That Dáil Éireann:
— that Ireland’s first National Maternity Strategy, Creating A Better Future Together 2016-2026, was launched by the Government on 27th January, 2016;
— that the strategy acknowledges that various reports and reviews highlighted significant service deficits and failings which undermined confidence in our maternity services and staff morale, including:
— a lack of choice for expectant mothers;
— inadequate emphasis on general health and wellbeing;
— ageing infrastructure;
— poor staffing ratios by international standards; and
— geographic variation in services;
— that the commitment to develop the strategy arose from the report entitled 'Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients, including pregnant women, at risk of clinical deterioration, including those provided in University Hospital Galway, and as reflected in the care and treatment provided to Savita Halappanavar', and that report recommended that a strategy be developed to implement standard, consistent models for the delivery of a national maternity service that reflects best available evidence, to ensure that all pregnant women have appropriate and informed choices, and access to the right level of care and support;
— that the Programme for Government: Our Shared Future commits to implementing the National Maternity Strategy and the commitment in that strategy to co-locate the four standalone maternity hospitals, and the acknowledgment therein that the plans to redevelop the National Maternity Hospital on the St Vincent’s University Hospital campus ‘are well advanced and a planning application is imminent’; and
— the recommendation of the Sláintecare Report to implement the National Maternity Strategy;
further notes that the Health Information and Quality Authority (HIQA) report entitled 'Overview report of HIQA’s monitoring programme against the National Standards for Safer Better Maternity Services, with a focus on obstetric emergencies', published on 12th February, 2020, highlighted its concern at the overall level of progress of implementation of the strategy, the eight recommendations set out therein and the urgent need for these recommendations to be acted upon in a timely manner; and
calls on the Government to:
— ensure the immediate development and publication of a comprehensive, time-bound and fully costed National Maternity Strategy 2016-2026 implementation plan, which spans the remaining timeframe of the strategy;
— immediately develop a plan for implementing the recommendations of the HIQA report, including clear actions and timelines for completion of the actions; and
— further ensure the public ownership and operation of the new National Maternity Hospital.
Baineann mo rún leis an straitéis náisiúnta máithreachais a foilsíodh i 2016. An aidhm a bhí ag an straitéis sin ná na cuspóirí a chur i bhfeidhm go hiomlán laistigh de thréimhse ama deich mbliana. Táim ag díriú isteach ar an straitéis inniu de bharr na heaspa dul chun cinn atá ann ó thaobh na straitéise sin. Tá moill i gceist agus tá an cur i gcrích easnamhach amach is amach. Ní hiad sin m’fhocail ach na focail ón áisíneacht HIQA. D’fhoilsigh an eagraíocht sin tuarascáil i bhFeabhra na bliana seo caite agus dhírigh siad an spotsolas ar an gá práinneach plean gníomhaíochta a fhoilsiú chun an straitéis a chur i gcrích agus na cuspóirí a bhaint amach. Tiocfaidh mé ar ais ag an tuarascáil sin.
I am delighted the Minister is here. I wish I did not have to move this motion. I see there is no amending motion from the Government but perhaps I am wrong. It would be good news. I thank Beibhinn O'Connor who works with me in the office. I also thank my colleagues for signing the motion. As I understand it, most of the parties and Independent Deputies in the Dáil support it. The next step it is what we will do with the motion.
The National Maternity Strategy 2016-2026 Creating A Better Future Together was launched by the Tánaiste, Deputy Varadkar, who was then the Minister for Health, with his full endorsement and commitment to advocate for it and fully implement it. Unfortunately, this has not happened. The vision for maternity services articulated in the strategy is an Ireland where women and babies have access to safe high-quality care in a setting that is most appropriate to their needs. Imagine we need a strategy to tell us women and babies need access to this. Women and families are to be put at the centre of all services and treated with dignity, respect and compassion.
That it took 100 years from the 1916 Proclamation, and the deaths and sufferings of so many people and children, speaks volumes. We are now midway through the strategy and the pace of its implementation, to put it at its most benign, is patchy or it is not implemented at all. This is entirely unacceptable. The continued failure to implement the maternity strategy is all the more worrying given the circumstances from which the strategy arose. The Minister is as familiar as I am with all of the reports, most particularly, the executive summary of the maternity strategy, which acknowledges that several reports and reviews over many years highlighted significant service deficits and failings, which undermined confidence in our maternity service and staff morale. There has been a lack of choice for expectant mothers, inadequate emphasis on general health, ageing infrastructure, poor staffing ratios by international standards and geographic variation in services. Unfortunately, many of these deficits remain.
