Maria Corrigan (Fianna Fail)

I also welcome the Minister to the House and thank her for the time she so freely makes available to the House. Patient safety and quality of service are central to our health care system. Every patient should feel confident in the service provided to them, whether it is provided in a major regional centre or a local nursing home or whether they are a patient in the community, in the acute hospital setting or in long-term care. The establishment of the Commission on Patient Safety and Quality Assurance and the Health Information and Quality Authority is a vital step undertaken by the Government to ensure quality and safety of care for patients.

The implementation of quality and safety standards in nursing homes, the development of infection control standards, the monitoring of symptomatic breast disease standards and the development of core acute hospitals standards, including adverse event responses, are immediate priorities, together with work to be done in intellectual disability and child care. The Commission on Patient Safety and Quality Assurance has set out to develop clear and practical recommendations to ensure that quality and safety of care for patients is present. I look forward to its recommendations, which will be reached later this year. One of the commission's terms of reference is specifically to examine and make recommendations in respect of a statutory system of licensing for public and private health care providers and services. The current system where anyone can open a hospital or a clinic is not in the interests of patient safety and I urge the Minister to establish a system of licensing as soon as it is practicable.

As part of the health reform programme, the progression of the Health Information and Quality Authority ensures that there will be a national independent inspectorate for all nursing homes for older people, both public and private, as well as for centres for people with disabilities. This includes centres for children with disabilities who, up until now, had been exempt from the inspectorate for residential facilities for children. A core function of the authority is to set standards on safety and quality of services and to monitor enforcement of these standards in an open and transparent way. The Health Information and Quality Authority is committed to developing a supportive culture for supporting patients, families and clinicians when adverse events involving patients occur. The alleviation of a culture of blame and practical improvements in the reform of the system are paramount in producing a service of quality and safety where trust between the patients and health care provider can be fostered in a healthy way.

International research in countries such as the US, Canada, the UK, Australia and Denmark has shown that between 7.5% and 12.9% of patients admitted to the health care settings will experience an adverse event or patient safety incident. Ireland is no different and mistakes do occur but ensuring provisions are in place to prevent or deal with them is where the focus should lie.The recent case involving a young child in Our Lady's Hospital for Sick Children in Crumlin, which came to light in recent days, is devastating. It is essential that a comprehensive review of this case and the procedures employed from the moment the child left the ward be undertaken to enable us to fully understand what happened and how a mistake of this gravity could occur. As a matter of absolute urgency, we need to ensure lessons are learnt and applied immediately to prevent such an occurrence in the future.

On a national level, the Commission on Patient Safety and Quality Assurance and the Health Information and Quality Authority will be invaluable in ensuring the establishment of the necessary frameworks and the accompanying implementation of policies that will ensure the strongest best practice in the interests of every patient's safety whether he or she be based in a community, hospital or long-term care setting. However, at local level in all these settings, it is essential that attention be paid to issues such as staffing, the environment and adverse incidents.

In addressing staffing issues, it is essential that optimum staff mix be achieved, that staff competence be attained, maintained and monitored, that safe practices be undertaken by all clinicians, including adhering to hygiene standards in between contact with patients, and that adequate staff complements be identified and adhered to. Issues in the environment such as the number of beds, space, hygiene, cleaning and maintenance are all necessary factors for the maintenance and enhancement of patients' safety.

As stated previously, research and experience has shown that, on average, 10% of patients will experience an adverse event or patient safety incident. It is essential at a local level that clear procedures exist and are implemented to report and record such incidents, to investigate them and ensure immediate application of all lessons to be learned from them. I ask the Minister to consider extending such procedures beyond hospital settings to community and long-term care settings where such adverse events occur and where patient safety incidents have occurred.

An immediate challenge to the safety of patients in the community is the pending withdrawal of services by the pharmacists. I ask the Minister to address that issue if time permits.