Liz McManus (Wicklow, Labour)

I commend the report and welcome members of Patient Focus to the Visitors Gallery. Judge Harding Clark has done an excellent job in meeting the requirements of a difficult brief. She has made some points about the practical problems she encountered in terms of lack of security and inadequate accommodation for her and her staff. Since investigations of this type are likely to recur, it would be wise to ensure these matters are addressed by the Government for the future. I welcome the role of this judge in formulating a compensation scheme for those who suffered so much and I will be vigilant in ensuring there is no undue delay in processing this scheme.

The terrible and tragic saga of the women who suffered at the hands of Dr. Michael Neary must lead to change in the health services. The first task, however, is to meet the needs of the women themselves. As one woman who had an unnecessary hysterectomy said:

I was so grateful eight years ago to be alive that any questions or doubts I may have had about my treatment went unanswered. I was given a second chance of life. I was unique. Dr. Neary had saved my life. The revelations over the past 18 months have shattered my illusions. I feel we have been living a lie all these years. What I believed and accepted as the truth was a lie. People have totally betrayed me and I now need, and feel I deserve, answers. How could this have gone unnoticed for so long in a hospital involving an entire body of people?

She has received answers to her questions in this report but she also posed a question of all of us. How can we ensure that something like this cannot happen again?

Last night the Labour Party put forward proposals for a whistleblowers Bill. We argued and will continue to argue that there is a pressing need for protection for whistleblowers, whether in the public or private sphere. If health staff working in Our Lady of Lourdes Hospital over the 24 years of Dr. Neary's practice had been protected in this way, the likelihood is he would have been stopped from injuring women much earlier than he was. It took an exceptional young midwife to stop him and the debt the women owe her, named as Ann in the report, is enormous.

Fidelma Geraghty, a woman who underwent an unnecessary hysterectomy after her baby was stillborn, said:

Everyone owes her a debt. If it were not for her, this could still be going on today and hundreds more women could have been affected. I would love to know who she is.

Judge Harding Clark states: "If it were in the power of the inquiry to make an award of bravery to any person, it would be to the midwife, whom we shall call Ann, who made the first complaint to the North Eastern Health Board solicitor".

The young midwife took a lonely, difficult route and until today she has maintained her anonymity, a fact that speaks volumes in itself. According to the report there was no forum for expressing her concerns, the implication being that there should be such a forum in every hospital and across the health services.

I was reminded recently that while Dr. Neary was practising at Our Lady of Lourdes Hospital, the health board was concentrating on suspending another consultant in the same area. This was in the early 1990s. Unlike Dr. Michael Neary, no disreputable practice was ever ascribed to Dr. Muldoon. His only crime was that, in the view of the health board, he kept his patients in hospital for too long. According to his colleagues his care of patients was exemplary but the health board was sufficiently exercised to suspend Dr. Muldoon.

Never, however, did it examine the terrible record of unnecessary procedures for which Dr. Neary was responsible. Even when Dr. Neary's work was examined by three fellow hospital consultants, they gave him a clean bill of health. Their recommendations chill the hearts of anyone reading them. One obstetrician goes so far as to state: "It is my view that the mothers of the North Eastern Health Board are fortunate in having the service of such an experienced and caring obstetrician". Later these consultants expressed regret and said that compassion and collegiality had affected their judgment. Their remorse is welcome but the lessons are crystal clear.

Change in how our health services are made accountable is imperative. There is a real danger that what is presented in this report will be seen only as having historical relevance but the report itself points out that there is still inadequate risk management in Our Lady of Lourdes Hospital, stating: "Interviews with professionals involved in clinical governance and risk management abroad lead me to believe that similar problems have occurred and do occur in other hospitals". If ever there was a warning for the future those words contain it. It is remarkable that there is no framework whereby hospitals are inspected, licensed or held to account.

We must take action on two fronts. I said in the Private Members' debate that a whistleblowers Bill had many applications but none more important than in our health services. Too often scandals have arisen because of a fundamental failure to ensure proper accountability and oversight. I instanced the hepatitis C scandal, the deaths of haemophiliacs, the nursing home charges and, most recently, the experience of patients of Dr. Michael Neary as testimony to that failure. The health services have no shortage of examples of systemic failure where it took actions by an individual to make a difference. The Labour Party offered an opportunity to legislate to protect the future midwife, bank official or public servant who sees a wrong and refuses to close their eyes to it. We can act by passing such legislation and should do so. That is the proper way to ensure accountability and it is long overdue.

One striking aspect of the report on Our Lady of Lourdes Hospital is the use on more than 20 occasions of the word "hierarchical" to describe the organisation of medical and nursing services. Judge Harding Clark writes:

Hospitals appear to run in a hierarchical system based on division of tasks. There is hierarchy among the nurses, and correlating medical hierarchy from the medical students to the interns, the SHOs, the registrars and the consultants.

