Déirdre de Búrca (Green Party)

It is an independent authority established to drive improvements in the quality, safety and accountability in this country's health and social care services. The authority's priorities include establishing a standards framework for health and social care, implementing a comprehensive programme of monitoring, measurement and, where necessary, enforcement, against the standards, as well as providing a comprehensive information framework to support safe and efficient health and social care. It is a matter of concern that the HIQA does not have jurisdiction over private providers but hopefully this will be the case in the near future.

Patient Focus, which is one of the leading groups representing patients' interests obviously shares many of the concerns that were expressed here today about patient safety. It has enunciated several important principles concerning patient safety. The group points out that lessons must be learned from the past, a point which has been affirmed by other speakers here today. I will not mention the cases which have been already mentioned but improvements must be made. Proper safety systems must be put in place and Patient Focus supports the establishment of a patient safety authority. It also suggests that patients need constant reassurance that services are safe, that they will be at the centre of service provision and that their safety is paramount. The group believes that everybody has a role to play in ensuring patient safety and that it is not just the responsibility of risk managers. It also argues that proper communication and record keeping is essential.

Patient Focus has called for the establishment of a health service ombudsman. It has also pointed to the need for more education for the general public and staff on the importance of good hygiene. It particularly stresses the need to inform the public as to why good hygiene is so important in hospitals, particularly in the context of hospital-acquired infections such as MRSA and clostridium difficile.

In terms of systems reform to achieve higher levels of patient safety, Patient Focus emphasises quality assurance, risk management and advocacy. The group calls for greater investment in ongoing education and training. It urges that peer review procedures become standard practice and calls for the incentivising of clinical audits and research as normal professional activities.

In the area of risk management, Patient Focus wants to encourage a risk reporting culture among staff and patients. It has suggested establishing a national risk resource centre for collection, benchmarking and dissemination of data on good practice. The group also encourages the promotion of systems where savings can be negotiated from insurers for implementing risk prevention measures. It has called for the monitoring of medical litigation and the evaluation of all cases for prevention potential.

Patient Focus has called for the introduction of advocacy services, which it claims are often needed by members of vulnerable groups and occasionally by even the most articulate, when they find themselves in difficult circumstances as patients. It also emphasises the point the Minister made regarding the importance of promoting a culture of disclosure and of recognition and validation of those who take the difficult step of naming and drawing official attention to some of the problems that can occur in our health care services.

In the past, there have been real problems experienced with complaints in our health service. These have often arisen because of an absence of procedures in handling complaints within the service. Another cause has been a form of what has been called "institutional arrogance", which has been characterised by delayed formalised communication or, in some instances, no communication, an unwillingness to believe a complainant and an unwillingness to accept responsibility for problems which arise. Patient Focus has also pointed to the existence of an approach in the past where complaining has had a negative influence on patient treatment.

The group has pointed to the fact that the circumstances and conditions in accident and emergency departments have given rise to problems because of delays and overcrowding. It believes that conditions in these departments have increased the possibility of medical error.

Patient Safety has examined proposals for improving regulation in the area of patient safety and has focused on the role of the Medical Council. It has suggested that the new council structures should include at least 50% lay people, as well as those in various sectors of the health professions and those involved in patient advocacy. It has also called for the new council to have new powers and the ability to impose penalties. It wants the council to be enabled to temporarily remove a doctor from the register during its assessment of a case without resorting to the courts. It has also called for those investigating a case to be fully and properly trained to do so. It further suggests that any fitness to practise hearing should be held in continuous session over a maximum of six months from the date of the complaint. It has called for other convictions to be made available for transgressions other than serious professional misconduct and for penalties to reflect these changes and to include fines, further training or limitations on the practice of a doctor. It has also asked that the council be obliged, where appropriate, to refer a case to the Garda Síochána or to the Director of Public Prosecutions.

Patient Focus has called for the council findings to be made known to the complainant and for appeals to be made available and accessible. If a complaint is rejected, the group believes that the reason for the rejection should be explained to the complainant. In general, the council should become more accountable to the public, provide regular reports and show that it is capable of assessing its own effectiveness and reviewing its procedures regularly.

The health care system has been much slower than other information-intensive sectors to exploit the potential of information and communication technologies, especially in support of the direct delivery of patient care. Health information technology has been demonstrated to have a positive impact on patient safety across many areas of health care, for example, in electronic prescribing. There appears to be a need for improved co-ordination and leadership in the implementation of a national strategy for health information technology.

I thank the Minister for her presence in the House and look forward to her response to this debate.