This report was published in December 2006. The subgroup was chaired by Professor John Higgins. you will find the report here.

The radical proposals for change in the delivery of health care contained in the "National Task Force on Medical Staffing" (Hanley 2003) stimulated the Institute to undertake this review. The views expressed reflect a long tradition of advocacy for the highest standards of care in women's health, which in earlier times resulted in the establishment of three Dublin Maternity Hospitals, and the subsequent well recognised world-wide reputation for excellence. It is from such beginnings of proactivity in women's health that the Institute wishes to encourage policy makers to ensure that the highest standards of care are, in future, achieved throughout the whole obstetrical and gynaecological service.

Public services of a specialist nature commenced with these Lying-in Hospitals, but it was not until the 1970's that specialist services extended to the whole country. The Health Boards in association with Comhairle na nOspidéal, which set standards for appointments, oversaw the establishment of units with a minimum of three consultants associated with similar paediatric units. Unfortunately the pace of these developments was slow, and thus there is still a considerable deficit in services in comparison with the other major specialties of Medicine and Surgery.

This review uncovers much that is undesirable: poor infrastructure with considerable operational difficulties, even in some cases very awkward access to facilities for emergency caesarean section. Overcrowding, lack of privacy and long waiting times are recurrent complaints when a prompt friendly service is what is required. For some units, recent technological developments and sub-specialisation, although welcome, make it impossible for small numbers of consultants to provide the range of services the public knows about and expects.

Twenty-two Units provide specialist care; all their services are necessary. There is a wide variation in the services they provide, as they are necessarily limited by size and staff numbers. It is clear that proposals about the organisation of workloads and work practices, staffing, and networks, as well as infrastructure would lead to a coordinated integrated service with the greatest opportunity of access to quality clinical care.

The Institute hopes that policy makers will regard this document as a blueprint for the changes necessary to bring about easy access to appropriate care in complex circumstances, as well as providing the highest standard of care close to home. It recognises that these proposals have considerable resource implications but is of the view that the benefits will prove their worth.

In conclusion, the Institute is indebted to all who spoke with or met with the

Subgroup, or submitted written observations. The Subgroup and its Chairman

impressed by their willingness to travel long distances and take part in long tedious discussions despite heavy personal clinical workloads. By their commitment to the task set and their spirit of contribution a report has been produced. Their endeavours are gratefully acknowledged.