Mary Harney (Dublin Mid West, Progressive Democrats)

If any of us was the subject of criticism, in all fairness, we are entitled to respond and to have that response considered. That is the reason it has taken a long time to get to the position we reached last Friday. Finally, as regards last Friday, I am now being criticised because I did not turn up at the press conference. If turning up at press conferences is a sign of commitment, interest and concern, then we have come a long way down the road in politics. It was not my job to be at that press conference. It was called by the people who commissioned the report, namely, the Health Service Executive. I was available to the press and gave extensive interviews. Deputy Twomey should know that I do not run from things. I took on this job as Minister for Health and Children well aware of the challenges and the difficulties. I love the job, the challenge and trying to do the right thing, which is what I remain focused on.

Professor O'Neill's report is obviously extraordinarily critical of the level of care in Leas Cross nursing home. It is a chronicle of neglect, no less harrowing for its being short and succinct. I deeply regret the distress caused to the older people and their families who have been affected by the failures of care shown in that report. There was a gross lack of respect for older people and their dignity. I know all Members of the House will join with me in condemning in the strongest possible terms what happened at Leas Cross. The fact the nursing home in question is now closed in respect of the previous management is some small measure, but this is of little comfort to the relatives of those whose loved ones were failed so badly. It is clear warning signs and complaints were not given the attention they were due. This is a message that emerges from Professor O'Neill's report, from analysis by Mr. Martin Hynes and from a separate report for the HSE by Dr. Dermot Power, who dealt with a number of individual complaints. These events and reports challenge us to respond in a comprehensive way. It is the intention of the Government to do so in three areas.

The Government will bring forward new legislation to strengthen regulation and inspections to assure the public about quality and safety. The legislation will be published before Christmas. The Government will continue to increase funding for services for older people substantially, as it has done this year. It will also fundamentally reform the basis on which we provide financial support for people needing long-term residential care, so that care is affordable and care at home and in the community can be supported as much as possible. These actions will respond to the challenges presented by the failures evident at Leas Cross, and meet the wider challenges of securing the best possible care and support for people in long-term care.

The motion from the Opposition parties is well-intentioned. It is also clear that the actions suggested in the motion are largely contained in, and borrowed from, the draft heads of the Bill I published in March. I welcome recent statements by some members of the Opposition that they intend to facilitate the passage through the House of the substantive health Bill that the Government will publish this session. I look forward to that co-operation.

The Bill is substantial, the centrepiece of the Government's reform programme. The draft heads I published amounted to 122 pages. Over three months, 73 organisations and individuals submitted comments, valuable input that is informing our work on the Bill. The Opposition calls for immediate setting up of a new agency. The Health Information and Quality Authority, HIQA, is already in existence on an interim basis. Its board is carrying out preparatory work for its role on a statutory basis and it has recruited a top class chief executive, Dr. Tracey Cooper, former deputy chief medical officer in the UK. Opposition Members have recently been briefed on the role and work of HIQA.

I wish to focus on one aspect of the new health Bill. It will provide for the office of the chief inspector of social services in HIQA, with specific statutory responsibilities for the registration and inspection of all nursing home places, both public and private. The chief inspector will also inspect residential centres for children and people with disabilities. This is not merely a process improvement. It will mean a major change in the strength and independence of inspections and will substantially increase public confidence.

In respect of nursing homes, the new regime will be stronger and more robust to ensure that standards of care, not just standards of buildings, are met. The chief inspector will inspect the homes against new regulations governing these homes and standards set by HIQA. The Bill will also strengthen and modernise the registration and cancellation of registration process. The chief inspector will have the power to refuse to register, attach conditions to a registration, or cancel a registration in the event of non-compliance with regulations.

This Bill will demonstrate that the Government is making patient safety a driver of substantive reform throughout our health services. We will set new standards, strengthen inspections and gather and publish new information on outcomes as we have done already on hygiene in hospitals, for example. We will ensure that patients' voices are listened to, both the complaints and the compliments. Patient safety will help us to make the right decisions on the best organisation within hospitals and the best organisation of our hospitals. We will provide as many services as possible, as locally as possible and as safely as possible. Patient safety and quality outcomes will inform the investment in and organisation of our new cancer control strategy. Everyone working in health can unite around this agenda of patient safety.

