Dáil Éireann díospóireacht -
Tuesday, 30 Sep 2014

Vol. 852 No. 1

Topical Issue Debate

Pupil-Teacher Ratio

Deputy Paul J. Connaughton

I thank the Ceann Comhairle for selecting this issue and for facilitating the debate, because it was deferred last week. I also thank the Minister for attending. This is a serious issue relating to pupil-teacher ratios, PTRs, in two schools. The first is Donaghpatrick national school in Caherlistrane, north Galway. When the school forwarded its enrolment numbers to the Department a number of months ago, it had the correct number to secure an additional developmental teaching post. However, through no fault of the school, a family had to leave the area for economic reasons, reducing the number of pupils by three. Unfortunately, that has left the school in a terrible predicament whereby it will lose the developmental post at the end of October. The concern for the school is that this will result in a class of 42 students in junior and senior infants, which is unacceptable. This is also causing a great deal of concern for parents. To add insult to injury, the post will be given back to the school next year and, therefore, for the sake of four or five months, 42 students will be put together in one classroom. It is unacceptable and I would like the Department to demonstrate some flexibility in retaining the teacher and taking the pressure off the teachers and pupils.

The second school is Cappataggle national school near Ballinasloe, County Galway. This relates to the changes in the PTR for two-, three- and four-teacher schools in rural areas. If the school enrolment remains as it is, the school will lose a teacher next September. This is unbelievable, because the State pumped a great deal of money into the school a number of years ago. If the post is lost, the two classrooms that the money was invested in will no longer have a teacher or students. I acknowledge that budgetary measures have been implemented, but could the PTR for 2013 be used? This would give the school an opportunity to retain its allocation.

We need a review of how teachers are allocated. It makes no sense to remove a teacher from Donaghpatrick national school when the post will be given back to the school next September.

Deputy Brendan Griffin

I thank the Ceann Comhairle for selecting this issue and I thank the Minister for being present to reply to the debate. I regret that she has declined my numerous requests since August to meet to discuss this matter, but I have an opportunity now. Since the measures were announced in budget 2012, I have worked hard to have some reversed and to have their impact eased, with some success, through, for example, the introduction of the appeals process. However, the impact on schools has been profound and it has led to huge difficulties. In particular, geographically isolated schools, which will never have the option of amalgamation and are far away from the nearest other schools, have been hit hard. The Department's message at the time the changes were introduced was that the entire process would encourage amalgamation.

For a small number of schools, mainly on the western seaboard, amalgamation will never be an option. Lauragh national school, on the Beara Peninsula in my constituency, is located on a stretch of 26 km where there are no other primary schools. It has lost its second teacher because it has 17 pupils, which falls below the threshold of 20.

It would be easy for the Department to allow a geographically isolated school to appeal its staffing allocation on the grounds that it is isolated. The Department's appeals board could then consider each appeal on its merits. Unfortunately, the Department is not showing any flexibility in this matter. I have been informed that the issue cannot be discussed until the value for money report has been published, which is an unacceptable position. Children living in geographically isolated communities are not any less important than children living in urban environments. This matter could be addressed with the stroke of a pen. I ask the Minister to act. The appeals process was introduced without any great difficulty and this issue could also be rectified. Unfortunately, it has not been addressed and children are suffering as a result.

Minister for Education and Skills (Deputy Jan O'Sullivan)

I thank Deputies Paul Connaughton and Brendan Griffin for raising this important issue. I apologise that I was not able to attend the House to discuss this issue last week. The Minister of State, Deputy Damien English, and I were both appearing before the Select Committee on Education and Skills to discuss the Estimates. I note, however, that Deputy Brendan Griffin spoke about this issue earlier in the summer when he explained to me the position on small schools in his locality.

The staffing arrangements for primary schools include a provision whereby schools experiencing rapid increases in enrolment can apply for additional classroom posts on developing grounds. These are not the types of school the Deputies have highlighted. In addition, a staffing appeals process is available to schools, including a new criterion for the 2014-15 school year which is aimed at schools that make a significant contribution to absorbing demographic growth.

