Wednesday, 28 May 2014
Maternity Services: Motion
The Minister for Health, Deputy Reilly and I have had a couple of opportunities recently to discuss this issue. As he is aware, following last week's elections, particularly in counties Leitrim, Sligo, South Donegal and others, this is a serious issue that exercises many people and there is much concern about it. The Minister and I have had the benefit of debating this as a matter on the Adjournment when I questioned his word on the issue on the basis that he had broken his word on other issues. I now have the report whereas at the time of the previous debate I had only rumours of what it would contain. When the Health Service Executive was first asked about it, Setanta Communications Limited, which it employs, denied the existence of a report but quickly acknowledged that it did exist and said that it came to no decisions. It is marked "strictly confidential" and the title is High Level Review of Maternity Services in the West Northwest Hospital Group. The Health Partnership is the consultancy firm that undertook the study.
That Seanad Éireann - noting –- the deep disquiet about the proposed reconfiguration of obstetrician-led maternity services in the West and North West hospital group following the emergence of a private and confidential Health Service Executive (HSE) report on the matter prepared by Health Consultants Health Partnership in February of this year;agrees that –
- that there are clear signs that the HSE is considering downgrading maternity services at Sligo Regional Hospital, Mayo General Hospital, Portiuncula Hospital and Letterkenny General Hospital and other centres throughout the country; and
- that Ireland has the lowest ratio of obstetricians to patients in the OECD;- any such downgrading would compel expectant mothers in the area to travel much further to access the necessary obstetrician-led maternity services;calls for –
- there is a need for investment in maternity and neo-natal services across the country; and
- providing accessible, safe and high quality obstetrician-led maternity services to all mothers and babies, regardless of where they live must be a core objective of public health policy;
and- the publication of all interim and/or draft reports provided to the HSE on the review of Maternity Services for each hospital group area and the terms of reference prescribed for the preparation of same;
- confirmation of the continuity of obstetrician-led maternity services at Sligo Regional Hospital, Mayo General Hospital, Portiuncula Hospital and Letterkenny General Hospital following the ongoing review into maternity services countrywide;
- the HSE to focus on attracting the necessary number of qualified consultant obstetricians to facilitate an accessible, safe, high quality obstetrician-led maternity service to all existing maternity centres nationally and to promote obstetrics as a career option among our medical professionals in order to achieve this and in order to overcome the challenges that our obligations under the working time directive present; and
- maternity services at Sligo General Hospital, Mayo General Hospital, Letterkenny General Hospital and Portiuncula Hospital to be retained.
It is dated February 2014. It exists and there are a number of options set out in it. Four of them include the closure or downgrading of Portiuncula Hospital, and others include the downgrade or closure of Sligo Regional Hospital and Mayo General Hospital at Castlebar. It seems to question the Higgins report from last year on the hospital groups, which stated that Letterkenny hospital, as a result of its geographic location and similar to Kerry and Wexford general hospitals, should retain its full range of emergency department, surgical, maternity and paediatric services.
The Government in its amendment argues that this report has no status. What did the report cost and is the HSE in the business of spending people's money on reports which have no status? When I first raised this matter I wanted to know the terms of reference given to the Health Partnership but nobody is prepared to tell me what are those terms. We also want to know what other reports exist. Do all the hospital groupings have similar reports that are seeking to downgrade or shut maternity services? What is the position?
I was accused of scaremongering and being highly political about this before.
The chief executive of this hospital group, Mr. Bill Maher, has stated that people are very concerned and upset about this issue. That is correct, although people are not upset that a report labelled as private and confidential was exposed by me. They are concerned that in secret the Government is considering plans to downgrade maternity services. They have expressed anger in this regard at the ballot box last week in some of these counties.
Are the reports for all these hospital group areas seeking to downgrade the services? We are specifically calling for the retention of obstetrician-led services at centres in Letterkenny, Sligo Regional Hospital, Castlebar and Portiuncula, as it is important. With tragedies, including the case of Ms Savita Halappanavar, among others, and inquests that will come to light over the next number of months, it is vital that people can have obstetrician-led services within easy access and not an hour's drive away. That is suggested in some of the recommendations of this report.
