Joe McHugh (Donegal North East, Fine Gael)

I welcome the Minister to the House and I congratulate Deputy Reilly on putting forward this motion. The substance of the Fine Gael motion proposes the establishment of a new, independent patient safety authority which would incorporate the Health Information Quality Authority. This is necessary because the State's existing health care complaints facility is a function of the HSE, as Deputy McCormack alluded to in his contribution. Its staff are employees of the HSE. Health complaints officers in other countries are independent of those countries' health service providers. HIQA can only function effectively if it is answerable to an organisation that is independent of the HSE. Today, it receives complaints from patients and feeds them directly back to hospitals and into the HSE's complaints system.

I would like to raise an issue that the Minister might consider parochial, but it has the potential to become a serious national issue. I refer to an indication by the HSE management that they are looking to replace the out of hours cover by specialist junior doctors in Donegal hospices with locum GP cover from the local out of hours Now Doc service. Such cuts shatter the confidence of people in the HSE. Replacing specialist palliative medical care with Now Doc care is unthinkable for hospice patients. Locum GPs will not know patients' medical histories and will not have the required medical expertise, which is expressed in the Government's own 2001 report on palliative care.

The report by the national advisory committee on palliative care in 2001 was described by the Minister as a blueprint for the future of Irish palliative care. It is based on two principles. A needs assessment is regarded as a foundation upon which health care priority setting should rest. Specialist palliative care should be available in all care settings and should support the patient wherever he or she may be - at home, in hospital, in residential care, in day centres and outpatients or in a specialist palliative care unit. There is a growing concern at local level in my constituency, among experts in the field and among patients, that this system of replacing specialist junior doctors with locum GPs does not represent the philosophy contained in the report. The report also notes that all specialist palliative care services should have available an essential minimum core professionally staff, with recognised post-qualification specialist training. It states that in delivering palliative care, different professional groups will have areas of common interest that require different levels of specialist knowledge.

How much did it cost the State to commission the report by the national advisory committee on palliative care? Why is it being blatantly contravened? Specialist junior doctors are paid monthly in block payments for providing this out of hours service in the HSE north-west area. It is accepted by practitioners that there will be cutbacks and there has to be more value for money. However, there is a proposal on the table that the HSE should pay specialist junior doctors on a call by call basis - there may only be 12 to 15 calls per month - rather than giving them a block payment per month. I know the Minister will allude to the consultants' contract and say that this is not possible, but where there is a will, there should be a way. This proposal would achieve the Minister's targeted savings while maintaining specialist out of hours palliative care. Will the Minister engage with the practitioners and the experts on this proposal?

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