Joint Committee on Health and Children
Meeting
Thursday 1st October 2015
Opening Statement
by
Liam Woods
National Director Acute Hospitals Services Division
Good Morning Chairman and members of the Committee.
Thank you for the invitation to attend the Committee meeting. I am joined by a number of
my colleagues:
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Ms. Angela Fitzgerald, Deputy National Director, Acute Hospitals Services Division
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Dr. Susan O’Reilly, CEO Dublin Midlands Hospital Group
-
Dr. Alan Finan, Consultant Paediatrician Cavan Hospital & Clinical Director for
Women and Children Services in RCSI Hospital Group
-
Mr Patrick Lynch, National Director, Quality Assurance and Verification
In my opening remarks I will update you on the following issues:

Service Developments

Maternity Clinical Networks

Women and Infants Programme

Maternity Charter

Maternity-Neonatal Clinical Management System (MN-CMS)

Irish Maternity Patient Safety Statement
Service Developments
Maternity Services are delivered in 19 hospitals of which five are stand-alone maternity
hospitals. There were 67,347 births in 2014 and it is projected that there will be 65,473 for
2015. Since 2012 there have been a number of reports on maternity services and lessons
have been learned that are informing how maternity services are now delivered. In line
with the HSE Accountability Framework 2015 the Acute Hospital Division has established
governance and management arrangements to support ongoing monitoring and
measuring of implementation of recommendations from all reports.
The imminent Maternity Strategy will provide the platform for how maternity services are
delivered in Ireland in order to have a world class maternity service.
Since 2014 a number of maternity staff has been recruited that will improve maternity care
including additional midwives to Portiuncula Hospital, Midland Regional Hospital
Portlaoise, Midland Regional Hospital Mullingar and Wexford General Hospital.
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A maternity antimicrobial pharmacist has been put in place in each hospital group.
Funding for six additional obstetricians in 2015 for Midland Regional Hospital Mullingar,
Midland Regional Hospital Portlaoise, Wexford Hospital, Waterford University Hospital,
Letterkenny General Hospital and Sligo General Hospital and these posts are currently
being progressed. The requirement for additional midwifery staffing nationally will be
informed by the outcome of the HSE commissioned national midwifery workforce planning
review (Birthrate Plus©) and the 2016 estimates has made provision for additional
midwifery staff as an immediate requirement.
Maternity Clinical networks
Clinical networks are an important element of our strategy for increasing evidence-based
practice and improving models of care. Hospital Groups provide better opportunities for
building effective networks to provide direct support that goes beyond oversight and
planning and into direct hands on responsibility for solving problems.
Planning commenced at the beginning of 2015 for the integration of the Coombe Women’s
and Infants University Hospital and the women and infant’s service in Midland Regional
Hospital Portlaoise. The process of establishing the first clinical network is a model that
will provide a framework for all groups. This hub and spoke model of obstetrics is intended
to deliver the Coombe services on two sites according to agreed pathways and policies. In
March 2015, the Coombe Board and the HSE (Dublin Midlands Hospital Group) signed a
Memorandum of Understanding to achieve this goal, contingent on well planned
integration. A senior obstetrician from the Coombe was appointed as the Director of
Integration and is on site in Portlaoise. The Coombe/ Portlaoise implementation planning
is proceeding well, there have been joint multidisciplinary workshops defining the
pathways according to HSE national policies and the HIQA Better Health Care Standards.
Recommendations from the ongoing maternity strategy will be integrated. My colleague Dr
Susan O Reilly can provide further detail and answer any questions you may have in
relation to this evolving maternity clinical network.
In addition Wexford General Hospital and Midland Regional Hospital Mullingar are
developing closer links with the National Maternity Hospital, Holles St as part of the
Ireland East Hospital Group. These links will strengthen clinical governance arrangements
and will involve the review of the maternity services' medical manpower needs.
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The RCSI Hospital Group has appointed a Clinical Director for Women’s and Children who
is leading on the development of the maternity clinical network to include Cavan General
Hospital and Our Lady of Lourdes Hospital. My colleague Dr Alan Finan can answer any
questions that you may have in relation to this. Work is well underway in SSWHG and a
review of maternity services is underway that includes the establishment of a maternity
clinical network with Cork University Maternity Hospital as the hub.
The Saolta University Hospital Group has in place a Clinical Director and Group Director
of Midwifery for Women and Children’s Directorate across the group and the clinical
network is being established.
To support the networks the National Neonatal Transport Service is now a 24/7 service
for the retrieval, stabilisation and transfer of critically ill neonates up to the age of 6 weeks
from maternity units outside of Dublin to one of the NICU’s or paediatric intensive care in
one of the Children’s Hospitals.
Women and Infants Programme
The establishment of managed clinical networks will promote consistency and quality of
the service throughout the care pathway. The HSE considers that more needs to be done
at a national level to ensure appropriate oversight and clinical leadership and to drive
necessary reform and reconfiguration in maternity services. Looking to the system for
precedents of successful organisational reform, the National Cancer Control Programme
stands as a model which has significantly improved cancer services and patient
outcomes.
A programmatic approach to maternity services will underpin the provision of quality and
safe, patient centred, sustainable maternity care. The Programme will provide the
necessary governance, integration and leadership to drive reform and standardise care
across all units. Such a dedicated structure will also ensure that learning from adverse
incidents is applied in a comprehensive and consistent manner and promote a national
approach to consistent, evidenced-based practice in maternity care.
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This approach will support staff and enhance the opportunity for optimal clinical outcomes
for mother and baby through the integration of the best research evidence, clinical
expertise and patient values, into the decision making process for patient care.
Maternity Charter
A Charter for Maternity Care is currently being developed in partnership with the Clinical
Programme for Obstetrics and Gynaecology. The Charter will outline a set of principles
which describe what matters to women and their partners when engaging with and using
maternity services in Ireland. It aims to inform and empower women to actively look after
their own health and the health of the unborn baby, whilst influencing the quality of
maternity care in Ireland. The work will be completed once the maternity strategy is
finalised as the key components of the strategy need to be reflected in the Charter.
Maternity-Neonatal Clinical Management System (MN-CMS)
The MN-CMS is an Electronic Health Record (EHR) for all women and babies who access
the Maternity Services in Ireland. This system will provide accurate and up to date
information to all those involved in the care of mothers and babies in our maternity units.
The vision is to continue to develop the system to meet the ongoing changes within
Maternity services and to work closely with other national systems and initiatives, to
capture and provide key information. This system when implemented will provide a
seamless, complete and reliable source of all the information clinicians require to quickly
and to accurately make care decisions for the health and well-being of mothers and
babies within Ireland. Phase 1 of this project is focused on the initial rollout to the following
four Hospitals in 2016:

Cork University Hospital

The Rotunda Hospital

Kerry General Hospital

National Maternity Hospital
This system will then be deployed to the remaining 15 Maternity Hospitals from 2016
onwards.
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Irish Maternity Patient Safety Statement
A key concern for patients is that they receive safe and appropriate care. The CMO
Portlaoise Report sets out the requirement for a maternity patient safety statement.
The Maternity Patient Safety Statement will provide up to date information for
management and clinicians in maternity units on key patient safety issues. It will have the
advantage of creating a source of information that is much more accessible and
transparent for the purposes of external scrutiny including by the public. The information
within the statement will support local and Hospital Group management to identify trends,
to target quality improvement measures and support ongoing risk assessment.
It is
expected that these statements will be published online on a monthly basis commencing
with August 2015 data published in early October 2015.
This concludes my opening statement and together with my colleagues we will
endeavour to answer any questions you may have.
Thank you.
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