James Reilly (Dublin North, Fine Gael) | Oireachtas source

I thank Senator MacSharry and other Fianna Fáil Senators for the opportunity to address maternity services in the west. It is not the first time I have addressed this matter. Senator MacSharry wants to get the idea across that, through some tremendous detective work, he has managed to unveil how a report has been commissioned by the Health Service Executive to examine maternity services in the west-northwest hospitals group. This was dealt with on 18 February as a Topical Issues matter in the Dáil when Deputy Calleary and my party colleague, Deputy John O’Mahony, raised it then. Senator MacSharry asked me what I would have done if I were in opposition. I would have listened to what the Minister had said three months ago.

Let me put the record straight. There are no plans to close any maternity units, or indeed reconfigure maternity services in the west-northwest hospitals group. Any reports of such proposals are speculative, disingenuous and unhelpful to staff and patients of these hospitals. I fully recognise such unsubstantiated and politically motivated reports are designed to be a cause for concern for patients and staff. I very much regret any upset which may have been caused.

The reality is that in the context of the implementation of the recommendations of the HIQA report into the death of Savita Halappanavar at University Hospital Galway and the report on the establishment of hospital groups, the west-north west hospitals group undertook a review of its maternity services. The establishment of hospital groups is the most radical and fundamental modernisation of our health system infrastructure since the State's foundation. It is a key building block in delivering on our programme for Government commitments to health reform. Hospital groups will provide the optimum configuration for hospital services to deliver high-quality, safe patient care in a cost-effective manner. It is logical, therefore, that as hospitals move to working as part of a group, services will be reviewed and evaluated to ensure the delivery of high-quality, safe patient care which is cost-effective and guarantees better outcomes for patients.

The review of maternity services undertaken by the west-north west hospitals group included the maternity units at Portiuncula Hospital Ballinasloe, Mayo General Hospital, University Hospital Galway, Sligo Regional Hospital and Letterkenny General Hospital. While the draft report presents various options for service reconfiguration, I understand the report does not recommend any option in particular. I am aware that an issue has arisen, however, concerning the commissioning of the review of maternity services on behalf of west-northwest hospitals group. At the request of the director general, the HSE internal audit unit has undertaken a review and established that the procurement of services was not in accordance with HSE national financial regulations. I further understand that the director general has written to both the hospitals group chairperson and the chief executive officer outlining his concerns, seeking to ensure the recommendations of the audit unit are implemented and that there will be no further breaches of procurement rules. I am satisfied this operational matter is being dealt with appropriately by the HSE working with the chief executive officer and the group board and that any issues will be resolved in that context.

Maternity services in all parts of the country will be subject to review and evaluation this year as part of the development by my Department of a new national maternity strategy. The development of this strategy is under way and will determine the optimal configuration of maternity services to ensure women have access to safe, high-quality maternity care in a setting most appropriate to their needs. It is the intention to publish the new strategy later this year. Developing the strategy will provide us with the opportunity to take stock of current services and identify how we can improve the quality and safety of care provided to women and their babies. The strategy will ensure our maternity services will be developed and improved in accordance with best available national and international evidence.

While the review on maternity services undertaken by the west-northwest hospitals group may stimulate debate and may help inform the strategy, any decision on maternity service reconfiguration will be taken on a national rather than on a local basis. No decisions on service reconfiguration will be implemented without my agreement. The commitment to develop a maternity strategy arises from my acceptance of the recommendations of the HIQA report into the death of Savita Halappanavar. I regret the manner in which Senator MacSharry referred to the late Ms Halappanavar and I will apologise to her family if any offence was taken. The report recommended a strategy be developed to implement standard consistent models for the delivery of a national maternity service that reflects best available evidence to ensure all pregnant women have appropriate and informed choice and access to the right level of care and support 24 hours a day.

The Health at a Glance 2013 - OECD Indicators publication provides evidence that Ireland does not have the lowest ratio of obstetricians to patients in the OECD. However, Senator MacSharry is only too willing to misinform the House on this. Nonetheless, I recognise that across some specialties, the ratio of consultants per head of population is lower than in some other jurisdictions. However, it is the Government’s policy to move to a consultant-delivered service. There has been a significant increase in the number of consultants, whole-time equivalents, over the past decade. Since the establishment of the HSE, the number of approved posts increased by 723, from 1,947 in January 2005 to 2,670 in December 2013. The most recent census returns, to end of March 2014 reported 2,581 consultants. If Senator MacSharry checked the figures, he would find both Canada and Holland have fewer consultant obstetricians per head of population but can deliver safe maternity services. We may require more consultant obstetricians but we must also examine the model of maternity service delivery. We also need more involvement of midwifery in this area. We are working to address recruitment problems in this regard.

I also acknowledge there are difficulties in recruiting in certain specialties.

There are some hospitals to which it has historically been difficult to attract applicants for consultant posts, in particular smaller or more remote hospitals or those with onerous rosters due to the limited number of consultants available. It is particularly difficult to retain academic consultants, given the competitive international market. Such shortages are typically met through the use of locums in order to ensure service delivery is maintained. I am confident the establishment of the hospital groups will help address this issue, as it will support the appointment and deployment of consultants as group resources.

We are planning for the future recruitment and retention of consultants including those who specialise in obstetrics and gynaecology. The number of doctors in training generally reflects the current projected future staffing needs of the Irish health service. Of the basic specialist training posts filled by the training bodies in 2013 and 2014, some 75 are in the obstetrics and gynaecology specialty, while of the higher specialist training posts, 50 places are in the specialty.

