Mr. Tony O'Brien:

I will ask my colleagues to respond on certain questions. I will ask Mr. Liam Woods to comment on outpatient care and waiting lists generally.

Mr. Pat Healy will speak on the safeguarding policy and community rehabilitation, Ms Anne O'Connor on mental health services and Ms Laverne McGuinness on dental services and palliative care. In response to the questions on maternity services and Deputy Ó Caoláin’s concern about the nature of care in large maternity units, approximately 40% of the babies born last year were born in large maternity units. The three Dublin units are not associated with an absence of compassionate care. They are associated with very high standards of care. There should not be a suggestion that if there were to be a centralisation into larger units, it would be equated with a downgrading of the level of compassion and care. That correlation does not exist at all.

In response to Deputy Kelleher, who reminded me of the commitments made in the 2014 service plan, the quality and patient safety enablement programme identified has been established. It intends to ensure there are differential focuses on quality improvement on the one hand and quality assurance and verification on the other. That is having a significant impact on the system which all those who interact with it have recognised. He also mentioned the issue of health care acquired infections. When the latest performance assurance report is published shortly it will show for example that in Clostridium difficile, C. diff, we have the lowest recorded incidence at 2.1. There are areas where progress is being made.

The Deputy asked specifically about the response to the publication of the Chief Medical Officer’s report last February. On the day of its publication a new manager and a new director of midwifery were installed in the maternity services in Portlaoise. They are judged in the HIQA report to have made a very significant impact on the improvements that have occurred there, so much so, that, although it was described as a slightly innovative approach, HIQA has recommended the approach in general hospitals that have maternity services and that having a separate director of midwifery should be replicated. That is a sign of confidence that initiative went through. Two obstetricians have been appointed. The Irish maternity early warning system, IMEWS, has been implemented on site. In regard to the Dublin Mid-Leinster hospital group, in order to bring the strongest managerial focus I could to the group, I moved one of the most senior leaders in the HSE, Dr. Susan O’Reilly, who was brought to this country to head the national cancer control programme, into that group, specifically to ensure it had the type of managerial and clinical leadership focus required to address the issues there. That is also bearing considerable fruit.

The institution of a serious reportable events recommendation that the chief medical officer included in his report was implemented by my direction throughout the system from that day forward and it has since evolved, has been strengthened and is being audited. There has been a significant response. None of that of course is intended by me to take away from the fact that there were prior events from which there was insufficient learning and Deputy Kelleher referred to one of them. The letter to staff I issued was a reflection of my reaction to the particular unbelievable experiences of patients, their families and bereaved parents in terms of how they were responded to at their time of greatest need. It was intended to send a clear signal, which it did, that we can all, each of the 100,000 in the health service, do better than that.

Deputy Ó Caoláin asked me in particular about my position on the HIQA report. In terms of anything that went before, I had not seen, because it is not the practice that one would see, the recommendations of the HIQA report as part of a draft sent for fact checking and verification. That is not how it is done. Any comments I made about the report were not about the recommendations because I had not seen them. I was briefed verbally on those recommendations this day last week and received them when I received the full copy. I had and have absolutely no hesitation in agreeing with, supporting and committing to the implementation of the recommendations because I believe they will contribute to an improvement.

The issue I raised previously with HIQA was characterised here as threatening to injunct it, which I did not do. I did raise the prospect of a judicial review in circumstances where I had been asked to provide feedback on a draft report, without sufficient information to enable me to do so. I had on five occasions attempted to reach an engagement with those involved in order to overcome an impasse. Ultimately, at my appeal, the Department of Health was able to facilitate an engagement where we overcame some of those issues, appropriate time was allowed and a comprehensive submission made to the HSE. As to the extent of change, I do not think this is the time for that discussion. At the moment it is appropriate to focus on the report itself. My acceptance of the recommendation does not mean that I agree with every line in the report but that is not for now.