Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank colleagues for their comments, feedback and acknowledgement of what has been done in healthcare in the past year and a half. We all know that the healthcare system in Ireland, and I have been involved in healthcare systems abroad, is under constant attack and criticism. We all know that when things go wrong in healthcare, it is the most serious situation we can have. I know from my current role and my previous jobs that it can be very demoralising for those working in healthcare - in a department of health, the HSE or the NHS - to be criticised again and again. If we were to look at the public narrative around the world - it is not unique to Ireland - we would be forgiven for thinking nothing good happens in healthcare systems. I really welcome the comments from colleagues acknowledging our healthcare workers; not just front-line workers but also managers including directors of nursing, directors of medicine, managers of hospitals and civil servants. My view, which I think is shared by everyone else, is that over the past year and a half, those working across the healthcare family have demonstrated the very best of our nation. It has been really tough for them. They have had a brutal year and a half. Many of them are traumatised by it and it is great to hear an acknowledgement from the Oireachtas of what they have managed to do in the middle of the biggest health crisis in 100 years.

Regarding the motion, they are extraordinary powers but they are being extended by just 11 weeks. In answer to the question "why 11 weeks?", that was the public health advice. That was the recommendation I got from the chief medical officer. While we hope not to use these powers, we are mindful of what happened the week before Christmas when we found out about the Alpha variant and how quickly we had to move. We simply cannot legislate and implement policy in that period of time. We could not have done it last time. The ask of the House is that it would agree to that. I thank colleagues for their input, debate and support.

Regarding global justice for vaccines, it is essential that we have a global and just solution to this. I think the waiving of IP rights has merit. The analysis I have seen, which looks solid, makes the point that waiving IP rights on its own will not answer the question. These are highly sophisticated compounds that require highly sophisticated manufacturing, cold chain storage, containment and distribution and one must get it all in place. I am very happy to be able to report that Ireland recently donated a large number of vaccines to Uganda. We will be doing more and through the international mechanisms of COVAX, we will donate millions of vaccines. We should be proud European citizens on this. The EU stands out as the region that has exported out of its region way more vaccines than any other region in the world. Some parts of the world that should know better have put restrictions on exports of vaccines and the raw materials for them. I want Europe to continue to play a leading role and I want Ireland to be a leading voice in the EU on this. It is essential.

I know the next issue is not part of today's debate but as most colleagues and the Acting Chairperson have raised the question of maternity visits, I might have some leniency to discuss it. Covid has resulted in awful restrictions across the healthcare system. They have affected mums and their partners, nursing homes, hospital visits to people on bed wards and ICU. I have spoken with seasoned experienced ICU nurses who over decades have seen many people get very sick and die in intensive care and they tell me that they have been traumatised by Covid - both the viciousness of the disease and how it kills people, and the isolation of those people when they are so sick and trying to communicate with their families on phones and iPads. It is vicious. It has been brutal for mums and partners, patients and people in nursing homes and it has been brutal in intensive care. Covid caused a horrible situation for patients and our healthcare professionals supporting those patients. That is true in maternity services and across healthcare. I acknowledge the men and women who have come to Leinster House today to have their voices heard and I acknowledge their passion, frustration and anger.No woman in this country should be asked to deal with pregnancy loss alone. The brutal reality is that women have been asked to do that because of Covid. The question is what are we doing about it. I have worked very closely with the HSE and Department of Health on this. We established four criteria that had to be met. As we pushed successfully back against Covid and the vaccine programme took hold, we moved from four to eight criteria. We then moved from those eight criteria to much more comprehensive guidelines.

The HPSC guidelines were updated at the start of September. The guidance facilitates access for support partners when women are attending for antenatal care, during the period of labour and childbirth and during postnatal care. It includes, critically, antenatal appointments for 12-week scans and 20-week scans and unscheduled attendances. It also includes a minimum of two hours access for partners per day where the woman is in a multi-bed room. If she is in a single occupancy room, the HPSC guidelines say that there is no time restriction. They are the guidelines, and more detail on the guidelines is available online on the HSE website.

There is a point on which we have to be very clear, namely that the safety concerns being raised by our clinicians are real and very present in maternity care today. I would like to share with colleagues one piece of data that emphasises how important it is that we are careful around maternity care. Pregnant women reflect 1% of the population. Believe it or not, pregnant women represent 8% to 10% of those with Covid in ICU. Let us think about the implications of that. Our clinicians have acted to try to protect mums and babies. We have to find a way to make access as full and complete as possible while protecting mums and babies.

I sought an update on this. As of yesterday, the HSE has advised that hospitals are broadly compliant with the current guidelines. We must always keep pushing on those guidelines to make them more and more open. Seventeen of the 19 units are being reported to the Department as being fully compliant. Two hospitals - St. Luke's in Kilkenny and Mullingar - are non-compliant. St. Luke's is non-compliant for high-risk emergency presentations. Mullingar is non-compliant for high-risk emergency presentations as well, but it is noted that following a clinical assessment on a case-by-case basis attendance is facilitated where it can be determined by the clinical team.

I wrote to the board and chief executive of the HSE yesterday and today to state that we must have full compliance and ongoing and very clear monitoring of that compliance, and where there is non-compliance we must understand exactly what the local reason for that is and do everything we can to support the maternity hospital or unit in addressing that issue. However, I have gone further. I believe that the women and men outside have experienced very real and traumatic experiences.

It is very easy for people to say that there are guidelines in place and compliance is being monitored. That is not enough. This morning I wrote to the chief executive of the HSE and board of the HSE to ask for a mechanism to be put in place immediately that would facilitate mums and partners who find themselves denied the access that is contained in the guidelines to contact the HSE to ask why access is being refused and to ask that it be followed up on. I want reassurance that if there is non-compliance, it is for a legitimate local clinical reason. If there is not a legitimate local clinical reason, we need to know about that so we can intervene.

I can assure the House and, more importantly, the men and women who have come to Leinster House today that we are taking this seriously and will always put safety of mums and babies first. Obviously, in a global pandemic that is priority number one. Once that is addressed to the satisfaction of the clinical experts, all other restrictions need to be removed.

A lot of the restrictions that are causing real frustration have nothing to do with Covid. They have to do with historical underinvestment in women's healthcare and maternity care in this country. A really good maternity strategy was introduced by the previous Government in 2016, the national maternity strategy. It puts choice for women right at the centre. If they want specialist obstetric care, they can choose that. If they want midwifery-led care, they can choose that. If they want a hybrid between the two, they can choose that.

This year, for the first time, that maternity strategy has been fully funded. I have been in maternity units and have spoken to caregivers who have talked to me about the benefits and increased choice that is beginning to happen for women. I cannot commit to next year yet because the budget has not been agreed and signed off on, but I am again looking for considerable funding to continue the roll-out of maternity care. That is not enough because the facilities are not fit for purpose.

I do not believe it is a coincidence that some of the oldest hospitals are maternity hospitals. I honestly believe that if men had babies, all of these hospitals would look like the Blackrock Clinic, the Hermitage or some very fancy place. They do not. The Rotunda is 250 years old. Stand-alone maternity hospitals and maternity units need a level of investment they have never had, and that is something I, as Minister, am determined that we are going to see. I am determined that we are going to build a state-of-the-art national maternity hospital that can provide the care and experience that mums deserve and that our clinicians deserve to work in. Ultimately, that capital investment and increase in facilities is what will allow things like single-room occupancy and unrestricted visiting for partners.