Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank the Ceann Comhairle for the opportunity of raising this important issue which is of concern to women and families throughout the country. I regret that the Government has not provided time for this to be addressed in the Dáil in a more substantive way. I reiterate my call on the Minister for Health and Children, Deputy Harney, to address the House on the issue and take questions from members.

When Melissa Redmond courageously spoke out about her experience in Our Lady of Lourdes Hospital in Drogheda she was followed by other women across the State who had similar experiences. The common factor was that the women were not properly listened to when they raised their concerns about their diagnoses of miscarriage. They trusted their own instincts and sought second or further opinions. All were women who had previously experienced pregnancy and, in some cases, miscarriages. They had learned from experience. They were in a position to make their own judgment and seek a second opinion. They had happy outcomes, thank God, and their children are alive and well today.

However, our thoughts must go also to the many women who are now living with the dreadful thought that their pregnancies may have been terminated based on a misdiagnosis of miscarriage. This is not just about the Melissa Redmond case or the women who have spoken out. They would be the first to acknowledge that, because the very reason they spoke out was to alert people to the wider implications.

The Minister has stayed largely silent on the issue, which is a cause of great concern and grief to many women. Now, for the first time, the Minister, in reply to a Dáil question from myself, has admitted that she had known of the Melissa Redmond case since August 2009, the month following the mistaken diagnosis of miscarriage. In her reply yesterday, the Minister described how her Department and the HSE handled the Redmond case. Crucially, however, she gives no indication that the wider implications were considered, or the possibility that women had similar experiences in other hospitals.

The Minister needs to explain why it was only after the issue received widespread national publicity that the HSE ordered its review of cases over the past five years. Why was it only after the story broke in the media that the HSE wrote to all public and private maternity units advising them to establish immediate measures to ensure that decisions to avail of drugs or surgical intervention with women who have had diagnoses of miscarriage must be approved by a consultant obstetrician? Why have different standards and practices apparently been applied in different regions and maternity units? HSE West has said that second scans in cases of suspected miscarriage in early pregnancy are now standard. Is that the case in other regions? Is the HSE setting standards?

This will be a highly traumatic experience for possibly hundreds, if not thousands, of women who may find that their viable pregnancies were terminated after being wrongly diagnosed as miscarriages. The Minister stated in her reply to my parliamentary question that the HSE is-----

Johnny Brady (Meath West, Fianna Fail)
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The Deputy has one minute remaining.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I urge Members of the House to listen to this. The Minister's words were that the HSE was "in the process of initiating the review of cases over the past five years to determine the number of patients who were recommended drug or surgical treatment when the diagnosis of miscarriage was made in error, and where subsequent information demonstrated that the pregnancy was viable". Will these women be contacted directly, and how soon? This issue has been known to the Minister, her Department and the HSE at least since August 2009. It is a classic case of patients not being listened to. We must have full disclosure of the truth and we must endeavour to ensure that such tragic misdiagnoses will never again occur in any of our maternity units.

Martin Mansergh (Tipperary South, Fianna Fail)
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I am replying to this matter on behalf of the Minister for Health and Children. All incidents of this kind are serious and are treated as such. They are distressing to the women and families involved and I express my sincerest sympathies to all those affected.

On 7 August 2009, solicitors for the couple concerned wrote to Our Lady of Lourdes Hospital, Drogheda, seeking certain assurances about the woman's care and other actions to be carried out by the hospital. On the same day, the solicitors wrote a short letter to the Minister for Health and Children enclosing a copy of that letter. This was also copied to the CEO of the HSE and to the State Claims Agency. The case was handled by the Department of Health and Children in line with the patient safety protocol adopted in September 2008, which deals with correspondence on issues of patient safety from patients, doctors, health service staff and solicitors. In view of the fact that a medical assessment of any potential patient safety issue is required, this is managed by the chief medical officer on behalf of the Minister for Health and Children.

Within one week the HSE responded to the solicitors, and a further letter was sent on 24 August. The Minister for Health and Children was copied on both these letters. The case was placed on the patient safety register and was reviewed regularly. In line with the protocol, the Department of Health and Children followed up with the HSE by telephone and letter to determine whether any risk issues had arisen from its investigation of the case. Following these contacts, the hospital's risk management unit advised the Department in January that a number of measures had been put in place to ensure that the chances of such an error being repeated were minimised. The Department requested further details, which were received in April 2010.