Worryingly, although the Government notes many of the issues we do and supports many of the goals we seek, the amendment falls short of seeking the retention of services. It mainly states that no decision has been made about maternity services at this stage and the Government has indicated there are no proposals at this point to downgrade services. If there are no such plans, what is the function of the 56-page report? I would love to work for the Health Partnership, as it seems to get money for nothing. It gets money for reports that have no status and which people do not read. If it is the case, it is great news.
When preparing my contribution, I noted how the Minister and others argued I was scaremongering. What would the Minister, Deputy Reilly, have done with this report if he was in Opposition? Would he have not worried as the report has no status? The practice in the Department of Health and with Ministers in general is to waste money on reports, seek proposals and then ignore them. The Government has been caught with this one as we got hold of a report we were not meant to see. It is now in the public domain, as it should be. The Department officials are smiling and I am glad my contribution is humorous for them. It is certainly not humorous for the people in the north west of the country or those working in the smaller hospitals in the other hospital groups, such as those in Tralee, Wexford, Drogheda, Tipperary and elsewhere. There is likely to be a report about them which, I presume, again has no status. All I can go on is what is in black and white, and agencies for which this Government is responsible are considering options that include midwife-led services only at some of these centres. That is a fact in the report and there is nothing the Minister can say to deny its existence. The Health Partnership, with a virtual office on Trinity Street, produced it. I do not know who works for it. I tried to make contact but I spoke to a lady who could only put me on to the HSE, with the usual laundered answers coming from it about people's services and money.
We have the lowest number of obstetricians in the OECD group of nations.
The Minister will get his opportunity to speak. With that in mind, we can consider how services function within the obligations under the working time directive and, arguably, the new consultant contract, as well as competition from abroad and elsewhere. More lucrative medical disciplines can be chosen, meaning further pressure may come to bear. Our concern is that the Government, as it has with other issues, will take the easy option. It will look to rationalise the number of maternity centres as it does not need all of them, and it will be able to use the case of Ms Halappanavar and other issues as good cover for downgrading certain hospitals. That is instead of seeing that, from a geographical perspective, there must be services in the north west at Letterkenny, with obstetric-led services in Sligo and other centres. The women of Ireland are entitled to that.
We must not replicate what is happening with cardiac care and the National Cancer Control Programme. They are a great success from a statistical perspective and when speaking of outcomes for 80% of the population but what about the 20% in the north west, where no cardiac catheterisation laboratory facilities exist? There are no plans for them and, as usual, it is kicked to touch with the statement that the Department is discussing the issue with colleagues from the North. Frankly, the people in the north west do not want the Queen looking after their health services. The Minister is in charge and these people are entitled to services in this area. His track record of commitments to people in the north west, including Roscommon, Sligo or elsewhere, is poor in the extreme. It gives me no pleasure to say this but people simply do not believe the Minister.
Worryingly, the amendment indicates that decisions on maternity service provision will be taken in the context of a proposed national maternity strategy; it will be a national rather than local basis. This is similar to what happened with the National Cancer Control Programme and the cardiac programme and whether this boils down to medical politics, officialdom or the political will of the Minster and his colleagues, the north west of the country is a gaping wound in the context of adequate service provision. I would like the person who wants to have a baby in Glencolmcille to have the same chance of that baby being safely delivered as the person living in Salthill.
I would like the person in Ballyshannon to be able to have a baby delivered with the same access to obstetrician services as the people in Dublin. They are entitled to that. As it stands under the policy driven by the Minister, if a person has a heart attack in those locations, his or her chance of surviving is less than that of people elsewhere. The Minister may laugh all he likes. He can cast his mind to the debates in which he participated as an Opposition Member and ask himself if he is being fair to the people of the north west. We found him out and this is his report, on which he spent money on behalf of the people.
I move amendment No. 1:
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;".
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;agrees that -
- 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;- providing accessible, safe and high quality maternity services is a core objective of public health policy; andcommends the Government -
- 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;- 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.”.
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.
I second Senator MacSharry’s motion. I compliment him on bringing the issue to the fore and highlighting the critical situation that might arise. I welcome the Minister, Deputy Reilly, and thank him for coming to the House. I appreciate that he has always been available to this House.
