Seán Fleming (Laois, Fianna Fail)
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CervicalCheck is a key issue. Separately, we recently wrote to the State Claims Agency about the overall bill facing the State as a result of medical negligence. To be upfront, we sought very extensive details of the breakdown of the figure of €2.4 billion for medical negligence claims. We have received some information today and I spoke to Mr. Breen earlier in the week. Some information is not yet available but will come to us in due course.

One of the items I want to highlight for the public which I do not believe has been made public before is the breakdown of the estimated liability by size of the estimated claims. The figures about which we are talking are the sums for which the State Claims Agency expects the cases to be settled.

The cases have not necessarily been to court, but they are not our valuations. They are the State Claims Agency's valuations of how it thinks these claims might work out. We asked for details of the claims that the agency expects to settle for less than €1 million, between €1 million and €4 million, between €4 million and €10 million, and in excess of €10 million. The agency tells us that it expects to settle 2,954 cases on its books for less than €1 million, 207 claims for between €1 million and €4 million, 91 claims for somewhere between €4 million and €10 million and 113 cases for in excess of €10 million each. The Committee of Public Accounts has to look at these figures because medical negligence is a major bill, and it goes without saying that the less medical negligence, the more money the HSE has for its work in the health service and building hospitals among other things.

I want to put the information on the large figure into public domain as it has not been known to date. I refer to the more than 100 cases with the State Claims Agency each of which will cost in excess of €10 million. I understand that ten of those cases are in the Dublin North East hospital group, 17 are in the Dublin Midlands hospital group, ten are in the Ireland East hospital group, 22 cases are in the South/South West hospital group, 29 cases are in the Saolta University hospital group, 14 cases are in the University Limerick hospital group and five are in the Children's hospital group. The 113 cases are estimated to cost the taxpayer approximately €1.4 billion, which is an average of €12.8 million each. The figures are staggering. We know some of the cases are catastrophic and involve lifelong issues. Some of the costs will be very high.

We do not have information today on a difficult issue, which is one the committee will have to discuss with the State Claims Agency, in terms of the 3,000 cases on its books, especially some of the 113 cases, namely, whether any one medical professional is connected with more than one case. If a number of cases have been taken against an individual and negligence is an issue, then action should be taken to ensure such an individual does not continue to practise in a hospital. I had a conversation with Mr. Breen earlier and I will ask him to comment on it before we begin to discuss CervicalCheck. Many of the claims that are made, especially involving maternity departments, involve several staff. When something goes wrong, one cannot always pinpoint it to one individual, so individuals per seare not held personally responsible, and the hospital, State or HSE takes overall corporate responsibility for defending the case. That means, however, we are not formally compiling incidences of consultants who might be involved in several cases and we need to know such information. The State needs to know there is a system in place.

The information I outlined is based on hospital groups, but ultimately we need to get the information on a hospital-by-hospital basis. I accept that issues will arise for hospitals in that, if there were a couple of big cases in one hospital, it might look bad, but everyone knows the big hospitals will have the biggest figures and we would expect the smaller ones to have the smallest figures. That is an issue to which we will return. I accept Mr. Breen has said that publishing those figures individually could cause other unintended problems as it might identify cases and compromise the State Claims Agency's defence or it might be unfair in certain circumstances.

The Committee of Public Accounts will examine further the expenditure of €2.4 billion. We have got the first headline breakdown of the figures and we will discuss the matter of further information with the State Claims Agency. From dealing with the HSE and the State Claims Agency, my observation is that there is a demarcation line that is not helpful to the State. Once a case is sent to the State Claims Agency, the HSE says it is nothing to do with it anymore and it is for the State Claims Agency to tell it at the end of the year how much it owes for the cases that have been settled. I do not think there is enough ongoing joint work between the two agencies to identify where the problems lie. We should not find out there is a recurring problem in a hospital at the end of a case settlement for €10 million. People need to know and to take action on matters as they arise and not wait for cases to be settled.

Those are my personal observations. They are not the views of the Committee of Public Accounts. The committee will discuss the issue and members may have stronger views or different views on the issue. As a committee I am flagging that the sum of €2.4 billion should be available to build hospitals and to provide health services and should not be spent on medical negligence. I have asked for details of the increase in that bill in recent years. We must discuss what the HSE can do in the first place, not to mind the State Claims Agency, to reduce the number of medical negligence cases in hospitals and other health settings. Mr. Breen might make a brief comment. If he wants to disagree with anything I have said, he should please do so, I am just making opening remarks and this is something we will discuss again on a more structured basis.