Hospital Services

87. Deputy Pádraig Rice asked the Minister for Health her views on recent changes to the DOMINO scheme in Cork University Maternity Hospital; if she has engaged with the south-west region and local management regarding the changes to this midwife-led service; and the way in which the decision to materially alter the scheme's model is consistent with the aims of the national maternity strategy. [73318/26]

I too express my sympathies to the people of Waterford arising from the events of recent days. I ask about the DOMINO scheme. It is considered the gold standard in maternity care. It is a community-led midwife service that offers continuity of care to women at no cost to the patient. As Sarah Thatt-Foley wrote in the Irish Examiner earlier this month, the DOMINO scheme is a good news story. It is one of the most sought after maternity services available to Cork women. Why then would the Minister allow it to be cut to the bone at CUMH, and fundamentally alter the model of care? The reason given is staff shortages. According to the Irish Nurses and Midwives Organisation, there are 80 nursing and midwifery vacancies in CUMH. The DOMINO scheme aligns with the national maternity strategy and Sláintecare but has become the latest casualty of staffing shortages in the south-west region. I want to get the Minister's response.

I have spoken with the chief nursing officer about this directly. I am afraid that what the Deputy has presented is not in fact correct. I am happy to say the scheme continues to operate and is open to women attending at Cork University Maternity Hospital. The commitment is reflected in significant investment. Overall staffing has increased by 16% since December 2023. Even this year, staffing has increased by 6%. There have been 49 additional posts funded since the national maternity strategy was introduced. Crucially, the staffing uplift has been 16% since 2023 and 5.3% since December 2025. Some staff have been redeployed. Several senior midwives are currently on maternity leave. As part of an ongoing effort to ensure continued and safe delivery of intrapartum maternity services, a small number of experienced DOMINO midwives have been temporarily redeployed to support staff in its skill mix requirements within the labour ward. That considered reorganisation of midwifery resources is a sensible and safe approach to managing the workforce generally and to ensuring the continued delivery of all services. This has resulted in some changes to how postnatal care is delivered directly by the DOMINO team. However, women and babies continue to receive postnatal care through the early transfer home midwifery service, which is important. The early transfer home team services serve the same catchment area and the HSE has confirmed that no woman will be refused postnatal care through those arrangements. The measures I referred to are temporary and the intention is to reverse this temporary redeployment from quarter 1 of 2027. However, the Deputy can see that staff numbers have increased over the past two and a half years. They have increased this year. A number of senior midwives are on maternity leave and staffing has been reorganised to make sure that all of the services are as safe as possible and that no woman's postnatal care will be impacted.

There is nothing short of serious anger among women in Cork about these changes. People really value the DOMINO scheme. They see a midwife in their community clinic, the same midwife supports them at delivery and then, when they get early transfer home, the same midwife supports them at home. The changes we are seeing fundamentally alter the DOMINO scheme. We have been told the antenatal clinic will now operate with one DOMINO midwife and two outpatient midwives while DOMINO midwifes are redeployed. The DOMINO support during labour will depend on operational feasibility. Postnatal home visits will be transferred to the early transfer home team. The dedicated 24-hour telephone service will now redirect to an emergency line, and the dedicated DOMINO antenatal classes have just been removed. This fundamentally alters a scheme that provides continuity of care. We should be expanding continuity of care for women, not restricting it. This is a serious issue. The Minister said this has to do with staff shortages. There are newly qualified midwives in the audiovisual room this morning who do not have jobs, would want to be part of these services and need to be employed in the health service. I encourage the Minister to change tack.

There are currently 52 women registered with the scheme in Cork and a total of 114 women registered through the scheme in 2026. It is highly valued and will continue to operate. The staff uplift has been important and considerable. It is a 5.3% uplift this year on the back of a 16% uplift over the past number of years. Because of a particular group being on maternity leave at the same time, staff have been redeployed and services reorganised. I am sure the Deputy is not suggesting there is anything wrong with the early transfer home midwifery team or the support it provides to women. These are all qualified midwives working in different ways. I am sure that is not what the Deputy is suggesting. I know the Deputy would like me to continue to ensure there is recruitment into the south west. As I have said to him several times, that region has recruited more than twice its allocation for this year. There are significant budgetary impacts from that. I am sure we will discuss those separately in the Oireachtas health committee. We have opportunities for nurses and midwives all over the country. We want to recruit them, they should be recruited and it is possible to recruit them, but that must be done in a strategic way and they must be deployed to where they are needed.

I have no doubt good care will be provided. What we are talking about is ending continuity of care provided to women through the DOMINO scheme in Cork. That is why there is such anger among my constituents. We need to restore the continuity of care and invest in the services. When there are vacancies they should be filled. When somebody is out on maternity leave those posts should be filled so these services can continue. The concerns are not just coming from me. Cork City Council unanimously passed a motion on Monday night urging the Minister to intervene to fix this. The Minister's Fine Gael colleagues supported that motion, proposed by Councillor Niamh O'Connor, to ensure this service is not curtailed. We know, more broadly, that 1,000 patients were treated on trolleys in Cork University Hospital in the past month. There was a 12% increase in presentations to the emergency department. The CT scanner is now operating at 50% capacity in the hospital. Some 21 beds due to open December are delayed and other beds opened without staff. There are serious pressures on CUH and CUMH, and we are seeing it in the context of the services delivered to people. What is crucially important is that women in Cork want this service to continue. They want it restored and they want the Minister to resource it. That is fundamentally important.

I have stated the level of investment that has happened, not just this year but over the past two and a half years. Those posts are in place. Again, CUH is a hospital that has recruited 233 people this year. Let us compare it with Beaumont Hospital, which has recruited considerably less, at between 50 and 80 people. I cannot recall the exact figure. It has the same level of increased presentations and does not have the same trolley pressures because it has reorganised the way in which it works. Let us compare it to the Mater Hospital which has had a similar uplift in staff, either 50 or 80, whereas CUH has had an uplift of 233. No hospital in Ireland has recruited more people than CUH in 2026. The closest is Limerick, which has recruited approximately 130 people. No hospital in Ireland has recruited more than CUH, yet it is one of the seven hospitals with persistent trolley issues. Hospitals that have recruited considerably fewer staff do not have trolley issues. No area has opened beds in the way that area has opened them. An example is all of the staff who have gone into Mallow hospital. All of that is a resource for CUH and a resource for the area. All of it must be used.