Mary Harney (Dublin Mid West, Progressive Democrats)

I am happy to be before the Seanad to speak about the issue of patient safety. A new era has arrived in the Irish health care system. It is an era where patient safety is central to everything we do. The journey of ensuring the setting of standards and the enforcement of those standards has begun with a couple of key milestones. The first was the establishment of the Health Information and Quality Authority, HIQA, a State body independent of service providers whose sole remit is to set standards and monitor their enforcement. I will speak more on this later.

Patient safety is central to the manner in which we regulate health professionals. Just over a year ago, we brought through the Oireachtas major legislation which reformed the Medical Council. At present, elections to the new Medical Council are taking place. In particular, the fact that the new council will have a lay majority is a significant step in ensuring the profession does not regulate itself. Ireland is the first country in the world to embrace a lay majority but I am aware of several jurisdictions following in our footsteps.

The same applies to the changes made to the legislation governing pharmacists, which was almost 200 years old. The new Pharmaceutical Society of Ireland, which I established last summer, also contains a lay majority. I understand from the society that it is working incredibly well in terms of the regulation of the pharmacy profession.

As part of the patient safety agenda and journey upon which we have embarked, we must ensure that when errors and mistakes occur they are properly investigated so we can minimise the capacity of those mistakes ever happening again. We must learn from errors and not in a culture of blame. If I have learned anything over the past three years from a number of key conferences I attended under the auspices of the World Health Organisation, during the British Presidency of the EU during which patient safety was central to the agenda — the chief medical officer heads the world alliance for the World Health Organisation — and in conferences I attended in this country, it is that those health systems which seek to investigate when errors occur and to learn free from a culture of seeking to blame an individual are those which improve fastest.

We have a history of serious errors occurring without being investigated. We know that for 25 years in Our Lady of Lourdes Hospital in Drogheda people knew that what was happening in the maternity unit was wrong yet no audit or investigation took place. Audit will be a common feature of how services are provided in the Irish health care system. From here on in all community and hospital health care settings and even within hospitals themselves, standards of patient care will decide where and how things happen.

Perhaps one of the best examples of this is the new cancer control programme. We have learned not only from our own experience but from strong international evidence on symptomatic breast cancer, for example, that unless this is treated in a unit dealing with at least 150 new cases a year and by a surgeon dealing with at least 50 individual cases a year, we will not obtain the best possible outcomes for the women concerned. We know from at least 250 medical publications that the chances of a woman treated in such a centre are improved by 20%. This means one in five women who would die otherwise survive and have a good outcome. This is compelling evidence for moving with the cancer control programme adopted by the Government and which is now being implemented by Professor Tom Keane.

The change driven from a standards of patient safety perspective is far more powerful than change driven by budgets, industrial relations or staffing issues. Change is often driven by these factors. One of the issues highlighted in the Irish health care system, as it is elsewhere, is the issue of hospital-acquired infections. A national plan is now in place and being implemented by the HSE to reduce the incidence of infections acquired in the Irish health care system. We want to reduce the overall incidence by 20% over the next five years. We want to reduce the incidence of MRSA by 30% and that of antibiotic prescribing, which is a major contributory factor, by 20% over the same period. Unless we know the starting position, we will not be able to measure progress.

Later this month, the HSE will publish data, hospital by hospital, on hospital-acquired infections. This will give us a baseline from which to measure progress. Thereafter, the data will be published every quarter. We saw the results of an investigation by the HSE on the outbreak of c.diff in one hospital. I recently made this a notifiable disease. If we are to improve standards from a patient safety perspective, it is important we audit performance, know what the base is and that we measure performance against it. With regard to MRSA in particular, the countries which do best, such as the Netherlands, are those with a much lower level of antibiotic prescribing than we have in Ireland.

