John Gilroy (Labour) | Oireachtas source

I am anxious to speak on the legislation before us. Listening to the Opposition, I fear it is taking advantage of the good and generous nature of the Acting Chairman by introducing extraneous material instead of discussing the Health Identifiers Bill 2013. We are talking about unique health identifiers. I welcome the Minister to the Chamber and say that I am amazed these unique health identifiers are not already in place. They were first mooted in 2001 and again by an expert group in 2008. Some 13 years later, we are getting around to doing it. It is an indication of the continuous reform the Minister and the Government are achieving in the health services and in the provision of health service delivery.

Sharing information across the health service is what this is about. I was a psychiatric nurse for 28 years of my career and the real difficulty we had in the mental health service, and in all branches of the health service, was the sharing of information. Different hospitals, different units and different people in the same hospitals used different methods to keep track of records by allocating different numbers. Looking for a particular file on a patient involved searching under three or four filing records and one could still be unsuccessful. This was particularly the case in respect of out-of-hours admissions, such as in the middle of the night, when the medical records staff were not at the office. For ward staff, finding the relevant records was nigh-on impossible. This is a welcome initiative. Patient safety and efficient management of the system is what is intended in the introduction of these models.

I have several questions about the operation of the system and Senator Crown referred to some of these by asking how much of the patient information will be available on the system administered through unique identifiers. The protection of patient privacy is of primary importance. I see this is ensured in the Schedule to the Bill. For instance, there does not seem to be difficulty if GPs in small practices access information on file. What about busy accident and emergency units or acute admission wards in the mental health services? In such cases, access would be required by all staff involved at some level. Does access to the system leave a unique identifier trace by the person accessing the records? There were media reports of unauthorised access to social welfare files some years ago and staff seemed to have easy access to information that was not relevant. It seemed to be the result of curiosity rather than delivery of a service. It is impossible to achieve the reform we are trying to achieve, the model of money following the patient, without these unique identifiers. It could not possibly work unless we can trace the patient with the money through the system.

Hearing ICT and the HSE in the same sentence is enough to spark terror in anyone's heart. We remember the PPARS system, which was proposed to be introduced at a cost of €6 million and ended up costing €250 million. It did not achieve the objective it set out to do. At the time, the PPARS system was there to collect only one type of information, payroll, and we could not deliver it. Do we have confidence that the system in place now has the ability to achieve results that PPARS could not? Is there a requirement for standardisation of templates of information gathering across all GPs? In complex medical situations, there is a tendency to generate huge volumes of information about patients. I see this in the mental health services where some nursing care plan models generate two or three pages of information a day about a patient. Does the system have the capacity, or is there a necessity, to record this information? Is there remote access to it? Is there a requirement that there will be a particular server or will it be stored in a cloud? These are questions that need to be asked. The idea that it will not cost a great deal of money is a statement from the Minister that I view with a sceptical eye. In Ireland, our ability to roll out ICT systems is such that they tend to cost a lot of money. I refer to the Garda PULSE system; we will not mention electronic voting, as it descended into farce. I have every confidence the Minister has considered these questions and has reached conclusions.