Oireachtas Joint Committee on Health and Children
Thursday 1st October 2015
Opening Statement by Dr. Chris Fitzpatrick,
Consultant, Coombe Women and Infants Maternity Hospital
Mr Chairman, members of the Oireachtas Joint Committee on Health and Children, I would first and
foremost like to offer my sympathies to all who have suffered loss or serious injury in our maternity
services. As a doctor, I am only too well aware of the harrowing consequences that adverse
outcomes have on mothers, fathers, babies and families. Secondly, I would like to thank you for giving
me the opportunity to share some of my experiences with you of working in the Irish Maternity Service
over many years.
As a clinician who has worked as a consultant in a busy tertiary referral women and infants university
hospital for almost twenty years (seven of which were as Master), I cannot overemphasise the
importance of the responsibility that politicians have, and most particularly those in government, for
the planning, resourcing, provision and regulation of effective health services on a national basis. In
the context and ethos of ‘Open Disclosure’, clinicians have a responsibility to honestly and
transparently explain and apologise to patients and their families when their care falls short of
appropriate clinical standards. And although health service managers are also now being investigated
in relation to their individual and corporate performances - even the most rudimentary root cause
analysis will reveal, in the context of the Irish Maternity Services, that critical strategic decisions made,
in relation to prioritisation and funding at the highest levels of political authority - have had a
significant impact of clinical outcomes in hospitals - hospitals that were often run into the ground in
terms of chronic under-investment over many years.
It is important to say that what I have stated should not in any way be interpreted or misconstrued to
excuse poor individual professional performance or negligent clinical care. It is however important, if
we are to gain a full understanding of what went wrong, to scrutinise why a service that is designated
to look after our most precious and our most vulnerable resource - i.e. mothers and babies - never
became a political priority until such time as a series of adverse clinical outcomes hit the headlines of
our newspapers and news bulletins on successive occasions in the recent past.
During the boom-years there was little, if any, investment directed into the maternity services and
when the bust happened - the maternity services were exposed to systematic cut-backs while at the
same time having to absorb unprecedented levels of clinical activity, complexity and demographic
change. The fact that the overall clinical outcomes for mothers and babies in this country still
indicate, by international comparison, a high level of clinical performance, is a testament to the
dedication and professionalism of clinical and support staff and local managers and other health
service officials, who often felt, and were at many times, abandoned by the political system over
successive administrations. Despite the overall reassurance of our national clinical results, there were
outcomes that undoubtedly should have not happened and there were near-misses that turned out
better than expected.
The succession of problems that have come to the attention of the general public in very recent years
and that have been the subject of simultaneous and sequential investigations have arisen in a very
particular context. The warning signs were there for a long time and were raised by many within the
system. Unfortunately they were, in the main ignored, and when acknowledged merely became the
subject of reviews and reports - often costing considerable amounts of money - and which when
completed were, in the main, not implemented in any meaningful sense.
In 2011, as Master of the Coombe Women and Infants Hospital (CWIUH) I established and chaired a
multidisciplinary team of clinicians and healthcare managers from the CWIUH, Portlaoise and
Mullingar Hospitals. Having highlighted a number of significant clinical risks across this network of
hospitals, we identified a number of critically important posts required to manage these risks.
Conscious of budgetary constraints, we developed a comprehensively funded innovative strategy that
involved piloting these posts with strict Key Performance Indicators as well as a long-term savings
potential.
Despite several modifications of the proposal and presentations at the highest levels of authority and
at a national forum – there was no response. These risks were also highlighted in the risk-register of
the CWIUH that was submitted to the HSE on numerous occasions. It is noteworthy that this model of
tertiary and secondary hospitals working in close co-operation emerged some years later as the
appropriate strategic response to certain clinical incidents that occurred in Portlaoise Hospital and
also as the model for the alignment of maternity services within hospital groups. It is also of concern
that many of the risks highlighted in the 2011 tri-Hospital submission are still present – throughout the
country.
If the current maternity strategy is to have any credibility and if it is to bring about a sea change in the
way the maternity services are funded, organised and run in this country then it must be more than a
cut-and-paste exercise of generalisations (as many previous reports have been). It must have
specifics in relation to models of care, staffing levels and infra-structural development. To do this it
must have a methodology of implementation and a ring-fenced budget. Most importantly it must be a
political priority with a life-expectancy beyond the next election.
The National Cancer Control Programme is an example of how political prioritisation improves clinical
outcomes. Accordingly I believe that the Minister for Health should establish a National Women and
Infants Programme in order to drive change and clinical excellence. The Minister must act decisively
to restore confidence in this service otherwise there will be more critical incidents, more traumatised
mothers, fathers, babies and families and ever fewer school-leavers and graduates will choose to
become midwives or obstetricians in this country.
Dr Chris Fitzpatrick
BA FRCPI FRCOG FRCS (Ed) DCH DTM Dip GUM Dip Medical Management
H Dip Health Care Risk Management
Medical Council No: 00110
27th September 2015