David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I want to respond to some of the Minister's points. First on the patient advocacy service, yes, it is a service that is available. As Deputy Shortall rightly said, it is under-resourced. It does not apply to private nursing homes. I accept the Minister's bona fides that he will engage with the patient advocacy service in the context of the passage of this Bill and will look at resourcing and staffing issues, but I will press the amendment. However, I will not call for a vote on any of the amendments because I want the Bill to pass as quickly as possible for the obvious reasons.

Returning to the broader point around the section, the Minister spoke on who would be obliged or mandated to make a report. I accept much of the logic of his response. That is why I said we have to be careful. There has to be a balanced approach. I tabled an amendment and I am pleased the Minister has looked at the matter to see how it operates internationally. However, we must also be honest. I do not want to prejudge reviews, processes and audits which are now in place around CAMHS in Kerry. However, some of the senior officials were before the committee some weeks ago. There was a failure in clinical supervision at the very top. It is accepted by the HSE. There were failures at management level and at very senior clinician level. I understand that in CAMHS in Cork it was a social worker who made disclosures, not because she was mandated to do it but because she felt it was the right thing to do. I just have a fear here.

While there is some logic in what the Minister said and you do not want to create the anxiety that he spoke about where everybody feels they have to report everything, that is not what the Bill does. Schedule 1 sets out very clearly what is a notifiable incident. Clearly any mandated report has to be under that Schedule by using this Act. We can improve in this area. This goes back to where I sought a separate patient council that would look at the operation of this Bill given its sheer importance that this is something that as part of that review process would be looked at. I hope it is not the case, but I fear that we could end up, after the passage of this Bill, in one, two or three years' time, where we have had a number of incidents where those senior clinicians or relevant senior clinicians the Minister spoke about may not have reported what should have been reported. Then there will be a failure in that area. Yes, there are processes to deal with that but there may be other staff members in and around that clinician who were aware of incidents but were not mandated to report them. We will then ask why not? We will find the reason they were not making the reports is that they were not mandated to do so. If that is the case, then the Act will have to be amended.

I very much hope this Bill will work and that we do not have those kinds of situations but the possibility of those arising is very real. We can look at examples of failures at management and senior clinician level. It very rarely happens. We have excellent staff in our health service. The senior clinicians are really good at what they do and it is very rare that we have these kinds of failures. However, they occur and when they do and there are failures on the part of a senior clinician, there should be responsibility on the others to come forward. My amendment might not have been the best way to do it and maybe there is a happy medium or a balance between what I was proposing and what is in the Bill. For the purpose of moving this debate on, I will leave it at that. I welcome the Minister's response but I fear it is an issue that we may have to return to in the future. I hope that is not the case.