Danny Healy-Rae (Kerry, Independent) | Oireachtas source

I am pleased to speak to the Bill as it deals with a matter that affected many people when they presented at a hospital and the right result was not achieved for them. This is an issue that does and will continue to affect many.

As the Minister mentioned, open disclosure is about an open, honest and consistent approach to communicating with patients and their families when things go wrong in health care. The open disclosure process should include keeping the patient informed, providing feedback on investigations and the steps taken to prevent a recurrence of the incident. It may also include, depending on the particular circumstances involved, an apology for what happened. I note that the Minister first announced his intention to push forward legislation to enforce a medical negligence open disclosure policy in an address to delegates at the State Claims Agency's first annual quality, patient safety and clinical risk conference at Dublin Castle in September 2016.

It is a fact that many involved in the legal profession make a great deal of money out of cases where people make a claim to obtain redress because things had gone wrong in hospital, something should not have happened to them and, in some cases, lives were lost or people were hurt and the right result was not achieved. The Minister also said at the event that the establishment of a new national patient safety office would "lead a programme of significant patient safety measures" that would include a review of how adverse medical events were disclosed to patients and their families and the process for claiming medical negligence compensation. I would be worried if this were to be another governance arm set up in the HSE where we would have to depend on the HSE to tell the patients about their rights. An independent body should be monitoring this area. It should not be another job handed to the HSE to correct itself or check what happened. I would not trust it in that scenario. It must be an independent body to monitor this area.

I note that A Programme for a Partnership Government also makes it clear that open disclosure is an essential component of patient safety and commits to measures to support it. The programme also states it will be made mandatory to report specified patient safety incidents or serious reportable events to the authorities and the patient harmed. That is certainly necessary.

The general scheme of the Health Information and Patient Safety Bill also has provisions on voluntary external reporting of non-serious incidents to the States Claims Agency, supporting and complementing the current reporting process to the agency. However, it is not proposed to legislate for mandatory open disclosure to patients. That is wrong. That is what we should be hoping to achieve in the Bill, that there would be mandatory open disclosure and that doctors, nurses, matrons or whoever who makes a mistake or an error would come clean and tell patients or their families what had happened. That is what this is about. It appears that doctors and others involved in the medical profession are prevented by the HSE from disclosing to patients what happened in different cases. That is wrong. This measure should legislate for mandatory open disclosure to patients. We are told the reason it is not proposed to legislate for this is related to creating the positive voluntary climate for open disclosure laid out in the Madden report and which will be reviewed in line with experience to see whether it needs to be strengthened and how, if necessary, that could best be done. I do not trust that aspect of the Bill

In Australia one of the central principles of open disclosure policies involves the presence of good governance and the insistence that quality assurance requires organisations to be able to demonstrate that they learn and improve their performance through continuous monitoring and by reviewing the systems and processes in place for meeting their objectives and delivering appropriate outcomes. Can we hold out any great hope the HSE will be capable of demonstrating that approach? As the Australian model of open disclosure also notes, health care organisations need to ensure appropriate direction and internal control through a system of governance. It is imperative that each facility and its management show the capacity and a willingness to learn from adverse events. As noble as the aim is and as good as the principle is, do we really need to go about creating an additional level of governance within the HSE? How can we prevent the difficulties that will go along it?

I welcome the principle of the Bill, but I have serious concerns about the capacity of the HSE to carry it through. There is a need for a radical change in its culture first. We all know about the serious events where the lives of family members have been lost, where family members have been left with serious disabilities, where babies have been left with serious disabilities caused by negligence during child birth and where mothers, likewise, have suffered during child birth. Doctors and nurses know at that point that they have slipped up and it would be much easier if they were allowed to come clean. I know that most of them would, but they are prevented from doing so by their organisation, the HSE. I refer to people who have lost a family member, a father or a mother, the breadwinner in the family, because cancer was not diagnosed in time. Men and women have lost their lives because a heart complaint was not diagnosed. Sadly, after spending days in hospital, when it should have been detected, they died. Someone has to be held to account. Someone must be accountable when something dreadful like that happens and family life as they knew it is finished forever. In cases where the breadwinner dies the wife and children will suffer for years and never recover following their loss. I know of one hospital which I will not name where six lives were lost in the space of two months. They lost their lives because they had developed clots as their complaints were not addressed when they presented at the hospital. I know about these incidents because I was very close to one of the people concerned. That is not right. I know that the doctors and nurses involved knew that things were not right and that they would have come clean, but the system in place does not allow them to do so. A lot of money has been lost in the courts with mounting legal costs. When an award is made, a percentage of it goes directly to the legal profession, including barristers and solicitors; that money could be used to pay damages to many people to give them some retribution, while freeing the courts to deal with other business.

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