Lisa Chambers (Mayo, Fianna Fail)
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The issues at the maternity unit in Mayo University Hospital have been ongoing for a number of years. Continued underfunding and understaffing at the hospital have created considerable risks for patients and their babies. That is what staff told me today. This came to a head last November when midwives at the maternity unit took part in a lunchtime protest outside the hospital. Some of those who protested are long-serving midwives with extensive experience in their field. It was not an easy decision for them to take but they felt so strongly about the situation and the risks being posed to mothers and babies in their care that they felt they had no choice but to take strike action. One can only imagine how difficult things must be in the maternity unit to prompt such action by experienced midwives and nurses. The Minister of State can be guaranteed that they had exhausted all avenues open to them to have their concerns heard by hospital management and the HSE. Their voices fell on deaf ears and it was not until they publicly took to the streets that hospital management and the HSE sat up and took notice, as did the wider public who are now very much aware of the issues at their maternity unit.

At the time of the aforementioned protest, I raised this issue in this Chamber with the Government but to date, the Minister for Health has done absolutely nothing to address it. Has the Minister even met hospital management at Mayo University Hospital to discuss the staffing crisis at the maternity unit? If not, why not? Following on from the strike, unions and hospital management engaged with the Workplace Relations Commission, WRC, in an effort to resolve matters. They met in February this year and again approximately one month ago. It is my understanding, having spoken to staff, that at the last meeting both unions and hospital management agreed there was an issue with staffing in the maternity unit. Due to nurse shortages in theatre at the hospital, midwives are regularly being called away from the maternity unit, where they are needed, to do jobs in theatre. This is coupled with the fact that there is not enough staff in the maternity unit in any event to cover maternity leave and sick leave. Moreover, the hospital's inability to attract nursing staff to take up posts has meant that the maternity unit is operating below safe staffing levels. I am relying on the expertise of staff members, who are adamant that they need more midwives and nurses at the maternity unit. Unions and hospital management are due to meet again at the WRC on 8 June in the hope of finding a solution. I am told that hospital management would hire temporary staff but it cannot get anyone to take up those posts. Mayo University Hospital is competing with other hospitals for staff and it appears that the types of contract being offered are not enough to entice staff to take up positions at the hospital. It is clear that the HSE needs to offer better contracts to midwives and nurses and to improve working conditions.

The Minister for Health must engage personally on this matter. It is not okay for him to abdicate responsibility. It does not matter that the WRC, the HSE and management are engaged because the Minister is ultimately responsible for this issue. It is imperative that he engages on this matter. We saw strike action seven or eight months ago but to date the Minister has not engaged. The fact that he has done nothing to address the staffing shortages is totally unacceptable. What steps will the Government and the Minister for Health take to address this issue? What steps will be taken to engage with hospital management and staff to ensure that the WRC process results in additional staff and resources for the maternity unit? At the end of the day it is mothers and their babies who are suffering. The fact that this has been widely publicised is creating massive concern among those women who will be going into the maternity unit in the coming weeks and months to deliver their babies. It is essential that we, as public representatives, ensure that the service they get at Mayo University Hospital meets their needs.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputy Lisa Chambers for raising this important matter, which gives me the opportunity to update the House on the position regarding staffing levels at the maternity unit at Mayo University Hospital. I have been informed by the HSE that the staff allocation levels at Mayo University Hospital have not been reduced. However, a number of posts are vacant through unexpected sick leave, maternity leave and retirements. As I understand it, some of these vacancies have already been filled and work to fill the remaining vacancies, both on a permanent and temporary basis, continues. I have been assured that all shifts are reviewed on a daily and weekly basis and set staffing levels are in place to ensure safety.

I should also mention that proposals agreed at the WRC between the Departments of Health and Public Expenditure and Reform, the HSE, the INMO and SIPTU have committed to increases in the HSE’s national workforce plan for nurses and midwives in 2017. Management will increase the nursing and midwifery workforce in 2017 through a broad range of initiatives that will result in the delivery of 1,208 additional permanent posts, including the conversion of agency staff to HSE direct employees and offering all graduating nurses and midwives full-time contracts. This is in addition to the many other initiatives currently under way to improve nursing and midwifery staffing levels throughout the country. The number of nursing and midwifery staff increased by 113 whole-time equivalents from the end of March to the end of April. Numbers increased by 625 whole-time equivalents between the end of April 2016 and April 2017. I am delighted to confirm that the overall number of nursing whole-time equivalents is at the highest level since 2011, with numbers increasing since 2015 notwithstanding intense global competition for our nurses and midwives. The HSE’s national recruitment service is actively operating rolling nursing recruitment campaigns. Recruitment open days were run over Christmas and more recently in March. In addition, a HSE delegation attended health sector jobs fairs in London and Cardiff, with further recruitment events scheduled in early June.