The Government recognises that small schools are an important part of the social fabric of rural communities and they will continue to be a feature of the education landscape. The staffing schedule at primary level disproportionately benefits small primary schools. It is worth noting that more than two thirds of the 3,200 primary schools have more than 86 pupils and, therefore, a much higher average class size than all of the schools affected by this measure. For example, a two teacher school with 32 pupils has an average class size of one teacher for 16 pupils. In contrast, a typical ten teacher school with 272 pupils has an average class size of 27.2 pupils. Nevertheless, I accept Deputy Paul Connaughton's point that teachers in smaller schools must teach a number of different classes.

Notwithstanding the phased increases implemented in the period between 2012 and 2014, the threshold for small schools will still be significantly lower than the minimum of 28 pupils that was required for the appointment of a second teacher in schools prior to the mid-1990s. An appeals process is available to small schools affected by this budget change. A school with four classroom teachers or fewer which is losing a teacher or failed to gain an additional teacher as a result of the budget 2012 measures can submit an appeal to the primary staffing appeals board. Details on the appeals process are widely available.

I acknowledge that specific issues arise in respect of populations that are geographically spread out, including those to which the Deputies referred. How best to sustain provision for widely dispersed and small communities presents a particular challenge, especially in localities where school enrolment is declining to single figures and amalgamation is not an option because there are no other schools in the locality.

The value for money examination of small schools was referred to on the Order of Business. The document specifically addresses the issue of the location of small schools relative to other schools of a similar type. I intend to publish the report as soon as I have discussed it with my Government colleagues. The report is under active consideration. I am aware that the issue the Deputies raise presents a significant problem in areas where the population is widely dispersed. The Government will consider the matter.

Deputy Paul J. Connaughton

Teachers and parents of students at Donaghpatrick national school are watching these proceedings and will have noted that the Minister did not refer to the school. I accept that she is new to her brief and wish her luck in it. On the specific case I raised, the removal of a developmental post at the end of October will create a class of 42 students and the post will be reinstated next September. This does not make sense. We hear of improvements in the budgetary position. The problem in this case is a lack of flexibility. Someone must engage with the school and understand the concerns of parents. The developmental post should be retained for the rest of the year and established on a permanent basis thereafter.

On Cappataggle national school, I ask the Minister to freeze the pupil-teacher ratio at its 2013 level to allow the school to retain a teacher. It would be pointless to turn this discussion into an urban versus rural debate. The Department is under pressure and we must try to relieve the pressure on schools by maintaining the pupil-teacher ratio, which has been increased, at its current level.

Deputy Brendan Griffin

On Deputy Paul Connaughton's final point, which he made very well, perhaps the changes made in budget 2012 might have merit if urban schools were deriving significant benefits from them. That is not the case, however. In 2012-13 the Department saved €2.6 million before tax from the new measures related to smaller schools. The figure will decline to €2.2 million in 2014-15. At best, the measures saved €1.5 million after tax, which is a pittance in the context of the departmental budget. They are, however, having a profound impact on small, rural communities and not benefiting larger schools. This issue needs to be cleared up immediately.

I have been hearing about the value for money report on small schools for the past three years. One of the first questions I tabled on my election to the Dáil was to ask when the report would be published. Rural communities must be given an opportunity to scrutinise and dissect the report and contest its findings. The Department is hiding behind it and taking what could almost be described as a threatening approach to those who raise issues about small schools by stating it will publish the report. Given that the report will probably be leaked a few weeks before the election, it would be better to publish it now and have an honest debate on it. It is unacceptable that it has been held back for the past three years, during which communities with small schools have suffered. In one school in south County Kerry only one teacher is available for 17 children across eight streams. Amalgamation is not an option for that school and a handful of other geographically isolated schools. With political will, this matter could be addressed overnight. I ask the Minister again to do so.

Deputy Jan O'Sullivan

This is not an urban versus rural debate. I am aware of a school in an urban area that is in precisely the same position as Donaghpatrick national school in County Galway. For demographic reasons, it too will lose and subsequently have reinstated a development post. The issue in such cases is that demographics in the locality are changing from one year to the next.