The Department's patient safety protocol meeting of 6 May 2010 reviewed the hospital's action in the case and was satisfied that it had been dealt with in a suitable manner and that a patient safety risk for other users of the service did not arise. It was determined that follow-up actions to enhance patient safety had been put in place at the hospital, and the chief medical officer was satisfied that the case had been dealt with appropriately.

I must point out that there has been no other case of this type on the patient safety protocol register since its inception in October 2008; neither was it indicated to the Department that any other such cases had been identified. However, as a result of media coverage in recent days a number of other cases were brought to the attention of the Minister for Health and Children.

As a result, a number of actions have been agreed by the HSE in conjunction with the Department of Health and Children to ensure the safe management of early pregnancy loss across the country, as follows. The HSE is in the process of initiating a review of cases over the past five years to determine the number of patients who were recommended drug or surgical treatment when the diagnosis of miscarriage was made in error, and where subsequent information demonstrated that the pregnancy was viable. The terms for the conduct of the review are being finalised at present and the HSE hopes to make them public in a matter of days. A joint letter from the Department's chief medical officer and the HSE's national director for quality and clinical care has been issued to all public and private obstetrics facilities advising them to put in place immediate measures to ensure the decision to use drugs or surgical intervention in women who have had a miscarriage diagnosed must be approved by a consultant obstetrician.

In addition, a clinical programme for obstetric care has been established by Dr. Barry White, the HSE's national director of quality and clinical care. The obstetrics programme will define standardised care for early pregnancy loss and other aspects of obstetric care. This programme is led by Professor Michael Turner of the Coombe Women's Hospital, who was appointed last month and will develop a guidance document for the management of early pregnancy loss in conjunction with the Institute of Obstetrics and Gynaecology.

Any objective look at the initiatives the Minister for Health and Children has taken and is taking demonstrate a determination and an earnestness to improve the safety and quality of care for all patients across the broad spectrum of health services activity. Under her stewardship key steps in this regard include statutory establishment of the Health Information and Quality Authority; the introduction of competence assurance for clinicians; the establishment of the commission on patient safety and quality assurance to set the agenda for change to improve the experience and outcomes of service users; the enactment of legislative provisions for protected disclosures by employees in the public health services who have concerns about safety of patients; preparation of legislative proposals to support open disclosure, adverse event reporting and clinical audit, which will be included in the Health Information Bill published this year; and legislative proposals for standards-based licensing of public and private health care providers, which are to be the subject to public consultation early next year.

I assure the Deputy careful attention will be given by the Department of Health and Children and the HSE to promoting learning from these incidents in order to improve patient experiences and outcomes.

Jack Wall (Kildare South, Labour)
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I thank the Ceann Comhairle for accepting this Adjournment debate. There is major concern about the changes that will take place in respect of respite care in the Kildare and west Wicklow area. Respite care will no longer be provided at the Drogheda Memorial Hospital. There are concerns about people who have attended the hospital for a period of time. In that time, people create friendships with staff and others in receipt of respite care. Changes are now being implemented and patients are being told that the liaison public health officer or a nurse will be in touch with them. Patients are not sure if the dates on which they were entitled to respite care will be honoured or where they will be sent. This is a major upsetting factor for senior citizens. The families involved are deeply concerned about the upset and torment this creates for senior citizens.

The Drogheda Memorial Hospital has served Kildare well. It was originally referred to as the jockey hospital. Anyone involved in the bloodstock industry who was injured was brought to the jockey hospital and the facility progressed to what it is today, a wonderful facility with wonderful staff and care. The INMO is deeply concerned about the suggestion that respite care will be stopped and the uncertainty about the future of the hospital now that there will be ten empty beds. I hope the Minister for Health and Children, through the Minister of State, Deputy Martin Mansergh, can give us a clear indication that there is no threat of closure to the hospital and that this is a short-term solution to financial circumstances of the HSE.

