Yesterday, the Minister for Health told reporters that maternity services may be closed at a number of smaller hospitals. He said this against the backdrop of his visit to Portlaoise and his meeting with bereaved parents who tragically lost newborns there in recent years. This follows his announcement last week of the establishment of a steering group to advise on the development of a national maternity strategy, which is to report by the end of the year. Irrespective of our political views in the House, we are all deeply concerned at the series of tragic outcomes at a number of maternity units across the State, including at Portlaoise and at Cavan in my constituency. Our thoughts are with the grieving parents and their families. We all want to know the full facts as to why these distressing events took place and what must now be done to ensure as far as humanly possible that there are no further such incidents.

I must ask the following in the context of what the Minister for Health said yesterday and repeated this morning at the Joint Committee on Health and Children. It is fuelling further concern and distress at a time when we clearly have not yet got the report of the new steering group. The Minister is being pre-emptive in suggesting the closure of any number of maternity units. Will the Tánaiste undertake to ensure that these sad, tragic and distressing outcomes are not employed to serve a programme of closures which is a long-standing objective of some within our health services? On foot of her position in government, will the Tánaiste ensure instead that all appropriate measures to address the deficiencies and needs identified out of all the reports, some of which have yet to be presented including the one on the Cavan incidents, are acted on or introduced?

First, I also express my sympathy with the families who lost children and who very bravely met the Minister over a prolonged period yesterday in Portlaoise. I understand from media reports that they told him their personal stories.

Were you talking to them?

It is difficult to contemplate a more distressing scenario for parents than the death of a baby during childbirth or shortly after delivery.

It is all the more difficult for women in that I do not think anyone is quite as vulnerable as a woman when she is having a baby. I cannot say enough to express how sorry I am for the families and parents, in particular the mothers, involved. Having heard the distressing news about a further death in Cavan General Hospital and considering what the mother, the parents and the family must be going through, I offer my sympathy.

Before answering Deputy Caoimhghín Ó Caoláin's specific questions, we should be able to agree that the objective ought to be a health policy which focuses on the best health outcomes for mother and baby and the safe delivery of the baby. These babies are very much wanted. The best outcomes have to be at the core of our approach to maternity services in Ireland. Nothing other than this as a policy will serve women and babies as well as they might be served. It used to be said baby deaths and maternal mortality rates were exceptionally low in Ireland. I do not know the international figures and I am not an expert in the area. However, as almost every woman, mother and father has been shocked, I have been shocked by the repeated reports of deaths associated with maternity services. We need to agree that the best health outcome for mother and baby is the policy we should agree.

In that context, I welcome the decision by the Minister for Health, Deputy Leo Varadkar, to have the national maternity strategy review carried out this year. The strategy will provide the policy to underpin the women and infants health programme. The steering group advising on the strategy met for the first time last week and I understand it had a very useful discussion. The group is made up of people with wide experience, both in terms of personal experience and professional qualifications. That is as it should be. We need to agree that the core of the policy has to be one that promotes the best outcomes for mother and baby.

Deputy Caoimhghín Ó Caoláin has a supplementary question.

It is in total agreement that I take my second opportunity. This has to be the case. We cannot have a pre-emptive and prescriptive addressing of these problems and the Minister for Health's comments yesterday equated to such. For him to suggest in the context of these tragic outcomes that maternity services at a "number" of so-called smaller hospitals may close is the wrong answer, one which was offered before the review group had even commenced its work. His statement undoubtedly fits the agenda of those who are advocates of further centralisation and subscribe to the controlling obstetricians' view of child delivery. I say "controlling" obstetricians rather than obstetricians in general. I do not view expectant mothers as ill - far from it - or in need of consultant care generally. The overwhelming number require the services and support of a midwife or midwives. Nowhere in the eight recommendations made in the report on Portlaoise hospital is there a mention of closure. It is within the gift of the system to address the deficiencies and needs in order to ensure a safe service for women and the child or children they are expecting. That is absolutely what the Tánaiste has said and I agree that it must at all times be the critical focus.

I again appeal to the Tánaiste because I am concerned that an agenda is being oxygenised. She should ensure the assessment process is allowed to finish and not allow those with an agenda to seize the moment and set the scene for the closure of any number of the remaining 19 maternity units across the country. Will she defend the right of women to access a safe service of their choice and not to be pressed against their will into heavily centralised conveyor belt child birthing settings?

I thank the Deputy for agreeing that the best outcomes for mothers and babies are the key objective. HIQA's Portlaoise hospital report makes eight recommendations, of which I want to pick out two. In terms of the recommendations to the Department of Health, the third is to develop a national maternity strategy. In terms of the recommendations to the HSE, the sixth is to develop a strong clinical network. These are very important recommendations and, in that context, what has happened is that the Minister has developed the group to further develop the national maternity strategy. That is the right approach because people have to sit down and look at where we are now, what are the resources and what will produce the best outcomes. That is good and should be welcomed.

The other recommendation is to develop strong clinical networks. We have a long tradition in maternity services in this country which has been very good in terms of the commitment of the people who work in the services to the health of mothers and babies. They are the obstetricians, the midwives and all others who work in the services and their commitment goes back generations. In the case of Portlaoise hospital, what has happened - perhaps it is something that might be explored in the case of Cavan General Hospita - is that a network has been developed in the context of the Dublin Midlands Hospital Group. The Coombe Women and Infant University Hospital, a recognised international centre of excellence, has, as we all know, a very high number of births annually. We know that there is a correlation, particularly when there are difficulties, between births which offer challenges to the mother or the baby and medical expertise with a high volume of experience. We know this from other areas.

The relationship and protocol established by the Coombe and Portlaoise hospitals make a lot of sense and will have to be resourced. I have had a private conversation with the Minister about the matter. It is a good approach, but it requires resourcing. We know in the case of Portlaoise hospital that there have been significant additional resources. There have also been failures in the practice of what we have come to expect as a people from medical services. Elements of it, including the management issues that arise, are under examination. That is the right way to approach the matter.