Mick Wallace (Wexford, Independent)
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I understand the Health Service Executive was due to deliver a report to Government last night setting out is proposals for achieving the required saving of more than €660 million next year. I also understand that the Department of Public Expenditure and Reform and the Department of the Taoiseach will be involved in assessing those proposals. The plan comes in the wake of a recent report by the OECD, entitled Health at a Glance 2013: OECD Indicators, which notes that Ireland has a low ratio of doctors to population and one of the lowest levels of gynaecologists and obstetricians per 100,000 women in the OECD area.

Ireland has a legacy of under-staffing in maternity care, with a 2008 study of staffing levels in the greater Dublin area identifying a shortfall of 221 midwives, 20 neonatal nurses and 35 theatre staff.

Hence, there was a shortage of maternity staff, even during the good economic times, but the situation has significantly worsened since the beginning of the economic crisis. Dr. Peter Boylan, clinical director of the National Maternity Hospital, has stated that Ireland is approximately 30% short of internationally recommended maternity staff levels.

Following numerous inquiries into the tragic death of Savita Halappanavar last year, including a HIQA report which noted the three vacancies at University Hospital, Galway that remained unfilled owing to the moratorium on hiring staff, it is obvious that funding cuts and recruitment embargoes in the name of austerity are having detrimental effects on people's lives. Other reports, including the report into the death of Tania McCabe, already highlighted issues in maternity staffing levels as far back as 2007. However, despite inquiries, reports and recommendations, nothing has been done. Instead, the Government's policies seem to be making the situation worse.

I note the Minister for Health has said that it is not about overall numbers but the type of staff in place. I remind the Minister that if a football team has nine players and has to deal with what comes its way, there is no point in saying they can deal as well as otherwise without the required number or if they are short. The Minister also made the point that patient safety is the responsibility of the chief executive of any hospital or hospital group. Let us suppose I put it to a restaurant manager that we are going to save some money and I am going to take away a chef and a commis chef, but I want the manager to ensure that none of the customers is waiting on their food and that they all go away happy. In fairness to the manager, it would be difficult for him to deliver if he does not have the resources to do so. It is well to say that the responsibility is with the manager to make it happen but if we cut resources and tell the manager that he can make this happen with less, then it must be challenging for that manager. Given the HIQA report in October, will the Minister of State outline whether the Department will increase the numbers of staff and consultants in maternity hospitals? Is that part of the Government's plan?

Alex White (Dublin South, Labour)
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The director general of the HSE forwarded the 2014 service plan to the Department of Health late yesterday evening. In accordance with the Health Act 2004, as amended, the Minister for Health has a period of 21 days from the date of receipt of the plan to either approve the plan or to seek amendments to it in consultation with the Minister for Children and Youth Affairs.

The question of amending the plan might arise if, for example, the Minister was of the view that the plan did not contain the required information, did not have sufficient regard to previous directions issued or did not accord with the policies and objectives of the Minister for Health, the Minister for Children and Youth Affairs or the Government. The Minister for Health must make a decision in respect of the plan by Monday,16 December next. When approved, the plan must be laid before both Houses of the Oireachtas by the Minister for Health and published as soon as possible thereafter by the HSE. Until such time as the Minister for Health, Deputy Reilly, has had an opportunity to give detailed consideration to the plan, as he is required to do by statute, it would not be appropriate for me to publicly discuss either the broad contents of the plan or to detail any of its specific provisions. However, the HSE was made fully aware when drafting the 2014 plan that the over-riding national service plan priority is, first and foremost, patient safety and treating patients in as timely a manner as possible.

I assure the Deputy that the matter of any necessary patient-centred improvements in maternity care arising from the Health Service Executive and HIQA reports into the Savita Halappanavar tragedy will be prioritised in this regard. We are determined that as a consequence of the sad loss of this young woman our entire health system will learn profound lessons which will ensure that safer more patient-centred maternity care is provided. Naturally, the Minister has accepted the HIQA's recommendation that, as a priority, maternity services should be reviewed and that a national maternity services strategy should be developed and implemented.

I wish to inform the House that maternity services policy will be part of an overarching policy framework to be put in place for hospital groups. The maternity strategy will be developed by the Department in collaboration with the HSE and its national clinical programmes in obstetrics and gynaecology. The development of the strategy will build on the work already undertaken as part of the comprehensive review of maternity and gynaecology services in the greater Dublin area, resulting in the KPMG report, which was itself informed by an international analysis of maternity and gynaecology service configurations. The strategy will address issues, including the issue of appropriate maternity services staffing, as raised by the Deputy, and will recommend best practice models of care for maternity services in future.

Mick Wallace (Wexford, Independent)
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I can only hope that the issue will be addressed in a positive manner. We are all wondering what sort of scheme the Government can come up with and how it can save so much money yet still provide adequate care. Perhaps there are some surprises for us. It will be interesting when we see it.

I note that the HSE national director of quality and patient safety, Dr. Philip Crowley, has said that it is well recognised that "if you have adequate staffing levels in terms of midwives and consultants we can provide a more consultant-led service" but that we do not have the numbers to do so currently. The OECD report, to which we referred, rather optimistically states "countries can make further gains in patient safety, thereby reducing costs and health burdens associated with adverse events". However, health spending continues to fall in Ireland and the reduction here was the second most dramatic of all countries in Europe since the economic crisis started. Only Greece has reduced its spending on health more than Ireland. I will not prejudge what the Government does but I hope maternity care is considered in a favourable manner by the Government.

Alex White (Dublin South, Labour)
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The Deputy make the point well. He has raised this issue before. What I said in my reply stands. A maternity strategy will be developed. As I indicated in my concluding remarks, the strategy will address issues, including the issue of appropriate maternity services staffing, and recommend best practice models of care for maternity services in future. That is the position.

The service plan was only furnished to the Minister late yesterday evening. He has three weeks to deal with it. However, I take seriously the observations the Deputy has raised. I am sure the Minister will respond to him as soon as possible following his consideration of the service plan.