She comments that hierarchy works well in normal life. There is much to recommend hierarchy where escalation of rank is based on degrees of competence and experience. A move up the ladder ought to be commensurate with experience and increased knowledge, with the higher echelons reserved for candidates who show leadership qualities. However, the report states: "If there is little upward movement or if promotion automatically follows tenure, hierarchical structures can create a negative and dangerous environment". There is no doubt that in the maternity unit of Our Lady of Lourdes Hospital, there was a dangerous environment. Largely due to the hierarchical approach and in deference to the judgment of superiors — not because information was unavailable or suppressed — basic questions went unasked and unanswered for many years.

We must encourage, not discourage, whistleblowing and divert protests into productive channels. I have made it clear that I do not believe it is sufficient to rely on the professionalism of doctors alone to police themselves. It is welcome that doctors increasingly work within teams rather than in isolation. However, the power relationship between consultants and junior staff, other medical professionals and patients is still imbalanced. The medical profession, through the Medical Council, has been pressing for reforms for up to ten years but its pleas have fallen on deaf ears. While allowing for reform of the Medical Council, it is important to recognise the role of whistleblowers. There will always be space for abuse no matter how good is the system of competence assurance.

A second important role is or should be that of an external inspectorate. We have inspectorates for schools, the Garda Síochána, psychiatric institutions, workplaces and prisons but we do not have an independent hospitals inspectorate. If it is to be truly independent, it should not be located in or under the Health Service Executive, rather in the Department of Health and Children or under a statutorily established health quality and information agency. Its remit should extend to State, voluntary and private hospitals and it should report to the Houses of the Oireachtas, reports that should be fully examined by Oireachtas committees.

On behalf of the Labour Party and as a result of what I have read in this report, I will publish this month our proposals for a hospitals inspectorate. What we have in mind is a chief inspector of hospitals and an appropriate number of assistant inspectors, including persons with relevant medical and nursing qualifications and other expertise, such as in administration. The inspectorate's functions would be to visit and carry out an annual review of hospitals and report in writing on the organisation and operations of those hospitals and the quality and effectiveness of services provided therein, including the quality of care and treatment of patients and hospital services generally, with comparisons with relevant international practice and standards. We should remember that it was someone from abroad who determined what was really going on upon examining the records of Dr. Neary's patients.

The inspectorate, as it considers appropriate, should report on the degree and extent of compliance by hospitals with any relevant enactment, directive, code of practice and such other matters relating to hospitals and the needs of hospital patients. The information collected should be disseminated and the inspector should have all powers that are necessary or expedient for the purpose of performing his or her functions. The chief inspector should have special powers to inquire into a report on the operation and administration of a hospital during a specified period or the care and treatment provided to a specified patient.

If change is to come about, it is vital that we establish a framework wherein hospitals and their work are examined thoroughly, openly and in a transparent way. This goes right across the board whether the issue is one of the maintenance or refurbishment of a hospital, recommendations for temporary or permanent closures, the numbers of patients — we clearly have problems with overcrowding — the staffing of a hospital, the introduction of reviews of specified policies, protocols and procedures and any other matter. Many issues, such as cleaning, maintenance, care and welfare of patients, design and even heating, lighting and ventilation, must be considered. In particular, the issues of records and data collection, which are the responsibility of hospitals, for how long they should be kept and how to make them safe should be considered. We all know that files were robbed from Our Lady of Lourdes Hospital, which is a criminal act. It is incredible that anyone could succeed in stealing such important medical material without somebody seeing what was going on or proper security being in place to ensure such a criminal act did not take place.

The experience of up to 250 women at the hands of Michael Neary has left a terrible legacy of sorrow and suffering. Individual women and men had their lives fundamentally altered and damaged by what one man did with impunity. Some people believed he was saving lives while others suspected what he was doing was deeply wrong but were afraid to act. One young woman called a halt and an administrator in the health board pursued the scandal into the open. Their courage is commendable, as is the dignity and determination of the women who lost so much at the hands of Michael Neary but stood and worked together to ensure that what happened to them will never happen to anybody else.

Our role must be to console and compensate, but it must also be to legislate to ensure that such a scandal does not recur in our health service. This means there is a requirement. It is not enough that the Tánaiste tells the House this or that must happen and everybody should behave better. We must have a plan of action in terms of the roll-out of legislation to deal with the issues raised in the Harding Clark report, which were not in the Tánaiste's report. A certain number of commitments have been given in respect of reform of the Medical Council but they do not go far enough. Beyond this, there have been aspirations but we now know that aspirations will not protect patients. There must be a statutory framework to ensure that patient care is fully protected.

This means we must do our jobs and legislate. Last night, the Labour Party moved a motion on a Bill for the protection of the whistleblower. I regret that the Government has shirked its duty and refused to take on board the Bill but we will persist. Protection of the whistleblower is our responsibility, as is reform of the Medical Council, and we will play our part when the Government publishes the documents. However, part of our responsibility must be to establish a full hospitals inspectorate to protect patients and, appropriately, pay tribute to the pain and suffering caused in one of our hospitals to so many innocent women who deserved the very best but did not receive it or get our protection.

See this speech in context