Dáil debates

Wednesday, 3 May 2017

Maternity Services: Motion [Private Members]

 

6:25 pm

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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I move:

That Dáil Éireann:notes:

— that since 2011, maternity services in Ireland have been marked with investigations and, in some cases, alleged cover ups of maternal and child mortality or injury in Portiuncula as well as University Hospital Galway, Portlaoise, Cavan, and Drogheda;

— that Ireland has the lowest number of consultant obstetricians per 100,000 women in the Organisation for Economic Co-operation and Development and a consultant obstetrician in Ireland is responsible for 597 births per annum, compared to 268 in Scotland;

— that the three Dublin maternity hospitals are operating at a 17 per cent deficit in the number of midwifery staff needed to run the services;

— that most of the 19 maternity units do not offer foetal anomaly screening, as prenatal ultrasound assessments by qualified sonographers and foetal medicine specialists are not available outside larger units;

— that, despite the enactment of the Protection of Life During Pregnancy Act 2013, there is a dearth of perinatal psychiatrists and other specialists;

— the serious inequalities and absence of resources which exist within the Health Service Executive (HSE) to provide services to children with life-limiting and complex medical needs, and to those under palliative care; and

— that such shortcomings have directly led to tragic incidents involving mothers and children;acknowledges and supports the findings of:— the National Maternity Strategy, Palliative Care for Children with Life-limiting Conditions in Ireland – A National Policy by the Department of Health, the HSE National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death, and the Report on End of Life and Palliative Care in Ireland by the Joint Committee on Health and Children in 2014; and

— the National Standards for Safer Better Maternity Services Report by the Health Information and Quality Authority submitted to the Minister for Health;further acknowledges:— that the Programme for a Partnership Government states it will implement the National Maternity Strategy and ‘invest in end of life care, including the provision of hospice and “end of life care” during the perinatal period, infancy, childhood and adulthood’;

— the need for continuity of care for women and parents during pregnancy, at the point of delivery and after birth, inclusive of where children have life-limiting conditions;

— the need to support bereaved parents in their transition out of hospital, with appropriate services and the availability of frontline bereavement counselling;

— that the above is best delivered by medical teams basing their decisions on best medical practice and not in any way beholden to any religious ethos; and

— the plans to move the National Maternity Hospital at Holles Street to new, modern facilities at St. Vincent’s Hospital campus; andcalls on the Government to:— honour commitments in the Programme for a Partnership Government in respect of funding and implementing the National Maternity Strategy;

— ensure that the new National Maternity Hospital is built on the St. Vincent’s Hospital campus as quickly as possible, remains entirely within public ownership and has legally guaranteed independence from all non-medical influence in its clinical operations within the laws of the State;

— ensure swift approval, dissemination and implementation of the National Maternity Standards for Safer Better Maternity Services;

— ensure all maternity hospitals have access to foetal anomaly screening, with the requisite staff and equipment;

— work with nursing and medical unions in the recruitment and retention of medical staff, so that all maternity hospitals meet the Birthrate Plus standard for midwifery staffing, as well as international standards for consultant obstetricians and gynaecologists;

— establish an independent patient advocacy service; and

— implement the recommendations of the Report on End of Life and Palliative Care in Ireland by the Joint Committee on Health and Children in 2014, prioritising those parts relating to care for children with life-limiting conditions."

On behalf of Sinn Féin, I welcome the women watching this debate. We should make no mistake about it as they are watching it and there has been a huge amount of discussion about maternity services, which is fantastic, as I have been raising the maternity services issue consistently in this Chamber.

The recent controversy over the ownership and governance of the National Maternity Hospital has thrust the spotlight on to maternity services but the provision of maternity care for the women of this country is not a priority for this Government. It is a priority for those people watching us and they are very interested in what happens in here because it directly affects the availability of the care they can access. The Government's amendment is yet another exercise in patting itself on the back, a big "well done" for all the achievements it is in the process of actioning. These are what it is just about to do any minute now. It is a "well done" for publishing a strategy; well done indeed but the words are meaningless to those women who will wait years for a gynaecology appointment or the women who will today, next week and for the foreseeable future be denied a basic 20-week anomaly scan.

The 20-week anomaly scan is a screening test but in six of the nine maternity facilities in this State, these scans cannot be accessed as a matter of course. One can only get them when clinically indicated. If a woman has no screening, there is no way of determining what can be clinically indicated. The Minister knows this, as do his officials and the Health Service Executive, HSE. When we ask a question about those scans, we are told they are offered when clinically indicated and only at six sites. In case the Minister is wondering why we need anomaly scans, I remind him of the case of Ms Jazmine Sands, a young woman whose baby, Isabella, was born in Kerry and rushed to Dublin. This little baby was born with hypoplastic left heart syndrome on 23 May 2016 and 12.01 p.m., weighing 5 lbs 1oz. She was immediately rushed to the children's hospital at Crumlin, dying there a short time later. Her mam had to endure an horrific journey after a caesarean section from Kerry to Dublin. There was no way her baby would have survived and there was nothing, despite their best efforts, that the doctors and nurses could have done. However, if the woman had access to a 20-week anomaly scan, the problem with her baby's heart would have been picked up and she would have had the opportunity to make arrangements to bring her family to Dublin. She would not have left her family in Kerry had she known the only choice she could make was to have a bit of time with her baby and cherish it. It should be a very basic right of a pregnant woman to access a 20-week anomaly scan and it is considered a very basic entitlement in most developed countries.

Maternity services have been neglected and the truth is women and babies are suffering on a daily basis because of this. The motion calls on the Government to do not much more than implement its own policies and commitments but all we get are fine words without commitments, dates or a timeframe. There is nothing concrete to give women any hope. It is another strategy to add to the Government's collection but there is no specified action or date for when women can have access to this routine scan. I have asked the Minister and the Taoiseach about this countless times but they have not been able to give a date by which we could say to women that they will able to access this very basic scan.

I also raise the issue of the new maternity hospital, as everybody is talking about it. This motion seeks to ensure it will be kept in State ownership and the people providing the service will have the ability to deliver those services free of any religious interference. The Bishop of Elphin was very clear, as the Minister is aware, in saying that where the church owns the land, canon law prevails. That cannot be allowed to happen but we must have the new maternity hospital. A young woman in my family gave birth at Holles Street about a year and a half ago to a beautiful baby boy but she was very sick afterwards and had to go to intensive care. She could not have her baby with her because the woman in the bed beside her was grieving the loss of her baby. That is why we need this hospital. Sinn Féin supports the building of our maternity hospital but we cannot have a position where the hospital would be controlled by anybody other than this State.

That must be legally guaranteed.

6:35 pm

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Maternity care in Ireland has been in a state of crisis for many years. Underfunding has led to a severe shortage of staff in hospitals, thus resulting in us lagging behind international standards. Maternity services lack both midwives and obstetricians. Ireland has the lowest number of consultant obstetricians per 100,000 women in the Organisation for Economic Co-operation and Development, OECD. There are 597 births per consultant obstetrician per annum in Ireland, compared to 268 per consultant in Scotland. Midwives play a pivotal role in the health system, but an increased workload, stress and dissatisfaction with clinical practice have resulted in many midwives leaving for other areas of nursing such as public health and education. For this reason, among several others, we must urgently address the environment in which midwives work to ensure we can retain adequate numbers.

In addition to the serious problems pertaining to capacity, it is a damning indictment of the Government that most of the 19 maternity units do not offer foetal anomaly screening and that perinatal psychiatrists and other specialists are few and far between. There is no doubt that a combination of these serious failings have led to tragedies that include deaths in health care settings across the State. Since 2012, four hospitals in Portlaoise, Galway, Sligo and Cavan have been investigated following deaths, including neonatal deaths. The Government is failing the women and children of Ireland. Expectant mothers due to give birth in maternity hospital settings must be reassured that the care provided is of the highest standard.

To add to the colossal difficulties in maternity hospitals, the recent revelation of plans to place the new National Maternity Hospital in the ownership of the Sisters of Charity is simply mindboggling. Sinn Féin has welcomed the relocation of the National Maternity Hospital to the St. Vincent’s University Hospital campus. The current hospital on Holles Street is not fit for purpose. However, the decision to give ownership of the new National Maternity Hospital to the Sisters of Charity is simply unbelievable. In this day and age there should be absolutely no connection between the provision of health care services and religious orders. A particular religious ethos should have no influence on clinical decisions. This debacle must be resolved as a matter of urgency. We must ensure the new hospital on the St. Vincent’s University Hospital campus will remain entirely within public ownership and have legally guaranteed independence from all non-medical influence in its clinical operations within the laws of the State.

In addition, as promised in A Programme for a Partnership Government, there must be full and proper implementation of the national maternity strategy. Foetal anomaly screening, with the necessary staff and equipment, must be provided in every maternity hospital. I think of the case of baby Conor Whelan and his parents, Siobhán and Andrew, from Ballyjamesduff, County Cavan. Their loss and campaigning must receive a positive response. The Birthrate Plus standard for midwifery staffing must be met, in addition to the recruitment of consultant obstetricians and gynaecologists. Patients should have access to an independent advocacy service and priority should be given to care for children with life-limiting conditions, as was recommended in the report on end-of-life and palliative care in Ireland by the Joint Committee on Health and Children in 2014.

The impetus behind these matters is, quite simply, a matter of life and death. For far too long the State has failed women and children, particularly those who have lost their sons or daughters as a result of the Government’s failure to provide the necessary care. The acceptance and implementation of all that is contained in the motion have the potential to improve greatly the standard of maternity care. I ask all Members to support it.

Photo of Imelda MunsterImelda Munster (Louth, Sinn Fein)
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Ireland has a dark history when it comes to the provision of health care for women and babies. My party's motion outlines the ongoing problems in that regard. Ireland has a long history of mistreating women and children. For too many decades the church colluded with the State in implementing and managing the horrendous practice of institutionalising women who were deemed to be problematic or inconvenient. Their children were institutionalised, too, owing to the perceived sins of their parents because they lived in poverty or for some other arbitrary reason. The Catholic Church managed this regime on behalf of the State.

