James Reilly (Dublin North, Fine Gael)
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I move:

That Dáil Éireann:

noting with concern:

— that to date the Health Service Executive (HSE) has received almost 300 telephone calls from concerned women and their families about the treatment received in maternity hospitals around the country;

— that to date approximately a dozen women have come forward with stories of having been wrongly told by maternity hospitals that their babies had miscarried, only to give birth later to healthy infants;

— the failure of the Minister for Health and Children, Mary Harney, T.D., to take direct action on the miscarriage misdiagnosis scandal and to alleviate the concerns of many families facing the trauma of having their case reviewed;

— that six months after Melissa Redmond's erroneous scan, the ultrasound machine at the hospital was still in use;

— that a review carried out by staff at Our Lady of Lourdes Hospital, completed last December, found that the ultrasound machine displayed 'evidence of fatigue' and that the image resolution was 'not adequate to accurately assess early pregnancies and their complications';

— that people's trust in the HSE has been shattered; and

— that too many families have lost loved ones through various scandals that have emerged in our health services such as those in Portlaoise, the North East, Cork, Limerick, Galway and Ennis in recent years;

recognises the urgent need for the Health Information and Quality Authority (HIQA) to conduct an audit of antenatal and maternity services including the standard and safety of equipment, staff workloads, care protocols and training of personnel; and

calls on the Government to establish a dedicated independent Patient Safety Authority, which will incorporate HIQA, to:

— reassure patients that they have a safe place to go with their complaint;

— act as an advocate for them; and

— ensure that investigations take place when and where appropriate.

I wish to share my time with Deputies O'Dowd, Bannon, Tom Hayes, McCormack and McHugh.

Brendan Howlin (Wexford, Labour)
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Is that agreed? Agreed.

James Reilly (Dublin North, Fine Gael)
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The wording of the motion I have moved deserves to be emphasised, particularly the section in which we call on the Government to establish a patient safety authority to ensure "investigations take place when and where" necessary. As things stand, such an authority is not being established, unfortunately.

We are having this debate on foot of another serious scandal - the misdiagnosis of miscarriage in pregnant women, which is mentioned in the motion. This problem has emanated from Our Lady of Lourdes Hospital in Drogheda, which has been beset by difficulties and scandals over the years. In recent times, the serious pressure on the hospital has become even more horrendous as a result of the Government's deliberate policy of stripping essential services from hospitals in the surrounding counties and moving them to Drogheda. This approach is making it more difficult for the staff of the hospital, who have an increased workload, to carry out their duties with any degree of safety.

I wish to give an example of the problems encountered during foetal assessments. A lady told me that the person who performed the ultrasound on her was bleeped on three separate occasions during the course of the short examination. Anybody who knows anything about learning knows that concentration is important. We all know that anxiety interferes with concentration. If a bleep goes off in one's pocket, it is not just distracting - it creates anxiety too. One will be distracted while one performs this important examination if one is aware that somebody is in great trouble and needs one's services.

It is important to remind the House what happened to Melissa Redmond. Eight weeks into her pregnancy, on 22 July 2009, Melissa Redmond went for a scan in the early pregnancy unit of Our Lady of Lourdes Hospital in Drogheda. It should have been an occasion of joy and hope, but instead it was a devastating experience. She was advised that her unborn baby was dead, eight weeks into her pregnancy. A dilation and curettage procedure was arranged for two days later, on 24 July 2009, and she was given an abortive drug to take on the morning of the operation. The drug in question is designed to open the neck of the womb to make the procedure easier. We must bear in mind that a dilation and curettage procedure involves the evacuation of the contents of the womb. If there is a live foetus in the womb, its life will be terminated as part of the procedure. A report on TV3 last night referred to an extraordinary case in which a probable twin survived a dilation and curettage procedure. That is highly unusual.

Fortunately, Melissa Redmond had sufficient strength of character to seek a second opinion. In that context, I will speak later about the gross unfairness in our system. As she had already had two children and suffered four miscarriages, she was not prepared to allow matters to rest there. She went to her general practitioner in Donabate, who gave her another scan, which found that the baby was alive. The baby was born healthy, thankfully, and is now alive and well. I am sure the Redmonds would have nothing but good to say about the staff who looked after Melissa for the rest of her pregnancy, subsequent to events at Our Lady of Lourdes Hospital.

After the story broke, the HSE said the wrong diagnosis of miscarriage, such as that in this case at Our Lady of Lourdes Hospital in Drogheda, was "extremely rare". This was contradicted by women who came forward with similar experiences over the following days. To date, approximately a dozen women have told stories of wrongly being informed by maternity hospitals that their babies had been miscarried, only to give birth to healthy infants at a later stage. The HSE has received almost 300 telephone calls from concerned women and their families about the treatment they received in maternity hospitals throughout the country.

It is important to remind the House that when different people make the same mistake in different locations, there is a problem with the system. If the same person makes the same mistake, clearly there is a problem with the person. Nobody should doubt not only that we have a problem with our system, but also that we have a problem with who runs the system. This problem was not addressed immediately to ascertain its prevalence. We had to depend on brave and strong people like Melissa and Michael Redmond, who were prepared to forego their privacy and to let the country know, through the media, what happened to them. This resulted in other women coming forward with their stories.

Although we realise we have a problem that requires investigation, the Minister for Health and Children will not order an independent investigation. The Minister, Deputy Harney, wants the HSE to investigate the HSE. She has been a stalwart proponent of not allowing the medical profession to investigate the medical profession, or the dental profession to investigate the dental profession. I agree with her that the days when any profession or group - the Garda or other body - was allowed to investigate itself are over. We need third party verification. We need to be assured that those conducting investigations do not have any conflict of interest.

There have been other cases of misdiagnosis. Martha O'Neill Brennan from Galway told her story.

In both these cases, the women trusted their instincts, stood up to the system and insisted on a second scan. Both are right and both have since given birth to healthy babies. Michael and Melissa Redmond have since said they were disgusted by the HSE's reaction to the misdiagnosis.

An internal review showed that the equipment was faulty and the facilities inadequate. The inquiry found that the image resolution on the ultrasound machine in the early pregnancy assessment unit was not adequate to accurately assess early pregnancies and their complications and that the machine displayed evidence of fatigue. The internal review recommended that the equipment be updated to ensure it was fit for purpose. Despite this, the scanner continued to be used until January 2010, six months after the incident. The review also suggested that a dedicated ultrasonographer be recruited to the unit. One year on, that position has still not been filled. What is the recommendation from this, so called, independent HSE report? It is that we get a sonographer for four hours a day. This maternity unit delivered more than 4,000 babies last year. By any international standard, having spoken to professionals in this area, there should be at least two, if not four, whole-time equivalent sonographers available and not the proposed half-time equivalent, who still is not present.

This puts me in mind of the self serving system the HSE has become. It looks to itself and its own convenience before it looks to patient care.

