Mr. Tony O'Brien:

Deputy Doherty asked me about an article in The Sunday Business Postlast week and I am happy to have an opportunity to address it. Ms Susan Mitchell, the journalist, requested permission from us to have a little more access to the health service with a view to giving a slightly more rounded view than would normally be possible of the many different moving parts in it. As she was first to ask, we decided to grant it and she had an opportunity to sit in at part of a briefing of an emergency department task force. She attended various parts of the health service, which are generally reflected in the three pages of her article. Deputy Doherty stated what she understood by the headline, which was no vision, no plan and no future, but when I saw the tweet of the front page I noted the headline stated no vision, no money and no plan. I guess the words are similar enough. Having seen the tweet and not having access beyond the paywall, I waited anxiously to see what had been reported in the newspaper. Having read the article I must say I was satisfied with it. I thought it accurately reflected the various issues the reporter had seen and our conversations.

The headline was not made up of my words and neither were the words attributed to me as they were not in parenthesis. If one read the article one could not find those words attributed to me. This not a complaint. I understand that having invested a lot of time to get a three page insight into the health service one would want something on the front page to encourage people to buy it and which would grab attention. As I stated, it certainly caught my attention. I am glad to say they were not my words.

I spoke in the article about my view that as a country over a period of time, and I relate this right back to the foundation of the State and some of what is reflected in Maev Ann Wren's book, Unhealthy State, I do not think we have arrived at a place where we have a collective national settled will as to what in the very long term we want from our health service. It would be helpful if we do so. I shared this opinion with Ms Mitchell and she accurately reflected it.

I also think we have reached a point where we have a view about risk and safety in the health service which has become unrealistic. Providing health care, particularly in acute situations is an inadvertently risky business. Things do go wrong, and where they go wrong inappropriately it is appropriate there should be accountability. However, we must replace where we have what I described in the article as something akin to showtrials on performance issues. This is quite dangerous for the future of health care in this country and for the ability of professionals to make the types of decisions about which Dr. Hanlon has just spoken and have the confidence to do so. They are not charged with criminal offences but go in and out of buildings with camera crews outside, where everything is reported, including all of the allegations, but later, very little attention is often paid to the outcome of the review. Accountability is appropriate, but we perhaps need to find a different way.

I also referred in the article to the process around compensation for poor outcomes, particularly regarding significant critical and life changing outcomes. These are put into an adversarial framework, where we often hear reports of things that happened being settled in the courts eight, nine or ten years later. People feel, probably correctly, they have had to fight tooth and nail to get the resources they need. This affects their relationship with the health care system on which they have a higher than average dependency. It also affects the general population's perception. I was effectively voicing support for moving towards a different system, which takes the adversarial nature out of it, recognises there are birth canal events which produce profound life-changing events with regard to cerebral palsy, which often feature. The truth is some of these cases go on for up to ten years and the State and the HSE loses 99% of them. Why do we have all of this trauma to get a point when people get the support they ultimately need but ten years later? This was my central point.

Something that has disappointed me is that the headline has been somewhat abused in recent days to do exactly what I was asking people not to do. I was asking that we have an adult and grown-up debate over time about the type of health system we want to have 30 years time against which we can then plan. Of course health care is innately political. Choices are innately political, but it saddens me that my words are being used by some, not many thankfully, in a knockabout way which does not contribute in any sense to the development of a real national consensus on what type of health care system we want. This is the context of the article. As I stated, I am actually very happy with how the article came out. There has been a huge response and debate and I am satisfied the article itself on the three pages inside is a pretty accurate portrayal of the encounters I and others had in the health system. People who read it will probably get a better sense of the complexities of some of the issues about which we are speaking today and how all of these issues join up, or not, as the case maybe. I thank the Deputy for giving me the opportunity to clarify this.