Almost 60 years ago the mother and child scheme was scuppered by the Government of the day, albeit under pressure from the church. Now we have the ongoing issue of malpractice and cover-up in maternity hospitals. We have the lowest number of consultant obstetricians per head of population in the OECD. We do not have enough midwives and do not know if the Minister has a specific recruitment plan for the new hospital. We do not offer foetal anomaly screening to most women. The motion outlines a long list of shortcomings on the part of the State but handing over the National Maternity Hospital to the Sisters of Charity takes the biscuit. We all know that a new hospital must be built and that it must be built as quickly and efficiently as possible. However, it is unacceptable that the State should build the hospital and hand it over to the Sisters of Charity. The State is responsible for the provision of health care for citizens, not the church.

There have been too many cover-ups in the past and too many people were not, and still are not, held to account. Most recently, there has been the Tuam mother and baby home scandal. It follows a litany of scandals in which the church and State colluded, all under the guise of providing care. Why would we wish to continue a practice with such a dark history? Last week the Minister for Health, Deputy Simon Harris, appeared to have been taken aback by the backlash against this plan. Is the Government so far removed from public opinion on this matter that it thought this was acceptable? Is it so out of touch with reality and the society it governs that it thought people would be happy with it? Women's health and women's rights must be at the core of the new hospital which must be State owned and State run.

Photo of Carol NolanCarol Nolan (Offaly, Sinn Fein)
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I am grateful for the opportunity to speak about this important topic. I commend my colleagues, Deputies Louise O'Reilly, Mary Lou McDonald and Kathleen Funchion, for their hard work in campaigning on this issue. The figures speak for themselves. Ireland has the lowest number of consultant obstetricians per 100,000 women in the OECD. Three Dublin maternity hospitals are operating with a 17% deficit in the numbers of staff required to run their services. Most of the 19 maternity units in the country do not provide essential screening owing to the lack of specialised staff. The women of Ireland deserve better than what they have been receiving from the Government. The national maternity strategy must be implemented fully and resourced. The Government must work to retain medical staff and provide the specialist service needed across the State. The National Maternity Hospital must be built without delay and must be independent of all considerations, other than providing the best possible health care for pregnant women and their babies.

As my party's spokesperson on education, I must make the point that the proposal to establish the new National Maternity Hospital in the ownership of a religious body is very concerning. Recent reports show that various religious bodies owe the State hundreds of millions of euro in respect of the redress scheme for the survivors of abuse in State institutions, including schools. In the immediate aftermath of these revelations the prospect of the National Maternity Hospital being gifted to a religious order has rightly outraged citizens across the State. Anything other than complete independence for the new hospital is unacceptable. The Government must get its act together and ensure the best possible care is provided for pregnant women and new mothers. That must happen now.

6:45 pm

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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6 o’clock

I move amendment No. 1:

1. To delete all words after “Dáil Éireann” and substitute the following:

“notes:— that Irish maternity services compare favourably with those in other countries in terms of safety and patient outcomes;

— the publication, in January 2016, of Ireland’s first National Maternity Strategy (the Strategy), which demonstrates a new and enhanced focus on maternity care at both policy and service delivery level and will fundamentally change how maternity care is delivered, improve the risk profile of the entire service and benefit the approximately 80,000 families who access it each year;

— the establishment of the National Women and Infants Health Programme to lead the management, organisation and delivery of maternity, gynaecology and neonatal services, strengthening such services by bringing together work that is currently undertaken across primary, community and acute care;

— the development of Maternity Networks to strengthen the operational resilience of smaller units such that they can provide safe quality services;

— the establishment of a new National Patient Safety Office (NPSO), located in the Department of Health, to prioritise work in this area and to work on a range of initiatives, including new legislation, the establishment of a national patient advocacy service, the measurement of patient experience, the introduction of a patient safety surveillance system and extending the clinical effectiveness agenda;

— the monthly publication of Maternity Patient Safety Statements by each maternity hospital/unit, as recommended by the Chief Medical Officer in his 2014 report on perinatal deaths in Portlaoise;

— the development of the Health Information and Quality Authority (HIQA) National Standards for Safer Better Maternity Services, which set out the key elements that a maternity service should strive to attain in order to promote the provision of safe and high quality services;

— the implementation of the Maternal and Newborn Clinical Management System, and the introduction of the electronic health record for mothers and babies which marks a very significant development in the delivery of maternity care and will support better, safer clinical decision-making and a more connected health service delivering improved health outcomes;

— the 2016 allocation of an additional €3 million for maternity services, as well as the increased funding of €6.8 million being provided in 2017, to allow for the continued implementation of the Strategy;

— the growing maternity workforce and the falling number of births, both of which are giving rise to improved staff to birth ratios;

— the highest ever number of consultant obstetrician/gynaecologists employed in Ireland at 142 Whole Time Equivalent (WTE), an increase of 26 WTEs since December 2010;

— the 1,583 midwife WTEs employed, and the recruitment of an additional 100 midwives in 2016, the allocation of which to individual maternity hospitals/units was informed by the needs identified by Birth Rate Plus, an evidence-based workforce planning tool;

— that one of the priority aims of the Health Service Executive (HSE) National Service Plan 2017, is the design and development of perinatal mental health services capacity;

— that anomaly scans are available in all Hospital Groups and the Strategy recommends that all women must have equal access to standardised ultrasound services;

— the publication of the HSE’s National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death, and the development of specialist bereavement teams;

— the very substantial implementation of the recommendations relating to children with life-limiting conditions contained in the Report on End of Life and Palliative Care in Ireland by the Joint Committee on Health and Children in 2014;

— the range of services provided for infants with life-limiting conditions and complex medical needs; and

— that these developments represent key building blocks in the provision of high quality maternity services;

endorses:

— the proposed new model of maternity care set out in the Strategy, consisting of three care pathways – supported, assisted and specialised, meaning every woman will be able to access the right level of care, from the right professional, at the right time and in the right place, based on her needs;

— the Strategy’s recommendation that services should be woman-centred, and provide integrated, team-based care, while increasing choice to women and ensuring safety;

— the Strategy’s intention for a partnership approach to be taken, with women to be encouraged to maintain regular contact with maternity services throughout pregnancy and following birth, have access to all necessary information, all of which will be underpinned by the principles of informed consent;

— the intention to relocate all four stand alone maternity hospitals with adult acute hospitals and plans to build a world-class maternity facility, namely the National Maternity Hospital at Elm Park, which will have clinical, operational and financial independence without religious, ethnic or other distinction, and the submission in March 2017, of the strategic infrastructure planning application for the hospital to An Bord Pleanála;

— the Minister for Health’s intention to meet with both hospitals and consider further the legal mechanisms necessary to absolutely protect the State’s considerable investment in the hospital, and to report to Government and the Oireachtas on this project at the end of May 2017, including on the issue of ownership of the new facility;

— the plan for the National Women and Infants Health Programme to oversee the implementation of the National Maternity Standards for Safer Better Maternity Services and for HIQA to, in time, develop an appropriate monitoring programme in relation to these standards once they have been embedded in the healthcare system;

— the prioritisation by the National Women and Infants Health Programme of the provision of anomaly scans, to ensure that women will have equal access to standardised ultrasound services;

— the agreement reached recently, following engagement between the Departments of Health and Public Expenditure and Reform, the HSE, INMO and SIPTU nursing unions on a number of specific measures to attract nursing and midwifery graduates and to retain nurses and midwives;

— the resultant commitment given under that agreement to deliver the 2017 funded nursing and midwifery workforce plan, including 1,208 additional posts, 96 of which are additional midwives to support the implementation of the Strategy;

— the commencement of work by the NPSO on a Patient Safety Complaints and Advocacy Policy, the development of which will be informed by public consultation; and

— the intention to fully implement the recommendations of the November 2016 Evaluation of the Children’s Palliative Care Programme, to further improve the supports and services available both to children with life-limiting conditions and palliative care needs and their families; and

supports the commitment, as set out in the Programme for a Partnership Government and in the developments outlined above, to implement the National Maternity Strategy, which will be carried out on a phased basis over the lifetime of the Strategy and will ensure the provision of a safe and high quality maternity service for women and babies.”

I thank Deputies for giving me the opportunity to speak about our maternity services. I acknowledge the constructive nature of the Fianna Fáil amendment, in particular its focus on the legal mechanisms necessary to complete the new national maternity hospital at the St. Vincent's campus.

Too frequently maternity services make the headlines for the wrong reasons. While any one loss or negative experience is one too many, in particular for the individuals and families concerned, it would be remiss and irresponsible of us not to acknowledge that Irish maternity services compare favourably with those of other countries in terms of safety and outcomes. Of course, there is always room for improvement and to learn from past mistakes.

When it comes to maternity care, we not only know what we need to improve but we already know how we are going to do it. To that end, Ireland's first ever national maternity strategy was published in January 2016. It maps out the future for maternity and neonatal care to ensure that it will be safe, standardised, of high quality and offer an enhanced experienced and more choice to women and their families. This strategy has been broadly welcomed and I have no doubt it was enriched by the more than 1,300 voices which contribute to its development.

Starting with this strategy, 2016 was a landmark year for maternity services. In August I launched the HSE national standards for bereavement care following pregnancy loss and perinatal death and in December HIQA's national standards for safer and better maternity services were published. These developments, when taken together, represent key building blocks to facilitate the provision of a consistently safe and high quality maternity service.

The development and publication of the national maternity strategy demonstrates a new and enhanced focus in this country on maternity care at policy and service delivery level. I firmly believe that the strategy will fundamentally change how maternity care is delivered, improving the risk profile of the entire service in the process to the benefit of the approximately 80,000 families who access it every year. The proposed new model of maternity care set out in the strategy consists of three care pathways: supported, assisted and specialised. Such an approach means that every woman will be able to access the right level of care from the right professional at the right time and in the right place, based on her needs.

It recommends that services should be woman-centred and provide integrated team-based care. It aims to increase choice for women at a very special, individual and private time for them and their families, while also crucially ensuring that services are safe. The strategy outlines that a partnership approach should be taken, with women to be encouraged to maintain regular contact with maternity services throughout pregnancy and following birth and have access to all necessary information, all of which will be underpinned by the principle of informed consent.

Safety is the first and overriding principle. Integral to this are guidelines to assess and place women in the appropriate risk category which will ensure that their care is managed in line with best evidence. To this end, the strategy underlines that this new model of care will be underpinned by evidence-based guidelines which will provide the necessary patient safety assurances and help to ensure consistency and practice across the country. The national clinical effectiveness committee has commenced the development of a national clinical guideline in this regard.

