I propose to take Questions Nos. 650 and 803 together.
The Deputy will be aware that the statistics reported to Maternal Death Enquiry Ireland (MDE Ireland) require anonymisation due to the small number of such incidents occurring across the country's 19 maternity units. Thus, naming the hospitals and maternity units where such events occurred would not meet the Data Protection standards required for protection of otherwise identifiable patient information (Data Protection Acts 1988 and 2003, Section 5(h)); such statistics are not, therefore, publicly available.
The Deputy may wish to note updated statistical information published by MDE Ireland for December 2016:
'For the years 2012-2014, a total of 22 maternal deaths, occurring during or within 42 days of pregnancy end, were identified by MDE Ireland. Of these 22 deaths, 20 were classified as direct or indirect maternal deaths among 204,999 maternities, giving a maternal mortality rate (MMR) of 9.8 per 100,000 maternities. A further 2 maternal deaths were attributed to coincidental cases'.
Per MDE Ireland, classification of maternal deaths for the triennium 2012-2014 has now been compiled in line with the World Health Organisation (WHO) guidance on classification of maternal moratality, (ICD-MM, WHO 2012) 'in recognition of the importance of maternal suicide and its direct link to pregnancy'. This reclassification has resulted in a change in the ratios of direct and indirect maternal deaths in this period compared to the previous classification system, the UK Confidential Enquiry into Maternal Deaths (CEMD) which used a disease based classification system but no change in the overall statistics. The Deputy will find further detail at the following link: http:www.ucc.ie/en/mde/.
A maternal death is classified as a Serious Reportable Event (SRE) and as such must be reported through the national Incident management System (NIMS) within 24 hours, investigations commenced within 48 hours of the organisation becoming aware of the incident, and investigations completed within four months of commencement. I understand that maternal deaths are reported to the Coroner a a 'rule of practice'.
The Health Service Executive (HSE) Irish Maternity Indicator System (IMIS) second National Report (2015), published in October 2016, provides national results for 30 metrics from all public maternity units and hospitals for 2015. Senior managers in hospitals are now using IMIS to monitor and manage their hospital activities and continue to take measures to improve the quality of their data and their data collection and reporting processes as well as measures to improve the quality of care delivered. It is the intention this year, following a review of IMIS in collaboration with staff in the maternity units, to refine definitions of the existing metrics and extend the range of these measurements. IMIS data is also being used to populate the monthly Maternity Patient Safety Statements, as recommended by the Chief Medical Officer's 2014 Report into perinatal deaths at Midland Regional Hospital, Portlaoise. The IMIS information system supercedes earlier annual reporting as referenced by the Deputy.
The Government is committed to the progressive development of maternity services. In 2016, Ireland’s first National Maternity Strategy was published, followed by the HSE’s National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death and HIQA’s National Standards for Safer Better Maternity Services. In 2017, a National Women & Infants Health Programme has been established within the HSE to lead the management, organisation and delivery of maternity, gynaecological and neonatal services across primary, community and acute care.
The safety of all users of our maternity services is of paramount importance. The above initiatives and ongoing developments represent key building blocks to facilitate the provision of a consistently safe and high quality maternity service.
Finally, in relation to the publication of individual maternity unit reports I have asked the HSE to respond directly to the Deputy.
