Speech by Dr James Reilly, T.D., Minister for Health to the All Ireland Midwifery Conference

As a profession, midwifery is one which is currently very much in the spotlight and I want start today by assuring you of my commitment to creating a better environment to support you in meeting the demands placed upon you and the services within which you work.

I am aware that those demands have increased both in complexity and volume over the past few years. There have been demographic changes which have increased demand. Ireland’s fertility rate is the highest in the European Union and contrary to earlier predictions, the number of births has increased. There have been increases in the proportion of first time mothers, an increase in the mean age of mothers and rising levels of maternal obesity.

All of which combine to make an already pressurised environment even more so.

Last week I read carefully HIQA’s Report into the care and treatment provided to the late Savita Halappanavar at University College Hospital Galway in October 2012. It is a compelling and sobering reminder of the importance of placing patient safety at the centre of our attitudes and actions at all times and in all circumstances.

I want to ensure that the findings and recommendations from HIQA’s Report will mean that we change the way we think and do business in the provision of healthcare. I want to ensure all involved in the provision of these services have the information and support they need to fulfil requirement and I want to ensure the monitoring of performance in our health service must incorporate a visible emphasis on patient safety.

I have identified five key actions to be taken

  • The prioritisation of a patient safety culture in the HSE’s Annual Service Plan through specific measures focussed on quality and patient safety including healthcare associated infections, medication safety and implementation of the Early Warning Scores.
  • The development of a Code of Conduct that clearly sets out employers’ responsibilities in relation to achieving optimal safety culture, governance and performance.
  • Monitoring progress on the implementation of the HIQA report recommendations, as part of HIQA’s monitoring programme against the National Standards for Safer Better Healthcare.
  • Development by my Department of a national Strategic Plan for Maternity Services in collaboration with the HSE. This initiative will take account of the development of midwifery led services and midwives will be consulted on its formulation.
  • The commissioning by the National Clinical Effectiveness Committee of four national clinical guidelines in line with the recommendations of HIQA’s report.

As I outlined earlier today at the First National Clinical Effectiveness Symposium, I will be mandating that the NCEC commissions and quality assures essential national clinical guidelines to address the significant patient safety issues outlined in the HIQA report.

I have requested that four national clinical guidelines are immediately commissioned as part of this process and as a matter of urgency. These guidelines are

  • A National Maternity Early Warning Score Guideline
  • A National Paediatric Early Warning Score Guideline
  • A National Sepsis Management Guideline and
  • A National Clinical Handover Guideline

I expect these guidelines to not only detail best practice but also to make recommendations for staff education and training. This is in order to provide for assurance of the competence of our doctors, nurses and midwives to handle these critical life-saving clinical issues.

In a similar manner to how I endorsed the National Early Warning Score Guideline as policy in February this year I will insist that the implementation of these guidelines is monitored and published on an on-going basis through an agreed accountability framework between the HSE and my Department.

I am pleased to report that all 41 target HSE hospitals have commenced implementation of this national guideline with 56% having completed.

There is also encouraging progress to report in other areas. Progress for which I want to thank all involved.

You will, I’m sure, be aware of the major work that has been taking place under the HSE’s National Clinical Programmes. Developing clinical care programmes is about improving and standardising patient care by bringing together clinical disciplines and enabling them to share innovative solutions capable of delivering benefits to users of the Health Services. Nurses and midwives have made a major contribution to the development of these new and innovative models of care.

Last May, the Government approved a plan to reorganise public hospitals into more efficient and accountable hospital groups that will harness the benefits of increased independence and greater control at local level.

The establishment of hospital groups is a key building block in reform in our health services. It is intended that they will, in time, qualify as independent competing hospital trusts as we progress towards Universal Health Insurance.

Maternity services policy will be part of this overarching policy framework. It will guide the development of a National Strategic Plan for Maternity Services, which will be developed by the Department in collaboration with the HSE and its National Clinical Programme in Obstetrics and Gynaecology.