The strategy also supports the implementation of the HIQA national standards for safer and better maternity services. The standards 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.

For most people, pregnancy and birth is a joyous life event. Sadly, however, many families suffer a pregnancy related bereavement. The strategy recognises the importance of improving and standardising bereavement care throughout maternity services. The HSE national standards for bereavement care following pregnancy loss and perinatal death will ensure that clinical and counselling services will be in place to support women and their families in all pregnancy loss situations from early diagnosis from early pregnancy loss to perinatal death, as well as situations where there is a diagnosis of foetal anomaly that may be life-limiting or fatal. I trust that they will ensure that all families who have the terrible experience of a pregnancy related bereavement will receive the care and compassion they need.

As I previously mentioned, a key pillar of the national maternity strategy is to ensure the safety of our services. Since December 2015, each maternity hospital has published a monthly maternity patient safety statement as recommended by the Chief Medical Officer in his 2014 report on perinatal deaths in Portlaoise. These statements contain information on metrics covering a range of clinical activities, major obstetric events, mode of delivery and clinical incidences. These statements are publicly available on the HSE website, ensuring transparency.

Now that a clear and comprehensive strategic and policy framework is in place, our intention must turn to implementation. To ensure that all of these plans translate into improved care and outcomes, we have put in place new structures which are dedicated to maternity care. To that end, the national women and infants health programme has been established within the HSE to lead the management, organisation and delivery of maternity, gynaecological and neonatal services, strengthening such services by bringing together work that is currently undertaken across primary, community and acute care.

The programme will also oversee the establishment of maternity networks in each hospital group, the development of which will strengthen the operational resilience of smaller units. This will result in a co-operative approach to service delivery which ensures that each hospital site within the network delivers care appropriate to the facilities and services available on that site. Any future development funding for maternity, gynaecological and neonatal services will now be ring-fenced and allocated through this programme. With its wide remit and dedicated expertise, it is envisaged that the programme will facilitate greater oversight and support for service providers and ensure the appropriate allocation and targeting of new resources.

The programme will draw up a detailed action plan that will inform the full implementation of the strategy. This work will include the identification of capital and revenue funding requirements which will, in turn, inform the annual Estimates process over the lifetime of the strategy. The implementation group has held its first meeting and I expect the action plan to be completed in the coming months.

In the interim, work to implement the strategy has already begun. In demonstration of the Government's commitment to the progressive development of maternity services, €3 million in development funding provided for majority services in 2016 was allocated in line with the strategy and included funding for additional staff, including 100 midwives, the development of specialist treatment teams and the implementation of the maternal and newborn clinical management system. Increased funding of €6.8 million has been provided for maternity services in 2017, which will allow for the continued implementation of the strategy.

While it must be noted that the growing maternity workforce and the falling number of births are giving rise to improved staff to birth ratios, the strategy acknowledges the need to increase further the maternity workforce. While the Private Members' motion points out that the overall number of obstetricians was one of the lowest in the OECD when last measured, significant recruitment has taken place since then. As of February 2017, a record number of obstetricians, that is 142 whole-time equivalents, were employed within our maternity services. This represents a rise of 25 since 2011 when the OECD data quoted in the motion was gathered, despite the decreasing number of births in the country since then. The Government is committed to building on this progress.

We have also increased the number of funded midwife posts, including the recruitment of an additional 100 midwives in 2016, the allocation of whom to individual maternity hospitals was informed by the needs identified by Birth Rate Plus, an evidence-based workforce planning tool. Currently, there are 1,583 whole-time equivalent midwives throughout the services. I have been assured that the maternity strategy will make Ireland a more attractive place for midwives to work.

During recent engagement between my Department, the Department of Public Expenditure and Reform, the HSE, the INMO and SIPTU nursing unions, agreement was reached on a number of specific measures to attract nursing and midwifery graduates back to Ireland and, indeed, to remain in Ireland. This commitment has put in place a funded workforce plan for nurses and midwives, including 1,208 additional posts, 96 of which are additional midwives to support the implementation of the maternity strategy.

I want to return to the issue of anomaly scans. While I accept that the provision of anomaly and dating scans is not uniform throughout the country, foetal anomaly scans are available in each hospital group. We are working and must work to improve this further. The national maternity strategy is very clear that all women must have equal access to standardised ultrasound services. This issue is a priority for the new programme, and as a first step clinical guidance on routine detailed scans at 20 weeks will be developed. In the meantime, the programme will work with the six hospital groups to increase access to anomaly scans for those units with limited availability.

In regard to co-location, the model of stand-alone maternity hospitals is not the norm internationally. Government policy is, therefore, to co-locate all remaining maternity hospitals with adult acute hospitals. Co-location of maternity services with adult services provides mothers with access to a full range of medical support. On 10 March, a planning application for the new national maternity hospital at St. Vincent's Healthcare Group was submitted to An Bord Pleanála. The remaining stand-alone maternity hospitals in the Coombe, the Rotunda and Limerick will relocate to the campuses of St. James's Hospital, Connolly Hospital and University Hospital Limerick, respectively.

Tri-location with paediatric services ensures immediate access to on-site paediatric services when foetal or neonatal surgery is required. The availability of these services will help to ensure the delivery of an optimum safe service, in particular for high-risk mothers.

I now want to deal specifically with the relocation of the National Maternity Hospital to St. Vincent's campus, an issue which I know has been the subject of serious public concern in the past few weeks and has highlighted the need for a broader conversation we discussed during Priority Questions earlier. I would like to make it very clear that in asking for time, my Department and I will work with both hospitals for reporting back to the Government and Oireachtas. We will use this time to pursue solutions that address the issue of the ownership of the facility that is the new national maternity hospital.

The need for the new hospital is beyond doubt and I respectfully ask the House that we use this time to work on the issues and arrive at a solution which can deliver it. While Holles Street has since 1894 served and continues to serve the women of Dublin, the building is no longer appropriate for our needs. When completed, the new state-of-the art national maternity hospital at the St. Vincent's campus will give physical expression to the national maternity strategy. I assure the House that the new hospital will have complete clinical, operational, financial and budgetary independence. I will report back to the House with further detail in the coming month.

6:55 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Deputy Billy Kelleher is sharing with colleagues and they have 20 minutes.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I will take seven or eight minutes or thereabouts.

We welcome the opportunity to speak on the proposed move of the national maternity hospital to the St. Vincent's health care group in Elm Park, which has been generating headlines for the last couple of weeks. This has stimulated a broader debate our society must have about the ownership of our health facilities and the ethos within them. It is something we must address in the short, medium and longer terms. I understand fully that divestment might have huge cost implications, but we must set in train a process whereby capital investment by the State in health facilities is retained in the ownership of the State itself while within hospitals owned by the State, there is clinical, ethical and medical independence free from any religious ethos. That is the broader issue that has to be addressed in the longer term. It will have huge cost implications and it should be approached in partnership. We did it very effectively in Cork with the Erinville, St. Finbarr's and Bon Secours maternity hospitals, which had a Catholic ethos. They amalgamated with the establishment of the maternity hospital at CUH, which is a State-owned facility run according to the laws of the land. These things can be done with imagination and a willingness on everybody's part to engage in a meaningful way. In Dublin the maternity hospitals at Holles Street, the Rotunda and the Coombe are all voluntary. These three voluntary maternity hospitals cater for approximately 27,000 to 28,000 births annually. We must not lose sight of where we are in terms of the State's provision of capital and current investment while these hospitals are retained in a voluntary capacity.

There are broader issues to address here. On the national maternity hospital itself, we can come here and be very critical. The Minister probably deserves an element of criticism. However, we have to address the problems that are there now. Everybody accepts that we need to move the national maternity hospital to St. Vincent's. If that move fails, there will not be too many other hospitals on the south side of Dublin which could accommodate the national maternity hospital. The best clinical outcomes are where there is co-location with an adult teaching hospital and St. Vincent's fits that bill in the context of the clinical supports available there. What is fundamental is that there can be no interference in medical or ethical oversight by anybody. The laws of the State must be sacrosanct in the context of what happens within the national maternity hospital and the problems that may flow from that hospital to St. Vincent's itself. We have to be very conscious of the latter point also. We must look at that. The Kieran Mulvey report is not a legal agreement, but is rather a document which perhaps contains many compromises to get people off difficult hooks. However, the Minister's obligation and our obligation as legislators is to ensure that investment in a capital project allows the State to have a charge on it or, hopefully, ownership where that can be achieved. The other area that must be looked at is to bring certainty and clarity to the issue of medical, ethical and financial independence and oversight.

Over the last number of days there has been a great debate with an exchange of views from the present and former masters of the national maternity hospital. The national maternity strategy has outlined in detail for some time the plans ahead for maternity services nationally. I hope we can address this to the satisfaction of everybody and, more importantly, ensure there is a move and that women in Dublin have a proper maternity hospital with the proper infrastructure and medical services available. I hope the month the Minister has requested bears fruit in that regard. I urge him to use whatever means are necessary to progress the matter. People have referred to CPOs and the like but, as I said earlier, it is a long time since we passed a Bill of attainder, picked out a group of people and seized their assets. We have to work within the Constitution and the law. As such the Minister must embrace this month, as must other actors, because the public needs to see certainty around the investment from the State and medical and ethical oversight.

On the broader issue of maternity services generally, we must accept, looking at the OECD figures, that we are falling very far behind in the number of obstetricians per capitahere. In fact, we have approximately half the number of obstetricians we require which, in itself, is a sad indictment of the fact that our maternity service, while comparable in terms of outcomes, involves the cutting of corners because of the huge pressure and stress on our maternity hospitals. That is a given. It is only the fact that we have wonderful midwives, consultants and other medical professionals that keeps this whole maternity service afloat. We must accept that if we do not do something quickly on investment in personnel, we will have further difficulties in the years to come. We see that where there are problems with staff, staff training and pressures on staff, there can be catastrophic adverse outcomes as incidents in certain maternity hospitals in this country in recent times have shown. We must accept that there is a great deal of work to be done. While we acknowledge the maternity strategy itself, there is a short-term issue around fetal anomaly scans and access to ultrasound. Unfortunately, this is a regional issue. While in Dublin one can access an anomaly scan, that is not the norm in other parts of the country. It is something that must be addressed very quickly because every woman should be entitled to a scan where required. The idea that one has to prioritise and assess risk to provide a scan is not acceptable. We must invest in ultrasound and the personnel required to operate that service.

