Maternity Services: Motion [Private Members]

I move:

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.

I thank the Acting Chair for the opportunity to contribute on our motion on national maternity services and I would like to commend my colleague, Deputy Catherine Connolly, and her staff Béibhinn and Rachel, on their work on the motion. I was very happy to put my name to the motion to call on the Government to publish a time-bound and comprehensive implementation plan for the remaining years of the 2016-26 strategy.

It is 2021, three years since we voted to repeal the eighth amendment and nine years since Savita Halappanavar tragically lost her life. There have been many other unspeakable tragedies in maternity hospitals across the country. Our first national maternity strategy was published in 2016 and was to run until 2026. There are now five years left in this strategy and it is time for the Government and HSE to be held accountable for the commitments made. Women are consistently being let down by the State. It must be exhausting. Front-line staff in maternity services and midwifery staff are overworked, undervalued and working in physical environments with infrastructure that is not fit for purpose. I welcome that HIQA’s report of early 2020 focused its recommendations on the HSE and the Government.

Covid has meant that pregnant people have been attending prenatal appointments alone. I have made regular representations regarding Letterkenny University Hospital and support for pregnant people during Covid. I understand that there must be additional restrictions to ensure that Covid is kept out of hospitals, but there are pregnant people receiving devastating news alone and partners missing out on wonderful moments of hearing heartbeats on ultrasounds.

Just this week, on Monday, 31 May, I was informed that birthing partners are allowed a 30-minute visit each day to the maternity department in Letterkenny University Hospital after the birth of a baby. Even when everything goes perfectly there is still a need to check in on the person giving birth. We all know that there are many stories and incidents of traumatic births which may not begin to be processed until weeks or even months after the birth.

I have been told that from this week birthing partners in Letterkenny can accompany pregnant people to dating and anomaly scans. Letterkenny is now allowing the birthing partners of people in labour to attend. Partners can also attend a caesarean section done under regional anaesthesia. In those cases, partners must be screened and wear PPE - in fairness I think they are usually in scrubs when attending caesarean sections.

The spokesperson for the hospital said that if a partner has Covid-19 symptoms, is awaiting a Covid-19 test or test result or has had a positive test within the last 14 days he or she must not come to the hospital, and in this event an alternative birth partner may attend. So far, so good, but the spokesperson went on to state that partners must wear a face mask at all times, maintain social distancing and use the available hand gel to clean their hands regularly. From whom are they to maintain social distancing? Is it from the staff or the person giving birth? If they live together, why would they have to socially distance during the birth process? In cases where a baby is in the neonatal unit, just one parent at a time may visit.

On 7 and 8 August 2019, HIQA visited Letterkenny University Hospital unannounced. I welcome that the inspection report found that all standards bar one were compliant or substantially compliant. I particularly welcome that Letterkenny has a formalised process for people who have used the maternity services. It was standard 2.7 where Letterkenny Hospital was found to be non-compliant. HIQA found that the infrastructure in the maternity ward and assessment room was outdated and that infrastructure was listed as a risk on the risk register. HIQA inspectors were informed that there was no funding available to address the infrastructural deficits. The key finding included that the obstetric operating theatre for emergency cases was not adjacent to the labour ward, but is instead three floors above. There was an operating theatre there at the time but it did not have any staff.

Our motion calls for the eight HIQA recommendations to be implemented but, more importantly, that there are clear actions and timeframes for implementation and completion. As with all areas of government, progressive strategies are not worth the expensive paper they are printed on if the recommendations and changes are not put into practice.

Another example of the Government's lip service to issues of public importance is that of the ownership of the National Maternity Hospital. I fully support the campaign against church ownership of women's healthcare regarding the proposed new maternity hospital at Elm Park. For years now, activists have raised the issue of Catholic ethos practices in maternity, gynaecology and women’s health services. Particularly since we repealed the eighth amendment and abortion services were rolled out across our 19 maternity hospitals, the possibility of the Catholic ethos overriding legislation is hugely concerning.

In our motion we call for legally guaranteed independence from all non-medical influence in the hospital's clinical operations within the laws of the State. However, campaigners are concerned that this is the language being used by independent legal experts advising on public engagement. Campaigners have provided documents showing that such guarantees cannot be provided within the terms of the largely private ownership and full private operational control demanded by the Religious Sisters of Charity and its company, St. Vincent's Healthcare Group. The Minister might consider raising this aspect with the relevant parties. Only full public ownership and full public governance can guarantee a full service in reproductive health.

Conversations around the need to co-locate maternity hospitals with acute general hospitals began in 2008, following a KPMG recommendation that timely access to complicated care should be readily available when needed. The National Maternity Hospital’s Holles Street campus was found to be dilapidated and the need for change urgent. As per the usual pace of government change, it was 2013 before the then Minister for Health, James Reilly, announced the chosen site of Elm Park to co-locate with St. Vincent’s Hospital for the National Maternity Hospital.

Three years later, in 2016, a dispute emerged over the governance and ethos of the National Maternity Hospital. It was agreed a new company with clinical and operational independence should be established. This brought us St. Vincent’s Healthcare Group, of which the Religious Sisters of Charity was the shareholder. Not only that, but it was also revealed that the State would gift the hospital to the group. Therefore, not only were we allowing nuns and the Catholic church to run a national maternity hospital, but we were also going to hand over ownership. It really beggars belief. I must commend the campaigners and the vocal repeal campaigners who have been keeping this issue in the media for years. In 2018, 66.4% of the electorate voted to repeal the dangerous eighth amendment, yet there were still conversations that abortion care could not take place at our new and improved national maternity hospital. Dr. Peter Boylan resigned from the executive board of the National Maternity Hospital, saying it was “blind to the consequences” of transferring ownership of the hospital to the group.

Various taoisigh have stood up in Dáil Éireann and given official State apologies to the vast numbers of people who have been hurt by the Catholic church, and indeed the State, in the past. We talk about our dark history but there are people around us for whom this history is very, very present. There are families trying to be reunited, having had babies forcibly taken from them. There were illegal adoptions and illegal birth registrations and survivors are still not being heard. How can we atone as a country for the State’s part in all this trauma without acknowledging the need to now separate the church and the State? How can we keep saying we must change our patriarchal system of delivering healthcare when we do not prioritise women’s health?

There are larger conversations around the suitability of those who are accessing fertility treatment or experiencing miscarriage having to sit in waiting rooms with heavily pregnant people and joyful scenes. There are huge issues around the diagnosis and treatment of endometriosis and many other gynaecological issues. I say to the Minister that we all know that if men suffered through women’s health issues, complications, and other traumas, the services would be completely different and would respond to our needs. That is what we need to do, to respond to the needs of women.

The Minister has ten minutes.

My understanding was that I had 15 minutes. Would it be possible to check that?

Ten minutes is what is listed here, so it is ten minutes.

Is the Acting Chairman sure?

Okay. I thank Deputy Connolly for tabling the motion on maternity care. The Government will be supporting the motion. Women’s healthcare has never been prioritised as it should be in this country. It has never been invested in as it must be. Our maternity hospitals are not fit for purpose. We are reported as having the lowest rate of breastfeeding in Europe. There is insufficient choice for pregnant women in terms of midwifery-led care, community-based care and birthing options. Mental health supports are insufficient, including in identified critical areas such as eating disorders for girls and younger women. IVF supports are not good enough. Support and promotion of physical activity at all age groups is behind where it needs to be. A national conversation on menopause is speaking volumes for what has not been done for women’s health and well-being. Gynaecology waiting lists are unacceptably long. Conditions like endometriosis have been largely ignored. This list goes on and on. We have incredible people working in women’s healthcare, in community and hospital settings, and in maternity, gynaecology, mental health, oncology, screening, well-being and in many more areas. However, we need more of them and they need a lot more resources to provide the services that are required.

Women’s healthcare is a top health priority for me and for this Government. That means extra resources, more services, quicker access, more choice and appropriate facilities. It means an approach informed by national strategies, including the national maternity strategy, and one in which women’s voices are central, including the essential work of the women’s health task force. The under-investment in maternity services, along with many other areas of the health service that cater for the well-being of women, has led in some instances to regrettable and tragic outcomes for women and babies. These events continue to be deeply traumatic for the women and families concerned, and I hope we will all bear them in our thoughts today as we discuss this motion.

The national maternity strategy is a central part of that learning process for improving women's healthcare. Its publication in 2016, mapping out the future for maternity and neonatal care in Ireland, was widely welcomed. Delivering on the strategy’s vision of services that are safe, standardised, of high quality, with enhanced experience and more choice of care for women is the reason its full implementation is so important. It is also essential to ensuring that dignity and respect are at the forefront when we develop and deliver our services. Progress has been made to move us towards that goal and we have already seen developments in how maternity care is delivered. There has been a marked increase in the number of consultants, midwives and allied health professionals, with more than 330 whole-time equivalent posts funded under the strategy. Services have been made safer through the recruitment of maternity-specific quality and safety managers in each hospital group, the mandatory publication of maternity safety statements, and the establishment of serious incident management forums. Investment in scanning services has enabled maternity units and hospitals to now offer all women a routine anatomy scan. Midwifery services are increasingly available in community settings, and early transfer home services continue to be established. Each of our 19 maternity units and hospitals now have bereavement teams with clinical midwifery specialists, along with lactation consultants, recruited to each site.

