Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I note that my colleague, Deputy Ó Caoláin, spoke on this legislation in January of this year and that it has taken us almost a year to come back to Second Stage. I welcome the opportunity to discuss this legislation and other issues relating to the medical profession and safety in our health system. We have been told that this legislation is designed to protect the public and to have a proactive system of robust registration and regulation of the medical profession in order to minimise the risk to the public and to safeguard the health and well-being of people accessing health services. The legislation is supposed to do this by making it mandatory for medical practitioners engaged in medical practice to provide evidence to the Medical Council of minimum levels of indemnity insurance cover on registration with the council and on annual renewal of the registration.

While researching this legislation, I noted with interest that issues relating to medical negligence and clinical negligence cases were central to this and to other upcoming legislation. This struck me because I see our health system as being under-resourced and having capacity issues and an inability to recruit and retain staff. These issues are the greatest enabler of medical or clinical negligence currently. While we are legislating to ensure that medical practitioners are sufficiently covered, we are not making enough strides to ensure that the health system is robust enough to offset potential incidents. This is what we are discussing, namely, the likelihood, or otherwise, of these incidents occurring. For example, the Minister might take the frequency with which the full capacity protocol is being deployed in our hospitals. It was deployed 2,300 times in a 321-day period in 2016 across 26 hospitals. The protocol of last resort is now being used with such worrying frequency that alarm bells must be going off in the Department of Health about the lack of capacity. Yet, despite the Government rhetoric of there being the largest investment in health in years - I have heard so many times about the largest investment ever in the history of the health service - it seems this is not enough. Even as we sit here this evening, the full capacity protocol is being overused. The full capacity protocol should indicate that a hospital has breached maximum capacity but it appears to be a constant state for many of our hospitals now.

With accident and emergency departments overcrowded, people languishing on trolleys and understaffed services across all parts of the health service, how can we expect that we can deliver quality, safe care without any incident? We see nurses and midwives balloting for industrial action in some areas, precisely because they do not have the confidence in the services. The decision by INMO members to commence industrial action is based on their concerns in regard to patient safety and their ability to provide safe care. These concerns are well known and have been articulated in the media many times. It is a great concern to front-line midwives that the ongoing clinical risks due to a shortage of staff remain unaddressed. What is the Minister of State doing to address this? I am sure the Minister of State would agree that in order to make the health system patient-focused and progressive, as previously stated, these issues must be addressed urgently.

I would like to use some of my time to refer to another matter, albeit a slightly tangential one relating to general practitioners. From deliberations we have had in committee with the Minister for Health and officials in the HSE it is clear that preparations for the next phase of the discussions on a new GP contract are under way. Similarly, as I have read in the newspapers and elsewhere, the HSE has commenced a comprehensive public and stakeholder consultation process. I raise this issue because of the current dispute and problems surrounding Shannondoc. I am very cognisant that there are many facets of the GP contractual relationships with the HSE to be addressed in the new GP contracts, but I believe that the current issues with Shannondoc and the provision of services present some important issues that must form part of these deliberations. The people of west Clare have been very active recently in holding public meetings on this issue and they have discussed the issue across the length and breadth of the county. It would be important for the Minister and his officials to engage directly with these people, to navigate a mutually beneficial response to the situation in which they find themselves. On the one hand, we have the GP co-operative claiming that falling GP numbers was behind a decision to scale back services in east, west and north Clare while on the other hand, the HSE says there are two fewer doctors in the county over the past six years.

In terms of the issues in west Clare, it is becoming clear that a row over out of hours rostering is the main driver behind the recently announced changes to services in this part of the county. It is fair to say that this is not a funding issue. The funds have not been cut despite the fact the service to the public is being reduced. Out of hours rostering and the availability of GPs is an issue. When people cannot access these services out of hours they are more likely to head directly for the hospitals, to be on the safe side and to avoid wasting time. This puts pressure on our hospital system which will, inevitably, lead to the litigation and the issues we are discussing this evening. It is not enough to ensure that doctors have indemnified themselves against the failings of the health service. We should be looking comprehensively at the issues that lead to the levels of litigation and the levels of patient safety we discuss perennially.

Galway University Hospital operated the full capacity protocol 181 times up to November and in Limerick, it was 283 times. The cuts in Shannondoc are forcing the people of west Clare into these hospitals. We are not developing primary care; instead, we are simply overburdening an already overburdened system.

Shannondoc provides a really vital, urgent out of hours GP service the people of Clare cannot do without. This scaling back of Shannondoc services will only result in more people joining the queue in the already overstretched accident and emergency departments. It can have no impact other to ensure the accident and emergency departments, which are already stretched to capacity, are further stretched.

We are becoming a more litigious society, but the best way to combat this is investment and open disclosure, to take the burden off the individual. Individualising the issues caused by the systemic failure in the health service, by forcing each medical practitioner to account for himself or herself in regard to indemnity is not necessarily going to solve the problems. The problems are systemic. Sinn Féin has no difficulty in supporting the Bill but we do so by using our time to point out the fact that this will not change the issues that cause people to find themselves in a combative situation with the health service.

I echo the sentiment expressed by Deputy Kelleher on the manner in which the HSE and the Department of Health fight with their own patients and their own staff. As a union official, I have had occasion to represent nurses. We all know that nurses are at the coalface of our health service. I am all in favour of ensuring full accountability but it is astounding the amount of money that is put into fighting with staff and patients. It is beyond comprehension at times. We support the legislation but do not believe it is anything other than a tiny piece of a very large jigsaw.

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