A number of motions were tabled. There was a complaint about prayers in this place today, but one would nearly need divine inspiration to work out the amendments to the amendments. Sinn Féin has tabled the motion and we welcome the debate on it. Fianna Fáil has tabled an amendment but in the context of working together to ensure there is unity of purpose in advocating for maternity services, we will certainly accommodate Sinn Féin's motion in circumstances where there has been an inclusion of the ownership issue. We have to be clear, however. While we want to see the hospital in public ownership, I accept that may not be possible for many reasons. The last thing I want to do is leave this place this year or the year after with the whole deal having unravelled. That would leave us in a position where 8,000 to 10,000 births per year continue to be delivered in Holles Street because people would not compromise or come to the table to agree a solution. I urge the Minister to use everybody and every means at his disposal to bring this to a conclusion for everybody's sake, primarily women in Dublin who have been giving birth in a substandard infrastructure in Holles Street. Were it not for the staff working there, we would have had many more serious outcomes. That has been seen in the last couple of days with the difficulties in the absence of co-location.

For all these reasons I ask the Minister to use the month wisely, and perhaps in future when announcements are made have all the t's crossed and the i's dotted before the fanfare is unfurled, because it creates difficulties in trying to bring these issues to finality.

7:05 pm

Photo of Fiona O'LoughlinFiona O'Loughlin (Kildare South, Fianna Fail)
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There is no doubt in saying the time of being born and the time of giving birth must be the most vulnerable times in anybody's life, for the infant being born and the mother giving birth. As a nation, we absolutely owe these women and their children the very best of professional care and support in the highest end hospital with all the necessary equipment should anything go wrong. I will begin with points on maternity care itself and then speak on the situation with regard to Holles Street and the relocation of the National Maternity Hospital.

It is very clear the provision of accessible, safe and high-quality obstetrician-led maternity services to all mothers and babies, regardless of where they live in whatever part of the country, must be the core objective of public health policy. It is increasingly clear our national maternity infrastructure is under strain and needs serious review and investment to make it sufficient to meet the needs of the country over the coming years. Any debate on maternity services needs to include a discussion on what greater role community midwifery can play, the urgent need for a greater number of consultant obstetricians, and the level of investment needed in physical infrastructure. We agree with proposals to relocate the maternity hospitals in Dublin alongside acute hospitals and this absolutely makes sense.

When we look at the OECD reports on this, Ireland has one of the lowest ratios of obstetricians to patients and this tells it own story. There is a huge need for investment in maternity and neonatal services throughout the country. We believe obstetrician-led services must be a priority and we call for them to be in place in every maternity hospital in the country. It is crucial that maternity services are protected and enhanced rather than downgraded. We must look at those outside Dublin who must have high quality health and maternity services. These include, as my colleague, Deputy Kelleher, said, anomaly scans, which are extremely important in monitoring the development of the baby in the womb. They are carried out as a matter of routine in the main maternity hospitals in Dublin and Cork but only in some of our regional maternity units. Women in Cavan and Monaghan who want to have an anomaly scan must travel to Dublin. This is deeply unfair and a source of much anxiety for parents to be.

The hospital on Holles Street is a place I know well. My ten younger siblings were born there. In my younger years, we were trotted up to the hospital and the car was outside from which we waved-----

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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The bus.

Photo of Fiona O'LoughlinFiona O'Loughlin (Kildare South, Fianna Fail)
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-----to our mother and whatever new sibling had arrived at that point. The hospital was built in 1892. Women are going in at the most vulnerable point in their lives and Holles Street is absolutely not fit for purpose. When the Minister announced last November there was going to be a relocation he received great accolades and there was great fanfare, and deservedly so if the details were what we thought they were. However, the devil is in the detail, the details were not worked out properly and now it is a mess of the Government's own making. It has not been open and transparent and it has caused massive confusion and anger among the public.

Everybody agrees that a new maternity hospital is urgently needed. To hear over the past week that clinicians have resigned from boards as they have genuinely held concerns about the future ownership of the maternity hospital is extremely worrying. I and my party find it very hard to believe the State would not own any maternity facility in which it is investing at least €300 million. The ownership would absolutely have to reflect this investment by the State.

The Mulvey report, to which my colleague has referred, forms the basis of what is yet to be negotiated as a legal deal between Holles Street, the HSE and St. Vincent's group. This surely would allow an opportunity to lock down the concerns on absolute clinical and corporate governance independence. The new hospital must be completely ethically independent of any religion. The Mulvey report also allows the Government to negotiate a line that should and will reflect the taxpayers' investment. I understand from recent coverage a CPO was not legally possible at the time of the negotiations, but surely a 999 year lease may help to resolve the ownership issue. We must acknowledge the land is owned by the sisters and they are donating use of it to the State. Certainly locating the maternity hospital with a tertiary hospital is recommended best practice. It is also a teaching hospital and located close to UCD.

Fianna Fáil also believes any private income from maternity patients should be State owned, as is the practice now in Holles Street. Many, if not all, of us in the House have received many e-mails and contacts over the past week on this issue. Unfortunately it is the case the redress scheme and the dubious history of the religious orders with regard to mothers and babies has been caught up in this. I accept it is a separate issue but, unfortunately, in the minds of the Irish people and the taxpayers these issues cannot be separated. We absolutely have to do our very best to give comfort to those who are concerned and rightly so.

The Minister has asked for a month. This month needs to be put to the best possible use to make this division. It is very clear what the people need and want. Having a very strict division between State and religion to ensure all the patients in the many years to come, including expectant mothers, mothers, young children and infants before and after birth, have the very best possible support and medical care not connected to a religious ethos.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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I welcome the opportunity to speak on the motion as the Labour Party's spokesperson on health. I wish I had much more time than I do because this is a very important issue for all of us. In the time I have I want to focus on the need for independence of the new maternity hospital and the lack of staffing in maternity services, which the Minister knows is an issue about which I speak quite regularly at committee meetings and personally to the Minister. I believe it is in our national maternity strategy. I also want to speak about regulation.

Despite the best efforts of clinicians and staff in our health services women are continuously let down by Governments in respect of maternity care in Ireland. The controversy about the new national maternity hospital is only the tip of the iceberg. Here we are in 21st century Ireland debating whether a religious order or the State should own a taxpayer-funded institution charged with providing maternity care to the women and young children of this country. It is quite extraordinary that the Government would, aside from all else, consider gifting sole ownership of this incredibly important State-funded hospital to the Sisters of Charity, the same people who were party to a €128 million redress scheme with the State. Given what we know about how this order behaved, is there any other modern, developed country in the world which would actually act in this way?

Yet, in this country, we were going down that road.

Only last week, we saw the resignation of Dr. Peter Boylan from the board of Holles Street, citing that he can "no longer remain a member of a board which is so blind to the consequences of its decision to transfer sole ownership of the hospital to the Religious Sisters of Charity, and so deaf to the disquiet of the public it services". Further in his resignation letter he states, "To believe the new National Maternity Hospital will be the only hospital in the world owned by a Catholic congregation to permit serialisation, IVF, abortion, gender reassignment surgery and any other procedures prohibited by the Church is naive and delusional". In a more warning manner he states that "all women who will require transfer along the interconnecting corridor to the general hospital for specialist care will be, as you must be aware, transferred into an environment where there is no dispute that [a] Catholic ethos applies". I agree wholeheartedly with Dr. Boylan's comments and sentiments. I have spoken to him at considerable length. I believe he has done the State a huge service and has done it an even larger service in the last few weeks. The influence of Catholic teaching arguably has no bigger impact than it would under maternity services. Every hospital owned and funded by the taxpayer must be in a position to provide any and all medical procedures allowed under Irish law, not just currently, but we need to future-proof it, and that is not what St. Vincent's said. This is simply not up for discussion.

An interesting piece by a former Senator and oncology professor, Professor John Crown, raises further concerns about the clinical independence that might be an issue in the new maternity hospital. He has said: "I had the firsthand experience of having clinical trials delayed - not by long, because I fought them on it - on an issue where it was specified that contraception was required for patients who would be exposing themselves to drugs which could be horrific to a developing foetus". The idea of any religious interference in health care decision-making is absolutely, clinically wrong. There is an indisputable need for the urgent construction of the new National Maternity Hospital. I said it myself. I have spoken on it on new numerous occasions. The current situation of having three maternity hospitals operating on separate sites is unsustainable and contrary to clinical best practice. I know that following persistent public pressure, the Taoiseach has come forward to say he can confirm that there will be complete clinical independence and that the Sisters of Charity will not have a majority on that board.

The Minister, Deputy Simon Harris, now wants one month to decide the best course of action. I have spoken with the Minister and have no problem with giving him that month, but I do say it in the spirit that he comes back with the right answer. I do not want to spend too long with this, because we have to have a wider discussion on divestment, but this is up-front and now. We need to solve this now and we need to deal with the wider issue. We need to solve this issue in one month. We cannot come away with the wrong answer. There are many options out there including leasing, compulsory purchase orders and a number of others. I do not buy the fact that we cannot do some of those. This is a Chamber that bailed out the banks in 24 hours. Surely we can sort out this and surely the Minister can sort this out in a month. I have the same concerns the Minister had, because he was right three years ago in the Committee of Public Accounts, when he raised all those questions on how the Sisters of Charity could use the ownership of St. Vincent's as collateral in regard to developing their private practice, car parks and all the rest. The Minister was right.

7:15 pm

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Thank you.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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Now he should follow through on the sentiments of what he said three years ago and come back with the right answer in a month's time.

I want the Minister to address a number of questions. We know that Mr. Thomas Lynch, the CEO of the Ireland East Hospitals Group, warned the Department of Health that this could transpire. I have asked the Minister this question publicly. Why did he not heed this warning?

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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What warning?

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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This needs to be clarified. Did his Secretary General get a warning? Did the Minister's officials get a warning? Was any documentation transferred from Mr. Thomas Lynch, or did he orally say anything to anyone in the Minister's Department about concerns about this? Let us get this clarified once and for all. I have asked this question numerous times and have not got any clarity. If the Minister felt that the original deal, which was announced with such great fanfare, was so good, why did he need to write to St. Vincent's to re-emphasise his view about the ownership issue once this controversy arose? If the deal was so right last year, why did he need to do it?