However, I must also acknowledge that there is significantly more that needs to be done. This is why we have renewed our commitment to the strategy’s implementation in the programme for Government. This year we have invested more in the development of our maternity services, and in women’s healthcare in general, than ever before in a single year. Budget 2021 saw increased allocations of development funding for maternity and gynaecology services to the tune of €12 million. The funding allocated specifically for the implementation of the national maternity strategy is €7.3 million; that is the biggest investment in the strategy since it was launched. To put it in context, it is a one-year increase in the strategy of around 500%. I have also spoken with the chair of the HSE’s board about regular monitoring of the implementation of these national strategies to ensure this investment is translated into the much-needed service improvements. This will significantly enhance our ability to deliver on its vision and to improve the experiences of the women and families accessing maternity care. Specifically, the funding provided in 2021 will help underpin the further development of community midwifery as well as specialist services. In addition to this, €5 million has been allocated to the women’s health fund.

A number of significant initiatives in relation to gynaecology services are also being advanced. These include establishing or expanding services across nine see and treat ambulatory gynaecology clinics in 2021 and additional fertility hubs. We are establishing and expanding services across nine gynaecology clinics in 2021 in Dublin, Drogheda, Waterford, Wexford, Letterkenny, Portlaoise and counties Kerry and Mayo. It is estimated that approximately 70% of general gynaecology referrals are suitable for management in the ambulatory setting. This would include conditions such as abnormal uterine bleeding and chronic pelvic pain. In addition, care available in the ambulatory setting could encompass common investigations such as pelvic ultrasound, and diagnostic hysteroscopy as well as minor procedures, including cervical and endometrial polypectomy, and intrauterine device insertion, removal and replacement. We are establishing two new regional fertility hubs in Nenagh General Hospital and Galway this year, bringing the total number to six, one for each of our six hospital groups. The budget for this year also provided for a dedicated multi-annual €5 million women’s health fund to implement a programme of actions arising from the very positive work of the women’s health task force.

I recently announced the expansion of the endometriosis service at Tallaght University Hospital. This investment will help to deliver a much-needed specialist centre for the management and treatment of all forms of endometriosis, with particular focus on advanced and complex cases, treatment for which has not been readily accessible in Ireland. I was delighted to receive a proposal from the Irish College of General Practitioners for a clinical general practice lead for women’s health and recently announced funding for this position. This will enable the development of a range of new educational and support services for GPs to enhance women’s health services in their practices. I also recently announced further funding to the HSE of approximately €1.6 million to fund 24 additional lactation consultants, providing increased breastfeeding supports to every maternity unit in the country. To date, the HSE already has 30.5 whole-time equivalent lactation consultants.

My Department is progressing a range of actions on menopause. Initiatives that are being advanced include a menopause workplace policy, provision of specialist support in the area of menopause and a health awareness campaign to increase visibility and awareness of menopause. More work can be done in that area.

Returning to our maternity services, I will reference HIQA’s 2020 monitoring report. It is important to note that the report shows that there have been positive developments in maternity services and that HIQA found high levels of compliance against most of the national standards. The HSE’s national women and infants health programme has been working on a revised implementation plan for the national maternity strategy, based on HIQA’s recommendations. I hope that speaks directly to the points Deputy Connolly raised. The revised implementation plan will set out the actions required to fully implement the strategy and will also reflect developments since it was published. In addition, the implementation plan will set out funding required each year to achieve the targets so that these can be considered as part of the annual Estimates processes. I agree wholeheartedly that multi-annual funding and a level of forward planning by the people involved in developing and rolling out the strategy are needed.

As referenced in the motion, the HSE is also preparing a plan in response to the other recommendations of the HIQA report, which included responding to infrastructural deficits identified across a number of maternity services. Last year, as recommended in the strategy, we saw the roll-out of the very first national maternity experience survey. Thousands of women across the country had the opportunity to tell us about their experiences. I was particularly glad to see from the survey results that many women have had very positive experiences. It is important that we recognise what we are doing well and then seek to expand those practices right across the system. It is also essential that we recognise some women did not have a positive experience and we must learn from that.

The Government is committed to the development of a new national maternity hospital on the St. Vincent’s campus. The project is unprecedented and complex. We are relocating one voluntary hospital to the campus of another voluntary hospital and into a hospital building owned by the State. A legal framework is being developed to protect the State's investment in the new hospital and ensure that it remains in State ownership. The legal framework will also ensure that health services at the new hospital will be provided without religious, ethnic or other distinction. I know I am out of time but I ask the Chair to bear with for a few seconds. I want to state categorically something I previously stated at a meeting of the Joint Committee on Health and stated again yesterday when I met the National Women's Council of Ireland and others who have been involved in campaigning for these services. I will not countenance any new maternity hospital that has any governance or influence whatsoever involving any religious ethos. That is an absolute commitment. Services will be provided in accordance with the law and national policies. That is all.

There is much work to be done to ensure girls and women in Ireland have access to the healthcare and well-being services they need. Good and steady progress has been made in the past year. The task now is to increase this progress, grow services, make the experience better and better and improve access for all.

I thank Deputy Connolly for bringing forward this motion and allowing for an urgent and timely discussion on the national maternity strategy. I also thank Ms Beibhinn O'Connor and Ms Rachel Hynes for the work they have put into this motion.

I listened to what the Minister said. While HIQA made the point that there has been some progress, an awful lot of issues still have not been progressed. That is why this motion was put down, calling for an annual report and plan, and for that annual plan to be brought back to the Dáil for reasons of transparency and accountability. We must accept that the national maternity strategy was initiated in 2016 with a ten-year implementation timescale. It followed a number of baby deaths in the Midland Regional Hospital in Portlaoise and the death of pregnant mother, Ms Savita Halappanavar, in Galway University Hospital. We know a public consultation process was undertaken with 1,300 responses. Of those, 25% described maternity services as poor in terms of quality and safety. Has that changed? When will we see quantitative and reported change in that regard?

Specific concerns expressed in that public consultation process included a lack of support for breastfeeding; limited care options; lack of choice; an overly medicalised approach, especially to women at low risk; overcrowding; poor staff; and waiting times in both pre- and post-natal clinics. Years of underfunding and staff shortages have resulted in a service with serious deficiencies in a country with one of the highest birth rates in Europe. Does the Minister think we have reached the point when those deficiencies will not be reported any more? Are we reaching that point? When will those deficiencies no longer be reported? When will the plan be implemented?

All of the concerns expressed by pregnant women were confirmed in a report on maternity services across the 19 maternity hospitals for HIQA. Only one in four of those hospitals offered natal well-being scans or ulatrasounds. It is not all bad, as we know from the HIQA report. Some services were described as "excellent". Those included the domino scheme in the national maternity hospital, evidence-based practice in the Coombe, caesarean births in Limerick and home birth services in Cork, among others. However, if one lives in a more rural area, major geographical inequality still exists. Are those inequalities still there? Where are we on that? Can we have a report outlining what has been done and where we are leading to in the next five years? Units are under-staffed, infrastructure is inadequate, some care options depend on ability to pay and community midwifery is limited. Have those things changed? Where are we at in that regard? A physical report should be given to the Dáil and public representatives on those matters. There are limited mental health services for post-natal depression. In fact, such services are practically non-existent. We have one of the lowest levels of breastfeeding in the world. Where are we at on that? What has been put in place and what will be put in place in the future?

More than 60,000 babies are born every year in Ireland. The overwhelming majority are born with no problems, due to the commitment of front-line staff who work long shifts in difficult conditions. Can we have a report and accountable update of where those services are at and what jobs have been put in place?

Five years after the conception of the national maternity strategy, it has not been implemented the way it should have been. Parts of Sláintecare are still gathering dust on a shelf in the Department of Health. The question of choice in these services comes up again and again. Another issue around choice is the choice to terminate a crisis pregnancy. According to the National Women's Council of Ireland, only one in ten GPs and half of maternity hospitals are offering abortion services. Three years after the repeal of the eighth amendment, one woman is going to the UK every day for a termination. These are difficulties, in particular, for migrants and the Traveller community. A patient needs a PPS number and Irish address to avail of the service. The upcoming review must deal with these problems if the will of the majority who voted in the referendum is to be respected.

The Minister referred to reports in his reply. Can we see a report from the HSE about what point we are at in our implementation of the national maternity strategy? What is the plan for implementing the rest of the strategy over the next five years? Where do we have to go from here?

