Smaller maternity units 'can no longer be run in isolation'
Smaller maternity units around the country can no longer operate as "stand-alone" facilities, two new reports have warned.
The HSE-commissioned reports, which are likely to have implications for the future of these units, said they cannot operate in isolation either clinically or financially.
It calls for maternity networks - where they link up with larger units as part of hospital groups - to be fast-tracked.
In that instance, the smaller units remain open but the more complex cases are looked after in the big hospitals.
The examination of the units in Cavan General Hospital and South Tipperary Hospital, Clonmel, was carried out by ex-NHS executive David Flory in the wake of the Portlaoise Hospital scandal in which five babies died.
Smaller units feel they are at the back of the queue for funding and are suspicious that someone is planning their downgrading, he said. In the case of Cavan Hospital, it would be networked with the Rotunda Hospital in Dublin. The Clonmel unit would be linked to Cork University Maternity Hospital.
But he warned there is little evidence yet of practical networking of maternity services within the hospital groups.
"There is a lot of talk about it, and some preparation, but as yet not much action," he stressed.
The report on the Clonmel unit said some parts of the building are not fit for purpose.
It is led by just one senior obstetrician and two locum doctors. This is not sustainable.
"However capable the junior doctors, and however accessible the consultants are when not on site, this model has an inherently higher level of risk than a rota with more consultants present," said Mr Flory.
The general management team is small and the information systems to support performance management and improvement are not well developed.
It delivers 1,100-1,200 babies a year, making it the smallest unit in the country,although its gynaecology service is as busy as others. The hospital's death rate for babies at or around the time of birth is "relatively low" and it receives high patient satisfaction.
The report on the Cavan Hospital maternity unit said there is strong leadership from the general manager, and staff often come in on their days off to help when it is busy.
The death rate for babies is below the national average and lower than other similar units. But a cluster of four serious incidents over 30 months has "hit the place hard".
A spokesman for the RCSI hospital group, of which it is part, said more progress will be made in progressing a maternity network. The HSE said in response that both reports will feed into the new national maternity strategy which will provide a "national roadmap" for services.