In asking me to freeze the pupil-teacher ratio Deputy Paul Connaughton is asking me to pre-empt a budgetary decision. As he is aware, as a Minister, I am unable to do this. A budget will be announced in two weeks.

I will be pleased to publish the value for money report once I have discussed it with my Government colleagues. I agree with Deputy Brendan Griffin that a public debate is needed on the issue. The report has been completed, but the Government has not yet agreed to publish it. I must, first, have a discussion with my colleagues before I can publish it. I acknowledge, however, that a specific issue arises in isolated geographical areas where amalgamation is not an option because the distances between schools are too large and the number of children is too small. We will address the issue.

Deputy Brendan Griffin

Will isolated schools that are suffering be allowed to submit appeals?

Deputy Jan O'Sullivan

As the Deputy is aware, an appeals system is available to schools.

Deputy Brendan Griffin

The deadline for appeals has passed.

Acting Chairman (Deputy Brian Walsh)

We must proceed to the next issue.

School Completion Programme

Deputy Seán Crowe

I welcome the Minister for Children and Youth Affairs, Deputy James Reilly. It is a pity that the Minister for Education and Skills has left the Chamber as the issue I raise also relates to education. Children from certain household backgrounds are more likely to die young, experience poor health and have literacy problems, yet educational supports for such children have been targeted for cuts. The background to this issue is that for the past six months meetings have been held in a number of local communities to highlight and explain to public representatives what is coming down the track.

For the last six years there has been a 33% cut in the school completion programme. Those schools are now asking for a halt to those cuts. They hear statements from the Tánaiste, Deputy Joan Burton, and the Minister for Education and Skills, Deputy Jan O'Sullivan, to the effect that things will change but they have not seen that happen.

I have visited a number of schools in my constituency recently, including St. Mark's, St. Maelruain's and St. Dominic's, as well as others in Old Bawn, East Tallaght, Killinarden, Brookfield, Fettercairn and Jobstown. Those schools have wall charts of all the different things on their programmes but one could see that after six years those programmes had been gutted and filleted. The schools are saying that the cuts have to stop.

The cuts are affecting the most marginalised students and their families. More cuts is the message coming from the Minister's new agency, Tusla. Talk is cheap but action is really important. Every euro taken from these programmes is a huge loss to society and a kick in the teeth for those communities.

How can the Minister stand over these cuts? Most of us in this House - some of us more strongly than others - believe in the idea of an inclusive and progressive society but that is not happening. Over the last six years, such school programmes have gone backwards instead of progressing.

In real terms, it will mean fewer people attending third level education. Recent figures showed that in Dublin 24 some 16% of school students continue to third-level education, whereas literally down the road in Dublin 6 some 99% of students continue to third level. That is the sort of divide that exists in our society. It comes down to the fact that if children leave school early they have nowhere to go. They will not go into well paid jobs. Many of them will be hanging around street corners while some will get involved in drug dealing and other criminal activity. It makes sense to provide such supports, including monitoring school attendance.

The OECD has reported that 93% of young people complete second-level education in Ireland compared to the OECD average of 84%. People around the world are examining the Irish model, so what have we got right? We are literally filleting it and tearing it up.

I hope the Minister will have some answers. Everyone will be looking at the next budget but some schools have already been told that this year's cut is 6.5%. As I said earlier, there has been a 33% cut in the school completion programme in the past six years. It is very hard to stand over this.

Given the Minister's message, are we really sincere about trying to keep young people at school through the school completion programme? If so, we will have to change direction and stop this drift away from the programme.

Minister for Children and Youth Affairs (Deputy James Reilly)

I thank the Deputy for raising this question. I wish to confirm that we are very serious about this matter. The aims of the school completion programme are to help young people stay in the formal education system until they complete senior cycle, as well as generally improving their school attendance and participation in education. The programme is a targeted intervention for schools identified through the DEIS action plan for educational inclusion of the Department of Education and Skills.

The school completion programme involves 124 locally managed projects and related initiatives, operating across 470 primary schools and 224 post-primary schools. It provides targeted supports to some 36,000 children and young people who may be at risk of educational disadvantage.

Every project in the school completion programme is managed and directed by a local management committee, which includes representatives of schools, parents and other education stakeholders in the locality.

