Colm Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I apologise for not being here earlier but I had to be in the Seanad for a Commencement matter. I have come across open disclosure on many occasions. If an incident occurs in which the medical team does not know exactly what went wrong, it can decide on an external review. However, I have seen cases where there was agreement as to who would carry out the review but where the HSE administration interfered and the review was still to be completed 18 months later. The medical people had a problem meeting the patients concerned because they did not have all the answers and they felt an independent medical review was the best way to get the correct information for those patients. How do we intend to manage situations whereby a medical team does not know exactly what went wrong and wants a second opinion so that accurate information can be given to the patient? What about the timeline in such cases? We want open disclosure but we have to ensure the medical team does not give one view without having all the answers, while an independent review leads to a different opinion. How does the office co-ordinate that? Open disclosure is very important.

Dr. Holohan said that €350 million was paid out between 2012 and 2016. My understanding was that it was far higher than that. Is it possible for the health committee to get the exact figures, both for compensation and legal expenses, for each of the past four years? These are important because we are supposed to be learning from the process so that we can reduce the level of claims and the risks involved but it appears to be going in the opposite direction. How will we deal with it without a handle on the number of claims that are coming in? We need to learn from mistakes made in the past.

My third issue is the movement of personnel in the HSE. Somebody spoke about learning from previous mistakes but how can we do that when a hospital has ten hospital managers in 18 years? The average hospital manager stays in one hospital for 18 months so how can we have continuation and improve the standard of care if the administration keeps moving, meaning mistakes which have been made are not learned from going forward? This is a question of accountability in respect of both the administration and the medical team. There is a constant movement of people and some of them have responsibilities for one area on 1 January but for another area on 1 June, which is a big issue for the HSE. It is something we need to deal with by giving people fixed-term contracts, especially at senior level in the HSE administration.

There have been examples of administrators overruling medical personnel. I was speaking to a consultant recently who told me the administration had started dictating to them how to run their operating lists, asking consultants to do minor procedures first and then complex work at the end of the day.

As the Chairman will be aware, if one is doing a complex case, one should be fresh doing it. It is probably the first thing one should be doing. An administration was dictating how medical people should provide a service and do the work in a particular hospital. How is that dealt with? We want to reduce risk and improve the level of care but we have non-medical staff dictating to medical staff about how they should provide that level of care.