Mattie McGrath (Tipperary South, Independent)
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I thank the Ceann Comhairle for allowing me to raise this very important issue. It was intended to be raised yesterday, which was World Prematurity Day, but due to the change in business and the statements in the House I am raising it today.

In recognition of yesterday being World Prematurity Day, I wish to raise the need for the Government to make prematurity and neonatal health a health care and welfare policy priority. Approximately 4,500 babies are born prematurely every year in Ireland and yet despite that, there is no national neonatal health policy or programme in place. The number of premature births is rising but, sadly, the issue is not on our radar. It was not on my radar until my first granddaughter was born ten weeks premature almost two years ago. Amy-Berry, who spent 81 days in hospital before being brought home, is thankfully thriving today and that is due to the excellent care she received in both Cork University Maternity Hospital and in the maternity services unit in South Tipperary General Hospital. The health care professionals were excellent and the care she received both in hospital and in the follow-up process was second to none. It is important to state that fact.

I compliment and thank the staff in both hospitals as well as the early intervention team in south Tipperary all of whom have been fantastic. That said, there are significant issues surrounding preterm birth in this country which need to be addressed. It is not acceptable that the care any vulnerable preterm baby should receive would be dependent on his or her geographic location. Our neonatal health policy is fragmented and unco-ordinated and the absence of a targeted national policy is preventing access to high quality health care and social support for preterm infants and their families.

Two years ago, the national neonatal transport programme was thankfully extended to a 24 hour service. This year the focus is on the need to put in place and fund a retro transfer service. We have experience of this system working very well whereby my granddaughter, Amy, who was born in Cork, was transferred back to South Tipperary General Hospital after seven weeks when she became well enough to continue care there, thereby freeing up an intensive care unit bed in Cork. Beds in intensive care units are vital. The transfer of patients frees up pressure on the hospital system and can reduce the pressure on families as their child can be moved to a regional hospital closer to home for continuing care. That is important for families and extended families. This system works well but in order to ensure that every baby in the country has access to equal care, we need a fully operational retro service to compliment the neonatal transport programme. It is important to free up pressure in regional hospitals and it brings babies closer to home in local hospitals.

The second major issue is the lack of consistent follow-up care for preterm infants across the country. Geography plays a vital role in determining what aftercare services one can avail of. That is not right or fair by any yardstick. Some units carry out developmental check-ups but, sadly, many do not because they do not have the expertise and resources to do so. That discriminates against certain regions and affects families and their children in those areas. If we invested in adequate follow-up care for neonates, we would pick up on far more developmental problems and initiate early intervention at the earliest possible opportunity. It is vital that we would pick up on a range of issues that might affect infants and provide timely intervention. As I am out of time, I will wait for the Minister of State to reply before I add anything further.

Paudie Coffey (Waterford, Fine Gael)
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I apologise to the Deputy for the unavoidable absence of the Minister for Health today. I wish to respond to this Topical Issue debate on his behalf. Premature birth is the largest cause of neonatal death worldwide. In Ireland, 6% of babies are born prematurely, a rate that is increasing for a variety of reasons, including assisted reproduction, higher rates of multiple births and increasing maternal age.

It is a sad fact that many families have been touched directly or indirectly by the consequences of premature birth.

Thankfully, however, there has been a dramatic fall in mortality and morbidity rates for newborn infants and 90% of infants born prematurely at 28 weeks now survive, whereas in the early 1980s, 90% of those babies unfortunately died. Clearly, neonatology is one of medicine's greatest success stories over the past 30 years. This success is not only because of scientific advances and the availability and application of new technology but also is due to the centralisation of complex cases in tertiary hospitals and the training of a highly skilled and specialised workforce.

The national clinical programme for paediatrics and neonatology was established in 2011 as a joint clinical initiative between the Health Service Executive, HSE, and the faculty of paediatrics in the Royal College of Physicians of Ireland, RCPI. The programme aims to provide high-quality care to more than 67,000 babies born in Ireland annually through effective screening, the provision of equal, rapid access to neonatal intensive care where and when required and the eradication of fragmentation and duplication of newborn specialist and intensive care services. High-quality care is vital for fragile infants and, together with good policies and well-planned programmes, the outcome for preterm infants is very positive.

