Martin Daly calls £100m maternity funding 'minuscule'

Thank you to both HSE and the Department for coming here this morning and for your comprehensive statement which I have read. Yes, there has been a lot of progress and thankfully there has been a lot of progress in this area, but there is a lot to do yet, I would imagine, and I think you probably would agree. I am going to ask firstly from the Department, you are talking about £100 million in capital funding in ten years. Am I correct that that the right figure? To me that is minuscule in terms of the overall budget. In terms of investment in our maternity and I would say it goes hand in hand, our gynecology infrastructure, that would seem to be a very small amount of money when you compare to the investment we are making, for example, into the children's hospital. There are deficits in infrastructure right around the country in obstetric units. Often they are the least pleasant places to be in the hospital infrastructure. How does the Department feel about that? What I would say, Deputy, is that £100 million capital investment has supported the renovation and modernisation of maternity facilities through the life of the strategy. Of course, we would always like more and, you know, to me, without interrupting, to me £100 million buys you 10 primary care centres approximately. So it seems to be, I wouldn't be lauding this as some sort of achievement. That is my only observation. I am not attacking you or anything, but I certainly wouldn't be lauding it. I mean, look, we were in the Rotunda last night, you know, that is emblematic of what is going on. We are supposed to be getting a new maternity hospital out to St Vincent's and Ellen Park, what is happening with that. How are we going to drive that forward? Because the women of Ireland do deserve better. So what I would say, Deputy, is, and, you know, I mean, obviously, I have responsibility for acute hospitals policy nationally, and so I am very conscious of competing priorities, and, you know, there are a whole range, obviously, of capital infrastructure projects that we are very keen to move forward. Maternity services is an area that is very close to my heart. I have been involved in it since the outset, and, you know, we are very deeply committed to this policy in the Department, as the Minister is. What I would say is, maybe if I just focus in on what that £100 million has achieved in the first instance, and then talk about, you know, where we want to go to. Well, no, in fairness, you have laid a statement, and I am on a limited time, but I accept it. But I do want to say, Deputy, I mean, you know, £20 million of that funding, obviously, you know, that has advanced our information sharing infrastructure, so the maternal and neonatal clinical management system. And, you know, I suppose capital investment, through successive capital plans and under the maternity strategy, has modernised facilities. Of course, we always want to do more. And, you know, and so genuinely, we have made maximum use of that funding. I understand that. And what I would say is that... Can I just say to you, you know, that you have come from a very low base on the digitalisation of maternity services. At least it is moving ahead compared to other services within the hospital sector. But we have an awful long way to go. We are so far behind. I would just like to move on, and thank you for your answer. I am just on limited time. Access to services for people who are vulnerable, people who are in lower income groups, particular parts of our... I am talking now to maybe Dr Henry here. Are we making enough effort to get into those communities with outreach services? We see a lot of centralisation. Yes, we have to have safe services. But, you know, it can't be all or nothing. We have got to have our safe central centres for more complex births and more complex pregnancies. But we also need to be reaching out in communities, people from various communities, such as New Irish communities, the traveller community, the rural community, people in just low deprivation areas, can't actually get to an antenatal clinic. There is no point in having this castle in the sky somewhere in the city. Yes. So, first of all, from two perspectives, Deputy, first of all, looking at obstetric care, it has changed. We have seen the falling birth rate. What we are seeing is a more diverse population, as you point out. We are also seeing a great proportion of migrant, of deliveries from migrant women, by one in five, one in four, and probably going to rise further. And that poses particular challenges. We are also seeing a rising age for women having their first pregnancy. And these, we are also, in addition, seeing higher rates of comorbidity, which is perhaps more prevalent among certain groups. So, a challenge looking forward, which we wouldn't have anticipated to the same degree back in 2016, is how we address the needs of a population are fundamentally different from that which we faced in 2016 and the issues we faced in 2016. In a specific answer to your question, we are addressing our system of quality and patient safety, where we pick up on signals from the system, do point towards the need to tailor antenatal care more towards migrant population, where individual units have provided translation facilities, we need to reach out more to avoid late bookings and all the other behavioural issues or access issues that may actually impinge on outcomes of care. In gynecology, Deputy, I could cover briefly, we have seen a doubling of referrals since 2019, a huge number of referrals. So, we have greatly increased our capacity. We now have 19 ambulatory units, but our long stairs have greatly reduced, but certainly the changing profile of population. If there is additional information in relation to migrant populations, we might want to address briefly for your benefit. Could I ask the question, and it might fit into the answer as well, because I am on down to two minutes, the references to networking and government, joint governance, which is hugely important. We live in a small country, but we have a dispersed population. We have had issues in some units, and I accept that we want the highest quality, safest care for women who are delivering their babies, but we also need accessible care. For example, in Porto Yonkla Hospital, there was a suggestion at the outset of the crisis earlier in the year, this time last year, that a very good diabetic service was going to be closed down. To me, that made no sense. If you have a very good outlying diabetic service for gestational diabetes in a clinic, you can do that there, and you can still manage the complex delivery if it has to be in the centre. My concern is that in Porto Yonkla, you had a walker report in 2018, which described a one hospital two sites project, joint governance, and then suddenly this abandonment of it. No one has still given me a reason why they said it wasn't workable. Galway said it was workable. Why wasn't it workable? Why wasn't it made workable? I think it's really important, because as we go further down, we need the smaller units to be supported robustly, governance and standard and quality-wise, in order to keep those units up, because we do need accessible units. We can't just abandon everything. Yeah, absolutely. So to talk about ethnicity and our underserved communities, so there's been a lot of focus on that in the last few years, and in fact the HSE has collaborated with UCC in doing some research around that, and what has been found is some of the barriers are not necessarily distance, but in information, in knowledge about our health service. Some of these women are coming from populations where they haven't had the same access to healthcare, and some of the feedback was actually very positive, but there are areas we can improve, and our health service is very motivated to try and do that. And so ways that in which we have successfully improved is there was a project with the Roma community in Dublin, where we linked with the Roma intermediaries, if you like, and they were able to explain to the Roma community what services were there and how they could access that. Similarly, with our traveller community, we know we can do better, but it's doing those interventions with members of the community, so there's a better understanding on both sides. But, you know, there can be things like systemic bias that we all need to work against, you know, against, and to make our communication materials more accessible, but there's been a lot of work in that regard. To speak about, as you have pointed out, things like diabetic clinics, and that we recognise our diabetic population is increasing, so from, kind of, to 2014, gestational diabetes might have been four or five percent. Some units now have up to 16 percent of gestational diabetics. And yes, it's not feasible for all of those to be in a large urban centre, and it's very reasonable. And with regard to Porto Yungla, there was no issue with regard to clinics. There was a concern about intrapartum care, which is a different matter. So, I totally agree with Dr Daly with regard to making sure that as many facilities that can be close to a woman's home should be open to a woman's home, and the link then with the intrapartum care where it should be. Can I move on to the or something? And again, that, from, of all the work that I've taken, what may have been brought to you in this ferm