Joan Collins (Dublin South Central, Independents 4 Change) | Oireachtas source

I thank Deputy Connolly for bringing forward this motion and allowing for an urgent and timely discussion on the national maternity strategy. I also thank Ms Beibhinn O'Connor and Ms Rachel Hynes for the work they have put into this motion.

I listened to what the Minister said. While HIQA made the point that there has been some progress, an awful lot of issues still have not been progressed. That is why this motion was put down, calling for an annual report and plan, and for that annual plan to be brought back to the Dáil for reasons of transparency and accountability. We must accept that the national maternity strategy was initiated in 2016 with a ten-year implementation timescale. It followed a number of baby deaths in the Midland Regional Hospital in Portlaoise and the death of pregnant mother, Ms Savita Halappanavar, in Galway University Hospital. We know a public consultation process was undertaken with 1,300 responses. Of those, 25% described maternity services as poor in terms of quality and safety. Has that changed? When will we see quantitative and reported change in that regard?

Specific concerns expressed in that public consultation process included a lack of support for breastfeeding; limited care options; lack of choice; an overly medicalised approach, especially to women at low risk; overcrowding; poor staff; and waiting times in both pre- and post-natal clinics. Years of underfunding and staff shortages have resulted in a service with serious deficiencies in a country with one of the highest birth rates in Europe. Does the Minister think we have reached the point when those deficiencies will not be reported any more? Are we reaching that point? When will those deficiencies no longer be reported? When will the plan be implemented?

All of the concerns expressed by pregnant women were confirmed in a report on maternity services across the 19 maternity hospitals for HIQA. Only one in four of those hospitals offered natal well-being scans or ulatrasounds. It is not all bad, as we know from the HIQA report. Some services were described as "excellent". Those included the domino scheme in the national maternity hospital, evidence-based practice in the Coombe, caesarean births in Limerick and home birth services in Cork, among others. However, if one lives in a more rural area, major geographical inequality still exists. Are those inequalities still there? Where are we on that? Can we have a report outlining what has been done and where we are leading to in the next five years? Units are under-staffed, infrastructure is inadequate, some care options depend on ability to pay and community midwifery is limited. Have those things changed? Where are we at in that regard? A physical report should be given to the Dáil and public representatives on those matters. There are limited mental health services for post-natal depression. In fact, such services are practically non-existent. We have one of the lowest levels of breastfeeding in the world. Where are we at on that? What has been put in place and what will be put in place in the future?

More than 60,000 babies are born every year in Ireland. The overwhelming majority are born with no problems, due to the commitment of front-line staff who work long shifts in difficult conditions. Can we have a report and accountable update of where those services are at and what jobs have been put in place?

Five years after the conception of the national maternity strategy, it has not been implemented the way it should have been. Parts of Sláintecare are still gathering dust on a shelf in the Department of Health. The question of choice in these services comes up again and again. Another issue around choice is the choice to terminate a crisis pregnancy. According to the National Women's Council of Ireland, only one in ten GPs and half of maternity hospitals are offering abortion services. Three years after the repeal of the eighth amendment, one woman is going to the UK every day for a termination. These are difficulties, in particular, for migrants and the Traveller community. A patient needs a PPS number and Irish address to avail of the service. The upcoming review must deal with these problems if the will of the majority who voted in the referendum is to be respected.

The Minister referred to reports in his reply. Can we see a report from the HSE about what point we are at in our implementation of the national maternity strategy? What is the plan for implementing the rest of the strategy over the next five years? Where do we have to go from here?

The location of the national maternity hospital is mentioned in the national maternity strategy. Guarantees were given that the national maternity hospital would be on the basis of co-location with St. Vincent's hospital, would be built on State land and would be 100% owned by the State. Guarantees from then Taoiseach, Deputy Varadkar, and then Minister for Health, Deputy Harris, and more recent announcements from the Taoiseach, Deputy Micheál Martin, and the current Minister for Health, Deputy Donnelly, to the effect that the national maternity hospital will not have a Catholic ethos and all that implies, do not correspond with the facts. That is not happening at the moment. The reality is that the national maternity hospital will be built on land owned by the St. Vincent's Hospital Group, which will lease the land to the State on a 99-year lease. That is what we have seen. St. Vincent's Hospital Group was established by the Religious Sisters of Charity, a Catholic institution, effectively to maintain a Catholic ethos. This is now common practice as numbers in the religious orders decline in order to protect their property and the Catholic ethos into the future.

This was done by religious orders elsewhere. It has been done by the Sisters of Charity here. The State has conceded on the issue of co-location. It has conceded on the issue of building on State land. With an estimated build cost of €500 million, plus another €500 million to equip the hospital, the State will build a €1 billion facility that it will not effectively own. That is the current situation.

We ask the Government to outline how it has stepped in and stated that that is not going to happen. I note the Minister stated that the hospital will not have a Catholic ethos, but what mechanism is the Government employing to ensure that will not happen? We are not seeing it at the moment and we are yet to be advised on that point. It is delusion to believe that an agreement can be reached on the issue of the ethos of the hospital. It is delusion to believe that the new national maternity hospital will be the only Catholic-owned hospital in the world to allow sterilisation, IVF and abortion procedures. What is the Government going to do to ensure that does not happen?

The new national maternity hospital must be a public hospital built on public land, run publicly by the State. The situation shows the absurdity of trying to build a modern public healthcare system within the limits of a system that has never moved beyond the Victorian model of healthcare as an act of charity provided by religious institutions. It has huge implications for Sláintecare, if ever there was a real commitment to its implementation, as envisioned by all parties in their support for it.

I will finish on a note from Dr. Peter Boylan who said that the bottom line is the HSE must not approve the transfer of St. Vincent's Hospital Group to St. Vincent's Holdings for two reasons, first, that the national maternity hospital would be owned by St. Vincent's Holdings, the successor to the Sisters of Charity, with the same Catholic core values and that women's reproductive health would not be served by this and, second, that the State would be acquiescing to the ownership of a large, publicly-funded hospital group by a private company on privately-owned land with all the implications that has for Sláintecare.

I note the Minister's comments. However, we want to know what is being done to avoid the situation that we have seen publically. The St. Vincent's Healthcare Group, SVHG, has clearly set itself up. Co-location is not happening. The SVHG wants to integrate the new national maternity hospital into ethos and services of its own hospital. We are meeting with the Minister on Thursday, 17 June. Perhaps he can set out clearly at that meeting what the Government has done to date. Perhaps he could clarify if the Government has bought the land, if it has procured the land through a compulsory purchase order and if it has instructed the Sisters of Charity that they, and their Catholic ethos, will not have a role to play in the public hospital.

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