We will now take Leaders' Questions under Standing Order 29. I call Deputy Micheál Martin.

Again this week we have had a very tragic situation. I refer to the deaths of two babies in the same maternity unit in the space of a week and to the news of the tragic death of a mother who lost her life in Holles Street on 8 May last. It has to be said that the vast majority of pregnancies in Ireland are safe and uneventful. Nonetheless, the recent deaths will create further uncertainty. It is clear that issues arise from them. These deaths follow earlier deaths in other hospitals, including Portiuncula Hospital and the Midland Regional Hospital in Portlaoise. It is worrying that they follow four deaths in 2014-15. It is of particular concern that we have not yet had sight of the four reports that were done. In other words, we do not have a clear idea of what transpired because the reports in question have not been published. That is unsatisfactory. A former Minister, Senator James Reilly, indicated that he would ask HIQA to undertake an independent review into a death in Cavan, but that never happened. I note that in the Holles Street case, just one external person is involved in the internal review that is taking place. We need external reviews of these issues to provide certainty.

I will explain why I am worried. I have read the two reports that were published following the review carried out at South Tipperary General Hospital and the review carried out by a management consultant at Cavan General Hospital in July 2015. I have also read the maternity strategy and the presentation made by Dr. Sam Coulter-Smith to the Oireachtas some time ago, in which he made the point that "Ireland had the highest birth rate in Europe between 2004 and 2013, yet we have the third lowest number of consultant obstetricians per 100,000 women in the population, among 34 OECD countries". All of the reports consistently refer to a lack of resources, to fundamental problems in the recruitment of clinical and managerial staff in the key obstetric centres and to fundamental manpower and resource issues. We have had many warnings and reports, but no comprehensive action has been taken to deal with the resourcing of our maternity hospitals. Does the Taoiseach accept that our maternity services are under-resourced? Does he accept that there is a need for urgent intervention and transparent action on the part of the Government?

When a death like this occurs, either at birth or in giving birth, it is always a source of stress and tragedy for the families involved. Obviously, the death of Mrs. Malak Thawley in the National Maternity Hospital was a very stressful time for her husband, Alan, and their extended family. I am aware that in this case, the HSE has confirmed that the master of the National Maternity Hospital has commissioned a full investigation into the circumstances surrounding the death of Mrs. Malak Thawley. This is as one would expect. I want to stress the importance of patient confidentiality and sensitivity to the needs of this family at this time.

The Deputy also raised the deaths of two babies at Cavan General Hospital. On behalf of everybody, I would like to express deepest sympathy to the two families involved. The HSE has confirmed that the RCSI hospital group is conducting a review of both of these cases. I assure the House that the safety and quality of maternity services is a priority and will remain so for the Government and for the Minister for Health. Deputy Martin will be aware of the publication of Ireland's first-ever maternity strategy, which demonstrates a new and enhanced focus on maternity care at policy and service delivery levels.

The Taoiseach needs to turn off his guitar.

This document sets out how we can improve and promote maternity and neonatal care in the years ahead in order to ensure such care is safe, standardised and of a high quality. The Minister for Health and the Department of Health are working with the HSE to ensure the full implementation of the strategy. Since December of last year, each maternity hospital, including Cavan General Hospital, has been publishing a monthly patient safety statement, as recommended-----

I ask the Deputy whose telephone is interfering with the microphones to silence it, please.

It is not my telephone.

There is a bit of feedback on the electric guitar.

It is the Taoiseach's telephone.

The Taoiseach can continue.

Gabh mo leithscéal.

Okay.

Every maternity hospital is now publishing a monthly maternity patient safety statement, as recommended in 2014 in the Chief Medical Officer's report on prenatal services in Portlaoise. I can also report that the draft scheme for the health information and patient safety Bill will provide for mandatory external reporting of serious reportable events that arise in the health service. The Bill, which is currently with the Chief Parliamentary Counsel for drafting, will require health service providers to report such events to the State Claims Agency, the Health Information and Quality Authority and the Mental Health Commission. The Department is aware of four infant deaths which occurred at Cavan General Hospital's maternity services between 2012 and 2015. Each of those deaths is the subject of a review. I understand that one of the reviews has been completed and two others are at an advanced stage. The early completion of these reviews is obviously important for the families concerned. It will ensure any lessons to be learned will be implemented in our maternity services. I will deal with the recruitment situation in my follow-up reply.

The Taoiseach's response is unsatisfactory because it does not cut to the core of the question I asked about the under-resourcing of our maternity and obstetric services. My understanding is that maternity services received just €3 million in additional funding in 2016. I always said that last year's budget was a false and fraudulent one in terms of public figures. Adequate provision was not made for the implementation of the strategy. I put it to the Taoiseach that this is a recurring theme in all the key presentations to the Oireachtas by those involved and in the various reports.

To quote Dr. Sam Coulter-Smith: "All of these factors combined have resulted in all hospitals having difficulty retaining and recruiting quality staff... resulting in an over reliance on locum and agency staff," and this is a key recurring theme.

The Taoiseach made reference to the legislation and I put it to him that in situations such as this we should have independent reviews of the incidents rather than internal reviews. Legislation is not needed to do that. The Minister could intervene and ensure that it happens. HIQA or an external independent review of the incidents would give certainty and confidence. Does the Taoiseach find it acceptable that in the four deaths between 2012 and 2015 we have, as yet, no information regarding those and no published report?

One of the reviews is complete, as I said, and two others are nearing completion. I am just as anxious that these would be expedited. With regard to independent reviews I believe it is important to first of all have the internal review completed under the systems that apply. If an independent outside external review is then necessary, that can happen.

By the end of March 2016 overall health service employee numbers had increased by 5,856 over last year, an extra 1,300 in the first quarter of 2016 alone, and most of those are front-line positions. During the last 15 month period the numbers employed in acute hospitals increased by about 3,500 wholetime equivalents which represents a 7% increase in the workforce. Deputies are aware that the expenditure in the area of health is over €13 billion at the moment. Numbers in the medical dental category increased by almost 600 wholetime equivalents, or 6.5% during that period and nursing figures rose by 1,700. Yes there are shortages in areas like emergency medicine, anaesthesia and psychiatry but these are not specific to the Irish health system. Alternative marketing strategies are being developed by the HSE for these hard to fill posts to encourage people to take up employment. There has been a significant increase in the number of consultants working in the public health service. Since the establishment of the HSE the numbers have increased by over 850 to 2,761. This is a matter of considerable focus by the Minister.

A mediator has been appointed to look at the question of a difference of opinion between the National Maternity Hospital Holles Street and St Vincent's Hospital. Money is in place, planning permission is in place and rows like this should not impede the provision of proper, high standard, quality care for mothers using maternity services.