Tim O'Malley (Limerick East, Progressive Democrats)

I do not know how the Tánaiste and the medical profession will drive forward the findings of this report but that is indefensible behaviour and we must do everything to ensure it never happens again.

The judge also stated in the report:

Obstetricians should keep a fair balance between private work and clinical contractual commitments. Private practice should not be so onerous that performance is affected nor should it interfere with the consultants' capacity to carry their full weight in teaching duties towards junior doctors in training, continuing professional development or clinical audit.

For too long we have allowed consultants to do what they like, not fulfilling their contracts or carrying out their responsibilities to teach, particularly in teaching hospitals. The report's finding that the Royal College of Surgeons found the practice in Lourdes hospital to be acceptable is unbelievable. When one analyses this report in the clear light of day it is extremely difficult to understand.

The religious ethos of the hospital was mentioned by a number of speakers. I take the basic point about a religious ethos in an institution but with regard to Dr. Neary, the inquiry rejected his evidence that 75% of the hysterectomies performed were attributable to the ethos of the hospital. Senator O'Toole and others referred to Dr. Neary's motivation but I do not know and cannot understand what motivated him. I do not know if it was religious belief but he certainly did not engage in acceptable practice.

Judge Harding Clark has produced an extremely comprehensive and fair assessment of the events at Drogheda. The challenge before us in the Dáil and Seanad is to ensure that the various lessons to be learned are quickly taken on board by the health system as a whole, and not just in respect of maternity services. I emphasise that it should not just be in respect of maternity services, because many speakers have referred to the fact that similar problems may exist in other specialities.

I assure the women involved in these events at Drogheda — I welcome them to the House — that many lessons will be learned by the Government from this report. Equally, I assure them that the Government will respond fully to the report's findings. These findings state:

. . . any isolated institution which fails to have in place a process of outcome review by peers and benchmark comparators can produce similar scandals as those which occurred in the Lourdes hospital. Support systems must be in place to conduct regular obligatory audit. There must be mandatory continuing professional development and skills assessment at all levels of healthcare.

As the Tánaiste emphasised yesterday, action is being taken to learn the lessons and implement the recommendations of the report in order to ensure the safety of every patient and prevent the recurrence of such events. I will not discuss the redress board because the Tánaiste and others have spoken at length on the issue. I will, however, give a commitment that the Tánaiste and the Government will drive forward the redress board, which is in very good hands. We eagerly await the report of Judge Harding Clark on the matter.

The Lourdes hospital inquiry report has strengthened the Government's determination that patients and the wider public will be the primary focus of decisions relating to health policy. The report will act as a significant catalyst in the reform agenda, in strengthening clinical audit, in the preparation of the new medical practitioners Bill, the reform of the current consultant contract and the improvement of management systems within hospitals. The Tánaiste will bring proposals to the Government to establish a mechanism to ensure that clinical governance arrangements are strengthened throughout the health system. This will entail the fostering of a continuing culture of openness, preparedness to acknowledge errors and an ability to analyse clinical practice in an environment that does not resort to blame and recrimination.

Several speakers referred to the medical practitioners Bill, preparation of which is well-advanced. The Government intends to make the heads of the Bill available to interested stakeholders and to publish the legislation later this year. The recommendations of Judge Harding Clark's report will be addressed in the Bill in a variety of ways. It will underline the role of the Medical Council as the body in this State which acts to protect the public by way of regulation of the medical profession. It will introduce more streamlined and transparent procedures for the processing of complaints and modernise registration processes to allow for flexibility where required. It will also integrate registration, education and training, ongoing competence and fitness to practise processes.

The Bill will clearly define the responsibilities of the Medical Council with regard to the education and training of medical practitioners and provide, for the first time, a legal framework for the council's implementation and administration of a system of competence assurance. The Government intends that the new legislation will make continuing professional development and education compulsory for medical practitioners.

Several Senators spoke about whistleblowing. The Government believes that whistleblowing is an inadequate term to reflect expressions of serious concern about aspects of medical practice. Systems should be in place within the hospital setting to allow managers, medical practitioners and health care professionals to raise concerns about aspects of practice. Such concerns should be capable of being addressed in the context of rigorous processes of audit, peer review and external evaluation. That is the best way forward.

The Lourdes hospital inquiry has affirmed the approach being pursued by Government in the context of negotiations for a new contract for hospital consultants. The days of consultants working in isolation without effective clinical leadership are now at an end. In the recently published report on mental health, A Vision for Change, the chairperson of the expert group, Professor Joyce O'Connor came to a similar conclusion about psychiatrists, that they found it extremely difficult to work in clinical teams. The challenge for the Government and the medical profession is to change that so that consultants can no longer be allowed to work in isolation. They must be compelled to work in teams with ongoing peer review. Members will agree that Judge Maureen Harding Clark's report is comprehensive and fair. Many people must learn the myriad lessons of the events outlined in the report. Changes must be made to ensure the events that unfold in the report will never happen again in a hospital. The findings and recommendations are being examined in detail by the Department of Health and Children in consultation with the Health Service Executive, the Medical Council and other professional regulatory bodies. Action will be taken. The Government is determined to prevent any events such as these recurring.