Colm Burke (Fine Gael) | Oireachtas source

I thank all the witnesses for their presentations but also for their dedication and commitment to the work they are doing. It is important that we give recognition to the important part they play in this country's health service.

I come from a legal background and many of the issues raised touch on the legal area. I listened to what Dr. King said about not doing resuscitation but an issue arises in that respect. If medical personnel who are called out to a house arrive and are seen not to take any action, the blame game starts and they find it difficult to try to explain the reason they are not taking action. The easiest course for them to take, therefore, is to take action even though it might not be the best approach if the person has died but they are afraid to be seen to be not taking action. That is an issue that arises for staff in those circumstances.

Likewise in hospitals, medical negligence is the biggest growth area. It is not necessarily about the standard of care being provided but that people appear to have more access to information and are more willing to go down the legal route. That is a huge issue for medical staff. Professor Twomey will find from his experience that it is putting people into various corners from a medical care point of view. I do not know how we can deal with that but it must be tackled. We set up the Injuries Board to deal with claims arising out of car accidents and industrial accidents but we have done nothing to review and change the way we deal with litigation involving medical negligence cases. That is something we need to review.

Dr. Madden spoke about the role of the family in a hospital setting.

I had a case myself a few years ago where someone was calling to an elderly person three times a day and providing all of the care for that person, who had no contact at all with his family. The person was then admitted to hospital and the family instructed the hospital that the care assistant was not to be let near the ward. The difficulty for the staff in the hospital is how to deal with that. Even though the person was competent to give his own instructions to the hospital staff, they were getting caught between the two sides. The person died in hospital and was traumatised as he died because he felt his care assistant had deserted him, whereas in fact it was the other way around. I have seen that issue arise on a number of occasions. How do hospitals deal with that?

The other issue raised was about staff support. There is not enough staff support in hospital units where a death rarely occurs, and when it does occur, there are no procedures in that setting. People can be working in a particular unit where death does not occur that often, and there are no procedures for them. I have come across staff in such situations who are very traumatised by what has occurred, but there is no fall-back for them. We should look at that within hospitals. There is a better structure in elderly care for dealing with that, but in other units that is often not the case, and I think we should look at that.

One of the frightening things I have found with elderly care over recent years is the amount of litigation arising in respect of the administration of estates. In my first 20 years of practice, I never had to deal with this litigation, but it is arising a lot more. It is coming into the hospital setting and it is a case of how we deal with that through education and information. We need to look at it.