It is recognised that the key to good neonatal services is to concentrate the care of preterm infants in a small number of centres where highly trained staff become experienced in managing the complex problems these high-risk infants develop. In this regard, there are 19 neonatal units and 300 special care baby unit cots across the State to care for preterm and sick newborn infants. The neonatal units provide differing levels of care depending on their size and medical and nursing numbers. Four tertiary units provide the most complex level of care and four secondary units provide an intermediate level of care, while the 11 remaining primary units provide routine newborn care and immediate resuscitation facilities. The process that integrates these neonatal units is the national neonatal transport service. This facilitates the rapid transfer of babies who need a higher level of clinical support. A specially equipped ambulance staffed by trained neonatal doctors and nurses travels from Dublin to the smaller hospitals to help with the transfer of the baby to the tertiary centre. These babies can be transported at short notice, day or night, seven days a week.

The Minister for Health also is delighted to mention today that last Monday, the HSE, working in close partnership with the RCPI, launched a new model of care for neonatal services in Ireland. This was developed following wide consultation with professional groups and parents. Importantly, the recommendations have been benchmarked against international standards. The model of care is intended to ensure sustainability in the neonatal services and has three core objectives, namely, improving safety and quality in the delivery of baby-centred care, improving access to the appropriate services and improving cost-effectiveness of services delivered. In conclusion, I assure the Deputy and Members that there is little need to discuss making prematurity and neonatal health a national health care and welfare policy priority, because it already is a priority.

Mattie McGrath (Tipperary South, Independent)
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I do not accept the last statement made by the Minister of State. While I acknowledge he is doing his best here today, I am disappointed by the absence of the Minister of State in the Department of Health, as I met her in the House only half an hour ago. This issue is not a national priority and must be dealt with sensitively. Were the health service to invest in adequate follow-up care for neonates, it would pick up far more issues, would be able to mount early intervention and could address many other issues. The availability of proper early intervention services is not simply a preterm issue, however, and the system is failing many children with special needs due to a lack of access to appropriate services. This is clear and the Minister of State cannot claim Ireland has state-of-art services. The Government has been claiming for the past four and a half years that a free medical service would be implemented but it has capitulated on that for the present. There is no point in putting one's head in the sand.

The lack of social and financial support also is a major issue because the cost to families with preterm infants places undue stress and economic hardship on those families. As I stated, the financial costs in respect of pre-terms is considerable and the State must understand this and must provide the services. The Minister of State mentioned the transfer ambulance but in cases in which South Tipperary General Hospital must transfer an infant to Cork, that is, in the opposite direction to the journey made by my granddaughter Amy, who came back from Cork, a specially-trained nurse must travel in the ambulance with the infant, thereby leaving behind a shortage of such scarce and vital nurses who do such good work. Consequently, there is much tweaking and much work that can be done. The front-line staff in most parts are excellent and do tremendous work but through no fault of theirs, the lack of a national neonatal health policy means some premature infants or their families simply will not get the care they need because of where they live and this is most regrettable. This is why I disagree with the Minister of State's concluding remarks.

I also compliment the Irish Neonatal Health Alliance and the Irish Premature Babies group, both of which offer wonderful supports to the families of premature children. However, they cannot do it alone. This is a growing issue and the Government must address it to ensure that all premature children born in Ireland can reach their full potential. My family is delighted with our situation now and are thankful to the HSE and its staff but the issue must be examined and considered. Each year, 4,500 babies are born in that situation, which is a high number. I recognise the Minister of State's observation that the position and the numbers have improved but much more tweaking and a lot more assistance and support is needed on this highly sensitive issue.

Paudie Coffey (Waterford, Fine Gael)
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I acknowledge to the Deputy this is indeed a sensitive issue and this is why the Government treats it with the highest of priorities. I will take this opportunity to congratulate the Deputy on the arrival of his granddaughter, Amy, and I am happy there was a positive outcome. The Deputy is right to put on record the assistance and support of the health services that assisted his granddaughter to come into the world in a preterm situation that now has proven to be successful. I congratulate the Deputy and his family in this regard.

I reiterate that neonatal services and preterm care are a national priority for the Government and this is reflected in the positive mortality reports that have been published. I have already referred to some statistics and the facts are that in the 1980s, 90% of infants who were born at 28 weeks unfortunately did not survive whereas at present, with the current level of services, technology and sciences, as well as the support and care available to preterm births and babies, 90% of those infants born at 28 weeks survive, which is a wonderful achievement. However, this is a highly sensitive matter and I am conscious of the 10% and more of infants who unfortunately do not survive and it is extremely tough for any family or mother and father to find themselves in that situation.

I will pass on the Deputy's comments to the Minister and reassure him that this service and this matter are being treated as a priority.