The Minister for Health James Reilly is committed to creating a better environment to support midwives in meeting the demands put upon them and the services in which they work. This was according to Dr Siobhán O’Halloran, chief nursing officer of the Department, who was speaking at the INMO/RCM Northern Ireland All-Ireland Midwifery Conference in Dublin last month on behalf of the Minister.

The conference is a collaborative initiative by the INMO and the Royal College of Midwives (RCM) Northern Ireland. Its theme this year was ‘Maternity Care – Everyone’s Affair. Practices, Partnerships, Policies and Possibilities’.

Dr O’Halloran told those attending the conference that Minister Reilly is aware that the demands on midwives in Ireland have increased both in complexity and volume over the past few years.

She said: “There have been demographic changes which have increased demand. Ireland’s fertility rate is the highest in the EU 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.”

Savita Halappanavar
Dr O’Halloran spoke about HIQA’s report into the care and treatment provided to the late Savita Halappanavar at UHG in October last year. She described it as 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,” she said.

“ 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,” she added.

Dr O’Halloran identified five key actions to be taken:

• The prioritisation of a patient safety culture in the HSE’s Annual Service Plan through specific measures focused 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 the Department of Health 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 (NCEC) of four national clinical guidelines in line with the recommendations of HIQA’s report.

Pictured at the All-Ireland Midwifery Conference were (l-r): Geraldine Talty, INMO first vice president; Mary Higgins, international officer of the INMO Midwives Section; Mervi Jokinen, RCM, London; Breedagh Hughes, RCM, Northern Ireland; Dr Siobhan O’Halloran, chief nursing officer; Claire Mahon, INMO president; and Allison O’Connell, INMO Executive Council member

New clinical guidelines
According to the chief nursing officer, Minister Reilly has requested that the four national clinical guidelines be immediately commissioned as part of this process and as a matter of urgency. They are:

A national maternity early warning score guideline

• A national paediatric early warning score guideline
• A national sepsis management guideline
• A national clinical handover guideline.

These guidelines are expected to make recommendations for staff education and training in order to assure the competence of doctors, nurses and midwives to handle critical life-saving clinical issues. Their implementation will be monitored and published on an ongoing basis through an agreed accountability framework between the HSE and Department of Health.

Early Warning Score
Dr O’Halloran reported that all 41 target HSE hospitals have commenced implementation of the National Early Warning Score, with 56% reaching completion. She said that nurses and midwives have contributed hugely to the development of the HSE’s new national clinical programmes.

“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,” she said.

She added that maternity services policy 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.

New maternity hospital
The chief nursing officer also spoke about the new national maternity hospital, which is to be built on the campus of St Vincent’s Hospital. She told the conference that there are already “significant synergies” between the two hospitals.

Dr O’Halloran said that the project will result in midwives operating in a vastly improved facility, enabling them to provide a better level of care.

Patient Safety Agency
The conference heard that the Department of Health is working closely with the HSE to ensure that there is visible and distinct leadership responsibility for patient safety and quality at a national level.

Dr O’Halloran said: “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.”

She said that the agency 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.

Attending the All-Ireland Midwifery Conference were (l-r): Deirdre Daly, Mary Higgins,Margaret Carroll and Colm O’Boyle from the INMO Midwives Section

Haddington Road
Dr O’Halloran acknowledged the role that the INMO played in negotiating the Haddington Road Agreement.

“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.”

President’s address
Claire Mahon, president of the INMO, also addressed the midwifery conference.

Speaking at the event, she said: “In this era of decreased resources, the pressure is always on to find more effective and efficient ways to provide quality assured care. It remains my firm belief that midwives, if only the policy makers would allow, could lead out quickly on new models of care.

Ms Mahon said that this should begin with the establishment of new midwifery-led units for low-risk mothers, without delay. “All of the evidence emanating from such units in the areas of Louth and Cavan, only confirms that this type of service is preferred by mothers. It most certainly delivers high quality care on a more cost effective basis.”

Elizabeth Adams, INMO director of professional development, is now working with the senior midwife managers of four major maternity hospitals to examine the issues of staffing needs and the requirements for safe care.

The Rotunda, the National Materni ty Hospi tal , the Coombe and Cork University Maternity Hospital have already done a significant amount of preliminary work in this area. It is the INMO’s view that this work must influence the national review of maternity services, which is resulting from the recent reports from HIQA and other bodies.

Midwifery officer
Ms Mahon welcomed the appointment of Dr O’Halloran as the new chief nursing officer of the Department of Health. For the first time, this post is at assistant secretary (senior management) level.

The INMO is already seeking the appointment of a midwifery officer at the earliest possible date and is confident of early progress on this issue.

“This senior appointment, which will see the post holder sitting at the management team level in the Department of Health is a significant development. It will help both the nursing and midwifery professions to achieve their full potential by ensuring a nursing and midwifery perspective is brought to bear in all policy analysis, consideration and formulation.”

Pink Power
She also spoke about the INMO’s Pink Power initiative, which was launched in autumn 2012 in response to the increasingly high levels of nurses and midwives making claims on their income protection scheme (available via their INMO membership) for breast cancer.

Almost 3,100 members in 19 locations attended Pink Power breast check. Some 452 required follow-up appointments, including 113 mammograms and 46 biopsies. Three members were diagnosed with early stage breast cancer and are currently receiving treatment.

Due to the success of the campaign, the INMO will be campaigning for the extension of the national Breastcheck service to include all women over 40. The service is currently only available to women over 50.

Maternity services
Commenting on the Savita Halappanavar tragedy and the subsequent HIQA report, Ms Mahon said: “We welcome the National Review of Maternity Services and will actively participate in this important project.”

She said that the INMO is conscious of the many issues raised by the HIQA report, and the coroner’s and HSE’s enquiries, which, she said had focused a “very sharp light” on staffing levels and standards of care in all maternity services in the Republic”.

The INMO is actively supporting members who were working in UHG at the time of Ms Halappanavar’s death, and has committed to devoting all resources necessary to ensure that only positive things emerge from the tragedy.

Ms Mahon said:“This must involve adequate staffing levels, appropriate skill mix and absolute clarity that midwife managers have the authority and autonomy to ensure adequate resources are always available to guarantee safe practice leading to safe care.”

Poster competition
The winning entry in the conference’s poster competition was entitled ‘What women want’. It was presented by a group from UCD, including lecturer, Denise O’Brien, and stage 4 midwifery students, Jean Doherty, Deirdre Kane and Kim Ryan.

Health Minister
Health Minister, Dr James Reilly, arrived too late to address the conference due to Dáil commitments. However, he met with a group of more than 20 midwives from both jurisdictions after the event for a full and frank debate on midwifery matters, which was much appreciated by all attending.

Minister’s commitment to better environment for midwives heard at annual conference