The location of the national maternity hospital is mentioned in the national maternity strategy. Guarantees were given that the national maternity hospital would be on the basis of co-location with St. Vincent's hospital, would be built on State land and would be 100% owned by the State. Guarantees from then Taoiseach, Deputy Varadkar, and then Minister for Health, Deputy Harris, and more recent announcements from the Taoiseach, Deputy Micheál Martin, and the current Minister for Health, Deputy Donnelly, to the effect that the national maternity hospital will not have a Catholic ethos and all that implies, do not correspond with the facts. That is not happening at the moment. The reality is that the national maternity hospital will be built on land owned by the St. Vincent's Hospital Group, which will lease the land to the State on a 99-year lease. That is what we have seen. St. Vincent's Hospital Group was established by the Religious Sisters of Charity, a Catholic institution, effectively to maintain a Catholic ethos. This is now common practice as numbers in the religious orders decline in order to protect their property and the Catholic ethos into the future.

This was done by religious orders elsewhere. It has been done by the Sisters of Charity here. The State has conceded on the issue of co-location. It has conceded on the issue of building on State land. With an estimated build cost of €500 million, plus another €500 million to equip the hospital, the State will build a €1 billion facility that it will not effectively own. That is the current situation.

We ask the Government to outline how it has stepped in and stated that that is not going to happen. I note the Minister stated that the hospital will not have a Catholic ethos, but what mechanism is the Government employing to ensure that will not happen? We are not seeing it at the moment and we are yet to be advised on that point. It is delusion to believe that an agreement can be reached on the issue of the ethos of the hospital. It is delusion to believe that the new national maternity hospital will be the only Catholic-owned hospital in the world to allow sterilisation, IVF and abortion procedures. What is the Government going to do to ensure that does not happen?

The new national maternity hospital must be a public hospital built on public land, run publicly by the State. The situation shows the absurdity of trying to build a modern public healthcare system within the limits of a system that has never moved beyond the Victorian model of healthcare as an act of charity provided by religious institutions. It has huge implications for Sláintecare, if ever there was a real commitment to its implementation, as envisioned by all parties in their support for it.

I will finish on a note from Dr. Peter Boylan who said that the bottom line is the HSE must not approve the transfer of St. Vincent's Hospital Group to St. Vincent's Holdings for two reasons, first, that the national maternity hospital would be owned by St. Vincent's Holdings, the successor to the Sisters of Charity, with the same Catholic core values and that women's reproductive health would not be served by this and, second, that the State would be acquiescing to the ownership of a large, publicly-funded hospital group by a private company on privately-owned land with all the implications that has for Sláintecare.

I note the Minister's comments. However, we want to know what is being done to avoid the situation that we have seen publically. The St. Vincent's Healthcare Group, SVHG, has clearly set itself up. Co-location is not happening. The SVHG wants to integrate the new national maternity hospital into ethos and services of its own hospital. We are meeting with the Minister on Thursday, 17 June. Perhaps he can set out clearly at that meeting what the Government has done to date. Perhaps he could clarify if the Government has bought the land, if it has procured the land through a compulsory purchase order and if it has instructed the Sisters of Charity that they, and their Catholic ethos, will not have a role to play in the public hospital.

First, I wish to thank the Independents who have brought forward this motion. I wish to commend the motion and its three main demands, namely, that there must be an immediate step change in the implementation of the national maternity strategy, including a comprehensive, time-bound, fully resourced implementation plan for full implementation by 2026; that immediate action is taken on the eight recommendations from HIQA's overview report of its monitoring programme against the new standards for safer, better maternity services; and absolute iron-clad assurance that the new national maternity hospital will be publicly-owned and operated, with absolutely no room for error or mistakes.

Women's healthcare is not something in respect of which this State has a good reputation. The history of the State's attitude towards women's healthcare is not one we can be proud of - from the avoidable deaths of several babies in the years prior to the strategy, consistent negative international comparisons of the performance of maternity units, the CervicalCheck scandal, the vaginal mesh implant scandal, and the historical wrongs committed against women and their children. We need a women-centred approach to women's healthcare to be adopted very rapidly.

CervicalCheck campaigners continue to face barriers to justice with the CervicalCheck tribunal still not hearing the number of claims that would have been anticipated. It does not seem to be fit for purpose. There is little trust between women and the Irish healthcare system.

The national maternity strategy was supposed to be part of the answer, but the fact is that it was never properly resourced. The resources committed in the last budget to the national maternity strategy was a start, but it was a start after many years of underinvestment or very little investment. Several maternity hospitals have significant infrastructural deficits. HIQA has recommended that all maternity units are reviewed.

I have visited the Rotunda Hospital a number of times. I am sure the Minister is aware of how cramped conditions are and how difficult it is for staff who are trying to provide the very best maternity care in that hospital. They need capital investment to ensure that they can expand and provide a much higher standard of maternity care in a much safer way. That is the bottom line. That is only one maternity unit. There are many more.

It is highly concerning to hear that not all clinical staff involved in the management of obstetric emergencies have received the necessary multidisciplinary training. The lack of a standardised national approach and provision of training for obstetric emergencies is a huge failing in respect of mothers and their babies. There are also significant protocol deficits. There is a lack of transfer protocols to the most appropriate care settings for women and newborns and a lack of a shared learning from reviews of clinical incidents across maternity units.

Covid-19 has been blamed for the strategy falling behind, but if we are honest, it was never at the races to start with. Funding was made available for 23 consultant roles but they are not filled by permanent staff. Consultant working conditions are preventing recruitment for those roles because Government has refused to address the recruitment and retention crisis in our hospitals, and indeed, the two-tier consultant pay issue which still exists and prevails.

Talking about new public-only contracts sounds great, and that is something that I obviously support, but we have to deliver. It also has to be agreed with the Irish Medical Organisation and the Irish Hospital Consultants Organisation. We need to win support from hospital consultants and their representative groups for new contracts, so that we can attract the highest quality consultants into maternity services and other areas like cancer care, as we heard at the meeting of the Joint Committee on Health this morning.

We are meant to have a community midwife-led service in all of our maternity hospitals, but five years on, only two hospitals have this service and have considered closing it. In our manifesto, Sinn Féin committed to providing an additional €70 million to fund and implement the national maternity hospital. That is the level of investment which is necessary.

I wish to finish by stating that we need an absolute commitment that the national maternity hospital will remain completely in public ownership. Why we had to go down the route of establishing a company to manage the land and the hospital, is beyond me. Surely, the land should have been gifted to the State? That is what should have happened. It should have been transferred or gifted to the State, then the national maternity hospital would be fully owned by the State. The land would be owned and managed by the HSE as opposed to being managed by others on a board. We must look at this issue. I commend the motion on highlighting the issue and seeking clarity on it.

I listened to what the Minister said earlier. He has provided some clarity, but there are still questions outstanding in relation to how it would all work in practice. The only way forward is for the land to be gifted to the State and for the hospital to be in full public ownership.

First, I wish to commend Deputy Connolly and her colleagues on bringing forward this motion. I agree with much of the sentiment that has already been expressed around the importance of having the national maternity hospital in public ownership and the fact that there should be no religious influence.

However, I want to take the opportunity to specifically focus on the maternity services situation in St. Luke's Hospital, which is based in Kilkenny, but provides services for the counties of Carlow and Kilkenny. There has been no easing of Covid-19 restrictions for expectant mothers in St. Luke's, for scan appointments, the labour and the birth. It is most important that the Minister looks into this issue directly. He must ensure that this hospital and these women are not left out.

The point has been made by others that pregnancy and childbirth is an important and exciting time, but it can also be a nerve-racking and scary time. It is important that women have their partners at their side not just for the labour and the birth, but also for the scan appointments. Some have referenced the 20-week anomaly scan as being significant, but I also think that some of the earlier scan appointments are important. Many women end up finding out that they have had a miscarriage when there has been no indication of a problem. They go in, have a scan and receive the very sad news that there is no heartbeat. That is devastating for people. Therefore, it must be ensured that these women can have someone with them at their appointments. It should not be the case that partners are left standing outside in the car park when a woman's whole world is falling apart. It must be ensured that those people are there.

If these were issues that affected a group of men, I doubt that we would be having this debate because the issues would have already been resolved. There was a good, well-organised protest - it was organised by a number of women - outside St. Luke's Hospital some weeks ago and I was struck by the fact that when one looks at the people who are making the decisions, with all due respect to the Minister, they are all men.

