Seanad debates
Wednesday, 18 May 2022
Nithe i dtosach suíonna - Commencement Matters
Health Services Staff
10:30 am
Joe O'Reilly (Fine Gael)
Link to this: Individually | In context | Oireachtas source
I welcome the Minister of State at the Department of Health, Deputy Butler, to the House. We begin with Senator Sherlock's Commencement matter.
Marie Sherlock (Labour)
Link to this: Individually | In context | Oireachtas source
Go raibh maith agat, a Leas-Chathaoirligh. I welcome the Minister of State and thank her for coming to the House.
A year, a week and a day ago, the Minister for Health announced that there would be 24 new lactation consultants appointed in 2022. My simple question to the Minister of State is: where are they?
I must credit the wonderful campaigning group, Bainne Beatha, for alerting us to the date last week. When the announcement by the Minister was made last year, we very much welcomed it, but from talking to campaigners on the ground, there is a real question mark now as to where exactly are those posts. Have people been appointed?
As the Minister of State will be aware, the scale of the challenge is enormous if we want to improve breastfeeding rates in this country. It is about improving the interventions; it is about improving the peer-to-peer experience and it is about improving the culture, both within hospitals and within the community.
It is really important to acknowledge that it is every individual family's right to decide how best they want to feed their own baby, but it is those women and families who want help and who have been seeking help but have been so badly let down by the public system that we really need to help.
According to the Irish Maternity Indicator System National Report 2020, breastfeeding was initiated after birth for 62.3% of babies born in 2020. That is a decent number. That falls to 58.5% either exclusively breastfeeding or combination feeding upon discharge of hospital. Within six months, that falls to approximately 15% of babies.
There is a real failure, both in hospitals that we would see any drop in breastfeeding rates between when a baby is born and upon discharge, and then, of course, when women are back within their own communities.
I suppose the failures are that we have considerably inconsistencies in hospitals with regard to culture, practice and availability. I was talking to a woman the other day who was telling me of how she struggled trying to feed and, unknown to her and without her permission, her baby was given a bottle of formula when she happened to be asleep. This was only two years ago in a national maternity hospital; that is disgraceful. The hospital has yet to acknowledge that such an incident happened and yet two beds over, a woman had a completely different experience and does not recognise that other lady's terrible experience at all. We have situations where the master of a maternity hospital and the ward sister are walking around telling mothers to put away the bottles that are on their shelves and hiding that babies are being fed formula.
Of course, there are issues with the availability, particularly at weekends, of lactation consultants. We know from the Bainne Beatha survey last year of women repeatedly making requests for a lactation consultant within the hospital, yet those requests went unheard. We accept we have had Covid and all that, but this is not a new phenomenon. This has been going on for many years.
Within the community, I am still hearing varying experience with regards to the service and advice, in particular, that public health nurses are providing. I am told within CHO 9, within Dublin north city and county, that all 22 public health nurses have received breastfeeding training, yet I know on the ground that there are some public health nurses actively advising mothers to give up breastfeeding and that there is an easier way.
Do we have these new posts on the ground and what is being done about training those who are in really important roles with vulnerable mothers at an important time in their lives?How does the Government propose to improve the situation?
Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I thank the Senator for raising this important issue. I am delighted to be here, as a woman, to discuss this. The Senator focused on one line which she said was important. It is up to each family to make the decision and the Senator is clear on that. We agree that it is important the family make the best decision for the mother and baby.
I am answering this on behalf of the Minister, Deputy Stephen Donnelly. The promotion, support and protection of breastfeeding is a priority for children's health in Ireland. Breastfeeding in a Healthy Ireland: Health Service Breastfeeding Action Plan 2016-2021 is the framework for progressing supports for breastfeeding. The HSE is partnering with key divisions to provide the supports that mothers require at all stages of the breastfeeding continuum. The Deputy is right that if that decision is taken, it has to be understood that the supports are there. Some people find it difficult and some find it easy. We all know of cases where people give up in frustration even though they want to continue to breastfeed.
Due to the impact of the Covid-19 pandemic on the delivery of some actions, the HSE will extend the implementation of the breastfeeding action plan into 2023 and continue to work on the priority outstanding actions. Ireland has a culture of bottle feeding and, in order to improve child and maternal health and reduce childhood obesity, we need to improve our breastfeeding rates.
