Liz McManus (Wicklow, Labour)

I welcome this opportunity to debate this important issue of patient safety. I thank Fine Gael for sharing their time in this important debate. This issue has never been more important than it is now. In recent times there has been a litany of shocking revelations about deficiencies in the health service to such an extent that public confidence has been undermined.

The task of any Government is to restore confidence in the health service and to introduce robust, effective measures that are statutorily based and serve to empower and protect patients. Instead the Government has prevaricated, obfuscated and delayed taking the necessary action. When the Leas Cross nursing home scandal was broken by RTE, the Taoiseach promised swift action and new legislation, yet 18 months on, we are still waiting. When tough decisions were to be made, the Minister, Deputy Harney, talked tough, but when the time came last May to publish the Leas Cross nursing home report, she hid behind her legal advice. We pointed out very clearly that the Minister had the authority under the Health Act 2004 to ensure the publication of this report. She chose not to do so. A press conference was held last week to oversee the report's publication. Remarkably, not a single Minister turned up. That was probably the most telling point. The abject absence of political leadership simply added to the distress and pain experienced by the families of those who died at Leas Cross. People found it unfathomable that there should have been such an absence of political leadership.

This report can now be added to the sad litany of reports that has built up during the Government's watch. The Our Lady of Lourdes Hospital Inquiry report, the report on the deaths of Pat Joe Walsh, Peter McKenna and Róisín Ruddle, and the Leas Cross report are only some of the reports that examine institutional abuse of the elderly, the surgical mutilation of young women and the death of a middle-aged man who bled to death in a modern Irish hospital. Other tragic events have also been examined.

There is also the anecdotal evidence that arrives on Members' desks on a regular basis. The patient who contracted MRSA but was not told about it and the family only discovered the fact when it appeared on the death certificate. The child with a broken arm left for 20 hours without water in a hospital ward. An older man left undiagnosed in extreme discomfort and covered in his own faeces while in hospital. The complaints range from dirt in the toilets to the death of a child through medical misadventure. These complaints are disturbing, but when we get them we ask ourselves what we can do with them. There is nobody we can trust to ensure these complaints are acted upon. The complaints we get are only a drop in the ocean. Data collected by the State Claims Agency show that 1,000 adverse incidents involving patient care are occurring in Irish hospitals every week. It is estimated that this is only 30% or 40% of the real figure.

Action needs to be taken, but it cannot be small-minded, defensive, or of the typically minimalist approach that the Government appears to think is good enough. We need an independent, co-ordinated and standardised approach to patient safety with clear accountability, including political accountability, and enforcement. It is interesting to note that among service providers, including private nursing homes, there is an appetite for better co-operation and improvement in inspections and regulation to allow staff deliver services. People want to deliver facilities and treatment, but they want to do so in circumstances where everybody is governed by best practice.

Labour and Fine Gael recognise the urgent need for the establishment of an independent body with a strong legislative base, focused on patient safety. We have joined forces and today published the framework for a patient safety authority that puts patient safety at the heart of the health service. We want a robust, statutory authority to empower and protect patients. We want to restore confidence in a health service system that has become dogged by too many scandals, too much neglect and too many people dying needlessly and without dignity. The irony is that we have great health professionals who work hard to ameliorate the effects of illness and ill health. They often work in very trying conditions that are overcrowded and overstretched. Both patients and health professionals deserve better from a Government that has let them down so badly.

Labour and Fine Gael propose a patient safety authority that will bring ministerial responsibility back into the health service. It is essential that patients within our health service feel safe and know they have an authority that advocates for them and demands answers on their behalf, as well as having the power to improve standards of care and safeguard patient safety.

The report of Our Lady of Lourdes Hospital Inquiry is one of the most revealing accounts of medical failure in the history of the State. It raises serious questions about how the State ensures patients are properly protected from doctors who may lose the ability to perform to an acceptable standard. It beggars belief that so many women could have been subjected to what amounts to unnecessary surgical mutilation of their bodies. The distress caused to those women, often young women, by the removal of their wombs without their consent, thus robbing them of the capacity to have further children, is almost unimaginable. Anyone reading this report will wonder how it happened and how it went on for so long. Yet, were it not for the courage of a midwife and the swift response of the health board, the medical practice and the consultant would still be in operation today. From 1974 to 1998, 129 women were subjected to this practice until someone blew the whistle. To this day, that whistleblower has not been identified publicly. That is telling too. The shocking fact is that were it not for the courage of a relatively junior midwife who drew attention to Dr. Neary's record in 1998, more women could have suffered.