I congratulate the Redmond family of Donabate and others who have come forward with their experiences. It is not fair to expect devastated couples, who have just been told they have lost their unborn child, to have the composure, confidence and courage to demand a second opinion. It should happen as a right. A patient centred service would listen and ask. Our service thinks only of the inconvenience to itself, as encapsulated by another woman who told of asking, when she was on her way to have a D and C, for a second scan. She was told that was not possible. When she continued to insist she was further informed that not alone was it not possible but that is she did not stop insisting she would miss her slot in the queue and would not have her D and C for another week. Is this a demonstration of compassion, of caring or of a patient centred service. The ethos of the HSE has become something horrible and not something of which anyone in this Chamber can be proud. I can give example after example of that.

Meanwhile, the HSE has announced it is developing national guidelines for clinical practice in obstetrics care. It has announced the establishment of a miscarriage diagnosis review to examine the cases known or identified in the past five years. The review has subsequently expanded to cases beyond five years. While we recognise and welcome the decision of the Institute of Obstetricians and Gynaecologists at the Royal College of Physicians of Ireland to develop its own guidelines in conjunction with the HSE so that it will standardise practices at a high level and welcome the announcement of the HSE review, this is not enough.

The Minister for Health and Children and the HSE must call on HIQA to conduct an urgent audit of ante-natal and maternity services, including the standard and safety of equipment, staff workloads and the workload on equipment, care protocols and training of personnel. This is critical. I am given to understand there are not many more than 120 ultrasound machines involved in foetal assessment. How long could it take to assess those? A year after this matter arose privately between the hospital and Melissa Redmond - the HSE was aware of it - this has not happened. The lethargic, lazy approach of the HSE to these issues, which are so important to patient care, is not acceptable. Matters are put on the long finger and patients are left at risk, instead of urgent action being taken as would happen in a proper patient centred service rather than the self service system we have.

We call on the Government to establish a dedicated independent patient safety authority that would incorporate HIQA, reassure patients that they have a safe place to go with their complaint, act as an advocate for them and ensure that investigations take place when and where necessary.

Our Lady of Lourdes Hospital has had an unfortunate history. It has been mired in a series of scandals and controversies, many of which centred on the standard of care given to pregnant women. Given the number of scandals, one would expect the hospital to be extra vigilant when dealing with patient safety and care. Instead of this, patients attending Drogheda and other hospitals around the country often feel let down and ignored by the system.

Do I need to remind Members of what has happened in this hospital and how people in the north east of the country have been let down? I know I do not have to remind my colleague, Deputy Fergus O'Dowd. The disgraced obstetrician Dr. Michael Neary was struck off the medical register in 2003 after an investigation found he had needlessly removed the wombs and ovaries of dozens of expectant mothers. Garda Sergeant Tania Corcoran-McCabe died, along with one of her twins. An inquest returned a verdict of death my medical misadventure in relation to the young mother. I sympathise with her family. Symphysiotomy procedures were carried out there long after the practice has ceased elsewhere. Mother Kathleen Naughton, who is still living with the consequences of the symphysiotomy she underwent there 35 years ago, said doctors at the time considered themselves to be "gods". There was also the terrible case of abuse by Michael Shine. We now know the great work done by Dignity for Patients.

Would these groups need to exist if a patient safety authority had been in place? Would medical people have been allowed to continue with their practices had a patient safety authority existed, which would have been an advocate for complainants and would have been independent and not employed by the hospital? Complaints officers in the hospitals are employees of the hospital. Where does their loyalty lie?

Thousands of X-rays had to be reviewed after a locum radiologist mistakenly gave the all-clear to nine lung cancer patients, eight of whom subsequently died. The radiologist worked at Our Lady of Lourdes in Drogheda and Our Lady's Hospital in Navan between August 2006 and August 2007. How did the HSE react? It knew about it. My colleague, Deputy Fergus O'Dowd, through a freedom of information request, established that the HSE knew about this real danger to patients in September 2007 and took no action until May 2008. This lazy, lethargic approach screamed at patients, "We'll deal with you when we are ready. In the meantime, you take your chances."

I will now refer to Portlaoise and the disgraceful situation where a consultant surgeon, having reviewed the files in fives and sixes, gave them to an official who put them in a room and left them there until a "cohort" was reached. What was the cohort to be? Was it 100 or 200? It did not matter that these women might have had breast cancer - some did. That was not the issue. The system would deal with these people when it was good and ready. That is not the system in which I grew up or was trained. It is not the system that pertained prior to the installation of the HSE.

In Tallaght, a local general practitioner highlighted the X-ray issue in April. The HIQA became involved in June. It interviewed people in August and in December the Minister was informed. She was not told the extent of the problem and she did not ask because she did not want to know. Months went by before the issue was properly addressed. Once a problem was acknowledged and recognised, all the X-rays - which were digital - could have been e-mailed to radiologists throughout Ireland and the United Kingdom and the matter could have been resolved within weeks. Instead, it was left on the long finger because, once again, the system served itself, and the patient was left to wait. I wish to mention, in particular, the tragedy in Ennis Hospital, where Ann Moriarty twice attended and was given the all-clear. She also went to St. James's Hospital and was again given the all-clear.

The Minister stated last week that HIQA could be the patients' safety authority. HIQA has told me it cannot be a patient safety advocacy. However, it could be subsumed into a patient safety authority. I would like to talk about all the other matters on which it could advise and over which it could preside. Will we find ourselves here again talking about the plight of our young people with cystic fibrosis who still have no isolation unit? They were promised one would be built this year but it has not yet even been tendered for properly.

All the issues I spoke of would have come to light earlier if a patient safety authority were in place. Consider the situation people must go through in seeking redress for their hurt young, having to mortgage their homes to get justice for their children. I urge the Minister not to miss this opportunity to instruct HIQA to undertake an investigation and give people back faith in their health service. They do not trust the HSE and a HSE investigation will not do it for them. I would like to see an audit of our maternity and ante-natal hospital services performed by HIQA but, most of all, I plead with the Minister to take this opportunity to set up a patient safety authority and restore some faith in our health service.

Brendan Howlin (Wexford, Labour)
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Deputy O'Dowd has four minutes. I shall tell him when three have elapsed.

Fergus O'Dowd (Louth, Fine Gael)
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I agree with everything Deputy Reilly said. I live in Drogheda and know hundreds, if not thousands, of the people concerned. More than 1,500 people work in Our Lady of Lourdes Hospital; I probably know most of them and certainly know their families. They, too, feel deep concern and distress that patients who came into the hospital were failed over the years by Michael Neary, that Tania McCabe died in childbirth, that there were the symphisiotomy and X-Ray issues, and that Michael Shine worked there. Some of these events occurred when the Medical Missionaries of Mary were in charge of the hospital; others occurred under the HSE. Many honourable and decent people have worked with both the nuns and the HSE but this issue has never been resolved.

