Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

It is important to note that while there is a lot of focus on the issue of open disclosure, the original, horrific and fatal problems associated with CervicalCheck the last time were to do with poor standards in the labs. That was the fundamental problem. In the past week or two, we read some of the background to that decision taken in 2008 by the then Minister to outsource all of the lab analysis to the US, with no regard to the poor standards that applied. What Dr. Scally came up with in that regard was horrific and shocking. Lessons have to be learned from that both in terms of health services and across the board generally.

The argument that the then Minister made for removing the labs from Ireland - several labs here had dealt with large numbers and there had not been an issue about it before then - taking the work away from Irish labs and outsourcing to those standard labs in the US, which had fatal consequences, was on the basis of saving money. People were told that the Minister was of the view that the cost of outsourcing would be approximately one third of what it cost to do the analysis in Ireland. It has turned out, in human terms originally and primarily, lives were lost unnecessarily. That was a massive price to pay. In addition, for all the other reasons in cost terms, it turned out to be a massive cost. As a result of that, we lost a lot of expertise, corporate memory, corporate expertise and so on, which will be hard to restore to labs in Ireland.

Fundamentally, we have to get a guarantee regarding the standards in labs. While I note what Dr. Scally said about Quest Diagnostics currently, we need to accelerate the programme of developing capacity in the Coombe hospital. Major issues remain regarding the lack of staff, principally, and a lack of forward planning for those qualified staff.

There is also a question about whether recent recruits to the lab have the requisite qualifications. The Minister must get to grips with these issues. He must be in a position soon to give guarantees about the standards that will apply to the analysis of smear tests and the repatriation of those tests to Ireland.

The duty of candour is another key issue. Dr. Scally stated that the duty of candour should come as naturally as breathing, but that has not been the culture within Irish medicine. This issue must be addressed. Discussing legislating for future arrangements is all very well, but one of the key findings in a previous report by Dr. Scally - it may have been the first report - related to the failure of consultants to be candid with their patients and the need to introduce some measure to restore trust, given that trust had been lost. His recommendation was that there be restorative meetings, whereby all of the consultants involved made arrangements to meet their patients to try to restore trust, apologise and provide some kind of acceptable explanation for why the patients were kept in the dark. As far as I am aware, those meetings have not happened to any great extent. It is an outstanding recommendation that needs attention, having received none recently. Will the Minister devote some attention to it?

It is only right that women be able to request a review, and I welcome his proposals in this regard. However, an issue arises concerning the list of notifiable incidents. I spoke to him about this earlier. Dr. Scally was clear on this point and stated:

The limited scope of the Bill is problematic. The Bill only specifies the mandatory requirement for open disclosure in the case of 13 categories of incidents. 12 out of the 13 highly specific incidents where notification would be mandatory relate to the death of a patient. This, under any circumstances, represents a tiny proportion of harm caused to patients through clinical error.

I tabled amendments to include significant harm in those 13 incidents. Unfortunately, they were ruled out of order. That was wrong. The Minister has stated that it is his intention to extend the definition in a Schedule. Will he put on record that he intends to do so? In the past week or so, I have been in touch with the 221+ group regarding his amendments. This matter is one of the group's principal concerns. In fact, it was the only concern the group relayed to me. Will he commit to broadening the scope of the notifiable incidents and set out a timeline for doing so? He has stated that broadening the scope is his intention, which is fine, but who knows who will be the Minister next year or in five year? I ask that the Minister be clear in what he is putting on the record.

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