Charlie O'Connor (Dublin South West, Fianna Fail)

I thank the Minister for sharing time. I welcomed the decision of the Health Service Executive to publish Professor Des O'Neill's report. I note the Minister has welcomed its publication and has stated the HSE will work to implement its recommendations. As I have stated at other times, I know Des O'Neill very well. He works in Tallaght and took care of my father during his last illness. I value his work on behalf of elderly citizens. While I should not be struck by such matters, I noticed that the Minister mentioned Eilis McGovern. It reminded me that when I underwent heart surgery, she was the lady responsible. It is good to see she is doing other things.

The issue of safety in the delivery of health services lies at the heart of any care system which has the confidence of the people using those services. While the health sector is one of the most complex areas of activity in any country it must, by its very nature, command the confidence of those who use it. To obtain that confidence, the measures set out by the Minister are fundamental. There must also be a framework of ethical behaviour by service providers and professionals if the trust of patients is to be secured. Governance, in the broadest sense, is critical if any system is to put in place the correct elements that will create the necessary framework of good behaviour.

I will describe some of the developments regarding these elements as they affect the HSE and key professional bodies. At the outset, it must be acknowledged that those who work in the health services and have real concerns regarding the safety of patients, otherwise known as whistleblowers, should be listened to and their position protected when genuine concerns are expressed. This is a complex area and one must be careful that different views regarding a problem are considered in a structured way. While the issue of staff who disclose concerns on patient safety has been under examination in the Department of Health and Children, the complexity of the matter has meant it has not proved possible to draft an appropriate provision in time for inclusion in the health Bill. However, I understand the Department continues to develop legislative proposals on this issue, which I welcome.

A number of statutory and other provisions are already in place in respect of governance in the health system. For example, under the statutory frameworks governing health professionals, there are provisions concerning the ethical conduct of such professions. The Health and Social Care Professionals Act enacted last year provides for the establishment of registration boards for each of the professions covered by the Act, the functions of which include giving guidance concerning ethical conduct and support to those registered with the boards in respect of the practice of their professions.

The Medical Council has a guide to ethical conduct and behaviour which deals with matters of confidentiality and consent under circumstances in which there are exceptions to the rules of confidentiality and in which doctors should report on the behaviour and competence of other doctors.

Section 25 of the Health Act 2004 provides that members of the board of the HSE, members of any committees of the board, employees of the HSE or any person engaged by it as an adviser shall maintain proper standards of integrity, conduct and concern for the public interest. In order to ensure the implementation of such standards, the HSE is obliged to draw up a code of conduct for employees not covered by standards applied by the Ethics in Public Office Act, as well as advisers and their employees. Such a code must indicate the standards of integrity and conduct to be maintained by them in performing their functions.

Furthermore, section 35 obliges the HSE to draw up a code of governance that will include guiding principles applicable to the HSE as a public body. The Department issued a framework document for corporate and financial governance for the HSE and requested the executive to draw up a code of governance in line with it. The framework document highlighted specifically that in 2001, the Government approved a code of practice for the governance of State bodies under which such bodies are obliged to set out their objectives in respect of the maintenance of proper standards of integrity and disclosure of confidential information. Under the 2004 Act, the HSE is obliged in its annual report to indicate its arrangements for implementing and maintaining adherence to the code.

The HSE submitted a draft code of governance to the Department in September 2006, which is currently under examination in the Department.

The proposed medical practitioners Bill will introduce more streamlined and transparent procedures for the processing of complaints. It will integrate registration, education and training, ongoing competence and fitness to practice processes. It will define clearly the responsibilities of the Medical Council regarding the education and training of medical practitioners. I understand it will provide for the first time a legal framework for the Medical Council's implementation and administration of a system of competence assurance. It is intended that the new legislation will make continuing professional development and education compulsory for medical practitioners. The new medical practitioners legislation will be complemented by the Health and Social Care Professional Act, as well as other forthcoming legislation governing nurses, midwives, pharmacists and dentists. This legislation will have the common purpose of ensuring robust governance, clarity of procedures and formal systems of accountability. Such measures are aimed at the protection of the patient, while simultaneously recognising the need for due process in respect of the processing of allegations against health care professionals.

The purpose of the proposed nurses and midwives Bill is to modernise and strengthen the regulatory framework for nurses and midwives. I understand it will update and amend the Nurses Act 1985 to reflect and respond to the significant changes experienced by the health services and nursing and midwifery professions since 1985. It will seek to ensure that people are better informed and protected and will have increased confidence that the nurses or midwives caring for them are properly qualified, competent and in good standing with An Bord Altranais, the independent statutory body responsible for the regulation of these professions. The draft heads of this Bill include proposals for greater public interest representation and more public transparency, accountability and opportunity for redress. Changes to registration requirements are proposed, as are improvements in the fitness to practise procedures and the promotion of the highest standards of professional performance by nurses through making provision for competency assurance.

In conclusion, it is clear that much work is being done and will be done to improve the safety of patients in our health system. The Opposition has given the impression that nothing has been achieved in this area and, as the Minister indicated, nothing could be further from the truth. A structure is being put in place which will have national application——

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