David Stanton (Cork East, Fine Gael) | Oireachtas source

A number of amendments have been grouped and I will address these together. The Minister for Health fully appreciates the reasons some Deputies believe open disclosure should be mandatory. Deputy Daly indicated there was some contact earlier today on the issue. Considerable deliberation of the respective advantages of a mandatory and voluntary open disclosure framework took place before we came to a view that a voluntary approach offered the best way forward. This judgment, which is one informed by the Commission on Patient Safety and international evidence, is that this legislation will be successful only if there is a marked culture shift - I return to this issue of a culture shift - within our health services and that the best way of facilitating that change lies with fostering a voluntary approach to open disclosure. Deputies will agree that if we want to reach a point where voluntary disclosure takes place.

Deputies will be aware that the Joint Committee on Health also considered this issue in its pre-legislative scrutiny of the open disclosure legislative proposals. The joint committee was sympathetic to the views expressed by stakeholders that cultural buy-in to open disclosure is necessary to its success and was wary of introducing a mandatory burden on front-line workers which could hinder the desired outcomes we all want to see emerge. Internationally, a blame culture has been shown to stifle the learning that a good patient safety culture requires. We return again to the philosophy of culture. Open disclosure is a human experience for all involved, both the doctor and the patient. As I have stated repeatedly, it should be a meaningful engagement between the doctor and the patient, not a tick-box exercise.

The committee recommended that the success of voluntary open disclosure should be assessed in the future. If it appears the voluntary system is not having a satisfactory impact on increasing rates and quality of disclosure, the possibility of mandatory open disclosure could be then considered. The Minister for Health has given a commitment to do this. It is of note in that regard that recent inspections of hospitals by the Health Information and Quality Authority, HIQA, have identified a growing awareness of open disclosure across the health system. Open disclosure is already beginning to take place.

Amendment No. 36 provides for a statement of what further inquiries into a patient safety incident the provider believes are appropriate and which of these it will undertake. The Minister for Health considered this amendment and sought legal advice. The advice given is that the current provision already covers such further inquiries the health services body believes are appropriate and which it will undertake. Therefore, the proposed amendment appears to be unnecessary.

I assure Deputies that the open disclosure provisions are one part of a number of initiatives to improve the management of patient safety incidents. The Minister for Health has recently approved new standards on the conduct of reviews of patient safety incidents which expand on the existing national standards for safer better health care. The new standards were developed by HIQA and the Mental Health Commission and will be published shortly. This set of standards, along with the mandatory reporting of serious reportable events provided for in the Health Information and Patient Safety Bill and the provisions on open disclosure we are discussing, will provide a comprehensive patient centred approach to preventing, managing and learning from incidents. This may address the issue raised by Deputy O'Callaghan.

The Minister for Health has directed the recently established national patient safety office to prioritise the early progression of these important patient safety initiatives.

I have endeavoured to set out the carefully considered pros and cons of mandatory versus voluntary open disclosure. For the reasons I have outlined I hope Deputies will understand that I cannot accept their amendments.

We all agree that our objective is to achieve a shift in culture. Let us be courageous and seek to achieve voluntary open disclosure, which international evidence shows is the best outcome. We want to encourage this model, rather than mandatory disclosure.