Staffing deficits just one area of concern threatening maternity services, HIQA finds

The state health watchdog has warned that the HSE needs to develop a "comprehensive, time-bound and fully-costed" plan to implement the National Maternity Strategy.

The HSE has made "limited progress" implementing the strategy, which was agreed by government in 2016, according to the Health Information and Quality Authority (HIQA).

HIQA has, this morning, issued eight recommendations to ensure the sustainability of Ireland's maternity services.

The recommendations have been published alongside an overview of HIQA's inspections of Ireland's 19 maternity units and hospitals.

While the report commends the overall level of professionalism, teamwork and commitment displayed by maternity staff across the country, it identifies a number of areas of concern. These include poor infrastructure, onerous rosters and a reliance on staff working overtime, and a lack of clarity on the implementation of the National Maternity Strategy.

Chief among the recommendations outlined by HIQA is the need for the HSE to immediately develop a "comprehensive, time-bound and fully costed" National Maternity Strategy implementation plan, the health service watchdog has warned.

"This plan should include clear governance and accountability arrangements for its implementation", including defined milestones, performance indicators and named persons with responsibility and accountability for implementing the actions, HIQA said.

HIQA also called for a review of specific infrastructural requirements to enable the implementation of specific elements of the National Maternity Strategy and a review of current workforce arrangements in maternity units and hospitals nationally to determine the level of staff and skill-mix needed.

Mary Dunnion, HIQA's Director of Regulation, said it is "imperative" that the HSE acts on HIQA's eight recommendations "to ensure that Irish maternity services are enhanced and placed on a more sustainable and equitable footing for women and their babies".

She said that improvements have been made since HIQA started monitoring standards but specifically identified "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 improves choice for women, and ensures that smaller maternity units, in particular, are better supported to provide sustainably high-quality and safe care," Ms Dunnion said.

"It was of concern to HIQA that the HSE had made only limited progress in advancing this strategy since it was approved by Government in 2016, and a more comprehensive, time-bound and costed implementation plan is required.

"While more formalised governance structures were introduced by the HSE at the end of 2019 to improve national leadership in this area, the HSE must now implement the strategy and establish maternity networks to ensure that pregnant women, mothers and newborns across the country have access to the same level of care and support regardless of where they live."

Sean Egan, HIQA's head of healthcare, said addressing shortfalls in the sector will "require significant funding".

"Our inspections showed that services around the country were reliant on front-line medical staff working onerous rosters — some on call every three nights — and midwifery staff working overtime to address staffing deficits and maintain service levels," he said.

"In addition, the poor infrastructure and physical environment across maternity services significantly impacts on a woman’s comfort, dignity and privacy, and increases the potential risk of cross-infection for women and babies. Addressing the ageing infrastructure across many maternity services will require significant funding."