John Crown (Independent) | Oireachtas source

Deputy Healy has kindly yielded. I am very sorry I was not here for Mr. O'Brien's presentation. This is not a day I normally have blocked off for Seanad activities. I am afraid that there are certain parts of the schedule that have become a little inflexible. I thank Deputy Healy for giving his time to me. If any of my ten minutes are left over, I would like to give them back to him.

The reality is that Mr. O'Brien has been given a certain job and framework within which to work. People who study management systems and health systems would see there is a certain internal logic to the way in which the whole system has reacted. It is not one we would necessarily approve of but there is a certain internal logic to the way certain management responds when certain issues arise.

I will now ask a few brief questions about the response to individuals who had raised issues of concern about the quality of care their families had received and also through their representatives, professionals, the media and public representatives. How much of the response does Mr. O'Brien believe has been formulated directly by those with line responsibility and how much has been formulated by people who are professionals in public relations, stakeholder engagement and the law?

I ask Mr. O'Brien to give a heartfelt answer to another question which is not redolent of judgmentalism. That is because I think certain organisations behave in certain ways because they were set up to behave in these ways. Does Mr. O'Brien think there is a sense that the HSE adopts a reflexly adversarial and defensive posture in the face of quality issues brought to its attention by its clients, by patients? Does he think there is a tendency to suddenly see people who come to raise an issue as somehow being disenfranchised as clients, customers or patients and as something else, as an external threatening force that is now looking at it from the outside?

I suspect that Mr. O'Brien is being put on the grill a little bit, but I want to get his opinion. Does he think we have an abnormal health system? Does he think the health system is, by international standards of comparison, very odd in terms of staffing ratios, the extraordinary internationally unprecedented reliance placed on the efforts of trainee doctors who are still undergoing senior professional and sometimes very junior professional training as actual service providers? In some of the cases about which we have heard in the past few days it is quite obvious that this is the case, that people who were clearly not fully trained and inexperienced were put in the position of having inappropriate levels of responsibility thrust on them.

This is a harder question. We have fought long and hard for systems to deal with disciplinary infractions by doctors, nurses and various other professionals. We have regulatory bodies, some of which the professionals sometimes reckon can act with a degree of heavy handedness. In many cases, they arose in response to prior deficiencies where there had not been sufficiently vigilant regulatory agencies monitoring the activities of professionals. We have them now. The truth is there really should not be any reason a patient, a relative, a bereaved person or anybody who believes the actions of a doctor or a nurse have fallen short of acceptable standards should not have some form of redress involving an appeal to a regulatory body. Does Mr. O'Brien think we have this on the administrative side of the health service because I do not?

The tragic hysterectomy case in Drogheda arose again today. Trust me, I am not doing a collective professional Pontius Pilate in trying to stand up for doctors. There is no doubt that an awful series of fundamentally inexcusable, unforgivable and horrific malpractices which caused terrible life destruction to a lot of people occurred there. I kept looking at it, however, and was thinking about it from the outside saying, what kind of health system lets somebody, operate effectively single-handedly for so long without backup, without a sufficient number of colleagues in place to provide for a degree of peer review, without an intensive care unit, without an adequate number of anaesthesiologists, without the same staff being there on an ongoing basis to see trends emerging, or without a blood bank? In that way, somebody with a severe deficiency and shortage of skills would have been picked out.

It always struck me that there were individuals who had been warned about that system and let it continue. After 22 years the word I use to describe my reaction to try to reform the health service is "despondency". I do not think it is fixable. I was very taken and upset this morning by what I had read in the paper. It was a report that serious, expert, professional notification had been made by senior obstetricians that there were problems. It was not from people who could be dismissed as perhaps inexpert. I would not be the one to accuse them of this, but I am sure it is the kind of charge that is levelled by people who are too emotionally involved. However, serious, dispassionate, sober professionals looked at it and said, "There is a problem here," and it looks like it was ignored.

There has been a great deal of discussion here of the issue of individual versus collective responsibility. We are not supposed to name names, but I will name a few: Howlin, Noonan, Martin-----