To our great regret, the Lourdes Hospital still makes the headlines in appalling incidences such as the recent one involving Melissa Redmond. I have a constituency member who in August 2008 went through the very same situation, being told after a scan that her baby was dead. Arrangements were made for a D and C but she insisted on a second opinion and the baby was found to be alive. At that stage everything was all right but other events happened later and, unfortunately, the baby was not born alive. Another similar instance arose at least a year earlier. There was an issue about scanning in the hospital long before this latest case was brought to public attention. As Deputy Reilly mentioned, we did not know about it and the lady thought her case was unique.

The lack of transparency and accountability under the present system is totally unacceptable and immoral. There is no standard other than, "If you find out at the end of the day then we'll talk about it, then we'll have the inquiry, then we'll try and do something about it". However, unless there is a patient safety authority to deal with the issue immediately and at all stages, an authority to which people are accountable, which acts for and on behalf of patients, there will not be the health services we all want.

Another issue is at stake here, that of transparency and accountability, of freedom of information. More than six months ago I submitted a freedom of information request to the HSE in regard to an issue. At this stage it has gone to the Information Commissioner because I received no acknowledgment, letters or response - no information of any kind. The Minister, Deputy Harney, presides over an abysmal service that is not accountable, hides its errors and only acts when it is dragged out into the light of day in disgraceful circumstances, as happened in this case.

I put it to the Minister it is time for change and for her to have a hands-on approach for the period left to her in Government. I brought to her attention a report she has had since last November regarding the death of Peter McKenna at Leas Cross nursing home. This inquiry was set up by the Minister set up and run by the HSE, using taxpayers' money, but it refuses to publish the report unless the family signs off on its acceptance of what the report contains and gives a promise to stay dumb and silent as to its content for ever and a day. That is not good enough. I have asked the Minister about this privately a number of times. She has told me and can announce tonight that she will put that report into the light of day in this House so we can see exactly what went on in that case. This inquiry was paid for by the Minister on behalf of the Government and the taxpayers of this country.

It is time for change but we are getting more of the same, which is unacceptable. The country is up in arms because fine and decent people are being put through appalling traumas because of the lack of determination from the Minister and her Department to make the HSE ultimately accountable for its errors.

James Bannon (Longford-Westmeath, Fine Gael)
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The horrific problems of women who were told they had miscarried their babies but subsequently gave birth to healthy children have raised a number of questions about our maternity care, not least about its exorbitant cost in our republic. In a move that mirrors cross-Border shopping expeditions, women are halving the cost of giving birth by going to Northern Ireland. When one considers there is a possibility of being refused admittance to a hospital run by the HSE because of some initiative or other and that in consequence one would have to travel miles to another facility, perhaps going across the Border is not unduly stressful.

What women gain is a quieter hospital environment and lower medical costs. One in eight babies born in Daisy Hill Hospital in Newry last year were born to women who had decided to opt out of the HSE system and into the Northern healthcare system. The financial difference is quite marked. In the Northern Ireland hospitals a private consultant charges approximately €2,300 for between eight and twelve antenatal visits and attendance at the birth. The equivalent cost in the South is between €3500 and €5000. The nightly rate in Newry for accommodation is also half that of the three main Dublin hospitals. Cross-Border dental care is already well established as are food and drink shopping trips which, although detrimental to our economy, are not surprising given that Ireland is the second most expensive city in the EU for food. These facilities are joined now by maternity care. We have out-priced ourselves and are reaping the dubious rewards.

Although no scandal in maternity care attaches to the Midlands Regional Hospital in Mullingar in my constituency of Longford-Westmeath, there have been other medical scandals driven by HSE failures which have given grave cause for concern. In one case phantom appointments were given for a dermatology consultant who had not worked at the hospital for the previous six months. In another worrying cost-cutting measure the hospital refused to provide X-Rays and scans deemed necessary by local doctors for their patients, who were forced to travel to Dublin for the diagnostic procedures. Cancer and mortuary services have been removed from the hospital.

However, nothing could beat the shock for an expectant mother to be told she has miscarried her baby and that it will be aborted. It is a miracle that Melissa Redmond had the conviction and presence of mind to seek a second opinion. Otherwise her perfect baby would have been killed because there was an incorrect diagnosis of miscarriage when there was a viable foetus. This case encouraged other women to come forward leading to the setting up of a review which is to last for six months. It will be chaired by Professor William Ledger.

Patients must be protected from the general and specific mismanagement that has dogged the HSE since its conception. No pun is intended. The HSE has been the black hole of the medical sector. In a game of pass-the-buck between the Minister and the HSE, patients have lost out, trust has been eroded and responsibility has been conspicuously absent as letters, requests for care and other medical requirement are lost in the general mayhem.

Life is sacred. Given our history of care for the unborn, this latest scandal is one too far. How many times can the Minister escape the obvious conclusion? She is not providing the medical care the people of this country deserve and the HSE is colluding with her in the mismanagement of the nation's health. It beggars belief that with a population of approximately 4.3 million the Government cannot safeguard the people of this country and offer them a safe and efficient health service in which they can have complete confidence.

That is not the case here and it is important that the Minister addresses the issue.

Brendan Howlin (Wexford, Labour)
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I call on Deputy McCormack. There is an allocation of a few minutes for Deputy Tom Hayes. In the event that he does not appear, there is five minutes for Deputy McCormack and Deputy McHugh.

Pádraic McCormack (Galway West, Fine Gael)
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Since this misdiagnosis scandal broke, more than ten women have come forward with their personal story of being misdiagnosed with a miscarriage, but going on to have healthy babies, thank God. One of those was a courageous woman in County Galway who came forward and exposed what had happened in her case. It is beyond belief that if these women had not sought a second diagnosis, their babies would simply have been killed.

The HSE has received hundreds of calls from concerned families about the way they have been treated in maternity hospitals throughout the country. In the aftermath of this scandal, the Minister for Health and Children must conduct an urgent investigation of maternity services, including the effectiveness of equipment and the training of staff. It is a false economy with dreadful consequences for the HSE to operate in this slipshod manner. Only last week a man was awarded €4.25 million in a settlement for an action over negligence at his birth in a Cork hospital. How many more such settlements have taken place while services at the front line are being cut?

It has recently been exposed that over €2.25 million was put aside in a SIPTU and HSE account to fund unnecessary foreign travel for officials and their spouses, yet we have not received an explanation. How can I explain all this to the mother who came into my office on Monday who is a full-time carer in her home, looking after her sick, elderly husband and a handicapped daughter who is confined to bed and suffering double incontinence and who had her supply of nappies cut back because the HSE simply did not have the money? Is that not a scandalous situation? How can I explain this to the daughter who gave up her job to care full-time for her aged mother, who had a stroke and who cannot now feed or wash herself and needs 24 hour care, and has had her home help cut by half to six hours per week? Everyone in this House could give several examples of such cases.

There has been such a waste of money at the highest levels of the HSE. Are the executives in the HSE not ashamed of themselves drawing bonuses on top of their salaries of €300,000 to €400,000 a year? It is time somebody cried "Stop", and the buck stops with the Minister. What will she do about it? That is the question I am being asked every day in my office and on the street. All our pleas are falling on deaf ears and the dedicated people on the front line must struggle on because the Government has run the health service into the ground due to its mismanagement of the economy and the health service over the years.

