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

I welcome the delegates and thank them for their presentations. I think everybody agrees that we must introduce a duty of candour or open disclosure in such a way as to ensure confidence in the system on the part of those availing of and providing the service. It must be fair and equitable and defend the integrity and rights of individuals providing the service. Clinicians have a right to integrity and respect and to defend it, even if it means through litigation. The hope always is that open disclosure and a duty of candour would reduce recourse to the adversarial and legal process and that people might be able to accept open disclosure as final.

Dr. Ryan spoke about a mediation service. Will he give us some further information? Would it be possible for a mediation service to be provided within the scope of the Bill whereby the service and the evidence provided would not drift and be used in a court case? It is one thing to provide for open disclosure, but it is another to sit around a table and start discussing a mediation process that might eventually break down and end up in the adversarial court system. Are there examples in other countries?

At what stage is there an obligation on a clinician or a health care professional to look an administrator or manager in the eye and say the service is no longer safe? At what stage is there a moral or ethical duty on members of the association to say they can no longer do something because it is unsafe? We have seen cases where very often it is the doctor or nurse who talks to the patient or the family about an adverse event and those who may ultimately be responsible are nowhere to be seen, as in the case of the report on the Midland Regional Hospital, Portlaoise. Is there an obligation on us to extend the duty of open disclosure and candour not only to clinicians and the medical professionals working on the front line but also to senior management in the health service and those who may ultimately be responsible? I would like to hear the delegates' views on that matter. I am not talking about headhunting, but open disclosure ultimately involves accountability for those who have experienced an adverse event.

Perhaps I might have clarity on these issues.

As regards its organisational mindset, the HSE is made up of myriad organisations, including representatives of trade unions and professional bodies. Is there an awareness and an acceptance among Dr. Ryan's members that having a duty of candour and open disclosure would be positive, or is it just at the top levels where people sit around tables and have a chat and believe it is the right thing to do? Are the individual members who do their jobs every day supportive of the process involving open disclosure and a duty of candour? Are they even aware of what it is about? Have broad discussions taken place with the membership about this legislation and what it could entail for individuals? They may have to stand in a room, issue an apology and explain what happened among their peers.

The Dáil recently dealt with a Bill concerning the State Claims Agency. When enacted, it will obligate clinicians in the private sector to take out professional indemnity insurance. The State Claims Agency will pay out approximately €212 million in costs this year. In 2014 it paid out €106 million; therefore, the figure has doubled in the space of two years. That is a frightening statistic in view of the fact that a lot of that money could have been spent elsewhere in funding services to prevent adverse events.

How difficult is it to recruit and retain staff? Dr. Ryan mentioned that some people were throwing in the towel owing to indemnity insurance costs. I assume that there are huge variations. In dermatology, for example, the costs are reasonable, but they are expensive in obstetrics and gynaecology. Is there any way to have a cross-cover system in place? We talk about risk sharing and equalisation in the health insurance market; is there any way, therefore, we could be imaginative in risk sharing in the insurance cover market for health professionals? If not, we will have loads of dermatologists but very few obstetricians, which would not be great for either profession.