More specifically, the commitment to develop the national maternity strategy arose from the death of Savita Halappanavar in my city of Galway. Among other things arising from the review into this was the national maternity strategy. I want to personalise this for a minute. Savita was 17 weeks pregnant, a 31-year-old woman looking forward to her baby and looking forward to breastfeeding that baby. This was all documented in her records. She died approximately seven days after being admitted to the hospital in Galway, which I will come back to with regard to the recommendations made arising from what happened. One of the most significant things was the lack of basic care.
The strategy is intended to provide the framework for a new and better maternity service. It acknowledges the service is hospital-based and a new model of care representing fundamental change is required. It is to be woman centred with integrated team-based care and women seeing the most appropriate professional based on need. I will not go into the strategy, the three pathways identified or the normalisation of the birth process. Imagine we have to go back to normalising the birth process and put into a strategy that we need to deal with women and children with dignity and care. We had to do this.
There is an obligation on the Government and the HSE in the strategy to produce annual plans. The last annual plan was 2018. The last implementation plan was 2017. On 12 February 2020, HIQA published an overview report on maternity services which made eight recommendations. In this report, HIQA highlighted the calls it made in October 2013 and May 2015 for an adequately resourced national maternity strategy. The report notes some of the progress made and HIQA was positive but stated it was concerned about the overall level of progress of implementation, for example the levels of funding allocated to implementation, the governance and accountability structures, and arrangements for driving the strategy at national health executive level. The first recommendation was for comprehensive planning with aligned costing measures, in other words, a fully costed implementation plan. The final recommendation was a plan to implement all of the recommendations of the report.
As I said, the strategy was launched in 2016. By the time HIQA published its report in 2020, nobody was driving it. In September 2019, nobody knew to whom they were reporting. HIQA identified that a lack of clarity on the governance and accountability arrangements of the national women and infants health programme, which was supposed to be the driver, represented a significant risk to the ongoing and effective implementation of the strategy, thereby also impeding progress on implementing national standards and greater transparency. HIQA found that progress was relatively limited and generally predated the strategy.
I said I would come back to Savita. Three reports were written about Savita Halappanavar. They highlighted a lack of basic care and basic monitoring and assessment in addition to a lack of choice. She had sepsis, which became severe, and then there was sepsis shock. In all of the analysis what jumps out is the absence of basic care, basic monitoring and treating a person with dignity. Of course, the eighth amendment overshadowed the whole proceedings.
It was acknowledged in the report that an urgent change in the law was needed and that happened. That report was not in isolation; it was one of three.
I come from Galway and worked in Ballinasloe. There was an inquiry into Portiuncula covering a particular period of time. It started with six cases and, I understand, expanded to cover 18 cases. There were investigations in Drogheda and Portlaoise. I mention these cases only to highlight the urgency of the strategy and the urgent need to implement the strategy. That is what I am asking the Minister for today. If he agrees to that, that is good news. There must be a time limit for the publication of the action plan and its implementation.
The last part of my motion relates to the new planned maternity hospital. I could not but mention it because it is mentioned in the national maternity strategy. On page 14 of the strategy it is acknowledged that plans to redevelop the National Maternity Hospital on the St. Vincent's Hospital campus are well advanced and a planning application is imminent. That was in February 2016. In 2008 there was a report from KPMG on co-location.
There have also been a number of different comments. I will read just a few of them. The then Minister for Health, Deputy Simon Harris, stated in June 2020 that the new maternity hospital will remain in State ownership and will be built on a site leased from St. Vincent's Hospital, which is a change from the previous position. Prior to that the Tánaiste, Deputy Leo Varadkar, said that the new national maternity hospital and another hospital will be State-owned buildings on State land. The Minister, Deputy Harris, referred to the hospital being State-owned on leased land. Dr. Peter Boylan asked the National Maternity Hospital lawyers who will own the hospital building and the response was that there would be a plethora of different structures and ownerships.
If our words, the deaths of women and children and the disabilities resulting from different operations are to mean anything, we need a commitment to a national maternity hospital that is publicly owned and operated on public land. Whether that means buying the site or a compulsory purchase order, so be it. In the 21st century, more than 100 years after the 1916 Rising, it is time to treat women with respect and dignity and as equal human beings and realise that a national maternity hospital in full public ownership is absolutely fundamental.
I am tired of the Kafkaesque - I have used this term so often - arrangements between holding companies and designated companies. It is a puppet on a string for the controlling Catholic religion behind that. I would say the same thing about any religion. It has no place in a public hospital. If the Minister can confirm today, in addition to the plan that will be published, that he is fully committed to the National Maternity Hospital being in full public ownership on public land, whether it is bought through a contract or by compulsory purchase, I would appreciate it. I will leave the remaining time for my colleague.