I have made our party's position clear on numerous occasions in the last few weeks, but I believe this is a seismic moment in our State, where we have an opportunity to take this country forward or to take it ten steps backwards. We need to discuss this whole issue of divestment. This is the up-front and real issue now. This is the example and issue that the Minister is going to have to deal with. We need to come back with the right answer. I ask the Minister to please not deceive me or anyone else and to please not come back in a situation where he is saying that this is part of a bigger picture with regard to divestment. We need answers to this issue alone. The issue of divestment is going to take a long time. We all know that.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I said that.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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The initial part of this motion deals with the lack of obstetricians, midwives and other specialists within our maternity care sector. Those of us who serve in the health committees have discussed this at length. If one looks at Organisation for Economic Co-operation and Development, OECD, levels with regard to the number of clinicians across this area, we are way down, and it is an area of real concern and we need to deal with it. We are not meeting the averages across the OECD or indeed across Europe. We need to put a plan in place for it. I support that component of the motion as well. It is critical when it comes to the future of our health care services.

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
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Amendment No. 3 in my name and in the names of my colleagues in People Before Profit-Solidarity states:

To delete all words after “Dáil Éireann” and substitute the following:

“notes:— that maternity hospitals are not just for supporting women through childbirth but should provide the full range of reproductive health services, with due respect to the bodily autonomy and human dignity of their patients, coordinated with primary care services and GPs and that this fact should be reflected in the hospitals written policies and their available services;

— the failure of the Religious Sisters of Charity Ireland to compensate victims of abuse and neglect in its residential Mother and Baby Homes and its continued failure to adequately fund the State Redress Scheme;

— the failure of health facilities run or under the influence of this religious order to provide services, products, procedures and operations required by citizens in the areas of reproductive health;

— that reproductive health services in publically funded hospitals should provide a spectrum of birth control services including information, contraception (including sterilisation), the morning after pill, early medical abortion and surgical abortion services, in addition to all other services currently available;

— that the quality of information made available should be a priority so as women can make informed decisions on their health;

— that since 2011, maternity services in Ireland have been marked with investigations and, in some cases, alleged cover ups of maternal and child mortality or injury in Portiuncula Hospital as well as University Hospital Galway, Portlaoise, Cavan, and Drogheda;

— that Ireland has the lowest number of consultant obstetricians per 100,000 women in the Organisation for Economic Co-operation and Development and a consultant obstetrician in Ireland is responsible for 597 births per annum, compared to 268 in Scotland;

— that the three Dublin maternity hospitals are operating at a 17 per cent deficit in the number of midwifery staff needed to run the services;

— that most of the 19 maternity units do not offer foetal anomaly screening, as prenatal ultrasound assessments by qualified sonographers and foetal medicine specialists are not available outside larger units;

— that, despite the enactment of the Protection of Life During Pregnancy Act 2013, there is a dearth of perinatal psychiatrists and other specialists;

— the serious inequalities and absence of resources, which exist within the Health Service Executive (HSE), to provide services to children with life-limiting and complex medical needs, and to those under palliative care; and

— that such shortcomings have directly led to tragic incidents involving mothers and children;acknowledges and supports the findings of:— the National Maternity Strategy, Palliative Care for Children with Life-limiting Conditions in Ireland – A National Policy by the Department of Health, the HSE National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death, and the Report on End of Life and Palliative Care in Ireland by the Joint Committee on Health and Children in 2014; and

— the National Standards for Safer Better Maternity Services Report by the Health Information and Quality Authority submitted to the Minister for Health;further acknowledges:— that the Programme for a Partnership Government states it will implement the National Maternity Strategy and ‘invest in end of life care, including the provision of hospice and “end of life care” during the perinatal period, infancy, childhood and adulthood’;

— the need for continuity of care for women and parents during pregnancy, at the point of delivery and after birth, inclusive of where children have life-limiting conditions;

— the need to support bereaved parents in their transition out of hospital, with appropriate services and the availability of frontline bereavement counselling;

— that the above is best delivered by clinical teams basing their decisions on best clinical practice and not in any way beholden to any religious ethos; and

— the plans to move the National Maternity Hospital at Holles Street to new, modern facilities at St. Vincent’s Hospital campus; andcalls on the Government to:— ensure that the new National Maternity Hospital is built on the St. Vincent’s Hospital campus as quickly as possible, remains entirely within public ownership and has legally guaranteed independence from all non-clinical interference in its clinical operations within the laws of the State;

— issue a compulsory purchase order for the lands at St Vincent’s Hospital, in order to proceed with the building on this site of the National Maternity Hospital;

— declare that all State funded hospitals will provide all operations and procedures that may be required in the event of a change in abortion laws, including the recommendations of the Citizens’ Assembly;

— ensure the Religious Sisters of Charity Ireland, and any other religious organisation, is precluded from any control over, or any operational function in, the running of the new National Maternity Hospital;

— honour commitments in the Programme for a Partnership Government in respect of funding and implementing the National Maternity Strategy;

— ensure swift approval, dissemination and implementation of the National Maternity Standards for Safer Better Maternity Services;

— ensure all maternity hospitals have access to foetal anomaly screening, with the requisite staff and equipment;

— work with nursing and medical unions in the recruitment and retention of medical staff, so that all maternity hospitals meet the Birthrate Plus standard for midwifery staffing, as well as international standards for consultant obstetricians and gynaecologists;

— establish an independent patient advocacy service; and

— implement the recommendations of the Report on End of Life and Palliative Care in Ireland by the Joint Committee on Health and Children in 2014, prioritising those parts relating to care for children with life-limiting conditions.”

I would like to start with something that we are going to be dealing with later in the month, which is the question of how we treat and pay our hospital staff. The Irish Nurses and Midwives Organisation, INMO, is having its conference today. The Minister is probably addressing it at some point. I do not know how he will be received, but if I was a midwife working under the current conditions - and my older sister has been a midwife all her life - I would be pretty angry with the Minister, because there is much stress, staff shortages and hardship that nurses and midwives have to face on a daily basis. I say we will be dealing with this later on because we will be dealing with the public sector pay talks that are coming up. One part of the solution to the future of maternity services in Ireland is to treat maternity workers properly and to pay them properly. That refers to midwives in particular. In that way, we should be able to recruit enough of them and to retain enough of them.

I want to address not just the issue of church and State and the question of St. Vincent's hospital and its future ownership, but the wider concept of what maternity and reproductive services should be about. I do not think it is just about mother and child. I think it is also about a whole range of services relating to our reproductive health that should be available to women. I mentioned one earlier on, the question of tubal ligation. It is not available in some hospitals in this country. It should be available. It is a simple procedure.

I would also like to mention the glaringly obvious fact that we are going to, in the next few months, hopefully deal with the outcome of the Citizens Assembly. That assembly has expressed the sentiment that we have to repeal the eighth amendment and start to deliver access to abortion services in this company. In that context, the ownership and control of maternity services is fundamentally important to the ability and the future of being able to deliver those services in this country. I would like to move the amendment put by People Before Profit-Solidarity. It is quite a long amendment, as most of them are that are before us tonight. It deals with a number of issues, including the failure of the Sisters of Charity to compensate the victims of abuse and neglect in their residential homes. It also deals with providing a spectrum of birth control services, including clear and quality information. I would like to ask the Minister, and maybe he could refer to it in his reply, when we can see and if it is possible to fast-track the Bill that is before us to do away with bogus abortion information clinics.

These are cropping up as a real problem for the women in our society who are in a crisis pregnancy and seeking guidance.

Bogus abortion information clinics, sometimes in receipt of State funding, are continuing to operate with impunity. They are not regulated. It is ironic that they are not regulated but information centres that give out real, proper, decent health information are indeed regulated. There is a Bill before the House on that and we should make every effort to try and fast-track it, if we are serious about dealing with women's reproductive health in all its aspects and not just in the narrow confines of mother and baby, which of course are extraordinarily important. I have many friends and neighbours who have been through the horrors of having to carry a dead foetus for many weeks under the Irish maternity service because of the fear of the eighth amendment. Some hospital specialists are never sure that the heartbeat is gone. They might be 99% sure but not 100%, and therefore the women have to carry the foetus for another few weeks until the doctors can be sure. It is mental and physical cruelty for the women involved. We have to move on and move into the 21st century. Our amendment addresses much of that.

I welcome many of the other amendments and motions as well. There are many similarities. What goes to the heart of this debate is the elephant in the room that we must not avoid mentioning, and that is the control of State services by the Catholic Church. I am sure that the Minister for Health, Deputy Harris, is probably tired of us mentioning this. He gave what I regard as quite a confusing answer earlier today. What he says is not what the bishops say, and it is certainly not what the Sisters of Charity say. Somebody is telling the truth and somebody is not. We need to get to the bottom of that.

The Minister is asking for a month. I dearly hope that the Irish people do not give him that month. We have waited too long for equality, for proper treatment for women in this country, and for us to be taken seriously so that the Catholic Church are no longer dominating our lives. I hope that the people of this country keep the pressure on the Minister and insist that the church have no say in the new maternity hospital. It will be wonderful once it is delivered, as long as the Sisters of Charity do not get a say on the board of management or any other aspect of that hospital. We need that copper-fastened, iron guarantee from the Minister. If he cannot give it now I worry that he might not be able to give it at all in one month's time. I hope that the pressure is kept up by the march next weekend by Parents for Choice - happening at 2 p.m. from Parnell Square for those who are interested in attending - and beyond that where parents are lobbying Deputies and insisting that we finally put an end to the interference of the Catholic Church in our maternity services.

7:25 pm

Photo of Clare DalyClare Daly (Dublin Fingal, Independent)
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Regardless of the justifiable public outcry over the handling of the new national maternity hospital and the prospective ownership of that facility being given to a religious order, this motion is incredibly timely. There is no doubt that our maternity services are in desperate need of reform. It is something that we need to discuss. The best response that the Government can come up with is that we compare favourably to other countries. Do we, and if so, which countries? I would not like to be compared to them.

Let us look at some of the facts. Between 2011 and 2013 there were 27 maternal deaths. These were otherwise healthy women who went in and lost their lives in childbirth or shortly afterwards. There were inquests in only three of those cases. In 2014 there were 365 reported cases of severe maternal morbidity, but our data is incomplete because not all of the maternity hospitals participated in that. Between 2007 and 2015 the HSE incurred a staggering €66 million in legal fees arising from maternity cases involving serious injury or death to women or babies. During the same period the HSE, through the state claims agency, paid out an even more staggering €282 million in damages in maternity cases. That is 116 times more paid out in legal settlements and fees than the extra €3 million that is being given to the new national maternity strategy. Unless that culture of litigation, denial, lack of accountability and lack of oversight is dealt with our problems will continue.

