Maternity services in Ireland are very reliant on staff working onerous rosters and lots of overtime, and such arrangements are not sustainable in the long term, a major new report has found.
Over 60,000 babies are born in Ireland every year and the report by the Health Information and Quality Authority (HIQA) is based on its inspections of the country's 19 maternity units and hospitals.
"Overall, HIQA found high levels of compliance against most of the national standards assessed during this monitoring programme. The majority of maternity units and hospitals had arrangements in place to identify women at higher risk of complications and to ensure their care was provided in the most appropriate setting.
"All maternity units and hospitals had arrangements in place to respond to obstetric and neonatal emergencies with response teams available 24/7 - a critical safety measure across maternity services," the report noted.
However, it also highlighted a number of serious concerns, including staff shortages and poor infrastructure.
"Our inspections showed that services around the country were reliant on front-line medical staff working onerous rosters, some on call every three nights, and midwifery staff working overtime to address staffing deficits and maintain service levels," explained HIQA's head of healthcare, Sean Egan.
Responding to this, the Irish Nurses and Midwives Organisation (INMO) insisted that midwives' dedication and commitment "is being abused and their hard work used to paper over cracks in staffing".
Meanwhile, the report also highlighted the poor infrastructure and physical environment found in maternity services nationwide.
"This impacts on a woman's comfort, dignity and privacy, and increases the potential risk of cross infection for women and babies. Addressing the ageing infrastructure across many maternity services will require significant funding," Mr Egan noted.
HIQA also expressed major concern that implementation of the National Maternity Strategy, which proposed major restructuring and reform of services over the 10-year period 2016-2026, has achieved "only limited progress".
According to HIQA's director of regulation, Mary Dunnion, the authority found "a lack of clarity and national leadership within the HSE regarding the responsibility for implementing the National Maternity Strategy".
"This strategy provides a framework for a new and better maternity service that improves choice for women, and ensures that smaller maternity units in particular, are better supported to provide sustainably high-quality and safe care.
"It was of concern to HIQA that the HSE had made only limited progress in advancing this strategy since it was approved by Government in 2016, and a more comprehensive, time-bound and costed implementation plan is required," Ms Dunnion said.
She noted that while more formalised governance structures were introduced by the HSE at the end of 2019 to improve national leadership in this area, "the HSE must now implement the strategy and establish maternity networks to ensure that pregnant women, mothers and newborns across the country have access to the same level of care and support regardless of where they live".
HIQA has made eight recommendations to the HSE aimed at improving the quality and safety of maternity services in Ireland. These include:
-The immediate development of a comprehensive, time-bound and fully costed plan to implement the National Maternity Strategy
-Addressing the infrastructural deficits in all maternity units and hospitals
-Conduting a review of workforce arrangements
-Ensuring that all clinical staff who manage obstetric emergencies have received the necessary training.
"It is imperative that the HSE acts on HIQA's eight recommendations in a timely manner to ensure that Irish maternity services are enhanced and placed on a more sustainable and equitable footing for women and their babies," Ms Dunnion added.
The HIQA report can be viewed here.
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