Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I thank the Minister of State for coming to the House to deal with this important issue, which concerns the midwifery-led unit in Cavan General Hospital. I am sure he has been briefed on the background to this unit, which was established back in 2004. Sixteen years on, it has delivered many babies to many happy mammies and daddies across the Border region and the midlands area.

In 2016, the national maternity strategy was launched and, as part of that, there was huge emphasis on promoting the importance of midwifery-led units. The strategy clearly states that there should be an emphasis on supported, assisted and specialised care pathways for maternity services. Its key goal was to develop an expansion of midwifery-led services. I cannot emphasise enough the importance of this service, not only to Cavan General Hospital but also to the whole of this island. If we are to make a comparison with the North, it has eight midwifery-led units whereas we have just two in the Republic. As I said, the first was established in Cavan General Hospital in 2004 and then a second unit was developed at Drogheda. I understand both units are out the door with bookings from eager parents and expectant mums and dads who want to use the service. We know the service is extremely professional and is an holistic and unique, natural pathway of care for parents.

It was disappointing that, in June, deep concern was raised that the service might be in any way diminished or pared back because, as I said, it is a very significant part of the maternity services in Cavan General Hospital. This came about in a very curious way and in a way that any of us would find concerning. It did not come in writing and nobody can tell me who gave the order, or anything like that, but a directive was given last June to staff within the midwifery-led unit to stop taking bookings. I raised this at the time with the then Minister for Health, Deputy Harris, and he picked up the phone and met with the midwives in the hospital. He gave them assurances that it certainly was not part of his or his Department's plan that there be any diminution of service in the midwifery-led units.

At the time, the Department requested a review of the service and I hope any review would seek the expansion of the capacity of the service. As I said, there are only two such services in the Republic and, therefore, the significance and importance of this cannot be overstated. In June, when there was concern that the service might be in any way diminished and the Minister got involved, the directive that had been given evaporated. While all of us would say that was a good thing because it removed the uncertainty for the staff and parents, nonetheless, the review was left hanging there. Clarity, guidance and direction are needed in terms of where that is going, what is its purpose and who has requested it. As I said, the Department seems to have taken this route after that particular incident in June. The review was promised for the end of September and it is now November, but the review has not happened or has not been published. I hope that, today, the Minister of State will be able to provide clarity on that.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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First, let me thank the Deputy for raising what I know is a very important issue. I fully understand how important the midwifery-led unit at Cavan General Hospital is to the women and families who access maternity care there. In that regard, on behalf of the Minister, Deputy Stephen Donnelly, I would like to commit to ensuring that midwifery-led services will continue to be available at the hospital.

Last June, the Department of Health became aware of reports in local media referring to the planned merger of the midwifery-led unit and consultant-led services at Cavan General Hospital. The Department was not advised of any intention to merge the services at the hospital or, indeed, of any intended change to the arrangements that had been in place. I should be clear that the programme for Government contains a firm commitment in respect of the implementation of the national maternity strategy. Therefore, current Government policy is to provide and expand midwifery-led maternity care right across the country, including in Cavan.

I should remind the House that budget 2021 provided new funding of €12 million for maternity and gynaecology developments. This significant funding will ensure a renewed impetus to the implementation of the national maternity strategy and the roll-out of the new model of maternity care. In particular, the funding will help to build capacity in the maternity services workforce and further develop community-based midwifery services.

With regard to the situation in Cavan, the Deputy will recall that the Department requested the national women and infants health programme to engage with the RCSI Hospital Group to provide a report on the matter. Assurances were also sought that maternity services within the RCSI Hospital Group are, and will continue to be, developed in line with Government policy. The Department has recently been advised by the HSE's chief clinical officer that the RCSI Hospital Group has undertaken an initial assessment of the Cavan midwifery-led unit. I understand that the findings of that assessment indicate that if the service is to continue and, indeed, expand, the input and support of a senior external clinician will be required. I am pleased to confirm that a clinician has been identified from within the existing Rotunda Hospital consultant complement and will commence working and attending at Cavan General Hospital for an average of two days per week in the coming months. In the meantime, the Department has been assured that the midwifery-led service will continue operating as normal and that bookings are being accepted from women wishing to avail of it.

I assure the Deputy that the Department will work with the national women and infants health programme to ensure that any additional supports required to secure and expand community midwifery services in Cavan will be put in place. This will ensure that midwifery-led services at Cavan General Hospital are supported, strengthened and expanded, in line with the national maternity strategy.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I thank the Minister of State. I cannot help having a suspicious mind as to why a review is being held in the first place.

That said, the Minister of State's response is welcome. I sense that he, the Minister for Health and the health team are fully behind the midwifery-led unit, and that is clear in the response. This is an issue I feel passionate about. This is a terrific service which provides an option for women in maternity care, not just in County Cavan but throughout the Border region and in the midlands. As the Minister of State knows, it is Government policy to roll out midwifery-led units throughout the country. I have always had a sense that the midwifery unit in Cavan General Hospital does not have the support it should have, the backing the staff need or the promotion it deserves. I hope the Minister of State, Minister for Health and Department will do everything they can to close gaps that exist in terms of promoting the service, informing women and encouraging GPs to inform women to consider it as an option. It has been my sense heretofore that that has not been the case.

As is evident from the national maternity plan, and as the World Health Organization has stated, midwifery-led units provide good maternity care. I am all for women having options. There are eight midwifery-led units in the North. We should have quadruple that number on the island of Ireland. I will fly that flag for women in this country.

The Minister of State's response is welcome. I will follow up with him and the Minister for Health to ensure extra staffing is in put place to benefit the midwifery-led unit in Cavan General Hospital. I encourage the Minister of State to do anything he can to ensure the unit gets the support, backing and promotion it deserves because the staff there are second to none.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputy for her passionate work and support on this important issue. Much good work has been done since 2004. The programme for Government commits to the implementation of the national maternity strategy, which recommends the development and expansion of midwifery services through the provision of a midwifery-led model of care within a multidisciplinary team for pregnant women deemed to be at normal risk. Good progress has been made since the strategy's publication in 2016, with midwifery-led care and community-based maternity services increasingly available across the country. The significant funding provided in budget 2021 will facilitate the further expansion of midwifery services next year.

I assure the Deputy that the Department and Minister will work closely with the national women and infants health programme to ensure that any supports required to secure and expand community midwifery services at Cavan General Hospital will be put in place. This will ensure that midwifery-led services at the hospital are not only supported and strengthened but expanded and developed in line with the national maternity strategy.