Mattie McGrath (Tipperary, Independent) | Oireachtas source

I am also happy to speak on this Bill this evening. There are certain technical elements of the Bill that deal with step payments and reform in that area, and these are important. I want to focus on the elements of the proposed legislation that deal with the importance of open disclosure in health care settings. I heard Minister of State at the Department of Health, Deputy McEntee, speak on this Bill in the Seanad. She spoke about the purpose of Part four of the Bill. The provisions are there to support open disclosure as part of a broader package of reforms aimed at improving the experience of those who are affected by adverse events within the health service. The Minister of State, Deputy McEntee, went on to note that last December the Minister for Health, Deputy Harris, launched a new national patient safety office located in the Department of Health to prioritise work in this area. He also directed the office to work on a range of initiatives, including new legislation, the establishment of national patient advocacy services, the measurement of patient experience, the introduction of a patient safety surveillance system, and extending the clinical effectiveness agenda.

Within the programme of legislation, it is intended to progress the licensing of our public and private hospitals. This is very well meaning, but we will have to see where it goes. Open disclosure, as the Minister mentioned, is about an open, honest, consistent approach to communicating with patients and their families when things go wrong in health care. We all know that things can go wrong, and we have had some horrific experiences. The open disclosure process includes keeping the patient informed, providing feedback on investigations and steps taken to prevent a recurrence of the incident. It may include, depending on the particular circumstances involved, an apology for what happened. That is very important. I note that the Minister for Health, Deputy Harris, first announced his intentions to push forward with legislation to enforce medical negligence open disclosure policy in an address to delegates at the State Claims Agency's final annual quality, patient safety and clinical risk conference at Dublin Castle in September 2016. It is a fact that many barristers make tidy sums from this area of legal practice, with some receiving up to 89 payments from the State Claims Agency. That is unacceptable. It has become a gravy train. The Minister also said at that 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 are disclosed to patients and their families and the process of claiming medical negligence compensation.

I note A Programme for a Partnership Government makes clear that open disclosure is an essential component of patient safety and commits to measures to support it. The programme also states that it will be made mandatory to report specified patient safety incidents or serious reportable events to the authorities and to the patient harmed. The general scheme of the Health Information and Patient Safety Bill also has provisions on voluntary external reporting of non-serious incidents to the State Claims Agency, supporting and complementing current reporting to the agency. However, it is not proposed at present to legislate for mandatory open disclosure to patients. The reason for that, we are told, is related to creating a positive voluntary climate for open disclosure, laid out by the Madden report, which will be reviewed in line with experiences to see whether it needs to be strengthened and how, if necessary, that can be best done.

In Australia, one of the central principles around open disclosure policy is the presence of good governance. Quality assurance requires that organisations shall be able to demonstrate that they learn from and improve their performance through continuous monitoring, by reviewing the system and processes in place for meeting their objectives and delivering appropriate outcomes. Can we hold out any great hope that the HSE will be capable of demonstrating that kind of approach? I do not think so. 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 willingness to learn from adverse events. As noble as the aim is and as good is the principle, do we really need to go about creating an additional level of governance within the HSE? I do not think so and neither does anybody else. We have all governance and very little compassion, transparency or acceptance where things go wrong. How can we prevent the difficulties that go along with that?

While I welcome the principle of the Bill, I do have serious concerns about the capacity of the HSE to carry it through. There will need to be radical change in the culture of the HSE and I cannot see that happening anywhere in the organisation - governance, accountability and responsibility. Quite frankly, apart from the front-line services and the excellent skilled people working there, such as surgeons and the like, it is just a system of governance. We have managers and more managers and little hope anywhere of seeing any bit of sanity. I am not talking about insanity, as the Taoiseach was yesterday in respect of something else. We see precious little sanity prevailing in the system. It has become too big and cumbersome, too all-protecting and self-serving and it is not serving the patients and the sick people.

We have seen too many cases in which children were adversely affected at birth, with court cases going on for years. They are on the steps of the court four and five years later at enormous expense to the State with the barristers, and then the HSE admits liability. Obviously, children cannot get payments until they are 18 or 21. We must have a staged payment system. If the State drags people through the courts, fights them all the way and then accepts liability, and there is an award made, there must be a system whereby those monies so hard fought are paid out. The money cannot sit in some solicitor's account, it must be paid in stages to help the family. Goodness knows those families have gone through enough with the disabilities or whatever the young person is suffering from. They have to wait until the child is 21 although the family might need that funding after going through the courts and taking on all the expense of travelling to the High Court, and the trauma as well. They need to be compensated and need to be able to access that compensation on a staged basis. I cannot see why we cannot have that included as well.

We need open disclosure and we need a whole culture change right across the HSE and in many other agencies and Departments as well. I do not see that coming. I am in the House ten years today. I am delighted that the people elected me in Tipperary and West Waterford on a number of occasions. I see things becoming more cumbersome. We saw with Caranua how it has become so cumbersome and we see all the sub-agencies it is setting up. I call them quangos. They are putting up more barriers to serving the public and being open and honest in disclosure, particularly with these institutions. It is not good enough. It is backwards we are going instead of forwards.

See this speech in context