Liz McManus (Wicklow, Labour)

Yes, half the people who die, die in hospital. That, surely, is the point. We need to ensure there is regulation of hospitals because it is at a vulnerable time in our lives that we are likely to be in care in the acute hospital setting. Yet the Bill does not provide the important powers to end bad practice, to regulate the services and to encourage good practice because that is as important as ending bad practice. Instead we have got a commission, 18 months into the future, after the general election and lots of talk retracing ground that has already been retraced. An opportunity has been lost.

The Labour Party and the Fine Gael Party together produced a proposal and, frankly, I was disappointed the Government did not steal our clothes. It could have done so and we would have welcomed it, but instead we have a Bill that is not up to the task. Consider the reports that have been produced, particularly the Harding Clark report which put it succinctly: "any isolated institution which fails to have in place a process of outcome review by peers and benchmark comparators can produce similar scandals as those which occurred at Lourdes Hospital". That report showed clearly that systems had to change and that regulation was required. In addition, there should be registration of hospitals to ensure there are clear and comprehensive systems in place.

Professor O'Neill made the same point, that given the lack of structure, funding, standards and oversight, similar deficits in care to those at Leas Cross are very likely to be replicated to a greater or lesser extent in institutions throughout the long-term care system. It could be described as a seamless problem extending from acute hospitals to long-term care.

What lessons have been learnt? As far back as 1998 the HSE inspectors declared that Leas Cross should be denied official registration. There have been calls from experts for inspections of nursing homes to move away from the undue emphasis currently placed on examining the physical facilities and to focus more on quality of care. I am concerned about this because it is clear that despite the furore about, and concentration on, inspections there is insufficient expertise to consider fully the aspect of the care of the patient compared to the attention given to the physical environment of these homes. The environmental health officers tend to concentrate on their area of expertise as opposed to the clinical care of the elderly.

With regard to inquiries surrounding patient safety failure in our hospitals, the health report by Maev-Ann Wren and Dale Tussing noted that "the absence of a national licensing system for hospitals is a glaring deficiency in Ireland's health care system that exposes citizens to unacceptable risk". I do not have confidence this legislation will lessen that risk. It simply does not go far enough to give us such confidence. The Minister has missed the mark. She has failed to recognise, resource and empower agencies to protect patients. What she has done is provide a type of knee jerk reaction.

Leas Cross became the issue when it was all over the newspapers and featured on television. The people were outraged when they saw what was happening and demanded action. The Minister has now brought forward legislation that will, hopefully, deal with many of the concerns, although we will put forward a number of amendments in that regard. However, in terms of the tranche of care that is provided by other institutions and facilities, including in the community — I have in mind the unfortunate woman in County Wicklow, Ann, who has been so badly let down by the local authority and the HSE in her area — all the deficiencies cannot be addressed by this legislation because the means are not there to do so. We have not been given the means to ensure that patients who are suffering because of failures in the system will, first, be listened to and, second, will have their needs addressed.

The explanatory memorandum sets out the functions of the authority. The authority "may require the Health Service Executive or a service provider to provide it with any information or statistics the Authority needs in order to determine the level of compliance by the Executive or the service provider with the standards set by the Authority". That is an innocuous statement. The authority is to set the standards and the HSE and other service providers must provide the information to ensure that those standards are being met.

I wish the HIQA luck. Parliamentarians can get neither information nor statistics from the HSE. When I asked the Secretary General of the Department at a committee meeting if he was having difficulty getting information from the HSE, he said it was an unfair question. We cannot get information from the HSE, and there is supposedly a system in place to facilitate the flow of such information. I am still asking a simple question that arose from the Estimates. I will ask it now again, to give the Minister an idea of the frustration that exists and how HIQA will be trammelled when it tries to figure out what is going on.

In the Estimates the regions that are described for funding allocations are the old health board regions. There are four new HSE regions. When I ask the HSE to give me a breakdown of the population areas in terms of the old health board regions, it will not tell me. It continues to give me the figures for the four regions. It is simple statistical information and either it does not know the information, which is incredible given that the HSE is allocating the money, or it will not give me the information. What does that tell us? Will HIQA have to take the HSE to court to extract the information that should be publicly available?

As far back as 2004 the Composite Report recommended that HIQA should "have a role in ensuring that health professionals and the public have access to information that enables them to make informed decisions". That would be nice but the lack of transparency is worrying. The one thing that is clear about the health service is that where there is no transparency, the level of risk increases and the chance of scandals is far greater. We must have a system that is accountable. Regardless of what one thinks about the old health board system, there was some accountability in it. That has been ripped out in this reckless drive to centralise. It is extremely worrying and I cannot see how HIQA under this Bill will be in a better position than many others in trying to get information.

Health systems data which should be regularly published include health accounts, the national bed count, discharge and treatment patterns of public and private hospitals and earnings of health care professionals. There must be a new health accounting system within our health service. Debates concerning the proper level of health spending in Ireland have been confounded with debates concerning what the actual levels of health spending have been because Ireland has no national health accounting system. Figures commonly cited as representing Irish health care spending are widely known to include social spending. Reported current health expenditure is estimated to overstate actual health spending by more than 20%. At the same time, there are no regular and comparable data on private health care spending. A further confusion concerns inconsistent treatment of medical education. The education of a nurse appears in health expenditure, while the education of doctors appears as an education expenditure.

The other question I asked the HSE related to the number of beds currently in the system and where they are located. I still have not received an answer. It makes no sense that a body managing the health service releases so little information. Good decisions cannot be made unless there is evidence available on which to base them. At the core of many of the problems in the health service is lack of information. Any system or provision that will improve data collection and widen the evidence resource will be welcome. However, the spectre of PPARS will hover over all the commitments made in respect of spending money on computers.

The Minister is not helping in this regard when one considers her plans. There is a wilful determination on her part to privatise the health service. She is creating new and difficult dilemmas relating to patient safety. It is interesting to note the conclusions of Mr. Gerry Robinson with regard to the problems in the NHS. He could hardly be described as a socialist. He has come from the private sector and understands management in that sector. However, he made the point that there is better management within a health service where staff are directly employed in the NHS rather than employed by a myriad of private employers, to whom they are answerable.

I will quote a number of the questions raised with me by a hospital doctor working in a public hospital who is examining the proposal to co-locate private hospitals on public grounds. He examined the ethical and clinical decisions he would have to make to protect patient safety and the dilemmas that will arise. He listed a number of issues we must examine because of a wrong policy decision, for example:

Are co-located private hospitals intended to provide the same range and level of care as the public hospitals? If for any reason the range or level of care is less in the private hospital, how will decisions be made in relation to which patients with private health insurance will be admitted to the private hospital? How will the public hospital administration and staff be informed as to the level of care available in the private co-located hospital? Will patients who have private health insurance being admitted from accident and emergency be offered a choice of public hospital admission? If they have a choice how will they be informed as to differences in the care level between the public and private hospitals? If there is no informed consent, what are the legal implications of transferring a patient to a smaller institution with a different level of care, emergency cover or expertise available? Will there be a guaranteed right of return to the public hospital in any situation where doctors feel that it is in the patient's interests? If members of the medical or nursing staff believe that a patient opting for admission to the private hospital is not acting in his or her own best interests will they be free to so advise the patient?

These are the kind of questions that are emerging as a result of a flawed policy decision. The list continues. I have read only eight of approximately 16. We have not examined this.

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