Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

As we look into the future, and not too far into the future, we know health care will become very expensive in the years ahead. The idea of having people in the acute hospital setting for longer periods than they should be makes no economic sense and is certainly not good patient practice in terms of communicable diseases and other problems associated with people in high-density acute hospital settings.

In a previous life, when I was involved in trade a number of years ago, there were an amazing number of companies developing software packages for the monitoring of patients through the system and back into the home care setting.

I believe there is a strong need to embrace that issue. I know the Government has published a paper on it, which I have read, but we need to go beyond that and ensure we have a meaningful virtual hospital in the community, if the Minister of State understands what I am trying to say. This is a requirement as well. We must ensure we have proper health identifiers in it so that one has guaranteed access to patient information and it is concise and clear.

When one talks about health identifiers, data protection and individuals' details being placed with other people, there is always concern that it can lead to people accessing information for other reasons or ulterior motives. This is why I said I would raise the issue regarding Article 8 of the European Convention on Human Rights. In general, this Bill is a positive step and we will be supporting it.

Generally speaking, the advances in information technology coupled with advances in medicine are key areas we should explore and exploit. Remote diagnostics is one area towards which we are moving. When we talk about reconfiguring hospitals, which is always a contentious issue, rather than just diminishing services in a community, we need to complement services in hospitals by using remote diagnostics in a proper structured way. A radiographer and others could do the X-rays and CT scans and people could be diagnosed elsewhere. A group of clinicians with competence and expertise would be able centrally to look at these X-rays or scans remotely and make an informed decision. We are looking at this area but much more could be done. I urge the Minister of State to look at that issue again.

The question of how we come up with imaginative solutions to providing and complementing services rather than just using reconfiguration as a means to reduce services is the key issue in terms of e-health over the next few years. That is why people are very wary when the Minister of State raises issues regarding reconfiguration and assessing capacity in our health system. The perception is thatthequid pro quo is normally a reduction in services. We have had that case in the context of the reconfiguration in the mid-west with regard to Nenagh, Ennis and Dooradoyle in Limerick. There was meant to have been a transfer out of Dooradoyle to Ennis and Nenagh, but that has not happened with the speed with which it should have happened to give people confidence that while they will sacrifice one service, another meaningful one will be provided in their community not just for the sake of putting a service into the community but to complement the overall health service.

The Health Information and Quality Authority today pointed out that many common causes of adverse events such as incorrect administration of medicines or transfusion of the wrong blood into a patient can be due to poor patient identification processes, basic human error, incorrect filing or a failure in communication. That is something that has caused major difficulties in previous times, and we have had inquiries and tribunals in that context from time to time. Certainly, this Bill is a step forward in that context. It is about efficiency and traceability, ensuring proper procedures are in place and being able to quickly identify a breakdown in those procedures. The Bill in general has looked at those key areas to ensure this does not happen and that if it does happen, it can be rectified very quickly. In his two hats as Minister of State and barrister, the Minister of State might refer to some of the issues raised in the context of concerns e-mailed to me by some people who raised the issue that because of the glut of information available, there could be some way of identifying individuals through the system. That would be a very worrying development.

Last year, the Government published the e-health strategy and eHealth Ireland will be established to implement it. A new IT system for the health system as a whole will be published in early 2014 by eHealth Ireland. Priority projects for eHealth Ireland include a national health identifier infrastructure, e-prescribing systems, online referrals and scheduling, tele-health care, development of patient summary records, online access to health information and a national patient portal. It is a seven year strategy that is divided into two phases - years one to four and years five to seven. One of the aims for the first four years is patients being able to access their own health records, which is clearly a very important issue.

I do not expect the State to roll over easily when people consider that harm is being done to them by it. Obviously, the State has an obligation to protect itself and the integrity of the institutions under it. However, at times when there is obvious liability, we see situations where people who have been damaged by the State or State institutions must go to extraordinary lengths not only to vindicate their good name but just to get access to records. That is an area where we must be conscious of the need to be open and transparent in ensuring people can access information about themselves. For example, there were issues in Portlaoise regarding information that was sought not being made available with regard to the very tragic cases in the maternity hospital there in recent times. That in itself feeds suspicion and undermines people's confidence in our health services. When we have proper records and details whereby one can trace all procedures for an individual right through the health system because of this and other legislation, the records should be opened up and made freely available rather than making people go to extraordinary lengths to access them.

I have tabled some parliamentary questions on Dignity 4 Patients in Drogheda. The State is involved in taking on the Information Commissioner because of his findings that the information should have been made available. I am not blaming the Minister of State personally. Obviously, he takes advice from the legal apparatus available to Government, but at the same time, it leaves people with a sense of distaste that organs of the State are acting aggressively as if they are trying to prevent information from flowing to citizens. As we all know, openness, making as much information as possible available and allowing individuals to vindicate their rights if they have been damaged in some way are healthy in the context of a broader democracy and individuals' rights. That is an aside but it is a critical component.

The quid pro quois that if the State is entitled to gather as much information about people as possible, it should equally be obliged to release as much information as possible to those individuals when they request it. It is fair. With responsibilities come rights, but it works the other way as well. That is something I urge the Minister of State to look at in terms of the broader policy of making information available. The cases at the maternity unit in the Midlands Regional Hospital in Portlaoise were very tragic and we know a review is being carried out. Families have been very hurt and damaged by the tragic loss of life, but there was also the issue of how it was handled. I do not want to prejudge anybody or point fingers at any individuals but having met with some of the people involved, their major concern after the tragic events was the way they were handled in terms of information flow. Trying to gather records and seek information was almost impossible. That does not augur well for openness and people being able to find out what went wrong and to right that wrong as best they can in terms of reaching conclusions.

Turning again to the e-strategy as part of the broader health strategy in the years ahead, the Digital Hub and software conferences that are continually held in Ireland display the world's most dynamic companies. They provide wonderful quality products, software designs, etc. The State should embrace them more by using their cutting edge technologies, which they export all over the world from Ireland. Although some of those companies export their products for use in government agencies and departments, it used to be the case that we did not engage with them as efficiently and effectively as we should have. One would like to believe that a company has been supplying the Department of Health or so on with a product, but we often find that the opposite is the case and the company has been convincing other countries to embrace their products before relaying that information back. This is not a criticism of any Irish Government, but we should be more proactive in considering what is in Ireland. The areas of e-health and e-medicine are clearly ones in which we have an advantage over other countries, given what companies in this country have developed.

By and large, I welcome the Bill. A commitment was given to the troika to publish legislation on health identifiers. Obviously, it is not one of the conditions the current Government renegotiated, but there was no need to anyway, as it is a positive step. We support the broad thrust of the Bill and look forward to some of the discussions that may be held on Committee Stage.

Could I get further information on the questions of information, the dissemination of same and medical confidentiality? These are issues of concern, but if they could be alleviated, even through a statement as opposed to an addition, that would be fine by me, but when one sees a state that is gathering information afraid for whatever reason to disseminate that information, it leads to suspicions of Big Brother watching and being in control. It undermines what is being done to a certain extent.

See this speech in context