There is no doubt that one of the key reasons for our problems is the significant under-staffing level of midwives and doctors across the State. Meanwhile, reports and reviews into adverse incidents are either not made available publically or they are badly delayed. The review of adverse incidents in Portiuncula hospital, for example, was supposed to be available by mid-2015. We still do not have it. We did discover last week, however, that the hospital was carrying out a secretive review of care, with a doctor even ignoring advice and saying that he did not see the reason why there should be any review at all. We have to deal with these issues, because our maternity services are consistently running at sub-optimal levels, which is undoubtedly leading to trauma for women and their families and to catastrophic outcomes because of the lack of accountability and the completely inadequate and non-binding HSE open disclosure policy. What we need is a statutory duty of candour in order to deal with these cases. It is more than urgent. It is one of the reasons why I moved the Coroners Bill 2015 and why that is so critically needed, yet we still do not know whether the Government has passed a money message even though the Committee for Justice agreed more than six months ago that it would go to committee stage next week.

We need accountability and openness if our services are going to improve. The widowers who lost their wives and the mothers of their children can testify to the failures of our maternity services and the need to change. We know from the eight inquests held between 2007 and 2015 into the deaths of women in our maternity services that vital information was withheld. They were often not privy to internal investigations and reports until the HSE was ordered to produce them in public hearings by the Coroner's offices. Although hospitals and the HSE indicated that they would change procedures and protocols, those were not implemented and carried through. That is utterly devastating for those families. It is not an exaggeration to say that if the HSE recommendations issued on foot of the tragic death and inquest into the death of Tanya McCabe had been made enforceable national policy then Savita Halappanavar may not have died. If the inquest into Dhara Kivlehan's death had not been delayed for four years - she died in 2010 and the inquest was in 2014 - then Sally Rowlette, who died in 2013 in the same hospital of the same condition, leaving four children, may not have died. These are very urgent issues that need to be addressed. It shows systemic failures and a lack of openness in our system. We know that there are countries across the EU which have much better health outcomes than we have. We need proper audit and genuine open disclosure. We have to have automatic inquests into maternal deaths in order for maternity services to improve.

It is unforgivable that in this day and age that fetal abnormality scans are not available as a matter of course to women. The Minister has told us over and over again that all hospital groups offer such scans, but the reality is that the scans have to be implemented by doctors. Women outside of major centres have to travel, and the consequence is that abnormalities are not always picked up. It is not good enough.

I welcome the motion, but it does not go far enough. That is not a criticism, it is a point of observation. The national maternity strategy is far from flawless. The language in it is feeble. We talk about woman-led care, when there has been a deliberate decision not to have midwifery-led care because there is some seemingly mythical and highly polarised debate out there about midwifery care. I reject that. I would say that it is far more likely that expensive private obstetric practices are the ones who are worried about midwives. No one else is. Midwifery-led care is the way forward. In Scotland they have 18 free-standing or along side midwifery-led units serving a population the same as Ireland, yet we have two pilot schemes in Cavan and Drogheda.

There has not been a single sod turned to provide even one midwifery-led unit in Ireland, despite the national maternity strategy making promises on the issue over 14 months ago. The Scottish national maternity strategy provides that every woman will have continuity of care provided by a primary midwife who will provide the majority of her antenatal, intrapartum and postnatal care. The input of an obstetrician is an addition, but the provision of care is centred on the midwife, which is best for the State, health outcomes for women and the public purse.

The national maternity strategy is non-statutory, which is a huge problem. It is only the third national document on national maternity services since the early 1950s, but because it is non-statutory, it is not binding. We can refer to A Vision for Change which is a lovely vision, but it does not tally with the reality. The Government has one month in which to look at the maternity hospital and we will see what happens, but St. Vincent's University Hospital was built with public money. Is it not ironic that, in 1972, Noel Browne was questioning the funnelling of public money and cash into a hospital for the Sisters of Mercy? There should be no debate on this issue. It has to be sorted out as it is a public hospital which was built with public money and should be publicly owned.

7:35 pm

Photo of Michael HartyMichael Harty (Clare, Independent)
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I wish to concentrate on the National Maternity Hospital and the absolute necessity for a new hospital to replace the hospital on Holles Street which has outgrown its usefulness. St. Vincent's University Hospital is the ideal location for a new maternity hospital because there will be many add-on benefits from co-locating it there. Many pregnant women have diseases which are complicated by their pregnancy and many develop diseases because of pregnancy. It is essential, therefore, they have the expert services that will be available to them on site at St. Vincent's University Hospital. Nobody would argue with the location, but the care of pregnant women must be the central part of this debate, not the site or its ownership. The central argument should be about the best facility for the care of women. The mastership model is very important and must be retained as it will ensure clinical governance in the best interests of the patient. The mastership model should be extended to other maternity hospitals because it is the most efficient form of management. An increase in the numbers of obstetricians and nurses is absolutely essential also.

The ethos of the hospital is of absolute importance. It must be free from religious influence. In a modern multicultural society such as Ireland, the best standards of obstetric care must be followed within the governance of the hospital. They must be within the laws of the land, whatever they might be in five, ten or 50 years' time. The board must have clinical, financial and operational independence. We need to look beyond five years and even beyond 30 because the hospital will have a finite life and will not last forever. The Minister needs to work out a way to ensure the hospital will have no material value to the Sisters of Charity. It is within his competence to make sure the sisters will not be left with a disposable asset. We must have a modern functioning hospital on the site of St. Vincent's University Hospital, ensuring clinical governance in a secular and independent way.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
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There is a compelling need for a new maternity hospital which must be built as soon as possible. We need a modern hospital for mothers and children-to-be, built to the best standards in the world because the people of Ireland are entitled to it. I heard Deputy Michael Harty call for the maternity hospital to be co-located with St. Vincent's University Hospital, but I would have thought the maternity and children hospitals should have been co-located together, although somewhere more accessible than where the children's hospital is to be built at St. James's Hospital. Many would have thought that the edge of the M50 or the site of Connolly Hospital would have been more suitable. I am also of that view because there are deficiencies at St. James's Hospital in terms of access and parking facilities, among other things.

This issue has gone on for long enough and the hospital needs to proceed to construction stage as soon as possible. We look forward to the new National Maternity Hospital being built as soon as possible. The timeline is three or four years, but that seems long when one considers the state of the hospital on Holles Street which is clearly not fit for purpose, has outgrown its suitability and needs to be replaced.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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This is a very important issue and there is a lot of controversy, but, at the end of the day, the National Maternity Hospital is not fit for purpose. It is an excellent hospital, but the building is crumbling. It is about time people had a proper maternity hospital because they have been waiting a long time. I am sorry about the controversy that arose in the past few weeks which has upset a lot of people. Many people have strongly held views on the matter and I hope it can be sorted out. The main thing is that babies be delivered safely.

Photo of Michael FitzmauriceMichael Fitzmaurice (Roscommon-Galway, Independent)
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I support the motion. It is recognised across all parties and none in this House that there is a need for a good maternity hospital. We all agree that we need top services in Dublin, but they are needed in the different regions also. The hospitals in Ballinasloe, Galway and Castlebar also need proper funding to make sure mothers in these areas will have safe delivery. I am aware that this is a specialised area, but what has happened is a fiasco. Whoever it was in the Department who dealt with it was never at a fair because they did not know how to engage in a bit of horse trading to solve the problem.

I cannot understand how we cannot have a 100 or 200-year lease for €1 as the State should be well able to obtain it. Is there a problem with the site? Is it tied up with the other buildings or has money been borrowed against it for other parts of the hospital? Has the Minister tried to secure a lease for a minimal amount? That is a solution. If there is a problem which cannot be solved, I agree with Deputy Danny Healy-Rae that the National Children's Hospital and a good maternity hospital should be located next to each other. We should not have put all our eggs in one basket. There is still an opportunity, in the coming weeks, to hammer out a deal. We need the hospital urgently, but it should not be at any cost. We should acknowledge that St. Vincent's University Hospital has given good service.

7 o’clock

It has been brought into disrepute with an argument over something about which there should never have been an argument. If people approached it to be able to do a deal in the way I am suggesting, it could solve the problem.

7:45 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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I call Deputy Shortall who is sharing time with Deputy Eamon Ryan.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I commend Deputy O'Reilly and her colleagues on tabling this timely motion. There is no doubt there are many shortcomings in our maternity services. While the maternity strategy is to be welcomed, it is meaningless unless it is adequately funded and implemented. That process needs to be accelerated in order to bring our services up to modern standards and made fit for purpose.

I want to concentrate on the issues surrounding the proposed move of the National Maternity Hospital. While I have some sympathy with the Minister who inherited this situation, it is not acceptable in any circumstances to proceed with the transfer of ownership of the hospital as proposed. Based on what we know of the agreement brokered last November, transferring ownership of a €300 million State asset to private interests is utterly unacceptable to the public. People are outraged by that.

The composition of the board is not acceptable under any circumstances. It is proposed to have four, four and one, with the one expert person being appointed effectively by St. Vincent's Healthcare Group. By any standard the proposed board structure gives St. Vincent's Healthcare Group a five-four majority on the board. That is quite clear from the details of the agreement.

It is incomprehensible for people that the Minister is proposing to set up a new company that is wholly owned by St. Vincent's Healthcare Group. There is no justification for that and people are horrified. They cannot understand how that was agreed to.

On clinical governance, the diagram in the Mulvey report shows that the master of the National Maternity Hospital along with a number of other clinical directors will be answerable to the overall clinical director of St. Vincent's Healthcare Group, who in turn is answerable to the CEO of St. Vincent's Healthcare Group, who in turn is answerable to the board of the St. Vincent's Healthcare Group. Under no circumstances can that be considered clinical independence; it simply is not the case.

The Minister has been landed into this. He signed up to this agreement last November, which was a mistake. It was a mistake to welcome that agreement, as the Taoiseach also did. Now that the detail of that agreement has come out, it is utterly unacceptable to the Irish public. The Minister has been at pains to talk about various safeguards. He has talked about reserved powers and a golden share, neither of which will carry any weight in law under the terms proposed at the moment. There are big legal questions over whether there is such a thing as a golden share, but that can come into play only within the boardroom and the Minister will not be in the boardroom. The idea of a golden share is deceiving people. Perhaps the Minister has been deceived on that, but it does not carry any weight, nor do reserved powers. They have no meaning in a subsidiary that is 100% owned.

