Dáil Éireann díospóireacht -
Thursday, 5 Nov 2020

Vol. 1000 No. 3

Saincheisteanna Tráthúla - Topical Issue Debate

Maternity Services

Deputy Niamh Smyth

I thank the Minister of State for coming to the House to deal with this important issue, which concerns the midwifery-led unit in Cavan General Hospital. I am sure he has been briefed on the background to this unit, which was established back in 2004. Sixteen years on, it has delivered many babies to many happy mammies and daddies across the Border region and the midlands area.

In 2016, the national maternity strategy was launched and, as part of that, there was huge emphasis on promoting the importance of midwifery-led units. The strategy clearly states that there should be an emphasis on supported, assisted and specialised care pathways for maternity services. Its key goal was to develop an expansion of midwifery-led services. I cannot emphasise enough the importance of this service, not only to Cavan General Hospital but also to the whole of this island. If we are to make a comparison with the North, it has eight midwifery-led units whereas we have just two in the Republic. As I said, the first was established in Cavan General Hospital in 2004 and then a second unit was developed at Drogheda. I understand both units are out the door with bookings from eager parents and expectant mums and dads who want to use the service. We know the service is extremely professional and is an holistic and unique, natural pathway of care for parents.

It was disappointing that, in June, deep concern was raised that the service might be in any way diminished or pared back because, as I said, it is a very significant part of the maternity services in Cavan General Hospital. This came about in a very curious way and in a way that any of us would find concerning. It did not come in writing and nobody can tell me who gave the order, or anything like that, but a directive was given last June to staff within the midwifery-led unit to stop taking bookings. I raised this at the time with the then Minister for Health, Deputy Harris, and he picked up the phone and met with the midwives in the hospital. He gave them assurances that it certainly was not part of his or his Department's plan that there be any diminution of service in the midwifery-led units.

At the time, the Department requested a review of the service and I hope any review would seek the expansion of the capacity of the service. As I said, there are only two such services in the Republic and, therefore, the significance and importance of this cannot be overstated. In June, when there was concern that the service might be in any way diminished and the Minister got involved, the directive that had been given evaporated. While all of us would say that was a good thing because it removed the uncertainty for the staff and parents, nonetheless, the review was left hanging there. Clarity, guidance and direction are needed in terms of where that is going, what is its purpose and who has requested it. As I said, the Department seems to have taken this route after that particular incident in June. The review was promised for the end of September and it is now November, but the review has not happened or has not been published. I hope that, today, the Minister of State will be able to provide clarity on that.

Minister of State at the Department of Health (Deputy Frankie Feighan)

First, let me thank the Deputy for raising what I know is a very important issue. I fully understand how important the midwifery-led unit at Cavan General Hospital is to the women and families who access maternity care there. In that regard, on behalf of the Minister, Deputy Stephen Donnelly, I would like to commit to ensuring that midwifery-led services will continue to be available at the hospital.

Last June, the Department of Health became aware of reports in local media referring to the planned merger of the midwifery-led unit and consultant-led services at Cavan General Hospital. The Department was not advised of any intention to merge the services at the hospital or, indeed, of any intended change to the arrangements that had been in place. I should be clear that the programme for Government contains a firm commitment in respect of the implementation of the national maternity strategy. Therefore, current Government policy is to provide and expand midwifery-led maternity care right across the country, including in Cavan.

I should remind the House that budget 2021 provided new funding of €12 million for maternity and gynaecology developments. This significant funding will ensure a renewed impetus to the implementation of the national maternity strategy and the roll-out of the new model of maternity care. In particular, the funding will help to build capacity in the maternity services workforce and further develop community-based midwifery services.

With regard to the situation in Cavan, the Deputy will recall that the Department requested the national women and infants health programme to engage with the RCSI Hospital Group to provide a report on the matter. Assurances were also sought that maternity services within the RCSI Hospital Group are, and will continue to be, developed in line with Government policy. The Department has recently been advised by the HSE's chief clinical officer that the RCSI Hospital Group has undertaken an initial assessment of the Cavan midwifery-led unit. I understand that the findings of that assessment indicate that if the service is to continue and, indeed, expand, the input and support of a senior external clinician will be required. I am pleased to confirm that a clinician has been identified from within the existing Rotunda Hospital consultant complement and will commence working and attending at Cavan General Hospital for an average of two days per week in the coming months. In the meantime, the Department has been assured that the midwifery-led service will continue operating as normal and that bookings are being accepted from women wishing to avail of it.

I assure the Deputy that the Department will work with the national women and infants health programme to ensure that any additional supports required to secure and expand community midwifery services in Cavan will be put in place. This will ensure that midwifery-led services at Cavan General Hospital are supported, strengthened and expanded, in line with the national maternity strategy.