It is very important that women's issues, particularly women's health, are taken seriously. There have been countless debates about women's health in my time in this House since 2016, and there were debates well before that. There was the cervical screening situation, the problem with vaginal mesh and many other debates. There are many things that do not even get on the radar. Members may or may not have heard the recent discussions on Joe Duffy's radio programme about the menopause and the number of women who rang in who had no help or support and who were not given adequate information. Why is it always the case that when it comes to issues that affect women, and particularly their health, there is no information? It is the same with endometriosis. There is very little information, help or support. Women are being forced to go abroad. Women are suffering pain and agony for years and almost being made to feel that they are going crazy when they are told that this could not be happening or that it is something else. I know somebody very well who was on the verge of having her gall bladder removed. It was decided to carry out a last-minute scan. This person was in the gown and ready to go, but it was not the gall bladder at all. It was only then that it was decided it was endometriosis. It is actually ridiculous that we are discussing that level of lack of medical information. There is a shying away, not facing it and not knowing how to deal with it. It is not good enough for the women in this country.

I specifically ask the Minister to look at the situation in St. Luke's Hospital and in Carlow and Kilkenny. It is an excellent hospital and provides excellent care. At present, however, it is failing women who are expecting babies, who are struggling to get pregnant, and who are dealing with early miscarriage or the various situations one encounters. Then there is the labour, the birth and the level of visitation in the aftermath. I heard that some hospitals allow a 30-minute visit per day. That is not available in St. Luke's Hospital. Those issues must be examined. As I have the opportunity today to speak directly to the Minister, I appeal to him to examine that situation in particular.

There is much talk at present about things reopening, and rightly so. It is very welcome. I do not oppose it. However, with all these areas reopening, maternity hospitals are still denying access to partners. One can go to shopping centres and, from next Monday, one can have a meal outdoors or go to a museum, yet a partner cannot be present with a woman during the labour and when she is giving birth. What is worse is that the Minister and the Government are trying to present a minimal, tiny level of access as a major reopening. It is a cod. It is presenting the problem as if it has been resolved. Yes, there are some that are even further behind, but in all instances the level of access is totally unacceptable. It is a fraud.

Just before last Christmas, my partner, Eimear, had an emergency appointment with the early pregnancy unit because she was bleeding. I waited outside in the car park, looking up at the window of the early pregnancy unit waiting room. It was as close as I could get. I am glad to say that everything was okay, but we were worried. If it had not been okay, Eimear would have had to face that appointment alone. She would have got that bad, devastating, earth-shattering news alone. The situation is still the same today. If a couple in that situation, worried about the same thing, goes to any hospital today, tomorrow or next week, the partner must stay outside the hospital door. That is an outrage. Whatever about a year ago, hospital staff are now vaccinated. Increasingly, pregnant women are vaccinated and many partners will be vaccinated too before long. That is welcome. Partners and expectant mothers almost always come from the same household and present the same Covid risk. There is no justification.

The South/South West Hospital Group website advice on when a partner can have access when a mother is giving birth says the partner can join after the woman is in strong active labour and soon after birth is kindly asked to leave. Women in labour need support, full stop. The WHO and the chief medical officer say so. The idea that an arbitrary decision on how many centimetres dilated a woman is should dictate when she needs support is ridiculous and outrageous. On the same website there is a link to the Royal College of Midwives report which states that having trusted birth partners present is known to make a significant difference to the safety and well-being of women. Once more, however, they are asked kindly to leave. When a woman has been through all that, and God knows how many hours the labour might have been, and when she needs to rest and recuperate the partner who can help her do that, even for little things like a shower or a rest, must leave. The Minister must stop dragging his heels on this and force action. He must stop presenting these minimal changes as enough. Women need their partners during all the labour, after the birth and at key appointments. Partners are not visitors; they are essential support.

I welcome the opportunity to speak on this important motion. It is now five years since the national maternity strategy was launched. It was hailed at the time as setting out radical reforms of maternity and neonatal services over a ten-year period. However, last year HIQA published a report following inspections of 19 maternity units and hospitals, during which it discovered that the HSE had no plan for how to implement the strategy. Years after launching the plan, the HSE did not know how it would be implemented. That makes it appear that the launch was just put together to make it look as if something was being done.

A key recommendation in the strategy was that maternity services should be woman-centred. Unfortunately, for the best part of the last year maternity services have not been woman-centred. They are still not today. Women are being left without the support of a partner at appointments, at scans, during the full labour and after the birth, and there are restrictions on visiting. They do not have the support of their partner to allow them just to have a rest or a sleep after giving birth. Trinity College Dublin carried out research last year on women's experiences of maternity care during the Covid pandemic. Women spoke about feeling emotional, anxious and fearful when entering the maternity hospital alone. While women described their midwives as being very supportive during their early labour experience, for most this was not enough. They needed their partner. Many women described the unusual situation of their partner waiting in the car park while they were in early labour. They spoke about going out to the car park to walk with their partner, to pass time and to be with their partner in sharing the experience. I cannot begin to imagine how worried and scared those women were.

It is bad to launch a maternity care strategy and not implement it up to now, and then to leave women in the situation they were left in during the Covid pandemic, particularly when it comes to labour. The least the Government can do now is implement the strategy with full funding.

Women are an afterthought in many instances, but particularly with regard to healthcare. Over the decades, time and again we have seen scandal after scandal in women's healthcare. That must stop now. It is unacceptable for maternity care to be pushed to the margins as we move out of lockdown. While golfers are back on the greens and we will be able to drink a pint outside from next week, pregnant women are once again forgotten. I have been contacted by many mothers and fathers who have been damaged as a result of this. One woman told me she gave birth in my local hospital in Galway last June. She was alone for most of the labour while her husband sat in the car park, also alone. He spoke about the devastation of dropping her off, alone, and waiting for her outside. I am sure the Minister can accept that this caused a great deal of stress for both parents. She said: "I was alone in the bath for hours without the company of anyone, just a midwife to check on me every so often". These are harrowing words. I was also contacted by a father who missed the birth of his child as a result of the restrictions.

The Government must act and end the restrictions. The CEO of the HSE has said that the conditions are right to end maternity restrictions and the CMO has said there is no good reason to continue the restrictions. However, three weeks later I still cannot get an answer from University Hospital Galway as to why it is continuing the restrictions. It refers to when active labour is initiated. I am not told what active labour is.

Labour is labour, and that includes early labour. Induction of labour is labour. Early labour is labour. They have not specified at what point in labour partners may attend. I am blue in the face trying to get an answer to these questions. In University Hospital Galway, partners are only allowed to visit between 7 p.m. and 9 p.m. and only for half an hour in the neonatal intensive care unit. This does not go far enough. Fathers are not visitors. They are parents who are as responsible for their child as the mothers and their support and presence during the first days of their child's life are essential.

The recommendations in HIQA's maternity overview report found a lack of clarity and national leadership within the HSE regarding the responsibility for implementing the national maternity strategy. This strategy provides a framework for a new and better maternity service that will improve choice for women and ensure that smaller maternity units in particular are better supported to provide sustainability, high quality and safe care. It recommended the expansion of community and home-based care to ensure greater access to midwifery-led services in all geographical locations.

This was echoed in the Programme for Government: Our Shared Future, which committed to implementing the national maternity strategy. In June 2019, while in opposition, the Minister brought forward a motion on national maternity services that called, among other things, for progress to start in 2019 on all projects not yet commenced and for investment in community-based pathways to ensure choice for mothers. Despite all these commitments and promises, midwifery-led services are still only available in two locations - Our Lady of Lourdes Hospital in Drogheda and Cavan General Hospital. Indeed this was almost reduced to one midwifery-led unit last year when the lack of clarity and national leadership within the HSE that was highlighted in the maternity services overview report was in evidence. In total contrast to the recommendation of the national maternity strategy, there was an effort to subsume the excellent midwifery-led unit at Cavan General Hospital under a new consultant-led model of care. It took a public backlash to halt this contradictory proposal and bring about a commitment to undertake a review of the maternity services at Cavan General Hospital, which eventually recommended that the midwifery-led unit service be expanded. The commitments and promises made by this Government with regard to the expansion of midwifery-led services across all geographical locations must be delivered. Women have waited too long for these commitments to be realised.

There is growing public disquiet about the ownership, governance and ethos of the planned new national maternity hospital. I believe there are many legitimate concerns about the implications of private ownership of the national maternity hospital by a company with a religious ethos. The site is to be leased to the State but ownership will be retained by a private entity. Although the proposed facility can be expected to cost taxpayers over €1 billion, only the shell of the hospital will be publicly owned. The State is to have no involvement in the private company set to own the new facility and no role in its operations. I have serious concerns regarding the potential impact of this on women's healthcare and services and believe these should be provided in a publicly owned hospital. A public hospital and its grounds should be fully owned by the State rather than a private company. I support the motion.

I thank Deputy Connolly and her colleagues for bringing forward this motion, which we will support. I note the Deputy's track record on this because I know we have been raising similar issues for many years. I am disappointed the Minister left just before I began to speak. Perhaps he was afraid I was going to remind him of what he said in opposition regarding all these issues because it was quite comprehensive. If he was to implement in government what he called for while in opposition, it would be great.