This case clearly highlights the urgent need to provide legislative protection for whistleblowers, not just within the health sector but in all areas of Irish life. The Labour Party has long sought protection for whistleblowers who are worried about bad practices or wrongdoing in their place of work. The patient safety authority will give protection to whistleblowers who act in good faith where there is danger to health and safety of a patient, staff member or member of the public, miscarriages of justice or crimes or breaches of legal obligations. The leader of the Labour Party introduced the Whistleblowers Protection Bill in 1999. It passed Second Stage in June of that year, but the Government has since resisted all efforts to have it progressed further. The culture of secrecy continues. I noted a doctor complaining most vehemently about the most recent draft consultants' contract which contains a clause that would deny consultants the right to talk to the media or the public of serious concerns they may have. While that stricture may have applied in the past, it goes completely against the rhetoric so often used by the Minister for Health and Children who promises accountability. At the same time as she is espousing this rhetoric, she is responsible for shutting down the best and long-standing conduits of information when setting up the Health Service Executive.

I note that the HSE yesterday launched an initiative called "Use the Right Door". While I am sure it is a good initiative, I am equally sure it would raise a wry smile among many people. The real difficulty with the HSE is that one cannot find the right door. If one is seeking information or trying to find the person responsible, one does not know which door to use — there probably is no door anyway. One is fobbed off by the Minister for Health and Children when one puts down a parliamentary question. The HSE may respond six months later saying that it does not have the information, but may have it in a further six months. This is the reality of trying to access information from the health service.

There is one lesson more than any other that we should have learned from all the scandals that have been revealed and the anecdotal evidence we receive in correspondence — terrible things can happen where there is a culture of secrecy and where a service as important as the health service is neither open nor accountable. It is dangerous for patients to be treated within a closed system. It is much better to have openness and accountability so people feel they can trust the service. A patient safety authority can provide that security. We do not currently have this. Public representatives do not know where to turn.

It makes no sense to write to the HSE. It is a vicious circle. One is complaining to the people responsible for the problem. When the HSE was to be established, before Deputy Harney took over as Minister, there was a clear framework to set up a parallel system comprising the HSE and an authority that would ensure information and quality standards. However, the Government does not see the importance of quality, information and standards. It never got the balance right. There would have been tensions with the parallel system because a statutory authority would have been established at the same time as the HSE as a watchdog or guardian for patients, the type of authority we have elaborated on in a more comprehensive form in our proposal for a patient safety authority.

We got nothing and since then we have seen what can happen. We see it in the Leas Cross report: institutionalised abuse of elderly and frail people. That is the legacy and to this day, despite all we have read and seen on television, we know it is not restricted to Leas Cross. We also know the Government does not have its act together and the legislation does not exist. There is no excuse for prevarication. While the Government has no problem speeding legislation into the House to ensure people pay nursing home charges, it cannot provide for the protection of patients. It is the characteristic of the Government. It can provide tax breaks for private hospitals but cannot deliver the 200,000 medical cards it promised. That is a feature of a Government that is incapable of ensuring that patients are the centre of our health service. We must empower patients. If we fail to do so we must live with this litany of deficiencies, failure and neglect which we have seen in these reports. That is one of the great failings of the Minister and her predecessor, who established the idea of getting rid of the health boards willy nilly and establishing a central body. It is hard for any of us to pinpoint the benefits of the HSE. Perhaps the Minister will tell us what, precisely, has been the experience of patients that allows them to say it was a good political move to deliver a central body.

I know a public patient who has waited 15 weeks for open heart surgery and has been told he will have to wait three to five weeks longer. He is an ordinary, working-class man who deserves better. What can I do for him? Where can I go to say what is happening to him is wrong? I hope this will bring a change of heart from the Government, but I suspect it will not. There will be more defensiveness. We have seen from the amendment to this motion that we are getting more of the same. That is a pity and I regret it. Irish patients deserve better.

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