I will not refer to any hospital other than Portiuncula Hospital in Ballinasloe of which I have personal knowledge. My children were born there to my wife Mary. It was a wonderful service. At the time the nuns there provided, and still provide, first class maternity services to the region, including towns such as Athlone and Roscommon. I urge the Minister to state clearly that there is no danger to the hospital and that he is not going to close the maternity service in a quality hospital such as Portiuncula Hospital.
I was chairman of the Western Health Board in 2002 when the Department bought the hospital from the nuns. I signed the contract. It was necessary at the time. The Minister for Health at the time was Brian Cowen. He provided the funding and the Department bought the hospital and it became a fully State-run hospital. We bought it on the basis of providing a service to the people of Roscommon, east Galway and elsewhere in general medicine and in particular maternity services.
I cannot speak too highly of the hospital. I urge the Minister not to allow uncertainty to develop. A report has been published. The Minister is aware of the situation in Ballinasloe. He was briefed very well by a consultant who ran for election, prior to the previous general election. The Minister knows the place very well. That is my request to him.
Nothing concentrates the minds of politicians or those in Government like a by-election. It is like facing the gallows. The Minister was in Roscommon recently. I did not attend because I could not participate in an event given the closure of the accident and emergency service by the Minister. I urge the Minister to carry out a full review of the decision. I was chairman of the Western Health Board when I signed the contract and funds of approximately €10 million were provided by the then Minister for Health, Deputy Micheál Martin, for a state-of-the-art accident and emergency department. The department’s closure is a subject of current concern in Roscommon. Fine councillors lost their seats following the election because of the decision taken by the Minister and his colleague, the Taoiseach. During the campaign I came across an accident at Lisnamult in Roscommon. A lady fell on the footpath and was badly injured. The ambulance was called straightaway and arrived within five minutes. It is an excellent service.
The technicians gave immediate care on the spot and made her comfortable. I inquired of the ambulance driver if she would be brought to the urgent care centre at Roscommon County Hospital. He said no, that he would be bringing the patient to Portiuncula Hospital Ballinasloe. If I had given her a lift - although I would not interfere in a case like this because the patient was injured - she would have been admitted to the urgent care centre in Roscommon County Hospital. As a general practitioner himself, does the Minister consider it ludicrous that an accident occurs in Roscommon town, an ambulance arrives but does not take the injured person to the acute centre in the town? This, by the way, was not at 8.30 at night but 2.30 in the afternoon.
I was amazed that the woman in question had a minor, below-knee injury to her leg which was not treated at the urgent care centre in the town but taken off to Portiuncula. When that patient presents at that hospital, then the rest of her treatment will continue there. That is how one degrades a hospital. Accident and emergency is the most crucial service any hospital can provide. The Minister will be in Roscommon for the forthcoming by-election in September or October. In the meantime, I appeal to him to examine the decision to downgrade Roscommon County Hospital. Will he also explain why an injured person would be taken from the streets of Roscommon town to Portiuncula hospital 40 miles away in Ballinasloe?
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.
I do not think the provision of a world-class maternity service is funny. It should be a priority for the Government. I do not understand why Government Senators would come into the House with smirks on their faces when we are raising serious issues which were raised throughout the Midlands-North-West constituency during the election.
These issues clearly are not being addressed today. I listened in my office to the response of the Minister. I have not received any reassuring comments on the provision of services, whether in Letterkenny General Hospital, Sligo, Mayo or Ballinasloe. I commend my colleague, Senator MacSharry, on raising these important issues. A report was commissioned, and in light of what the Minister stated here today, further issues now arise with regard to it. The Government is clearly stating the report has no status. I would like the Minister to clarify what he means by this.
What is meant in the wording of the Government counter-motion that the report has no status? Procurement issues arise, to which the Minister referred in the final lines of the first page of his address with regard to the commissioning of the report.
We would like to know who sanctioned the report. What were the terms of reference of the report? Who signed off on commissioning the report? Was the Secretary General in the Department aware of what was happening? Was the head of the HSE, the Minister's office or the Minister aware the report was proceeding?
