Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

The Deputy is correct. He did refer to it, but a Deputy who spoke after him took a different view.

Now that the economy is growing again, we can do better. Increasing staff numbers, coupled with a falling birth rate, mean that, although there is a way to go to reach OECD or international levels of staffing, the situation is improving and will continue to improve.

Spending cuts and freezes across the health service from 2008 onwards had an inevitable effect on services. However, this year an extra €2 million has been provided in the HSE national service plan 2015 to address current pressures in maternity services. It includes provision for the recruitment of additional obstetricians this year, over and above mentioned, midwives and other front-line staff.

As I outlined, the issues in Portlaoise are not directly or solely related to resources. Recent media reports have suggested Portlaoise hospital was in some way drastically underfunded compared to similar hospitals. In fact, the funding for it is broadly on a par with similar, formerly model 3 hospitals such as Portiuncula, Wexford and south Tipperary hospitals which all serve a similar sized population. The budgets for them in 2014 were as follows: Portlaoise hospital, €53.5 million; Portiuncula hospital, €54.9 million; Clonmel hospital, €51.4 million; and Wexford hospital, €52.9 million. In response to Deputy billy Kelleher's question earlier, the former Minister, Deputy James Reilly, explained that Portlaoise hospital was not included in the small hospitals framework because unlike the other then called "model 2 hospitals", it had maternity and paediatric services and anaesthetic services 24/7. Therefore, it was not comparable to other smaller hospitals.

There has been much commentary on accountability. As I am sure the House will agree, everyone involved in this matter has a right to a fair hearing in accordance with stated disciplinary procedures. HIQA does not name any individual and it is not in my power to effect summary dismissals or sanctions against persons who are not in my employment. I do not propose to comment further at this time, other than to say a number of staff have had complaints made to their professional regulatory bodies about their involvement in care in Portlaoise hospital. These complaints will be investigated in line with standard procedures and the law. In addition, the HSE is finalising an investigation in line with its code of governance and disciplinary procedures. This may result in disciplinary action being taken against some individuals in management positions.

A culture of patient safety needs to be embedded in the health service. We need a health service with the patient and his or her needs at its centre. I have a clear focus on patient safety and have ensured this has been made a priority within the HSE's annual service plan. My officials meet the HSE each month to discuss the service plan and patient safety is a standing item on the agenda. There are many facets to patient safety and several initiatives have the potential to drive significant change in the coming years. Leadership of this change, through governance and management, will be a key dimension. Guaranteeing better outcomes for patients is a fundamental principle of our health reform programme. We all continue to strive to ensure patients receive the best care possible when they need to access health and social care services. Recent reports show that we still face many challenges to ensure health and social care services are truly safe and the highest quality. I am, however, confident that implementation of the HIQA and chief medical officer's reports on Portlaoise hospital will ensure patient safety is everyone's priority and reassure patients that the services they access are of the highest quality and safe.

Before I became Minister for Health, there was a plan to create a patient advocacy agency as a sub-agency of the HSE. I strongly believe any new patient advocacy service should be independent of the HSE. That is why the HSE was told to remove the proposed agency from its service plan for 2015. My view has been supported by the recommendation made in the report on Portlaoise hospital. I plan to establish a fully independent national service before May 2016. The scope, role and functions of the service need to be considered, with the structural, governance and funding arrangements needed. My Department will consult widely on the best way to get the service up and running in the shortest possible timeframe.

Informed by HIQA reports on various hospital services and based on analysis and internal discussions on patient safety priorities, I intend to strengthen the patient safety role and functions of my Department. I will develop a significantly enhanced patient safety function in the Department, with a clear mandate for leadership, direction and oversight for national improvements in patient safety, clinical effectiveness and patient experience. This new function is in addition to other patient safety policy initiatives in progress, including legislative proposals for the further regulation of health care, patient safety provisions in the Health Information Bill and the recently completed work on the code of conduct for employers which clearly sets out employers' responsibilities in achieving an optimal safety culture, the governance and performance of the organisation.

My Department continues to progress the Patient Safety (Licensing) Bill. However, as an interim step towards licensing, I will shortly bring a memo to the Government seeking approval to draft amendments to the 2007 Health Act. The amendments will seek to extend HIQA's remit to the private health care sector in the short term. I also intend to bring forward legislation to give effect to recommendations made by the Commission on Patient Safety and Quality Assurance to facilitate open disclosure of adverse events to patients. In the meantime, the HSE has begun to implement the national policy on open disclosure across all health and social services. The policy is designed to ensure an open, consistent approach to communicating with patients and their families when things go wrong in the provision of their health care.

The HIQA report on Portlaoise hospital called for a group to oversee implementation of the recommendations contained in the report. I have approved the composition and terms of reference of this group which will be chaired by the Chief Medical Officer and include senior officials from my Department, as well as patient representation. I have also written to the HSE director general, requesting a plan and a timetable to implement HIQA's recommendations. This plan will be used by the oversight group to monitor the HSE's progress on implementation. A named person in the HSE will have responsibility for reporting to the oversight group on behalf of the directorate on progress made on a monthly basis. The reports will be published quarterly. The House will be aware that for 2015 the Minister of State, Deputy Kathleen Lynch, and I will develop as a priority a mechanism to better monitor implementation by the HSE of the recommendations contained in previous HIQA reports. I will seek regular updates and intend to use it to drive a much improved commitment to implementation than we have seen in the past.

I want to finish by reassuring the House that I will do everything in my power to ensure the recommendations made in the report are implemented without delay. We cannot undo the loss families have suffered or the experiences patients have had, but we can ensure the lessons learned will not be ignored. I spoke about the bravery of those who had spoken out and believe there is some space for political bravery on the part of all of us here. We all have a responsibility to act as leaders, either nationally or in our constituencies, to ensure all decisions made in the health service are made on what is best in terms of patient access, safety and clinical outcomes, rather than giving in to vested, institutional or political interests. In the next few years as we implement the hospital groups we will need to consider reconfiguring and restructuring how services are delivered across them. There is a role for us all as public representatives to ensure we deliver the best health service possible, but we need to ensure that in doing so we do not approach reconfiguration through the "save our local hospital at all costs" approach; nor should it be about financial savings, rather, we need to view issues from the perspective of what is best for patients, see what services can be safely delivered in each hospital within a group and plan services accordingly.

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