Tim O'Malley (Limerick East, Progressive Democrats)

The Government last week published Judge Maureen Harding Clark's report on peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda. In launching the report, the Tánaiste and Minister for Health and Children was conscious that the last few years have been particularly difficult and traumatic for many former patients of the maternity unit at Drogheda. I also want to express my deepest regret and to apologise to these women and their families for what happened. I assure the women involved that many lessons will be learned from this report, and I equally assure them that the Government will respond fully to the report's findings.

On the day following publication, the Minister met Patient Focus, the group that represents many of the former patients of Dr. Neary, to express her concern and to discuss the report. The Minister and I appreciate the manner in which Patient Focus assisted the work of the inquiry, which was conducted on a non-statutory basis. I hope the publication of this report will in some way help to give answers to the questions that have been asked concerning events at the Lourdes hospital.

I also want to thank Judge Maureen Harding Clark and the inquiry team for the work that they have done in the preparation of what has been widely received as an excellent, fair and comprehensive report.

Since publication of the report, the Tánaiste has had a number of meetings with key agencies to discuss the findings. Steps must now be taken to ensure that its findings are quickly taken on board by the health system. The task facing us is to ensure that the failures found to have occurred at Drogheda in the past are never allowed to recur.

One of the issues discussed with Patient Focus was the question of redress for the women involved. The Government has considered the matter and agreed that Judge Harding Clark will advise on an appropriate scheme of redress arising from the findings of her report. She will also advise on the cost of such a scheme and on a mechanism for ensuring the maximum recoupment of such costs from wrongdoers and indemnifiers.

The Tánaiste is convinced that Judge Harding Clark is the best person to advise the Government on the issue of an appropriate redress scheme based on her discussions with Patient Focus and the reaction of various other parties to the report of the Lourdes hospital inquiry. The quality of her work and report has been widely acknowledged. Her unique insights and skills can be brought to bear on the issue of redress and she has the respect and confidence of the women affected and the other parties involved. Judge Harding Clark will commence her work immediately and will bring her proposals to the Tánaiste as soon as possible.

The recommendations in the report will act as a significant catalyst in the reform agenda. They confirm the appropriateness of the actions being taken in the preparation of the new medical practitioners Bill, the reform of the current consultant contract and the changes in management systems within hospitals.

Yesterday the Tánaiste announced the establishment of a new national perinatal epidemiology centre at Cork University Hospital, that will be up and running in the autumn of this year, with annual funding of €630,OOO. Every time a mother gives birth in this country, the important interventions, the good outcomes and the complications will be recorded and analysed at a national specialist centre. Unusual trends will be easily and quickly observed and, most important, acted on.

International experience of health service failures demonstrates the value of reviewing mechanisms to ensure clinical governance and quality throughout the health service. The report of the Lourdes hospital inquiry should cause us to deal clearly with the implications that its findings have for the health service as a whole. It is the Tánaiste's intention to come back to Government shortly with proposals to establish a mechanism to ensure that, in particular, 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.

The Department is to develop proposals to address the need for stronger clinical governance arrangements throughout the health system. In addition to the actions already being taken in the preparation of the new medical practitioners Bill, the reform of the consultant contract and changes in hospital management systems, there is a need to analyse the implications of the report for the health system as a whole.

We need to address the risk of such a level of malpractice happening again in the future. This means we need to identify and tackle weaknesses in any part of our health system, whether regulatory, governance, organisational, managerial or clinical. The Tánaiste intends to bring proposals to Government shortly to establish a process that ensures the lessons of this report are built into stronger clinical governance arrangements throughout the health system.

Work on the forthcoming medical practitioners Bill is well advanced. This Bill will completely update the Medical Practitioners Act 1978 and will address the recommendations arising from the Lourdes hospital inquiry report in the following ways. It will underline the Medical Council's role 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; it will modernise registration processes to allow for flexibility where required; it will integrate registration, education and training, ongoing competence and fitness to practise processes; it will clearly define the responsibilities of the Medical Council with regard to the education and training of medical practitioners; it will provide for the first time a legal framework for the Medical Council's implementation and administration of a system of competence assurance; and it will make continuing professional development and education compulsory for medical practitioners.

Systems should be in place within the hospital setting to allow management, medical practitioners or other 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.

The purpose of the Medical Council is not only to provide a registration service for medical practitioners. It must also be seen as the competent authority for dealing with serious allegations of professional misconduct. Patients require assurances that their interests are paramount and override any sectional concerns. While the medical practitioners Bill will be an important piece of legislation, it is only one part of a suite of legislative instruments which is now being put in place to ensure greater accountability of all health care professionals.

The Lourdes hospital inquiry report has affirmed the approach being pursued by the Government in the context of negotiations for a new contract for hospital consultants. The necessity for improvements in teamworking by consultants is underlined, but it also reinforces Government proposals on the contract on the need for clear clinical leadership which will ensure that individual clinical practice is in line with acceptable standards of practice. The report highlights the necessity to have clear responsibility for the training of non-consultant hospital doctors. It is from these specialist trainees that we will be provided with consultants who will be clinical leaders in our future health service.

The Government has approved the publication of the general scheme of the Bill providing for the establishment of the health information and quality authority, HIQA, on a statutory basis as part of a publication process on the proposals in the general scheme. The HIQA will set standards for most services provided by or on behalf of the HSE and monitor those standards with powers to investigate, at the request of the Minister or the HSE, the safety, quality and standards of any such service. The House will be aware that the Tánaiste has expressed the view that there should be a licensing system in place for all hospitals and she intends to consider the mechanisms required to put in place such a system.

It may be useful to briefly remind the House of the background that led to the establishment of the Lourdes hospital inquiry. The Medical Council found that the facts with regard to ten complaints against Dr. Neary of unwarranted peripartum hysterectomy were proven. Dr. Neary was found guilty of professional misconduct and in September 2003 was struck off the Register of Medical Practitioners.

The Government decided in April 2004 to establish the Lourdes hospital inquiry to examine the matters raised by the findings of the Medical Council. Anybody who has read the inquiry's report will have been struck by the phrase used by Judge Harding Clark when she referred to the number of peripartum hysterectomies performed at Drogheda as "truly shocking".

A total of 188 peripartum hysterectomies were carried out in a 25-year period from 1974 to 1998. Of this figure, 129 are attributed to Dr. Neary alone, 53 of which were carried out from 1990 to 1998 following the transfer of the obstetric service to a new unit. Dr. Neary's caesarean hysterectomy patients had a different profile compared with the rest of the unit. They were younger and were of lower parity, that is, they had a lower number of pregnancies. The rate of caesarean hysterectomy at the hospital for the period 1974 to 1998 was one for every 37 caesarean sections. In contrast, the rate per section at other hospitals of similar ethos and over a similar period was one for every 300 at Airmount Hospital Waterford, owned by the Medical Missionaries of Mary, and one for every 254 at Portiuncula Hospital, Ballinasloe, which was Franciscan. The rate per section in two other non-Dublin maternity hospitals was one per 315 at St. Finbarr's Hospital and the Erinville Hospital, both in Cork.

The inquiry found that the facts were there for all to see and the operations were openly recorded. This is not the story of a surgeon with poor surgical skills or a doctor deficient in academic excellence. It is the story of a doctor who, at critical points during his training, was inadequately supervised. Dr. Neary came to work in a unit which lacked leadership, peer review, audit or critical capacity. It is the story of a doctor with a deep fault line and a misplaced sense of confidence in his own ability. The inquiry found that no one who worked with Dr. Neary suggested that he had any ulterior motive for what he did.