The taxpayer deserves to know how much the report cost. If there are procurement issues, one would expect the HSE has not paid for the report at this stage. Will the Minister confirm whether the report has been paid for, and if there are procurement issues whether the money is being recouped by the HSE on behalf of the taxpayer? My colleague, Senator MacSharry, will raise some of these issues, but clarity is needed because the Minister cannot come in, provide a few lines, rubbish a report and state it is not convenient so we will not allow it to go ahead and that there are procurement issues. It appears the Government is distancing itself from the report simply because its councillors throughout the country got it on the chin at the doors during the local elections.
Maternity services have been reviewed and they are under-resourced. Not only are maternity services under-resourced but other services are too, including accident and emergency services about which concerns were raised by my colleague, Senator Leyden. This question was not answered. The accident and emergency facilities at Letterkenny General Hospital are in crisis. Staff are precluded from speaking to public representatives about the issues affecting them on a weekly basis. Why must elderly people aged 90 years wait 24 hours on trolleys beside coffee machines? This is what is happening.
One of the findings of the report highlighted by Senator MacSharry is a lack of resources, particularly staffing resources, whether obstetricians or midwives. The embargo on recruitment is having a detrimental impact on services throughout the country. Of course the Minister can say this is not the case but why does he not visit some of the hospitals where the staff and patients who have been lying on trolleys for 24 hours will tell him otherwise? We need answers today on what is happening in the north west. We are told in a statement issued on 12 May by the hospital group management in the north west that there was a report, all of the maternity services units in the five hospitals are being looked at, reconfiguration is an option, everything is on the table and the closure of any hospital or maternity unit cannot be ruled out, but the Minister stated here that the report has no status. How does this add up? The HSE appears to be saying one thing, the hospital group in the west is saying another and the Minister and his colleagues are saying something different. Clearly it does not add up and the public are not buying it. I commend Senator MacSharry on taking the initiative on this issue. He must be commended. It is not convenient for the Government or the Minister to hear what he and we have to say and so they try to rubbish it.
Why did the Minister not give a commitment here today that all of the services in the five units in the north and west hospitals will not only be retained but will be enhanced and the embargo on recruitment will be lifted to provide for extra midwives and obstetricians who are required?
There is no doubt this is a very serious matter. We are all agreed that improving maternity services for women in this country and for the birth of children is a key issue and there should be no disagreement about this. I welcome the fact there is a review of national maternity services. It would be a nonsense to review one part and not the other. We live on a small island and are all interconnected. It would be a folly, and the Opposition would be right to jump up and down, as it were, if a review was being done of one part of the country but not of the others.
I am surprised by Senator MacSharry's confusion over the report with regard to some of the matters raised in it. Senator Ó Domhnaill stated it is all on the table. I would have thought any review should rightly put everything on the table. Any proper review should state every single thing that goes on should be reviewed. This is my understanding of the word "review". If the Opposition were jumping up and down stating only one or two suggestions had been made and asking where the rest were, I would agree, but everything has been put on the table. The report states these things are possible, that they could all be closed down and moved to Timbuktu. It is not a folly at this point to review everything, because in the interests of proper research and providing information, one looks at everything and, one by one, those suggestions which are not at all appropriate are excluded. One cannot possibly carry out the review required at this point without reviewing all the options.
The report makes very clear on several pages, none of them mentioned by either Senators Ó Domhnaill or MacSharry, the grave risks that would occur if various options were pursued. The report mentions in particular the distance people would have to drive. Anybody who has ever taken an interest in the research done in other countries and the experiences of other countries knows two key things are at play, namely, economies of scale and distance, and they are probably equal in value. Big risks are written against the options, such as that the travel distance will deprive certain people of certain things or that the travel distance is too great.
Did Senator MacSharry not see that when he read the report? That is what it meant and the people making the decisions are experts, unlike me. Unlike him, I do not claim to be an expert and would not wish to be charged with making the final decisions.
I understand from talking to the HSE in recent weeks about this matter that it proposed and is engaged now in a full and frank discussion about this issue with the staff concerned in this group of hospitals. I say to Senators MacSharry, Ó Domhnaill and anybody else that those staff are the experts. They are the people who deliver thousands of babies and they are the people who employ midwives. I see that Senator MacSharry finds reading his iPad far more interesting than engaging in a debate that he called for.