The public have little recourse in these matters. My wife has been involved in a patient focus group, but when a complaint is made to the hospital, the hospital management itself investigates the complaint. What conclusion will they reach other than to back up their own staff? It becomes extremely frustrating for the families of patients who have been mistreated in hospital to get any satisfaction when they make a complaint, because it is a closed shop inside. The Minister would want to do something about that.

Joe McHugh (Donegal North East, Fine Gael)
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I welcome the Minister to the House and I congratulate Deputy Reilly on putting forward this motion. The substance of the Fine Gael motion proposes the establishment of a new, independent patient safety authority which would incorporate the Health Information Quality Authority. This is necessary because the State's existing health care complaints facility is a function of the HSE, as Deputy McCormack alluded to in his contribution. Its staff are employees of the HSE. Health complaints officers in other countries are independent of those countries' health service providers. HIQA can only function effectively if it is answerable to an organisation that is independent of the HSE. Today, it receives complaints from patients and feeds them directly back to hospitals and into the HSE's complaints system.

I would like to raise an issue that the Minister might consider parochial, but it has the potential to become a serious national issue. I refer to an indication by the HSE management that they are looking to replace the out of hours cover by specialist junior doctors in Donegal hospices with locum GP cover from the local out of hours Now Doc service. Such cuts shatter the confidence of people in the HSE. Replacing specialist palliative medical care with Now Doc care is unthinkable for hospice patients. Locum GPs will not know patients' medical histories and will not have the required medical expertise, which is expressed in the Government's own 2001 report on palliative care.

The report by the national advisory committee on palliative care in 2001 was described by the Minister as a blueprint for the future of Irish palliative care. It is based on two principles. A needs assessment is regarded as a foundation upon which health care priority setting should rest. Specialist palliative care should be available in all care settings and should support the patient wherever he or she may be - at home, in hospital, in residential care, in day centres and outpatients or in a specialist palliative care unit. There is a growing concern at local level in my constituency, among experts in the field and among patients, that this system of replacing specialist junior doctors with locum GPs does not represent the philosophy contained in the report. The report also notes that all specialist palliative care services should have available an essential minimum core professionally staff, with recognised post-qualification specialist training. It states that in delivering palliative care, different professional groups will have areas of common interest that require different levels of specialist knowledge.

How much did it cost the State to commission the report by the national advisory committee on palliative care? Why is it being blatantly contravened? Specialist junior doctors are paid monthly in block payments for providing this out of hours service in the HSE north-west area. It is accepted by practitioners that there will be cutbacks and there has to be more value for money. However, there is a proposal on the table that the HSE should pay specialist junior doctors on a call by call basis - there may only be 12 to 15 calls per month - rather than giving them a block payment per month. I know the Minister will allude to the consultants' contract and say that this is not possible, but where there is a will, there should be a way. This proposal would achieve the Minister's targeted savings while maintaining specialist out of hours palliative care. Will the Minister engage with the practitioners and the experts on this proposal?

Mary Harney (Dublin Mid West, Independent)
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I wish to share time with the Minister of State, Deputy Áine Brady, and Deputy Beverley Flynn.

I move amendment No.1:

To delete all words after "Dáil Éireann" and substitute the following:

"expresses sympathy with any woman who has been affected by misdiagnosis of miscarriage;

recognises that Ireland has achieved, and is maintaining, very high quality maternity services and has, by reference to international standards, maternal, perinatal and infant mortality rates that are among the lowest in the world;

welcomes the key actions that have been taken to address the issue of misdiagnosed miscarriages including:

— the fact that the Chief Medical Officer of the Department of Health and Children and the director of quality and clinical care in the Health Service Executive, HSE, have jointly written to all obstetric units advising them to ensure that the decision to use drugs or surgical intervention in these circumstances must be approved by a consultant obstetrician;

— the HSE's announcement of details of a miscarriage misdiagnosis review team, and its terms of reference, including the appointment as chair of an independent expert from outside the jurisdiction; and

— the establishment, earlier this year, of a clinical programme for obstetric care by the HSE's national director of quality and clinical care which will define best practice care for early pregnancy loss and other aspects of obstetric care;

welcomes the actions that have been taken by the Minister for Health and Children, with the support of the Government, to improve the safety and quality of care for patients across the broad spectrum of health service activity including, in particular:

— the establishment of the Health Information and Quality Authority, HIQA, as an independent authority to drive continuous improvement in Ireland's health and social care services; and

— the work being done to implement the recommendations of the commission on patient safety and quality assurance;

recognises the effectiveness which HIQA has already demonstrated in carrying out its role as a regulatory authority, which already incorporates the role of a patient safety authority;

endorses the Minister for Health and Children's intention to bring forward legislative proposals that will include the mandatory licensing of private and public hospitals and welcomes, in this regard, the preparations currently being made by HIQA to initiate an early public consultation on draft national standards for better, safer health care; and

supports the other reforms currently under way to improve the quality and safety of our health and social care services including the introduction of competence assurance under the provisions of the Medical Practitioners Act 2007, the promotion of clinical leadership and the development of national care standards and protocols."

I wish to again express my sincerest sympathy to all those women, who have had a misdiagnosis of miscarriage, and their families. I can only imagine the distress, trauma and the hurt it has caused them and their wider families. It is a serious matter and it is treated seriously.

Since this issue arose, a number of changes have been put in place. First, I want to deal with the issue that arose in Our Lady of Lourdes Hospital last summer. In July, when this issue was brought to the attention of the hospital, it introduced a requirement for a second scan and a requirement that where drugs were to be administered or surgical interventions were to take place that they would have to be signed off by a consultant obstetrician.

In moving my amendment to the motion, I said that chief medical officer and Dr. White of the HSE have written to all obstetric units in the country, the 19 in the public system and those in the private system, advising them to take immediate measures where a miscarriage has been diagnosed and where drugs or surgical intervention is recommended that this would have to be approved by a consultant obstetrician. That has been done to give women the reassurance they deserve.

Prior to this matter arising, the HSE appointed Professor Turner in May of this year, as it has appointed 23 other clinicians to lead clinical care pathways, particularly in chronic illness management but in other areas where there is a high volume of activity. The purpose of Professor Turner's appointment is to standardise care across our maternity services - to introduce protocols based on best international practice. He is working with the college of obstetrics, first, in regard to producing guidelines and, second, to ensure that such standard of care is put in place as quickly as possible. We did not have clinical leads in these areas until relatively recently with the appointment of the director of quality control and clinical care at the HSE.

In addition to that, as the Deputies have acknowledged, there is a review of what happened not only in Our Lady of Lourdes Hospital but of any other case that arose during the past five years where there was a misdiagnosis, where a miscarriage was diagnosed and where subsequently there was a viable pregnancy.

The purpose of that review - which is chaired by the vice president of the college of obstetrics in the UK, Professor Ledger, who is joined by Professor Turner, Ms Sheila Surgrue, the lead midwife, and Cathriona Molloy from Patient Focus and a patient representative - is to make recommendations that will inform the new protocols that will be put in place.