The Deputy can be assured that this Government is fully committed to the progressive development of our maternity services. Last year saw the publication of Ireland’s first ever national maternity strategy, as well as the HSE’s national standards for bereavement care following pregnancy loss and perinatal death and HIQA’s national standards for safer, better maternity services. In addition, each of our 19 maternity units is now publishing a maternity patient safety statement on a monthly basis. I am sure Members will agree that these developments represent key building blocks to enable us to provide a consistently safe and high-quality maternity service. The HSE’s national women and infants health programme is currently developing a plan for the implementation of the maternity strategy. In that context, the programme is engaging with the Saolta University Health Care Group to scope out its requirements. I look forward to receiving this plan at the end of June.

Lisa Chambers (Mayo, Fianna Fail)
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With respect, the Minister of State did not answer my question as to whether the Minister for Health has directly engaged with hospital management at Mayo University Hospital about the staffing crisis at the maternity unit. I would appreciate an answer to that specific question.

The Minister of State said that staffing levels have not reduced but that there were vacancies due to unexpected sick leave, maternity leave and retirements but such things are not unexpected. There will always be sick leave, maternity leave and retirements in the workplace. These are natural rather than unexpected events and we should be dealing with them and planning for them. The Minister of State has given a broad overview of the national picture but has not really addressed the issues specifically relating to the maternity unit at Mayo University Hospital. Midwives working at that unit have told me that they are nervous going into work in case something goes wrong and they do not have the staff to deal with it.

All they want is proper resourcing for the maternity unit so they can do the jobs the mums and babies need them to do. They want Mayo University Hospital to have parity with other hospitals, but it currently does not have that status. They have said to me that if something goes wrong and a baby dies - nobody wants to see this happen - the midwife, rather than the head of nursing or the general manager, is scrutinised. No one asks how many patients were on the ward at the time, how many staff were in operation or whether midwives were being asked to do the impossible. Midwives deserve far better than this.

I have been contacted by women who have given birth at the hospital in recent times. One lady recounted to me that just two months ago, the midwife who delivered her baby had to run off to the next room to deliver another baby because not enough staff were present. Another lady told me that a midwife was not able to be present when she was giving birth because she was next door delivering twins. She admitted that when the nursing staff told her to hold on because the midwife needed to be present, she used quite colourful language to say that holding on was not an option. I am not making a comedy out of this. I am setting out the reality of what is happening. It was not the midwife's fault that she could not be present because she was next door dealing with another delivery. Additional staff should have been on site. There were no complications in this woman's case, thankfully, but what would have happened if - God forbid - there had been complications? The negativity surrounding our maternity services nationally leaves a lot to be desired. The Minister of State did not address the specific difficulties at Mayo University Hospital. She did not answer my questions. I would like to know whether the Minister for Health has engaged personally with this matter.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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If Deputy Chambers wants a specific question to be answered, she should ask it specifically.

Lisa Chambers (Mayo, Fianna Fail)
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I have asked this specific question yesterday and again today.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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Excuse me. The Deputy did not ask it in her Topical Issue. I have the text of the Deputy's Topical Issue right here. The question she says was not answered was not asked in that text. If she wants a specific answer, she should include it in the text of her Topical Issue so that a specific answer can be obtained. In the meantime-----

Lisa Chambers (Mayo, Fianna Fail)
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That is quite pedantic.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I did not interrupt the Deputy, so I would really appreciate an opportunity to answer without interruption. I am hearing quite a lot of negativity from the Deputy about her local hospital. I think it is very irresponsible to create an impression that it is an unsafe place for people to attend to have their babies delivered. I have no doubt that the people who are working there are extremely competent and well capable of delivering babies when required. It is absolute nonsense to suggest we are abdicating our responsibility. The recruitment that the HSE is telling me it is doing is happening across the country. We are facing a national recruitment challenge that is not specific to a particular hospital. Having said all of that, I do not need to tell Deputy Chambers that the HSE delivers services on behalf of the Government. It is responsible for this. It gives us answers to explain what it is doing, or attempting to do, in areas like recruitment. The Deputy might not like what I am saying, but all I am doing is setting out what the HSE is telling me it is doing. The HSE has advised me that it is determined to fill these positions so that it can continue to help the women of the area in question to deliver their children in a safe manner, as they are used to doing.

Lisa Chambers (Mayo, Fianna Fail)
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On a point of order, to suggest that I am "irresponsible" for raising a genuine concern that has been brought to my attention by midwives working at Mayo University Hospital smacks of the arrogance of the Government.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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No, please Deputy.

Lisa Chambers (Mayo, Fianna Fail)
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It is really unacceptable. I ask the Minister of State to withdraw that remark.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Let us not get into that sort of thing.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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You said it. I did not say it.

Lisa Chambers (Mayo, Fianna Fail)
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You called me "irresponsible". You said it.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I just said it is "irresponsible" for Deputies-----

Lisa Chambers (Mayo, Fianna Fail)
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Check the record.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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-----to create the impression that people are-----

Lisa Chambers (Mayo, Fianna Fail)
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Check the record.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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Check it yourself.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputies, can we restore a little order please?