Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Ceann Comhairle for allowing me the opportunity to raise this important issue. I have no wish to sound alarmist. The Minister of State is fully aware of the issue facing the Health Service Executive in trying to provide support for maternity services in view of the number of highly qualified midwives who have built up a wealth of experience over many years but who are retiring from the health services sector. As January draws to a close, we should know the full impact of the projected retirements up to 29 February this year. That is something that we do not have to wait too much longer for. We know that there will be fewer midwives working in the HSE in the months ahead. That in itself will create huge difficulties but coupled with the projected rise in the birth rate, this will put huge additional pressure on the maternity services in this country.

The director of the HSE's obstetrics and gynaecology programme, Professor Michael Turner, said on 18 January 2011 that staff reductions and cuts to the HSE maternity service programme could see an increase in Ireland's maternal and infant mortality rate. That is a very serious statement from a highly qualified eminent person. On 24 January 2012, consultant obstetrician Gerry Burke said, "Unfortunately some babies and women may pay for [this] with their lives".

I do not want to be alarmist but if there is a contingency plan in place it should be published in advance. The Government and the HSE should outline it quite clearly in order to allay everybody's concerns. I am not just talking about the concerns of pregnant mothers, but also the concerns of staff who are providing the front line services. Will they have enough colleagues in the event of pressure coming on the service after 1 March? The contingency plan should be published in the next few days, because at that stage, the Government will know how people will be retiring on 29 February.

The Government should not dismiss, as has been the case so far, the comments of eminent people who are at the coalface of health service delivery, and who have an in depth knowledge of the maternity services in this country. They are saying quite clearly that there is potential risk to life in the event of there being no contingency plan in place and no increase in the number of midwives available to the HSE in providing services after 29 February.

Róisín Shortall (Dublin North West, Labour)
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I thank Deputy Kelleher for raising this issue. It is a matter of concern and is receiving much attention at the moment. The Government is fully aware of the impact the early retirement package will have on the provision of all services nationally, including maternity services. Together with the HSE, we are committed to minimizing the impact through a range of strategies, including fast-tracking new innovative and more efficient ways of using available resources. Our priority is the safe delivery of care for patients. In this regard, the Minister for Health has requested the HSE to prioritise the ongoing delivery of safe patient services and to ensure that all necessary steps are taken to avoid risk in their delivery.

Planning for the delivery of health services is undertaken within the context of the annual national service planning process. This process ensures that all factors, such as budgets and staffing levels and any other emerging issues, including the impact of the retirements, are factored into the plan for the services to be delivered within the coming year.

In parallel with this process, each of the HSE's four regions is required to develop a more detailed regional service plan which translates the national goals and targets into service specific targets for the year. All of the regional plans are being developed on the basis of the anticipated number of staff that will be in post after the end of February. These plans are due to be finalized in early February. Managing the specific risks associated with the forthcoming retirements has been undertaken within this planning context.

During 2011, the HSE established a process to identify and record the number of staff expected to retire before the end of February 2012. This information has been updated on a regular basis as retirements become known. The HSE is now finalising the figures for the actual number of staff who will retire at the end of next month. However, it should be remembered that staff who have indicated that they wish to retire still have the possibility to change their minds. It is not possible, therefore, to provide definitive figures today. Subject to this consideration, the HSE's latest information, supplied today, shows that a national total of 34 midwives have indicated their intention to retire at the end of February 2012.

Contingency plans are being developed to cover any gaps that may arise in staffing as a result of these midwives retiring. These plans are at an advanced stage. The scope to replace the staff who will retire is in itself limited, so we need to adopt an innovative approach. Addressing the reduction in staff numbers as a result of these retirements, as well as the wider programme of reducing public sector numbers, requires more significant productivity increases as well as changes to organization structures and work practices.

The HSE is continuing to utilize the provisions of the Croke Park agreement as it seeks to change staff rosters, work practices and to redeploy staff. This will assist in minimising the service impact. Contingency plans to address the impact of the retirements include a focus on staff redeployment and streamlining and amalgamation of some management structures and services. The HSE will seek to deliver greater productivity through the national clinical programmes. These programmes are a key strategic support to the risk management process which is in place around these retirements. The related work of the special delivery unit will also be critical in supporting the achievement of overall resource management in the coming year.

A number of additional initiatives are set out in the HSE's national service plan that will assist in minimising the impact of the retirements on services. These include focused recruitment within the context of the cost containment plans and budgets for each service. Agency staff may be used where there is a critical requirement. The national service plan also makes provision for some conversion of agency costs into whole-time equivalent staff which will be explored in limited circumstances.

We are very much aware of the potential impact of the upcoming retirements. We have taken steps to ensure that the impact is minimized and that the safe delivery of services for patients is prioritized. I believe that with good planning and a co-operative approach by all, we can continue to ensure the best possible service for patients. I thank the Deputy for raising this matter.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister of State for her reply but I do not believe that the HSE has a contingency plan in place. A quarter of the total number of midwives in the Mid-Western Regional Maternity Hospital are leaving at the end of the month. Deputy O'Dea has raised these concerns on a number of occasions. The consultant obstetrician, Gerry Burke, has said that people could die. These are not outrageous comments. They are comments of concern coming from eminent people who are expressing the view that there is no contingency plan. He said that if there was such a plan, the HSE and the Government are not sharing it with anybody who should be involved in delivering a plan to make sure that we have safe delivery of babies in this country. It is incredible at this stage that the HSE has not got a contingency plan that it can show to the people. We are one month away from an exodus of the most experienced midwives in this country.

While I thank the Minister of State for her reply, I know that it is a reply that was scribbled together from the HSE contingency plans. There is no meat in it. It is basically a bland answer to fob me off. The bottom line is that the director of the HSE's obstetrics and gynaecology programme, Professor Michael Turner, and a consultant obstetrician, Gerry Burke, have clearly stated that this could cost lives. Accident and emergency and midwifery are the two key areas where we have to ensure that we have a competent number of staff in place at all times. We can deal with elective surgery and so on at another time, but we cannot have a deficit in key front line services when we wake up on 1 March and realise that a quarter of the total number of midwives have retired.

Róisín Shortall (Dublin North West, Labour)
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I am not attempting to fob the Deputy off at all. Nobody is under any illusion about the major challenges posed to many different public services, including the health service, following the retirements that will take place at the end of next month. Contrary to media reports that 40 midwives are due to leave a specific hospital, the figures available to me indicate the total number of midwives nationally who have indicated an intention to take retirement is 34.

The loss of midwives and many other critical front line staff poses a challenge. For this reason, as I indicated, work is under way, following on from the service plan process, to draw up regional service plans taking account of the retirements that have been indicated. Limited funding has been provided to backfill a number of posts, albeit not all of them, and work is under way to identify the posts that need to be filled. In addition, we will use the Croke Park agreement to its fullest to secure the flexibility and redeployment of staff promised under the agreement. This work is taking place as we speak and will continue until the end of February. Notwithstanding the challenges presented by the forthcoming retirements, we are hopeful we will be able to continue to provide a level of service that meets demand and guarantees the safety of patients. These are our priority concerns.