As Deputies are aware, misdiagnosis is a feature of all health care systems. Misdiagnosis did not happen today or yesterday or since the formation of the HSE. Unfortunately, for many years misdiagnosis in Ireland was covered up and swept under the carpet - that is a fact. Much of the misdiagnosis that has been brought to public attention in recent years happened prior to the establishment of the HSE five years ago - that is fact. The reality is that these issues were dealt with by way of litigation. I advise Deputy McCormack that, by international standards, Ireland has a low level of litigation in regard to both brain damaged children and misdiagnosis generally.

Pádraic McCormack (Galway West, Fine Gael)
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How much have such cases cost the State?

Mary Harney (Dublin Mid West, Independent)
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It is recognised internationally where research has been carried out - we have had no such research here but there is no reason to believe we are any different - that approximately 10% of hospital experiences are an adverse experience - that the patient has an adverse experience. Thankfully, these are not fatal experiences, although perhaps 1% of them are.

Pádraic McCormack (Galway West, Fine Gael)
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What about all the money that was lost on those cases?

Brendan Howlin (Wexford, Labour)
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The Deputy was allowed to make a contribution without interruption, he should allow the Minister the same courtesy.

Pádraic McCormack (Galway West, Fine Gael)
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The Minister was addressing me.

Mary Harney (Dublin Mid West, Independent)
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I am responding to the point you made.

Brendan Howlin (Wexford, Labour)
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The Minister should address her comments through the Chair.

Pádraic McCormack (Galway West, Fine Gael)
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How much have these cases cost the country during the past five or ten years?

Mary Harney (Dublin Mid West, Independent)
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Misdiagnosis is a challenge for health care systems throughout the world and there is no substitute for expert clinical examination. Professor Turner made that point clearly and succinctly to the media only a few weeks ago in a very convincing fashion. There is no substitute for expert clinical evaluation. There are no tests, irrespective of how advanced they are, that are perfect. There are tests and the use of diagnostic technology that have false positives and false negatives - that is a fact. Tests have to be combined with expert clinical examination and expert clinical opinion. When errors are identified or anticipated, particularly in areas where there is a high volume of activity and where the consequences can be very serious, we must have in place fail-safe measures that identify such errors, that enable us to quickly learn from them and to put into effect protocols to avoid them happening again.

Pádraic McCormack (Galway West, Fine Gael)
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God bless the courageous women who came forward.

Mary Harney (Dublin Mid West, Independent)
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I will not allow the Deputy to interrupt me; I want to continue to say what I have to say.

The purpose of reviews is to learn from the experience and to put that learning into effect. That is the reason we have them. We have had a number of them and they have been put to good effect. For example, in my Department since the Portlaoise incidents, a new patient safety protocol is in operation. When letters in this respect arrive in a routine fashion in my office, that of any of the Ministers of State or that of any other member of the Government, they are handled by the office of the chief medical officer. Heretofore, the chief medical officer and his team were advisers to the Department, now they head up a division that primarily deals with patient safety issues, and that is the appropriate response. Correspondence is received from patients, lawyers, health care professionals, including doctors and it is not possible for a political head or anybody with a political perspective or an administrative background to be able to handle those issues appropriately. They should be handled by the clinical expertise in the Department, and that is what happens.

Patient safety generally has been a high priority of mine. We have established HIQA and the purpose of doing so is to have an independent body, independent of the service providers, to set standards, monitor the implementation of those standards and enforce them. HIQA is free to carry out its own reviews or it can carry out reviews if requested to do so by me. It has been involved with this review group. It was consulted on the terms of reference and the scope of the review. Although there has been criticism that the review only extends back to the past five years, the review group will examine other issues that extend beyond five years from which there can be a learning that will influence protocols.

In addition to establishing HIQA, if we are serious about having a quality authority, we have to be prepared when it makes recommendations to enforce them. I spend hours in this House seeking to make changes in the interests of patient safety, but we are constantly opposed in that respect. I challenge somebody to tell me that it is in order for a country with 4.4 million people to continue to operate the kind of hospital system we have at present, or particularly the one we had a few years ago which has improved, where 32 hospitals were performing breast surgery and in some cases a surgeon performed one procedure a year. That system was defended by many Members of this House and others outside this House. If we are serious about ensuring patient safety, we know that is not a safe environment for any woman to present herself for breast surgery. The same applies in other areas of acute, critical and complex care. If we are serious about ensuring patient safety, we must have the courage to back the decisions of those who seek to do something about patient safety, including the reform agenda in the north east. If there is anybody in this House who believes we can have five hospitals for a population of 300,000 people operating to best international standards, providing safe care with the resources that this country can provide for health care, then they need to think again. It makes sense to have critical and complex care in two hospitals in that region, which is what is now happening, and to have more minor procedures, including day procedures and the procedures most of us would have if we were sick, carried out in smaller hospitals. Thankfully very few of us are seriously ill or require complex procedures. When people need to go to hospital they generally require routine care, treatment of minor injuries and diagnostics.

That type of care can be provided safely in smaller hospitals. However, acute, complex and critical care cannot be provided in the number of hospitals in which it is currently available throughout the State. Anybody who is serious about these issues must accept that.

As part of our patient safety agenda we intend to introduce the licensing of all health provision, beginning with acute hospitals in the public and private sectors in 2012. The legislation is currently being drafted and the Health Information and Quality Authority is producing draft standards which will be available next month for public consultation. Those standards will underpin the legislation, and there will be a statutory requirement on all hospitals in the public and private sectors to meet them. It is only by a system of licensing in accordance with standards with a statutory basis that we can guarantee to provide patients with the safest possible care.

No authority can deliver that without the backing of legislation and statutory standards. I hope that when those standards are produced next month there will be genuine engagement by the Oireachtas Committee on Health and Children and by political parties in this House, so that we have an input that is wider than just the clinical community and those responsible for managing and running hospitals and which includes the political community. The standards will be the basis on which licensing will operate. Moreover, following the publication of the report of the Commission on Patient Safety and Quality Assurance we are making legislative changes in addition to those in the licensing area. The Health Information and Quality Authority Bill will provide for adverse reporting, clinical audit and open disclosure. These are extremely important developments if we are to have a health care delivery environment that is focused on patient safety.

I am delighted that Deputy Reilly supports the changes we made to introduce a majority on the Medical Council. That is good for the profession and for patient confidence in the profession. There was not much support for that provision when we introduced it in 2006; it was strongly opposed by many organisations, including many Members in this House. Now, however, it is working well and doctors have great faith in the Medical Council despite the initial scepticism of many of them. As part of that, a competence assurance process has been recently triggered whereby doctors will have to maintain their skills by engaging in professional education and training on an ongoing basis. We all accept that scientific endeavour and the world of medicine is very complex and changes rapidly. Persons who qualify today will not be fit for purpose in ten, 20 or 30 years unless they engage in ongoing professional education and training and meet competence assurance requirements.

