Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I appreciate the opportunity to update the House this evening on the work the Government is doing on open disclosure and accountability, in response to the motion before us this evening from Deputy O'Reilly and her colleagues, which we will not be opposing. We will not be opposing it because we want to work with this House to legislate in this area. I welcome the invitation from Oireachtas colleagues to work with speed and priority in terms of trying to legislate in this area. It is abundantly clear that the cases of women and families affected by the recent issues which have emerged in relation to the CervicalCheck screening programme raise very great issues of trust in our health service. Dealing with patients honestly and openly, including when errors and mistakes are made, is key to restoring and improving that trust. I have heard clearly the calls that some good must come from such awful pain and hurt and that we must learn and work to ensure it will never happen again.

As Members are aware, last week the Government approved proposals to provide for mandatory open disclosure, through the forthcoming patient safety Bill, in respect of serious patient safety incidents, including issues relating to screening. The new Bill will provide for mandatory external notification of serious patient safety incidents to the appropriate regulatory body, be that the Health Information and Quality Authority, HIQA, or the Mental Health Commission, mandatory open disclosure of serious incidents to the patients affected by them, ministerial guidelines for clinical audit and the extension of HIQA's remit to private hospitals, which is something that has long been sought.

In the context of the motion before the House and in light of some recent commentary, it would be helpful to recall the policy approach my Department has adopted on open disclosure in recent years. It has been informed by a number of elements, including the experiences of comparable countries and the 2008 report of the Commission on Patient Safety and Quality Assurance, more commonly known as the Madden report. The open disclosure provisions brought forward last year were based upon the principles set out in the Madden report. That report recommended the adoption of legal protections for health service staff when making a disclosure to patients or their families. It did not recommend that mandatory open disclosure be legislated for but it did recommend that it should be mandatory to notify the relevant regulatory authority, such as HIQA, when a serious incident occurs. That is now being provided for in the patient safety Bill.

The legislation to provide for a voluntary approach to open disclosure has been enacted following the passage of the Civil Liability (Amendment) Act 2017 and regulations flowing from it are due to be brought forward shortly. As colleagues are aware, this legislation was also subject to pre-legislative scrutiny by the Oireachtas Joint Committee on Health. We have seen in recent weeks much understandable criticism of the use of the word "voluntary" in this context, but I want to be very clear: that should never be equated with a view that open disclosure is something which clinicians or health service staff should regard as optional, which clearly was the case. It is quite clear that there is a completely understandable expectation, one that I share, that patients should be told about any incidents with regard to their care that may have occurred. Open disclosure should happen in the right way, in all circumstances. Put simply, patients must be informed. That is clearly the standard expected in the HSE's own national policy on open disclosure, and as Deputy Mitchell indicated, it is a requirement placed on doctors by the Medical Council. It is a standard that, while expected, has simply not been met. Open disclosure works best when doctors, nurses and other professionals are supported and encouraged to be open, honest, communicative, empathetic and supportive to their patients when things go wrong. They should apologise. Maintaining the trust and confidence of patients is essential. Unfortunately, as we know all too well it does not always happen. There are too many examples where patients have not been dealt with honestly and openly and some of those painful and devastating experiences are all too fresh in our minds and in the minds of citizens. The trust we place in those who care for us or those we love when we are ill is a sacred one and when breached, it adds an extra painful injury.

In seeking to change the culture of the health service with regard to open disclosure, it is recognised that there is a number of serious incidents where it is appropriate to introduce a requirement in law for mandatory open disclosure. That is why provisions for mandatory open disclosure will be incorporated into the new patient safety Bill. When this legislation is enacted, Ireland will be placed at the apex, legislatively, of international practice in this area. We have made some strong progress in promoting patient safety and quality in the delivery of health services and we must do all we can to ensure that we prevent harm and error.