In a letter to The Irish Timestoday, I pointed out a severe constitutional impediment to having any kind of independence for ownership transfers to a religious organisation. I set out the clear grounds and the case law in this regard. The Minister talks about being solution-focused. I hope he will bring forward solutions within the next month, but those solutions cannot entail the transfer of ownership of the new National Maternity Hospital to any outside agency. This is a public hospital. It is publicly funded and should be publicly owned in its entirety.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I also commend Deputy O'Reilly on tabling this motion, allowing us the opportunity to present the arguments. There seems to be clear agreement that, as anyone who is acquainted with the Holles Street facility knows, the National Maternity Hospital cannot stay as it is and must move. Given the medical choices, St. Vincent's Hospital is the obvious location. Not only is it an excellent hospital in my experience, but co-location on that site allows for incredible efficiency and the ability to deal with patients in a far more effective way. I do not know any other site on which it would be appropriate to locate the new National Maternity Hospital.

There is also clear agreement on the need for medical independence. Central to this is the realisation that in all likelihood - it is up to the people - we will move towards a repeal of the eighth amendment to the Constitution. In any future system, we cannot completely legislate for every different eventually. The future arrangements will need to put the centre of responsibility in the relationship between the mother and the doctor, and give them the capability to provide the best service to the mother. In those circumstances we have to be certain of the medical independence of that doctor to provide for the mother.

Likewise, I have not heard a single dissenting voice from anyone who does not believe the hospital must be in complete public ownership. That should involve not the creation of a lease arrangement but rather the transfer of ownership of the site to the State so that there is no uncertainty or lack of clarity on the ownership. Along with a number of other Members, last week I pointed out that the mission of the Sisters of Charity surely now lies in the work they are doing in combatting the trafficking of women, in addiction counselling services, in climate change, in caring for the poorest of the world where they are active, and not in the ownership or running of a general public hospital. In those circumstances they should be gifting the site for this hospital to the State.

I agree with the Minister that we need to go beyond that and look at the wider issue of ownership of our hospitals which has been built up in a haphazard way with a range of different ownership structures, with approximately 20 public hospitals in the care of a variety of religious orders. As we go through this process we should be looking at mechanisms to arrange for the transfer of ownership. It is time for the State to step up, to manage and to accept its responsibilities. In the past that was not the case and it is now time for us to do that. Included in this process we must ensure we have ownership of those hospitals.

I add two other elements that have not been considered. One is the issue of the private or public nature of this hospital. I disagree with Deputy Harty; I have concerns over a master-led system. What I have seen of our National Maternity Hospital is that it is master led. Part of that involves highly lucrative well-paid positions for masters who run a private system to their own benefit. I have serious questions and concerns over creating a new National Maternity Hospital that will replicate a private facility within a public building; that should be just as much an issue of concern.

We also need to look at the nature of the service, based on the history of the active management system. I am not an expert; as a man, I cannot speak with any real authority, but those I trust and care for do. There are questions about the master system which was all about the doctor and not about the patient or the midwife. That active management system should be also called into question as we review the National Maternity Hospital. Let us have a public hospital of which we can be proud in every way, caring first and foremost for and centred on the patient and the doctor-patient relationship we need to provide for today.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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I call Deputy Cullinane, who is sharing time with Deputies Jonathan O'Brien and McDonald.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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It is difficult to understand why the Government even tabled an amendment to our motion. In the first instance the motion simply acknowledges failures which even the Minister agrees have existed in our maternity services for a number of years. I will not recite them; they are listed in the motion. It also acknowledges and supports the findings of various independent reports, which I am sure the Minister will also accept. It further acknowledges commitments given in the programme for Government and commitments made by the Government itself. It then calls on the Government to do things on which, as Deputy Eamon Ryan has said, there is broad agreement in the House. If there is broad agreement, why have the Government and the Fianna Fáil Party tabled amendments? I cannot understand that because I think the motion is straightforward.

The only reason I can come up with is that the Government has a difficulty accepting a motion calling for complete separation between the State and the Church on maternity services.

We cannot have a situation in which any religious congregation or order has any level of control of any maternity service in this State. To me, that seems to be the problem for both Fianna Fáil and Fine Gael on this issue. That is for them to answer, but we in our party are very clear that for all of the right reasons, which many Members across all parties have articulated, there simply cannot be any situation in which any religious congregation can have any level of input or influence in the running, management or ownership of any national maternity hospital.

In the short time I have, I wish to quickly deal with staffing problems for nurses and midwives in maternity services, as well as in our hospitals generally. It is an area and an issue that is preventing public health services from delivering the level of service that people need. We see wards being closed in hospitals across the State. We know there is a shortage of midwives and nurses. The Irish Nurses and Midwives Organisation have published report after report and figure after figure that show that we are spending much more money on agency staff because we are simply not employing the front-line staff that are necessary. We know that when Fine Gael came into power in 2011, €127 million was spent on agency staff. That has doubled over the last number of years. That is not just spent on nurses; it is also spent on midwives. That is a real problem as well. We want to make sure that the women of Ireland have the best possible maternity services. We want to ensure that the resources are being put into the system.

I have been told by my colleague that Fianna Fáil will be withdrawing its amendment. I welcome that because I believe there should be all-party support for this motion. I know one of my colleagues wants to come in so I will finish by calling on the Government to also withdraw its amendment. Why not send a clear message out from this House - Government and Opposition - that we want the best for the women of Ireland, the best possible maternity services and the complete separation of church and State? In the Minister's absence, I was pointing out that the Fianna Fáil party has withdrawn its amendment. Why can the Government not do likewise? What is so objectionable in our motion that the Government cannot support it? Would it not be better if a strong, coherent and consistent voice came from this Dáil that we want to do the best we possibly can for the women of Ireland and have the best possible maternity services, which is all this motion does? I commend my colleague, Deputy O'Reilly, for tabling the motion in the first place.

7:55 pm

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
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I will begin by thanking and commending our colleague, Deputy Louise O'Reilly, for tabling this motion and for doing so at this time. I think we are in agreement, despite the fact that we have regularly commended ourselves for having the best maternity services in the world - it almost became like a catch-cry or a matter of national honour - that there are massive deficits and shortfalls within our service provision. This motion sets all of that out: the shortages in consultant obstetricians and other specialist staff; the operational deficits in midwifery staff; the operational deficit of a magnitude of 17% in the Dublin maternity hospitals; and the lack of fetal anomaly screening, which has been referred to. I also want to register and recognise the lack of perinatal psychiatrists. There are only four, as we know, to cater for the entire State. I believe there are part-time positions in addition to that.

We know from the statistics - though these are never just matters of statistics, these are pregnant women - that 16% of women attending maternity services are at probable risk of depression. These statistics are from the Well Before Birth study. We know that risk of depression increases as pregnancy advances. Some 12.9% of women are at risk in the first trimester, 13.8% are at risk in the second and 17.2% are at risk in the third. We know, of course, that for many women post partum after delivering their babies, it is not merely a case of the baby blues. We can have full-blown post-natal depression, which is a most debilitating condition.

I welcome the fact that the Minister has commended and extolled the virtues of the maternity services strategy. While we have a strategy, I want to reiterate that we had a strategy for mental health service provision way back when called A Vision for Change. The thing about these strategies is that they have to be resourced, driven and delivered. There is much work to do.

The motion makes reference to the really horrific circumstances of mother and child mortalities or injuries. It cites Portiuncula University Hospital, University Hospital Galway, Portlaoise, Cavan and Drogheda. There was a time when week on week and month on month one waited in the horrific expectation of another bad story from our maternity services for the women of Ireland.

These matters are matters of women's health. In very real terms, they are matters of life and death in many instances. They are also about choice. They are about women's choices, decisions, autonomy and capacity to make decisions for ourselves in partnership with medical practitioners. In that regard, I come to the issues of ownership of the new maternity hospital at St. Vincent's. It is entirely outrageous and unacceptable that the Minister would come to the floor of the Dáil in the year 2017 and make the statement he made earlier welcoming the confirmation by the board of St. Vincent's Healthcare Group that any medical procedure that is in accordance with the laws of this State would be carried out at the new hospital. The Minister might ask why I would cite that as outrageous. It is entirely unacceptable in this day and age and at this time that the Minister would require such a confirmation from the board of St. Vincent's Healthcare Group. It has to be taken as an absolute given that services in accordance with the law are provided in publicly-funded hospitals. Sin é.

There is a bigger question about divestment across the health services, but we need to start with this hospital. I have lost count of the number of women in particular who have asked me why in the name of God the Catholic Church would want to own, control or even influence a maternity hospital. That is the question out there. In addition, I have lost count of people who have said to us collectively as Members in this House to make sure that does not happen. The history of interference and of religious dogma blinding good medical practice is writ large. The cost of that policy was very high for women in this State. To this day, it remains a problem for us.

I welcome the fact that the Government is in fact withdrawing its amendment. I am very glad to hear that we will have cross-party agreement on this matter. If nothing else, we can credibly and collectively give a response to the public that we have heard what the public mood and view is. That is for first-class health care for our women without interference of ideology or dogma and for women to come first.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I want to thank everybody who has contributed and who will contribute to what I believe has been an important and good debate. I just want to pick up on a few points. I will begin with the issue of safety. This is an issue that many people have raised throughout the debate. Safety is and must remain an absolute priority in our health service in general. The Department and the HSE continue to work together to make improvements in this regard. I referred earlier to the monthly publication of the maternity patient safety statements. In terms of wider patient safety developments, last December I launched a new national patient safety office. This is an office located within my Department to prioritise and drive patient safety work in this area.

I have directed the office to work on a range of initiatives including new legislation, the establishment of a national patient advocacy service, the measurement of patient experience, the introduction of a patient safety surveillance system and extending the clinical effectiveness agenda. Within the programme of legislation, it is intended to progress the licensing of our public and private hospitals.