I would place great faith in the managers, obstetricians and midwives of the hospitals that serve our communities because they have served them very well and will continue to serve them very well. I hope that when the completed reports come to the Minister and to the senior managers in the HSE, the serious viewpoints of the experienced and qualified staff will be taken into account. I am quite sure that will happen. I would place greater trust in what they have to say than in what the Senators have to say. It is as simple as that.
There have been tragic deaths in hospitals in Ireland. We all remember Savita Halappanavar with great sadness. It must be very difficult for her family to keep remembering that she died in the way she did and that her death has caused these kind of debates. We should not just mention her in passing but pause and think about what happened to her. We should also reflect on what happened to Sally Rowlette and Dhara Kivlehan who died at Sligo General Hospital.
I think we are all of the view that trying to avoid maternal deaths is always the best outcome. As the Minister has always said, patient safety should be and will remain our primary concern. I would be distraught if I thought for a moment that any review of national maternity services would do other than put patient safety first. I take his assurance that it is the primary thing. In the 21st century, the ways and means of providing maternity care have changed from the way it was provided in the past. I shall give one small mention to one of the complexities that has arisen. I refer to the numbers of older mothers who give birth and the numbers of women who are obese when giving birth, which has changed the way maternity services must be configured. I mention them solely to show that expertise is required to try to provide the sort of services that are appropriate for a changing environment and changing type of mother. These matters cannot be ignored. They have not been ignored by the research in this document. They have not been ignored by the research carried out in other areas of the world, particularly in the UK which probably has the closest profile to Ireland. The idea that we can hang on to the services that we have in the way that they are configured is a nonsense. We must do something that is different to make sure we continue to provide patient safety in the 21st century when so many things are changing.
I trust and I am assured that through having this conversation, patient safety will remain the primary concern for patients of the west, north-west, south, midlands and east regions. It is much more difficult in the north west because of geographical constraints, which I trust will be put into the mix to ensure patient safety benefits and is taken into account because we live with roads that are less good or in an area where we are, potentially, further away. I trust that patient safety will become the number one consideration in the north west. That has already been outlined in this report but the Senators, as ever, have opted to ignore it.
Cuirim céad fáilte roimh an Aire. Táim an-sásta go bhfuil deis agam labhairt ar an rún seo.
was We have heard the two sides of the argument but, to be honest, they are the two extremes. The truth is somewhere in the middle and I will outline what I mean. I speak from a certain amount of personal experience of the maternity services in the west because I have five children who were all born with the help of the services. It is important for me to say that my experience of the services, certainly at Galway University Hospital, were always very good. My first child was born under the Domino scheme. It was a fantastic midwifery-led scheme that was axed by a previous Administration, which led to a huge outcry. I favour a midwifery-led type of service but it must be backed up by a full hospital service in case anything goes wrong.
I have issues with the way the hospitals groups have been configured, an issue that I have raised on previous occasions. The initiative has moved us down the route to privatisation and I am very concerned about the type of model proposed. Some of the oversight issues flag my issues with the initiative.
As someone who comes from Galway, the case of Savita Halappanavar focused attention on maternity issues. Many issues have arisen in maternity units around the country. Therefore, it is only right that there is a national review of maternity services and, where issues arise, they must be addressed. I am afraid that I do not agree with some of the things that have happened here. I have attended briefings held by the hospital group on the issue.
It is interesting to note that the Minister mentioned in his statement the procurement issues around the report but he did not say that he fundamentally disagreed with its approach. There are other issues, as mentioned by Senator Ó Domhnaill. One is left wondering why the report was sanctioned if there was an issue with it, what the cost of it was and who was paid for it, etc. However, I prefer to focus on other issues. Also, I noted the statement made by the hospital's chief operating officer who said that they have not recommended or approved reconfiguration of the group. They have not said that they will not do so in the future.