We introduced legislation on whistleblowing in the health service some years ago. If any staff member in the public health services is aware of any issue where patient safety is at risk, he or she is totally protected by law in bringing forward that issue. Our initiative in this regard was a first in this area. There is much emphasis now on whistleblowing legislation for financial services and other areas; we did it in health several years ago.

Under the new consultant contract, we now have clinical directors in all hospitals and in many care areas throughout the State. They are responsible for audit, peer review, professional education and training, and for ensuring that appropriate risk management is being pursued by staff within their hospitals. In addition to clinical directors at hospital and network level, we have the national needs directors who will be rolling out care pathways in many areas of chronic illness and other areas such as obstetrics.

I said earlier that there is no substitute for clinical examination. A full-time dedicated ultrasound sonographer will begin work on 15 July at the maternity unit at Our Lady of Lourdes Hospital. The machine in question was examined in November last year and was found to be fit for purpose. It was not an old or clapped out machine. I understand it was five or six years old and that these scanners are expected to have a life span of at least seven years. The reality is that a scanner on its own, as Professor Turner said recently in public, should not be relied upon. There is no safe diagnostic test; it always must be backed up with appropriate clinical expertise. Mistakes happen in the health service, some of which are genuine clinical errors. Humans make mistakes; sometimes there is a lack of knowledge, sometimes a failure of communication and sometimes there are technical difficulties. In regard to the provision of health care at hospital level, we must ensure we have a sufficient number of experts working together in settings such as maternity hospitals to ensure that whenever a risky pregnancy is involved or where there may have been a misdiagnosis of a miscarriage, that it is signed off by a consultant obstetrician.

Deputy Reilly suggests we need a new authority. I am frequently criticised in this House because there are two many authorities and bodies. I did not see the programme but I understand Deputy Barrett spoke on television on Sunday night about the plethora of organisations in health care. The reality, however, is that we have already subsumed a large number of those organisations in the health care area. Some 58 were incorporated into the Health Service Executive on its establishment and, more recently, other organisations such as the Office of Tobacco Control and the Crisis Pregnancy Agency are also being subsumed into the executive.

The reality is that setting up another organisation is not the way to deal with patient safety. We must have patient safety at the heart of everything we do. Every clinician, whether in primary care or hospital care, must be involved in patient safety. We must have a licensing regime based on best practice internationally as far as the provision of services at hospital level are concerned.

Pádraic McCormack (Galway West, Fine Gael)
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When will we have that?

Mary Harney (Dublin Mid West, Independent)
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We must have protocols that standardise care across our maternity units so that we no longer have a significant variation. That effort will involve the obstetric community and the new clinical leads the HSE is appointing. In the case of obstetrics, that person is Professor Turner.

These initiatives will go a long way to reassuring patients that patient safety is being taken seriously. Some 70,000 births take place in this country every year and some 14,000 miscarriages, or approximately 20% of all pregnancies. Deputy Reilly referred to 300 telephone calls, but not all those calls are necessarily from women who were subject to a misdiagnosis. We must be clear about that. We do not know what the number is over the past five years but we will when the review is completed and published forthwith.

James Reilly (Dublin North, Fine Gael)
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No, we will not.

Mary Harney (Dublin Mid West, Independent)
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Any woman who is concerned has been asked to contact her hospital. All those records will be examined and will be made available to the review. The reality is that Ireland is one of the safest places in the world to give birth. We have very low levels of infant mortality, maternal mortality and perinatal mortality relative to other countries. That is something for which we should be grateful.

As far as I am concerned, as Minister for Health and Children, any error is an error too much. Everything we are seeking to do is with the objective of minimising the capacity for errors. In particular, it is about making sure we are open and transparent. There is a requirement on hospitals, for example, to notify the State Claims Agency of all adverse events. Everything I have learnt indicates that it is only by open disclosure and admitting errors that people will learn how to put things right. The purpose of all we are doing is to learn from errors that occur so that we minimise the capacity of those mistakes ever recurring, recognising that there will never be an error-free world when it comes to health.

James Reilly (Dublin North, Fine Gael)
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The Minister is not doing that.

Pádraic McCormack (Galway West, Fine Gael)
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If the Minister means what she says she will accept the Fine Gael motion.

Áine Brady (Kildare North, Fianna Fail)
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I begin by expressing my sincere sympathies to all women and their families who have been affected by these distressing incidents. I take this opportunity to outline to the House additional areas that are being examined and developed following on from the recommendations of the Commission on Patient Safety and Quality Assurance. Those recommendations set out an extensive and challenging agenda to develop the capabilities of our system in the area of patient safety. Work in this area is being overseen by a broadly representative implementation steering group established by the Minister for Health and Children last June. Work to implement the commission's recommendations includes the introduction of standards for better, safer health care, the HSE's directorate of quality and clinical care's work to establish national programmes for specific chronic diseases, and the development of the serious incident management team within that directorate.

Progress is also being made in other areas. In the area of service user involvement, the HSE and my Department have completed consultation on a proposed guide for service users that will prompt patients to engage assertively in their own health care and to ask questions designed to ensure their care is safe. Regarding health information, a Bill to be published this year will provide the legislative and information governance framework for safeguarding the confidentiality and privacy of health information while facilitating its more effective use. This legislation is a fundamental prerequisite to modernising the delivery and planning of our health and personal social services to significantly improve the experience and outcomes of service users. Also in this area, work is being progressed on laboratory information management and HIQA published GP messaging standards in April 2010, with preliminary testing to commence July or August.

In the area of education and training, the ISG has endorsed and agreed to promote in Ireland the use of the Australian patient safety education framework and associated WHO patient safety education curriculum guides. Actions on foot of this decision include ongoing liaison with regulators and educators about implementation of the recommendations; engagement with the training schools and bodies; the completion by undergraduate medical schools of a self audit on current practices in this area; clear reference to patient safety included by An Bord Altranais in the newly approved requirements and standards for post-registration and continuing competence nursing and midwifery education programmes; and a patient safety education on-line training programme that has been commissioned though HSE's medical education training revenue funding programme and that will be available to all medical training bodies in the coming months.

Medication safety is a core area of patient safety, particularly as adverse drug events are the most frequent single type of adverse event. The Irish Medication Safety Forum is now well established and working to improve communication and collaboration between the various bodies and health professionals with a role in medication safety. A mapping exercise of Irish medication initiatives to identify and exchange information on the volume and breadth of medication safety initiatives ongoing throughout our health services has been completed by the forum.

Arising from this, a number of initiatives have been undertaken and are ongoing at local and regional level throughout our health services to improve medication safety. Some specific examples include the development of clinical pharmacy services in many hospitals, the EU safety vest project, the development of e-learning medication safety initiatives in certain hospitals, the Mental Health Commission audit of antipsychotic prescribing in Irish in-patient psychiatric units and many others.

