Mary Harney (Dublin Mid West, Independent)

I will not allow the Deputy to interrupt me; I want to continue to say what I have to say.

The purpose of reviews is to learn from the experience and to put that learning into effect. That is the reason we have them. We have had a number of them and they have been put to good effect. For example, in my Department since the Portlaoise incidents, a new patient safety protocol is in operation. When letters in this respect arrive in a routine fashion in my office, that of any of the Ministers of State or that of any other member of the Government, they are handled by the office of the chief medical officer. Heretofore, the chief medical officer and his team were advisers to the Department, now they head up a division that primarily deals with patient safety issues, and that is the appropriate response. Correspondence is received from patients, lawyers, health care professionals, including doctors and it is not possible for a political head or anybody with a political perspective or an administrative background to be able to handle those issues appropriately. They should be handled by the clinical expertise in the Department, and that is what happens.

Patient safety generally has been a high priority of mine. We have established HIQA and the purpose of doing so is to have an independent body, independent of the service providers, to set standards, monitor the implementation of those standards and enforce them. HIQA is free to carry out its own reviews or it can carry out reviews if requested to do so by me. It has been involved with this review group. It was consulted on the terms of reference and the scope of the review. Although there has been criticism that the review only extends back to the past five years, the review group will examine other issues that extend beyond five years from which there can be a learning that will influence protocols.

In addition to establishing HIQA, if we are serious about having a quality authority, we have to be prepared when it makes recommendations to enforce them. I spend hours in this House seeking to make changes in the interests of patient safety, but we are constantly opposed in that respect. I challenge somebody to tell me that it is in order for a country with 4.4 million people to continue to operate the kind of hospital system we have at present, or particularly the one we had a few years ago which has improved, where 32 hospitals were performing breast surgery and in some cases a surgeon performed one procedure a year. That system was defended by many Members of this House and others outside this House. If we are serious about ensuring patient safety, we know that is not a safe environment for any woman to present herself for breast surgery. The same applies in other areas of acute, critical and complex care. If we are serious about ensuring patient safety, we must have the courage to back the decisions of those who seek to do something about patient safety, including the reform agenda in the north east. If there is anybody in this House who believes we can have five hospitals for a population of 300,000 people operating to best international standards, providing safe care with the resources that this country can provide for health care, then they need to think again. It makes sense to have critical and complex care in two hospitals in that region, which is what is now happening, and to have more minor procedures, including day procedures and the procedures most of us would have if we were sick, carried out in smaller hospitals. Thankfully very few of us are seriously ill or require complex procedures. When people need to go to hospital they generally require routine care, treatment of minor injuries and diagnostics.

That type of care can be provided safely in smaller hospitals. However, acute, complex and critical care cannot be provided in the number of hospitals in which it is currently available throughout the State. Anybody who is serious about these issues must accept that.

As part of our patient safety agenda we intend to introduce the licensing of all health provision, beginning with acute hospitals in the public and private sectors in 2012. The legislation is currently being drafted and the Health Information and Quality Authority is producing draft standards which will be available next month for public consultation. Those standards will underpin the legislation, and there will be a statutory requirement on all hospitals in the public and private sectors to meet them. It is only by a system of licensing in accordance with standards with a statutory basis that we can guarantee to provide patients with the safest possible care.

No authority can deliver that without the backing of legislation and statutory standards. I hope that when those standards are produced next month there will be genuine engagement by the Oireachtas Committee on Health and Children and by political parties in this House, so that we have an input that is wider than just the clinical community and those responsible for managing and running hospitals and which includes the political community. The standards will be the basis on which licensing will operate. Moreover, following the publication of the report of the Commission on Patient Safety and Quality Assurance we are making legislative changes in addition to those in the licensing area. The Health Information and Quality Authority Bill will provide for adverse reporting, clinical audit and open disclosure. These are extremely important developments if we are to have a health care delivery environment that is focused on patient safety.

I am delighted that Deputy Reilly supports the changes we made to introduce a majority on the Medical Council. That is good for the profession and for patient confidence in the profession. There was not much support for that provision when we introduced it in 2006; it was strongly opposed by many organisations, including many Members in this House. Now, however, it is working well and doctors have great faith in the Medical Council despite the initial scepticism of many of them. As part of that, a competence assurance process has been recently triggered whereby doctors will have to maintain their skills by engaging in professional education and training on an ongoing basis. We all accept that scientific endeavour and the world of medicine is very complex and changes rapidly. Persons who qualify today will not be fit for purpose in ten, 20 or 30 years unless they engage in ongoing professional education and training and meet competence assurance requirements.

We introduced legislation on whistleblowing in the health service some years ago. If any staff member in the public health services is aware of any issue where patient safety is at risk, he or she is totally protected by law in bringing forward that issue. Our initiative in this regard was a first in this area. There is much emphasis now on whistleblowing legislation for financial services and other areas; we did it in health several years ago.

Under the new consultant contract, we now have clinical directors in all hospitals and in many care areas throughout the State. They are responsible for audit, peer review, professional education and training, and for ensuring that appropriate risk management is being pursued by staff within their hospitals. In addition to clinical directors at hospital and network level, we have the national needs directors who will be rolling out care pathways in many areas of chronic illness and other areas such as obstetrics.

I said earlier that there is no substitute for clinical examination. A full-time dedicated ultrasound sonographer will begin work on 15 July at the maternity unit at Our Lady of Lourdes Hospital. The machine in question was examined in November last year and was found to be fit for purpose. It was not an old or clapped out machine. I understand it was five or six years old and that these scanners are expected to have a life span of at least seven years. The reality is that a scanner on its own, as Professor Turner said recently in public, should not be relied upon. There is no safe diagnostic test; it always must be backed up with appropriate clinical expertise. Mistakes happen in the health service, some of which are genuine clinical errors. Humans make mistakes; sometimes there is a lack of knowledge, sometimes a failure of communication and sometimes there are technical difficulties. In regard to the provision of health care at hospital level, we must ensure we have a sufficient number of experts working together in settings such as maternity hospitals to ensure that whenever a risky pregnancy is involved or where there may have been a misdiagnosis of a miscarriage, that it is signed off by a consultant obstetrician.

Deputy Reilly suggests we need a new authority. I am frequently criticised in this House because there are two many authorities and bodies. I did not see the programme but I understand Deputy Barrett spoke on television on Sunday night about the plethora of organisations in health care. The reality, however, is that we have already subsumed a large number of those organisations in the health care area. Some 58 were incorporated into the Health Service Executive on its establishment and, more recently, other organisations such as the Office of Tobacco Control and the Crisis Pregnancy Agency are also being subsumed into the executive.

The reality is that setting up another organisation is not the way to deal with patient safety. We must have patient safety at the heart of everything we do. Every clinician, whether in primary care or hospital care, must be involved in patient safety. We must have a licensing regime based on best practice internationally as far as the provision of services at hospital level are concerned.

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