Some of the major issues people have in the west is with the framing of this debate. I do not completely agree with Senator O'Keeffe's comment that all the options were put on the table. That is not the impression of the workers' representatives to whom I have spoken in this debate. They are particularly concerned about the status of Portiuncula Hospital because the report contains six options that relate to the hospital. The first option was to let everything stay as it is, but that has been ruled out by Bill Maher, the chief executive of the hospital group, so the workers' representatives feel that option is no longer available. In their opinion, all the remaining five options recommend a downgrading or closure of the unit in Portiuncula Hospital. They are greatly concerned that all the options have not been put on the table.
They have raised these issues with me. It is a concern when one looks at the fact that the Portiuncula centre has won national and international awards for the type of service it provides. Quite a number of well-known politicians from these Houses have availed of the services at Portiuncula. The fact is 47% of the people who opt to attend Portiuncula come from outside the catchment area because its system is so good.
I have read the review report on maternity services. If one looks at the unit costs for Portiuncula, one finds that it is the second most cost effective maternity unit. The cost per birth for Portiuncula Hospital is €3,673 per unit, which is second only to Letterkenny hospital. Also, there has not been a drop in birth rates in Portiuncula in comparison with other hospitals.
The options and recommendations put forward are as follows: leave the number of maternity units as is; to have a main maternity hub at University Hospital Galway and three satellite maternity units; to have a main hub and two satellite maternity units; to have a main hub and one satellite maternity unit; and have a main hub and four satellite maternity units.
The people of Ballinasloe, with all due respects, do not put great stock in the responses from the Department and from the hospital groups because in their experience to date, the promises from the Department or from the HSE relating to services, particularly in Ballinasloe, have not borne fruit. In mental health services, for example, where they were given promises and told not to worry about the 22 acute mental health beds in Ballinasloe which would be okay, that did not come to fruition and those beds were closed down. Alcohol treatment services in St. Brigid's were also lost to the area. The people of Ballinasloe and that area are certainly very concerned when they hear of high level reports such as this going to the hospital trust that would even discount the possibility of maintaining a full maternity service in Portiuncula Hospital, and I would agree with them. I would certainly share many of their concerns.
They are also concerned that there has not really been any proper community or staff consultation around this issue. I am not saying this; this is being said by the workers' representatives. That is not acceptable. Their thinking is that, when one looks at the way the report has been framed, those who wrote this report had it in their minds already that Portiuncula would be closed down and the only options left on the table are ones which bear that in mind. That is totally unacceptable.
It went so far prior to the elections that a priest, from a pulpit, spoke out on this issue in the Ballinasloe area. He got a standing ovation from the people in the area only to be castigated, I understand, by a member of the Minister's party, from the balcony on the issue. The amount of unrest and disquiet on this issue is alarming.
We certainly do not accept any downgrading of those services, in particular, in Portiuncula. As has been stated previously, what we need is an enhancing of services. Certainly, we need an enhancing of the midwifery services available. I would welcome more of the Domino-type schemes that were available which were midwife led, but there would be no acceptance whatsoever of this report. The Minister should discount the report completely and ask the hospital trust to scrap it.
I welcome the Minister to the House and thank him for his speech to which I listened intently in my office in the past few minutes.
I thank Fianna Fáil for bringing forward this motion so that all the lies, untruths and misinformation that they and others have been spreading can be challenged and refuted. The Minister has done a pretty good job in that regard here today.
They have, by their behaviour, caused worry, fear, anxiety and concern to expectant mothers in my constituency and in surrounding areas, and particularly to the employees of Portiuncula Hospital. These employees were told by Fianna Fáil - this is not hearsay as they put it in an election document that was circulated around the town of Ballinasloe - that the decision to close the maternity unit in Portiuncula Hospital would be taken two weeks after the local elections. A new young candidate put that out in his election literature. The young man, for whom I have tremendous admiration, did not design it, but it was designed by an Oireachtas Member who mischievously attempted to misrepresent and cause fear and worry for so many around the Ballinasloe area.
He got elected but his colleague from the town did not, which is interesting.
However, it is extraordinary that in the middle of the election campaign, the HSE would have decided to make a presentation to the employees of Portiuncula Hospital presenting a so-called confidential report, knowing full well that it would be used for political purposes and any sort of opportunity would have been seized upon to spread misinformation.