The Irish Medical Council published the seventh edition of the guide to professional conduct and ethics for registered medical practitioners in November 2009. In this edition of the guide, the council has provided clarification on a number of specific areas, including consent, confidentiality, end of life care, provision of information to the public, prescribing practices and referral of patients. Increased emphasis in recent years on patient safety has also influenced the expansion of guidance on adverse events and open communication with patients. Regular meetings are taking place with all the professional regulatory bodies concerning fitness to practice issues in the newly-formed health and social regulatory forum.

I congratulate the Minister on all the initiatives she has taken on patient safety. It takes bravery and resolve to deal with these issues. No system is perfect but we need to face up to and deal with these challenges. That is what the Minister for Health and Children is doing.

Beverley Flynn (Mayo, Fianna Fail)
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Everyone wants full confidence in our health system, particularly women who have just discovered they are pregnant; it is both an emotional time and a vulnerable time when they place themselves completely under the expertise of those in the health service. It is vital they enjoy full confidence in that time.

For a woman to be told she has miscarried, or that her baby has died in the womb, is a dreadful experience. When I head the case of Melissa Redmond, I am sure many women asked themselves if, when they decided to have a surgical procedure, it had happened to them. We cannot have a health system that allows such questions to prevail and it is important that we move to reassure women.

In that regard, I welcome the review that has been announced by the Minister, particularly that it will be carried out within six months and that its report will be published. I also welcome some of the measures that have been put in place to bring about a situation where there will be a standard protocol in all obstetric units, particularly that the Chief Medical Officer has written to all obstetric units advising them to ensure the decision to use drugs or a surgical intervention in these circumstances must be approved by a consultant obstetrician. This is critical, that the right people are involved in making these decisions on matters that are critical. The fact that a clinical programme for obstetric care has been established by the HSE national director of quality and clinical care is welcome, as is the fact that where women are concerned about their care, they have access to the necessary information, support and reassurance.

The Minister mentioned that there were 300 calls to the helpline but we will probably never know how many women have been affected because there will be those who do not phone and women who will never know if a misdiagnosis was made. This is sad and is why it is so important that we move to reassure them.

I compliment the Minister for the measures that have been introduced, particularly in the area of patient safety and the fact that the Department of Education and Skills is currently working on proposals for licensing legislation designed to improve patient safety by ensuring that health care providers do not operate below core standards which are applied consistently. That is vital. The legislation she mentioned that will be introduced toward the end of the year and implemented early next year is an essential step forward and legislation of this type is the direction to go.

The Minister is also considering a national framework for clinical effectiveness and I encourage her to proceed with this so we have an effective means to establish and implement best practice in all areas of healthcare. People should be confident no matter if they are visiting a hospital in Mayo or in Dublin. This Minister has done a huge amount and she has told us in her speech what she has done about cancer. In my constituency I know a lot about this, that we are giving people the best possible treatment in the best possible location, with the same standard throughout the country for private or public patients.

An audit of hospital equipment should be carried out. In some hospitals, many machines are close to the end of their lifespan and some machines are obsolete but remain in use. People would be reassured by an audit being carried out in all hospitals to ensure equipment is safe and fit for purpose.

I look forward to the review and welcome the measures that have been put in place to reassure women. When the review is complete and we have the report, we will be in a position to have a standard system throughout the State and I look forward to that in the interests of all women.

Jan O'Sullivan (Limerick East, Labour)
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There is no doubt that there is a crisis of confidence in the health service that has been caused by a succession of scandals in recent years, most of them relating to misdiagnosis. The one described by Melissa Redmond on television, and other mothers who subsequently came forward, went to the core of many women's need to feel confident in the early stages of pregnancy. When they are told by an expert that the pregnancy is over and they will need a procedure to complete it, the very idea that it might not be the case has shaken women.

Deputy Flynn put her finger on it when she talked about the women who must be wondering if it was right in their case. Melissa Redmond was very brave, with a decent, nice looking family, and was dealing with this extremely well but I also thought of all the other women who will never be on television to speak about this issue but who feel deep in their hearts that this might have happened to them, that they had a viable pregnancy that was ended. That is having a huge effect on women who might never come forward or telephone a helpline and there must be many women who feel like that. I am very disappointed we do not have an independent inquiry because we simply have to restore confidence in the health services. We will not do so by constantly reacting to events that have happened. It is all very well for the Minister to state that from now on a consultant obstetrician must sign off before any procedure to end a pregnancy. We are told an ultrasonographer will be in Our Lady of Lourdes Hospital in July. We are told there will be an examination of equipment to ensure it all works properly. However, this is all after the event. It is closing the stable door after the horse has bolted. It is what has happened with regard to many inquiries; we have had interventions after events. What we need are systems to ensure these events do not happen and the public has to know these systems are in place and that they are fail-safe.

The Minister is correct to state that there will always be human errors in medicine. Therefore, we have to put in place systems to ensure human errors do not lead to bad outcomes. If a person states a pregnancy is over, there should be a system in place so another opinion is sought or a senior person is present.

The report stated that equipment was fatigued and that the image resolution was not adequate to accurately assess early pregnancies and their complications. The Minister was very disingenuous when she stated that it was only six years old and should have been good for business for another while. It was described as "fatigued" because it was in use so much. It is not necessarily a question of age. It is a question of ensuring definite procedures are in place with regard to the age of a piece of equipment or how much work it has done. I am not an expert on this but there are experts and people who know all of these things. We must ensure these procedures are in hospitals.

I spoke to someone who works in obstetrics who told me there is no equipment replacement procedure built into hospital budgets. There should be an automatic renewal of that section of the budget when a piece of equipment is ready to be replaced and it should be built into the budgets. What happens now is that if a piece of equipment is getting old and needs to be replaced, whoever controls the budget in the hospital must be chased to get the money to replace it. That is not how it should be. It should be built into the system so the money automatically comes into the budget when a piece of equipment needs to be replaced. This is done elsewhere; it is written into businesses when they write the age factor of equipment into planning. This should also be the case in hospitals, where patient safety and people's lives are involved.

We do not have enough consultants, particularly consultant obstetricians given the population level. We will now be faced with a shortage of non-consultant hospital doctors also. There is a real fear in maternity hospitals, which are already very overcrowded, with regard to what they are expected to do and population growth. They fear there will not always be time to do what is right. We cannot let that happen in our hospitals.

Deputy Reilly's motion proposes establishing a patient safety authority. My wording would have been that we turn HIQA into a patient safety authority but we do not differ greatly on this point. Deputy Reilly proposes that we introduce a patient safety authority and incorporate HIQA into it. I do not really mind what language we use on this; what is important is the power the organisation has and its function. There should be only one body and the Minister was being disingenuous when she stated the motion proposes the establishment of another quango. That is not what is being proposed. What is proposed is that the quango in existence would be replaced by another which would subsume it. I would do it the other way around but that is not important and we will support the motion.

