Colm Burke (Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after "That Seanad Éireann -" and substitute the following:“noting -

- that the draft report on reconfiguration of maternity services in the West/North-West Hospital Group has no status other than that it may help inform the development of the national maternity strategy;
- that no decisions on maternity service reconfiguration will be implemented without the agreement of the Minister for Health;
- that any decisions on maternity service provision will be taken in the context of the proposed national maternity strategy and therefore on a national rather than a local basis;
- that no decisions on maternity service provision will be made in advance of the publication of the national maternity strategy;
- that there are no proposals to downgrade maternity services at Sligo Regional Hospital, Mayo General Hospital, Portiuncula Hospital and Letterkenny General Hospital or other hospitals throughout the country;
- that in 2013/2014, 75 doctors are undertaking basic specialist training in the Obstetrics and Gynaecology specialty and a further 50 are undertaking higher specialist training; and
- that the implementation of the recommendations in the two reports of the MacCraith Group on Medical Career Structures and Pathways should help to remove the barriers to recruiting and retaining consultants within the health system;

agrees that -

- providing accessible, safe and high quality maternity services is a core objective of public health policy; and
- there is a need for investment in maternity and neo-natal services across the country and in this regard recognises that additional resources were provided in the National Service Plan 2014 for investment in maternity services;

commends the Government -

- on the commitment to the development of a new national maternity strategy which will determine the future model of maternity services to ensure that women have access to safe, high quality care in a setting most appropriate to their needs; and
- on the commitment, in the context of the development of the Strategy, to undertake a review and evaluation of maternity services nationally which will enable us to determine how services can be improved.”.

I welcome the Minister to the House. I also welcome the debate on maternity services, as it is important that we have a constructive debate on the matter. The amendment particularly states "that the draft report on reconfiguration of maternity services in the West/North-West Hospital Group has no status other than that it may help inform the development of the national maternity strategy;".

It is in that context that the report was drafted. The amendment outlines that there are no proposals to downgrade maternity services in Sligo Regional Hospital, Mayo General Hospital, Portiuncula Hospital and Letterkenny General Hospital, all of those hospitals which are providing an excellent service in their respective areas.

I wish to respond to issues raised by my colleague across the floor. He seems to be overly concerned about the publication of reports. I remind him that his party leader, when in the Department of Health and Children published 125 reports, all of which remained on the shelf. The Senator should not raise concerns about reports currently when his party leader had no difficulty spending money on the production of reports only to allow them to lie idle.

One report I wish to raise is the Hanly report, which related to the development of services in the hospital structure and the employment of doctors. It clearly set out that there was a need to examine maternity services. At the time the report was produced in 2003, it set out that the working time directive as it related to junior doctors would be implemented by 2004. It took a lot longer than that. By the time the previous Government left office we were nowhere near the implementation of the working time directive for junior doctors.

Another issue referred to on page 145 of the report is obstetrics and gynaecology. In 2003 there were 93 consultants in obstetrics and gynaecology and there were 50,000 deliveries annually. The Hanly report proposed that by 2009 there would be 179 consultants. Between 2003 and 2009 the country was flush with tax collected and Government budget surpluses. By the time the previous Government left office there were 125 consultants, one third short of what was set out in the plan. At the same time, the number of deliveries had increased from 50,000 a year to 75,000 – almost a 50% increase.

There has been talk of comparisons. We recently had a debate on Portlaoise hospital where the number of deliveries reduced from 8,000 a year to 2,000 a year but the number of consultants remained the same. If one compares it to the education sector, if one had a school that increased from 1,000 students to 2,000 students over a period and there was the same number of teachers we would all have been up in arms but for some reason we do not seem to have reacted in the same way in the area of maternity services in the period 2004 to 2010.

That is the reason we now need to review the structure of maternity services, especially in smaller units. There are 19 maternity units in the country and 11 of them have three consultants that are on one-in-three call, where one is on-call every day from 8 a.m. until 5 p.m., every third night and every third weekend. There is a problem getting locum consultants to cover when someone is on sick leave or holiday leave. The problem has not been addressed. Let us have a debate on maternity services, especially on the 11 units that have three consultants. Some of the units might have four consultants but I understand they have three whole-time equivalents. It is important that we have a structured debate on how to proceed with the reform that is required, in particular in terms of increasing the rota to one in four. It is very important that we examine the matter.

It is also important to consider the requirement for sub-specialisation in some maternity cases. Reference is made in the report to University Hospital Galway sub-specialising in particular cases. That is happening around the world where the smaller units focus on straightforward management of gynaecological and obstetric cases but where there are particular difficulties patients are referred to a specialist unit. We need to have a debate on how we go forward but we also need to have a debate on improving existing services. In the period from 2003 and 2004 to 2010, the required reform did not occur. Now we have an opportunity to do that and we should do it. There is a need for improved staffing levels and improved services in certain areas. We need a debate such as today’s not to focus on negatives but on positives and how we can plan into the future. That is what we need to do with maternity services in this country.