Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Members for their comprehensive contributions and the wide support for the legislation. There will be detailed scrutiny of it at the Select Committee on Health in the new year and there will be an opportunity to fine-tune the legislation and tease out, discuss and debate a number of the issues. It is heartening for patients and staff across the health service to see that cross party support for the Bill, which I genuinely think is landmark legislation. That is a phrase we use a lot in this House but I believe it is true for this Bill. It is an issue which Deputy Denis Naughten has championed for many years. He and Deputy Harty made very strong representations on it during the negotiations for the Programme for a Partnership Government, but before that there was his own legislation, so I thank him for helping us get to this point.

I am taken with the comments of many Members, including Deputies Harty, Naughten and Browne, on the Bill being very welcome but also on the need to see it alongside significant reform that is necessary in the legal area. We know our system is far too adversarial at the moment and that far too many people end up on the steps of the High Court who have no wish to be there. They are often people who have been victims of something that went wrong in the health service, they have been traumatised, they or their loved-one is in pain or sometimes they have been bereaved. Generally, they want answers, open disclosure, which this legislation provides, but they also want, where necessary, a mechanism to be supported or compensated in a way that does not involve lengthy trips to the High Court where the only people who benefit are the legal professionals. It is very costly for the Exchequer, and can be very difficult, painful and lengthy for the citizen and every day solicitors and barristers get wealthier on the back of it. That needs to change. I have some good news to share with the House. Deputies will be aware that Mr. Justice Charles Meenan has been doing some work on tort reform to fulfil the commitment in the programme for Government. We set up a group to review the area and examine the idea of a no-fault scheme. The initial report is due to me very shortly. I will definitely receive it this side of Christmas. I cannot pre-empt its contents but I am very hopeful and expect to be in a position to bring forward proposals to act on its recommendations early in the new year. I would be happy to provide a briefing to Members of this House once I have received the report.

I very much take the point made by Deputy Harty and others on the importance of resourcing and training our staff, clinicians and the people on the front line, as well as our health service managers on this legislation. It has been policy of the health service for many years, definitely since 2013, to have open disclosure yet as we know it has not happened. It is not that those working in the health service are bad people but legal protections were necessary. Also, we need to train, support and resource people in doing that. We will have a chance to tease it through and discuss how the legislation should be implemented in a very practical sense on Committee Stage. The Deputy is correct that, as we set up the structures to deliver Sláintecare, there is a chance to embed the legislation as core business of the health service, which it is. One of the very appealing things about the way we have drafted the legislation is the fact that there is such a clear obligation on the health service provider in reporting and ensuring the open disclosure takes place. What it will mean in a practical sense is that for the hospital manager or CEO it will be a very important part of their day-to-day job, and as important as finances or access issues in the hospital, because if something goes wrong, they are the people who will be directly answerable under the health service providers obligations under the law.

Deputy Durkan raised a wide range of issues relating to the health service, particularly around the need to recruit and retain more doctors. I fully agree with that. Yesterday, at the Joint Committee on Health, I used the phrase that I had no confidence in some of the work practices in place. I was returning to a phrase used by Deputy O'Reilly when questioning to me. She was putting the words of the Irish Hospital Consultants Association, IHCA, to me.

I wish to make clear that I have every confidence in our brilliant doctors, who work extremely hard. However, it is and will remain my view that we cannot be confident that some of the work practices we see as part of private practice in public hospitals are serving patients well, nor indeed the clinicians who are dedicated to the public health service. I intend to bring forward proposals shortly which will offer to pay consultants an awful lot more to work in the public health service, the key point or rub being that it must be in the public sector. I stand over my comments that in a situation where our public hospitals are under pressure, it is inexcusable that we would allow public beds to be used for private medicine. It is an issue we need to work on and there is a near cross-party consensus on which we can base that work. It is a thorny and difficult issue but one we must tackle.

Deputy Browne and others asked about the specialist register and the safeguards that will apply. The HSE has put in place arrangements to manage and supervise consultants who are not on the specialist register and ensure that any such appointments occur only where they are critical to support the delivery of essential services and with the approval of senior HSE management. That has been necessary in certain instances to fill vacant posts and ensure service delivery. The HSE has established a medical workforce and patient safety oversight group to agree and oversee implementation of a number of actions relating to this issue. I will keep interested Deputies up to date on that.

Reference was made to the Civil Liability (Amendment) Act 2017. That legislation was designed to facilitate a voluntary approach, but the word "voluntary" was used with reference to whether clinicians choose to avail of the legal protections offered by the Bill. I am conscious that the chief medical officer is not here and cannot speak in this House. I wish to make clear on his behalf that it was never his view that disclosure should be voluntary. Deputy Harty acknowledges that a lot of work was done in considering and scrutinising these issues. During the passage of that Bill, which was prior to the emergence of the CervicalCheck debacle, I undertook to return to the House with legislation to provide for mandatory open disclosure in line with the programme for Government. That undertaking is realised in the legislation before the House today.

Deputy Naughten made a valid point, which he has raised in reference to several Bills, about the importance of people being able to take somebody with them to meetings at which important matters are being discussed. I will reflect on his comments. My understanding, from engaging with my officials, is that this matter is covered by the relevant person clause in section 5(1) of the Bill. The relevant person may be a family member and it is a patient's choice as to whether he or she will have such a person in attendance. However, if there is a need to make the position clearer, I am happy to work with the Deputy to ensure it is explicit, in accordance with the expressed intention of the legislation.

Deputy Naughten referred to audiology services and acknowledged the work that has been done in this area. I will convey in the clearest possible terms the issues he vocalised in regard to the education part of those supports to the Minister for Education and Skills. I understand the Deputy has been in contact with the Minister on this matter. Either the Minister, Deputy McHugh, or I will revert to him as soon as possible.

This is significant legislation and its significance becomes more apparent when it is considered alongside the range of measures that have been taken in recent years to improve patient safety. The establishment of the national patient safety office in my Department is one such measure, and that office is now playing a key role in ensuring patient safety issues are constantly on the agenda when new policies and legislation are brought forward. The new system of publication of maternity reports on a monthly basis is helping to give a more transparent picture of what is going on in our maternity services. This is particularly important given the tragic issues that arose in the past. Last month, Ireland's first ever national patient advocacy service was established, funded through my Department but entirely independent in its functioning, and offering a website and dedicated helpline. It allows people with a complaint about the health service to access a qualified person who will advocate on their behalf and steer them through what can sometimes be a confused complaints system by making it simpler and easier to navigate. Notwithstanding these developments, we have a lot more work to do in this area.

Finally, I thank the patient advocates who have agitated in a positive way on this issue, in some cases for many years. I think of Róisín and Mark Molloy who came to see me when I became Minister for Health and with whom I have since met on several occasions. They had already been to see several previous Ministers at that stage. They are incredible people in terms of their kindness and their desire for improvements in the system. They have played a constructive role in that regard despite the huge adversity they faced and the personal trauma and devastation of losing baby Mark.

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