While breastfeeding is the most natural way to feed the baby, it is a skill that mother and baby develop over the first days and weeks. With the right help, support and information, most mothers can start breastfeeding and continue for as long as they want to.
A combination of interventions at public health, public policy, clinical and community levels are the most effective way to support mothers to breastfeed for as long as they wish. Evidence-based interventions at clinical level include changes to policy and practice within hospital and community settings in line with best evidence on practices that support optimum infant feeding in maternity, paediatric, and community services. Integrating routine lactation consultant support improves the experience of care that mothers receive, along with breastfeeding initiation and duration rates. Midwives and public health nurses are trained in supporting breastfeeding, commencing in the antenatal period with the delivery of antenatal breastfeeding education. Midwives support antenatal education and help mothers to establish breastfeeding in the early days. Public health nurses, many of whom are midwives and paediatric nurses, continue to support breastfeeding mothers through the postnatal period. Every mother is visited by a public health nurse within 72 hours of leaving hospital. Breastfeeding mothers receive follow-up support if needed.
Until 2020 the implementation of the breastfeeding action plan was undertaken within existing HSE resources. The Minister for Health has advised me that a total of 34.5 new infant lactation posts were approved through the national maternity strategy and the Department between 2020 and 2021 to ensure every maternity unit and community health service will have dedicated posts in place. The HSE, most importantly, has recruited a national lead at the end of 2021 to support implementation of national infant feeding standards within maternity services.
To answer the Senator's main question, of the initial 10.5 infant feeding posts approved through the national maternity strategy, eight are currently filled and recruitment continues for the remaining 2.5 posts. The Minister for Health announced funding for 24 additional infant feeding posts in May last year, with funding for these permanent appointments confirmed in the national service plan 2022. Following sign-off of that plan, primary notifications for these positions have been secured and recruitment has commenced. I have requested the HSE to provide specific details on the recruitment campaign, and this information will be forwarded when it is available.
I have a list of where the 8.3 posts are in place and can share it with the Deputy after this debate, if it is helpful. There are currently 8.3 whole-time equivalent posts working in community services and 14 of the 24 new posts announced last year are allocated to community services to ensure that every public health nursing service has dedicated breastfeeding supports within their service. The breakdown of the allocated posts is 14.5 for community services and 9.5 for maternity services. I can share the information with the Senator afterwards. I have a breakdown of which counties it is currently being provided in.
Marie Sherlock (Labour)
Link to this: Individually | In context | Oireachtas source
I thank the Minister of State. Maybe I am of a simple mind but either the 24 posts have been recruited and filled or they have not. The Minister of State is saying 14.5 of the 24 posts have been allocated to community services but that is a budgetary allocation. Either the people are providing the service or they are not. Will the Minister of State take back to the Department that we need to see clarity? At this time on a Wednesday morning, are new, qualified lactation consultants providing support to breastfeeding mothers or not, compared to this time last year? I am not sure this answer has shed any greater light on that.
Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Of the initial 10.5 infant feeding posts approved through the national maternity strategy, eight are filled. Cavan-Monaghan, Clare, north Tipperary, North Lee, and Longford-Westmeath have one each; west Cork has 0.8; south Tipperary, Wicklow south, Dublin south east, Dún Laoghaire and Wicklow north have 0.5 each. That comes to the 8.3 currently in place and on the ground today.
Marie Sherlock (Labour)
Link to this: Individually | In context | Oireachtas source
That is the pre-2020 situation.
Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
It is. Recruitment for nursing-related grades has been challenging, particularly due to Covid-19, but every effort is being made to recruit. The breakdown of the 24 lactation consultant posts is 9.5 for maternity services and 14.5 for community services. I have the breakdown here of where they will be allocated. I am keen, in my role as Minister of State with responsibility for older people, that the postcode lottery has to stop. Regardless of where one lives, one should have access to the service. It should not be that someone living in a big city or town has the service and someone in a more rural area does not. They are actively recruiting so hopefully we will have a further update. I will bring back the Senator's concerns because it is important for new mothers, especially on their first baby when it is all so new to them, to have that support.