Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I welcome tonight's motion on the need for mandatory and enforceable open disclosure. I acknowledge the work done by Deputy O'Reilly in tabling this motion which Fianna Fáil will be supporting.

The HSE's policy on open disclosure is not ambiguous. It is not a "nice to have" or an aspiration. The HSE's 2013 policy document describes open disclosure as "an open, timely and consistent approach to communicating with service users [...] when things go wrong in healthcare". It says that all health and social care staff have an obligation to fully and openly inform and support service users as soon as possible after an adverse event affecting them has occurred. What has happened with CervicalCheck is completely at odds with the HSE's own policy of open disclosure and represents a catastrophic failure of corporate and clinical governance.

Patients have a right to their own information, to know about their own care and to know when mistakes are made in that care. That is the essence of open disclosure and that is what the HSE policy has stated for the past five years but that is not what happened at Portiuncula Hospital, for example. The report on Portiuncula has not received the attention it deserves because of the CervicalCheck issue. Indeed, we must find time in the House to give that report the required attention.

A review of maternity services at the hospital was published two weeks ago. The review examined the delivery and neonatal care of 18 babies and found that serious failings in maternity care led to the death of three babies and serious injury to three more. The main failings identified were a lack of senior staff, a lack of training in midwifery and poor communication between staff and patients. In 17 of the 18 cases examined, parents were not given proper details about the care of their babies. Reviews were carried out but parents were not told about them. In fact, some parents only became aware of reviews carried out in 2011 when they read media reports in 2015 on serious deficiencies in maternity care at Portiuncula. Not only did they not know that a review had been carried out, they did not know that there was any clinical issue at the hospital. Open disclosure obviously did not happen with CervicalCheck either. As we now know, 19 women have died without being told the truth and hundreds of women are only now being told of errors in their screening because of the brave stand taken by Vicky Phelan and others.

I am not convinced that the spirit of open disclosure is being seen and experienced by the Oireachtas on this issue either. On 2 May, the Oireachtas Joint Committee on Health met senior officials from the Department of Health, the HSE and CervicalCheck. On 9 May, the committee met the Minister for Health, the Ministers of State at his Department, the then director general of the HSE, senior departmental officials as well as officials from the HSE and CervicalCheck. Those meetings took place over the course of about eight hours and after those eight hours, I went away with the very clear understanding that the first that the director general's office and the Department knew about this issue was in 2018. I have discussed this with colleagues on the committee and every one I have spoken to who spent those eight hours in committee also walked away with the same understanding, namely, that it was this year that the director general's office and the Department were notified.

The Minister can imagine my surprise when I found out the following day, due to questioning at a meeting of the Committee of Public Accounts, that the director general's office and senior departmental officials knew in 2016. In fact, there is a year's worth of correspondence in 2016 that somehow, over the course of eight hours of committee, the officials involved forgot to mention, ironically, in a meeting about a non-disclosure scandal. I am not accusing the Minister of anything because the officials have said that he did not know but that is not good enough.

A few hours ago we got copies of that correspondence. The memos include a warning that public confidence in the national screening programme could take a hit when women were told what had happened. I take no issue with such a warning because confidence in the national screening programmes is essential. Any official raising a flag about a potential risk to confidence and suggesting that the Department and the screening service need to think things through and respond appropriately is simply doing his or her job. That is fine. I do not take any issue with that but I do take issue with what is written in the 11th document in the folder of correspondence where the HSE and CervicalCheck, in collaboration or communication with the Department of Health, decide that open disclosure does not really apply to them. They opt out of open disclosure.

In a note prepared for consultants in June 2016 and shared with the Department there is a section dealing with the principles for communication of the outcomes of a reviewed case, which states that while CervicalCheck, "supports the principles of open disclosure, it is recognised that there are limitations to its universal implementation.". That is not the case according to the HSE's open disclosure policy. Not only do they not engage in open disclosure, they explicitly reference it and then say they are not applying it to themselves. The Department of Health knew this. The memo was prepared in 2016 and yet somehow, none of the officials thought to mention that during eight hours of health committee meetings on the issue.

As the Minister knows, a question and answer document was also prepared in 2016, which suggests that if it is indicated by the outcome of the review and "if it is appropriate for the circumstances of the woman", the doctor is asked to discuss the cancer audit process, the review and the review findings with the woman. They are giving themselves opt-outs all over the place. They are also giving the doctors opt-outs. Vicky Phelan's doctor took grave exception to this and wanted her to be told, although he did not want to do it himself. This culture has to change.

We need to introduce mandatory disclosure but we also need to understand why doctors are not already engaged in mandatory disclosure in these cases. We have been told at committee that this is partly because of legal threat or legal fear. If that is the case, it needs to be nailed down. If there are other reasons, they also need to be nailed down because it is fine for us to legislate for mandatory disclosure but we also have an obligation to clinicians to make sure it is safe for them to engage in same.

I believe the reaction to this scandal, in terms of supporting the women, has fallen well short. The Minister was told in a memo ten days beforehand that something could happen, but he ignored that. The HSE and the Department of Health were discussing it for two years beforehand. We found out in other minutes from 2012 that better communications were needed in respect of the patient safety issue. Despite years of warnings, nothing seemed to be done when the story broke in The Irish Times. We know that two in five of the women who have called the helpline are waiting on a call back. It is not good enough. We need more political leadership. The Minister and the Taoiseach need to step up and take more charge of this.

See this speech in context