It is equally important that we have appropriate isolation facilities in place, especially in our acute hospitals. I wrote to the HSE several months ago and directed it that private beds in public hospitals which were heretofore ring-fenced for privately insured patients had to be made available as a matter of priority for those patients requiring isolation and that there could be no situation where a private patient in a publicly funded facility could take precedence over a patient who required an isolation facility. This is important. In the context of the co-location proposal, where we will have 1,000 more public beds in our public hospitals, many of which will be in single rooms, we want to ensure these rooms are used to improve the much-needed isolation facilities we require in our acute hospital sector.

I stated at the outset that the establishment of the Health Information and Quality Authority was a significant step. At present, this authority works with clinicians and managers on putting in place appropriate procedures and processes at every health care setting to minimise hospital-acquired infections, especially but not exclusively MRSA. Obviously, c.diff and other infections now commonplace are also included. It is important to have a standards body which can work with the individuals whose jobs will be to implement the change locally.

Hygiene audits are a new feature of our performance measurement for hospitals. They will be carried out in a wider number of health care settings. We have had three audits to date and they indicated a major improvement, particularly as far as cleanliness is concerned. Hand washing is one of the most important things we all can do to minimise the capacity to pass on infection. Hand washing is important for visitors to hospitals, family members and especially important for health care professionals.

On a recent visit to a family member in an acute hospital in Dublin I was very impressed at how prominent the notices were at the entrance of the hospital. Many people did not know I was there because I stood way back in the corner and I noticed that virtually every visitor who came in washed their hands because the signs were so prominent and because they saw other visitors do so. I found that very encouraging and I hope every hospital can adopt the kind of prominent postering used by this hospital to advise visitors as they enter the premises.

The setting of standards is important but so too is the monitoring of standards. The Health Information and Quality Authority recently produced draft standards as far as nursing home care is concerned. Heretofore, nursing homes in the private sector were inspected but those in the public sector were not. From here on, all nursing homes, whether in the public or private sector, will be monitored. Not only will stronger standards be in place but each patient will have his or her own care plan, which is important because the care needs of older people differ hugely. It is important that each patient is required to have his or her own care plan so that those inspecting the facilities can ensure the care plan is being implemented.

The setting and monitoring of standards must be applied across the board in the public and private sectors and not only in public and private sector nursing homes. We have no licensing or accreditation regime as far as private healthcare provision is concerned. On my appointment as Minister for Health and Children, I said I regarded that as a major deficit in our regulatory framework as far as health regulations were concerned. No work had been done on accreditation or licensing and, therefore, we established a patient safety commission to make recommendations around the patient safety agenda but especially as far as licensing and accreditation were concerned.

That commission is chaired by Dr. Deirdre Madden and includes healthcare professionals, experts from other industries which have very high standards of safety in their sectors, patient representatives and family members of those who have had an adverse experience in our healthcare system. The commission is due to report to me in July and the report will be published immediately. I will act on the recommendations of the report as far as accreditation, regulation or licensing is concerned. When that happens, the role of the Health Information and Quality Authority will apply to the private setting as it does to the public one. That was not possible in advance of legislation and regulation.

I refer to a number of the inquiries which, I suspect, led to the request to have this debate. We have had a period of unprecedented inquiry, which is a good thing. For too long the only way people could establish what happened was by litigating. One of the first people I met on becoming Minister for Health and Children was Margaret Murphy from Cork whose son Kevin died as a result of a series of errors in hospitals in Cork. She wanted to find out why it happened. She knew she could not bring back her son but wanted the system to learn from the mistakes that had been made. She could not get any answers to the questions she raised so she had to litigate. She won and received compensation which she donated to a charity. She was not interested in any financial compensation but simply wanted to establish what happened. The remarkable thing was that I met her in the UK. She had been identified by the chief medical officer there as a champion of patient safety and he had involved her in a world health alliance for patient safety. I subsequently appointed her to different bodies, as I have other patient representatives.

