The need for a major review of maternity services to enable them cope with extra demand is identified in the first national service plan from the Health Service Executive (HSE).
The plan, which says 600 jobs in the health sector need to be cut this year, said maternity services faced "significant challenges in meeting demand" given increased activity levels, the changing profile of women presenting and risk management issues.
"It is therefore recognised that there is an ongoing need to review and re-engineer maternity service provision in order to meet changing needs," it states.
"This will involve expanding the range of models of care available to women, ensuring choice and continuity of care. Other initiatives will include increasing the availability and accessibility of services as well as improving the level and flexibility of available resources," it added.
There were, it said, 61,517 births registered in 2003.
The HSE plan for 2005 also points to significant shortages of convalescent and rehabilitation beds in parts of the State and says "the need to address these non-acute capacity issues is critical to the effective management of acute hospital beds, in-patient waiting lists and emergency medical admissions".
It adds that its National Hospitals Office will concentrate on key areas this year including A&E, cleanliness in hospitals, commissioning additional beds, and pursuing negotiations on the consultants' common contract.
A 2002 report, it said, acknowledged the requirement for 3,000 additional acute hospital beds and to date 709 have been provided.
Across several areas of the health service such as primary care and acute hospital services the plan states that actions begun last year "will continue to be progressed/implemented in 2005", but how this would be achieved is the subject of other plans still being prepared.
It acknowledges that mental health services for children and adolescents must be developed and commits to providing an acute psychiatric unit at Connolly Hospital, Blanchardstown. Service provision to asylum seekers will also be improved, it says.
Additional funding for development of services this year mentioned in the plan was announced in last November's Estimates when Minister for Health Mary Harney promised to spend millions improving conditions in A&E, services for people with disabilities, and the mentally ill as well as providing extra medical cards. The report acknowledges that major inequalities persist.
In a chapter devoted to human resources, the plan stresses the need to cut 600 jobs in the sector this year to comply with employment ceilings, but that the HSE wants to "maintain harmonious industrial relations with all staff associations".
The document states that a corporate plan for the HSE for 2005-07, which is being prepared, will deal with how to address key emerging public health issues such as obesity and alcohol misuse.
In his introduction to the document, the HSE's interim chief executive officer Kevin Kelly says the many challenges ahead include "capacity deficits in many sectors, historic under-funding of some services, skills shortages in nursing and other health professions, an increasing population, and clear expectations of improved performance and accountability throughout the health system".
He said the €11 billion plan would allow the HSE deliver services at the level they were delivered last year.