatal surgery is required. The availability of these services will help to ensure the delivery of an optimum safe service, in particular for high-risk mothers.

I now want to deal specifically with the relocation of the National Maternity Hospital to St. Vincent's campus, an issue which I know has been the subject of serious public concern in the past few weeks and has highlighted the need for a broader conversation we discussed during Priority Questions earlier. I would like to make it very clear that in asking for time, my Department and I will work with both hospitals for reporting back to the Government and Oireachtas. We will use this time to pursue solutions that address the issue of the ownership of the facility that is the new national maternity hospital.

The need for the new hospital is beyond doubt and I respectfully ask the House that we use this time to work on the issues and arrive at a solution which can deliver it. While Holles Street has since 1894 served and continues to serve the women of Dublin, the building is no longer appropriate for our needs. When completed, the new state-of-the art national maternity hospital at the St. Vincent's campus will give physical expression to the national maternity strategy. I assure the House that the new hospital will have complete clinical, operational, financial and budgetary independence. I will report back to the House with further detail in the coming month.

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