Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I will take seven or eight minutes or thereabouts.

We welcome the opportunity to speak on the proposed move of the national maternity hospital to the St. Vincent's health care group in Elm Park, which has been generating headlines for the last couple of weeks. This has stimulated a broader debate our society must have about the ownership of our health facilities and the ethos within them. It is something we must address in the short, medium and longer terms. I understand fully that divestment might have huge cost implications, but we must set in train a process whereby capital investment by the State in health facilities is retained in the ownership of the State itself while within hospitals owned by the State, there is clinical, ethical and medical independence free from any religious ethos. That is the broader issue that has to be addressed in the longer term. It will have huge cost implications and it should be approached in partnership. We did it very effectively in Cork with the Erinville, St. Finbarr's and Bon Secours maternity hospitals, which had a Catholic ethos. They amalgamated with the establishment of the maternity hospital at CUH, which is a State-owned facility run according to the laws of the land. These things can be done with imagination and a willingness on everybody's part to engage in a meaningful way. In Dublin the maternity hospitals at Holles Street, the Rotunda and the Coombe are all voluntary. These three voluntary maternity hospitals cater for approximately 27,000 to 28,000 births annually. We must not lose sight of where we are in terms of the State's provision of capital and current investment while these hospitals are retained in a voluntary capacity.

There are broader issues to address here. On the national maternity hospital itself, we can come here and be very critical. The Minister probably deserves an element of criticism. However, we have to address the problems that are there now. Everybody accepts that we need to move the national maternity hospital to St. Vincent's. If that move fails, there will not be too many other hospitals on the south side of Dublin which could accommodate the national maternity hospital. The best clinical outcomes are where there is co-location with an adult teaching hospital and St. Vincent's fits that bill in the context of the clinical supports available there. What is fundamental is that there can be no interference in medical or ethical oversight by anybody. The laws of the State must be sacrosanct in the context of what happens within the national maternity hospital and the problems that may flow from that hospital to St. Vincent's itself. We have to be very conscious of the latter point also. We must look at that. The Kieran Mulvey report is not a legal agreement, but is rather a document which perhaps contains many compromises to get people off difficult hooks. However, the Minister's obligation and our obligation as legislators is to ensure that investment in a capital project allows the State to have a charge on it or, hopefully, ownership where that can be achieved. The other area that must be looked at is to bring certainty and clarity to the issue of medical, ethical and financial independence and oversight.

Over the last number of days there has been a great debate with an exchange of views from the present and former masters of the national maternity hospital. The national maternity strategy has outlined in detail for some time the plans ahead for maternity services nationally. I hope we can address this to the satisfaction of everybody and, more importantly, ensure there is a move and that women in Dublin have a proper maternity hospital with the proper infrastructure and medical services available. I hope the month the Minister has requested bears fruit in that regard. I urge him to use whatever means are necessary to progress the matter. People have referred to CPOs and the like but, as I said earlier, it is a long time since we passed a Bill of attainder, picked out a group of people and seized their assets. We have to work within the Constitution and the law. As such the Minister must embrace this month, as must other actors, because the public needs to see certainty around the investment from the State and medical and ethical oversight.

On the broader issue of maternity services generally, we must accept, looking at the OECD figures, that we are falling very far behind in the number of obstetricians per capitahere. In fact, we have approximately half the number of obstetricians we require which, in itself, is a sad indictment of the fact that our maternity service, while comparable in terms of outcomes, involves the cutting of corners because of the huge pressure and stress on our maternity hospitals. That is a given. It is only the fact that we have wonderful midwives, consultants and other medical professionals that keeps this whole maternity service afloat. We must accept that if we do not do something quickly on investment in personnel, we will have further difficulties in the years to come. We see that where there are problems with staff, staff training and pressures on staff, there can be catastrophic adverse outcomes as incidents in certain maternity hospitals in this country in recent times have shown. We must accept that there is a great deal of work to be done. While we acknowledge the maternity strategy itself, there is a short-term issue around fetal anomaly scans and access to ultrasound. Unfortunately, this is a regional issue. While in Dublin one can access an anomaly scan, that is not the norm in other parts of the country. It is something that must be addressed very quickly because every woman should be entitled to a scan where required. The idea that one has to prioritise and assess risk to provide a scan is not acceptable. We must invest in ultrasound and the personnel required to operate that service.

A number of motions were tabled. There was a complaint about prayers in this place today, but one would nearly need divine inspiration to work out the amendments to the amendments. Sinn Féin has tabled the motion and we welcome the debate on it. Fianna Fáil has tabled an amendment but in the context of working together to ensure there is unity of purpose in advocating for maternity services, we will certainly accommodate Sinn Féin's motion in circumstances where there has been an inclusion of the ownership issue. We have to be clear, however. While we want to see the hospital in public ownership, I accept that may not be possible for many reasons. The last thing I want to do is leave this place this year or the year after with the whole deal having unravelled. That would leave us in a position where 8,000 to 10,000 births per year continue to be delivered in Holles Street because people would not compromise or come to the table to agree a solution. I urge the Minister to use everybody and every means at his disposal to bring this to a conclusion for everybody's sake, primarily women in Dublin who have been giving birth in a substandard infrastructure in Holles Street. Were it not for the staff working there, we would have had many more serious outcomes. That has been seen in the last couple of days with the difficulties in the absence of co-location.

For all these reasons I ask the Minister to use the month wisely, and perhaps in future when announcements are made have all the t's crossed and the i's dotted before the fanfare is unfurled, because it creates difficulties in trying to bring these issues to finality.

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