James Reilly (Dublin North, Fine Gael)
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Question 115: To ask the Minister for Health and Children her views on the establishment of a patient safety authority or patient ombudsman, either in conjunction with the Health Information and Quality Authority or independent of HIQA, in which patients who have serious concerns can have their concerns addressed without having to go to the media or court system in view of recent statements by her and the head of the Health Service Executive that there may be many more cases of misdiagnosis. [32674/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The health sector is one of the most complex areas of activity in every country and it must by its very nature command the confidence of those who use it. While I am confident that the majority of patients in Ireland receive effective and safe treatment, unfortunately, errors do occur in any health service and it is important that we have systems in place to detect and respond appropriately to them. Patient safety is everyone's concern and needs to drive all our decisions.

Patient safety has always been high on my agenda and that of the Government, as is evident from various initiatives we have taken in recent years. The Health Information and Quality Authority, HIQA, was established in 2007. One of the main functions of the authority is to set standards and monitor health care quality. The authority also has the power to undertake investigations as to the safety, quality and standards of services where it is believed that there is serious risk to the health or welfare of a person receiving services. Recent developments have led to the authority carrying out a number of investigations and it is acknowledged that there is public confidence in the work of the authority.

In addition, and as part of my commitment to prioritise the patient safety and quality agenda, I set up the Commission on Patient Safety and Quality Assurance. The commission's report, Building a Culture of Patient Safety, was published on 7 August 2008. The report contains proposals on patient advocacy and suggests appropriate arrangements for the involvement of patients and carers in service planning and evaluation. I am currently considering those recommendations in detail with a view to bringing an implementation plan to Government shortly.

The overall approach to implementation endorsed by the commission is to avoid short-term structural changes and, instead, to build on the structures already in place. The commission considered that this was the best way to deliver results quickly. On that basis, I am not proposing the establishment of a separate patient safety authority or ombudsman.

James Reilly (Dublin North, Fine Gael)
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I thank the Minister for her clear reply but I am sorry she has taken that approach. We could save people much pain and anguish if we had a patient safety authority. I note the report of the Commission on Patient Safety and Quality Assurance which fell short of recommending a patient authority, but I still feel that is the obvious way to go. We need a clear identifiable body that can deal with the anxieties of patients and their relatives when things do not go right.

The Minister stated previously, as has Professor Drumm and others — it is accepted fact — that there will be more mistakes throughout the country. Are we to ask other families to endure what the families in Ennis endured and what Rebecca O'Malley had to endure, that they have to go public to get satisfaction, clarity and justice? A patient safety authority or ombudsman would allow people to go in confidence without recourse to publicity or the expense of litigation to find out what went wrong. Most people are good people and they do not want trouble, publicity or to have recourse to the law, but they want information. They do not want to be treated as if they are stupid and to be fobbed off with weak excuses. They want the truth, often they want an apology, but most of all they want to be assured it will not happen again and that their own misadventure or that of their loved one will at least produce changes in the system that will make it less likely to happen again.

I urge the Minister to review the decision because HIQA is all very well but it was not able to act in this instance until the Minister instructed it. The Minister referred to its terms of reference, namely, when there is "serious risk to the health or welfare of a person". What happens when the event is over and the patient has passed away? People want answers and they are not getting them.

I am familiar with a case in my constituency where somebody wrote to the Minister who rightly referred them on to the HSE. It referred them on to the hospital safety committee, which said there was no case to answer. From what I know of the case, I regret to say there is a case to answer. It may not be the case that the person thinks there is to answer, but there is a case to be answered because a patient was allegedly prescribed three times the dose of a drug for a prolonged period of time that may have had a detrimental effect on them. It may or may not have been the cause of their demise but if it is true, in my view it certainly had a detrimental effect. I use the word "true" advisedly. Why not put this in place? It makes sense, would not be very costly and would not be another quango. The Health Information and Quality Authority can come in under it and can take, rightly I believe, the matter off this floor and off the politician's table. Several colleagues have come to me with examples in their constituencies, such as the matter mentioned by Deputy Michael Noonan last week. Why must people go through politicians to get satisfaction in these matters? They should be able to go to a clearly identifiable body, a patients' ombudsman or a patient safety authority.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I will take the last issue first, namely, the case raised by Deputy Michael Noonan. I was not aware of this when I was answering questions last Wednesday, but in fact the patient was contacted and given all the facts before I was aware of the need to establish facts. The authorities had made contact directly with the patient and given him the facts. That remains the position in the vast majority of cases. The issue of patient safety is not just for one organisation. It is not correct to say that HIQA needs my approval or needs to be asked by me to carry out an inquiry. It is totally independent in the exercise of its functions and if it wishes to carry out an inquiry it is free to do so. The current Ombudsman can deal with what could broadly be called administrative errors and does so all the time. The issue of clinical error, however, is a different matter. I do not envisage that could ever be dealt with by another organisation when we have the Medical Council. Under the new legislation that established the recent Medical Council, now with a lay majority, one of the provisions allows for a plenary inquiries committee where patients can complain and have matters inquired into. I know the new council is currently in the process of putting that in place.

As Deputy Reilly knows, mistakes occur in every health system and some of the best doctors make errors. What we are trying to do, especially with cancer care and in other areas, is arrange and configure services in such a way to minimise the capacity to make errors. We should not have had breast cancer services in a hospital like Ennis General Hospital because we did not have the clinical expertise. We could never have it in a hospital with such low volumes of patients or deliver the kind of care to which the late Ms Edel Kelly and Ms Ann Moriarty were entitled. This is why it is so important to reorganise services with patient safety in mind.