Poor infrastructure and overworked staff at maternity units

Conor Ganly


Conor Ganly

Overstretched staff and poor infrastructure has been highlighted by a health service watchdog in a newly published an overview of its inspections of Ireland’s 19 maternity units and hospitals which has found a lack of leadership at a national level in the HSE.

While Health Information Quality Authority, (HIQA), says found good practice in how maternity services detect and respond to obstetric emergencies,  the authority says it also identified opportunities for improvement to ensure that maternity services remain safe and effective into the future. 

It says that its report notes the overall level of professionalism, teamwork and commitment displayed by staff providing maternity care across the country — in what is a highly pressurised and demanding environment.

The carrying out fo the audits is a follow on from the problems at Portlaoise hospital's maternity unit in 2014.

Mary Dunnion, HIQA’s Director of Regulation, said: “Overall, our findings provide assurance that improvements have been made in maternity services since HIQA’s investigation into maternal care in Portlaoise Hospital. However, we 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. 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.”

Sean Egan, HIQA’s Head of Healthcare, said: “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.

“In addition, the poor infrastructure and physical environment across maternity services significantly 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.”

HIQA says it has made eight recommendations to the HSE to improve the quality and safety of maternity services into the future, including the development of a comprehensive plan to fully implement both the National Standards for Safer Better Maternity Services and the National Maternity Strategy.

Ms Dunnion added: “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.”

The Irish Nurses and Midwives Organisations said that this is further evidence of the chronic understaffing in Ireland’s nineteen maternity units and that midwives’ dedication was being used to “paper over cracks” in the service.

A statement said the union called for the long-delayed implementation of the National Maternity Strategy, which would increase midwife-led care and bring staffing levels up to the scientifically safe level of no more than 29.5 births per midwife.

The union is calling for:

Immediate HSE approval of midwifery posts to reach safe staffing levels
An end to the HSE recruitment freeze in nursing and midwifery
A renewed commitment from the next government to implement the National Maternity Strategy, including expanded midwife-led units

INMO General Secretary, Phil Ní Sheaghdha, said: “This report rightly celebrates the incredible dedication and skill of Ireland’s midwives. But their commitment is being abused and their hard work used to paper over cracks in staffing.

“There is a very clear strategy for the maternity service, but the HSE haven’t properly implemented it. We need to lift the recruitment embargo, get the staffing levels right, and pay them a fair, competitive wage.

“Part of this comes down to speed. Whether it’s recruitment, the strike settlement or the maternity strategy, the HSE’s go-slow approach has left midwives in an unsustainable position.

“Yesterday’s Intensive Care Unit audit shows that there simply isn’t enough capacity across the health service. Building up staffing and capacity must be a key goal for the next government.”

The full report by HIQA is available here.