Vincent P Martin (Green Party)
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The Minister of State is very welcome to Seanad Éireann. While it is good to see him in the Chamber, many people in Kildare will be disappointed that the Minister for Health is not available to answer this question today.

It has been reported that about 200 women from County Kildare are unnecessarily compelled to travel to the Coombe hospital every month for antenatal maternity care because the maternity service, which had been in Naas for many years, was removed at the time of the onset of Covid and has still not returned. With justified Covid concerns at the time, members of the local community, however reluctantly, understood the decision but they assumed it was temporary and not a permanent decision. The shadow and effects of Covid are far-reaching and society is still adjusting but the pandemic clearly did not cause a reduction in the size of buildings that existed before its onset.

For many years, a small consultant-led team travelled from the Coombe hospital to Naas General Hospital once a week but now County Kildare mothers must travel to the Coombe for this consultant-led service. The decision does not put women first. A tried and tested successful service which worked very efficiently from many years has been removed and, as a result, more pressure has been placed on the services in the Coombe hospital. We can see the traffic congestion and queues in the vicinity of the Coombe, including from time to time queuing cars blocking the main road into the hospital. From a green perspective, it is not sustainable. It increases carbon emissions but, crucially from a quality-of-life perspective, it does not put mothers first.

People deserve a proper explanation. We are entitled to know what consultation process, if any, took place before this decision was reached. I urge the Minister of State to ascertain if even one user of the service was consulted before the decision was taken to remove this service from Naas General Hospital. The Kildare Green Party has gathered numerous written testimonials from mothers adversely affected by the removal of this service who have first-hand experience of availing of the service at Naas hospital and then for later pregnancy having to travel to the Coombe hospital. The testimonials show that this can add to the stress of a pregnancy and what should be a routine local visit can now take a round trip of up to six hours, incurring longer, more expensive childcare costs, negotiating trains or buses and for many what should be an avoidable use of motor cars in rush-hour traffic.

If it is an accommodation space issue, the Kildare Green Party has located appropriate rooms for the service close to the hospital if required. It is reported that County Kildare accounts for 20% of all births in the Coombe hospital. Considering that this can entail several visits per mother, we are talking about thousands of antenatal visits. This is unnecessary and, in my opinion, it is avoidable. I am looking forward to an update from the Government in respect of this matter which is causing serious concern for many in County Kildare.

Neale Richmond (Dublin Rathdown, Fine Gael)
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I am extremely grateful to Senator Martin for raising this issue and giving me this opportunity to speak on it in the Seanad on behalf of the Minister for Health, Deputy Stephen Donnelly. The Senator will know from my long time in the Seanad and previously as a backbencher that this is an issue very close to my heart. It is one I have spoken on at great length more generally when it comes to antenatal care, but also given the geographic implications for my own part of the world, as well as dealing with many relations and, indeed, Kildare Green Party members in the Senator’s own part of the world.

I stress that, as evidenced in the programme for Government and the significant investment in maternity services in both 2021 and 2022, the Government is fully committed to the implementation of the national maternity strategy. Despite the very significant disruption experienced right across the healthcare system over the last number of years, maternity services have continued to develop in line with the national maternity strategy's revised implementation plan. As the Senator may know, the strategy outlines a new model of care for maternity services with three care pathways - supported, assisted and specialised - ensuring that women receive the right care, from the right professional, at the right time and, crucially, in the right place. In line with that model of care, pregnant women deemed to be at normal risk will be offered and encouraged to avail of care in the supported care pathway.

Key to realising this goal is the development and expansion of community midwifery services. The strategy is very clear that improved access to midwifery services is central to increasing women's choice of experience, a strategic principle of the strategy. In line with that, the HSE is working closely with hospitals and hospital groups to ensure that access to care, including maternity care, is improved for all. In April 2020, the Coombe Women and Infants University Hospital transferred its antenatal clinics from Naas General Hospital to the Coombe. This was in the context of risk mitigation measures undertaken by Naas General Hospital in response to its spatial challenges arising from the Covid-19 pandemic. As we are all aware, Covid pushed our healthcare system, including our physical facilities, to the limit. As such, rearrangements had to be made in certain hospitals and services, often with very little notice to implement these. After the initial move, temporary accommodation was found for a midwifery-led clinic in Newbridge, and more recently in Celbridge. These clinics are fully supported by a consultant clinic at the Coombe.

