Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

I thank Deputy Jan O'Sullivan for sharing her time. The Sinn Féin Deputies fully support the motion in the name of the Fine Gael Members. We welcome the fact that Fine Gael has used its Private Members' time to address this urgent and very serious health care issue.

It is, without question, a hugely traumatising issue for possibly hundreds if not thousands of women who may find, or who may have reasonable grounds to believe, that their viable pregnancies were terminated after being wrongly diagnosed as miscarriages. This is the first time the issue has been addressed substantively in the Dáil, despite the fact that Melissa Redmond's story was first revealed in the media at the start of June. The Government refused to provide time for statements and a question and answer session with the Minister on an issue that is of huge concern to thousands of women and their families throughout the country. I sought this opportunity repeatedly but without success. Last week, the Minister for Health and Children responded to questions on this issue. I stress "responded" because she gave responses rather than the answers that Deputies were seeking.

I asked why the Minister, the Department and the HSE had to wait until after Melissa Redmond's story went into the public arena, when it was first known as far back as August 2009. Did not the Minister, the Department or the HSE consider the implications of what was brought to their attention then, not only with regard to Melissa Redmond's story but for other women presenting at Our Lady of Lourdes Hospital, Drogheda and for women who, perhaps in other circumstances, would present or had presented, at other maternity units across the State?

I asked why the Minister only responds when the spotlight of public attention is directed at an issue. I find it very difficult to understand how something of such seriousness would not have triggered a spontaneous response throughout the system to try to establish the facts to eliminate any possible misdiagnosis presenting and reflect on fact that many women are in anguish each night since the time this story first became public. The Minister stated in response that from the time this case came to the attention of the HSE, her Department and the hospital, action was swiftly taken to establish what had happened. That was only answering a different question, not the question put. The question we still need answered is why the systems failure was not addressed and why the possibility of a systems failure beyond the Our Lady of Lourdes Hospital in Drogheda was apparently not even considered until after the matter went public at the start of this month.

The information given by the Minister in the Dáil last week was first revealed in answer to a parliamentary question tabled by me on 15 June. In that reply the Minister admitted that the Melissa Redmond case had been brought to her attention as far back as August 2009. When Melissa Redmond courageously spoke out about her experience in Our Lady of Lourdes Hospital in Drogheda earlier this month she was followed by other women across the State with similar experiences. The Minister, however, still stayed silent on the issue even though the numbers presenting continued to grow. The early cohort of women were all women who, thankfully, had happy outcomes. The diagnoses was questionable but they had enough within themselves to challenge that and seek a repeat diagnosis to secure confirmation of what they believed. All of this represents a classic case of patients not being listened to. We must have full disclosure of all of this.

I welcomed the announcement of the terms of reference and review team for the HSE's miscarriage misdiagnosis review. Women who have had these experiences need to be fully supported. I encourage women to contact the maternity hospitals where they received treatment to ensure they can access the information regarding their treatment if they have any questions or concerns regarding their experiences.

It is also welcome that from now on all decisions to use drugs or surgical intervention in women who have had a miscarriage diagnosis must be approved by a consultant obstetrician. The question is, again, why it took this public scandal for that to be implemented. Surely such a practice should have been in place. It is only now, in the wake of media coverage, that the review and the changes in practice are being put in place. This surely indicates a systems failure and examination of this failure should be added to the review's terms of reference.

The Association for Improvements in Maternity Services Ireland, AIMSI, has pointed out what it calls the "widespread fragmentation of maternity care services", which includes huge variability in the type and standard of care available to women, a lack of continuity of care, poor communication between health care professionals and women in their care, over-reliance on technological equipment, as well as under funded, overcrowded, under staffed centralized care units, which is very much the order of the day under this Minister and Administration. Crucially, it points out that such a service does not create a space for the voices of women to be either heard or listened to and allows for an unacceptable margin for error. This has undoubtedly resulted in undermining women's trust in the health care system. I agree with AIMSI and others when they say it should not be the responsibility of individual women to ensure they receive such care but, rather, the responsibility of health professionals, the HSE and, ultimately, the Minister for Health and Children.

AIMSI has also highlighted some very important information that the Minister and the HSE need to take on board and which should be examined by the review. AIMSI states that it is aware of many instances of questionable ante-natal scan diagnoses other than those highlighted in regard to foetal viability and early miscarriage diagnosis and misdiagnosis. It is also aware of cases in which dating errors have led to the premature births of babies. All of this information needs to be carefully examined and acted upon.

There has been and clearly still is over-reliance on technological equipment. That is why scans need to be checked and double-checked and repeated, especially in the case of miscarriage diagnosis. Nothing can replace the skill and experience of the health care professionals. Equipment must always be seen as an aid to that skill and not a substitute for it. In a time of widespread health cutbacks there is a danger that the machine will be seen as the cheaper, easier option, rather than the full attention of the health care professional.

Last week we raised with the Minister for Health and Children the need for her to order a full review of consent policies within the maternity system and initiate national guidelines for clinical practice in maternity care. She replied that the HSE has recently established a clinical programme for obstetric care led by Professor Michael Turner of the Coombe Women's and Infants University Hospital and that an important priority in the programme will be the development and implementation of national guidelines for clinical practice.

The Minister stated that she expected that, in regard to issues of consent, the provision of obstetric services in accordance with these guidelines, as is the case in all other health services, will meet ethical guidelines set by the Medical Council in 2009. She also stated that the miscarriage misdiagnosis review announced by the HSE will inform the development of the proposed national guidelines. That is welcome, as far as it goes. However, an internal HSE review is not enough. As the motion tabled by Fine Gael and Deputy Reilly states, the role of HIQA needs to be enhanced. An independent patient safety authority should be established.

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