Jimmy Devins (Sligo-Leitrim, Fianna Fail)

I thank the Chair for allowing me to speak on the Lourdes hospital inquiry report by Judge Maureen Harding Clark. Our thanks go to the author, who has presented her findings in a clear an unambiguous way. The report is a model of how such an inquiry should be carried out. There has been much comment on the report both in the House and the media and, in the limited time available, I do not wish to repeat what has been said already. I will focus on the future and on the recommendations made by the judge. Nobody here wants a repeat of what happened at this hospital. Our thoughts are with the women who had to undergo the trauma of a peripartum hysterectomy without any medical justification for such a radical procedure. These women have endured horrendous consequences and must live with the reality that they will not be able to bear any more children. For any woman to be told she cannot have more children for whatever reason is very difficult, but for it to happen without a medical reason is especially difficult. I urge the Minister of State to establish the redress scheme as quickly as possible and congratulate him on his speedy acceptance of this report.

I refer the House to recommendation No. 4 of term 7 of the report on page 322. The author makes the point that what happened in the hospital in question may have happened elsewhere, particularly in similar size hospitals. I do not know if it is so and sincerely hope it is not the case. In this regard, it is worth pointing out that most maternity units, with the exception of the teaching hospitals and the three Dublin maternity hospitals, have operated, by and large, with two obstetric consultants or, in some cases, only one consultant each for many years.

As we all know, babies have the habit of arriving at any time. As a result, the 40-hour working week that is the norm for most people has no relevance to the consultant staff of smaller maternity units across the State who work on a one-in-two rota. Tiredness is a common feature for most of these consultants and contributes to stressful working conditions. I strongly believe that all maternity units should have a minimum of four consultants. Not only would it allow the staff to have a more normal life, but, more importantly, would allow peer audits and professional interactions.

Judge Harding Clark's report states: "Fresh ideas must circulate; education must continue and review of outcomes must take place on a regular and continuous basis". This can only happen if there are sufficient numbers of medical and nursing staff to allow for robust analyses of case work. If there are too few consultants in the discipline, time to engage in the above process will not be available. Likewise, due to the hierarchical nature of consultant-led services, the necessary detailed questioning and analysis may not be engaged in, as was obviously the case in Our Lady of Lourdes Hospital.

I want to discuss competence assurance in the limited time available. In effect, this means that a doctor or nurse has a sufficient level of competence to carry out the duty or procedure to be embarked upon. It may appear blindingly obvious that nobody, least of all in the practice of medicine, should attempt to advise on or carry out procedures they are not qualified to do. However, once a doctor is qualified in his or her specialty, there is no further requirement to keep up to date on the latest advances.

In recent years, there has been a large explosion in the amount of new medical knowledge available as new drugs and investigative methods are discovered. It is not an exaggeration to state that such is the rate of new knowledge in health matters, medical textbooks can be out of date a year or two after they have been published. Imagine the situation of a doctor or nurse who does not keep up to date, attend conferences or engage in continuing medical education. While he or she may be practising conscientiously, the gaps in his or her knowledge will increase so that the patient, who is the single most important person in the health service, will eventually be exposed to less than adequate health care.

It is to prevent this dreadful scenario occurring that the Medical Council is seeking the establishment of a structured competence assurance programme. Under this, doctors will need to not only display their continuing medical education skills, but have them regularly undergo audits. In this way, the public can be reassured that the doctors looking after them have the necessary skills and education needed. There is no doubt that there are some within the medical profession who do not look on the assessment of competence as a positive development. They should not be afraid but should embrace it.

In my previous occupation as a general practitioner, I was involved in GP training for many years. In that capacity, regular audits were carried out on me so that my assigned training doctor could be assured of my competence. On superficial examination, the first audit was potentially threatening but the benefits that accrued to me, the training doctor, and by extension the practice, was such that regular audits and examinations were embraced by all. I urge the Minister of State to progress the competence assurance proposals as formulated by the Medical Council as quickly as possible and look forward to the medical practitioners Bill as a vehicle to drive continuous assessment of doctors' competences.

It is easy to be wise in hindsight. If the obstetrician at the centre of the debacle in Our Lady of Lourdes Hospital had been subjected to regular competence assessments and audits by his peers, perhaps the litany of disasters that occurred could have been prevented. By recognising the mistakes and faults of the past, we can learn for the present and protect and service the future well-being of patients and users of the health service. This report is shocking but timely. Let us adopt its recommendations so that the calamitous occurrences in that Drogheda hospital may never recur.

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