Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I respectfully disagree with the language he used. We would all have preferred it to have been paid within the first week after the Government decision was made. The HSE has been dealing with a lot, in fairness. The other thing is the financial management systems are being improved, which goes back to the Chair's point about e-infrastructure. The HSE was nervous about this, and I think legitimately so. It paid its own staff and paid many of them reasonably quickly. We would all have preferred it to be quicker but it was done reasonably quickly. However, the HSE was genuinely nervous about sending out moneys to private, for-profit companies like the home care companies and the nursing homes. Its officials were concerned if they sent out the wrong amounts, if they sent out too much, they would be hauled in here or before the Committee of Public Accounts and criticised for not taking sufficient care with public money. I have some sympathy with that. However, because it was taking so long to put in place safeguards they believed sufficient, I, as I was saying earlier, intervened and said I wanted a different process. That was to send out a self-assessment, let the private companies and the section 39 organisations do it, pay the money and then audit afterwards. That was a compromise to get moneys paid, but it is relevant 126,000 staff have been paid. Of course we want them all paid but that is relevant is well.

Returning to the State Claims Agency and medical negligence, there is a real issue here for many reasons.

I am sure members of the committee and the Deputy himself has spoken to clinicians who now talk of practising defensive medicine, such as over-referring and overuse of diagnostics, because in certain specialties they are scared of spending all of their time in court. In some areas I am aware they are finding it hard to hire people in because so much of their time is spent in, or preparing to go to, the High Court. That is not why they became healthcare professionals. It is an issue.

As the Deputy has quite rightly said, a jump from €80 million or €81 million in 2010 to an estimated €530 million this year and estimated to be higher next year is something to which we have to take a fundamentally new approach. We need to be very strategic about identifying where the patient safety issues are occurring and, first and foremost, stopping them, because what matters far more than any payouts from the State Claims Agency is minimising and eliminating harm to patients. We then need to have mechanisms available to patients who are not in the courts.

It turns out that 98% of clinical negligence cases handled by the State Claims Agency are resolved without court hearing. Nonetheless, there are mechanisms like no-fault compensation schemes, which are used in other countries, which we need to look at. The Deputy and the committee will be familiar with Mr. Justice Meenan’s report which contains many recommendations. The latest advice I have is that good progress is being made on those recommendations and there is more to be done.