Jonathan O'Brien (Cork North Central, Sinn Fein)
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The Minister of State, Deputy Kathleen Lynch, may have seen the article on the front page of the Evening Echo yesterday, which was very worrying for any expectant mothers in the southern region. I do not propose to indulge in scare-mongering about a crisis or safety issues in our maternity hospitals. I tabled this Topical Issue matter to allow the Government to outline its plans in the wake of the recent report and to give some reassurance to expectant mothers. I wish to give the Government an opportunity to outline exactly what steps it will be taking.

Having read yesterday's report, the Minister of State will know all the facts. The Irish Nurses and Midwives Organisation estimates it will take about 550 posts to be filled to bring the 19 maternity hospitals up to the international best standard for the birth rate, which is one midwife to 29.5 births.

The current national average ratio in the 19 hospitals stands at one midwife to 38 births while the figure in Cork University Maternity Hospital is one midwife to 37 births. The ratio ranges from one midwife to 30 births to one midwife to 55 births. This is a very worrying statistic as is the information that none of the 19 maternity hospitals is operating under what is known as the international best practice ratio of one midwife to 29.5 births. It is also worrying to consider that Liam Doran recently stated that even if all the posts were advertised in the morning, in his estimation it would take five to six years to fill all those posts with experienced registered midwives.

The HSE has given a commitment to undertake a national examination as a result of the report on the 19 maternity hospitals. I ask the Minister of State to outline how the Government intends to reassure expectant mothers.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this matter. As parents ourselves we are very conscious that delivering a baby is the most vulnerable time in any woman's life and the most anxious time for any family.

I refer to recent incidents which took place in Portlaoise and we should also extend our sympathies to people who have lost much longed-for babies. We all feel that loss.

With regard to the issue raised by the Deputy, I wish to make it clear that there is no embargo on the recruitment of midwives or other front-line staff in the public health service. While the numbers employed across the public health service must be reduced in order to meet fiscal and budgetary targets, it is recognised that certain services such as maternity are demand-led and require specialist staffing. The HSE has arrangements in place to allow the recruitment of such staff where it has been established that there is an urgent service requirement. I am satisfied that it is open to the HSE to recruit the levels of front-line staff necessary to ensure a safe service provision. More generally, in order to mitigate the impact on front-line services of the reduction in employment numbers, the priority is to reform how health services are delivered in order to ensure a more productive and cost-efficient health system.

At the end of 2013 the number of staff midwives, including senior staff grade in the public health service, was 1,341 whole-time equivalents, including 20 on the graduate placement scheme. At the end of 2007 the number was 933 whole-time equivalents. This shows how the HSE has the capacity to focus recruitment in specific areas where increases are required. The increase in nursing hours available under the Haddington Road agreement equates to nearly 1,400 additional nurses. The number of nursing staff increased by 100 in the first month of 2014, reflecting the take-up of posts under the graduate initiative.

In the case of staffing levels at Cork University Maternity Hospital, I have been informed by the HSE that from a staff complement of 397 whole-time equivalents, currently 388 midwifery nurses are employed. I understand that active recruitment processes are in place to fill the nursing midwifery posts, including 7.5 gynaecological nursing posts and two assistant directors of midwifery.

I draw the attention of Members to a midwifery workload and workforce review of maternity services in Ireland which will be undertaken by the HSE. This review will validate staffing levels for midwives and maternity care assistants in maternity units and will recommend appropriate midwifery staffing and skill mix levels and initiatives to meet emerging models of maternity care in order to ensure standards of safety and quality of care for women and their families. The workforce review will inform the new national maternity services strategy and as part of the development of the strategy, maternity services in all parts of the country will be subject to review and evaluation. The development of this strategy is under way and will determine the optimal configuration of maternity services to ensure that women in Ireland have access to safe, high quality maternity care in a setting most appropriate to their needs. I intend to publish the strategy later this year.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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I thank the Minister of State for her reply. I take the Minister of State at her word that there is no embargo on the recruitment of front-line staff in maternity hospitals in particular. If that is the case, I ask if she will enlighten us as to the reason for the log-jam. None of the 19 maternity hospitals has the best practice standard of the ratio of midwives to births, which is one midwife for 29.5 births. A total of 25 babies a day are being delivered in CUMH. According to a report in the local paper yesterday, it would take an additional 60 staff to bring the number of staff to the international standard ratio.

Is a recruitment campaign currently under way to recruit an adequate number of midwives to provide the maternity hospitals with the best ratio? I presume the HSE report will investigate staffing levels and also take a holistic view of maternity services to include safety and best practice. If the report is to be published before the end of the year, I ask the Minister of State to give a commitment that its recommendations will be implemented as quickly as possible if fiscal constraints permit. As the Minister of State said, having a baby is one of the most anxious times for women when they are most vulnerable. We must ensure that reassurance about resources or information can be provided to women who are pregnant and are patients in maternity hospitals and that all safety standards are being met at all times.

Kathleen Lynch (Cork North Central, Labour)
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It is intended to produce a strategy on maternity services to cover all the maternity units and hospitals in the country. There is no embargo on recruitment of staff considered to be necessary to the provision of a safe service. This includes midwives. We are taking a holistic approach to maternity services. I wish to reassure people that apart from recent events, our maternity services are very safe. Not alone are they safe, but they give a degree of confidence to every mother who uses those services. We must learn from the recent events and ensure that they will never be repeated. The Department of Health now has a post of director of nursing who will undertake the survey in order to produce a strategy. The grouping of hospitals will ensure a safer delivery of care across a range of issues. The grouping of hospitals is central to services in the greater Cork area. We must learn from the awful events in the recent past which left mothers and families bereft to ensure that there will never be a repetition. That learning has begun already.