Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the Minister, the Minister of State, the director general of the HSE and others. We accept we will have a meeting next week with the HSE to discuss the findings of the Portlaoise report, but it is important while the Minister and the director general of the HSE are before us to raise some points which are of huge concern about the report and any interpretation to be put on it.

Why we have the report in the first place makes for very sad and debilitating reading. When we see the testimony and listen to the families involved, the huge resistance put up by the HSE to engaging with them even on finding out basic and general information and trying to elicit the truth seems to be the culture and normal practice. To speak about freedom of information in general, this is extending throughout many Departments. I will make the political point that it is getting more and more difficult for citizens, be they Members of the Opposition or anybody else, to get information from the State. We must be very honest. We speak about open disclosure in the context of medicine and clinical decisions, but there must be open disclosure across the full remit of the State. In this context the HSE has much to do.

The service priorities for the 2015 service plan include improved quality and patient safety, with a focus on service user experience, the development of a culture of learning and improvement, patient, service users and staff engagement, medication management, health care associated infections, serious incidents and reportable offence, complaints and compliments, implementing quality patient safety and an enablement programme. We can only hope that on foot of the report into Portlaoise and its recommendations that we will act upon the opening statement of the HSE's service plan.

I read the letter Mr. O'Brien sent to all members of staff of the HSE after the "Prime Time" report. It calls for people to engage with patients, more openness and asking the staff in general to make the best efforts possible. It mentions an apparently unfeeling bureaucracy and excessive defensiveness in a way which appears only to serve self-interest. Much of this is explained. It was important to send the letter to the staff after the "Prime Time" report.

However, when I read the report it appears that even the person signed the letter on behalf of the HSE, Mr. O'Brien, did not even act on the recommendations of the CMO.

The HIQA report stated:

In his report, the Department of Health’s Chief Medical Officer said two previous HSE reviews published in 2008 into breast cancer misdiagnosis cases at Portlaoise Hospital should have provided a very strong case for ‘external oversight and support to Portlaoise Hospital as it dealt with the legacy of those issues’...

Six previous investigations into hospital care in Ireland have been carried out by the Authority [that is HIQA] between 2007 and 2013. These have made a number of important findings and recommendations which were intended to be used by all healthcare services to inform and improve practice. Had the relevance of these investigation findings been reviewed in the context of Portlaoise Hospital and the aligned recommendations been subsequently implemented, the Authority is of the opinion this could have vastly reduced the identified risks in the services being provided to patients.

We have had the Tania McCabe tragedy in Our Lady of Lourdes Hospital, we have had the Savita Halappanavar case, and we have had the investigations into Mallow and Ennis hospitals. There seems to be no ability for the organisation to take the best practice from within the system. More important, when recommendations are made, there seems to be a complete inability to follow through on those.

This is an issue for the Minister as well. Representatives of HIQA appeared before the committee yesterday. They made the point that the regulator should not be the body overseeing the implementation of the recommendations. Equally the organisation that is requested to implement the recommendations should not also be overseeing it.

Without being overly hostile to the HSE, any reading of this Portlaoise report would seem to indicate that almost nothing has been learned from the previous seven reports and, if it has, it has not been implemented. In the context of a patient safety advocacy group, we should consider establishing some form of commission to oversee the implementation of recommendations of a regulator.

The report also states: "At the time of reporting in May 2015 – some 13 months after the publication of this recommendation by the Chief Medical Officer – these arrangements were still not in place." Those arrangements were that in the interim Portlaoise hospital would continue:

to operate in the absence of formal systems enabling clinical cooperation and communication between it and some of the larger training hospitals that are to be involved in the group. The Chief Medical Officer’s report made a specific recommendation about ensuring the networking of senior clinical leadership between the larger Coombe Women and Infants University Hospital in Dublin and the maternity unit within the smaller Portlaoise Hospital.

I find it extraordinary that that had not been fully implemented in the context of the Chief Medical Officer's report that was published 13 months ago.

We can go into further detail on this in Tuesday, but I really need an explanation of this one. Page 12 of the report states:

The pivotal appointment of a director of midwifery to a maternity department located within a general hospital is unique to Portlaoise Hospital. This role has had a very positive influence in terms of assessing and improving the standard of midwifery care, enhancing multidisciplinary working relationships, improving staff morale and re-energising a patient-centred approach to care.

As with much of this report the next word is "however":

However, at the time of writing, a senior obstetric lead had not been appointed to the Maternity Department to provide independent senior experienced obstetric clinical leadership. This is despite a direct request by the Authority [that is, HIQA, again] to the Director General [that is, Mr. O'Brien] of the HSE in September 2014 to do so because of the investigation team’s concerns about the absence of adequate clinical leadership within the maternity unit and the failure to progress the development of a clinical network with the Coombe Women and Infants University Hospital.

I know that a memorandum of understanding has since been signed with the Coombe hospital. However, I find it extraordinary that more effort was not made.

The Minister's contribution did not really refer to the major crisis that is facing us with outpatient waiting lists. Some 412,000 people are waiting for an outpatient appointment and it is getting worse. At some stage the Minister will have to accept they cannot do it themselves. It will be necessary to re-engage the National Treatment Purchase Fund and admit that the system is not working. We need to engage with the private sector at least to allow patients a chance of being seen and getting treatment in a reasonable time.

May I come back again later?