The programme's project model approach gives local communities the autonomy they need to devise creative and innovative approaches to effectively address the needs of young people most at risk of early school leaving. Projects provide a range of targeted supports, including homework clubs, breakfast clubs, mentoring programmes, learning support, and social and personal development programmes for young people. In addition, a number of out-of-school supports including music, art and sports are provided, as well as a range of activities during holiday periods.

As with all major spending programmes, the school completion programme budget was examined in the context of the 2011 comprehensive review of expenditure. This process identified a requirement for savings of 6.5% per annum across the programme over the period 2012 to 2014. In 2014, an allocation of €24.76 million has been provided for the programme.

Since its establishment at the beginning of this year, the Child and Family Agency, Tusla, has operational responsibility for the school completion programme, including allocating funds to projects within the programme. This process requires local projects to develop annual school retention plans, with detailed service proposals for the forthcoming school year.

Allocations to projects are determined on the basis of these school retention plans, while having regard to the savings requirements set out in the 201 I comprehensive review of expenditure. I am advised that the agency has completed the detailed process of evaluating and approving the school retention plans prepared by individual projects for 2014-15 and that the first instalment of funding under the programme issued to projects in the first week of September. Further instalments will issue in December 2014 and May-June 2015.

The Child and Family Agency will continue to work closely with local management committees, schools and local school completion programme co-ordinators to assist projects through the process. The potential for any changes in the funding allocated to this programme in future years is a matter to be considered in the Estimates and budgetary process, and the resources available to Government.

The Deputy may be aware that a review of the school completion programme is currently under way, which is an important initiative in relation to the future development of the programme. The objectives of the review are to identify best practice in providing support to children and young people to stay in school; clarify the roles and responsibilities of those involved in the programme; and build upon the valuable learning and experience acquired to date.

It is envisaged that this work will be completed during the 2014-15 academic year. The review should help to identify any reforms that are needed to put the programme on a sustainable footing for the future. Most importantly, the findings of the review will be critical to ensuring that funding is directed to those services that provide the greatest contribution to better outcomes and brighter futures for vulnerable children and young people who are at risk of educational disadvantage.

Deputy Seán Crowe

We are talking about disadvantaged schools right across the country. It is not just a problem in urban areas but also in rural ones. I hoped that something positive would come out of the Minister's speech and he said there will be a review, which is grand. However, many boards of management involved in the school completion programme have told me that they cannot continue. No programme can sustain a 33% cut over a number of years. It sends the wrong message concerning the school completion programme. We are doing a similar thing in the drugs area but that is an argument for another day.

The whole idea of the programme is to give support to disadvantaged students. According to the attendance levels, it would appear that the programme is working. However, the level of incremental cuts over the past six years is now impacting on such services, so it has to stop. It may be a budgetary argument but the situation is not sustainable. Teachers and students in the relevant schools want the programme to continue working. I am appealing to the Minister to go forward instead of going back, but in order to progress the programme needs to be funded. I welcome any review in that regard. The school completion programme will stand up to any peer review.

Ultimately, we need to send to those communities a positive message that education is the way forward, that it is not set aside for a small elite in society and that there is a place for every child if he or she wants to proceed to further education. We genuinely believe in the concept of lifelong learning, but the children in question are only at the beginning and need the required supports. Will the Minister, in his new position, commit to championing the cause of those children who have been left behind and are disadvantaged through no fault of their own? Many come from a background in which we failed their families and parents. This is a challenge for the Minister and his new Department, but it is one he should take up.

