Liam Twomey (Wexford, Fine Gael)

Perhaps the Minister's advisers are afraid to tell her the truth.

We also had a situation whereby a HSE official asked doctors to stop writing letters to senior HSE managers so a paper trail would not exist. This was why the situation in Leas Cross was exposed and why we need patient safety authorities. We need such authorities because of the way the board of the HSE and ministerial advisers act and the way Fianna Fáil, because it has been in power for so long, uses the civil and public services as though it were an extension of the political party. Patient safety authorities are also needed because of the attitude of HSE officials that if letters are not written a problem will not exist.

This is the ethos we wish to change. We want the health service to work for people. The Health Information and Quality Authority, HIQA, makes no provision for patient advocacy. This means if patients want to complain about the HSE, health professionals or hold Ministers to account they run into brick walls. We must have an advocacy role within our health services because it is extremely difficult to follow the complexity of the bureaucratic system and we must help patients through it. We will change how the system works when patients can complain properly and give information to those who can change policy in a way which is understandable.

For these reasons, I will closely examine the Medical Practitioners Bill. Politicians and administrators are not the only ones who have a role to play in this; the medical profession also does. Either the Minister does not seem to grasp that concept or she is not willing to change the ethos of the health service. Advocacy is one of the best ways to start. The Minister should stop messing with another commission and implement our policy which contains a clear role for advocacy.

The main problem with the Bill is that it attempts to cover too wide a remit with far too many roles and functions. It makes hollow promises on patient protection. It also mentions evaluating IT projects and clinical cost effectiveness. The concept of clinical cost effectiveness can be quickly lost on people but it was not lost on the Minister. This is modelled on the British National Institute of Clinical Excellence which is extremely controversial. Under the remit of a patient safety organisation it becomes dysfunctional.

A national institute of clinical excellence may sound as though it does not do anything too distinct. Such an institute evaluates projects and drug costs. The case that caused considerable controversy in the UK related to a cancer treatment drug called herceptin. The institute said that some patients should be denied this treatment not because it was not working or that patients were at risk from it, but because it was not cost-effective. I find it very strange that the Minister would include an institution that denies treatment to patients in legislation that is also supposed to have a role in protecting patients. This, along with the setting of standards and the evaluation of IT projects, is giving rise to confusion as to exactly what HIQA is supposed to do in the coming years. The Minister has got it wrong and needs to step back. This needs to be separated because we are becoming very confused about the role of HIQA in the health care system.

I am worried about running out of time because I wish to cover a number of matters.

See this speech in context