Jan O'Sullivan (Limerick East, Labour)

There is no doubt that there is a crisis of confidence in the health service that has been caused by a succession of scandals in recent years, most of them relating to misdiagnosis. The one described by Melissa Redmond on television, and other mothers who subsequently came forward, went to the core of many women's need to feel confident in the early stages of pregnancy. When they are told by an expert that the pregnancy is over and they will need a procedure to complete it, the very idea that it might not be the case has shaken women.

Deputy Flynn put her finger on it when she talked about the women who must be wondering if it was right in their case. Melissa Redmond was very brave, with a decent, nice looking family, and was dealing with this extremely well but I also thought of all the other women who will never be on television to speak about this issue but who feel deep in their hearts that this might have happened to them, that they had a viable pregnancy that was ended. That is having a huge effect on women who might never come forward or telephone a helpline and there must be many women who feel like that. I am very disappointed we do not have an independent inquiry because we simply have to restore confidence in the health services. We will not do so by constantly reacting to events that have happened. It is all very well for the Minister to state that from now on a consultant obstetrician must sign off before any procedure to end a pregnancy. We are told an ultrasonographer will be in Our Lady of Lourdes Hospital in July. We are told there will be an examination of equipment to ensure it all works properly. However, this is all after the event. It is closing the stable door after the horse has bolted. It is what has happened with regard to many inquiries; we have had interventions after events. What we need are systems to ensure these events do not happen and the public has to know these systems are in place and that they are fail-safe.

The Minister is correct to state that there will always be human errors in medicine. Therefore, we have to put in place systems to ensure human errors do not lead to bad outcomes. If a person states a pregnancy is over, there should be a system in place so another opinion is sought or a senior person is present.

The report stated that equipment was fatigued and that the image resolution was not adequate to accurately assess early pregnancies and their complications. The Minister was very disingenuous when she stated that it was only six years old and should have been good for business for another while. It was described as "fatigued" because it was in use so much. It is not necessarily a question of age. It is a question of ensuring definite procedures are in place with regard to the age of a piece of equipment or how much work it has done. I am not an expert on this but there are experts and people who know all of these things. We must ensure these procedures are in hospitals.

I spoke to someone who works in obstetrics who told me there is no equipment replacement procedure built into hospital budgets. There should be an automatic renewal of that section of the budget when a piece of equipment is ready to be replaced and it should be built into the budgets. What happens now is that if a piece of equipment is getting old and needs to be replaced, whoever controls the budget in the hospital must be chased to get the money to replace it. That is not how it should be. It should be built into the system so the money automatically comes into the budget when a piece of equipment needs to be replaced. This is done elsewhere; it is written into businesses when they write the age factor of equipment into planning. This should also be the case in hospitals, where patient safety and people's lives are involved.

We do not have enough consultants, particularly consultant obstetricians given the population level. We will now be faced with a shortage of non-consultant hospital doctors also. There is a real fear in maternity hospitals, which are already very overcrowded, with regard to what they are expected to do and population growth. They fear there will not always be time to do what is right. We cannot let that happen in our hospitals.

Deputy Reilly's motion proposes establishing a patient safety authority. My wording would have been that we turn HIQA into a patient safety authority but we do not differ greatly on this point. Deputy Reilly proposes that we introduce a patient safety authority and incorporate HIQA into it. I do not really mind what language we use on this; what is important is the power the organisation has and its function. There should be only one body and the Minister was being disingenuous when she stated the motion proposes the establishment of another quango. That is not what is being proposed. What is proposed is that the quango in existence would be replaced by another which would subsume it. I would do it the other way around but that is not important and we will support the motion.

What is important is that the body is given the appropriate powers to do what it needs to do. HIQA does not have strong enough powers. It can instigate investigations but it cannot always get all of the information it requires unless it is asked to carry out an investigation. Issues arise with regard to the powers of HIQA. The legislation did not give enough teeth to the organisation. It can set standards and will do so on public and private hospitals, just as it has set standards on nursing homes. However, the problem is ensuring the resources are there to implement the standards. Unfortunately, on many occasions when the public system is not given sufficient resources, the standards are misused to close facilities rather than building up those facilities to comply with the standards, which is the approach we need to take.

It is all very well having public and private hospitals subject to standards but private hospitals can turn away people. They can pick and choose what they do. Therefore, they can easily comply with standards. More and more, the public system will be left with the more difficult and costly procedures. This will make it more difficult for the public system to comply with the standards. This is disingenuous. One cannot compare like with like if one allows private hospitals to cherry-pick. Ultimately, we do not agree with apartheid between public and private hospitals. If everybody was in the same system, we would have the same standards for everybody, which is what any decent public health system in a democracy should have.

A recommendation from the report into Rebecca O'Malley's misdiagnosis was that every hospital, and everywhere health care is provided, should have a patient advocacy service. This is very important but it has never been properly implemented. If one feels doubt about anything to do with one's treatment, one should be able to go to an independent advocate who does not represent the hospital but who speaks for the patient. The patient has to be at the heart of this. Deputy Reilly uses the name "patient safety authority". Whether it be called the "patient information quality and safety authority" does not matter; the patient must be at its centre. Advocacy at local hospital level is very important in this regard.

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