Martin Daly: '63% Is a Failure', Demands Defined Co-location

I note from the HSE report the birth rate is going down but the complexity of pregnancy care is increasing. I also note that only 5 of the 19 units meet equal standards, which is unfortunate. And that only 63% of women who look for maternity care have an electronic health record. That's better than a lot of the rest of the health service, but it's still not acceptable in this day and age. It should be 100%. I also note Professor Daly's commenting about kindness and the need to say kindness. I would hope that that's not a newly found value and that has been part of all of our services for years. It's nice that it's reiterated but it shouldn't need to be said. We should have kindness in our health services, especially women who are delivering babies. On co-location, which I'd like to spend a moment on. If I cut across, it's not out of rudeness, it's because I'm on a limited time. So just coming back to Professor Daly, the Rotunda would firmly believe it is essentially co-located with the Mater Hospital. What does essentially mean? From a practical point of view, I think that we have very well developed clinical pathways. The challenge with co-location is that nobody has defined it and I think we urgently need to define what co-location is. Was it not defined in the first plenary that it would be co-location with a Level 4 hospital? Yes, but what does co-location actually mean? Does it mean physically co-located on the same campus? No, well, I don't think that's necessary to be honest. I think that as long as you have established clinical pathways, we are 600 metres from the Mater. There are many campuses in Ireland which are larger than 600 metres. We have developed care pathways. But would co-location mean that on the same campus, physically in the same buildings, there's access to emergency teams who are disciplines other than obstetric care? So that's physical co-location, but I'm talking about something that I believe is much more important, which is clinical co-location. No, I accept that. It seems that there's a different view around this. It's also worth noting that many complications require women in medical institutions to have a current pregnancy. They're deemed normal risk and therefore occur in any unit of the country. I get a sense of a softening towards your view on co-location in that statement from the Rotunda Hospital. So you're not really fully committed to it? We are absolutely 200% committed to co-location. We are 200% committed to the safe delivery of service. We're 200% committed to maternal health. And I think the evidence from the Rotunda is that no woman has died there in 20 years, despite giving care to more than 200,000 women. So I think it is absolutely wrong to consider that we are not totally committed to co-location. And just again, coming back quickly to it, I mean, and I have to ask this question because it has been put to me privately. Is the institution of the Rotunda, as you're so quite rightly proud of, more important than an accessible modern service? Because we've noted that the infrastructure isn't good. It's a very old building, old facilities. I actually trained there as an undergraduate and not much has changed in the old buildings physically. So is the long-term view that that will be adequate for women's health? And by the way, I'm supportive to see, I'm sorry about the critical care unit. It should, I regret that it wasn't, that Board Planola turned it down. But go ahead, please. So you're absolutely right. The building is old. I think Hickwell called this out on every inspection. However... So is that a place that women in a modern Ireland should be delivering their babies? However... Long-term, should we have a plan for a modern fit-for-purpose hospital co-located physically? I think the long-term plan is for a new critical... So the question is, is the institution more important than the idea of co-location? I honestly don't think that is the question, Deputy Daly. I think the question is... No, no, no. The question is, I'm just asking, do you believe it's a yes or no? Is the institution of the Rotunda Hospital staying on a site that's there nearly 300 years, 200 years, 150 years more important than developing long-term a modern, new maternity hospital co-located? But that's our plan. That is our plan on the site of the Rotunda to develop... And I accept your view is that co-location is the matter, okay. The co-location from a clinical and safety point of view is... I accept your answer. Thanks for the rest of the day. And just moving on, I'd just like to ask the HSE, your view on co-location, I mean, my understanding the last time that you were in was co-location was a physical co-location with the Level 4 hospital. Is that an accept... Would that be accepted? I think as Deputy Dehdy said out there, there isn't a definition. It's not defined in the National Maternity Strategy. And my understanding is it's predicated on a 2008 report by KPMG around maternity services. From our perspective, co-location is eminently clinically responsible way to go. And I think Professor Dehdy set that out very clearly there. So from the HSE perspective, it's what works. I think there has been a change made to facilitate the critical care wing in the Rotunda, which is really good. Whether that's the end for the Rotunda or not, I don't think has been defined. We are very supportive of co-location. We're also supportive of making sure that women can deliver in safe environments too. Good. Can I just ask about the electronic health record, why we're not making progress in a really short period of time in a country that's supposed to be the centre of information technology in Europe and the world? Every day, people are banking, they're doing all their business with revenue, all the distractions. And we have a situation with information technology in Europe and the world. Every day, people are banking, they're doing all their business with revenue, all the distractions. And we have a situation where we still have, I mean, electronic health records in the HSE are one of the worst in Europe. In fact, the worst in Europe. What progress can we make? 63% to me is a failure in this day and age. At the moment, there are six maternity hospitals who have a full electronic health record. There are four in development, which by this time next year, hopefully will be either fully on board or well-developed. The challenge then is that the national electronic health record, which is hospital-wide or healthcare-wide, is being rolled out at the same time. So we have to sequence what comes after those 10 sites. So by this time next year, or by the end of 2027, there should be 10 hospitals on, which will bring us up to 70 plus percent. And then whether the national EHR takes over or we continue with MNCMS has to be determined. Thank you for that. Just on recruitment and retention, this is a recurring theme in the HSE. How long does it take to replace someone? Is there planning? Because it seems to me and to many people who are working in the system and looking in at the system that there isn't adequate planning. Someone retires and the recruitment process starts when they retire, rather than starting well in advance of that and planning for the future. And maternity leave is something that we live with every day, so that should be planned for also. It's very difficult, really, I suppose, a short answer. I don't mind, we might reach on. Yeah, so insofar as we can, we do plan in advance. And of course, it's different for different grades of staff. Replacement of a consultant or recruitment to a new consultant typically takes considerably longer, for example, than recruitment. But does that start, Tony, in advance of the person retiring? Because my impression, it doesn't. We have in primary care in East Galway and Roscommon, physiotherapists who go on maternity leave and no one to replace them. And the process didn't start in time, the planning didn't seem to start in time. It is a real difficulty. And being honest, it doesn't always start in time, particularly across all grades of staff. And also being honest, we don't replace all maternity leaves as a routine, but we do replace many of them. And what we've tried to do over the last two years is to shorten that time frame. So we've encouraged within our operational services that people would give us as much advance notice of maternity leaves or other leaves as they're coming up so that we can make a decision yes or no to approve. And just a final question, and I suppose I have to ask of you, Tony, is HSE West North West committed to implementing fully the Walker report and any recommendations that Sam Coulter-Smith have made in relation to the maternity unit reporting in Glasgow? Because as the ex-CEO of the HSE in Glasgow reflected, the Walker report wasn't fully implemented. So we are absolutely, and we have been working on the implementation of the recommendations for some years, and of course the team that are currently committed to the maternity services, we continue to implement them. Thank you. Thank you.