Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I welcome the opportunity to speak about our maternity services, to highlight the considerable progress made in recent years and the excellent work done by our front-line staff every day and night right across our maternity services and to outline the next steps we need to take.

Fianna Fáil will try to present this motion as some sort of policy development on its part. The reality is that it is a motion which reiterates Government policy; a Government that has actually prioritised maternity services, unlike when Fianna Fáil was on this side of the House. Fianna Fáil Governments, with all the bounty of a booming economy at their disposal during the Celtic tiger years, did not rebuild the National Maternity Hospital, Holles Street, the Coombe or the Rotunda. Nor did it set aside a single cent to do so under any capital plan. Fianna Fáil set up a HSE that did not have a women and infants health programme or a clinical director for such a programme. Fianna Fáil never had a national maternity strategy. It is quite remarkable and shocking that it was not until Fine Gael and Labour were in government and the current Taoiseach, Deputy Varadkar, was Minister for Health that we published the first ever national maternity strategy. When it came to holding a key referendum on women's reproductive rights and abortion last year, people like Deputy Lisa Chambers and others led on the issue but, sadly, 21 Fianna Fáil Deputies voted against allowing a referendum that would give women and the people of Ireland have their say. It is, therefore, difficult to trust that party when it comes to its newfound interest in maternity care, although that interest is welcome.

There has been a sustained and long-overdue focus on the development and improvement of our maternity services in recent years. Previously, these services did not receive the level of attention or investment they warranted, with deeply regrettable outcomes for women and babies in some instances, which Deputy Donnelly quite rightly outlined. These events are terrible for the women and families concerned and for the staff who work in our maternity services. We must always ensure that we care for them and learn from what happened.

At the same time, it is important to recognise that there are tens of thousands of positive, beautiful experiences across our maternity services every year. This care is delivered by exceptionally dedicated and talented people and I would like to put on the record that their work is very much recognised, appreciated and valued, not just by this Government and the Oireachtas but, most importantly, by the 80,000 women and families who access our maternity services in Ireland every year.

The national maternity strategy published in January 2016 maps out the future for maternity and neonatal care in Ireland. The aim of the strategy is to ensure that services will be safe, standardised, of high quality and offer an enhanced experience and more choice to women and their families. Together with the strategy, for the first time we also have HIQA’s national standards for safer better maternity services and the first ever bereavement care standards, providing the foundation on which we are building a service where women and their babies consistently receive safe, quality care, delivered with compassion and dignity.

With these developments, we are already well on the way to achieving the vision of the maternity strategy and I am pleased to outline the progress made to date for the benefit of the Deputies present. In 2017, the national women and infants health programme was established within our health service to lead the management, organisation and delivery of maternity, gynaecological and neonatal services across primary, community and acute care. The programme is charged with driving the implementation of the national maternity strategy. A priority for the programme, which is headed by Killian McGrane and Dr. Peter McKenna, since its establishment has been the safety and quality of the care provided to women and their babies, and considerable strides have been made to improve on these areas.

All 19 maternity units now publish maternity patient safety statements on a monthly basis, as recommended by the chief medical officer after the perinatal deaths in Portlaoise hospital. Directors of midwifery have been appointed in all but one hospital, providing crucial additional clinical governance, with recruitment at an advanced stage to fill one outstanding post. Quality and safety managers are being appointed to each hospital group, with several of those posts already in place and recruitment is ongoing for the remaining posts. Maternity specific serious incident management forums are being established across the hospital groups, with a number of these forums already operational. In addition, a maternity event review tool has been designed and is being trialled.

Significant progress has also been made in implementing the 35 recommendations outlined in the Walker report into maternity services at Portiuncula Hospital, about which Deputy Rabbitte spoke with such passion. I am happy to work with the Deputy on the issues she raised. As of March 2019, the implementation group confirmed that 95% of the recommendations were now complete or nearly completed, but of course we need to get that to 100%. All of these developments will help to ensure that our maternity services operate to the highest, safest standards and, crucially, that incidents and practices can be monitored and events escalated rapidly if the need arises.