I welcome the contents of the Government amendment. Everybody in this House wants to provide an accessible, safe and high-quality maternity service for all the people and it is only right that there would be a national review of maternity services in light of the many serious issues and problems that have surfaced in recent years.
I welcome the fact that no decisions on maternity service provision will be made in advance of the publication of the national maternity strategy. I also welcome the fact that there are no proposals to downgrade maternity services at Portiuncula Hospital in Ballinasloe or at the other units in the west and north-west region. This confirms the information given to me by Mr. Bill Maher, CEO of the West/North-West Hospitals Group, who stated that, far from downgrading the Portiuncula Hospital service, they were looking at a midwife-led service model alongside the obstetrician-led service in Ballinasloe. The confirmation that two additional obstetricians will be appointed shortly to provide a service in Portiuncula and in UCHG confirms my confidence in the information given to me by Mr. Maher.
Portiuncula Hospital maternity unit is one of the best in the country and should be used as the model for best practice in maternity care. It has received, as has been said, many awards. The Minister will be aware that over 2,000 births take place there annually and I am sure that he will be pleased to hear that the cost of a birth in Portiuncula is considerably lower than the cost of a birth in UCHG - €3,600 in Portiuncula versus €5,000 in Galway. As we look at the money follows the patient model, Portiuncula Hospital should be considered to be the centre of excellence for maternity care. In addition, the bed occupancy level at Portiuncula is higher than anywhere else in the country and mothers are making the decision that Portiuncula is their centre of excellence.
I want to see the Minister fix the many problems in the health service that he inherited from the previous Government, and he is making very significant progress. The women of Ireland must have the best quality maternity services that are properly resourced. The national review is a necessary element of improving patient safety. I look forward to the development of the maternity services in the west and north-west region and seeing my local Portiuncula Hospital continuing to be the jewel in the crown of that service. That is how people feel about Ballinasloe and that is based on the level of service and care that has being given to mothers down through the years in Ballinasloe.
I thank Fianna Fáil for the opportunity to speak on this issue. I want to nail, and see put to bed here today, the untruths and misinformation that have been peddled so widely over the past number of weeks.
I thank the Minister and welcome him to the House.
I am delighted to hear the Minister's commitment to women in this country, in particular, pregnant women in ensuring their safety in maternity units in our region. We have a fantastic maternity unit in Sligo General Hospital, and also in Letterkenny, Mayo, Galway and Portiuncula.
What has happened in the past few weeks is regrettable. It is disgraceful how Senator MacSharry scaremongered the women, particularly in Sligo. I have been on the doorsteps with a candidate who was seven months' pregnant. We met many women on the doorsteps, including pregnant women and women who will be pregnant in the future, who were frightened by what he was saying. He was saying it, if he does not mind me saying so, in an aggressive and arrogant manner, and that is regrettable.
I am delighted to hear the Minister state here today his commitment to maternity services in our region. I would also be very supportive of midwifery-led services, obviously, backed up by obstetricians and gynaecologists. Certainly, that is the future of maternity services in this country.
I compliment all the wonderful midwives who we have in those hospitals and the work that they do and their commitment to their job. However, I want to put on the record of this House that what went on during the local elections in Sligo was unfortunate. I know it was led by Senator MacSharry. It is good that we can debate maternity services in the country in this Chamber and discuss changes that we may like to see happen, but the bottom line for everybody is the safety of women in this country.
Ireland has very good maternity services thus far and I thank the Minister.
I thank the Cathaoirleach and will wind up. I see I have time and had thought there would have been a few more speakers on both sides. First, Senator O'Keeffe's research differs from mine and that is why the iPad is out. Ireland has the lowest number of obstetricians in the OECD and Greece has nine times as many obstetricians as do we. Perhaps that is wrong but in any event, Members will agree that Ireland is down the field. I have the report to hand, with no lies or no anything. This is the report that gives the options-----
What is under consideration is set out in black and white in this report. I am pleased to hear this report has no status. Senator O'Keeffe, who lost all her colleagues on Sligo County Council, states it does have some status.
