Liam Twomey (Wexford, Fine Gael)
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I would like to discuss with the Minister for Health the establishment of a patient safety authority in the Irish health service. I call on him to bring forward legislation to establish a robust patient safety authority that will inspire confidence in patients that their concerns will be properly addressed; to ensure that the structures and governance of such an organisation are properly resourced so that complaints are dealt with in a timely manner; and that the patient safety authority can enforce the changes needed in our health service to protect patients.

I call on the Minister to ensure the establishment of a comprehensive patient safety authority in this country, one that has real power and teeth in representing patients. I would like to see established a patient safety authority powerful enough to oversee the Irish Medical Council, the Health and Social Professionals Council, the nursing organisations, the Health Information and Quality Authority, HIQA, and the Irish Mental Health Commission. Currently, outside of the Department of Health there is no patient-focused organisation to represent patients in terms of their needs and complaints. This is not good governance. There is a need for a strong, robust organisation, outside of the Department of Health. The Health Service Executive is to be abolished. We need an organisation which patients can have confidence will protect them and for whom their interests are the primary focus.

The Irish Mental Health Commission has been in place for more than ten years and there is a policy document driving change in the mental health services, namely, A Vision for Change, yet in the health supplement of today's The Irish Times it is stated that patients still do not have individual care plans. Those working in the health service will know that the Irish Mental Health Commission has given increased autonomy and power to patients suffering mental health problems. While their rights within the health service have improved dramatically, there are weaknesses in the system.

In terms of the many weaknesses that have arisen time and again within our health services, which fell to the Minister to deal with, there is a need for a one-stop-shop, such as an ombudsman to whom patients can go to have their issues dealt with. I call on the Minister to ensure a robust and well resourced patient safety authority is put in place to protect patients. I do not think it is right that the Department of Health should be investigating itself when issues arise. The response to the Portlaoise crisis was rapid and good but to instil confidence in patients we need a separate, strong and powerful organisation.

When it comes to enforcing standards in our nursing homes and hospitals, HIQA does its job well. However, its remit is not the same as would be the remit of a robust patient safety authority. There has been a patient safety authority in the UK for more than a decade now. When this issue was raised years ago with former Minister, Mary Harney, the best she could come up with was the establishment of a commission to look into the matter. We have gone past that point. What we need now is a strong organisation in this area.

The Minister plans to introduce universal health insurance in this country and to reform how our health services operate. For this to work and to ensure that standards do not slip again, we need a robust patient safety authority. I ask that the Minister respond to my proposal.

James Reilly (Dublin North, Fine Gael)
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I thank Deputy Twomey for raising this critical issue. Patient safety must be at the heart of everything we do in health. It is a priority issue for me and the Government. It was for this reason patient safety was the primary focus of the 2014 national service plan for the HSE. It is also the reason we decided to expedite the patient safety agency through the HSE on an administrative basis, although ultimately, it will be supported by legislation and be independent.

I have listened carefully to what Deputy Twomey had to say, much of which I agree with. The recent report by the Chief Medical Office into the perinatal deaths at Portlaoise hospital indicates there is a huge need to improve the quality and safety of services across the health system. As the Deputy will be aware, HIQA has been asked to undertake a report into the services at Portlaoise hospital, which will follow on from other investigations undertaken by HIQA in recent years. The HIQA report into Tallaght hospital has prompted significant changes to the governance arrangements not alone at Tallaght hospital, but right across our hospital system. Similarly, a HIQA investigation into Galway maternal deaths will have implications for the safety and quality of maternity services nationally.