Deputy Niamh Smyth

I thank the Minister of State. I cannot help having a suspicious mind as to why a review is being held in the first place.

That said, the Minister of State's response is welcome. I sense that he, the Minister for Health and the health team are fully behind the midwifery-led unit, and that is clear in the response. This is an issue I feel passionate about. This is a terrific service which provides an option for women in maternity care, not just in County Cavan but throughout the Border region and in the midlands. As the Minister of State knows, it is Government policy to roll out midwifery-led units throughout the country. I have always had a sense that the midwifery unit in Cavan General Hospital does not have the support it should have, the backing the staff need or the promotion it deserves. I hope the Minister of State, Minister for Health and Department will do everything they can to close gaps that exist in terms of promoting the service, informing women and encouraging GPs to inform women to consider it as an option. It has been my sense heretofore that that has not been the case.

As is evident from the national maternity plan, and as the World Health Organization has stated, midwifery-led units provide good maternity care. I am all for women having options. There are eight midwifery-led units in the North. We should have quadruple that number on the island of Ireland. I will fly that flag for women in this country.

The Minister of State's response is welcome. I will follow up with him and the Minister for Health to ensure extra staffing is in put place to benefit the midwifery-led unit in Cavan General Hospital. I encourage the Minister of State to do anything he can to ensure the unit gets the support, backing and promotion it deserves because the staff there are second to none.

Deputy Frankie Feighan

I thank the Deputy for her passionate work and support on this important issue. Much good work has been done since 2004. The programme for Government commits to the implementation of the national maternity strategy, which recommends the development and expansion of midwifery services through the provision of a midwifery-led model of care within a multidisciplinary team for pregnant women deemed to be at normal risk. Good progress has been made since the strategy's publication in 2016, with midwifery-led care and community-based maternity services increasingly available across the country. The significant funding provided in budget 2021 will facilitate the further expansion of midwifery services next year.

I assure the Deputy that the Department and Minister will work closely with the national women and infants health programme to ensure that any supports required to secure and expand community midwifery services at Cavan General Hospital will be put in place. This will ensure that midwifery-led services at the hospital are not only supported and strengthened but expanded and developed in line with the national maternity strategy.

Local Authority Services

Deputy Martin Kenny

As I am sure the Minister of State is aware, there have been difficulties with the local authority veterinary service in recent years. The county veterinary officers do much of the veterinary work in the counties around the country. Until now, they have been funded by the Food Safety Authority of Ireland, FSAI, through a service level agreement with each local authority. In the past three or four years, there has been a reduction in the funding and a pull-back from the FSAI. Although the central funding going to the FSAI has increased, it has tried to cut the funding given to the local authorities to provide this vital service.

There was a dispute which would have caused the county veterinary officers to withdraw the service to local authorities at the end of this month. That would be detrimental to many small businesses around the country but I understand a crisis was averted in the last ten days when an interim agreement was reached for 2021, which will ensure the service continues. After that, however, we will not know where we are. We have an opportunity over the next 12 months to ensure a proper service level agreement is put in place for three or five years, as would be the norm, to ensure the current level of service is maintained.

One of the key roles the local authority veterinary service carries out relates to small abattoirs and food production companies that use meat as one of their core elements. The local authority veterinary service has to carry out inspections of these premises and ensure all the regulations are adhered to. If the service were to withdrawn, it would throw all these businesses into crisis. I mentioned this a few weeks ago and the Ceann Comhairle remarked that the Christmas turkeys could be in danger if the service were withdrawn. That is exactly what the county vets do. The people who produce turkeys, including small producers of a couple of hundred turkeys, must have the local county vet come to inspect and ensure everything is done properly. It is a vital service. Its role expanded in recent years as small food start-up companies are often referred to the local veterinary service and these vets then go out and work with them. The local enterprise offices, LEOs, in many local authorities work closely with the local vet to develop small businesses in the food sector.

This is a vital service. It is a retrograde step that this dispute went so close to the line that the service was about to be withdrawn entirely coming up to Christmas. We have a stay on that for 12 months and there is an opportunity to ensure the service is bedded down properly and made sustainable into the future through a three-year or five-year contract that would guarantee the service. I look forward to the Minister of State's reply.

An Ceann Comhairle

I can see the headline: "Minister Feighan and Deputy Kenny save the Christmas turkey".

Deputy Frankie Feighan

I thank the Ceann Comhairle for that and I thank my colleague, Deputy Kenny, for raising this issue of funding of the local authority veterinary service. I know how important these services are in our local areas and the work they do. The FSAI is the competent authority with overall responsibility for the enforcement of food safety legislation in Ireland. Enforcement is managed through service contracts between the FSAI and a number of official agencies, including the local authorities, as the Deputy said. Local authorities are responsible for food law enforcement at over 500 small food businesses, including small meat processing plants and more than 170 slaughterhouses. Activities undertaken by the local authority veterinary services, LAVS, on behalf of the FSAI under the service contracts are legally required under EU food law.