The Minister is now saying something that is extremely serious. In distancing himself from the report, he was saying he had nothing to do with it but clearly somebody commissioned the report. I wish to know who did so. Was it Mr. Bill Maher, the chief executive officer of the hospital group which wasted the public's money on a report that has no status? In response to Senator Henry, I make no apology to anyone for bringing in-----
In fairness, I am entitled to use privilege from time to time and when it comes to someone who was responsible for many billions of euro of the public's money and wasting it, I will use his or her name as often as is necessary. I have no apology to make to anybody for bringing into the public domain a report that has implications for the women of Ireland.
Senator O'Keeffe stated, in a heckle directed at my Sinn Féin colleague, that the consultants would be consulted in this review. Moreover, Senator O'Keeffe has said that everything is on the table. While the Minister says it has no status, Senator O'Keeffe has stated that everything is being reviewed and that this is what one must do. She also stated the consultants would be consulted. While that is great, as normal, the Government, the HSE and its agencies forget to consult the most important people, namely, the people of Ireland themselves.
Does the Senator think this report would have seen the light of day? Do Senators Mullins, O'Keeffe or Henry think its existence would have been brought to their attention at their respective parliamentary party meetings, had I not brought it out into the public domain? No chance. The Members opposite were caught this time.
While someone within the hospital group is being blamed, I want to know his or her name. How much did the Health Partnership group get for this report that has no status but which scares the people of the north west? Of course it scares us all and we are distraught to think that in secret, had it not been brought out by Fianna Fáil, somebody under the Minister's control commissioned a report that has no status, wasted the public's money and scared the people of the north west.
If it is the case that there is nothing to worry about, why does the Government's amendment not state that obstetrician-led services will be maintained in Letterkenny, Sligo, Castlebar and Portiuncula? It does not state this. Most worryingly, it states this matter will be examined in a national context and that the Government will not be driven by any local considerations. Senator Henry should note this is what frightens women, namely, the potential for downgrade. I find it to be humorous in the extreme that the Minister, Deputy Reilly, who in opposition was the champion of the patient, takes such issue with me bringing into the public domain a report that the buck stops with him. When he abolished the HSE board, he stated that he was taking control. Therefore, he should take responsibility and should provide the name of the person who commissioned the report and outline what were its terms of reference. Did the Secretary General of the Department of Health, the Minister, his special adviser or Mr. Bill Maher know about it? If it is the case, as the Minister says, that this report was not sanctioned by him, then heads must roll on this issue.
Everyone seeks the best medical maternity services possible.
To conclude this debate, the Minister's speech, the contribution of his colleagues and this amendment fall short of an assurance that each of these centres will continue to have obstetrician-led maternity services. The people of the north west of the country are entitled to better and as I stated in response to another Minister lately on a different issue, members of the Government need to get it into their heads that there is a culture in Ireland whereby people live outside Dublin and are as entitled to services as people anywhere else. Many of the Minister's colleagues, through no fault of their own, lost their seats last week. I hope the Minister is listening this time.
- Ivana Bacik
- Terry Brennan
- Colm Burke
- Paul Coghlan
- Michael Comiskey
- Martin Conway
- Maurice Cummins
- Jim D'Arcy
- Michael D'Arcy
- John Gilroy
- Aideen Hayden
- Imelda Henry
- Caít Keane
- John Kelly
- Denis Landy
- Marie Moloney
- Mary Moran
- Michael Mullins
- Hildegarde Naughton
- Marie Louise O'Donnell
- Susan O'Keeffe
- Pat O'Neill
- Tom Shehan
- Jillian van Turnhout
- John Whelan
- Katherine Zappone
- Ivana Bacik
- Terry Brennan
- Colm Burke
- Paul Coghlan
- Michael Comiskey
- Martin Conway
- Maurice Cummins
- Jim D'Arcy
- Michael D'Arcy
- John Gilroy
- Aideen Hayden
- Imelda Henry
- Caít Keane
- John Kelly
- Denis Landy
- Marie Moloney
- Mary Moran
- Michael Mullins
- Hildegarde Naughton
- Marie Louise O'Donnell
- Susan O'Keeffe
- Pat O'Neill
- Tom Shehan
- Jillian van Turnhout
- John Whelan
- Katherine Zappone