St. Patrick S Cathedral

ST. PATRICK’S CATHEDRAL

SUNDAY 27 TH JANUARY 2013

MASTER’S ADDRESS

Good afternoon ladies and gentlemen.

I am deeply grateful to the Dean of St. Patrick’s for his very kind invitation to use this afternoon’s service as part of our celebration of the tercentenary of the birth of Bartholomew Mosse.

Mosse was born in Port Laoise in the year 1712 and at the age of 17 came to Dublin to study medicine.

Five years later he married, but tragically, his young wife died in childbirth, as did their baby son. That was 1737, a time when mortality in childbirth was extraordinarily high in Dublin.

The following year, he became a surgeon in the British Army and during his travels throughout Europe visited a variety of hospitals where he got ideas on how he could improve maternity care for patients. Mosse decided to dedicate the remainder of his life to building an institution where mothers could be delivered safely and doctors and midwives could be trained in the art of midwifery.

In 1745, with the help of some influential and well to do associates, he opened his first hospital in a disused theatre on St. George’s Lane in Dublin. In its first year of operation, 190 babies were born with the loss of only one mother.

Mosse’s work quickly became well known throughout Ireland and the UK. Realising that the hospital was too small for requirements, he set about organising fund raising activities to purchase and build a new hospital.

1 Mosse organised lotteries and a variety of musical events and balls to relieve Dublin’s elite of their money. With the funds, he leased the Parnell Square site at the north end of Great Britain Street.

The waste land on the site became a pleasure garden with coffee shop and concert hall. He persuaded the famous architect Richard Cassells to design the new hospital building. And one of the great stuccodors of the time, Bartholomew Cramillion, designed the altarpiece and the ceiling of the new Chapel.

The foundation stone of the hospital was laid by the Lord Lieutenant in 1751 and, six years later, the hospital opened it doors on 8th December.

Mosse was appointed the hospital’s first Master for the duration of his life. Tragically, he died just a couple of years later, heavily in debt.

Despite his relatively short life, Bartholomew Mosse was an extraordinary man of his time.

With huge energy and great vision.

A man of determination with superb powers of persuasion and conviction to achieve what he did during his lifetime.

His physical legacy is a building that is one of the highlights of Dublin’s wonderful architecture. But, more importantly, he created a human legacy - an institution dedicated to the care of the needy women of Dublin. And as a place of learning for the education and training of doctors and midwives in the art of obstetrics.

Mosse was followed by a long succession of very skilled obstetricians who contributed hugely to the growth and development of obstetric practice in Ireland, Britain, Europe and across the world. Today, medical undergraduates and postgraduates travel from around the world to study and work at the Rotunda.

2 Part of Mosse’s vision was to put in place a service that would constantly improve and continuously evolve. Helped by funding from non-state sources. That support still exists, and there have been fantastic new developments within the hospital with a new labour ward, new theatre, new intensive care and new emergency room facilities.

Unfortunately, many parts of the hospital where care is provided to women and babies are not fit for purpose.

We still have the old Nightingale wards, with 8 and 10 beds and even extra beds at times.

We still have a situation where enormous numbers of women attend the hospital for antenatal care that should be provided in the community.

We’ve an emergency room where each year, 25,000 women attend with pregnancy complications. That’s busier than many casualty departments around the country.

We currently look after about 10,500 maternity patients a year. We’ve just completed two of the busiest years in the history of the hospital with record numbers of deliveries in 2011.

In 2012, we had one twenty-four hour period where 42 deliveries took place and just after Christmas we had a twelve-hour period where we had 22 deliveries.

That level of activity is simply unsustainable when patient safety and quality of healthcare must be paramount.

Bartholomew Mosse would have been extraordinarily proud of the quality of care and the extraordinarily high standards achieved by the hospital.

At the same time, he’d have been horrified to see that the postnatal wards have not changed since his time as Master. And extremely disappointed at the levels of funding and facilities provided for the care of the pregnant women of Dublin compared to cities in other countries. Despite all the

3 efforts of Mosse and those who followed in his footsteps, resources are not at the level they should be for delivery of this service throughout the city.