I appreciate that these changes may cause inconvenience to patients who must travel a longer distance to access their antenatal clinic and experience the rush-hour traffic which the Senator detailed. Equitable access to services is a priority for the Government. The Coombe hospital has informed the Department of Health that it is actively working with the Dublin Midlands Hospital Group to find a long-term solution to the relocation of this service within the midlands area. If considering options for accommodation of this clinic in new facilities in or near Naas General Hospital, the normal HSE procurement process and protocols would have to be followed. However, I encourage the Senator when, as he stated, he has recommendations or testimonials, to please bring them forward to the Minister, the HSE and the hospital group more generally. I assure him that the Government is committed to making real and sustainable improvements in our health and maternity services in Kildare and much further beyond.

Vincent P Martin (Green Party)
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We also commend and are grateful to the hard-working staff in the Coombe but there is an avoidable, unnecessary situation. With respect, there is no comfort in the Minister of State's reply so the campaign will go on. I urge the Minister of State to use his ministerial influence to give us this assurance. He gets it. He is a dad of young children. He knows this is unnecessary. He knows that the Celbridge and Newbridge services, while good, are midwife-led, although they are supported by consultants in the Coombe. That is an entirely different thing from the consultant-led service which existed for years, efficiently and well-utilised, in Naas General Hospital until it was removed. There is no evidence of any consultation, so until I hear otherwise, it is totally unsatisfactory. I and the people of Kildare will ratchet up our campaign in the coming weeks to ensure we get back that service. It is a sustainable, safe and proper service that, in an unjustified way, was taken from the people of Kildare.

Neale Richmond (Dublin Rathdown, Fine Gael)
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I am disappointed that the Senator finds little comfort in this reply because what we have here is a very clear determination from the Department and the hospital group to work to find those new facilities that the Senator rightly says are desperately needed for the people of Kildare and the wider midlands region. I disagree. Fundamentally, the clinic is staffed by brilliant people in Celbridge and Newbridge who are doing excellent work, although, of course, more can and will be done.

It is important to put on the record the context when this decision was made in April 2020. The Senator will remember, as we were fresh Members to our respective Houses of the Oireachtas, the chaos surrounding the country, particularly our health service, at the time. Tough decisions were made.I fundamentally agree with the overall campaign of which the Senator speaks. I agree with his efforts and I will, most importantly, bring his concerns to the Minister for Health, Deputy Donnelly, and the relevant figures in the Department and the HSE. I agree that we need that accommodation in Kildare as soon as possible.

Martin Conway (Fine Gael)
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I thank the Minister of State and Senator Martin for their contributions on an excellent Commencement matter debate. I commend the Minister of State on the campaigning he has done in this House and in Dáil Éireann on this issue.

I must apologise to Senator Eugene Murphy again because the Minister still has not arrived. I must bring the fourth matter forward now, which is in the name of Senator Fitzpatrick.

Eugene Murphy (Fianna Fail)
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On a point of order, I thought the Minister of State, Deputy Richmond, was answering my question, although I could be wrong. Maybe I am wrong.

Martin Conway (Fine Gael)
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No, I do not believe he is.

Eugene Murphy (Fianna Fail)
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Who was supposed to answer it?

Martin Conway (Fine Gael)
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It is not the Minister of State, Deputy Richmond. As of yet, we have not been informed as to who is taking the matter, which is completely unacceptable. In order to avoid delaying the Minister of State, Deputy Richmond, who is a very busy man, I presume Senator Murphy will not mind me calling Senator Fitzpatrick now.

Eugene Murphy (Fianna Fail)
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That is fine.