Martin Daly: Defending Rural Maternity Access and Care
Martin Daly addressed a committee hearing to thank witnesses, endorse the development of the critical care unit at the Rotunda, and press for balanced maternity planning that protects rural access. He highlighted recruitment and retention pressures, pockets of deprivation, and the need for wider, whole-of-government action to reduce health inequality.
Support for specialist care
Martin Daly affirmed his support for the Rotunda's critical care unit as a vital tertiary referral service for many parts of the country. He told the committee that where referrals and complexity concentrate, specialist centres must be developed and supported.
Access versus quality in rural services
Daly outlined the ongoing tension between locating services close to where people live and maintaining quality standards that require specialist staffing. He warned that some regional units are seeing declining delivery numbers and that removing services is not the straightforward solution.
Recruitment, retention and local hardship
The speaker raised recruitment and retention of specialist staff-especially in rural and peripheral units-as a central challenge. He described how pockets of deprivation, intergenerational unemployment and practical barriers to travel reduce access for many women and families.
Beyond health services: tackling underlying drivers
Daly argued for thinking beyond traditional clinical responses, suggesting additional supports for deprived communities and a whole-of-government approach to health inequality. He emphasised that wider social factors-education, housing, food-drive much of the demand seen by maternity and other clinical services.
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I just want to reiterate firstly the thanks to all the witnesses for coming here today and also to recognise, sometimes we're short of time and we're asking questions, but to recognise the work that's done in very difficult circumstances around the country by professionals in women's health services and in particular in obstetrics and also to say that I fully support the development of the critical care unit at the Rotunda, it's a secondary referral hospital, it's critical that we have a specialist referral hospital for many parts of the country as Professor Daly has outlined, those referrals are made and it's a vital service and it needs to be developed and anything that we can do at this committee to support that I'd be very happy to be associated with, so I just want that on the record. In addition, I just in a more general sense I suppose when we were talking about the national or the maternity strategy, one of the big challenges and this is not, it's a conversation, one of the big challenges is you've talked about recruitment retention of specialist staff especially in rural units or units that are outside the major centres and then of course that has to be balanced against access for women, many of those towns can have pockets of deprivation, people who find it very difficult to get to centres and Tony this is a conversation but Manislow being one, there's serious deprivation, intergenerational unemployment and a lot of other issues there but defined by PUBL and DASH plus one status for the schools there, is that going to be considered, there's a balance there and I note in Professor Daly's saying you know the money should go where the most complexity is and where the most, but that has to be balanced out with access to services, so I wonder if you have any views on that, any of you, again it's not a trick question, it's a general conversation, you're very suspicious from my view and it's informed by our experience over the last number of years and I've been involved in the maternity service in the west and northwest for a long time I guess you know so it has to be, you know and we face this issue all the time not just in respect of maternity service but a lot of clinical services, the balance between locating and giving access to people close to where they're living and balancing that against the need to maintain quality standards as you know as what we're able to deliver in terms of what healthcare improves and develops as well, that becomes an even greater challenge because it's not possible to provide that level of quality or that level of service at every hospital site, so it is a challenge for sure. I have to say I am convinced and probably after my years of working in the west and the northwest that it is important particularly for services like maternity services that they are available in places like Letterkenny and Castlebriar and Sligo and that they are available throughout the region. I know there's an absolute issue, you know we've talked about units that have less than 500 deliveries, three of the units in our region have less than 500 deliveries last year, probably four next year and with the way the numbers are going you know so it absolutely is an issue so it is but I don't think the solution to it is the removal of those services from those locations, they have to remain there so we have to find other solutions and we have to continue to work to try and make sure that those units do not become isolated. And do we need to think maybe outside the medical box some additional supports for people from deprived communities or people who don't have the resources to travel for services, you know I mean sometimes I would have patients in a rural area who are deprived and they simply don't take that journey into wherever because they can't afford to or they don't see the value in it for whatever reason I'm not judging them, I haven't lived in that position so I can't judge anyone else. It's impossible to judge Dr Daly but for us this was and I just want to bring this in because I think it's actually a really important point that you're making, deprivation and inequality is massive and in rural Ireland I think it's often not spoken about or not really recognized perhaps as much in urban areas and we're starting to do a project in the midwest around and particularly in Limerick City around health inequity and what we would encourage is that you know health care determines maybe 10 percent of how you know you're going to your outcomes right and the rest is all met up with other factors, your education, your housing, your food and all the rest of it and we'd be really encouraging of a whole of government approach around tackling health inequality because there's only so much we can do and if we look at the demand drive is the complexity of what's presenting to us we genuinely need to have a look at wider than the health service to respond to some of the stuff that we see coming into us because we have no control over it and you know we have some patients who are you know frequent flyers not because they want to be in hospital but because of the situations in which they live so there is an opportunity for us to do something wider than health care to support the most vulnerable and marginalized in our societies and I think that's really important that you've raised that because in order for us to manage some of those demands we need to manage the piece that's getting them to us in the first place. Thank you.
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