What is important is that the body is given the appropriate powers to do what it needs to do. HIQA does not have strong enough powers. It can instigate investigations but it cannot always get all of the information it requires unless it is asked to carry out an investigation. Issues arise with regard to the powers of HIQA. The legislation did not give enough teeth to the organisation. It can set standards and will do so on public and private hospitals, just as it has set standards on nursing homes. However, the problem is ensuring the resources are there to implement the standards. Unfortunately, on many occasions when the public system is not given sufficient resources, the standards are misused to close facilities rather than building up those facilities to comply with the standards, which is the approach we need to take.

It is all very well having public and private hospitals subject to standards but private hospitals can turn away people. They can pick and choose what they do. Therefore, they can easily comply with standards. More and more, the public system will be left with the more difficult and costly procedures. This will make it more difficult for the public system to comply with the standards. This is disingenuous. One cannot compare like with like if one allows private hospitals to cherry-pick. Ultimately, we do not agree with apartheid between public and private hospitals. If everybody was in the same system, we would have the same standards for everybody, which is what any decent public health system in a democracy should have.

A recommendation from the report into Rebecca O'Malley's misdiagnosis was that every hospital, and everywhere health care is provided, should have a patient advocacy service. This is very important but it has never been properly implemented. If one feels doubt about anything to do with one's treatment, one should be able to go to an independent advocate who does not represent the hospital but who speaks for the patient. The patient has to be at the heart of this. Deputy Reilly uses the name "patient safety authority". Whether it be called the "patient information quality and safety authority" does not matter; the patient must be at its centre. Advocacy at local hospital level is very important in this regard.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank Deputy Jan O'Sullivan for sharing her time. The Sinn Féin Deputies fully support the motion in the name of the Fine Gael Members. We welcome the fact that Fine Gael has used its Private Members' time to address this urgent and very serious health care issue.

It is, without question, a hugely traumatising issue for possibly hundreds if not thousands of women who may find, or who may have reasonable grounds to believe, that their viable pregnancies were terminated after being wrongly diagnosed as miscarriages. This is the first time the issue has been addressed substantively in the Dáil, despite the fact that Melissa Redmond's story was first revealed in the media at the start of June. The Government refused to provide time for statements and a question and answer session with the Minister on an issue that is of huge concern to thousands of women and their families throughout the country. I sought this opportunity repeatedly but without success. Last week, the Minister for Health and Children responded to questions on this issue. I stress "responded" because she gave responses rather than the answers that Deputies were seeking.

I asked why the Minister, the Department and the HSE had to wait until after Melissa Redmond's story went into the public arena, when it was first known as far back as August 2009. Did not the Minister, the Department or the HSE consider the implications of what was brought to their attention then, not only with regard to Melissa Redmond's story but for other women presenting at Our Lady of Lourdes Hospital, Drogheda and for women who, perhaps in other circumstances, would present or had presented, at other maternity units across the State?

I asked why the Minister only responds when the spotlight of public attention is directed at an issue. I find it very difficult to understand how something of such seriousness would not have triggered a spontaneous response throughout the system to try to establish the facts to eliminate any possible misdiagnosis presenting and reflect on fact that many women are in anguish each night since the time this story first became public. The Minister stated in response that from the time this case came to the attention of the HSE, her Department and the hospital, action was swiftly taken to establish what had happened. That was only answering a different question, not the question put. The question we still need answered is why the systems failure was not addressed and why the possibility of a systems failure beyond the Our Lady of Lourdes Hospital in Drogheda was apparently not even considered until after the matter went public at the start of this month.

The information given by the Minister in the Dáil last week was first revealed in answer to a parliamentary question tabled by me on 15 June. In that reply the Minister admitted that the Melissa Redmond case had been brought to her attention as far back as August 2009. When Melissa Redmond courageously spoke out about her experience in Our Lady of Lourdes Hospital in Drogheda earlier this month she was followed by other women across the State with similar experiences. The Minister, however, still stayed silent on the issue even though the numbers presenting continued to grow. The early cohort of women were all women who, thankfully, had happy outcomes. The diagnoses was questionable but they had enough within themselves to challenge that and seek a repeat diagnosis to secure confirmation of what they believed. All of this represents a classic case of patients not being listened to. We must have full disclosure of all of this.

I welcomed the announcement of the terms of reference and review team for the HSE's miscarriage misdiagnosis review. Women who have had these experiences need to be fully supported. I encourage women to contact the maternity hospitals where they received treatment to ensure they can access the information regarding their treatment if they have any questions or concerns regarding their experiences.

It is also welcome that from now on all decisions to use drugs or surgical intervention in women who have had a miscarriage diagnosis must be approved by a consultant obstetrician. The question is, again, why it took this public scandal for that to be implemented. Surely such a practice should have been in place. It is only now, in the wake of media coverage, that the review and the changes in practice are being put in place. This surely indicates a systems failure and examination of this failure should be added to the review's terms of reference.

The Association for Improvements in Maternity Services Ireland, AIMSI, has pointed out what it calls the "widespread fragmentation of maternity care services", which includes huge variability in the type and standard of care available to women, a lack of continuity of care, poor communication between health care professionals and women in their care, over-reliance on technological equipment, as well as under funded, overcrowded, under staffed centralized care units, which is very much the order of the day under this Minister and Administration. Crucially, it points out that such a service does not create a space for the voices of women to be either heard or listened to and allows for an unacceptable margin for error. This has undoubtedly resulted in undermining women's trust in the health care system. I agree with AIMSI and others when they say it should not be the responsibility of individual women to ensure they receive such care but, rather, the responsibility of health professionals, the HSE and, ultimately, the Minister for Health and Children.

AIMSI has also highlighted some very important information that the Minister and the HSE need to take on board and which should be examined by the review. AIMSI states that it is aware of many instances of questionable ante-natal scan diagnoses other than those highlighted in regard to foetal viability and early miscarriage diagnosis and misdiagnosis. It is also aware of cases in which dating errors have led to the premature births of babies. All of this information needs to be carefully examined and acted upon.

There has been and clearly still is over-reliance on technological equipment. That is why scans need to be checked and double-checked and repeated, especially in the case of miscarriage diagnosis. Nothing can replace the skill and experience of the health care professionals. Equipment must always be seen as an aid to that skill and not a substitute for it. In a time of widespread health cutbacks there is a danger that the machine will be seen as the cheaper, easier option, rather than the full attention of the health care professional.

Last week we raised with the Minister for Health and Children the need for her to order a full review of consent policies within the maternity system and initiate national guidelines for clinical practice in maternity care. She replied that the HSE has recently established a clinical programme for obstetric care led by Professor Michael Turner of the Coombe Women's and Infants University Hospital and that an important priority in the programme will be the development and implementation of national guidelines for clinical practice.

The Minister stated that she expected that, in regard to issues of consent, the provision of obstetric services in accordance with these guidelines, as is the case in all other health services, will meet ethical guidelines set by the Medical Council in 2009. She also stated that the miscarriage misdiagnosis review announced by the HSE will inform the development of the proposed national guidelines. That is welcome, as far as it goes. However, an internal HSE review is not enough. As the motion tabled by Fine Gael and Deputy Reilly states, the role of HIQA needs to be enhanced. An independent patient safety authority should be established.