Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

The amount for the State Claims Agency is very hard to predict because it is essentially what judgments the courts make or what agreements are made on the steps of the court. As it turned out, the €151 million which was partially provided for in the Supplementary Estimate at the end of last year was not all required. Only €135 million of the €151 million was required. That can often relate to the time of year the judgments are made and paid.

We are estimating a reduction to €96 million because the Department of Justice and Equality is introducing legislation to cover periodic payment orders. So instead of somebody getting one big lump-sum payment of €2 million, €5 million or €7 million, he or she will get an annual payment which can then be reassessed as his or her needs may change. So the €96 million is contingent on that legislation being brought through and implemented by the Department of Justice and Equality.

One of the Deputies made a very good point on open disclosure and the duty of candour. When I was in medical school it was always drummed into us that we had a duty of candour and should disclose where a mistake is made. People think medicine is an exact science. It is not an exact science; nor is midwifery. Essentially, a medical professional talks to the patient, takes his or her history, examines him or her, carries out a few tests, puts it all together and makes a judgment. Sometimes the judgment is wrong, but that does not mean one is a bad doctor. It is the nature of medicine. It is not an exact science; it is a judgment. By no means are all mistakes down to negligence. It is important to understand the real job doctors, nurses and midwives have in that regard. It is not necessarily that they are bad doctors because claims are made against them - they just made the wrong judgment based on the facts they had.

In some ways it is a bit like knocking somebody down on the street. Someone might run out in front of one and one might hit them. It might be one's fault, it might be their fault or it might be nobody's fault. Failing to disclose openly and not adhering to a duty of candour, for me, is the equivalent of a hit and run whereby one has knocked somebody down and one does not necessarily know whose fault it is but one drives off. That happens in our health service, and I am appalled by the number of cases that I have become aware of. Some of them have been in the news. Essentially, there is adverse clinical or medical misadventure, and rather than doing the right thing - sitting down with the patient and the family the following week to explain what went on - medical personnel effectively abandoned the patients. I find that really appalling. It is not the medicine in which I was trained.

If doctors and other health care professionals adhere to the duty of candour and respect the policy of open disclosure, considerably fewer people will sue. Often people sue because of the bad way their case was handled after a mistake was made. Because this is still happening, it is my intention to legislate for it in the health information Bill and to make it a legal requirement that there be open disclosure and a duty of candour, which I think is just right.

On HIQA, it will be costly to upgrade our community nursing units to HIQA's standards. In some cases they will just be replaced, because it makes more sense to build a new one than to renovate or rebuild an old workhouse, for example. In other cases they will be redesigned. At the moment HIQA and the HSE are trying to agree a multiannual plan to do that. In addition, we will need to build more community nursing units. The Minister of State, Deputy Kathleen Lynch, and I are seeking additional money from the Department of Public Expenditure and Reform in the next capital envelope to do exactly that. HIQA is, of course, an independent regulator. If the committee has not done so already, it should invite HIQA representatives to come before it to go through some of the issues that arise.

On the delayed discharges, we have thrown everything at this in recent weeks and delayed discharges have decreased from about 850 to 750. I had thought we would do better than that. We have set a target of 500, which I believe is realistic and achievable. Some people say it is not sufficiently ambitious and ask how we could possibly say it was acceptable to have 500 delayed discharges across our hospitals. However, when it is broken down, there are issues. For example, there are people who are waiting for rehabilitation, there are people who are wards of court, there are people with issues relating to refugee status and so on. There are one or two homeless people, and of course we cannot and should not discharge people into homelessness.

At any given time there are 200 or 300 people who are counted as delayed discharges but have, in fact, only been in the hospital for a few weeks. There will always be a delay in getting their paperwork together. They may have to go out to see the nursing home to see if they are happy with it. Their family members may want to check out the nursing home and the nursing home may want to check them out. So about 200 or 250 of that 500 will always be there. That is just the normal churn of new delayed discharges.

Deputy Conway asked about the elderly in emergency departments. We are trying to do two things in that space, the first is more community intervention teams. These are the nurses who go into nursing homes and change catheters, and can give intravenous fluids and medicine so that an older person can avoid going into hospital in the first place. We need more of that. I think some nursing homes are afraid of having a resident die in the nursing home. They send the person to the emergency department when it may be better not to and instead they could make more effort to get a GP or the community intervention team to come to the nursing home.

The national clinical programmes are developing a pathway for the frail elderly which might end up as a system of streaming frail old people to emergency departments in a different way. If one visits an emergency department, and I know all members present have, the majority of patients coming through for admission are elderly. I know of one private emergency department where the average age of admission is now 90 years. That is a big change in the past ten or 11 years from when I was working in hospital medicine. The inpatient population is now much older and that makes things more difficult on the front line.

An additional €35 million has been secured for mental health services this year. The Minister of State, Deputy Lynch, has done very well to do so and it is a great achievement. I know she will be looking for additionality on top of that in 2016.