The Health Service Executive privately warned the Department of Health six weeks ago that the Government's controversial cap on staffing numbers, which has led to an announcement of 600 job losses in the sector, could pose a risk to patients in maternity hospitals.
The executive said the employment cap had resulted in understaffing in key clinical areas in maternity hospitals.
It said the ceiling, operating at a time of increased activity, was presenting hospitals with "significant clinical risk issues".
The concerns were raised by the Health Service Executive in recent weeks as part of unsuccessful moves to have student midwives in maternity hospitals excluded from the official employment ceiling.
A spokesman for the department said last night that it was up to the executive to manage its staff within the employment ceiling and that shortages were met by the employment of agency nurses.
In recent weeks, the Department of Health put pressure on the Health Service Executive over breaches of the employment ceiling.
On February 15th, Minister for Health Mary Harney wrote to the executive's interim chief executive, Kevin Kelly, advising him that "the Government had decided that all necessary steps should be taken to meet the targets for reductions in public service numbers set by previous Government decisions".
She said the overrun in staff numbers in the health sector was "a matter of considerable concern to the Government" and that Minister for Finance Brian Cowen was awaiting specific proposals for this situation to be addressed.
Ms Harney said she wanted to secure a more appropriate balance between clinical and non-clinical posts, both in relation to the Health Service Executive and to voluntary service providers.
Internal health service documents reveal that on February 23rd, one of its officers wrote to the department about the ceiling and particularly about excluding student midwives.
The official said increased activity and the employment ceiling constraints had resulted in understaffing in key areas of maternity hospitals, such as neonatal intensive care units, delivery and antenatal wards. This was "presenting the hospitals with significant clinical risk issues.
"The hospitals' inability to deal adequately with these risk management issues in providing the necessary level of service is apparent from recent legal settlements awarded to clients of the hospital where birth outcomes were poor," the letter said.
A spokeswoman for the Health Service Executive said last night that this statement did not refer to any particular Irish hospital but referred to international research.
The executive's official told the department that all three maternity hospitals in Dublin had to rely on agency nurses to live within the staffing ceiling.
"The provision of agency nurses in such specialised areas does not, however, promote the provision of a consistent standard of continuous high- quality care," the official wrote.
The Health Service Executive estimated that the hourly cost of an agency nurse was 93 per cent higher than that of a staff nurse.
The Department of Health rejected the application to exclude student midwives from the employment ceiling and said the Department of Finance had indicated that the issue could only be dealt with following an improvement in the health sector's record on adhering to the ceiling.
The spokeswoman for the Health Service Executive said last night that it had provided over €700,000 for the recruitment of the 19 clinical staff required for the maternity services in Dublin.