I will cover three areas. The first concerns access to maternity services. In fairness, the contribution from Deputy Ó Laoghaire summarises what I have been saying here for months. I have told many stories of many friends who are being treated so badly because they cannot be with their partners. I have heard some really horrific stories. This issue needs to be dealt with once and for all.

The second issue relates to the national maternity strategy. This strategy is five years in and is going nowhere as regards scale. It is completely wrong. Mark Molloy resigned in June 2020 because it was going nowhere. Given the credibility of the other members, I would be surprised if they stay on board as well. In fact, I would not advise them to stay on board. It is not my business. This is going nowhere in scale. Obviously we need multiannual funding, which still has not happened. Regarding the issues outlined by HIQA, only Cork, Cavan, Drogheda and Wexford meet the requirements. The other 15 maternity units need significant upgrading and refurbishment. Local maternity services to me are in Limerick, where my children, my brother and I were born. Essentially, it has not changed. The structures are still the same. It is completely archaic and out of date. It is scandalous. The Government cannot even find enough money to push that forward. I will make a suggestion about that later on.

While I welcome some developments regarding the fertility hub in my local hospital in Nenagh, they are small by comparison to the overall scale of what is required. We must learn lessons relating to the scandalous situation that has affected so many women across the country. We made multiple promises that services to women would improve. I know because I have been fighting with regard to the CervicalCheck issue for years. Look what is happening with the tribunal. Look at what is happening with regard to gynaecological services where there are waiting lists of two years or more for some procedures and diagnostics relating to issues like endometriosis. That is just not good enough. That is reality. It is not good enough yet we make all these promises. Promises are a waste of time unless they are fulfilled.

Finally and most comprehensively, I want to deal with the ownership of the national maternity hospital. I have literally been dealing with this issue since 2017. This is the crux of the issue. The original decision regarding the national maternity hospital should not have been made. The officials who drove that decision have questions to answer. The Government that drove that decision has questions to answer. I believe we are now in a deadlocked situation. In the programme for Government, the Government said it would "Conclude the governance arrangements and commence the building of the new maternity Hospital at St Vincent’s Hospital, Dublin." It did not say anything about ownership. Until the ownership structures are sorted out, we cannot proceed. I looked at what the Minister said. He was quite equivocal regarding where the ownership would go, which I welcome, and said he would not do anything until it is sorted. Frankly, he will not be doing anything unless he does something about the ownership model that was structured and put in place in 2017 and has been thundering along since then. It has to be dealt with. This nettle must be grasped. The model will not work unless this is done through compulsory purchase order or is gifted. It is as simple as that.

While we are wasting time on all of this, the national maternity strategy is not progressing. Could we, at least, deal with the Rotunda and Limerick hospitals by pushing them on while we are losing all this time on the national maternity hospital, of which I am a huge supporter? I am a huge supporter of the national maternity strategy. I am on record as saying it is one of the best healthcare strategies in Ireland that has ever been written. This must be dealt with. I believe the 2017 decision to give sole ownership of the site to the religious Sisters of Charity was wrong. I believe in co-location but it could not have been done this way. In May 2017, under pressure from myself and others, the Sisters of Charity said it would not be involved in the running of it but it needed to get divestment permission from the Holy See. It received permission but there were conditions under Canon Law 1293. The cat was then let out of the bag when the Catholic primate, Eamon Martin, said he would oppose certain actions in the hospital such as abortion. We then saw the 2017 annual report of St. Vincent's Hospital, which said it would be obliged to uphold the values and visions of Mother Aikenhead. That showed where this was going but we have had no movement of any substance since then.

We are at a point now where, as the previous Minister, Deputy Harris, said, there are three tests before this can be moved on: that the building would be completely in State ownership; that there would be no religious association in any way, shape or form in the articles of association of the company; and that the board would be fully orientated towards the State.

There was also a very clear point made, which is the sticking issue, that this Government or any future Government, would have to make a decision to proceed. It would not just be a Minister's decision; the Government would have to make the decision. We are now at the point where a Government needs to make a decision. It, however, is a kind of tipping away and hoping that it will be gifted. If that does not happen then it must be done by compulsory purchase order, CPO. While we are doing that we need to progress the national maternity strategy in relation to an overall strategy, and especially in relation to capital investment for the likes of the Rotunda and Limerick hospitals.

This hospital needs to be independent. We must get it right. We must guarantee State ownership. We must guarantee and ensure the legal arrangements around this with regard to the board of directors are proper. The new national maternity hospital cannot be a subsidiary as currently constructed under the St. Vincent's Holdings CLG. It needs to be owned by the State, it needs to have its own governance and budgetary independence, and it needs to be absolutely bereft of any religious interference whatsoever. We are at a critical point and the Government needs to move this one. It needs to make a decision and to stop pussyfooting around on the issue and it needs to be open and transparent on it.

I am absolutely disgusted that the Minister, Deputy Donnelly, has left the debate this morning. He has come up with a speech that has all the right words in it, and yet he will not be in the Chamber to listen to women's voices and women's opinions on this matter. I am really annoyed that the Minister has left the debate and not given us the respect of listening to what we have to say on the issue.

I stand here today as the Social Democrats spokesperson for children. I stand here as Wicklow's only female Deputy, and despite the Minister for Health and the previous Minister for Health being my constituency colleagues. I stand here as a mother of two daughters. I stand here as someone who campaigned and voted to repeal. I stand here as someone who fundamentally believes that women's healthcare deserves to be free from religious influence, and that women deserve to have the healthcare they need and want, when and where they need it. I am really angry that the Minister is not in the House to listen to this.

I will specifically talk about the National Maternity Hospital and I thank the Minister of State, Deputy Mary Butler, for being here to listen to this today. I thank Deputies Connolly and Pringle and their colleagues for bringing this motion forward. It is a hugely important issue and one which the Social Democrats will absolutely stand behind.

I will speak specifically on the ownership of the National Maternity Hospital. In his speech, the Minister said that "[t]he legal framework will also ensure that health services at the new hospital will be provided without religious, ethnic or other distinction." This does not mean that the services provided will be without religious distinction; it means the hospital would not discriminate against people on their religion or ethnicity in the context of access to the hospital. The Minister also said:

I will not countenance any new maternity hospital that has any governance or influence involving any religious ethos. Services will be provided in accordance with the law and national policies.

This completely rings hollow because this is the same Minister who, a number of weeks ago, said there was no legal, policy or health reason maternity restrictions were required when it came to women who were giving birth under Covid restrictions at the moment, and that there was absolutely no reason for partners not to be allowed in with them. The Chief Medical Officer said there was no legislative or health reasons that could not happen. It is clear that the Minister does not have control over what is happening in the hospitals across the State. There are many women who must face the very vulnerable position of going for healthcare, having scans and then giving birth without their partner or support person. It does not make any sense in a situation where people will very soon be able to go to the pub and enjoy a pint. Yet, women cannot have the very person they need with them while they give birth. The Minister is saying that he will make sure that the national maternity hospital will meet all its legal and national policy requirements, but that he cannot do so when it comes to maternity restrictions at the moment. I am sorry, but the Minister's assertion absolutely rings hollow. I am not taking him on his word. Promises have been made repeatedly on this over the years and the Minister and the previous Minster have still not provided the governance and clarity on who will own this hospital, who will run it, and under which ethos and influence maternity care will be provided.

In my constituency in Wicklow 74% of people voted to repeal. We did not vote to repeal on condition. We did not say that it was repeal only for some women in the State or for only some hospitals. Every single woman in Ireland and every single woman in our constituency of Wicklow deserves to have the healthcare she needs, when she needs it, and to make choices about her own body in accordance with her wishes and not some puppet that holds governance over her.

I join the other Members in thanking Deputy Connolly and her team for bringing forward this very important motion. Over the past year I have had to repeatedly raise the issue of restrictions in maternity hospitals. Despite reassurances that this issue would be dealt with, it was not. While the rest of society had opened up, and while we could even go to the pub, mothers were and still are expected to go through labour mainly alone, while partners are lucky if they get to attend the birth of their own child.

Reflecting on this past year, it is very apparent that pregnant people do not have a lobby group and that they are not an economic priority. One year later and some efforts have been made to address this, but it is not enough. Last December, for example, the HSE reclassified partners as essential accompanying persons for the purpose of the 20-week scan, but then they became unessential for the remainder of the maternity journey, which makes no actual common sense to anybody.

That the Minister has left the House for this debate says it all. Maternity services are relegated because they are a women’s issue and they are overlooked because they can be. This is changing, however, and it is changing fast. The recent maternity restrictions campaign has shown an incredible solidarity and it is not only the people currently affected but also other parents. Other women are showing an incredible solidarity and families are sharing their stories of miscarriages and the need for more supports. There is a new strength of purpose in ensuring that maternity services are better for the women next to come in the door. The Government would do well to note this solidarity.

