Alan Kelly (Tipperary, Labour) | Oireachtas source

The Minister and I have spoken at length on this topic many times. When it comes to various different areas of health and all the strategies that are continuously put forward, this is pound for pound the best strategy that has been published in any area in healthcare. It is one of the best strategies I have seen written down and it is very comprehensive. The Minister will see it is about the implementation of the strategy and that is the real reason we are talking here tonight. It talks so much about providing a safe, high quality service that meets all women's needs. It states that women should be, "Placed at the centre of all services, and are treated with dignity, respect and compassion; parents are supported before, during and after the pregnancy." The strategy states that there are four strategic priorities, which are worth reading. Those priorities are as follows:

1. A Health and Wellbeing approach is adopted to ensure the babies get the best start in life. Mothers and families are supported and empowered to improve their own health and wellbeing;

2. Women have access to safe, high quality, nationally consistent [which is a critical phrase], woman-centred maternity care;

3. Pregnancy and birth is recognised as a normal physiological process, and insofar as it is safe to do so, a woman’s choice is facilitated [which brings us back to the community services];

4. Maternity services are appropriately resourced, underpinned by strong and effective leadership, management and governance arrangements, and delivered by a skilled and competent workforce, in partnership with women.

Those four points encapsulate this whole debate and everything we have heard here tonight because, along with that, we have a situation - a previous speaker made reference to a specific case of this - where for various different reasons, pregnancies are becoming more complex.

While there are better survival rates and more babies are being born, statistics show there are far more caesarean sections than 20 or 30 years ago, the proportion of low birth weight babies and pre-term births is increasing and breastfeeding rates remain low. There are a number of new challenges. The service needs to be continuously resourced but also changed. When children come along, it is an opportunity for many women and families to change life choices. The broader issue needs to be addressed.

The strategy is essential and needs to be supported. I wish to put a number of issues and questions to the Minister in respect of where we are after three years. It is a ten-year plan and we are three years into it. I have spoken to many people in the area and all of them feel the service is severely underfunded. They feel that how it has been treated is in some ways tokenistic and that they have been let down because of overruns on various capital and current issues. The lack of a task force to implement the service in a detailed way needs to be addressed. People are shouting from the rooftops about the need for something like that with teeth to push the Minister and whoever replaces him - if somebody replaces him in the coming years. The requirement for multi-annual funding to ensure that the services can be provided is obvious. According to the Department's figures, the funding provided directly for the implementation of the plan - €4 million - is very low. Have the positions that need to be filled even to start the process of implementation and keep it going been filled? It has been repeatedly said to me that no new developments in the future funding have recently been announced. There are 77 recommendations, all of which are important, in a range of areas I outlined, to fulfil the objectives of the strategy but there is no way they will be implemented within the ten-year timeframe because we are already well behind. We need to ring-fence funding, catch up and ensure we can provide the services in the future, with the required human resources.

Much has been said about staffing issues. I am not sure the Minister or the Government understands the situation. There is a serious issue with the number of obstetricians, midwives and a whole range of other disciplines. The report on the strategy stated the number of consultant obstetricians would be doubled within ten years but that will not happen. The requirement was to hire a range of midwives in various parts of the country but that will not happen. In diagnostics, specialist personnel are required to read the various diagnostic equipment, which evolves all the time, but that simply will not happen. Although I fully accept the Minister's bona fides in respect of wanting to provide diagnostic services throughout the country, it simply will not happen, or at least not at the pace required. That is discriminatory because one should have access to the same services throughout the country, as has been raised with me a considerable number of times.

I have a concern about perinatal services, which I have raised with the Minister numerous times. It is a hobby horse of mine. I have seen various reports and figures on issues of mental health for women who are pregnant, or in post-pregnancy or pre-pregnancy. The lack of services, particularly in psychiatry, is a real issue and an area where there is deep concern. I know this because it has been raised with me. Which hospitals in the country have the best services, the highest rate of services and the greatest range of services? The Minister might revert to the House with a response. In diagnostics, which hospitals have the highest rate of neonatal brain injury? While the Minister may not have those figures on hand, he might follow up with them later.

I come from the mid-west. A new hospital is required in Limerick and is provided for in the strategy. I have raised directly with the Minister that €5 million is required for the design of the hospital. If the €5 million cannot be found, no hospital will be built any time soon. The Minister cannot find the €5 million, however, and we are a year behind. I was born in the hospital, as were my brother and children. The staff operating in that building are amazing, incredible people but the services need to be moved to the university hospital.

I am glad previous speakers mentioned the new national maternity hospital. Two years ago, when the issue blew up, there was a notification from the Sisters of Charity that the relationship would change and that the hospital's ownership would be transferred from a charity to a company. On the charities register of the Charities Regulator, however, where is the company? I have a specific question for the Minister and I need a direct answer tonight. What organisation, company or charity - whichever phrase the Minister wants to use - currently exists, on 19 June 2019? How and where is it registered for the transfer of the ownership we were told about two years ago?

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