Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

Deputy Shortall asked if we will extend the remit of the patient advocacy service. Yes, we will. We want to extend it to nursing homes for all the obvious reasons. A tendering process is now under way. On the need for a bigger service, yes, we are expanding the service with more funding and staff and a wider remit. I fully agree.

There is much overlap in the points made by Deputies Cullinane and Shortall on the really important question of clinical accountability. I will try to decouple them slightly. When I was discussing the Bill with Department officials, we were teasing out some of these points. It was put to me that they are linked. We are trying to strike a very delicate balance between fostering a culture of openness, which is what this Bill is all about - it is all about mandatory open disclosure - and a culture where people are afraid, whether they should or should not be, to disclose because of what might happen to them. The advice we have from looking around the world at systems that do this better than we do is to try to keep them separate insofar as possible. For example, this Bill rightly contains requirements around apologies. However, they cannot be used as part of court cases or admissions of liability. My understanding is that Canada, for example, had a similar system. We are trying to strike a really delicate balance. First, we are telling people that under the 2004 Act they have protections if they want to come forward under protected disclosures.

Second, there are clear guidelines in place regarding mandatory open disclosure. Now this Bill adds another serious layer to that. It states it is a legal requirement and it is an offence if one does not do what one is meant to do in terms of mandatory open disclosure. At the same time, to refer to the points of both Deputies, which I fully agree with, there has to be accountability. There has to be clinical accountability and there has to be managerial accountability. We can refer to numerous examples, including south Kerry. We are trying to find a very fine line, or trying to walk the right balance, and get this balance right. This Bill is about the mandatory open disclosure part, not the accountability part.

However, we are proceeding with the regional health areas, RHAs, for many reasons. I was in Galway last week looking at the emergency departments and various other services. The case for the regional health areas from a patient service perspective is clear as day. We have many patients with delayed transfer of care and delayed discharge. Patients in emergency departments need those beds, yet there are separate organisations running the hospitals and running the community side of things. Obviously, it should all be the one organisation. The RHAs are very important from a continuity of patient care perspective. It is also through the RHAs that we will put the systems of accountability in place at the clinical level and at the managerial level. That work is ongoing. Not only is the work ongoing, I have also appointed an advisory group to me on the implementation of that. This is one of the areas on which that group will be providing feedback to me, to make sure that we get the right balance and that we have accountability, which we must have, but it does not come at the cost of creating a culture where people are afraid to step forward and admit when things have gone wrong.