Liam Twomey (Fine Gael)

When it comes to patient safety the Government has been, what could be described as, a very slow learner. Even though a great deal has been said about the Health Information and Quality Authority and the great work it is doing, it should be noted that it was established as a result of a great number of disasters, including that of the Leas Cross nursing home and the cases of P. J. Walsh, Bronagh Livingstone, Susie Long and Rebecca O'Malley, that came to light during the Minister's tenure of office. All these incidents occurred before HIQA was set up. It was due to be established at exactly the same time as the HSE but because of all those disasters, there was a rush to bring forward its establishment. HIQA was established in response to the number of disasters that were occurring in the health service and not because the Government had any clear commitment to patient safety in the way we understand patient safety.

Clinical accidents occur in all our hospitals and in primary care services. As a doctor, I know those who work in the health services and in Government are human, but when it comes to patient safety, we need to be clear about what we want in that respect. Fine Gael published a policy on patient safety more than two years ago. I am sure the Minister has read it. It was clear in pointing out that we need a patient safety authority to act as a counterpoint to the vested interests who have a stranglehold over how the Government reacts. Patient safety and patient issues are not at the centre of our health service. These types of mistakes and exposures will continue to happen until we put the patients at centre of health services. That is not happening at present.

Many administrators, the Minister, doctors and nurses hold the same core beliefs when it comes to protecting patients. We want to treat people with dignity, to be compassionate and respectful in how we look after them and to give them proper treatment. However, while we continue with a system where health strategies and reports are published and fine words are said about looking after patients' safety but nothing is done in that respect and no central authority is established with responsibility for protecting patients' safety, we will continue to find ourselves in the mess we are in.

I do not like to demonise those who work in the HSE, as many of the problems in that organisation have occurred because the Minister has not reformed the health services. Most hospitals throughout the country are examining clinical governance issues and such issues are also being examined by most HSE administrators in regard to the services they provide. Will the Minister indicate the number of management or administrative governance issues under examination in the HSE to ascertain if money is being wasted? We are constantly being told by Fianna Fáil representatives that the HSE is in a mess and that it is top heavy in terms of bureaucracy. Where do those problems exist? How many millions are being wasted in that bureaucracy that should be invested in looking after patients? Those representatives mouth off about something they believe will get them a byline but they are not genuinely interested in providing health services for patients.

The Minister has often started off well, as in the case of the Pharmacy Bill and in regard to the Pharmaceutical Society of Ireland and the Medical Council. Although, I disagreed with some of the points she raised during the Dáil debate on that legislation, hopefully, in essence, it will improve matters. A core issue in regard to the Medical Council and the Medical Practitioners Act is the issue of competence assurance. The competence assurance process does not focus on the doctors who need it. The process is in place in a general sense in terms of identifying a few doctors who might tick boxes, fill out the forms and send them back to the Medical Council. That does not constitute patient safety; it merely amounts to being seen to do something because there is a problem in this regard. If we are serious about being compassionate and respectful towards patients and ensuring they have proper treatment, we need to have a proper debate on these types of issues. We need to be able to speak about what is happening in, as the Minister said, a "no blame" way. When the Minister experienced problems in negotiating the consultants' contract in January 2006, I, as the then Opposition spokesperson on health, offered to back her, but for some reason she went all quiet about it for over a year. That contract has still not been finalised, regardless of what the Minister says about it.

Has the Minister signed off on the standards for nursing homes about which she spoke? Are they now legally enforceable in public and private nursing homes throughout the country? I do not believe they are.

What Senator Feeney said about Dr. Neary is wrong in that people are not afraid to speak out. However, because of the way the system is set up, his practices were identified only by accident by two midwives.