Michael Ahern (Cork East, Fianna Fail)

I thank the Senator for raising this matter on the Adjournment. I will be responding on behalf of the Minister for Health and Children, Deputy Harney.

The Minister supports choice for women in childbirth. However, the option of domiciliary births must be provided in a safe and secure manner. A national implementation committee on domiciliary births has been set up by the HSE to implement the recommendations of a 2004 report on domiciliary births. The committee has set up four sub-groups dealing with selection criteria and evidence base; legal, indemnity and grants; training and support for midwives; and development of maternity services. Membership of both the national implementation committee and the sub-groups includes key stakeholders from the HSE, primary community and continuing care, the National Hospitals Office, population health, HR specialists, consumers of the service, midwives, obstetricians and neonatologists as well as the State Claims Agency, and the Department of Health and Children.

There are approximately 19 midwives practising independently and they attend 200 to 300 births annually out of a total of 70,000 births nationwide. The Minister is aware of concerns regarding indemnity insurance for independent midwives. Independent or self-employed midwives are not employees of the public health service. As the independent midwives are private operators who do not have service level agreements with the public health service it is not possible at present for them to come within the ambit of the clinical indemnity scheme administered by the State Claims Agency. The Irish Nurses Organisation provides a certain level of insurance cover to independent midwives who are members of that organisation. The INO had indicated that it would not be providing insurance cover after 31 March. However, I understand that it has been in touch with its insurer about extending this cover until the end of September.

Officials from the Department of Health and Children are working with the HSE to put in place a robust national clinical governance framework in order to ensure that the practice of independent midwives is brought into close working relationships with maternity services delivered by the HSE and the voluntary maternity hospitals. Subject to this being achieved it would then be the intention to bring the independent midwives within the scope of the clinical indemnity scheme by means of an extension of the cover under the scheme to the HSE.