Deputy James Reilly

I am sure the Deputy will agree that we all want to see all children reach their full potential. We want those who are particularly vulnerable and at risk of losing out through leaving education early in life to be supported in the best way possible. The schools inclusion programme is a huge part of this process. There have been cuts because, as we know, the country found itself in a bailout having lost its financial sovereignty. However, we are now out of the bailout programme and will certainly do everything in our power to protect the school completion programme. However, Government expenditure in this area is not limited to that programme. Nearly €49 million has been spent on various youth services programmes to offer support to young people all around the country. There is no doubt but that we could not do without these youth organisations and the tens of thousands of volunteers who work in this area supporting children and programmes, not to mention the tens of thousands of volunteers in the sports organisations who help to keep children occupied and engaged in healthy and physical activity that is to their benefit. We certainly have not targeted this area for cuts, but it has been one that has had to endure cuts. It is an area in which I firmly believe it is worth investing. Money spent on prevention reduces expenditure on treatment in a general sense, but nowhere is the gain greater than with children. Certainly, from our point of view and in our budget negotiations, this has been to the fore in our minds. We want to continue to support children to get the best out of the education system and support them when they are getting into trouble. There are many programmes in addition to the one in question, including Garda diversion programmes, which help to achieve that end.

Maternity Services

Deputy Clare Daly

This issue arises on the back of the tragic and unnecessary death of Dhara Kivlehan which really saddened people throughout the country. She was a young woman in her prime and had just given birth to her first baby. The real tragedy is that this was not an isolated incident. Unfortunately, Dhara was the latest in a long list of others, including Savita Halappanavar, Nora Hyland, Bimbo Onanuga and Tanya McCabe. There have been inquests in Sligo and investigations in Portlaoise, in the middle of which are women hoping their giving birth to their children will be a joyous occasion.

All of the occurrences in question happened under the watch of the HSE. There is a systemic crisis in maternity care, for two reasons. First, the cutbacks have meant that not a single maternity hospital is operating to safe ratios. Critically, however, our policies are wrong. We have an outdated antenatal policy that has not been changed for years. We should be seeking to develop a country-wide strategy involving midwifery-led units; instead, the HSE is actively pursuing midwives. I find it sickening that on the same day that the verdict of death by medical misadventure was given against Sligo hospital, where a midwife said she could not tell a patient had jaundice because she was Indian, an independent midwife with 31 years of stalwart experience, Ms Philomena Canning, had her State indemnity insurance withdrawn consequent to a decision handed down in the courts.

All afternoon I have been receiving e-mails from people who worked with Ms Canning and women for whom she acted or has been acting as midwife. Her crime was not killing somebody or doing something which led to somebody's death; rather, it was that, while observing all procedures and protocols, she transferred a woman to hospital after a home birth when that woman felt dizzy. That woman was discharged ten hours later and she and her baby were fine. Owing to the actions of the HSE, there are ten women – many of whom are about to give birth imminently – who do not have a midwife. This is really serious, particularly when one notes the list of fatalities in hospitals under the direction of the HSE. Nobody was suspended, let alone fired. Ms Canning has devoted her life to women and proper birthing in which women have a choice. The policy is completely wrong and the Minister must consider a decent and proper system of maternity care.

Deputy Billy Kelleher

I extend my deepest sympathies to Mr. Michael Kivlehan and his family on their tragic loss. Mr. Kivlehan's perseverance in having the hearing held in the Republic did the State a great service in the sense that it has brought to light some of the issues regarding the death of his wife, Dhara. It was unacceptable in first instance that efforts were made not to have an inquest. It was said the inquest should be held in Belfast because that was where Dhara had died, but, thankfully, through the perseverance of Michael, his family and legal representatives, an inquest was held here. The information that has emerged on the care offered to Dhara in Sligo leaves a lot of questions unanswered on the longer term issues concerning maternity services, not only in Sligo but also across the country.

Ms Eilish O'Regan wrote an article in the Irish Independent today on the lack of information emerging from maternity services. We have raised this issue before on foot of the cases of Tanya McCabe, Savita Halappanavar and others who died while giving birth or just thereafter. Ms O'Regan states:

The blunt statement was made by Phelim Quinn, who is now acting head of the Health Information and Quality Authority (HIQA), when he was launching its report on the death of Savita Halappanavar in University Hospital Galway. He revealed that some maternity units have not even provided annual reports to give basic statistics and reveal how and why any babies or mothers died in their care. Maternity services have existed largely under the radar until the case of Savita and earlier this year revelations of four similar baby deaths in Portlaoise hospital since 2006. The full details of the tragic case of Dhara Kivlehan, who died in Sligo General Hospital, would probably never have come to light had it not been for her brave husband Michael.

