Major changes in the way maternity services are run have been proposed in two new reports by a leading UK health service consultant.
Understaffing, low pay levels and the slow pace of change were singled out for criticism in the reports by former NHS executive David Flory.
He questioned the sustainability of standalone smaller maternity units but did not recommend the closure of any services.
The current configuration and governance structure for maternity services across the State was not sustainable, he said in the reports commissioned by the HSE in the wake of the scandal over baby deaths at Portlaoise Hospital.
The two units reviewed in the reports, at Cavan General Hospital and South Tipperary General Hospital in Clonmel, emerge with a generally clean bill of health on clinical grounds, though criticisms were made of governance and staffing arrangements.
Mr Flory’s reports are the latest to focus on standards in maternity care and follow a number of investigations into the death of Savita Halappanavar in 2012 and a highly critical Hiqa report published earlier this year into baby deaths at Portlaoise.
A further review into whether managers should be accountable for the incidents in Portlaoise is still awaited.
Maternity strategy
A long-awaited and much-delayed new national maternity strategy is currently being drawn up by a group set up by the Department of Health. Mr Flory said the absence of a plan was giving rise to “speculation and suspicion” about what might happen to smaller units.
Underfunding of medical staffing requirements had resulted in significant shortages of healthcare professionals and pay levels were not competitive in an international context for either managers or doctors and nurses, the reports said.
Smaller maternity units could not operate in isolation and should share staff and facilities in order to provide sustainable services to their local populations.
“They simply cannot sustain the breadth and depth of clinical services that the populations they serve require without formal links and networks with bigger, stronger, more specialist units. Likewise, they cannot afford to do everything independently.”
Mr Flory said the development of networks of maternity units needed to be fast-tracked.
Hospital groups
He identified the delayed development of hospital groups as critical. “It is taking a long time. Key posts remain unfilled and operating models are not yet fully established.”
According to Mr Flory, media coverage of the issues in maternity services had contributed to a “culture of fear of getting it wrong” among some staff.
Mr Flory’s report on Clonmel maternity service, the smallest unit in the State, was strongly critical of gaps in management.
“Some parts of the building are not fit for the purpose of delivering high quality and safe care,” he said.
Mr Flory found Cavan, where four baby deaths over the past three years are being investigated, had “a generally fit for purpose infrastructure overall and is quite well maintained”.
The HSE welcomed the findings made by Mr Flory and said they would provide “important insights” in relation to quality standards and safety in other maternity units.
