I thank the witnesses for all they do every day and I thank them for coming before the committee this morning. How we read this document depends on through what lens we look at it. Through the lens I am looking at it now I see the use of the word "women" and "mother" throughout the strategy. In acknowledgement of equality in Ireland, and out of respect, perhaps we could change that to "person" or "pregnant person", in light of members of the transgender community feeling the strategy does not refer to them in any sense. I take slight issue with the term "mother" being used because sometimes one does not ever get to become a mother. One may get half-way there or three quarters way there. I would like the language to be tidied up a bit, in light of all I have learned in recent years.
I had a quick search of the document for the words "termination", "abortion", "crisis pregnancy" and "the eighth amendment" and I can only find one reference at the bottom of page 36. Whatever one's views are, it seems very unusual or strange that the document could be written without any nod to the impact of Article 40.3.3° on maternity services in Ireland and the impact it has had on professionals working in the area. There is also the fact the HSE provides HSE-branded information for women seeking terminations in the UK, so it is not like taxpayers' money is not being spent. I find it very strange this is not even referred to in the strategy. Post repeal of the eighth amendment, I hope, at the end of May, are the witnesses ready to edit the document in light of the potential change that will happen?
Feedback from the midwife-led services in Cavan and Our Lady of Lourdes Hospital is good. Do we have any data on actual outcomes? What is meant by feedback? Is it just a chat or is it women reporting it was better than the last time? What is that tangible data? The Domino scheme is very successful in Holles Street hospital and I hear very good reports on it. There are geographical issues with rolling out a similar programme outside Dublin. Do we have any plans for rolling it out?
I understand that public health nurses do not require a midwifery qualification. Has an audit or assessment been done on that change in qualification, with regard to the outcomes for mothers, newborn babies and any children already at home?
With regard to folic acid and our alarming rate of neural tube defects in this country, how are we on this now?
I know that the Food Safety Authority of Ireland has conducted a study of the safe upper limit for water soluble folic acid. Will we bite the bullet and start to fortify something that people could eat or drink to address the high incidence of neural tube defects? There is no need for me to explain the defects to the medical personnel present, but for the information of anyone listening to this broadcast, it means spina bifida and other health issues. Fortifying products would prevent some of the serious and challenging outcomes from occurring for parents and children as a result of poor pre-natal nutrition.
When he was here last year did Mr. McGrane say the health service was down 100 consultants? If so, we needed to recruit those consultants. Nine have been appointed. Did we lose any? What has been the net gain? What is the current position? Mr. McGrane said we would address the recruitment problem in the next ten years. The problem is that the health service is short 100 consultants. Also, it was projected last week that the population would grow by 1 million. I am sure some of them will be women who will look to have children. Obviously, demands are placed on health services owing to multiple births, the incidence of obesity, age, IVF treatment and other factors. To my mind, it is not good enough that in the health service there is a deficit in the number of consultants, unless Mr. McGrane spoke in error. If not, it is wrong for him to think it acceptable for women and their families - men, husbands and fathers - that it will take ten years to address a deficiency that was identified a couple of years ago. As my colleague said, women's health has been neglected for many decades and, possibly, a century. It is just not good enough to have corrective measures spanning ten years. Women are suffering and it is imperative that we deal with the deficiencies in the service as a matter of urgency.
The on-call issue must be addressed. I am fully aware that many doctors are not paid for being on-call and there is only so much time that their goodwill will last. Such work is unattractive. Someone would not be a consultant at 26 years of age but in his or her early 30s. It is grand being on-call and working every third night. However, we all know that as one gets on in age such work gets harder. It is no way to have a career, a family life or a personal life. It is just not an attractive career and we are shedding personnel. I refer to what Dr. Boylan said about the Australian model. We must do something about how we attract people into the system and keep them.
Ms Dunne said the level of public confidence in maternity care was poor. I disagree with her. I am not sure if her statement is based on research or what she is feeling, but I would say the level of public confidence in maternity care is quite high. I do not think anybody is terrified when a woman enters a maternity unit to have a baby delivered, but perhaps I am wrong. I had very good experiences when I used the public system and think the outcomes are very good, despite the deficits.
We have spoken at length about Sláintecare and anomaly scans. I am not sure whether it was here or elsewhere, but that does not matter. It is welcome that money has been released this week. We have also heard about the upskilling of personnel to perform anomaly scans. We have also heard about the difficulties owing to the job being repetitive and quite difficult and that if one has a bad day when there are a lot of anomalies, it generates stress. A year and a half has elapsed. Where are we now in dealing with the issue? It seems that there have been no tangible results. I fully acknowledge that it could not be an infrastructural or machine issue where one just buys the machines, that rather it is a people issue.
On the omission of gynaecology from the strategy, I do not want to criticise my own but the Taoiseach who is a doctor has signed off on the first page. It seems unusual that two aspects have been decoupled. I do not know how one can separate obstetrics from benign gynaecology when the same people do the same job and the two aspects are interconnected. Perhaps someone might make a suggestion in that regard. Do we slot an additional segment into the strategy?
On the mastership model, I fail to see how there is an issue with implementing it outside Dublin and ask the delegates to elaborate on the matter. I have heard that the model has worked quite well.
On triage policy and the prioritisation of scans for women based on data, a mother's age and the number of babies a woman is carrying, Professor Louise Kenny appeared before the committee some time ago. On that occasion we drilled down into the numbers and I extrapolated from what she had said that there was one case a week. That means that each week there is one child born somewhere in Ireland, perhaps in a regional hospital, with a condition that was not diagnosed prenatally. Whether it is 52 or 2 babies who are affected, that is just not good enough. In other countries it is standard procedure to scan. A scan brings peace of mind, but it also allows for preventative actions to be taken and measures to be put in place to be followed at the time of birth. The current measure addresses as a priority something that has been deficient for years; it is not a ten-year plan. From a director's point of view - I do not mean to be critical - I do not see this as being good enough.
Dr. Peter McKenna said there were imaginative ways by which the benign gynaecology issue could be addressed. I ask him to elaborate on the matter.
I am very supportive of having separate governance arrangements and budgets where there is co-location. It is co-location, not integration. There are historical reasons for the abandoning of women with gynaecological problems. Women seem to have accepted the fact that incontinence or having a prolapsed uterus are side effects of having babies, that they are things one gets over and walks around with. I challenge any man to walk around for a couple of years with a prolapsed anything and not to stand outside the gates of Leinster House holding a placard referring to his bits and bobs.
I wish to refer to what Deputy Bernard J. Durkan said about benchmarking. Recently in respect of the Civil Service it was mentioned that there should be a Dublin weighting or that an extra allowance should be paid to those who worked in the city. It is normal for staff who work in the National Health Service or the private sector to receive extra money to meet the higher rents and greater expenses associated with living in the city of London or urban centres in the United Kingdom. It is no good wringing one's hands and saying a weighting system could not be introduced for a midwife, a nurse or even a person who is training to be a doctor. It is not possible to commute from Tyrrellspass to St. James's Hospital. That is no way to start one's day or live one's life. We must adopt a multifaceted approach to make working in maternity services attractive.
I thank the Chairman and delegates for their patience.