Jim Glennon (Dublin North, Fianna Fail)
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Amendments Nos. 1 to 4, inclusive, in the name of Deputy Twomey, have been ruled out of order as they all involve charges on the Exchequer. Amendments Nos. 5 to 8, inclusive, are related and may be discussed together.

Tim O'Malley (Limerick East, Progressive Democrats)
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I move amendment No. 5:

In page 12, between lines 40 and 41, to insert the following:

7.—The object of the Authority is to promote safety and quality in the provision of health and personal social services for the benefit of the health and welfare of the public.

I hope Deputies Ó Caoláin and Twomey, who tabled amendments Nos. 7 and 8, respectively, will be satisfied to withdraw them on the basis of what I propose, especially given that I had strong regard to what was said during Committee Stage on this subject. As legislators, all Deputies are aware of the need to draft legislation carefully, having regard to what we wish to achieve. Consequently, in framing any legislation it is imperative to distinguish between functions and objectives. Functions are specified in a concrete manner because they relate to the activities that the body in question is required to carry out and they are interpreted accordingly in any legal proceedings involving their consideration. The objectives of any organisation, be it in the private or public sector, are goals it strives to achieve through the proper performance of its functions. Objectives are strategic and serve as means to guide the organisation in carrying out its business.

The functions of the Health Information and Quality Authority, HIQA, are clearly set out in section 7. On the amendments of Deputies Twomey and Ó Caoláin, explicit provision for the setting of standards is already made under this section and the overall objective of promoting safety and quality is implicit in the functions assigned to the authority as a whole, as it is in respect of every health service agency.

To make the Deputies' amendments would be to introduce a vague and unquantifiable element to the authority's functions. However, having considered the points raised on Committee Stage, I believe it would be helpful to set out in the Bill the core objective of HIQA. Its objective is to promote safety and quality in the provision of health and personal social services for the benefit of the health and welfare of the public. Amendment No. 6 expressly provides as a function of the authority that it will seek to further this objective to the extent practicable, and this marries the functions with the objectives to the greatest practicable degree. The joint effect of both amendments is to make certain that the core objective acts as a guiding principle for the new authority in carrying out the tasks associated with its wide remit and ensures the importance of patient safety is rightly recognised.

Liam Twomey (Wexford, Fine Gael)
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One of my problems with HIQA was that patient safety was not its core objective. The role of the Social Services Inspectorate is to examine standards in all institutions involved in health provision. HIQA's role does not just concern social services inspection but also the evaluation of technologies. This is a nice euphemism that slipped through in the explanatory memorandum. Another of its functions is the exact same as that of the National Institute for Health and Clinical Excellence in the United Kingdom. I have raised this on Second and Committee Stages and therefore the Minister of State will be fully aware of the role of that institute. Quite clearly, the core problem with the institute, which is supposedly built around patient care or safety, is that it decides whether one can receive treatment according to a cost-benefit analysis. If one is expected to live for so many years and one's treatment costs so much, one will receive it, but if one is expected to live only for a short time and the cost of one's treatment exceeds a certain figure, one will not receive it. This does not comprise a patient safety issue, even by the widest stretch of the imagination of a member of the Progressive Democrats. The Minister of State will agree with me in this regard.

The same problem applies to HIQA. When trying to create an ethos of patient protection, it is inappropriate to include among the functions of the organisation that deals with standards and safety issues in nursing homes and hospitals a function that would deny a person medical treatment because of its cost or because he or she will not live long enough.

We must all have an idea of costs and I would like nothing more than a cost-benefit analysis of the co-location of private hospitals on the grounds of public hospitals but unfortunately the Government cannot get around to carrying this out. Putting accountants in the same room as patient safety staff will confuse the ethos of HIQA and it will therefore not work very effectively. My first four amendments, Nos. 1 to 4, were deemed out of order because they attempted to address this.

The Social Services Inspectorate and the Mental Health Commission should have been amalgamated as part of a patient safety authority. My colleagues in the Labour Party would very much agree with this because we do not want to stigmatise those with mental illness as different from patients in the rest of the health service. Instead of breaking down barriers and destigmatising certain sectors, especially the one for which the Minister of State is supposed to be responsible, the Government is drawing in an even darker pen the line between patients with mental illness and patients in other areas of the health service.

I will not press my amendment on the basis of what I have said but I believe the Minister of State has made a mistake.

Tim O'Malley (Limerick East, Progressive Democrats)
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I move amendment No. 6:

In page 12, after line 41, to insert the following:

"(a) subject to this Act and to the extent practicable, to further the Authority's object;".

Liam Twomey (Wexford, Fine Gael)
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I move amendment No. 8:

In page 12, after line 41, to insert the following:

"(a) to ensure the highest standards of patient safety,".

Emmet Stagg (Kildare North, Labour)
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I move amendment No. 9:

In page 13, line 1, after "quality" to insert the following:

"(which shall as far as practicable be common standards of quality for services whether provided by the private sector or the Executive)".

This amendment is self-explanatory. The idea of only having provision for one sector is an omission the Minister may have missed.

