Mary O'Rourke (Longford-Westmeath, Fianna Fail)
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I am pleased to have an opportunity to air this matter. The shockwaves that were felt following the suspension of the delivery of breast services at Barringtons Hospital escaped many within the health service. A medical upset was caused, especially among women, when events unfolded there and Professor Drumm announced the HSE had no authority to investigate matters in Barringtons Hospital because it is a private hospital. The questions began to mount up and I cannot understand why there has been so little discussion of the matter.

It almost appears the issue is a reverse of the norm. Is it the situation that the Health Information and Quality Authority, HIQA, judges public hospitals but, as yet, does not have the legislative power to extend its remit to private hospitals? We have the ridiculous situation whereby if one pays money, one does not know what standard one will get, but if one does not pay, one is sure of decent standards.

Perhaps I am taking things up wrong. A number of people have contacted me to say they subscribe to the VHI and attend the Mater Hospital or the Blackrock Clinic or wherever they are sent by their doctors. They have heard Professor Drumm state neither he nor any other worthy member of the HSE has the right to judge the standards of care, or to authenticate the care, given in private hospitals. We are all of the belief these are excellent places to attend. However, it appears to be the case that if one waits for months to be called to a public hospital, one at least will be guaranteed standards of care.

When will HIQA be empowered to apply the same standards to private hospitals as apply in public hospitals? Is it a matter of a licensing arrangement whereby a body or institution has to procure a licence from a particular entity before patients will be clear and sure of what is involved?

I do not blame the Minister. The HSE has become a massive monolith. It has the power to gobble us all up. We do not know where it is going, what it is doing or what it is all about. I fear it does not know itself what it is about.

Simon Coveney (Cork South Central, Fine Gael)
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Agreed.

Máire Hoctor (Tipperary North, Fianna Fail)
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I am replying to this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

I thank Deputy O'Rourke for raising this important issue. The Government is committed to ensuring the delivery of the best quality health service possible and doing so both effectively and efficiently. We believe that to do this we had to radically reform the health service and we are currently well advanced in that process.

Earlier this year we made significant progress on this journey with the adoption of the Health Act 2007. That legislation provides for the establishment of the Health Information and Quality Authority, or HIQA as it has become known, and the Office of the Chief Inspector of Social Services. This represents a crucial element of the reform programme and is a new departure for the health services.

A core function of the authority is to set standards on the safety and quality of health services and to monitor enforcement of these standards in an open and transparent way. The Act gives HIQA strong powers in this area in regard to services provided by the Health Service Executive and bodies funded by the executive to provide health services on its behalf. The process by which such regulatory regimes are first introduced in the public sector is a feature of such developments in other jurisdictions.

The authority also has responsibility for undertaking investigations as to the safety, quality and standards of services where it is believed there is serious risk to the health or welfare of a person receiving services. Recent developments, particularly those relating to the unfortunate incidents of misdiagnosis in breast cancer, have led to the commencement of two investigations by HIQA.

I am keenly aware that one of those investigations is limited by the fact HIQA does not have a remit in the private hospital sector. However, the Deputy will be aware that my Department took swift and effective action to deal with the situation. Services at the private facility concerned were suspended and an appropriate look-back at the management of cases involved in the symptomatic breast disease services delivered from that hospital is currently under way. The review group expects to complete its work next month and any follow-up action required will be taken as a matter of urgency.

I would like to emphasise the progress we have made in the area of the development of quality care standards in health. For the first time, we will now have national standards across the major programmes of care. Such standards in the field of symptomatic breast disease services have already been developed and are in the process of being rolled out. The Minister has directed the HSE to ensure compliance with the standards within the public hospital system. The Minister has also called on hospitals in the independent sector to take steps to ensure their breast cancer services comply with these standards.

The Deputy will be aware that last week the HSE announced a major re-configuration of the delivery of cancer care in this country which will involve the provision of services from dedicated centres of excellence. In January 2007, we also established the Commission on Patient Safety and Quality Assurance to develop proposals for a health service-wide system of governance based on corporate accountability for the quality and safety of all health services. One of its terms of reference is to specifically examine and make recommendations in regard to a statutory system of licensing for public and private health care providers and services. Needless to say, this will include hospitals in the private sector.

In short, the direction of policy is clear. We are moving towards licensing and accreditation of all health care settings against explicit standards. The commission is currently seeking submissions from the public and key stakeholders on the issues within its remit and will welcome views from all quarters. I look forward to the recommendations from the Commission on Patient Safety and Quality Assurance, which is due to report by the middle of next year. In the meantime, we will be vigorous in ensuring a speedy conclusion to the HIQA investigations and departmental actions on the recent cases which led to the current public discussion on these matters.