In formulating proposals for the establishment of a patient safety agency, the Department of Health considered the international evidence and advice that suggests that health care regulation and the broader quality improvement and patient safety agenda are not appropriately situated together within one agency and that the regulatory function should maintain its independence and remain separate. This suggests that the health and social service regulatory and monitoring function should be maintained separately and enhanced within HIQA. The HSE has statutory responsibility for dealing with complaints from patients who are dissatisfied with the service they receive. National and international best practice would suggest that the best way of resolving complaints is to have them dealt with at a local level. Therefore, the vast majority of complaints to the HSE are managed and should be resolved locally. However, we know that this does not always happen. We know that sometimes people do not get satisfaction and that despite taking up matters with hospital complaints officers, they feel no better off.

I would like at this stage to make a few points rather than read the remainder of my script. I do not believe that we could provide that the Medical Council would be answerable to the patient safety agency or HIQA or that HIQA would be answerable to the Medical Council. All of these organisations are regulatory bodies and stand alone. What I would like to see in a patient safety authority is a champion for the patient, an organisation that can support the patient in getting satisfaction in relation to his or her complaint. It is my view and has been my experience as a doctor that the three As apply here. What people want when something goes wrong is an acknowledgement that something went wrong, an apology for it going wrong and an assurance that it will not happen again because things will change. I envisage that the patient safety agency will be such a body. It will be the patient's friend and the go-to-place for patients when issues arise, be that an issue such as the serious issues that arose in Portlaoise hospital or a staff member being rude.

I genuinely believe that the agency will be supportive of patients, improve the quality of care we provide and hugely reduce the amount of money we spend in medical legal litigation. It is a matter of grave concern to me that of the tens of millions of euro we pay out annually in relation to medical legal consequences, one third of it goes to the legal profession. It should be going to the people who have suffered as a consequence of misadventure and negligence and not the legal profession, whom I have nothing against.

The patient safety agency is a critical part of any new health service. Patients need to be empowered. The informed and empowered patient is the safest patient.

Liam Twomey (Wexford, Fine Gael)
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I thank the Minister for his reply and for coming to the House to take this issue, which shows he takes this matter seriously. What is important is not how the patient safety authority is set up, but that it can deal with complaints from individuals or groups before they become part of the system. We cannot expect the HSE or the Department of Health, no more than we can expect the Garda Síochána or any other organisation, to investigate themselves. We need strong legislation in this area. The establishment of a patient safety authority must be prioritised. As stated, it will instil confidence in patients and improve outcomes within the system for them. It is vitally important the legislation in this regard is prioritised.

In regard to the Minister's reference to an administrative structure, I do not believe that is what we need or that it would instil confidence in patients. I ask that the Minister prioritise the legislation for the patient safety authority and to ensure that what is established is the right type of organisation. It is important we wait until we get it right rather than establish an organisation that will not satisfy what patients want from the health care system.

James Reilly (Dublin North, Fine Gael)
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I agree with the Deputy that the new agency must be underpinned by legislation. In the interests of getting it up and running quickly and teasing out any problems in that regard, I believe it is sensible to introduce it on an administrative basis first.

When I spoke to the parents of the children who died in Portlaoise Hospital, they indicated their concern that such an agency should be established. They were very unhappy that, as the Deputy pointed out, this agency might in any way be dependent on the HSE. I was careful to explain that this is only a temporary administrative arrangement and that supporting legislation will be introduced to make the agency absolutely independent of the Department and, in particular, the HSE and the entity - namely, the proposed health commissioning agency - which is due to replace it.

As the Deputy indicated, the days when the Garda, the HSE and the Department of Health could investigate their own activities are gone. There is value to these entities carrying out initial investigations for their own quality assurance requirements. For any institution or body to have the confidence of the public, however, outside individuals must be involved. The need for this was made obvious in the past in the context of the issues relating to Dr. Neary and all of the women who attended Our Lady of Lourdes Hospital in Drogheda, who were so poorly treated by him and who have suffered dire consequences in their everyday lives since then. There is a need for independence, transparency and clarity in respect of all investigations carried out in this country in order that citizens will have absolute confidence that matters will be brought into the open rather than hidden. There must be no sense among people that a lack of objectivity might apply.