Today’s motion brings us to the reality of implementing a strategy that is about resourcing, staffing, and paying for the healthcare that parents and babies are entitled to. Crucially, we need the staff and facilities to run a safe and dignified service. Last year’s HIQA report into maternity services outlined how midwifery staff are working overtime to address staffing deficits and to maintain service levels. The Irish Nurses and Midwives Organisation, INMO, has consistently highlighted that our midwife-to-birth ratio is much higher than it should be. The Government must implement robust recruitment and retention strategies to make nursing and midwifery careers more attractive and to ensure that all our nurses and midwives in training are properly paid and have the option of working in Ireland.

Disgracefully there is essentially no consideration of disabled women in the current strategy. Witnesses at the Oireachtas Joint Committee on Disability Matters have highlighted the systemic barriers these women face, including the lack of proper infrastructure, absence of interpreters, and inadequate information for informed decision making in all aspects of maternal health. The strategy implementation plan needs to consider the needs of people with disabilities, as well as vulnerable or marginalised groups.

This motion rightly insists on the public ownership of the new national maternity hospital. It is unbelievable that in 2021 we have to even discuss this. Maternal healthcare needs to be free of private interests or religious control. It is intolerable that a particular ethos would determine what healthcare people get rather than medical need. The Minister needs to give an absolute guarantee today that the new national maternity hospital will be publicly owned and operated.

The current national maternity strategy is Ireland’s first. As we pass through a decade of centenaries, we are reminded that it took almost 100 years for the State to take a properly organised approach to maternal healthcare. Instead, women were too often sent to institutions, the mother and child scheme was heavily resisted, and until 2018 those in need of abortion care were shipped abroad.

These realities reflect the position of women's healthcare in our society. In case Deputies think I am exaggerating, they should read the motion, as the only reason we have a national maternity strategy is the very tragic death of Ms Savita Halappanavar. As well as the specific findings surrounding Savita’s passing, the HIQA report highlighted the lack of co-ordination and inconsistencies in the provision of maternity services. For the national maternity strategy to mean anything, it must be implemented and resourced properly. It is outrageous that we need this motion but we do.

The Government needs to listen. We do not need lists of the achievements the Department of Health has written for the Minister but rather real political decision-making to immediately provide a comprehensive, time-bound and fully costed implementation plan. Anything less is unacceptable.

I thank Deputies Catherine Connolly, Joan Collins and Thomas Pringle for tabling the motion. I know the debate is being keenly watched by people campaigning to ensure our National Maternity Hospital is in public control and I am not very reassured by the statements this morning from the Minister.

Three years after the referendum repealing the eighth amendment to the Constitution, which ensured we could finally access abortion services in this country, we are faced with the promised state-of-the-art new national maternity hospital being controlled and run by a religious order of the Sisters of Charity. I do not know what kind of imagination the Minister has but I cannot see how it would sit comfortably with that order to provide abortion services, IVF treatment, vasectomy, which it currently refuses to provide, sterilisation and operations such as gender realignment. I do not understand how the Minister can assure us on that. He stated that a legal framework is being developed to protect the State's investment in the new hospital and ensure it remains in State ownership without religious, ethnic or other distinction. It is difficult to understand or accept.

We need our Government to take the new national maternity hospital into public ownership. It should own the land on which it sits and control every aspect of it. Looking at the cost of the national children's hospital, it is likely that nearly €1 billion or more will be spent on the maternity hospital building. The Government has said it endorses this motion but it is like it is asking us to trust it and the Sisters of Charity. During the campaign to repeal the eighth amendment, we constantly asked people to trust women and I trust them to make their own choices. I cannot trust the State and the Department of Health with the record they have on reproductive healthcare and women's rights. It is absolutely appalling, whether we start with the mother and baby homes, the Magdalen laundries, the X case, Savita Halappanavar, the A, B, C and Y cases, women being forced abroad, the symphysiotomy and CervicalCheck scandals or vaginal mesh surgeries. You name it and the Department of Health and this State have overseen it with some of the worst treatment of women and their healthcare needs.

If all the decisions are being made by the State in that hospital, there are some glaring contradictions in the Minister's contentions. At the end of this, we need agreement with the Ministers concerned that this session on the motion, although very welcome, important and timely, should be continued with a longer debate with questions and answers to the Minister on the specifics of this deal. These specifics are being obscured and glossed over and the language is very worrying. We must demand at the Business Committee to go through these matters.

There is disquiet about the ownership, governance and ethos of the planned new maternity hospital for good reason. New information has recently emerged that assurances given on the ethos in 2017 cannot be relied on. The proposed facility, although expected to levy a cost on the taxpayer, will not be publicly owned and the State will have no involvement with the private company running it. There is no way of compelling the new private company, as planned, to provide services that fly in the face of Catholic ethos. A 2019 Government-commissioned report on the role of voluntary organisations in publicly funded healthcare indicated its premise on the fact that legally the State cannot compel private Catholic entities to provide services contrary to their ethos. The nuns have yet to divest themselves of the assets and they still own the lands and particularly the site on which it is planned to build the hospital.

According to the Catholic Church, abortion is one of the most serious crimes of all and one must ask what precaution has been taken by the nuns to ensure the services will be provided in the new national maternity hospital that could undermine their own teaching. Legal instruments relating to ownership and governance structures, constitutions, leasing and licensing arrangements, along with staff contracts and conditions, are all aimed at enforcing compliance with the ethos of the Catholic Church. A clear statement of this ethos can be found in the hospital's job specification, which cites that the core values of the Religious Sisters of Charity, under the new holding company, St. Vincent's Holdings CLG, will set its healthcare delivery in a religious framework.

Honestly, how can we be expected to trust the Government when we read that the St. Vincent's Holdings company directors are legally bound to uphold the ethos of the congregation? That is not my ethos or that of the vast majority of people. It is not what delivered us a massive change in this country with the referendum on repealing the eighth amendment.

There can no longer be obfuscation and confusion about where we are going with this new national maternity hospital. If we are not going to sit down and have an honest debate, with the Minister forensically questioned about all the matters relating to the contract and holding company arrangements, we are going nowhere. We cannot just fire statements back and forth here without such forensic questioning. Like everybody else, I am extremely worried that this is hurtling to a conclusion and the hospital deal will be done very soon. I appeal to everybody in the House to demand that cross-party debate to bring this matter forward.

Last Tuesday, 25 May, under questioning from me on Leaders' Questions, the Minister for the Environment, Climate and Communications, Deputy Eamon Ryan, stated the new national maternity hospital "will be operated by two separate voluntary hospitals". He did not mention the identities of the two separate voluntary hospitals and I can only presume they comprise the boards of the current National Maternity Hospital and the St. Vincent's Healthcare Group.

I am sure the Minister does not need reminding that the St. Vincent's Healthcare Group is the lay successor organisation to the previous owner of St. Vincent's Hospital, the Sisters of Charity, who are nuns. He also does not need to be reminded that they are obliged to uphold the values and vision of the founder of the Sisters of Charity, Mary Aikenhead, or in other words, Roman Catholic doctrine. The Minister does not need to be told the provision of abortion services, sterilisation, IVF, gender reassignment surgery etc. is completely inconsistent with the upholding of Roman Catholic doctrine.

Will the Minister tell the House why the Government has articulated support for giving operating rights to a privately owned Catholic lay successor organisation at our new national maternity hospital, which is being built exclusively by the State at a cost of more than €500 million to the taxpayer? The St. Vincent's medical group is hardly likely to provide abortion services at our new national maternity hospital so is the Minister honestly trying to tell us one medical team at the hospital will provide these services while the other will not? Is this not precisely the kind of Irish solution to an Irish problem that the people signalled they wanted rid of when they voted so overwhelmingly to repeal the anti-abortion laws three years ago?

The new national maternity hospital must be 100% publicly owned and fully provide abortion services, IVF, sterilisation and gender reassignment services. That is instead of having a bit over here and a bit over there.

I compliment Deputy Catherine Connolly and her colleagues on bringing forward the motion. It might have been an ill-judgment of the Minister to leave before some of the contributions were made. I say this with no disrespect to the Minister of State, Deputy Mary Butler, and I acknowledge her presence.

The Covid-19 situation and all the restrictions that came into being gave rise to angst and anger because of the disruption caused to maternity services. Nobody is to blame for Covid-19. One of the things we must learn from the pandemic is that maternity services were affected in a way that meant partners were excluded from what were special occasions in the lives of families. Those were sometimes also traumatic and sorrowful occasions, with high stress experienced by the mother and the partner.

We are now opening the country. As other speakers have said, however, there seems to be a reluctance on behalf of the management of hospitals across the country to do the same. It is very hard to justify it being possible for people to go for a drink, into a hotel and to do all of these types of things, yet partners, who are more than likely living together, cannot be together for these special, and sometimes sad, occasions that occur during maternity.

