Midwives’ commitment ‘is being abused’

Midwives are being used to “paper over the cracks” emerging in the country’s maternity services, the Irish Nurses and Midwives Organisation said tonight.

The INMO was responding to health watchdog Hiqa’s latest maternity services report.

The report found that while key patient outcomes were good and staff were “excellent”, the maternity system was understaffed and “very reliant” on “midwifery staff working overtime to maintain service levels”.

The INMO said this is further evidence of the chronic understaffing in Ireland’s 19 maternity units and that midwives’ dedication was being used to “paper over cracks” in the service.

The union called for the implementation of the National Maternity Strategy, which would bring staffing levels up to the scientifically safe level of no more than 29.5 births per midwife.

The union is calling for immediate HSE approval of midwifery posts to reach safe staffing levels, and an end to the HSE recruitment freeze in nursing and midwifery.

INMO general secretary Phil Ní Sheaghdha, said: “This report rightly celebrates the incredible dedication and skill of Ireland’s midwives.

“But their commitment is being abused and their hard work used to paper over cracks in staffing.

“There is a very clear strategy for the maternity service, but the HSE haven’t properly implemented it.

“We need to lift the recruitment embargo, get the staffing levels right, and pay them a fair, competitive wage.

“Part of this comes down to speed.

“Whether it’s recruitment, the strike settlement, or the maternity strategy, the HSE’s go-slow approach has left midwives in an unsustainable position.”

The Irish Hospital Consultants Association also expressed their its own concerns about the findings of the Hiqa report.

“The findings of Hiqa’s monitoring report on maternity services outlines a familiar story with our health services — a promising national launch of a health strategy, but a lack of follow-through,” said IHCA president Dr Donal O’Hanlon.

It is very concerning and disappointing that four years into the lifetime of the National Maternity Strategy, the commitment to fund and implement its recommendations is being delayed.

“This is failing many, many women.”

He also called on the next Government to restore the maternity strategy’s promised €8m-a-year funding, given the fact it has been reduced so dramatically over the past few years.

For example, a total of €4.55m was allocated in 2018, none was allocated in 2019 and just €1.5m has since been allocated to each 2020 and 2021.

“The women of Ireland have been let down by our health services in the past and have been made many promises in recent years, which the Government and health service management must now honour,” said Dr O’Hanlon.

Róisín O’Leary, patient advocate coordinator with Sage, said: “When the strategy was put in place, it was a very good start.

“But funding needs to be put in place.

“Otherwise, this is posing a risk to future babies.”

She added: “It is vitally important that there be adequate staffing levels and that people learn from mistakes from patient safety events.

Stephen McMahon, co-founder of the Irish Patients Association, said: “There is something wrong when the regulator Hiqa raises the same issue over similar reviews — and no reform implemented.

“This should not be a case of leveraging the necessary funds to meet the strategy because of the Hiqa report.

“It should be good governance to implement an already agreed strategy to save the fragile lives of some babies.”

A HSE spokesperson said: “The Hiqa report is broadly positive and demonstrates good progress in each of the 19 hospitals in compliance with the Hiqa standards.”

Welcoming the report, HSE CEO Paul Reid, said: “The Hiqa report is a comprehensive overview of the 19 maternity hospitals, and acknowledges the progress made at local level.

The issue of governance which Hiqa correctly raised is one I addressed soon after I was appointed, as the National Women and Infants Health Programme needed to be part of the chief clinical officer’s division.

“That strengthened governance will make a big difference in driving forward the National Maternity Strategy.

“However, in order to properly implement a strategy of this scale, the HSE needs to secure the necessary funding to ensure the appropriate level of progress can be made.”

Hiqa findings

• Dublin Midlands Hospital Group provides maternity services in the Coombe and Midland Regional Hospital Portlaoise. A memorandum of understanding (MOU) was in place between both since 2015, enabling joint appointments of consultant obstetricians and neonatologists. Progress in implementing the MOU had not led, however, to the full establishment of a maternity network as defined in the National Maternity Strategy. This means the Coombe senior management team had “no direct oversight or responsibility” for maternity services at the Midland Regional Hospital Portlaoise.
• The Royal College ofSurgeons in Ireland Hospitals Group provides maternity services in Cavan and Monaghan Hospital, Our Lady of Lourdes Hospital, Drogheda, and the Rotunda.Although Hiqa applauded “important and positive developments” in the group, it noted it that the group had yet to establish a maternity network.
• Saolta University Health Care Group provides maternity services in University Hospital Galway and Merlin Park Hospital, Mayo University Hospital, Sligo University Hospital, Portiuncula University Hospital, and Letterkenny University Hospital. Inspectors found University Hospital Galway the larger maternity unit in the group, did not have capacity or facilities to accept premature and sick infants from the other services who required level-three neonatal care.
• The South/South West Hospital Group provides services in Cork University Maternity Hospital (CUMH), University Hospital Waterford, South Tipperary General Hospital, and University Hospital Kerry.The Maternity Services Directorate implemented a mandatory acceptance policy to facilitate the transfer and acceptance of women and newborns who required specialist care to CUMH.
• Ireland East Hospital Group provides services in Regional Hospital Mullingar, St Luke’s General Hospital, Kilkenny, Wexford General Hospital, and the National Maternity Hospital, Dublin. At the time of Hiqa’s monitoring programme, there were “no formalised care pathways” to “ensure women with complex high-risk pregnancies” and newborns requiring specialist neonatal services in the smaller units would be accepted by the National Maternity Hospital.
• The University of Limerick Hospitals Group oversees University Maternity Hospital Limerick. Hiqa noted the fact there is only one maternity hospital in the group means formal links are not possible.