In general, we have very safe maternity services in this country, but there is still a problem regarding the collation of data on incidents and ensuring monitoring and proper oversight. We cannot continually blame staff when there are huge pressures on the system. There are systemic failures in the system regarding intensive care beds. A lack of such beds was identified during the inquest. We do not yet have a centralised system for intensive care bed allocation such that patients can be transferred to the place where the most appropriate care is available. We owe it to Dhara and the other women who have, unfortunately, died tragically to put in place safe services. Most important, we owe it to those women who are pregnant and the young women who intend to have a child at some stage in our maternity services. We also owe it to the staff.

Minister for Health (Deputy Leo Varadkar)

I thank the Deputies for raising this important issue and allowing me to address the House on the matter.

I offer my deepest condolences to Mr. Michael Kivlehan, his son, Dior, and their families on the sad and tragic loss of Dhara Kivlehan. I understand the HSE has offered sincere condolences and apologised to both families for the shortcomings in the management and care of Mrs. Kivlehan at Sligo Regional Hospital.

While cases of medical misadventure do occur in the health service, it is very important to reassure women and their families that maternal and perinatal health statistics indicate that Ireland continues to be a very safe country in which to give birth. Our safety record and maternal mortality rates compare favourably with those of other developed countries. It is important that we reassure people of these facts.

The tragic death of Mrs. Kivlehan took place in 2010. This was before the investigation by HIQA into a maternal death in University Hospital Galway and prior to the CMO's report on perinatal deaths at the Midland Regional Hospital Portlaoise. The actions required to address the recommendations of both reports are being undertaken across health services to improve patient safety and provide a more patient centred model of care.

A patient safety culture is now embedded in the HSE's service plan through specific measures, including performance indicators for health care associated infections, medication safety and implementation of early warning scores, which did not obtain at the time. My officials meet the HSE each month on the service plan and patient safety is a standing item on the agenda. The HSE has advised me that improvements in patient safety continue within maternity services at Sligo Regional Hospital. The HSE is also focused on delivering improvements in the way critical care is organised and delivered within the hospital group structures to ensure patients receive the same high quality of care no matter where they are treated.

Furthermore, as the Deputies will be aware, we are working on the development of a new maternity strategy for Ireland. Developing the strategy will provide us with an opportunity to take stock of current services and identify how we can improve the quality and safety of care provided for pregnant women and their babies. This will include both hospital and home care and obstetric-led and maternity led units. The strategy will ensure services comply with best available national and international standards. We want to make sure women are provided with the right care, in the right setting, by the right person, at the right time.

While maternal deaths in Ireland are rare, I know that is of no consolation to those families who have suffered such a loss, but I can assure them that we are learning from mistakes of the past, building on that knowledge in the present and endeavouring to ensure they are not repeated in the future.

Deputy Kelleher Billy asked about the availability of intensive care beds. I asked for a report on this issue this morning. I also checked how many intensive care unit beds were available this morning as a random test and at least two were available. However, it may be the case that availability presents a difficulty from time to time.

Deputy Clare Daly raised a separate matter, relating to Ms Philomena Canning. I understand this case has been in and out of the courts for some time. As I have not been fully briefed on the case, I do not want to comment on it, as I do not know all of the details of it. However, I am aware that the HSE supports and provides cover for a number of community midwives and that no effort is being made to reduce or remove cover for all community midwives. I suggest that if the HSE has decided to withdraw cover in the case of this individual midwife, there may be a reason for it.

Deputy Clare Daly

I appreciate the Minister's comment that he has not been fully briefed on the case, but I ask him to look at it because the reason is as I outlined, that she referred somebody to a hospital. This woman has an impeccable record. Sadly, the antics of the HSE have left ten women who are due to give birth imminently without somebody to assist them. I received many e-mails on this issue, but one I received this afternoon came from a woman who was a patient of Ms Philomena Canning and is 32 weeks pregnant. She says women are entering hospitals and leaving in coffins and that women are leaving maternity hospitals carrying their dead children home to be buried. She mentions that nine staff were found to have a case to answer in regard to the death of Savita Halappanavar but not one was suspended, never mind fired. All of them are still practising. She refers to inquests in Sligo, investigations in Portlaoise and says this is what the HSE calls care. She goes on to say: "I would rather birth on the side of the road than enter an Irish hospital as a pregnant woman."

