Clare Daly (Dublin Fingal, Independent)
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14. To ask the Minister for Health his views on the implications for patient safety of the shortfall in midwifery posts in maternity hospitals, particularly in Dublin; and his further views on whether this shortfall may lead to an increase on the sums paid out annually by the State Claims Agency in maternity cases, which amounted to €379 million in damages and legal costs in the years 2007 to 2015. [37783/16]

Clare Daly (Dublin Fingal, Independent)
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The former master of the Coombe Hospital has said unequivocally that Ireland has long been skating on dangerously thin ice when it comes to maternity services. His view seems to be supported by the phenomenal sums the State Claims Agency has paid out in maternity cases. A total of €379 million was paid in damages and legal costs between 2007 and 2015. Is the Minister concerned about the impact of the crisis in midwifery on patient safety?

Simon Harris (Wicklow, Fine Gael)
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I thank the Deputy for raising this important matter. I visited the Coombe Hospital only yesterday, I visited Holles Street Hospital only last Friday and I visited the Rotunda Hospital the week before. In years past, our maternity services did not receive the priority they needed in respect of investment and I am determined to fix that. This is not a political point; it is one levelled at all our doorsteps. This is not just about words. Earlier this year, I launched Ireland's first ever national maternity strategy. It is shocking in some ways that it is the first ever but it has been recognised as a good document with great input from experts but also from women who are the experts in this regard. Our first set of bereavement standards were also published for women who are bereaved through pregnancy or neonatal death, again with direct input from women, their partners and midwives. That will lead to a number of changes in maternity services.

There are plans to relocate the National Maternity Hospital to St. Vincent's Hospital because while there is excellent work going on there, the building is simply not fit for purpose and women deserve a state-of-the-art, world class facility. I also recently approved the HIQA standards for maternity services, which will be launched this month.

I am aware of, and am concerned about, increasing claims to the State Claims Agency arising from maternity cases. However, I assure the Deputy that the safety and quality of maternity services is a priority for the Government and a personal priority. The publication of the national maternity strategy earlier this year, I hope, demonstrates a new and enhanced focus on maternity care at both policy and service delivery level, and provides a road map for how we can improve services in the years ahead. This month, HIQA will publish national standards for safer better maternity services, the first standards in the area. They will provide a framework for maternity service providers to ensure that they are meeting the needs of women, their babies and their partners, and that a consistent service is delivered across the country. I am confident that the strategy, coupled with the new standards, will provide the building blocks for a safer and better service.

With regard to midwifery numbers, in 2014, the HSE commissioned a midwifery workforce planning project. The project will inform the allocation of new midwifery resources on a phased basis over the coming years. In May 2016, the HSE granted approval to the hospital groups to appoint an additional 100 staff midwives. The majority of these posts were allocated to the three Dublin maternity hospitals.

In line with the national maternity strategy, a national women and infants health programme is being established within the HSE to lead the management, organisation and delivery of maternity, gynaecological and neonatal services. The programme will drive the delivery of the strategy.

Clare Daly (Dublin Fingal, Independent)
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It is a good strategy but it is a long way from being implemented. It was followed by a report on midwifery numbers which suggested that to implement the measures in the strategy, a midwife to birth ratio of 1:29.5. would have to be achieved, which would require the recruitment of an additional 450 midwives and not just the 100 who have been recruited. While I welcome their recruitment at a cost of €3 million, there has been a twelvefold increase in litigation taken by women who have been damaged by our maternity services in precisely the same period that the budgets for maternity hospitals were cut. Maternity cases represent more than half the claims dealt with by the State Claims Agency, which is absolutely scandalous. The link between the two cannot be denied. Why are all these women and families suffering? A fraction of the amount spent by the State on legal costs and damages on maternity services would transform them.

Simon Harris (Wicklow, Fine Gael)
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I agree with the Deputy. Maternity services were neglected compared to other parts of the health service, even in years when money was aplenty. It cannot, therefore, just be put down to a recessionary challenge. It was an issue going back through the generations and we have to work collectively to rectify it. I acknowledge the Deputy said the national maternity strategy is a good document but it has not been fully implemented in any way, shape or form. However, it was published last January and it is a living, breathing document. We have to get on to implement it. We are using the same model to implement it as was successfully used by previous Governments to implement the national cancer strategy. Rather than it just being a strategy, there will be a national women and infants health programme within the HSE to drive it and, by any objective standard, that attaches a priority to its delivery and implementation.

According to the October census, there were 1,402 whole-time equivalent midwife posts within the health service and when midwives, midwife managers and other midwifery specialists are included, there were 1,934 whole-time equivalents.

Clare Daly (Dublin Fingal, Independent)
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The Minister said the strategy only came in in January but, 11 months on, 13 maternity hospitals do not have access to ultrasound scans and they have been unable to recruit programme directors and so on. An inherent weakness in the strategy is the lack of targets and timeframes. The need to deliver way beyond the number of midwives that has been sanctioned, which would have a valuable impact, has not been taken on board enough. The number needs to be doubled or trebled. I welcome the recruitment of 100 additional midwives but the HSE spent €6 million last year fighting claims in maternity cases. That money would have enabled the recruitment of 200 midwives. The Minister is going in the wrong direction and the strategy has not been implemented quickly enough. I have received horrific correspondence from midwives at the coalface of this crisis.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Midwives, who are members of the Irish Nurses and Midwives Organisation, in Mayo University Hospital are being balloted on industrial action, a decision they have not taken lightly. They are doing so because of staff shortages. An additional 100 midwives is not enough; a total of 450 is required. The Minister's recruitment plans for the health service are not achieving their targets. Even those who are coming to Ireland to take up posts are leaving to go abroad again. We are not competing with private hospitals and hospitals abroad.

Women deserve better treatment than they are getting. They have been badly served by the maternity services and that is no fault of the midwives who are providing that service. The midwives in Mayo are sending the Minister a very clear message that more staff are needed

John Lahart (Dublin South West, Fianna Fail)
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This is the Minister's final response.

Simon Harris (Wicklow, Fine Gael)
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I will do my best. The issue in Mayo has been referred to the Workplace Relations Commission and I hope everyone involved will use all available mechanisms to resolve the dispute. People do not take these decisions lightly but it is in everybody's interests, including those of women, that this issue be resolved as quickly as possible.

I accept the thrust of what Deputy Clare Daly is saying. There is so much more we need to do in maternity services. I ask the Deputy to believe that this is a project on which I will work with everyone and anyone in this House in order to ensure that we deliver. There have been generations of neglect in the context of investment in our maternity services. It is not that we have done nothing since the maternity strategy was published in January. We have seen the extra 100 midwives, which the Deputy has welcomed. We have seen the publication of the bereavement standards and HIQA is about to publish the national standards. We should not underestimate the importance of having national standards published by HIQA, which is an independent regulatory body. We have €150 million of capital funding to build a state of the art, world class, national maternity hospital for women in this country on the campus of St. Vincent's. We also have plans to move the Rotunda to Connolly Hospital and the Coombe to St. James's. These are issues we need to try to fund in the context of the review of capital.

The point on midwifery numbers is that there is a challenge in recruitment and retention and one could apply the same argument to nursing numbers. It is a challenge that goes beyond funding. I hope the public sector pay commission will look at these as well in exploring the sectoral challenges. I expect the HSE to look at its Bring them Home campaign which has been disappointing in terms of the results it has delivered to date.