The biggest problem I find with this situation is that the Department of Health has divorced itself from all responsibility in respect of hospital management. Hospital management in different areas has operated under rules. This has again created confusion and a question about who is in charge. Therefore, rather than just talking about this matter, it is important that the Minister issues a directive to the management of hospitals concerning how to proceed.

The other issue I want to raise is the national maternity strategy. I have often listened to people talking about strategies since I was elected to this House. A few Deputies said that the strategy was written in a given year. The easiest thing is probably to write a strategy, but the crucial aspect should be implementing it. However, that is not happening. There was a case in my constituency of a couple that had a traumatic experience in the form of a miscarriage, which was their second miscarriage. The problem faced by that couple was that when an issue arose over a weekend they were first directed to the emergency services, and then subsequently sent to maternity services. No CT scan services were available at the weekends.

A reply I received from the HSE is worrying, because it referred to a concentration on normal services and times of operation. CT services would be available for emergencies, but I do not believe we can have a service that is ad hoc from Friday evening until Monday morning. Whether it is maternity services or any other medical service, we need a more flexible approach in respect of people being available to carry out scans. That will cost money, but we are talking about having people available to ensure that we treat expectant mothers, the mothers of children and children themselves with the highest of respect and with the requisite services.

Another issue that came up during my conversation with this couple was that of training for staff when a miscarriage is suffered. I refer to how they deal with that situation and how they deal with the patient and the partner. It must be handled with compassion, and that is how many people act. However, in a situation where staff are overrun with work, sometimes a little of the required compassion cannot be given. We must ensure, therefore, that the requisite resources are provided and that every member of staff is trained in how to deal with a patient who suffers such a trauma, and including everyone in that training, even down to the person bringing in a cup of tea.

We have lost sight of many of the simple things because we get so involved in and buried within strategies. An example in that regard is antigen testing. Why can we not use that method in the maternity hospitals to allow partners to attend? That should not be done in just one hospital or another, but nationally. Let us have a national drive using this approach and ensure everybody is singing from the same hymn sheet.

We have heard from Deputies regarding their own experiences in this area. It has been a long time since my wife last gave birth, and that baby is now 35 years old, but it was a special time in our lives. It is a special time in the lives of those lucky enough to be in that position. We should, therefore, ensure that the women and newborn children of this country are treated properly. We do not need just a written strategy, but one that is implemented and that will continue to be implemented in a transparent way. Returning to the very start of when we began talking about maternity services, we have heard much talk about strategies, but what we must do is decide what we are going to do with the national maternity hospital in Dublin. We must get that sorted out and then move on, get the maternity services in place and increase the infrastructure in all the hospitals where it is needed.

We cannot have our hospital staff working in archaic buildings where they cannot provide a proper health service and then blame them for the outcome. If the experience of Covid-19 has shown us one thing, it is that our HSE workers are the best in the world and we must ensure that we recognise that fact. Recognising it is one thing, but, equally, we must also ensure that we continue to support those workers with the necessary infrastructure and resources to allow them to deliver excellent services throughout the health service, and particularly in the area of the maternity services.

Tá áthas orm labhairt ar an rún seo, atá fíorthábhachtach. We must not forget that Ireland and our maternity services are recognised internationally for the level of care given to expectant mothers. It is also important to acknowledge that this results from the hard work and dedication each day of the midwives and nursing staff in our maternity services. The motion refers to the various reports from HIQA and the failings identified. We must also remember that HIQA consistently found good practice in how maternity services detect and respond to obstetric emergencies. It also identified opportunities for improvement to ensure that maternity services remain safe and effective in future. One of the most recent HIQA reports also made it clear that an overall level of professionalism, teamwork and commitment is displayed by the staff providing maternity care in what is a highly pressurised and demanding environment.

Having said that, however, problems persist in how maternity services operate. All we must look at in that regard is the way in which many expectant mothers and their partners and husbands have been treated in respect of the Covid-19 public health restrictions. The restrictions on partners being allowed to attend important scans were cruel and harsh and went too far. I have repeatedly raised this issue since September. Upset constituents and midwives have contacted me in this regard and I ask that this issue be addressed. My understanding of what is happening here is that the HSE seems to be calling the shots and that it has repeatedly ignored the Minister for Health and the Government on this matter. The Minister must now step up to the mark and put an end to what is happening with the HSE. Partners should be allowed to attend important scans.

I congratulate the Acting Chairman on the birth of his new granddaughter, who came into this world after 1 o'clock this morning. I congratulate the parents, all the extended McGrath family and on their behalf I thank all the excellent maternity staff in Clonmel hospital. It is only right to acknowledge that and it is a proud day for the Deputy and his family.

We are all very glad to see lovely new little babies coming into this world, and not just in Clonmel and County Tipperary but in County Kerry and the rest of the country as well.

The motion we are discussing concerns a serious issue and I have been inundated with communication regarding partners not being allowed into scans. It is still an issue. I was grateful to the Minister for Health and the Department for making the HSE write to the State's 19 maternity hospitals telling them it was time to lift the restrictions on partners visiting. Unfortunately, that directive was not complied with.

We have to be respectful to the management in hospitals and maternity units. I am sure they think what they are doing is for the best but, at the end of the day, there are partners who want and need to attend. It is a very special time. It can be an upsetting time or a happy time. Some scans are critical, when little or big difficulties might arise and it is so important that people are there to support each other. For once and for all, I want to see the hospitals complying with the requirement to treat partners properly and give them the opportunity to be with the person who is having a baby.

I am glad to have the opportunity to speak on this very important matter. Like other Deputies, I have been constantly queried about this and asked when the restrictions will be lifted. Other Deputies have criticised the senior Minister for leaving the Chamber but I have the utmost faith in the Minister of State, Deputy Butler. I have every confidence that she will deal with this and respect our wishes. She, as much as anyone and more than some, values the birth of a child. I know that her views on this are the same as my own. The birth of a child is a joy and a pleasure for the mother and father and the wider family. It is very important for the future of our country that babies are born and are looked after properly. I am calling on the Government to ensure that these restrictions are lifted sooner rather than later. It is very important that the partner is there and that they start off together, being together for everything that concerns the baby coming into the world. Why are some hospitals complying with the Minister's direction and allowing partners to attend? It is good that husbands and partners want to be with mothers. It makes for a good start when they start out together. I am calling on the Government to do everything possible to reopen hospitals and allow partners to attend.

Finally, it is very sad to see so many babies being lost through abortion. I call on the Department, the Minister for Health and the Government to ensure that advice is given to expectant mothers who are considering abortion that will help them to keep their babies and bring them into the world. The babies in the country are our future.

I thank Deputy Connolly and her colleagues for tabling the motion. I congratulate the Acting Chairman on the birth of another grandchild, which is fantastic for him and his family.

There are 19 maternity hospitals in Ireland, with approximately 150 babies born every day. It is estimated that 25,000 babies were born during Covid, with between ten and 12 born in the maternity hospital in Limerick. The scientifically recommended ratio is one midwife for every 29.5 births but the ratio in Ireland at present is one for every 40 births. This must be addressed. The recent relaxation of restrictions in hospitals is very welcome but it does not go far enough.

My wife and myself are the parents of four boys. We are also the proud grandparents of a child who was born during Covid. We saw first hand what our son and his partner went through because of the Covid-19 restrictions and understand what such restrictions mean for the families waiting at home. A half an hour after the birth of our grandson, Noah, our son was allowed in for half an hour. That is not good enough for either partner. One of the most important events in life is the birth of a child and on coming into the world, he or she should see both parents. Mothers also need support during childbirth.

I want to thank those providing maternity services, particularly midwives and nurses, for everything they have done during Covid. I commend them on the support they provided when the management of certain hospitals did not allow partners to attend.

In closing, I again thank Deputy Connolly and her colleagues for tabling the motion. The quality of our maternity services is, for me, a reflection of the importance we place on women and their infant babies. It is not that long ago that such esteem was not clearly visible, something this House and the country as a whole should not easily forget. As an Irish woman and a mother, I am well aware of how important this issue is and am very happy to be able to contribute to the debate.

As the Minister for Health outlined, this Government is fully committed to delivering better health outcomes for the women of Ireland, not just in terms of maternity care but right across the board. We are determined to ensure that the success achieved so far in women’s health is further progressed and built on for generations of Irish women and girls into the future.

Recent developments, as noted by the Minister, and the very significant funding made available for 2021, certainly build on progress made in women’s health. This includes the ongoing implementation of the national maternity strategy, improvements in screening services and in sexual assault services and the implementation of the sexual health strategy. Key to this progress has been the inclusion of women’s voices. We have seen the very positive contribution of women to the development of the national maternity strategy through its public consultation process and through their inclusion on the steering group that developed the strategy. More recently, the views and experiences of hundreds of women have informed the work of the women’s health task force through its radical listening exercise. The national maternity experience survey has given voice to thousands of women regarding their experience of our maternity services.