I want to pick up on the point raised by Deputy Daly about why we do not say it is midwifery centred. I refer her to page 3 of the strategy which states that the mother is at the centre of the strategy. We have avoided as far as possible professional-centric terms such as consultant-led or midwifery-led as they incorrectly place an emphasis on the profession rather than on the woman. In future, maternity care in Ireland will be provided in an integrated manner by a multi-disciplinary team with women seeing the most appropriate professional based on their need.

At its core, the agreement that has been mediated by Kieran Mulvey between the two hospitals ensures and endeavours to ensure a full range of health services. We have heard the master of the maternity hospital and the former master, Professor Keane, on this. I welcome and acknowledge on the record of the House the further confirmation by St. Vincent's Healthcare Group that any medical procedure in accordance with the laws of the State will be carried out in the new hospital. I have made it clear that I want to use this month to further engage because I have heard public concern about this. I expect to have further details on the legal and other arrangements envisaged and will make available that information to the House and to Government. I hope this will allow the necessary clarity on the issues of concern that have been raised in advance of any contractual or other commitments being entered into in respect of this agreement. I have heard a lot of people talking about secret agreements. I refer people to the Department of Health's website and a statement on 24 November which was published when the announcement was made by the Taoiseach and me. It talks about much of the detail people are raising in the House. People are right to raise it but on 24 November much of that information was published.

It is also important to talk about the process to date. If this were straightforward one would suggest many people would have done it. I am not afraid to address this issue and to work with people in the House and in both hospitals to make sure we get this right. We have two voluntary hospitals. People talk about the national maternity hospital as a publicly owned hospital. It is a voluntary hospital. Legally the Archbishop of Dublin is the chair of that hospital. He does not play an active role but legally he is its chair. There are a number of religious people on the board of the national maternity hospital. The Minister of the day has no such golden chair or veto. It is important that we look at this in the context that two voluntary hospitals have to come together to deliver a new national maternity hospital. We had three mediation processes, two of which predate my time in this position. It is important to acknowledge we have an agreement between two hospitals; we do not have the legal and contractual arrangements in terms of the running of the new hospital. We have the document to which the hospitals have signed up. This is how they envisage working together. There is now an onus on the State and me to try to put in place the legal and contractual arrangements. We are not talking about just building a hospital. When we talk about co-location we are talking about two hospitals working together. We are talking about sharing ICUs, high dependency units and consultants. We are talking about a woman in need of emergency care going down a corridor bringing her from a maternity hospital into an adult acute hospital. It is appropriate for the adult acute hospital to want input into patient care and arrangements in terms of the overall running of a campus. It is important to say that.

In response to Deputy Kelly, I am terribly consistent on these matters. The issues I raised at the Committee of Public Accounts on St. Vincent's is exactly what we are making sure will not happen. We now, as a State, put in place liens so that a hospital cannot mortgage or borrow off buildings in which the State invests. That is right and proper. There is space to further examine the ownership issue. I have been very clear about that. There are a number of creative issues that can be looked at in that regard, including the issue of a long-term lease.

On the issue of clinical independence, it is important to say the agreement states it in black and white. People talk about church and religious interference. The agreement states there will be no religious interference. It is there in black and white. It is my job to make sure it is absolutely copperfastened in contractual and legal arrangements. I am entirely committed to that. Let me be very clear when speaking to the women in this country. We will not build any hospital that does not provide women with access to every health service they need today and any services that may be legal in this country in the future that are not currently legal. I cannot be clearer than that. The full range of services and full clinical independence will be provided at this hospital. People said the Protection of Life During Pregnancy Act would not be implemented in a number of these voluntary hospitals. We now see it is not the case. We will make sure we get this right. There has been a broader conversation. It is important. Deputy McDonald said sin é and I get the point she makes. When we say sin é, at least 15 of our hospitals today are voluntary hospitals. I pose this as a question rather than something to answer this evening. Are we now saying as a country that if we invest in any voluntary hospital we must own the asset? If we are saying that, it is not without consequences. It is a conversation we need to have. We need to have it in the responsible structured way we had the conversation on education in 2012 with the forum on pluralism and patronage. I intend to bring proposals on this to Government in the next month that I hope can facilitate a conversation that quite frankly the country is already having and that we in the Oireachtas and Government need to participate in.

I could pick holes in elements of the Sinn Féin motion and we could debate them politically back and forth and debate the numbers and the OECD numbers but in the interest of bipartisanship I will not. It is an important issue and in the interest of the House wanting to send a message that collectively we are committed to working together to improve our maternity services and that we want to see the issue of ownership addressed in the conversations my Department will now have with the two hospitals, I will withdraw my amendment.

8:05 pm

Photo of Denise MitchellDenise Mitchell (Dublin Bay North, Sinn Fein)
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Like many other Deputies in this Chamber, I have been contacted by members of the public who are deeply angry and upset at the mess surrounding the new national maternity hospital. Let us be very clear - it is the job of the State to provide health care to all its citizens based on need. There should be no non-medical interference in that process. Treatment should be based on the needs of the patients within the laws of the land. End of story. How can the Government justify spending €300 million of taxpayers' money on a maternity hospital and then simply hand it over to a religious organisation? The claim by some that the Sisters of Charity must own the hospital because it is built on their land is pure and utter rubbish. There are many options open to the Government if only it would show a bit of back bone. The Department of Health seems to be all over the shop on precisely what treatments would and would not be available. For example, most people find it absolutely outrageous that the availability of a standard procedure such as IVF is being brought into this debate. The view of Sinn Féin is that this hospital is desperately needed. Our maternity services are overcrowded and understaffed while our facilities are crumbling. The new national maternity hospital should be built as soon as possible. Having said that, the Government must ensure the new national maternity hospital remains entirely within public ownership and that the Sisters of Charity have no part in the running of this facility. The concerns of the citizens around the governance of the hospital have to be fully addressed because the women of Ireland will accept nothing less.

Photo of Gerry AdamsGerry Adams (Louth, Sinn Fein)
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Tá mé buíoch as an deis labhairt ar an rún tábhachtach seo. Ba mhaith liom mo chuid buíochais a ghabháil le Teachta Louise O'Reilly as ucht an rún a chur faoi bhráid na Dála. Iarraim tacaíocht ó achan Teachta don rún os ár gcomhair. The decision by the Government to give ownership of the new national maternity hospital to the Sisters of Charity has justifiably manifested itself in massive public concern and anger particularly, though not exclusively, among women.

It is unacceptable that any religious ethos should determine clinical decisions. The hospital should be held in public ownership and have legally guaranteed independence from all non-medical influence in its clinical operations within the laws of the State. This is a hospital which must carry out treatments such as in vitrofertilisation, IVF, sterilisation, gender reassignment surgery and, in some cases, termination. The notion that the Sisters of Charity must be given ownership of the hospital simply because they own the land is absolute nonsense. There are, as others have said, other options available to the Government and this motion, which will now be passed, will compel the Government to explore these options.

The priority must be to get the hospital built as soon as possible on terms acceptable to citizens, particularly women. We cannot continue with a situation where women and babies are treated in antiquated buildings that are not fit for purpose. Equally, we cannot continue with the situation where our maternity hospitals are operating at dangerously low staffing levels, where women are treated on corridors and where overcrowding and a lack of resources result in tragedy and upset. That is why a key component of this motion is to ensure that the national maternity strategy is implemented and properly funded.

The Minister for Health now needs to act with the utmost urgency to sort out the mess that surrounds the national maternity hospital. I acknowledge his remarks this evening and look to him to deliver on his commitments. I also welcome the withdrawal by the Government of its amendment to this motion.

I met Ms Vera Twomey this evening who is hoping to meet the Minister for Health. I appeal to the Minister to meet her, even if only for ten minutes before he leaves the House this evening. The Minister is a decent person and he should not leave these premises without speaking to this woman, even for ten minutes.

8:15 pm

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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I will begin by acknowledging the cross-party support for this motion, which sends a fairly clear message to women and indeed, to men. Perhaps they get a hard time sometimes but one gets the feeling that they made a lot of the rules that we are trying to undo at the moment. I have to say that for an order that takes a vow of poverty, chastity, obedience and service to the poor, the Sisters of Charity appear to have a fixation with property ownership and control. That is entirely a matter for themselves but I believe it is a little odd.

It is 34 years since Sheila Hodgers died in Our Lady of Lourdes Hospital. I knew Sheila, although I was very young when she died. Her death certificate will say that she died of cancer but she did not. She was killed by an ideology. The hospital did not treat her when she was pregnant for the cancer that was killing her. She died, her baby died and her husband was left bringing up two children on his own. Some 34 years on, not much has changed. The hope that we have when we leave here this evening is that real change will happen for Irish women and that no more will I have to stand here and repeatedly raise the issue of the lack of access to anomaly scans. It is not good enough that a post code lottery operates whereby a woman living in one county can, in some circumstances, access such a scan while a woman who lives in another county cannot. We have all seen the result of that. I have spoken previously about Jazmine Sands's loss of her beautiful baby girl. While an anomaly scan would not have saved her, it would have given her mam the opportunity to spend a bit more time with her daughter before the inevitable happened. It is for that reason and for the countless other tragedies, many of which will never see the light of day or get any publicity, that it is essential that anomaly scans, which are considered an absolute basic in any developed maternity service in any developed country, are made available. I emphasise the fact that these are screening tests which should be available to every pregnant woman not just where clinically indicated, but as a matter of course and routine.

We have heard this evening about the shocking lack of perinatal psychiatric services for women. As Deputy McDonald correctly pointed out, it is not the "after baby blues"; it is depression and we need to call it what it is. Just because it happens to a woman when she is pregnant or very soon after she gives birth does not mean that it is different or any less awful or horrific for her. We must improve the services that are available for those women who are in absolute torment and who need all of the support we can give them. This evening, we have collectively sent a very clear message to women that we can stand with them and support them. Rather than patting ourselves on the back, saying that we are doing a great job, we are showing here that we can be mature enough to acknowledge that we have let women down. I have seen that in my own family. We have let women down with the maternity services that we are providing. If we acknowledge that we have let them down and that we can do better, the women of Ireland will thank us for having this conversation. More than that, more than thanks for fine words, they will thank us for taking action and for providing the services that they so badly and desperately need.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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That concludes the debate. While I understand there is unanimity in the House, I must deal with the various amendments to the motion, the first of which is the Government amendment.

Amendment, by leave, withdrawn.

Amendment No. 2 not moved.

Amendment No. 1 to amendment No. 2 not moved.

Amendment No. 3 not moved.

Motion agreed to.