Mary Harney (Dublin Mid West, Independent)

I wish to share time with the Minister of State, Deputy Áine Brady, and Deputy Beverley Flynn.

I move amendment No.1:

To delete all words after "Dáil Éireann" and substitute the following:

"expresses sympathy with any woman who has been affected by misdiagnosis of miscarriage;

recognises that Ireland has achieved, and is maintaining, very high quality maternity services and has, by reference to international standards, maternal, perinatal and infant mortality rates that are among the lowest in the world;

welcomes the key actions that have been taken to address the issue of misdiagnosed miscarriages including:

— the fact that the Chief Medical Officer of the Department of Health and Children and the director of quality and clinical care in the Health Service Executive, HSE, have jointly written to all obstetric units advising them to ensure that the decision to use drugs or surgical intervention in these circumstances must be approved by a consultant obstetrician;

— the HSE's announcement of details of a miscarriage misdiagnosis review team, and its terms of reference, including the appointment as chair of an independent expert from outside the jurisdiction; and

— the establishment, earlier this year, of a clinical programme for obstetric care by the HSE's national director of quality and clinical care which will define best practice care for early pregnancy loss and other aspects of obstetric care;

welcomes the actions that have been taken by the Minister for Health and Children, with the support of the Government, to improve the safety and quality of care for patients across the broad spectrum of health service activity including, in particular:

— the establishment of the Health Information and Quality Authority, HIQA, as an independent authority to drive continuous improvement in Ireland's health and social care services; and

— the work being done to implement the recommendations of the commission on patient safety and quality assurance;

recognises the effectiveness which HIQA has already demonstrated in carrying out its role as a regulatory authority, which already incorporates the role of a patient safety authority;

endorses the Minister for Health and Children's intention to bring forward legislative proposals that will include the mandatory licensing of private and public hospitals and welcomes, in this regard, the preparations currently being made by HIQA to initiate an early public consultation on draft national standards for better, safer health care; and

supports the other reforms currently under way to improve the quality and safety of our health and social care services including the introduction of competence assurance under the provisions of the Medical Practitioners Act 2007, the promotion of clinical leadership and the development of national care standards and protocols."

I wish to again express my sincerest sympathy to all those women, who have had a misdiagnosis of miscarriage, and their families. I can only imagine the distress, trauma and the hurt it has caused them and their wider families. It is a serious matter and it is treated seriously.

Since this issue arose, a number of changes have been put in place. First, I want to deal with the issue that arose in Our Lady of Lourdes Hospital last summer. In July, when this issue was brought to the attention of the hospital, it introduced a requirement for a second scan and a requirement that where drugs were to be administered or surgical interventions were to take place that they would have to be signed off by a consultant obstetrician.

In moving my amendment to the motion, I said that chief medical officer and Dr. White of the HSE have written to all obstetric units in the country, the 19 in the public system and those in the private system, advising them to take immediate measures where a miscarriage has been diagnosed and where drugs or surgical intervention is recommended that this would have to be approved by a consultant obstetrician. That has been done to give women the reassurance they deserve.

Prior to this matter arising, the HSE appointed Professor Turner in May of this year, as it has appointed 23 other clinicians to lead clinical care pathways, particularly in chronic illness management but in other areas where there is a high volume of activity. The purpose of Professor Turner's appointment is to standardise care across our maternity services - to introduce protocols based on best international practice. He is working with the college of obstetrics, first, in regard to producing guidelines and, second, to ensure that such standard of care is put in place as quickly as possible. We did not have clinical leads in these areas until relatively recently with the appointment of the director of quality control and clinical care at the HSE.

In addition to that, as the Deputies have acknowledged, there is a review of what happened not only in Our Lady of Lourdes Hospital but of any other case that arose during the past five years where there was a misdiagnosis, where a miscarriage was diagnosed and where subsequently there was a viable pregnancy.

The purpose of that review - which is chaired by the vice president of the college of obstetrics in the UK, Professor Ledger, who is joined by Professor Turner, Ms Sheila Surgrue, the lead midwife, and Cathriona Molloy from Patient Focus and a patient representative - is to make recommendations that will inform the new protocols that will be put in place.

As Deputies are aware, misdiagnosis is a feature of all health care systems. Misdiagnosis did not happen today or yesterday or since the formation of the HSE. Unfortunately, for many years misdiagnosis in Ireland was covered up and swept under the carpet - that is a fact. Much of the misdiagnosis that has been brought to public attention in recent years happened prior to the establishment of the HSE five years ago - that is fact. The reality is that these issues were dealt with by way of litigation. I advise Deputy McCormack that, by international standards, Ireland has a low level of litigation in regard to both brain damaged children and misdiagnosis generally.

See this speech in context