Securing funding to appoint maternity staff will be challenging

The State’s new maternity strategy acknowledges that securing funding to appoint hundreds of new doctors, midwives and other staff will be challenging, and the posts should be filled on an incremental basis.

It recommends that the Government commits to allocating annual development funding for initiatives set out under the strategy which would then be ringfenced for this purpose by the HSE.

It says the HSE’s new national women and infants health programme should develop and manage a detailed implementation plan and timetable.

“The implementation plan will address recommendations that can be initiated and implemented within a short timeframe while working towards the achievement of the longer term vision,” the strategy says.

“The plan, therefore, will detail short-term and long-term goals. The focus initially will be to provide choice in pathway of care at maternity network level while building capacity to rollout the strategy across all maternity units over the 10-year lifetime of the strategy.”

The strategy says the reforms proposed will have a significant impact on health workforce requirements.

Training opportunities

It says consideration may need to be given to increasing undergraduate intake levels in third-level colleges or providing additional post-graduate training opportunities.

The document says the HSE’s clinical programme in obstetrics/gynaecology estimates some 100 additional consultants in this area are needed.

“The programme proposes that the number of obstetricians/gynaecologists should increase over a phased period, rather than recruiting a large number of consultants from developing countries.”

The document also says additional midwives will be needed, particularly if the maternity service is to move to a 1:1 midwife to mother ratio during all stages of labour in the various proposed new care pathways.

“Additionally, the changing role of the midwife as lead professional for women in the supported care pathway, as well as the development of the hospital outreach community midwifery service, will require the recruitment of more midwives.

“However, the need to build capacity in the midwifery workforce is not only in terms of numbers, but also in relation to capability to deliver the new model of service across the home, the community and the hospital settings. There will be a need to ensure that undergraduate programmes respond to the changing nature of midwifery practice.”

The document also says workforce planning will have to be undertaken in other disciplines outside of the core areas of obstetricians and midwives to include anaesthesia, critical care, perinatal, psychiatry, perinatal pathology, general practice, public health nurses, dietetics, physiotherapy, speech and language and social work.

It says the traditional model in hospitals of having one consultant anaesthetist and one non-consultant hospital doctor on call could not provide the level of care required to meet the strategy’s recommendation that there should be an emergency team available in all birth centres to respond immediately to obstetric emergencies.

Specialities

“In order to ensure that the maternity service is not in competition for the anaesthesia resource with other specialities such as critical care, emergency department or retrieval services, the minimum level of service for a hospital with a co-located maternity unit will require definition,” it says.

“This is likely to require two consultants and two non-consultant hospital doctors on call; a review of anaesthesia staffing for each maternity unit should be undertaken as a priority on publication of this strategy.”

The strategy also says historic staffing difficulties in the number of consultants specialising in neonatology must be addressed. “An increased number of neonatal nurses is also required to meet recommended ratios of 1:1 in intensive care, 1:2 in high dependency care and 1:4 in special care.”