Out of very tragic and painful circumstances, we have learned how to respond and to improve. That is referenced in the motion before the House tonight. It is true of maternity services in Portlaoise hospital and the subsequent HIQA investigation, and in the promotion of openness and accountability in Portiuncula Hospital, the report of which was published just two weeks ago. In both Portlaoise and Portiuncula, we have put in place comprehensive, focused plans that have seen clear improvements to the maternity services being delivered by those hospitals. That is an example of how the system can and must learn from painful events to ensure they do not happen again. It is a recurring theme that patients who have been through the worst of circumstances themselves are strongly motivated by the wish that what happened to them should never happen to anyone else. The desire to see good things come from bad situations - this fundamental humanity - has led to some people who probably never intended or expected it becoming public advocates, making a hugely beneficial contribution to our health service.

My Department and I will continue to place great emphasis on engaging with patients who have experienced harm in a sensitive and compassionate way and with a strong commitment to their needs and desire to help bring change. In keeping with that commitment, I wish to inform the House this evening that this morning, I notified the Government of my intention to ensure the appointment of at least one patient advocate to the new board of the HSE. If this board is to be any different to the boards of the past it cannot just be the usual suspects sitting on a State board with a box ticked. This must be a board that has the right skill sets and they must include patient advocacy and representation. I received approval this morning to proceed with that measure. I know there is cross-party support for it and I will work with colleagues to legislate for it before the summer recess.

Accountability, effective organisational alignment and good governance are central to the organisation and functioning of the health service. The Sláintecare report rightly placed an emphasis on the need for both clinical and managerial accountability, stating:

The Committee strongly believes there is a requirement for clearer clinical and managerial accountability and governance throughout the system. This includes clarity at all levels, from the Minister for Health, the Department of Health, the HSE and healthcare providers.

As such, I view the advancement of Sláintecare as representing a key opportunity to improve accountability processes - one which I intend to take with both hands.

It is important to recall that healthcare professionals can also be held to account through their individual regulatory bodies, be that the Medical Council, the Nursing and Midwifery Board, as well as the Pre-Hospital Emergency Care Council and CORU. Each of those bodies has defined procedures to operationalise this accountability system and to protect the public in line with the relevant legislation. Furthermore, the Health Act 2007 already provides significant powers to HIQA in respect of its monitoring and investigatory roles, including to enter and inspect at any time any premises owned or controlled by the HSE, to inspect, take copies of or extracts from and remove from the premises any documents or records, including personal records, inspect the operation of any computer, inspect any other item and remove it from the premises, interview any person working at the premises concerned in private and require an explanation of any record.

That said, the events of the past few weeks have no doubt been shattering. The Government has tried to be guided by some grounding principles, namely, getting to the truth of what happened, ensuring that women affected are being contacted and supported and rebuilding confidence in the lifesaving CervicalCheck screening programme and, more broadly, other cancer screening programmes. We have tried to move quickly to work with the Opposition to establish the Scally inquiry, based on broad terms of reference to reflect the concerns of the Opposition to look into these and other matters. We expect an interim report at the start of next month and a final report by the end of it.

This has not been kicked into the long grass. This is an inquiry to which we need answers quickly. The Government is then committed to establishing a full commission of investigation for any outstanding issues. There will also be an international clinical expert review led by the Royal College of Obstetricians and Gynaecologists. This will review the results of screening tests of all women who have developed cervical cancer who participated in the screening programme since it was established. This will provide independent clinical assurance to women about the timing of their diagnosis and any issues relating to their treatment and outcome.

We have also agreed a comprehensive package of health and social care measures to try to put in place some practical supports for the women and families affected by the issues relating to CervicalCheck, including things like medical cards, counselling services, transport costs to and from hospital, child care costs, experimental drug costs and anything else we can do to ease the burden even a little. The HSE has now appointed a central national co-ordinator to lead this service response and has put in place a local contact in each HSE area so that people can go and sit with the women and their families and talk to them about the personal package of supports that can be put in place for them.

As Deputies referenced previously, we have also announced that the State Claims Agency is advancing a new initiative aimed at expediting resolution of the nine outstanding legal cases in a sensitive manner utilising mediation wherever possible. In not opposing this motion, I want to be clear that the Government is committed to progressing, as a matter of urgency, legislation to provide for mandatory open disclosure for patients and mandatory reporting of serious incidents to the relevant regulator. I look forward to working with colleagues on all sides of this House to ensure we do so as quickly as possible.

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