I am loth to hear arguments about why this hospital should be closed. It would have major implications for health care in Kildare. At the moment there is Baltinglass District Hospital and St Vincent's Hospital, Athy, which is practically impossible to get into for long-term geriatric care. Nevertheless, there are ten beds that seemed to be unused. That the HSE has determined there will be no more respite care provided at the facility adds to the worries and concerns. I hope the reply clears up the position in respect of the hospital, the patients, the families and the staff involved. I hope the Minister of State indicates this is a short-term solution to a financial position. I hope the hospital is not under threat so that we can move forward and see the hospital retained as a central focus point in the services supplied at the three hospitals in Kildare and west Wicklow. Those three hospitals are of paramount importance to providing services to senior citizens, especially to those in receipt of respite care.

Martin Mansergh (Tipperary South, Fianna Fail)
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I will take the Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. The overarching policy of the Government is to support older people to live in dignity and independence in their homes and communities for as long as possible. Where this is not possible, the HSE supports access to quality, long-term residential care where appropriate.

In line with this overall approach, a priority of Government in recent years has been to develop a range of community-based supports such as home help, home care packages, and day respite care. Between 2006 and 2010, additional investment of more than €200 million was provided to the HSE to develop community based services for older people. Without these initiatives, many older people would spend longer than necessary in acute hospitals or would be admitted to residential care earlier than might be required. The HSE service plan 2010, approved by the Minister for Health and Children in February, commits the HSE to providing agreed levels of service nationally for these key community support areas. The plan includes respite care provision, often available via day care facilities or as part of a home care package. These services are delivered either directly by the HSE, or in partnership with the voluntary or private sectors.

Broadly speaking, the level of community supports for older people in 2010 is in line with the 2009 provision. This includes an increase this year in the number of home care packages available, due to an additional funding of €10 million given for this purpose in the last budget. The key activity targets contained in this year's HSE service plan are almost 12 million home help hours to around 54,500 people; increased home care package provision from 8,700 recipients at any one time in 2009, to 9,600 in 2010; and a total of 21,300 day care places, which is estimated to cater for up to 80,000 people. While this target is slightly down from a comparable figure of 21,600 places last year, the respite element of day care would be generally compensated for in the overall 2010 home care service picture. It should be noted that any changes to these national target commitments, as part of the agreed HSE service plan, must be notified to the Department.

The HSE provides more than 750 designated respite care beds benefiting an estimated 19,000 people. It also provides in excess of 1,000 dedicated rehabilitative, convalescence and assessment beds within its own facilities. In addition, the HSE is currently working to reconfigure services within its own facilities to ensure that the best possible use is made of public resources with regard to the provision of both long-term and short-term residential care services. The Department of Social Protection provides a respite care grant which may be used to purchase short-term care in private nursing homes.

Other important initiatives are also being undertaken at a strategic level to improve community based services for older people. Arising from an evaluation of home care packages, published by the Department last December, the HSE established a task group to progress various improvements in home care provision this year. The Department accepts the need for a more standardised approach to home care generally, whether by public or private provision. This year the HSE intends to introduce standardised access and operational guidelines for the delivery of home care packages; adopt a voluntary code of quality guidelines for home care support services for older people; and progress a new procurement framework for home care services. These initiatives will, as I have indicated, facilitate the HSE to implement a more standardised approach generally to home care services, including respite care, in the context of interlinking with the wider range of services throughout the acute hospital and primary care areas.

With regard to the particular case raised by the Deputy, I understand that the facility in question is still providing some respite and other care services, but faces challenges from new standard requirements and staffing issues. The HSE locally is arranging replacement care at present, as required, in local private nursing homes, or in St. Vincent's, Athy. This is done through the local public health liaison nurse who manages individual requests for respite.

As the Deputy is aware, the HSE has operational responsibility for the delivery of health and social services nationally. He will appreciate that all developments relating to older people, including respite care, have to be addressed in the light of the current economic and budgetary pressures. The HSE has been asked to make a rigorous examination of how existing funding might be reconfigured or re-allocated to ensure maximum service provision is achieved. This requires a stringent ongoing review of the application of the resources currently available. It is, consequently, a matter for the HSE to manage the services I outlined, at national, regional, or local level, bearing in mind all relevant factors such as overall resources, local circumstances, or evolving service priorities. This includes the provision of services at individual facilities within County Kildare, or elsewhere.