Tim O'Malley (Limerick East, Progressive Democrats)
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The standard set by HIQA will apply to the public health service, which is made up by the HSE and service providers funded by the executive. HIQA standards will also apply to services provided by the private sector on behalf of the executive. Moreover, the new inspection system provided for in the Bill with the establishment of the office of the chief inspector of social services will encompass private nursing homes. HIQA can also operate accreditation programmes for the public and private services. The spirit of the amendment, therefore, is to be found in the Bill.

It is important to refer to the Commission on Patient Safety and Quality Assurance that the Minister recently established. It will look at the issue of the licensing of hospitals and have an associated enforcement regime. A requirement for all health care providers, public and private, to be licensed for service delivery by the State would ensure that minimum standards of professional qualification and premises quality must be complied with. Accordingly, I do not intend to accept the amendment.

Emmet Stagg (Kildare North, Labour)
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The Minister of State is being vague. The Bill should deal with the reality, not the spirit. While there may be a spirit in the Bill, the reality is the meat of the issue. The Minister of State says the spirit is there but then tells us a commission will be appointed to look at what we are suggesting he can do now. I am not prepared to withdraw the amendment on that basis.

Tim O'Malley (Limerick East, Progressive Democrats)
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The private sector can avail of the accreditation services of the authority and the patient safety commission will address the issue of licensing all hospitals, private and public, and I expect the commission's report next year. The matters referred to are in the Bill and, consequently, I will not accept the amendment.

Liam Twomey (Wexford, Fine Gael)
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What will the commission do?

Tim O'Malley (Limerick East, Progressive Democrats)
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It is the Commission on Patient Safety and Quality Assurance.

Liam Twomey (Wexford, Fine Gael)
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What will it do?

Tim O'Malley (Limerick East, Progressive Democrats)
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It will inspect all matters of safety pertaining to health. It was set up by the Minister and the chairperson is Dr. Deirdre Madden. She will report to the Minister.

Liam Twomey (Wexford, Fine Gael)
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Is there a difference between private and public hospitals at the moment that this will specifically examine?

Tim O'Malley (Limerick East, Progressive Democrats)
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There is no difference. The commission will develop proposals to ensure clear responsibility among senior management and clinical leaders within our health system for performance in quality and patient safety. It will put in place more effective reporting of adverse clinical events and complaints to learn from them and ensure the rest of the health system learns from them and provides a clearer role for patients and carers in feeding back on care received and ways to ensure health care practice is consistently based on what has been shown to work in other centres. It will look at a statutory system of licensing of public and private providers of health care and better integration of the work of different regulatory bodies in the health system to achieve a joined up approach and a sharing of best practice. Those are composite principles of safety.

Liam Twomey (Wexford, Fine Gael)
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Is there a difference between public and private hospitals?

Tim O'Malley (Limerick East, Progressive Democrats)
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I said there is no difference.

Deputies:

I must ask Deputies to refrain from a question and answer session and to deal with Report Stage in the normal fashion.

Emmet Stagg (Kildare North, Labour)
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I move amendment No. 10:

In page 13, between lines 1 and 2, to insert the following:

"(i) hospitals,".

I will learn from the Minister of State's answer.

Tim O'Malley (Limerick East, Progressive Democrats)
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This amendment refers to setting standards for hospitals. Section 7 sets out the functions of HIQA and section 7(1)(a) provides that HIQA will set standards on safety and quality.

Emmet Stagg (Kildare North, Labour)
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What is HIQA?

Tim O'Malley (Limerick East, Progressive Democrats)
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The health interim quality and——

Liam Twomey (Wexford, Fine Gael)
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The health information and quality authority.

Tim O'Malley (Limerick East, Progressive Democrats)
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It will set standards on health and safety for the HSE, or a service provider in accordance with the Health Acts, the Child Care Acts and the Children Act, and private nursing homes. Deputies McManus and Ó Caoláin are anxious to establish beyond doubt that HIQA will have responsibility for setting standards on safety and quality in hospitals and for monitoring compliance with standards set. I assure them that is the case under section 7(1)(a) as currently drafted. Under the Health Act 2004, the HSE has responsibility for delivering health and personal social services or arranging the delivery of these services on its behalf. Hospital services are provided directly by the executive under the Health Acts and by voluntary hospitals on behalf of the executive and are therefore included within the relevant definition. Accordingly, this amendment is unnecessary and its inclusion might create the impression that providing standards for hospitals would be of a higher priority than for other services.

Emmet Stagg (Kildare North, Labour)
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The Minister of State is suggesting that the Labour Party spokesperson and Deputy Ó Caoláin are foolish people who cannot read the Bill but the Bill is drafted in such a complex manner that it does not refer to anything directly or simply. It is a poor standard of legislation. It is not clear what it is about. When senior parliamentary spokespeople and senior legal representatives who advised the Labour Party on the matter do not know what it was about, I think the Minister of State must be wrong on this issue. The limited scope of the Bill indicates that the Labour Party and the Sinn Féin spokespeople are right and the Minister of State is wrong. He should re-examine this and state it clearly in the legislation so that even barristers know what they are reading. If they are confused and suggest amendments that the Minister of State says are entirely unnecessary, there is something wrong with the legislation as written. I will press the idea that hospitals will be included. In fact, I ask the Minister of State directly, will St. Vincent's Hospital in Athy be covered by this legislation?

Tim O'Malley (Limerick East, Progressive Democrats)
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All hospitals supplying services on behalf of the HSE, either public or private, would be covered.