John Crown (Independent) | Oireachtas source

I welcome the Minister, the director general, Mr. Tony O'Brien, and the team, and wish them a happy new year. I know it will be a very challenging year for everybody working in the health service.

I welcome the focus on safety but it is important to realise that there is a lot of talk about this. I studied this formally when I studied health management and quality. With regard to the quality metrics that are used, clearly, for those who are on the front line, what is measured is compliance, not true quality. It is compliance with a predetermined standard. To be fair, the predetermined standard can be set as high or as low as those who are designing the standard wish it to be. I hate to personalise this, but in the Galway tragedy, for example, to me there is one key metric - which was mentioned, in truth, in the HIQA report - which is not irrelevant. The part of Western Europe that has the smallest number of consultant obstetricians per head of population, no matter how much it complies with a predetermined guideline, is not going to be the safest place for obstetric care. That part was the HSE west region. It has the lowest number of consultant obstetricians per head of population of any part of western Europe and, to the best of my knowledge, the lowest of any part of the OECD, despite the fact that Ireland has one of the higher birth rates within the OCED.

Safety is very important. I have been at the cutting edge of all kinds of safety issues over a long career in medicine and in college, and I utterly understand the tragedies that can occur. However, safety is not only a matter of errors of commission; it also involves errors of omission. People who are on waiting lists - who are waiting to come into the system but who have not engaged with the system - will not appear in the safety metrics, but they are ones who, I believe, suffer the greatest level of departures from true safety in the Irish health system.

On an allied issue - I am sorry if I sound pernickety about this, and I do welcome any reduction in waiting lists - it is not really obvious when looking at hospitals that the waiting lists are shrinking that fast, although I hope they are. I would like some reassurance about the internal HSE documents we got our hands on during the year - which, interestingly, contained whole bits of boilerplate lifted from an NHS document. They suggested that a new strategy was being used for measuring when waiting lists began in the outpatient component of the HSE services. It was stated that referral letters would be sent to clinics on behalf of patients, at which time they would be told that they would be contacted when there was a slot for them. At that stage patients go on the waiting list. I will be glad to make the document available to the Minister. One may not actually be on the waiting list for some months after one's GP has received the letter, which will have the effect of cosmetically appearing to abbreviate waiting lists which are, in fact, not shortening at all.

The question of health service reform, the money-follows-the-patient model, etc., do not represent this year's budget plus reform. This year's budget is having the trouble it is having because the system needs reforming. The system is full of perverse incentives and inefficient use of health care resources because of the way the system is funded and because of the silo-like nature of the different responsibilities. I have to be very careful how I say this because I do not want to get anybody into any sort of difficulty, but I can tell the committee that lots of patients in the public hospital system are put through very inefficient processes to obtain a test because it is realised that the outpatient wait for the test is so long as to be meaningless for the clinical history of their illness.

I wish to ask two very pointed questions. I notice that the projections for service numbers in the acute services are 2,000 down on those for 2013. Can I get the firm assurance of the Minister, the director general and their colleagues that these will come predominantly from administrative functions and not from front-line services? Can we get a commitment that we will end all public relations, all management consultancy contracts, all corporate affairs offices within the HSE until such time as the acute front-line needs of patients are being met? At that time we will be able to afford the luxury of public relations contracts, which, to be honest, do not exist to foster public relations but exist in a client-attorney relationship to advance the reputations of those who pay them.