Hospital Services

I acknowledge the presence of the Minister of State in the Department of Health and thank her for taking this Topical Issue. I also thank the Cathaoirleach for selecting it. I know the Minister of State will be familiar with it but just to put on record that the DOMINO scheme is community-based midwifery-led care. We do not always get the chance in these Houses to talk about services or initiatives that are win-win for the public and for the State but this is what DOMINO is. For the mother, the family and the baby, it provides an excellent level of care in the community. It ensures that low-risk pregnancies can be managed, stay in a low-risk environment and be supported to do so. It means, in some instances, that you could give birth in the hospital and within four or five hours be at home in your own bed. It is a terrific service but it is also in the interests of the State and the hospital if we can get things right. It ensures there is less pressure on hospital beds, that low-risk pregnancies do not escalate to high-risk pregnancies and it is very much in line with what is in the national maternal health strategy. Changes took place to the service on 12 October 2026. I state at the outset that it is not disputed that a service does continue and that DOMINO continues to be operational, but it is about the nature of changes to the service and restoring it to its full capacity. This was initiated as a pilot a bit over ten year ago. The objective at that stage was to see if it could be successful that it would potentially be expanded. That is what we should be looking at. First, we should be looking restoration but in the medium run seeing it expanded. That has not happened, even though the results speak for themselves. A number of years ago in its own publication, CUMH recognised that there are financial savings - not the primary consideration but it is worth noting - because of the early discharge and home care arrangements. I will outline some of the difficulties that exist or have existed. The telephone line was an issue. I understand this has been progressed to some extent but it is important that it remains monitored. There is also the capacity for home care. As I said, that is one of the biggest things that most appeals to mothers and families who are interested in accessing DOMINO care. At the moment, there is a question as to whether the early transfer home team has the staffing and capacity to provide the equivalent care, including at weekends. Access to antenatal education is a significant issue because people are trying to book the CUMH classes but have been told they are already full. There had been in the past, and there certainly is intended to be, dedicated DOMINO classes. We should ensure that is restored to full capacity and confirm whether the locations that had been in place for community antenatal appointments will be retained. We need to ensure there is adequate staffing to retain the full DOMINO model because it is the full suite of services that ensures this is attractive. I have spoken to some of the women who have experienced DOMINO and are campaigning on this issue. I acknowledge the work of the campaigners who have been highlighting this. They presented a petition to the Taoiseach on, I think, Monday. Their key point is that it needs to be the full suite of services. We should ensure not only that this is retained but that it is expanded into the future.

I thank the Deputy for providing this important opportunity to discuss the DOMINO scheme. He has set out very well and very strongly how important it is for low-risk pregnancies and giving women the choice to make the decision as to how they would like to give birth. I am taking this matter on behalf of the Minister for Health, Jennifer Carroll MacNeill. The Department has been engaging regularly with the region, and I assure Deputy Ó Laoghaire that the DOMINO scheme at Cork University Maternity Hospital is operational. It is fair to say he acknowledged that. This is a highly valued scheme available to existing participants and eligible new patients. As of the middle of October, 52 women are registered with the DOMINO scheme in CUMH, 38 of whom will give birth before the end of this year. In October, CUMH made some changes to staffing arrangements within the hospital due to a high level of maternity leave and staffing pressures. Some of the midwives from the DOMINO scheme have been deployed to support the labour ward. Patient safety remains the overriding priority for all arrangements. These changes do not represent a closure of the scheme but are a temporary solution to ensure the safety of women and babies in CUMH. Antenatal care continues through DOMINO and the hospital's outpatient midwifery services. Parentcraft education continues to provide antenatal classes. The HSE has further advised that the increased presence of DOMINO midwives within the birthing suite is likely to facilitate continuity of care for women in the scheme who present in labour at CUMH. Postnatal care will be provided through the early transfer home midwifery team. This includes support at home following discharge. CUMH continues to review the service and, following engagement with the DOMINO midwives, the dedicated 24-hour DOMINO telephone line was reinstated from 23 October, which was just over a week ago. CUMH was also among the sites involved in the original pilot of postnatal hubs, as the Deputy said, supporting the delivery of postnatal care closer to home for women and families in communities such as Ballincollig, Clonakilty, Mallow and Carrigtohill. I acknowledge the Deputy's concern about recruitment. While enhanced controls are currently in place, it is important to clarify that there is no blanket recruitment freeze. Recruitment to essential posts can continue, with decisions informed by clinical need, patient safety and patient benefit, and having regard to available funding. The DOMINO service remains operational and available to eligible women. HSE South West continues to review and prioritise staffing requirements to support the safe and effective delivery of maternity services. The staffing arrangements currently in place are temporary and it is intended that the redeployed staff will begin to return to the DOMINO service from the first quarter of 2027.

At the very minimum, that timetable needs to be held to. There will be women out there wondering. We need to get that communication very clear. The first quarter of 2027 for procurement might be fine but for a pregnancy, when you have a very specific date, you want to know whether you will have the full suite of services at the time you are giving birth or the period before and after. We need clarity as to what exactly that means. I ask the Minister of State to try to work with the Minister for Health to announce a specific date for the full restoration of services. I hope not only that is what the Minister of State can commit to but also that it is communicated very clearly because that will inform the choices women and families make in terms of their births. The capacity for home care is crucial. I live in a part of the city that is quite near the hospital so I see the CUMH cars around at people's homes delivering those home visits and supporting women before and after they give birth. It is crucial that is fully resourced and reliable. The point has been made that CUMH is short about 80 positions in terms of vacant posts and so on. Ultimately, moving staff between services does not resolve the underlying shortage. If we can get this service right, it will reduce pressure on doctors and on hospital beds. As I said, it is a win-win. I ask the Minister of State to bring back some key points to the Department. As regards antenatal classes, I know she has said the parentcraft places are still in place, but there needs to be dedicated DOMINO classes. That needs to be key. She has said the telephone access is restored. That needs to be maintained. The home care is crucial. It needs to be fully resourced in order that people are in a position to return home. I refer also to community antenatal appointments and a specific date.

I thank the Deputy for that. I will take on board everything he has said and it will be reflected back to the Minister, her team and the Department. There is evidence that investment in postnatal hubs in Cork and Tralee supporting care closer to the home, as well as the recently opened women's health hub in Tralee, do work. I agree with the Deputy that they absolutely do. The commitment to women's health services is reflected in Cork University Maternity Hospital. Since 2020, staffing across the region has increased by 27%. That includes 29 additional staff who were recruited this year. While births at CUMH have reduced by 7.8% since 2020, we remain committed to providing women with choice in their maternity care, including through the supported care pathway and the domino service. The HSE South West region is operating with additional recruitment controls, as I said. The region will continue to review and prioritise its staffing requirements. I take on board what the Deputy said about a timetable. As he said, quarter 1 is fine for procurement, but if you are somebody who is using the DOMINO scheme and you are nervous about what the situation is, timelines, communication and the helpline are really important. Operational decisions are taken by management from a safe staffing perspective and we cannot really question the decisions they make to make sure that it is a safe staffing process. At the same time, I will take on board everything the Deputy has said and the way he has presented it. As a woman who has had three children during her life, and there are lots of dads here as well, I understand that people need that certainty when they are about to give birth.