I am more broadly concerned about the retention of our young hospital doctors and I am progressing measures to ensure we will have an adequate supply of highly skilled consultants and non-consultant hospital doctors, NCHDs. Last July, I set up a group under the chairmanship of Professor Brian MacCraith to carry out a strategic review of medical training and career structures. The group will make recommendations aimed at improving the retention of medical graduates in the public health system and planning for future service needs. In December 2013, it provided an interim report focused on training. In April 2014, the group submitted its second report to me, which dealt with medical career structures and pathways following completion of specialist training. The final report of the group will deal with workforce planning and is due to be submitted by the end of June 2014. The work of the group is fundamental to ensuring positions within the public health service are attractive to consultants and doctors in training, particularly NCHDs, in the years ahead.

I am very concerned that so many are leaving our shores and I know it is not all to do with money but with the lack of a clear career path and lack of respect in how they are treated. While one can temporarily bully people into working without being paid, they will not stomach it any longer than they have to. We need a new code of conduct, which will be part of the recommendations. We need to respect those who work in our health service and treat them with dignity.

It is important to recognise that appropriate midwifery staffing is essential to ensure the delivery of safe maternity services and reducing error. In this context, a review of workforce requirements regarding clinical activity is necessary to future-proof our services over the next three to five years, thereby ensuring and assuring patient safety, quality of care and cost effectiveness. Such a review is currently under way and the aim of the project is to examine the current levels of midwifery staffing and health care assistants in the HSE and recommend appropriate staffing levels and-or initiatives to improve our skill mix. We must encourage innovation around how we care for patients and the models of care we develop. I commend those who work in our health service, especially midwives, on the great work they do.

One of the objectives of the project is to identify the key changes in maternity services and their likely impact on the requirement for midwives and maternity care assistants, taking into account recent and upcoming developments as a result of service reconfiguration, Government policy, industrial relations agreements, clinical research findings, clinical care programme outputs and changing demography. The project also aims to establish baseline midwifery and maternity care assistant staffing in all maternity units by undertaking a benchmarking exercise to validate the staffing figures received by the HR information unit nationally. It will examine the midwifery workforce planning needs in a defined number of maternity hospitals nationally, namely, two large units or hospitals, two medium-sized maternity units and two smaller units. Another objective of the project is to recommend appropriate midwifery staffing and skill mix levels and-or initiatives to meet emerging models of maternity care ensuring standards of safety and quality care for women and their families are met. This workforce planning exercise will provide data to support the determination of midwifery staffing, and I look forward to receiving it.

The House will be aware that I have a very clear focus on patient safety and I have ensured patient safety has been made a priority within the HSE's annual service plan. My officials meet with the HSE each month on the service plan and patient safety is a standing item on that agenda. There are many facets to the patient safety agenda and several initiatives under way have the potential to drive significant change throughout health service provision over the coming years. The leadership of this change from a governance and management perspective will be a key dimension to progressing towards this goal.

Guaranteeing better outcomes for patients is a fundamental principle of our health reform programme. We all continue to strive to ensure patients receive the best care possible when they need to access health and social care services. Improving the safety and quality of that care is our highest priority. The findings of recent reports demonstrate that we still face many challenges to ensure our health and social care services are truly safe and of the highest quality. I am confident that implementation of the recommendations of the HIQA report into the death of Savita Halappanavar and the report of the chief medical officer into perinatal deaths at the Midland Regional Hospital Portlaoise will ensure patient safety is everyone's priority, and reassure patients that the services they access are of the highest quality and safety. I am updated regularly by the HSE on progress made in implementing the recommendations of each of these reports.

Regarding the HIQA report into the death of Savita Halappanavar, the most recent progress report was forwarded to my Department on 2 May by the HSE's national director of acute hospitals, who has been assigned responsibility for this body of work. I have been assured that progress in implementing both the local and the national recommendations is well under way and will continue throughout the year. An additional €1.48 million and 6.5 whole time equivalent staff have been provided in the HSE's national service plan 2014 to target necessary patient-centred improvements in maternity care. Regarding the implementation of the chief medical officer's Portlaoise report, the HSE has established an implementation group, chaired by the national director of acute hospitals, to oversee and ensure the recommendations of the report are progressed in a timely and effective manner. Progress on implementation of the recommendations is reviewed by the HSE leadership team and a monthly report provided to the chief medical officer. The second progress report has now been received and the continued progress in implementing the recommendations is noted.

I regret any upset that reports regarding the alleged downgrading of maternity services in the west may have caused. As I said in the Dáil on 18 February when the issue was raised as a Topical Issues matter, such reports are speculative and unhelpful. It is not my intention to downgrade any maternity services in the west. Two consultant posts in obstetrics and gynaecology, one with a specialist interest in maternal fetal services, to be shared between Portiuncula Hospital and University Hospital Galway, have recently been approved and will, I am informed, be advertised shortly.

Far from downgrading services, my intention is to improve and develop maternity services throughout the country. For this reason, work is ongoing within my Department and the HSE to develop a new national maternity strategy. As part of the development of the strategy, we will review and evaluate maternity services provided in each of the 19 maternity hospitals around the country. We will also look at national and international evidence of best practice. This will allow us to determine how to move forward and provide better and safer patient-centred maternity services.

I still adhere to the underlying principle of the patient being looked after at the lowest level of complexity that is safe, timely and efficient, and as near to home as possible. On that basis, why would I want to oversee the closure of maternity services in the west where there is such geographical spread? With the new hospital groups we can have a centre to support these units and ensure the highest standards of care, compassion and outcomes for our citizens. I am sorry the people of the west and north west may have been distressed by mischievous pronouncements around a report that has little or no status. While the report might be of some value in informing the national review of maternity services, that is all it can do. The national review will determine the outcomes, which will have to be approved by me, and I have made my position crystal clear.