Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

Okay. I thank Deputy Connolly for tabling the motion on maternity care. The Government will be supporting the motion. Women’s healthcare has never been prioritised as it should be in this country. It has never been invested in as it must be. Our maternity hospitals are not fit for purpose. We are reported as having the lowest rate of breastfeeding in Europe. There is insufficient choice for pregnant women in terms of midwifery-led care, community-based care and birthing options. Mental health supports are insufficient, including in identified critical areas such as eating disorders for girls and younger women. IVF supports are not good enough. Support and promotion of physical activity at all age groups is behind where it needs to be. A national conversation on menopause is speaking volumes for what has not been done for women’s health and well-being. Gynaecology waiting lists are unacceptably long. Conditions like endometriosis have been largely ignored. This list goes on and on. We have incredible people working in women’s healthcare, in community and hospital settings, and in maternity, gynaecology, mental health, oncology, screening, well-being and in many more areas. However, we need more of them and they need a lot more resources to provide the services that are required.

Women’s healthcare is a top health priority for me and for this Government. That means extra resources, more services, quicker access, more choice and appropriate facilities. It means an approach informed by national strategies, including the national maternity strategy, and one in which women’s voices are central, including the essential work of the women’s health task force. The under-investment in maternity services, along with many other areas of the health service that cater for the well-being of women, has led in some instances to regrettable and tragic outcomes for women and babies. These events continue to be deeply traumatic for the women and families concerned, and I hope we will all bear them in our thoughts today as we discuss this motion.

The national maternity strategy is a central part of that learning process for improving women's healthcare. Its publication in 2016, mapping out the future for maternity and neonatal care in Ireland, was widely welcomed. Delivering on the strategy’s vision of services that are safe, standardised, of high quality, with enhanced experience and more choice of care for women is the reason its full implementation is so important. It is also essential to ensuring that dignity and respect are at the forefront when we develop and deliver our services. Progress has been made to move us towards that goal and we have already seen developments in how maternity care is delivered. There has been a marked increase in the number of consultants, midwives and allied health professionals, with more than 330 whole-time equivalent posts funded under the strategy. Services have been made safer through the recruitment of maternity-specific quality and safety managers in each hospital group, the mandatory publication of maternity safety statements, and the establishment of serious incident management forums. Investment in scanning services has enabled maternity units and hospitals to now offer all women a routine anatomy scan. Midwifery services are increasingly available in community settings, and early transfer home services continue to be established. Each of our 19 maternity units and hospitals now have bereavement teams with clinical midwifery specialists, along with lactation consultants, recruited to each site.

However, I must also acknowledge that there is significantly more that needs to be done. This is why we have renewed our commitment to the strategy’s implementation in the programme for Government. This year we have invested more in the development of our maternity services, and in women’s healthcare in general, than ever before in a single year. Budget 2021 saw increased allocations of development funding for maternity and gynaecology services to the tune of €12 million. The funding allocated specifically for the implementation of the national maternity strategy is €7.3 million; that is the biggest investment in the strategy since it was launched. To put it in context, it is a one-year increase in the strategy of around 500%. I have also spoken with the chair of the HSE’s board about regular monitoring of the implementation of these national strategies to ensure this investment is translated into the much-needed service improvements. This will significantly enhance our ability to deliver on its vision and to improve the experiences of the women and families accessing maternity care. Specifically, the funding provided in 2021 will help underpin the further development of community midwifery as well as specialist services. In addition to this, €5 million has been allocated to the women’s health fund.

A number of significant initiatives in relation to gynaecology services are also being advanced. These include establishing or expanding services across nine see and treat ambulatory gynaecology clinics in 2021 and additional fertility hubs. We are establishing and expanding services across nine gynaecology clinics in 2021 in Dublin, Drogheda, Waterford, Wexford, Letterkenny, Portlaoise and counties Kerry and Mayo. It is estimated that approximately 70% of general gynaecology referrals are suitable for management in the ambulatory setting. This would include conditions such as abnormal uterine bleeding and chronic pelvic pain. In addition, care available in the ambulatory setting could encompass common investigations such as pelvic ultrasound, and diagnostic hysteroscopy as well as minor procedures, including cervical and endometrial polypectomy, and intrauterine device insertion, removal and replacement. We are establishing two new regional fertility hubs in Nenagh General Hospital and Galway this year, bringing the total number to six, one for each of our six hospital groups. The budget for this year also provided for a dedicated multi-annual €5 million women’s health fund to implement a programme of actions arising from the very positive work of the women’s health task force.

I recently announced the expansion of the endometriosis service at Tallaght University Hospital. This investment will help to deliver a much-needed specialist centre for the management and treatment of all forms of endometriosis, with particular focus on advanced and complex cases, treatment for which has not been readily accessible in Ireland. I was delighted to receive a proposal from the Irish College of General Practitioners for a clinical general practice lead for women’s health and recently announced funding for this position. This will enable the development of a range of new educational and support services for GPs to enhance women’s health services in their practices. I also recently announced further funding to the HSE of approximately €1.6 million to fund 24 additional lactation consultants, providing increased breastfeeding supports to every maternity unit in the country. To date, the HSE already has 30.5 whole-time equivalent lactation consultants.

My Department is progressing a range of actions on menopause. Initiatives that are being advanced include a menopause workplace policy, provision of specialist support in the area of menopause and a health awareness campaign to increase visibility and awareness of menopause. More work can be done in that area.

Returning to our maternity services, I will reference HIQA’s 2020 monitoring report. It is important to note that the report shows that there have been positive developments in maternity services and that HIQA found high levels of compliance against most of the national standards. The HSE’s national women and infants health programme has been working on a revised implementation plan for the national maternity strategy, based on HIQA’s recommendations. I hope that speaks directly to the points Deputy Connolly raised. The revised implementation plan will set out the actions required to fully implement the strategy and will also reflect developments since it was published. In addition, the implementation plan will set out funding required each year to achieve the targets so that these can be considered as part of the annual Estimates processes. I agree wholeheartedly that multi-annual funding and a level of forward planning by the people involved in developing and rolling out the strategy are needed.

As referenced in the motion, the HSE is also preparing a plan in response to the other recommendations of the HIQA report, which included responding to infrastructural deficits identified across a number of maternity services. Last year, as recommended in the strategy, we saw the roll-out of the very first national maternity experience survey. Thousands of women across the country had the opportunity to tell us about their experiences. I was particularly glad to see from the survey results that many women have had very positive experiences. It is important that we recognise what we are doing well and then seek to expand those practices right across the system. It is also essential that we recognise some women did not have a positive experience and we must learn from that.

The Government is committed to the development of a new national maternity hospital on the St. Vincent’s campus. The project is unprecedented and complex. We are relocating one voluntary hospital to the campus of another voluntary hospital and into a hospital building owned by the State. A legal framework is being developed to protect the State's investment in the new hospital and ensure that it remains in State ownership. The legal framework will also ensure that health services at the new hospital will be provided without religious, ethnic or other distinction. I know I am out of time but I ask the Chair to bear with for a few seconds. I want to state categorically something I previously stated at a meeting of the Joint Committee on Health and stated again yesterday when I met the National Women's Council of Ireland and others who have been involved in campaigning for these services. I will not countenance any new maternity hospital that has any governance or influence whatsoever involving any religious ethos. That is an absolute commitment. Services will be provided in accordance with the law and national policies. That is all.

There is much work to be done to ensure girls and women in Ireland have access to the healthcare and well-being services they need. Good and steady progress has been made in the past year. The task now is to increase this progress, grow services, make the experience better and better and improve access for all.

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