County veterinary officers also perform a range of other functions and services such as the enforcement of animal health and welfare legislation at slaughterhouses, on-farm emergency slaughter and verification of competence to slaughter by plant operatives. They also have statutory responsibility in relation to dog and horse controls, dog licensing and the regulation of dog-breeding establishments.

The FSAI and the County and City Management Association, CCMA, on behalf of the local authorities, have been engaging for some time regarding the funding and effective delivery of the FSAI service contract. Both parties have agreed to work together to introduce a new, more efficient model of service. The local authorities are seeking additional funding for 2021, which is expected to be reduced, with the introduction of the new service model. The annual funding provided by the Department of Health to the FSAI is inclusive of funding to the local authority service contracts and, while funded by the Department, the FSAI is independent in the exercise of its functions. Notwithstanding the need for a more efficient model of services, additional funding is being made available by my Department to the FSAI in respect of LAVS service contracts for 2021 to provide stability to the service and the businesses which would have been impacted by the cessation of the local authority service contracts, which was being proposed by the CCMA for the end of November 2020. The FSAI is working closely with all parties to ensure a system of food safety controls is in place in local authority supervised premises from 1 December 2020. In this regard, I have been advised that the FSAI has in recent days had positive engagement with the CCMA regarding the extension of the current service contracts.

Deputy Martin Kenny

I thank the Minister of State. I was aware of most of what was in his statement and the proposals to upgrade and modernise the system to ensure that efficiencies can be brought in all seem well and good but we want to make sure that does not mean a reduction in the funding the veterinary services receive. Those kinds of terms are often a cover for a reduction in funding and we would be concerned about that.

We are also conscious that we are facing Brexit and everyone knows that the amount of food that we import and export within the island, North and South, and across to Britain, will be impacted if we do not get the kind of Brexit deal that we want. It is looking increasingly as if that is going to run into more difficulty. This service would absolutely have to step into the breach if that were to happen and it is vital for us to have a sustainable future and pathway laid down to ensure that will happen.

The Minister of State mentioned issues around animal welfare and all of that. Vital services are provided by the local authority veterinary services on the ground. For many people when they have a problem in an area with stray animals or whatever, the veterinary service is the first port of call. They provide a vital service in that respect.

The Minister of State raised the issue of the sustainability of services and the fact that business would be impacted by their cessation. To allow the service to arrive at the level where it was only a couple of weeks away from being withdrawn was a mistake that has undermined a lot of trust among the service providers here. There needs to be a re-establishment of that over the next year while we have this interim arrangement in place. I invite the Minister to inform the Dáil that a long-term contract will be put in place to make this sustainable for the next five years because that is what needs to happen so that local authorities know they are on solid ground and will get the money they need to develop a service the way they need to and that it will be in place come what may, Brexit or otherwise.

Deputy Frankie Feighan

I again thank the Deputy for raising the issue of funding for local authority veterinary services. As I said, the Food Safety Authority of Ireland, FSAI, and the County and City Management Association, CCMA, have been engaging for some time on the official food controls carried out by the local authority veterinary service under service contracts with the FSAI. It is accepted that the service model required review and the FSAI and CCMA, on behalf of the local authorities, have been in discussion over a new model to reform the service.

The FSAI has provided an increase in funding for 2020 and notwithstanding the work that is to be done to address the current service model's inefficiencies, it has offered further additional funding to the CCMA in respect of 2021, subject to a number of conditions.

On 28 October 2020, the CCMA agreed to the FSAI's offer of additional funding and associated conditions. The FSAI will now send contracts to the local authorities with a view to having them in place by 1 December. It is important to emphasise again that the current service model requires improvement and the FSAI needs to assure itself that the service and funding levels are appropriate and that the service provides value for money and fulfils EU obligations in an appropriate manner.

I welcome the fact that there has been positive engagement with the CCMA regarding the extension of the current service contracts and I am confident that the FSAI and the CCMA will work constructively together to ensure that a new service contract model is developed in 2021.

Deputy Martin Kenny has rightly outlined the wide range of services that are provided. I hope that when level 5 lockdown ends in the next few weeks, the Ceann Comhairle, Deputy Kenny and I can find a locally-sourced turkey and share it for a dinner shortly before Christmas, perhaps with some other accoutrements.

Deputy Donnchadh Ó Laoghaire

Otherwise we might have to cook the goose. That would not do.

An Ceann Comhairle

After that short exchange, the Topical Issue matters for today are complete. Apparently the other Members withdrew their matters for debate.