Listening to those voices is one thing; it is quite another to understand them and to act. That is why I am very proud of the efforts made by the Government to ensure those thousands of voices have been taken on board. We have, to borrow a phrase, put our money where our mouth is by putting significant funding into women’s healthcare. We heard from the Minister for Health earlier that €7.3 million has been allocated to the national maternity strategy this year. This funding will ensure that there is a renewed focus on delivering the vision of the strategy for our maternity care system. What is equally welcome is the focus on issues that have not always made the headlines, in particular gynaecology with its historically long waiting lists, and endometriosis, a condition that many women have borne silently for years. The investment made in 2021 will significantly enhance capacity in a system that requires further improvements.

It is only in recent years, and in particular since the national maternity strategy was published, that we have seen a deliberate focus on the area of maternity and women’s health more generally. Over that period, we have seen the recruitment of additional midwives, consultants, theatre staff, ultrasonographers and quality and safety managers. However, this year, through funding allocated to the national women and infants health programme, an additional 139 posts will be added to our maternity and gynaecology services, significantly boosting staff numbers. The benefit of this cannot be overstated and will undoubtedly make a very real and tangible difference to the women and families accessing services.

On perinatal mental health, it is important to note that the national maternity strategy firmly recognises the need to provide better supports to women during and after pregnancy. In November 2017, the HSE launched the document, Specialist Perinatal Mental Health Services: Model of Care for Ireland, which supports the actions on mental health outlined in the national maternity strategy. The model of care continues to be rolled out on a hub-and-spoke basis, with funding for the six specialist perinatal mental health hub teams provided to a total of €3.6 million. This funding covers the cost of the full hub teams in each of the six maternity hospitals, and recruitment of the outstanding team members is currently taking place.

An integral component of the model of care is the deployment of a mental health midwife to each of the 13 maternity spoke sites. The newly appointed mental health midwives based in spoke hospital sites work with the local liaison psychiatry services. With 12 of the 13 spoke mental health midwives in place, I am glad that the model of care has progressed significantly.

While I was in opposition, I often noted my disappointment with the slow progress to implement the national maternity strategy. As stated by the Minister, while highlighting that there have been positive developments in maternity services and high levels of compliance against most of the national standards, HIQA’s inspection report raises some concerns about the implementation of the strategy.

I am pleased, however, that the national women and infants health programme is in the process of developing a revised implementation plan with timelines and associated costs. The work being progressed through the programme now, and the timely implementation of that plan, will ensure that the strategy’s vision is fully realised for the benefit of the thousands of women and families who access care every year in our maternity hospitals and units.

As part of the Government’s broader focus on promoting women’s health, including the implementation of the national maternity strategy, the programme for Government includes a commitment to the co-location of all remaining stand-alone maternity hospitals with adult acute hospitals. The development of the new national maternity hospital on the Elm Park campus will be the first of these relocation projects to be progressed.

I understand that concerns have been raised regarding the ownership and clinical independence of the new national maternity hospital. I am advised that the corporate and clinical governance arrangements for the new maternity hospital are set out in the Mulvey agreement, however. The agreement provides for the establishment of a new company. that is, national maternity hospital at Elm Park designated activity company, DAC, which will have clinical and operational, as well as financial and budgetary, independence in the provision of maternity, gynaecology and neonatal services. The Mulvey agreement ensures that a full range of health services will be available at the new hospital without religious, ethnic or other distinction.

As the Minister for Health emphasised earlier, these overriding objectives will be copper-fastened through the legal framework that is being developed. The Minister has also committed to seeking Government approval for the legal framework once it has been finalised.

Progressing with the national maternity hospital relocation project is critical to providing women with the necessary infrastructure and environment to enable the delivery of a modern, safe, quality maternity service for women and infants. This is key to achieving the vision of the national maternity strategy.

I will conclude by reiterating to the House that this Government remains fully committed to renewing its focus on the development of maternity services through the implementation of the national maternity strategy. This Government has started as it intends to continue by providing investment in maternity and women’s healthcare services, and it will continue to support the national women and infants health programme in progressing those goals.

I agree wholeheartedly on a personal note with everyone who spoke about the challenges faced by mothers who are delivering babies in hospital or who are going for their 20-week scan. As a mother of three who had three induced deliveries, I believe it is essential that husbands, partners or a family member be allowed to be present at this most joyous occasion. Unfortunately, however, as has been stated, for some the news can sometimes be sad and devastating. The support of having a loved one present cannot be underestimated. One can understand why restrictions had to be put in place when we were having 8,000 cases of Covid-19 per day during January and February. As we start to exit Covid-19 and with 50% of the adult population now vaccinated, however, I appeal to hospitals to adhere to the advice of the CMO, the HSE and the Minister. It is very important that on this most joyous occasion for many mothers, which can be very upsetting and traumatic for others, women would be allowed to have their partners present as much as possible during the births and scans.

We will now move to Deputies Harkin and Connolly.

I also congratulate the Acting Chairman on the birth of his granddaughter; it is a happy time.

I sincerely thank my colleague, Deputy Connolly, for bringing forward this motion, which me and all my colleagues in the Independent Group were happy to sign. This motion refers to the national maternity strategy, the recommendations of the Sláintecare report on implementing that strategy and the HIQA report, which monitors the national standards.

In the short time available, I will concentrate on the 2020 HIQA report. It is the most recent and gives us some overview as to how the national maternity strategy is being implemented in individual hospitals and hospital groups. This report also deals with important issues such as governance, overseeing care pathways for women and babies, co-ordination between hospitals, co-ordination between medical professionals, staffing levels, staff training, etc. It is-----

We are running out of time because we have Leaders' Questions at 12 noon. Will the Deputy give a number of minutes to her colleague, Deputy Connolly, who introduced the motion? Deputy Harkin can see the clock. We have run behind; I am sorry.

I thought I had five minutes. We have eight minutes and 49 seconds left, according to the clock.

Yes, but we went over time during the debate. I am sorry. The Deputy might try to do as best as she can with her colleague.

What time do we have left?

There are only four minutes left in total.

Then I will defer to my colleague. This is not right. This should have been sorted during the debate. I will not complain or take Deputy Connolly's time. It is not good enough, however.

I concur completely with my colleague. What has happened is most unfair.

I would have thought that sometimes, on the odd occasions when we run over time, there is discretion. I have exercised that discretion in my capacity as Leas-Cheann Comhairle. I would have liked to have heard my colleague's opinion and views. She has signed the motion.

The Leas-Cheann Comhairle is always very decent with her discretion so I will allow extra time.

I will hand back to my colleague.

Deputy Harkin may carry on again.

Okay, I will be as brief as I can. I do not want to take from Deputy Connolly's time.

As I said, the HIQA report found high levels of compliance overall. It was clear from reading this report that there are weak links in the chain, however. That is why we have a national maternity strategy in place. While there is progress, we can see that certain gaps exist and until those gaps are filled, women and babies will be at risk.

One of the conclusions from the HIQA report stated, "The HSE needs to immediately develop a comprehensive, time-bound and fully costed National Maternity Strategy implementation plan", which to me is the most important point. The fact that we do not have that in place is an issue.

I am really concerned about the time left for my colleague, Deputy Connolly. I will finish with one point about which many colleagues had spoken. We need absolute clarity on the public ownership and operation of the new national maternity hospital. We need a debate in this House with the Minister present in order that we can have a to and fro to deal with this issue. Equally, however, we need to make sure the recommendations within the national maternity strategy are fully implemented.

I thank Deputy Harkin. I call Deputy Connolly.

I thank all my colleagues, and indeed, the Ministers, for their support of the motion. I welcome that; it is certainly positive. The urgent nature of it is lacking, however.

In its report, HIQA said the implementation of the recommendations was an imperative. I see no time span and no sense of urgency. Right up until February 20, or shortly before that, the driving body, that is, the national women and infants health programme, could not report precisely to HIQA what the report was. We need the implementation of a costed plan within the time span allowed. That is not happening.

The question has to be asked here today. Why did it take the motion? Why are those responsible still working on it? Why have the Ministers - especially the senior Minister - not asked the HSE where in God's name is the implementation plan for the HIQA report, which dates from back in February 2020?

I am not in any way reassured by the comments of the Minister or the Minister of State today on the National Maternity Hospital, unfortunately, in respect of the way forward. I want a firm commitment to public ownership of the National Maternity Hospital on public land. That public land has to be either acquired by compulsory purchase or bought or situated on a different site. We have to stop fiddling around with a mechanism that allows for Canon Law or religious law or a smokescreen. I support the call. I gather it will come with a full motion in due course and I call on the Minister to support it.

I am a stickler for time. According to the clock I have three minutes remaining but there has been such a commotion about time that I am going to concede. Perhaps we can improve our time management.

Question put and agreed to.