Clare Daly (Dublin Fingal, Independent) | Oireachtas source

I move amendment No. 18:

In page 21, line 26, to delete “the health services provider has” and substitute “there are”.

Many of these proposals are simple and straightforward and we think they would strengthen the Bill. We do not see them as controversial at all. This group of amendments relates to section 8 of the Bill. It aims to take the power to judge whether a patient was placed at risk or could have been injured out of the sole hands of the health service provider. That is all that these amendments seek to do. In the original general scheme of provisions on open disclosure, a patient safety incident was defined as either an incident in which a patient was harmed where there was reasonable grounds to believe that, during the provision of a health service to the patient, the patient was placed at risk of injury or harm; or an incident where, but for timely intervention, the patient would have been harmed. The definition of a patient safety incident is important as these incidents will be subjected to open disclosure in the Bill. In the Bill before us, the provisions in the general scheme have been changed such that an incident will now only qualify as a patient safety incident if the health service provider has reasonable grounds to believe the patient was at risk or to believe that, but for a timely intervention, the patient would have been placed at risk. In our opinion this puts far too much power in the hands of the service provider.

We know from both broader global literature on open disclosure and from our own experience of our health service that fostering a culture of openness and transparency within a health service is a very difficult thing to do. We know from the brutal experience of the HSE that the first impulse when something goes wrong is to pull up the drawbridge, fortify the barricades, deny all and circle the wagons. In this sense, we do not think it makes sense to leave the final word on whether a patient was placed at risk with the health service provider alone. They will certainly be in a good position to judge whether this was the case, and our amendment does not preclude them from making that decision. It just means that they are not the only ones who can decide what is a patient safety incident.

We would hope that, if the amendment was passed, in the vast majority of cases the health service provider would hold up its hands, admit a patient was placed at risk, and try to make it right. In reality, in many cases only the service provider will have this knowledge. We accept that is the case. If patients were put at risk, for example, during surgeries or scans and so on, the patient would obviously be none the wiser as to whether he or she was placed at risk. There would be some instances in which the health service provider would be the only one to know. These amendments deal with the small minority of cases in which the patient knows and the health service provider does not own up. It allows scope for a patient, or somebody connected to him or her, such as his or her family or a loved one, to rely on the legislation and to have what happened to him or her classified as a patient safety incident, thereby granting him or her access to open disclosure of all the circumstances around how and why he or she was placed at risk.

Information is power. Quite often what patients or their families want is reassurance that what happened to them will not happen to somebody else. That is why it is very important for our health service to learn from those situations. We believe that, as with open disclosure generally, allowing patients this scope, if they spot something which they believe put them at risk, should actually help hospitals, which often have a deep cultural aversion to accepting errors and to learning that the sky does not fall in when they do so. It will also help hospitals to put measures in place to ensure that mistakes are not made again with possibly more serious consequences. We think this is only a good thing. It is a relatively minor thing and we hope that the Minister agrees with us.

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