That was the era when one had to litigate to find out what happened but we are in a different era now. We must be brave and courageous enough to inquire and learn from those inquiries. After the inquiries into Portlaoise, a number of measures were taken. In the first instance, we established that the failure to have multidisciplinary care in cancer care leads to bad outcomes for patients.

We also learned that there were serious governance issues as far as the Health Service Executive was concerned. I wrote to the chairman of the HSE following receipt of the Fitzgerald report, which I asked it to commission, asking it to take a number of steps. The first one was to put in place a protocol to deal with serious errors when they arise and I am happy that an interim protocol is now in place.

However, it is not enough just to have a protocol. We need to make sure somebody is responsible for its implementation. The HSE has appointed an individual at national level who must oversee the implementation of that protocol. Among the features of the protocol is that patients must be informed in the first instance. As often happens in healthcare settings when information is put or leaked into the public domain, every patient of that service worries that it applies to him or her. That was one of the major problems which arose in Portlaoise. Huge panic sets in and the system cannot respond to inquiries made. That was the experience in Portlaoise.

A recommendation in the Fitzgerald report was that the patient must come first instead of me, other politicians or journalists. We must make every reasonable effort as quickly as possible after an error, or a potential error, is identified to contact patients and to make sure we engage with them. In cases since Portlaoise, that is the procedure in place which I very much welcome.

Reporting in itself is not sufficient if the mistakes identified are not put right. Everybody here knows that as long as we have roads and cars, we will have accidents and that as long as we have healthcare and hospitals, unfortunately, we will have errors. The best hospitals in the world make errors and sometimes very simple things can cause very serious errors. An X-ray read back to front can often lead to the wrong procedure happening. I attended a conference in the UK last year at which a surgeon from New York with 25 years experience said he removed the wrong leg from a colleague because he was in a theatre which was turned the other way from the one to which he was used. It sounds very simple but sometimes such errors can have fatal consequences, depending on the form of surgery. Therefore, we cannot be careful enough, especially as far as surgery is concerned.

Two years ago I launched a booklet by the Health Information and Quality Authority, which Senator Twomey attended, that contained a patient guide to best care. It advised patients to be vigilant in asking the hospital to mark the left leg or the left side of the brain, depending on the side being operated on. I remember thinking as I launched the booklet that one would want to be a very brave patient before one went to the theatre to think of that. Experts in the area inform patients and their families to do as much as they can to minimise the capacity for error making.

When errors occur, we must make sure we learn from, and minimise, them. I say "minimise them" because we will never have an error free healthcare system. No matter how many staff we have or what procedures and protocols are in place, unfortunately, errors will occur. Human beings will make errors no matter what we do. However, we must minimise the capacity for error making because errors in healthcare, unlike many other areas such as law, accountancy or engineering, can have dire consequences for patients and their families.

Members of the House will no doubt have questions. We are embarked on a massive transformation of healthcare. In particular, we are seeking to make sure acute services are provided in a safe environment with the multidisciplinary care that is not only important in cancer care but in many other areas of care. With a population of 4.3 million, that means we will not be able to have the expertise everywhere. There are 52 acute hospitals in the country. Many of the experts are sought after globally and they are in scarce supply. Therefore, when we acquire expertise, we must put it to best effect as far as patients are concerned.

I very much welcome the new contract of employment we have agreed with the Irish Hospital Consultants Association which represents 80% of practising consultants. I hope that the Irish Medical Organisation will, in time, be in a position to recommend the acceptance of the new contract. Central to that is the appointment of clinical directors. Doctors will work as part of a team rather than work as individuals and they will work under the direction of a clinical director who will have specific responsibility for risk, patient safety and so on.

Although many other aspects of the contract, including longer working days, equal access for public and private patients to outpatients and a one-for-all list instead of the separation we have at present, are fundamental changes, the clinical directorate model where clinicians are centrally involved in a leadership role within the hospital will act to improve patient safety in the healthcare system.