Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

There is quite a bit to unpack. If I go slightly over the seven minutes allotted, I ask the Acting Chair and colleagues to please bear with me.

I thank several groups of people for where we have got to, which is the right place for this Bill. First and foremost among these are the patient representatives, including the 221+ group. Members of that group and other patient representatives who are here this evening have been involved for the past two years in detailed design of the patient-requested review, not just in these aspects. We had a very productive meeting recently. My officials were engaged yesterday through the night and the wording was agreed this morning, which is why it came through. I thank the patient representatives for all their work, not just over the last few weeks but the last few years. I hope they will stay involved and I thank them in advance for that. It is a serious time commitment for people who have many other things going on in their lives. I thank everyone involved and note their presence this evening. It is great to see.

I also thank my Department officials. A huge amount of work has been done on the Bill. We have focused on one important part of it but this is a comprehensive Bill. Officials in the Department working with colleagues in the HSE have put a vast amount of work into it. They worked through the weekend, having worked right through since we discussed Report Stage previously.

I thank Oireachtas colleagues. This can be a messy process.

Some of Deputy Cullinane’s colleagues were suggesting that it is no way to make law on Report Stage; maybe it is. This is the legislative process. This is where we listen to each other and make changes. This is probably partly how we should do business. I acknowledge the work of colleagues across the House on this.

What is the Bill ultimately going to do? It will lead to better outcomes for patients and better clinical and health outcomes. It will also lead to a better experience for patients and some much needed transparency. It is important from that perspective. While there is, very understandably, a focus on cancer screening services and cervical cancer screening services, the Bill is much wider than that. Obviously, it covers the whole health service. It is absolutely correct that the genesis of the Bill comes from cervical screening, however, and from the women and men who stood up and said we are just not having this anymore; this is no way to run this and treat patients and we have had enough. We all know those involved, some of whom are here this evening and some who are sadly no longer with us. Their work and the stance they took, not just then, but in the work they have done right through since we started debating these issues back in 2018, has led to this Bill and other things that are happening.

On cervical screening, for example, this Bill is one part of the change that is happening. We introduced the human papillomavirus, HPV vaccine and the Laura Brennan HPV catch-up programme. We introduced a HPV test as part of the screening services. The new laboratory is now built in the Coombe. I was there a few weeks ago and it is state-of-the-art. It will be ramped up over time to take on the vast majority of cervical screening samples. A whole new workforce is being built up, or dare I say rebuilt, with new professionals being trained up. I spent quite a bit of time with them few weeks ago and they are absolutely committed and dedicated to that work and to this Bill as well. Thanks to the bravery and determination of so many people going back to start of what happened with CervicalCheck, all of these things have happened, including this Bill. Our health service and cancer screening services are in a completely different position now than they would have been without that and, ultimately, a lot of lives will be saved. I thank them for all of that.

I will very briefly go through the Bill because it is very important. Initially, the Bill aimed to do three main things, one of which was to bring in mandatory disclosure for patient safety incidences. Deputy Shortall raised the point around the Schedule being a very short list. That Schedule is not meant to be there as a complete list; that is the Schedule no Minister can take out. These are the patient safety incidences that would require the Oireachtas to change. The intention is that a much longer list will be developed through regulation. The reason this is through regulation rather than statute is because the nature of those incidences change. Some procedures may not happen anymore and new procedures will be added. They might be changed or updated in certain ways. That is the intent of this. The only reason that Schedule is there is to say that regardless of what any Minister thinks, he or she cannot actually remove these without amending the legislation and, therefore, the agreement of the Oireachtas.

That is the first issue. The second is that the Bill provides a framework for clinical audit. Deputy Cullinane asked whether we can include Oireachtas colleagues or patient representative groups in the future and ongoing design. Yes, absolutely we can. It will be very useful to have the Joint Committee on Health involved in that. The third thing the original Bill aimed to do was expand HIQA's power to the private hospitals, which we are all agreed is essential. That was the original intent.

I then sought to add to add three additional amendments at Report Stage, which we all agreed at Committee Stage. The first of those was that we further extend HIQA's powers to nursing homes. With regard to many of the patient safety incidences that happened in nursing homes during Covid-19, HIQA had no statutory ability to go in on individual patient safety matters. That has caused a real problem. We cannot put it that in retrospectively but we can at least put it in for the future. That is a new power HIQA will have, which is really important.

The second thing is mandatory disclosure of patient-requested reviews. Deputy Kelly raised the point, which he and I talked about previously, around patients who have a diagnosis pre-audit, which is, essentially, from 2018 until now. The answer is that all of them will have access. The way the patient safety reviews are being set up is that any patient can initiate a review within ten years of the diagnosis. Therefore, anyone who got a diagnosis in 2018, 2019, etc. are all covered. Indeed, someone with a pre-2018 diagnosis from BreastCheck or BowelCheck may within ten years of the diagnosis want to avail of the same thing. That is covered.

The third thing I sought to introduce at Report Stage was a review after two years. That will be taken very seriously. It is a statutory review as per the termination of pregnancy review, which we will have very shortly. We then had a very constructive Committee Stage-----

See this speech in context