Mosse blazed a trail for Irish medicine pushing for better quality for his patients. He lived at a time when Irish doctors and nurses led the world, setting standards, driving innovation and pushing the boundaries of medical practice.

Now, we’re moving to a situation where our doctors, nurses and midwives are under valued, under resourced, and are being asked to work from institutions which are not fit for purpose.

If we’re not careful, we will lose completely our most valuable assets. We spend large amounts of money teaching and training our medical and nursing graduates, only to lose them to distant shores and other health services. We must encourage those who make decisions and fund our health services to recognise the value and skill we have within our medical and nursing population.

Prompt them to invest in the services and put in place a system that encourages our brightest talents to return to Ireland to provide a better service. Because, right now, the opposite is happening.

We’re going through a time of enormous change within our health service. The funding and governance models of our health service are under review.

As part of that review, I hope that our decision-makers remember that under the voluntary hospital system, particularly in the Rotunda, hospitals are able to respond quickly to the needs of its population. They can bring in new and appropriate services quickly and efficiently.

Any change in the governance systems of our hospitals needs to reflect the benefits of this voluntary system so that the hospital services can continue to be responsive to the needs of patients.

4 Mosse’s life was dedicated to improving patient care and delivering quality outcomes, providing the best facilities possible for his patients.

No doubt he’d have been extremely pleased to see the Rotunda working closely with the Children’s Hospital in Temple Street and also the Mater Misericordiae adult hospital.

He would have approved of the joint appointments between the hospitals, the combined clinics and the care pathways so that the sickest of maternity patients can get appropriate care and treatment.

He would have been thrilled to see the plans to co-locate the maternity hospital with the adult and children’s hospitals and would have understood the impact and the significance of this forward thinking plan. Of course, there’d have been disappointment at losing the children’s hospital to the St. James’s site, but he’d have kept his eye on the ultimate goal of working closely alongside colleagues in the Mater.

The Rotunda Hospital remains absolutely committed to the principle of co- locating with an adult partner to provide optimal patient care for both mothers and babies.

Over the years, we’ve developed a strong network of clinical and operational links with our close neighbour and partner, the Mater Hospital. [It’s what led both hospitals to create the North Dublin Hospital Group to foster those relationships along with Temple Street and Cappagh Hospitals].

In the last 3-4 years, the links between the Rotunda and Mater have deepened and mulitplied. For example, we now share 18 joint consultant appointments – over 30,000 hours a year of shared specialist time. These inter-institutional and inter-disciplinary links allow us to continue to offer the kind of care our mothers and babies need and deserve.

5 As a hospital, we’re absolutely clear that any proposal to disrupt those patient-focussed links and rebuild them from scratch elsewhere would be not just impractical but also illogical. We wait with interest on the outcome of the Higgins report as to what hospitals will be grouped together. And we urge those making the decisions to put patient care and quality outcomes first in their considerations.

As Master of the Rotunda, I serve the hospital for a seven year term and our management team reports to a voluntary Board. That system was started by Bartholomew Mosse – 255 years ago. It’s a tribute to him that it still exists today and works so efficiently.

This system has evolved and served the hospital well over the years and should be a model for our hospital service.

I recognise and fully agree that we need to evolve, change, and improve to respond best to the needs of our patients.

But in bringing that change forward we must also value what is good, what has worked, and what continues to work well.

The quality of the health services in a country are a mark and an indicator of the type of society that we are.

If Mosse were alive today he would be horrified at the amount of health spend which does not go directly towards patient care. And that the funding of hospitals is not based on the level of activity or complexity of the cases they treat.

He would be equally disappointed that many of our oldest hospitals are still working out of facilities that are unfit for purpose.

He would, however, be extraordinarily proud of the results achieved by the skilled and dedicated staff of the hospital.

I am sure he would be urging us to continue in our quest for success. To work closely with our colleagues in the adult and paediatric services. To create co-located facilities with the best possible fit and most appropriate

6 clinic mix of services. That can support the increasingly complex nature of the patients we treat within the maternity services.

Ultimately, he’d want us to to deliver a bigger, better Rotunda Hospital that’s fit for purpose in the future.