Róisín Shortall (Dublin North West, Labour)

In amendment No. 22 Senator Cullinane proposes to remove the provision that a registered midwife must have adequate clinical indemnity insurance to attend a woman in childbirth for reward. There is clearly a need to ensure that midwives have adequate insurance lest a case of negligence is taken. As court cases in regard to birth where negligence is proven often result in very high damages being awarded this is an important issue to which we must give careful consideration. Unless there is that kind of assurance in regard to safety there is the potential for adding to the distress of parents if a case of negligence was proven and the midwife involved was not insured.

If we were here discussing a Bill to provide for a higher level of regulation in respect of the nursing and midwifery profession and we did not include these provisions on ensuring high standards in regard to safety issues, Senator Cullinane would be criticising the Government for not doing so, and he would be right to do that. If we are, as we are in this case, regulating for high professional standards in the nursing and midwifery profession it is essential that we insist on a situation whereby people working in this area have full indemnity in regard to potential cases that would be taken.

Senator Cullinane referred to the fact that medical practitioners are not required to have legal indemnity. That is the case but it is wrong that that position has been allowed to continue for so long. That is the reason the Government has given a clear commitment to address this issue. Legislation is being prepared and we are hopeful it will be ready for debate early in the new year. It is an area where there is a gap in terms of safety of medical services and we are currently working on that.

To facilitate self-employed midwives obtaining insurance an arrangement has been put in place to allow self-employed community midwives access the State's clinical indemnity scheme via the HSE. A self-employed community midwife who signs up to the memorandum of understanding, MOU, with the HSE and abides by its terms is covered by the State's clinical indemnity scheme. The MOU is constructed on the basis of appropriate forms of governance, clinical supervision, clinical care pathways, performance management and audit frameworks being in place, in other words, best practice in regard to home deliveries. Part of the MOU outlines conditions and factors which indicate increased risk. Home births are suitable for low risk, healthy women. There is a need to ensure that where the State is providing clinical indemnity a midwife adheres to the standards set by the HSE.

I would like to inform Senators that a national steering committee on home birth has been established by the HSE to review the implications of the MOU between the HSE and self-employed community midwives on the provision of a safe, evidence-based home birth service for low-risk, healthy women. The committee consists of representatives from a wide range of stakeholders including a representative of self-employed community midwives and patient groups. The Department of Health is also represented on the committee. The inclusive nature of this committee will undoubtedly facilitate discussion on the key areas of concern and inform future guidelines and developments. On that basis I appeal to Senator Cullinane to consider withdrawing the amendment because the State cannot possibly support that.