Mayo women 'deprived due to lack of investment in maternity services'
The president of the Irish Hospital Consultants Association, Dr Donal O’Hanlon, has stated the women of Mayo are being deprived due to a lack of investment in maternity services.
Giving his view on the findings of HIQA’s monitoring report on maternity services, he said he
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.
He said: This is failing many, many women.
“Currently there are 31,719 women waiting for gynaecological services across our national public hospitals and almost a fifth of these women are waiting for 12 months or more.
“The consultant recruitment and retention crisis is a major factor and despite having the third highest birth rate in the EU, Ireland has less than half the EU average number of specialists in obstetrics and gynaecology.
“So far, only approximately 20 of the 100 additional consultants recommended in the National Maternity Strategy have been hired.
“The lack of funding for the National Maternity Strategy is affecting the one in five women who have mental health problems in pregnancy or after childbirth.
“Approximately 2,240 of these are likely to suffer from more serious mental illness and would benefit from advice from or referral to a specialist perinatal mental health service.
“Such facilities were due to be established in maternity network hubs to treat women directly and provide expert advice to other maternity units in the country.
“It is extremely disappointing that the €370,000 required for the operation of the Galway University Hospital Specialist Perinatal Mental Health Service has been diverted.
“This means that women in the Saolta Hospital Group western counties (Donegal, Galway, Leitrim, Mayo, Roscommon and Sligo) who need this support are being deprived of services which are available throughout the rest of the country.
“It is vital that all specialist perinatal mental health services are funded adequately because of the very negative consequences of perinatal mental health disorders for the mother, the baby, their relationship and that with the partner and other children.
“We need a clear and consistent commitment from Government that it will adequately fund and resource the implementation of the National Maternity Strategy across the country.
“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."
INSPECTION REPORT
The conclusions reached in respect of Mayo University Hospital following an unannounced inspection at the facility last May were as follow:.
“Women and their babies should have access to safe, high-quality care in a setting that is most appropriate to their needs. Inspectors found that Mayo University Hospital was compliant with the majority of the National Standards in relation to quality and safety and capacity and capability that were focused on during this inspection.
“There was a clearly defined and effective leadership, governance and management structure at the hospital and within the Saolta University Health Care Group to ensure the safety and quality of maternity services.
“The hospital’s senior management team monitored performance data including patient outcomes, service user feedback and patient safety incidents to provide assurance on the safety of the maternity service.
“However, inspectors found that clinical governance arrangements required review to ensure that findings from clinical audits are reported and their implementation is monitored effectively at senior management level.
“Hospital management was actively working to optimise maternal care and to progress implementation of the National Standards.
“The hospital had developed collaborative working arrangements with the other four hospitals providing maternity services within the Saolta University Health Care Group.
“Saolta University Health Care Group were actively progressing the implementation of a managed clinical academic network. This was not formalised at the time of inspection.
“Hospital management was satisfied that they had control measures in place to address a potential risk identified by the hospital and also identified by HIQA during this inspection in relation to the safety of the mother and baby if there was no immediate access to an operating theatre for a category one caesarean section during core working hours.
“The hospital, with ultimate accountability, were assured that they had operating theatre capacity and control measures in place during core working hours to manage this risk.
“The hospital had systems in place to identify women at high risk of complications and to ensure that their care was provided in the most appropriate setting.
“Effective arrangements were in place to detect and respond to obstetric emergencies and to provide or facilitate on-going care to ill women and or their babies. The hospital had successfully implemented a daily multidisciplinary team clinical handover meeting which also functioned as a peer review safety meeting.
“The hospital had achieved a high level of compliance with some mandatory training programmes. However, hospital management should continue to ensure that relevant clinical staff undertaken mandatory and essential training at the required frequency, appropriate to their scope of practice in line with National Standards.
“The hospital had a suite of policies, procedures and guidelines in relation to maternal care and obstetric emergencies, but some of these needed to be ratified for local use.
“The hospital needs to ensure following this inspection that all policies, procedures and guidelines in use are ratified for use in the hospital by their Policies, Procedures and Guidelines Committee.
“Mayo University Hospital had an audit plan in place, but inspectors found that clinical audit activity in the maternity services was sporadic and audits conducted in the hospital did not follow a prescribed structure.
“Following this inspection, senior hospital manager’s needs to review the audit process to ensure that audits conducted in the maternity services followed a prescribed structure to provide the necessary assurances about the quality and safety of services.
“The hospital had implemented a number of quality improvement initiatives to support the delivery of a safe maternity service.
“Following this inspection the hospital needs to address the opportunities for improvement identified in this report and requires the support of the hospital group and the HSE to progress the development of maternity services at the hospital and the transition to a maternity network.”
The inspectors found the hospital did not meet the HSE’s national benchmark for midwifery staffing in line with the HSE’s Midwifery Workforce Planning Project.
The report outlined: “Inspectors were informed that the maternity unit, including Special Care Baby Unit, had 58.5 midwife positions filled on a permanent basis.
When the whole time equivalent (WTE) number for the Special Care Baby Unit was excluded, the hospital had 41 WTE with a deficit of three WTE midwife positions not filled.
“Senior Hospital managers told inspectors that the hospital had secured funding from the National Women and Infants Health Programme to fill these midwifery positions. Agency midwifery staff or nursing staff were not employed by the hospital.
"Any deficit in staffing was filled by staff employed at the hospital doing additional shifts.”