Regina Doherty (Meath East, Fine Gael)
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I thank the HSE for what has been presented so far, but it does not fill me with much confidence and I do not say that lightly. The programme broadcast last week was, to say the least, absolutely shocking, but rather than focusing on individual issues within Áras Attracta, I concur with the comments made by Ms Lorraine Dempsey when interviewed for that programme: that the buck on this issue and any and all other patient safety issues stops at the top of the HSE. The six-step programme Mr. O'Brien has just announced is welcome, notwithstanding the fact that we have a patients' charter which was so wonderfully lauded last year in terms of its objectives and all of the improvements it was going to bring. Not to be trite, however, I do not see any difference at the end of 2014 arising from these objectives which were issued at the beginning of the year.

I wish to ask some specific questions about the quality and patient safety division. How many individuals, specifically in St. Stephen's House, not just involved in social care across the country, are responsible for ensuring quality and patient safety? What exactly, arising from the patients' charter, has the quality and patient safety division done this year, notwithstanding what Dr. Crowley has said about responding to particular instances involving nutrition or other issues in Áras Attracta or other venues?

I want to ask about patient safety advocates, not just in the 90 facilities with which the HSE has met. Are there registered, known, named patient safety advocates in each of these 90 facilities? Are there patient safety advocates in each of the acute hospitals? In any service offered on behalf of the State to citizens are there patient safety advocates who are known to patients? Is there a patient safety charter process in all of these facilities which known to patients in order that they know that if they have an issue or a complaint, they know where they should go, what they should do and how they should make their complaint?

I want to ask specifically about the first three items in the patient safety charter. The first is a "commitment to supporting the development of an open and transparent culture with defined accountability for quality and safety". Obviously, that is not working, as people are not whistleblowing; they are leaving. It is great that a confidential recipient is being announced today and I wish her well, although we have a history with confidential recipients who have not worked in other areas. What are we going to do in all of the other services which could be in exactly the same position with regard to whistleblowing? Is there a concern that the confidential recipient is going to work under the umbrella of the organisation on which she is to report? Would there not have been merit in making the confidential recipient independent? Strengthening the HIQA legislation and allowing the person concerned to work for it might have given more strength and perhaps more credence to the position.

The second part of the patient safety charter is that there will be "clear governance and accountability for quality and safety at all levels of the Health Service and Divisions". We have seriously failed on that level in every single aspect. Notwithstanding what happened in Áras Attracta and Redwood this week, we know what happened in Galway last year and Portlaoise again this year. There are too many instances that highlight the fact that, as a national organisation, we do not have a real patient-led service. With respect, I was one of the people who often defended the service plan last year, particularly when we talked about the provision of money and patient-led services, because it was said so many times, even in the prologue to the plan, that the service was totally patient-centred. It is very clear that it is not.

One of the commitments in the patients' charter is that we are going to "support quality improvements throughout the health service [and] improve outcomes" by interacting with patients to find out what their experiences are of the services being offered. When was the last time a patient experience survey was actually conducted in any section of HSE? What did we do to inform and change the processes of the system arising from the recommendations made?

I also need to ask - Dr. Crowley will know from where I am coming - about the two independent organisations which had their funding removed. They were the only ones which were engaging independently with patients on behalf of the two private organisations and the HSE. Why was it seen fit to stop that funding? If there was an issue with money, why did we not start to conduct patient surveys on behalf of the HSE, although I do not agree with this?