The national maternity strategy recognises pregnancy and birth as a normal physiological process and rightly places priority on a woman’s choice. That is why significant efforts and resources have been invested in the expansion of midwife-led care, including the development of community midwifery teams. A total of 16 of the 19 maternity units now have a midwife-led, structured care pathway in place. A total of 15 are actively providing midwifery clinics off site where some are completely community based while many have a blended model of community and hospital-based care. The first alongside birth unit was opened in 2018 at University Maternity Hospital Limerick, adding to the centres already in operation in Drogheda and Cavan. Several units now also offer home-away-from-home services, providing midwife-led home-birth environments within the maternity hospital setting. I commend those midwives and doctors who have taken ownership of the strategy and who are championing it in their local services. Their hard work is ensuring that more women in our maternity services can avail of a wider choice of pregnancy and birthing experiences, as articulated in the strategy’s vision. It can no longer be doctor knows best; it has to be about the woman's choice and supporting her in that choice.

Another very significant service development is that of access to routine anomaly scanning, which is a very important issue. I have heard Deputies speak about this. The strategy is unambiguous about anomaly scanning, stipulating that all women must have equal access to standardised ultrasound services. Additional funding provided in 2018 facilitated approval for the recruitment of the 28 additional sonographers required to provide 100% access to such a service. To date, the targeted allocation of development funding has seen the number of hospitals and maternity units offering 100% access to 20-week anomaly scanning double, from seven in 2016 when I became the Minister for Health to 14 in 2019. It is envisaged that all 19 maternity units will offer 100% access to anomaly scanning by the end of this year. I know that all sides of the House agree this is a very significant improvement and an important development.

Spending on our maternity services has significantly increased over the last number of years. Development funding provided to date has been used to increase capacity through the recruitment of additional midwives, consultants, theatre staff, ultrasonographers and quality and safety managers. Since the strategy was launched there has been a significant increase in the numbers of clinical staff working in our maternity services, including 22 more wholetime equivalent, WTE, consultants and 165 more WTE nurse midwives compared with December 2015. This is 22 more consultants and 165 more midwives working in our maternity services over the last four years. When the birth rate is taken into account, we now have an improved staff to birth ratio in Ireland.

Deputies will be aware of the very significant investment the State is making in the new national maternity hospital at the St. Vincent’s University Hospital campus. This will be the single largest investment in maternity services ever made in the history of the State.

It is Government policy to co-locate all remaining maternity hospitals with adult acute services in order to provide optimal clinical outcomes for women and their babies. To that end the national development plan provides funding for the infrastructure to support implementation of the maternity strategy. Let me be clear, it is Government policy is to co-locate all remaining maternity hospitals with adult acute services in order to provide optimal clinical outcomes for women and their babies. To that end, the national development plan provides funding for the infrastructure to support implementation of the maternity strategy. Our development plan provides the funding to rebuild all four of these stand-alone maternity hospitals. This will facilitate the provision of an appropriate environment within all our maternity hospitals and units to enable the delivery of a modern, safe, quality service where the woman's need for privacy and dignity is respected. The Department is engaging with the National Maternity Hospital, Holles Street and St. Vincent's Healthcare Group to develop a legal framework to protect the State's significant investment in the new facility. While I note Deputy Donnelly's comments on the timeline for this, I also note his party Leader's parliamentary questions quite rightly asking that we get this legal framework right and protect the interests of the State and protect important ethical matters so that we can get this right for the women of Ireland and we are going to do that. It should also be noted that work commenced in February 2019 on the new pharmacy and the extension to the car park, which represents the first phase of the new national maternity hospital. Those works are under way on the site of St. Vincent's Hospital.

The value we place on the voice of the women who use our maternity services is central to that ongoing change taking place. The national maternity strategy is all the better for the 1,300 of such voices who were heard in its development. This was not a strategy written by a Department. It had the voices of 1,300 women who had used our maternity services, as well as the service user representatives on the strategy's steering group. We are continuing to listen and a national maternity care experience survey is being developed for launch in the first quarter of next year. We will extend the patient experience survey to the maternity hospitals. This will build on the success of the national patient experience survey and help inform the design and delivery of maternity services into the future. I reiterate my commitment to implementing the actions set out in the national maternity strategy and the Department will continue to support the national women and infants health programme in achieving those objectives during the remainder of 2019 and beyond.

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