Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I was talking to someone earlier today who had read many more books than I had and gave me the following quote: "The truth starts with the truth and ends with the truth." It is from the Nepalese poet Santosh Kalwar. I once meditated with Buddhist monks in the monkey temple in Kathmandu, but I am afraid that my knowledge of Nepalese poetry is somewhat limited. The poet was obviously not referring to the Irish health service when he said it, but it cuts to the nub of the Bill and speaks to some of the serious changes we need to make in healthcare. Patients and their families need to know the truth, while it is critical that medics be free to provide that truth without fear of sanction or penalty for doing so. I put it to the Minister of State than in the healthcare system neither of these conditions is met in a broad range of areas. As the Bill will go some way towards addressing the issues on both sides, Fianna Fáil will support it.

At its most basic, the Bill will ensure clinicians will inform patients of previous professional issues, which is to be welcomed. It will ensure doctors, nurses, midwives, pharmacists and other health professionals will, by law, have to supply details of sanctions imposed on them. It means that when registering with a professional body, these health care professionals must declare in their application whether they have had any conviction imposed by a regulator and that information will have to be updated every year, which is to be welcomed. It also means that any allegation of wrongdoing in another country can be used as evidence in fitness to practise proceedings in Ireland. Crucially, patients will have more access to information on the people treating them as all of the details will be made public. Patients will be able to look up the history of their treating clinician.

There has always been an imbalance of power in Ireland and, I imagine, everywhere else between doctors and patients. Economists call such an imbalance "power asymmetry". Patients are sick, vulnerable and worried and sit down with someone who they hope has all of the information and knowledge. It is a completely unequal relationship. A good friend of mine, Sinead Gleeson, recently published a book of short stories entitled, Constellations. In some of the stories she recounts her experience of the healthcare system as a young woman who needed help with her hip. She has written in articles in various newspapers about some of the awful encounters she had, including having to go to clinics to talk about very sensitive issues, only to be met by some overbearing, obnoxious, satisfied older men. I do not apply that description to every consultant, or the vast majority of consultants, as I believe we have extraordinary consultants in this country. However, I have been in that position. When I broke my back many years ago, I remember sitting in a consultant's office, utterly exhausted, frustrated and in constant pain. The eminent consultant told me that at some point my spine would rupture, that I would know what that meant when it happened and to come back to him when it did. He then asked me for €200 and ushered me out of his office. Many of us have been in that position or know someone who has or we have been in a room where people have done this.

I imagine the Minister of State has had the same experience in his brief. As health spokesperson for my party, I have met families who have had horrific experiences in our healthcare system, where people, including children, have died or where very serious lifelong conditions have occurred. In some of these cases the doctors involved have been struck off in other jurisdictions and should never have been practising in this country. In other cases, the doctors involved had a plethora of complaints against them going back over years. This tiny number of people were going about their business destroying people's lives. I am sure the Minister of State meets them and I meet them. It is so frustrating. These people found out afterwards that there had been complaints against these doctors for decades but nobody ever knew and they had no way of finding out. We can be damn sure that if people knew, no one would go near these doctors and they would be removed. Obviously this is about a tiny number of people, but a tiny number of people can cause extraordinary pain.

The Bill is welcome because it will address that issue head on. Knowledge is power and the Bill gives some more knowledge to patients and their families, which is powerful and will help address some of the imbalance. In essence, the Bill puts into practice an idea in which Fianna Fáil strongly believes, which is the need for transparency. In fairness to the Government, its recent credentials are to be acknowledged.

Quite a large number of doctors are working as consultants in Ireland but are not on the specialist register, and that number is increasing. We are being told openly by people in the HSE that if it needs a consultant post in the hospital and it cannot fill it, the service goes away. Therefore, it puts in someone who is pretty well qualified but has not completed their specialist training, which is not acceptable. We should watch this space. It is highly possible that the State will be taken to court in years to come. If these doctors make mistakes and patients and their families find out that the consultant they were sent to had not completed his or her specialist training and nobody told the patients or their families, it sounds like a court case to me. People need to be told and it needs to happen soon. I have raised the issue with the Minister and in fairness he has said he is awaiting a report. However, this kind of thing needs to happen now.

We support the changes to the Health Service Executive (Governance) Bill. I am not convinced that the culture of openness, perestroika, has arrived throughout our healthcare system. I think there is some resistance to this within parts of the Department and the HSE, and among some clinicians. I do not think all of the resistance is illogical. Clinicians believe they are getting sued left, right and centre. If they are faced with a hostile environment, people want to hold the information. It has to be safe for officials, HSE managers and our doctors.

