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

I thank the Mr. O'Connor for his presentation. I would raise two issues, those of clinical governance and accountability. The general scheme of the Bill states that "The Commission on Patient Safety and Quality Assurance creates a framework for better patient safety and quality in Irish health service". It also states, "However, the Commission recognises that fear of litigation and damage to professional reputation presents a significant challenge for professional bodies in engaging with incident reporting, open disclosure and audit process. This is supported by international experience". The reason I ask about this is that we in this committee are also having a discussion, in the context of another item of piece of legislation, on the issue of open disclosure and duty of candour. The more I read this legislation the more I think it is very unlikely to be compatible with what we are trying to do in the context of other legislation. When those in the Department were drafting this legislation did they just take into account the Commission on Patient Safety and Quality Assurance's recommendations or did they take account of the broader picture of what we are trying to do in terms of open disclosure and duty of candour? From a first glance at the Bill some days ago it did not appear to be anywhere near where we would like to be in terms of open disclosure and duty of candour in the context of the pre-legislative discussions we are having on the other Bill.

That leads me to another issue. When we talk about improving the quality of health care here we have an uncanny knack of putting the clinicians front and centre and we always absolve the administration from having any accountable standards whatsoever in terms of an obligation to ensure safe quality health care. I would instance the Portlaoise report, which was explicit and unearthed some poor practices, to say the very least, in the administration of health. Are we consistently putting the onus on front-line clinicians, nurses, doctors, consultants and other allied health professionals and yet absolving senior management from having any accountability in the context of potential risks to patient safety? In this legislation again I believe we are using the professional bodies to ensure clinical governance and accountability. Is that an area we need to examine if we are to have genuine meaningful accountability?

It is fine for us as parliamentarians to bring the Minister into a committee and criticise him for an hour or two over something that has happened or blame some doctor or nurse when it is quite evident that it may have been because of administrative inability or lack of ability, or heavy-handedness or short-handedness. Mr. O'Connor might give his observations on that.

I also wish to raise the issue of the licensing of hospitals. There is a great pretence in our health system as we well know. The Health Information and Quality Authority, HIQA, visits hospitals, observes some our theatres and requests that the hospitals do their best to improve them and bring them up to standards but, let us be honest, if there was a full detailed audit of our health system, we would be under huge pressure in the morning. What preparatory work is done in the licensing of our public hospital system in advance of there being a full licensing system in place in terms of an audit? What assessment has been done of the need to get from where we are to where we must be when a licensing system is in place? The reason I ask about this is on foot of discussion we have had in another committee on the capacity of our public health system to deal with what comes through the emergency departments and through appointments from outpatient and inpatient departments and the fact that we do not have necessary capacity. I have concerns about the areas covered under heads 71 and 72 of the Bill regarding the issue of open disclosure and duty of candour.