Barry Andrews (Dún Laoghaire, Fianna Fail)

I welcome the opportunity to participate in the discussion on the Bill tabled by Deputy Reilly which deals with the need to ensure that all doctors are properly indemnified and have appropriate medical negligence cover so that patients can be compensated in the event of unsatisfactory treatment.

This is an area in which I have some interest having been a barrister, a profession which has professional indemnity insurance and where compensation is provided for negligence. In my case, amazingly, it did not have to be called upon at any time but it provides a certain assurance to clients who use these professional services and develops the profession in many ways. The type of cases that are thrown up tends to inform professional standards and professional development. It serves the purposes of compensating those who have been wronged and brings along the profession, and is something that would be appropriate to other professions.

My area of responsibility as Minister of State with responsibility for children involves me with the work of social workers. The work they do is extremely complex. They deal with some of the most at risk and vulnerable children and children who have been failed by many other professional services, whether it be schools, family support or agencies of the Department of Social and Family Affairs. Some of them come to social workers damaged and very difficult to reach. For that reason the work that social workers do is extremely complex, yet it attracts a deal of criticism from people who should know better but who are probably not very well informed in these areas.

Nevertheless, like every profession there is bad practice but unlike other professions there is not sufficient examination of that bad practice. In medical negligence that practice is examined in forensic detail in court hearings and allows for learning within the profession. Might it not be appropriate to have more examination of those types of cases in social work? It strikes me that the reason this has never happened is that the clients and their families who avail of social work services are generally not well off and probably not aware of their rights or the type of compensation to which they normally might be entitled in the event of professional negligence. Negligence is not widespread in social work, or no more so than in any other profession, but it would benefit from the same type of forensic analysis that takes place in the medical negligence cases with which we are all familiar.

It is very clear from the debate to date that all Deputies share the view that we must do everything possible to avoid negligent care in the first instance. Patients have a right to a high standard of care and to patient safety, which is a priority for the Government. I will concentrate on measures which the Government has initiated on patient safety and quality assurance. There have been several developments in patient safety in recent years which reflect the Government's determination to deliver in this area. Two of the most significant are the establishment of HIQA in 2007 and the work of the Commission on Patient Safety and Quality Assurance which was also established in 2007.

HIQA has statutory responsibility for setting standards on safety and quality of services throughout the entire public health service with the exception of mental health services, which are the responsibility of the Mental Health Commission. HIQA also has responsibility for undertaking investigations as to the safety, quality and standards of services where it believes there is a serious risk to the health or welfare of a person receiving services. I want to take this opportunity to thank HIQA for the enormous contribution it has made to the development of child protection services in the State, particularly in the children's detention schools and in the area of youth justice. The standards it has set and the work it has done with the HSE is phenomenal and it has made a huge contribution to the implementation plan that followed the Ryan report.

HIQA has developed standards on care in symptomatic breast disease, hygiene, infection prevention and control and residential care for older people. It completed the hygiene service quality review of acute hospitals in 2007 and 2008 and it has also undertaken three major investigations, the result of which has been clear significant recommendations to improve the safety and quality of our health service. These are at an advanced stage of implementation.

There is no doubt the patient safety and quality environment which our public service delivers has seen a marked improvement in the past two years in particular. It is interesting to note that two weeks ago the European Health Consumer Index saw the Irish health service rising a further two places from last year and a total of almost 15 places over the past four years to 13th position among European health services. This gives us ample room for improvement but also cause to remark that the HSE has made a contribution to improvement in those standards. It is important that we challenge the often undisputed received wisdom that the HSE has made no difference since its establishment. I fundamentally reject that argument. The Health Service Executive, HSE, is the one development acknowledged by the European Consumer Health Index, as having contributed to the improvement in Ireland's position in the past four years. Due acknowledgement should be afforded to the HSE because it is an issue of morale for the thousands work in it who are routinely and systematically vilified in the media and this House.

The work of the Commission on Patient Safety and Quality Assurance is also significant. It was established in 2007 to develop clear and practical recommendations to ensure that the safety and quality of care for patients is paramount across the health care system. The commission's report, Building a Culture of Patient Safety, was approved by the Government last January and is being implemented. The report contained 134 wide-ranging recommendations, including proposals for legislation and licensing of all public and private health care providers, the development of standards on patient safety and quality that will apply across the service, a comprehensive national programme of clinical audit, mandatory reporting of adverse events and the introduction of a system of credentialing and privileging of health care professionals.

On the licensing of all public and private health care providers, the commission recommended that it should begin with acute hospitals and other health facilities based on an analysis of potential risk to patient safety. It specifically stated the first phase of licensing should include facilities where medical treatment is given under anaesthesia or sedation and obstetric services, a welcome recommendation. Following the introduction of this framework in these areas, the commission's view was that the licensing system should be subsequently rolled out to other facilities, such as primary, community and continuing care, following comprehensive consultation with all the relevant stakeholders.

We cannot underestimate the complexities involved in this major task. Preparatory work has already commenced in the Department and it is intended to bring detailed proposals to the Government next year. In the meantime, in advance of the introduction of legislation for licensing and in line with the commission's recommendations, the Health Information and Quality Authority, HIQA, is working towards the development of national standards on safety and quality to be applied to hospitals and all future licensed health care facilities with priority in areas where a high and immediate risk to the health and welfare of patients is identified.

HIQA has developed a model for quality and safety based on research and analysis of international and national literature on safety, quality and standard development. The process of wide consultation with stakeholders, including patient, service-users and patient advocates, clinicians, and service providers both in public and private health care, has commenced.

Credentialing is a process whereby health care organisations will be enabled to review the qualifications and track record of doctors and other professionals. Privileging is used by health care providers to define the scope of practice of health care practitioners. It is an important area with the development of private medicine. The intention behind the commission's proposals on these is to develop systems which will enable employers and regulatory bodies to share and verify information regarding the qualifications, competencies and disciplinary records of regulated health professionals operating in the public and private sector. These systems will enable employers to make informed decisions as to the appropriate range of treatments and services to be provided by each regulated professional, thereby enhancing patient safety and promoting the quality of care.

While the full implementation of these proposals will take some time, it is intended to prioritise work and information already in the public arena which could be more efficiently organised and shared without the need for significant changes. It is fully intended these systems will work across borders both within the EU and internationally.

I welcome the agreement by the Minister for Health and Children, Deputy Mary Harney, particularly in light of the complexities and sensitivities of medical indemnity insurance, to give the issues raised in the Bill detailed reflection from a legal, administrative and practical perspective. In particular, the issue of the further consideration of how best to provide for mandatory professional indemnity cover for medical practitioners will receive careful attention. Many issues arise which must be carefully thought out to ensure solutions are practical, proportionate and workable. Most important, the solution to this complex issue must have at its heart the protection of the public and the promotion of public safety.

See this speech in context