The right to bodily integrity and make a decision on when and how one wants to have children is and should be at the heart of a proper maternity care system. I suggest the Minister should review this issue because there has been a deliberate undermining of community midwives. I know that he is only new in the Department, but I ask him to look at the case mentioned in order to help women at the coalface on this issue.

Deputy Billy Kelleher

The Minister referred to the maternity strategy being brought forward. I am aware that there were concerns expressed about a strategy published, or partially published, for the north west, which has now been included in the overall national strategy. Whatever comes about, the key issue is that while we must have certainty in so far as we can, women about to give birth or who will give birth in the future must have confidence in the strategy.

There is huge anxiety and concern at times of tragedy such as those mentioned, but by international standards we have a reasonably good maternity service. However, this does not mean that we cannot do more. We should not just leave the report to the memory of the Kivlehan family. It should be acted on and any deficiency raised in the context of the inquest should be acted upon. While we are waiting for the maternity services report, some improvements to enhance the quality and safety of the service could be made. The pressures on maternity services such as the lack of consultants and the pressure on midwives must be examined. Comparisons with international standards show that we are short staffed in these key areas of maternity services.

Deputy Leo Varadkar

I do not want to get into the Philomena Canning case. It may well be that Deputy Clare Daly does not know all of the facts either. When the HSE withdraws cover from somebody, it tends to do so for a reason, not at the whim of an official. Without knowing the reason for the withdrawal, we should confine our comments on the matter.

I am probably closer to the Deputy on this issue than she thinks. Pregnancy is not a disease but a physiological condition and there is no reason women with a normal pregnancy should not have their baby delivered at home by a community midwife or in a midwife-led unit. Every pregnancy does not need to be dealt with by an obstetrician and this is the sort of issue the maternity review will consider.

Whether in the case of an obstetrician or a midwife, I put it to the Deputy that the HSE does not withdraw cover lightly or on a whim but for a reason.

Deputy Clare Daly

I just asked the Minister to look at the issue.

Deputy Leo Varadkar

On the matters raised by Deputy Billy Kelleher, I inform him of changes that have been made since 2010 when the case occurred. The national early warning score has been introduced to detect deteriorating cases; in the hospital in Sligo there is now a new structured hand-over meeting between medical staff when they move from one shift to another and there is an enhanced and updated admission and discharge policy for ICU. With these changes, there are continuing developments in risk management, structures and processes.

While I believe we need more obstetricians - 120 is not enough - according to the OECD's report, Health at a Glance 2013, we have more obstetricians and gynaecologists per head than in Canada and New Zealand. The report also indicates that the ratio of Irish midwives stands above the OECD average and above that in France, Germany and the Netherlands. People can be quite selective when they make comparisons. They pick the countries with which they want to compare. I am picking countries with which I want to compare.

As somebody who has worked in eight hospitals, including a maternity hospital, I believe it is important to point out that being short staffed should never be an excuse for medical negligence or misadventure. It takes 30 seconds for a laboratory scientist to ring a ward with a blood result about which there is concern. It takes about one minute to check a blood result. If one misdiagnoses an acute abdomen case, it has nothing to do with time or resources, but is a mistake. We should not allow people to claim that being short staffed is an excuse for medical misadventure or negligence. It should never be accepted as an excuse. If we accept that excuse, it will always be the excuse. Today I heard the suggestion that a patient's mouth was taped with surgical tape because a hospital was short staffed. That is not good enough.

Acting Chairman (Deputy Brian Walsh)

The Minister is not available to deal with the issue raised by Deputy John Lyons. Does the Deputy wish to comment on the matter?

Deputy John Lyons

The Minister for the Environment, Community and Local Government is not available today to deal with this issue. I ask that the issue be referred back to the office of the Ceann Comhairle for a date to be provided that will suit the Minister, the Ceann Comhairle and me.

Acting Chairman (Deputy Brian Walsh)

We will ensure the Deputy is accommodated.