In the Joint Committee on Health today we discussed CervicalCheck with the Minister, Deputy Harris, at length. I put it forward as an example of what not to do. What happened? Dr. Flannelly set up CervicalCheck, built it up from the ground, implemented and ran what is recognised as one of the best cervical cancer screening programmes that has ever existed anywhere in the world with what is acknowledged to have the greatest level of transparency, which is ironic because that is what it fell on. It was trying to achieve a level of transparency and look-back that no other screening programme in the world was trying to achieve. What happened? Details of Vicky Phelan's case broke on a Wednesday. On the Friday morning, Dr. Flannelly went into RTÉ and gave a bad interview. She could not say for certain that the 221 women had been contacted, but she was honest about it. She gave a bad interview partly because she was honest in saying that the people in CervicalCheck were working really hard on the issue and they would get to an answer. She ran and built a screening programme that identified 65,000 high-grade anomalies in its first ten years. She was thrown under a bus publicly by the Minister for Health. He never met her. He never asked to meet her. He never asked to meet the head of the national screening service. A few hours after Dr. Flannelly gave a bad interview but was honest about what she did and did not know, the Minister for Health said he had no confidence in her and she resigned the next day.

Today in the committee, the Minister was again attacking her reputation, using very strong language and even stating things that I have since looked up and found to be untrue. He claimed that in cases where the woman had died tragically, she had directed consultants not to tell the husband. It turns out she had not said that. She said that consultants needed to exercise judgment and get the balance right between telling people the results of the audit and potentially causing more harm. I accept we have had the discussion as to whether that was appropriate. If the sitting Minister for Health is willing publicly to throw senior clinicians, who spend their entire lives saving lives, under the bus for telling the truth, it sends out a very bad message right from the top of Government. It is not to say the audit loop should not have been closed. It should have been closed. We have all agreed the women should have been told. In passing this Bill, which is a good Bill, we need to change the tone and culture. Public executions of senior clinicians for telling the truth by a Minister for Health set exactly the wrong tone.

I am glad the Bill provides for clinicians to appeal against minor sanctions. However, the bar for them doing so should be lowered. My understanding is they have to go to the High Court, which is a pretty high bar for anyone, incurring God knows what expense for lawyers. Could we find a way for such appeals to happen with a lower bar, still obviously at the highest level of scrutiny but with a lower bar than the High Court?

We should all work together to address the issue of healthcare litigation in Ireland which seems to be completely out of control. The costs for the State Claims Agency on healthcare are spiralling. There are legitimate cases, which obviously need to be respected with payments made. However, the costs have reached such a level that it must be affecting the provision of services which need that money. Again on CervicalCheck, I am told that GPs are over-referring to colposcopy because they are scared of being sued. The labs are over-referring to colposcopy because they are scared of being sued. HSE officials have confirmed to the committee that one of the great challenges in getting labs to clear the backlog of 80,000 women waiting up to eight months is that the labs are scared of coming to Ireland because of the legal environment. Better safe than sued seems to be where people are at. I think these are rational decisions the clinicians have to make.

I would like us to go further. We need to figure out how to create an appropriate legal environment whereby when there is negligence, the person affected and their family can be treated with compassion and decisions can be reached quickly and cost-effectively both for the patient and for the State. Of course, a patient who loses can end up with a bill for €500,000. They could decide to take a negligence case legitimately, lose it and end up having to sell their house over it. That is not acceptable. It is not really recourse to the courts. In the spirit of creating more transparency and more knowledge, and balancing the power between clinicians and patients, ensuring clinicians are working in an environment where it is safe for them to tell and to disclose, we should make it less onerous on them to appeal against sanctions.

I believe the High Court is too onerous. Let us do that and let us find a way to ensure the money that should be spent on healthcare is not filtered away to the legal profession. Let us make sure it is spent on the patients.

We wish the Minister of State the very best with this Bill. It needs to be looked at in the context of Brexit. I am not sure it is fully Brexit-proofed. That is something we might tease out on Committee Stage. The UK will no longer be part of the automatic procedures in which EU member states inform one another of clinicians who have been struck off so we need to make sure that our State agencies are watching and that agreements are put in place with the UK to ensure that information continues to be flow. Obviously, that is something we need to have in place as well.

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