Simon Harris (Wicklow, Fine Gael) | Oireachtas source

There definitely is not a link. The Director General of the HSE has decided, as is his prerogative rather than mine, to restructure how people report to him within the HSE. He issued a circular to his staff outlining how people can report to him, subject to him filling the deputy director general post. That is the extent of the matter.

I take very seriously the point made by Deputy O'Connell. The committee has heard me make the point already that I have ideas about things I would like to see changed and improved in terms of structure. I have resisted doing so out of respect for the fact that we are trying to do something that we have never done before in this country - a ten-year plan with buy-in from all of us. It is important that we do this work and I echo and reinforce that message with the HSE.

As Deputy O'Connell mentioned, the way we treat women and patients in this country when they experience a tragedy or an adverse event in our hospitals is shameful. It is something that we should be collectively ashamed of. The system is far too adversarial. People who were preparing for a time of great joy - bringing a new baby into the world, bringing a child home and starting a family - have all of a sudden had that joy replaced with the most unbelievable grief and bereavement, in some cases, or extreme challenge in the case of finding that these parents now have the responsibility of rearing their child who has significant care needs above and beyond what anybody would have expected. We need to reform this system. As the committee will know, both the Tánaiste and Minister for Justice and Equality and I are working hard to carry out reform. I do not want to stray into her policy area. The Tánaiste has outlined that she will bring forward legislation on periodic payments.

Families do not want to go to court to get a lump sum payment. They want the care needs of their child met for the rest of their child's life. The only people who benefit from the current system are the legal eagles. We are funding a system that benefits the lawyers and not the patients. We can no longer do that and we are not going to do so.

Where my piece of the jigsaw fits into all of this is the piece on open disclosure. Since taking up this job I have had an opportunity to meet some people who have had bad experiences of the health services as well as, thankfully, many people who have had good experiences.

What the people who have had bad experiences and have experienced tragedies wanted was answers. They wanted to know what happened. As the Deputy correctly said, they wanted to get a sense that the system was learning, that they told somebody what had happened and that it was not going to happen again. The way people have been treated in our health service in regard to this, historically and in the not too recent past, is not acceptable.

Equally, on the other side, we have health care professionals who want to be able to provide that information in a safe environment. They want to able to provide the patient and the patient's family with information. We need to put in place a structure and environment for everybody in which to do that safely and in an informative manner at the quickest point possible. As part of that legislation, I will be bringing forward a piece about open disclosure, which I believe is very important. I know the Tánaiste is working on putting in place a much less adversarial system that should remove the occurrence of some of the dreadful experiences that the Deputy has outlined. For my part, I want to create a culture within the health service which, in fairness, we are already trying to embed, around making sure that we support people at a very vulnerable time. There is obviously a very strong patient involvement in the development of the national maternity strategy, as the Deputy will be aware. There were two patient advocates who fed into this strategy. Also, I recently launched the national bereavement standards for when things go badly wrong and people are bereaved for a variety of reasons within our health service. Again, it was very important that the voices of the people who had been bereaved and who had an opportunity to meet at the launch in Farmleigh are also being fed into the process.

We have a lot of work to do on this. The way we have treated women in our health service has been completely unacceptable. However, if one looks at the building blocks that have been put in place in very recent times such as the new national maternity strategy, the national bereavement guidelines, the policy of open disclosure, the movement to periodic payments, wanting to build a new national maternity hospital, which we have to build and which we cannot allow bureaucracy obstruct, and the women and children's health programme within the HSE, I believe we are at a very significant moment in making sure that we learn the lessons of the past.

On the issue of career pathways, I could not agree more with the Deputy. One of the more enjoyable moments of this challenging job I find myself in is that every time I meet people in the health service, they tell me they want to do more. I do not mean that flippantly. Every single representative group that I have met tells me that they are skilled professionals, which they are. They say that they could be doing more, whether they are radiographers, pharmacists, dentists, doctors, GPs or nurses. What we need to do now is make sure that everyone in the health service is doing to the optimal level what they are qualified and able to do. It exciting work and it will see real benefits for patients. This idea that other jurisdictions would offer better career pathways, better educational opportunities or better further training opportunities is something we must grapple with and that is a priority for me.

I am very pleased with what the Deputy said about drug pricing and the narrative around that. I find myself, as Minister for Health, having to bite my tongue, which is not a thing I like to do very often. I follow Deputy Durkan's lead. The moment I say, or anyone in my Department or the HSE says, that we are going to provide a drug is a moment in which we write a blank cheque for very large drug companies. When drug companies talk to me about patients' interests, it is my job to look after the patient and the company's job to look after itself. When we can align the two, it is ideal. However, I am very clear where I stand and I do not need anybody reminding me about patients' interests. That is our job in the Oireachtas, the Department of Health and the HSE. Therefore, it is important that there is a process in place. It is important that we try to find an even better one. It is so frustrating for people. I know that because they tweet me, talk to me, e-mail me and meet me on the streets. They tell me that they want this drug provided and want to know why I will not tell them I am going to provide it. What I will say to this committee and what I say to those people again today is the moment I say we will provide this drug is the moment I tie the hands of the HSE in the negotiating process which will hopefully lead to the provision of that drug. It is a balancing act.

In terms of high-tech medicines, the line I referenced about assistive reproductive technologies is the fact that we are keeping under review the classification of the high-tech medicines and the effectiveness of the drugs on that list. I will get the Deputy a more detailed note on that.