Jan O'Sullivan (Limerick East, Labour)

I welcome the opportunity to participate in this debate. The members of Patient Focus in the Public Gallery must be hoping all the words they have heard here will lead to results. We should pay tribute to the work they have done, which has been enormously important not just for their cases and for that of the hospital involved but for the health service and society generally. We must learn from this and ensure it never happens again.

Hierarchical structures cannot be so powerful that it takes so long for people to break them down to reach the heart of an injustice. What happened was obvious for many people to see but no one was able to do anything about it. The lessons learned must be implemented in health services structures and in other aspects of our society. We are still very hierarchical, we still doff the cap to those considered to be on a higher professional or social level. This attitude is alive and well in our hospitals still. We must develop a culture that fosters teamwork instead of placing people at the top of the pile in terms of power and decision making.

As others have noted, today is International Women's Day. If there was ever a group of women who were abused and had power exercised over them, it is the members of Patient Focus. The right to bear children is a basic right for all women and to have that right taken away unnecessarily by members of a profession held in high esteem who were abusing their powers is one of the greatest abuses possible. It is fitting, therefore, that we are discussing this topic today of all days. We owe it to those women to address their needs and to make certain that trust and power cannot be abused again in any context.

The hierarchical structure of the medical profession and the health services in Ireland is out of step with other countries where the team work ethos exists. People who have worked in the medical profession abroad know they treat each other as equals, whereas we still have an attitude that consultants are the gods of the system. That attitude is gradually disappearing but it is still necessary to confront the consultants and ensure they cannot exercise such power in the hospitals. It is not good for them, the system or the patients. Deputy Gormley referred to a newspaper article which claimed there is evidence still of discrepancies in obstetric practice in different areas; that shows some individual consultants are still very powerful. Induction of child birth is dependent on the culture brought by a consultant to an obstetric unit. There was a time in the past when this only happened for very good reasons. We must give the power back to those at the centre of this — the women who are giving birth.

Self-regulation does not work, not just in the medical field but in the legal and other areas, something those directly involved strenuously deny. The medical, legal and teaching professions, however, should not regulate themselves. We saw this clearly in the behaviour of the Royal College of Obstetricians and Gynaecologists, which exonerated Dr. Neary. He was allowed to select the nine cases to go before it. I am still unclear how that happened. It was never going to produce a fair examination of the practice and should never have happened.

I agree with the comments made this morning by Deputy McManus when she called for a health service inspectorate. There should be a regular monitoring and inspection system for all aspects of the health service. It is clear from this report that there was an appalling lack of regulation. Even when the hospital did not submit reports for years, no one asked why. The college in London admitted it received the reports, placed them in an archive and never read them. Even when reports were published, there was no proper monitoring of the situation.

whistleblowing is an important issue. The Labour Party has published a Bill on whistleblower protection that is currently being debated in Private Members' business but it will be voted down by the Government, which will continue with its piecemeal approach. What if there is no legislation in this area for ten years? Will whistleblowers be covered? I cannot imagine any major legislation to cover whistleblowers in education because a recent Education Act covers the general system. We need all embracing whistleblowers legislation that people can use for protection when they have concerns.

The report details how the midwives became concerned. One of them decided to have her child outside the hospital because she was worried about the number of Caesarean hysterectomies. A midwife who had the procedure carried out on her asked what was going on and it was shortly afterwards that another midwife blew the whistle. Those people are still powerless in the face of the system. The obstetricians call the shots and it would still be difficult for a midwife to decide to go to the authorities to say something like this was going on. That is the structure in operation.

There must be a cultural change in our hospitals and a teamwork strategy put in place. There are areas where teams work together and all members are treated equally no matter what their specialty. They all enjoy parity of esteem, something we need across the health system.

The "deliberate and malicious removal of information" detailed in the report is extremely serious. I hope it will be addressed rather than swept aside. It is incredible that so many charts, reports and files were deliberately removed to prevent a proper investigation.

I hope the many serious questions arising from Judge Harding Clark's inquiry will be addressed. What action will be taken with regard to the missing files? One cannot give back to the women affected by malpractice that which they have lost but what will be done to address their needs? What will happen to Dr. Neary and the system in which he operated?

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