As you are aware I announced in May 2013 that a new National Maternity Hospital would be built on the campus of St Vincent’s Hospital. While there are already significant synergies between the two hospitals at present, the new site will ensure that women receive the highest quality care in a safe and purpose built environment. For many of you present this afternoon this project will result in you operating in a vastly improved facility enabling you to provide the level of care that you as a profession are currently striving to provide in much less fit for purpose locations.

In recognition of the vital role that the nursing profession has in the development of our health services, my Department recently appointed Dr Siobhan O’Halloran as Chief Nursing Officer at the senior management level of Assistant Secretary. I did this to ensure that nursing and midwifery can contribute at the highest level in terms of policy making for the health service. Conscious of the audience here today I wish to assure you that midwifery will be central to the work of this office. I firmly believe that nurses and midwives are critical to driving the measures that are necessary to achieve the level of excellence that I know we have the potential to achieve in this country.

You will have heard me say over and over again that my primary concern is patient safety and patient outcomes. My Department is working closely with the HSE to ensure that there is visible and distinct leadership responsibility for patient safety and quality at national level. One of my priorities is the establishment of a Patient Safety Agency and I have been doing detailed ground work with my officials on the basis and structure of same. I am considering proposals at the moment and expect to make a decision on the framework for the Agency in the near future. The PSA will be modelled on international examples such as the Canadian Patient Safety Institute which aims to improve patient safety through shared learning and supporting implementation of interventions known to reduce avoidable harm.

Finally, earlier this month I launched the Tobacco Free Ireland which aims to have Ireland tobacco free by 2025. I am delighted to learn that the Nursing and Midwifery Board of Ireland have risen to the challenge by officially declaring the premises of the statutory regulator a smoke free campus early last week. I am also pleased to note that the regulator encouraged the professions as a whole to lead by example and become tobacco free.

All of these decisions, actions, innovations and policy developments are steps along a long road to achieving the reform needed in our health service. Reform that will improve the efficiency and structure of the service for everyone who works within it or is a recipient of its services.

When I took up office I promised that as a new Minister for Health my primary goal was to radically reform the health system. On Tuesday of this week budget 2014 was announced and it was a stark reminder of the difficult times that we are facing. We have to meet the dual objectives of fitting our health service to the budget available while still delivering the services needed. The key reforms we promised in the Programme for Government are essential if we are to achieve those objectives.

The burning platform for change couldn’t be hotter, with significant challenges to be met including a major cost reduction agenda. The measures we have to take are difficult and challenging for everyone involved but I firmly believe they represent a genuine opportunity to overhaul our health services for the good of the nation.

That said, I also recognise that such a deep and steep level of change and reform is not without sacrifice.

Earlier this year, the Government and the public service unions concluded the Haddington Road Agreement. I recognise that this was a very difficult process for all involved and that, again, front-line health service workers were asked to accept changes in their pay arrangements and to work additional hours. In my view, the sacrifices that public servants have made and continue to make, while at the same time maintaining and improving the health services, are playing a major part in the restoration of Ireland’s economic sovereignty. You will have heard my colleagues in Government say earlier this week that by December next, Ireland will have exited the EU/IMF bailout. This is a major achievement and I want express my sincere appreciation of the contribution of all health service employees to this outcome – not least the midwives and nurses, who are often at the front line providing healthcare in both hospitals and the community.

The Haddington Road Agreement is about achieving real savings in the public service pay bill and health service managers and staff must work collaboratively to maximise what can be achieved over the lifetime of the Agreement. I wish to acknowledge the role the INMO played in negotiating the agreement which I know was difficult for all concerned and now must be delivered.

This Government’s Health Reform Plan is fundamentally changing our service for the better. Strong leadership is needed for problems that do not have easy answers. Every single one of us in this room we can do our bit. Let our actions inspire others to accept the challenge of doing the most we can with what we have now and laying strong foundations of care and service for the future. It will be important to maintain and indeed quicken the pace of work to ensure that the planned reforms are implemented successfully and on target. I remain as strongly committed to advancing the ambitious programme of health reforms as I always have been. I thank all of you in the midwifery and nursing profession for your continuing commitment and service and I ask you to join with me in achieving the goal of a responsive and efficient service, suited to Ireland’s needs in the 21st century.