By Eilish O’regan

Copyright independent

The audit found that while there is evidence of governance structures at local sites there is no national structure in place for the home birth service .

For instance, no agreement was reached about the standard maximum travel distance of time from a pregnant woman’s home to the community midwife or the nearest maternity hospital.

This is a safety measure for home births, ensuring that if a woman or baby requires immediate hospital transfer, the ambulance can reach a facility within a safe timeframe.

In response the HSE said going forward, homebirth services will be operationally governed within the six HSE health regions.

Several national midwifery clinical practice guidelines are at final draft stage, replacing 2016 homebirth guidelines. A new antenatal midwifery guideline will incorporate criteria for homebirths, the spokesman said.

There will be recommendations regarding travel time and distance to maternity services, he added.

In 2021 of the 429 women who registered for a home birth, 248 gave birth at home.

A separate audit by the HSE internal audit office also pointed to weaknesses in the system for the HSE getting rebates from drugs companies arising out of medicines for patients such as those with a medical card. There is a risk of loss of income to the HSE.

It found that one supplier’s standard rebate calculation totalling €405,000 was calculated using the quantity of drugs provided by the supplier and not from dispensing data, breaching an agreement.

In another cases €21,000 was removed from an invoice due to a dispute over the inclusion of some drugs although there is no documented process for this to happen.

Around €54m was overdue in rebates at the end of August last year.

It called for management to develop an action plan to address and reduce the value of overdue accounts.

In a comment to the auditors, HSE management pointed to the resources available within its finance team and the large number of competing demands on its small finance team .

The HSE said it would examine debtors and where it is unable to resolve payment issues, will escalate those for consideration by senior leadership and the Department of Health .

This is due to be completed by March of next year.