It is an agenda for constant change and improvement that requires clear leadership at all levels of our services. As Minister, my job is to keep patient safety at the top of the political agenda, to bring forward policies and legislation to increase safety and quality. I look for leadership from consultants, the top clinical decision-makers on a change agenda driven by patient safety. I also look to other leaders in the medical, nursing and other professions in health who are well positioned to take on leadership roles for real and lasting improvements in safety and quality. I also encourage patients and their advocates to play their part in embedding safe care in our systems. Reliable and accurate information on what is happening in our systems is a critical prerequisite for effective action. HIQA will help us to improve our data collection, analysis and results dissemination so that learning to prevent clinical error is shared across our health services.

We must examine fundamental issues such as how our hospitals are designed and constructed so that we can tackle problems like hygiene more easily. All areas of service provision should be continually reviewed to ensure that safety is provided for our patients. This can include, for example, the broad area of equipment design. Some disciplines such as anaesthesia have shown what can be achieved by better design of equipment such as anaesthetic monitors. These changes have resulted in dramatic reductions in anaesthetic errors. Apart from the harm avoided and the lives saved this has also led to fewer malpractice claims and lower insurance costs. These principles can be applied in many other disciplines.

To reduce clinical error we need to tackle the culture that pervades many clinical settings. Rigid hierarchies can inhibit junior staff from highlighting areas of possible error. A culture of blame and shame makes it harder for individuals to admit error and learn from it. A culture of safety is based on accepting that the working environment and the wider organisational context are key determinants of clinical error. By moving from a blame culture to a safety and learning culture we will improve critical incident reporting and analysis. Interdisciplinary training could help to break down possible communication barriers in clinical settings.

Patients, their relatives and carers must be central to our efforts to minimise harm and we must develop mechanisms where they are empowered to point out any possible errors or care deficiency without fear of the consequences. I encourage patients to adopt a working motto such as "Nothing about me without me" and assert their right to comprehensive information on how their condition is being treated.

The inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda chaired by Judge Maureen Harding Clark was established by the Government in 2004 following the decision of the Medical Council to remove Dr. Michael Neary from the register of medical practitioners after finding him guilty of professional misconduct. The Government decided that a further inquiry into the matters raised by the Medical Council was necessary. Since the publication of the report in February 2006, I have met many of the key stakeholders including Patient Focus, the HSE, the Medical Council, and the management and medical board of Our Lady of Lourdes Hospital.

The recommendations in the report are informing the policies the Government and the HSE are implementing in a number of areas including the preparation of the new medical practitioners Bill; the new contract for hospital consultants, with particular emphasis on the development of clinical leadership within the profession; and changes in management systems and quality assurance within hospitals to develop care delivery through managed care networks.

The report will help to inform the continued approach of my Department to these important issues. As for the hospital today, the inquiry found that the possibility of the maternity unit falling behind in current practice is now remote. However, we cannot be complacent in respect of this finding and must ensure that all necessary measures are taken on foot of the report's findings. There have been major changes in practice in the maternity unit to minimise or entirely remove the climate of isolation referred to in the Medical Council report. The incidence of peripartum hysterectomy has fallen dramatically and now accords with national rates.

There is now a team of consultant obstetricians to facilitate improved clinical audit and clinical governance. The current consultants have developed a strong collegiate approach to practice. The unit is moving forward and offering care that is evaluated against known benchmarks.

The inquiry found the medical board and the new consultants to have the motivation, skills and energy to move the hospital forward as a fully recognised teaching hospital with specialist registrar training in all departments.

As I noted earlier, I met the medical board following publication of the report and was impressed with its obvious commitment to ensuring the very highest standards of care prevail in the department.

The Health Service Executive published the report of the independent inquiry into the death of Patrick Joe Walsh in Monaghan hospital on 7 September last. The report details the obstacles that arose when trying to secure Mr. Walsh's transfer from Monaghan to either Our Lady of Lourdes Hospital, Drogheda or Cavan General Hospital. Since the death of Mr Walsh, a new protocol regarding patient transfer has been put in place. It provides that all requests for transfer from Monaghan General Hospital to Cavan General Hospital or Our Lady of Lourdes Hospital, Drogheda should be granted and processed immediately.

International best practice demonstrates that patients have better outcomes when treated in hospitals with appropriate numbers of specialist staff, high volumes of activity and access to the correct diagnostic and treatment facilities. I am concerned that at present, some patients are being exposed to increased risk because specialist services are being provided in some hospitals that lack the necessary critical mass of activity and patient throughput. Patient safety and quality must be paramount and must be the key drivers in the reconfiguration of our acute hospital services. The policy of the Government is to provide safe, high quality services that achieve the best possible outcomes for patients. This will mean rebalancing service delivery in order that those services that can be safely delivered locally are so delivered and that more complex services requiring specialist input are concentrated at regional centres.

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