Vol. 419 No. 6
57 Mr. Sherlock asked the Minister for Health when it is planned to publish the patients charter which was promised in the Programme for Economic and Social Progress; if he will outline the rights, if any, which will be established by the charter, and if he will make a statement on the matter.
73 Mr. McGrath asked the Minister for Health the reason for the delay in publishing a patients' charter; and if he will outline the legal force he plans to give this charter.
91 Mr. G. Mitchell asked the Minister for Health whether he has satisfied himself with the present system for dealing with patient complaints regarding care they have received, and if he will make a statement on the matter.
100 Mr. Creed asked the Minister for Health when the patients' charter promised in the Programme for Economic and Social Progress will be published, and if he will outline the means envisaged to permit patients enforce their rights under the charter.
111 Mr. Currie asked the Minister for Health if he will introduce a system whereby health authorities would make patients aware of their rights to make complaints to the Ombudsman in respect of any aspect of the service they receive excluding only the clinical judgment of the doctor treating them.
145 Mrs. Barnes asked the Minister for Health if he will introduce a system whereby health authorities would make patients aware of their rights to make complaints to the Ombudsman in respect of any aspect of the service they receive excluding only the clinical judgment of the doctor treating them.
218 Tomás Mac Giolla asked the Minister for Health if he will outline (1) the progress which has been made with regard to the preparation of a patients' charter which was promised in the Programme for Economic and Social Progress, (2) the organisations or interest groups which have been consulted on the charter and (3) if a date has been set for its introduction; and if he will make a statement on the matter.
I propose to take Questions Nos. 57, 73, 91, 100, 111, 145 and 218 together.
As has been stated previously in this House, a patients' charter is currently in preparation based upon the following principles: the right of access to services in accordance with need; the right to considerate and respectful care; the right to privacy; the right to information; the right of confidentiality of all medical records; the right to refuse to participate in research projects; the right to respect for religious and philosophical beliefs and the right to make a complaint.
It is intended that the introduction of the charter should be linked to the current implementation of a package of improvements in acute hospital services, which have been recommended in the reports of the Dublin Hospital Initiative Group and which are being implemented on a national basis. Officials of my Department have also consulted with a number of training agencies and organisations which have introduced customer relations/quality assurance programmes for their personnel. It is envisaged that a process of further consultation will take place within the health services and with ICTU, following which it is intended to proceed with the launching of the patients' charter.
Does the Minister intend to include in the charter provisions whereby patients will be entitled, when they arrive at a hospital, to be dealt with in a timely manner? Will he ensure that the sort of block booking to which he referred, which is going on at the Mater Hospital, does not continue, that patients are called at a time when they are likely to be seen and will not have to spend hours in hospitals waiting for doctors who cannot see them at the appointed time?
I agree with the Deputy, and we in our own way can apply pressure on the hospitals concerned. I am a very agreeable person.
Is it the Minister's intention to put these rights on a statutory basis? Would he accept that anything other than a statutory basis would not give the type of assurance that is required? Second, would he indicate the type of extra resources he intends to give hospitals to meet these high standards and what type of monitoring he intends to put in place to ensure these rights are vindicated?
I do not think it would be possible to put the charter rights on a statutory basis, but we can apply considerable pressure on hospitals by virtue of the fact that the State is funding 99 per cent of their budgets. Regarding resources, I do not think special resources are required for a doctor to observe that the patient must be assured of privacy.
What about proper waiting rooms and space?
We do not need special resources to ensure that confidentiality about patients' records is maintained. With regard to the complaints procedure, the non-medical section of the hospital could be involved in investigating complaints. I would envisage an independent body which would not involve the doctor connected with the case. There would be a social worker and a sister not connected with the complaint and perhaps a member of the administrative staff. When a person makes a complaint to a hospital he or she should receive a written reply and the complaint should be investigated thoroughly. The complainant should be notified as to the result as quickly as possible.
The Deputy is right about monitoring. We have to inculcate into hospital personnel that this is what is required nowadays. There must also be treatment options. A doctor must be asked to spell out alternatives and to say how they equate with the course of action he proposes. The facts should be made available to the patients. They demand it, although years ago they did not. Doctors, nurses and medical personnel must be aware that patients demand these rights and we should be to the forefront in ensuring that they get them.
I am not happy with what I have heard from the Minister. What steps does he intend to take to empower patients to pursue their rights under the charter before, during and after hospitalisation? What structures will be put in place to enable patients to pursue their rights? Surely he sees a central body playing a role as against an individual making a complaint to a particular hospital.
Regarding that principle of the charter dealing with the right to equal treatment on the basis of need, is the Minister aware that there is an MRI scanner in each of the three private hospitals, St. Vincent's, the Blackrock Clinic and the Mater Private, and that there is none in the public health system? How does the Minister propose that patients needing access to costly equipment and drugs will be afforded the right of equal access?
The Deputy is injecting quite a lot of new matter.
With regard to MRI machines, funds have been made available to Beaumont Hospital and such a machine will be installed there towards the end of the year at a cost of £1.3 million. This will be made available to patients in all hospitals and every hospital will have access to it. With regard to costly equipment, the public sector is following quickly on the heels of the private sector. We cannot control what the private sector buy but we can control their costs in that the VHI can put a cap on the money they pay. The public sector hospitals have very high-tech equipment installed. St James's and Beaumont have the best equipment. I should like to see a certificate of need required before a hospital could instal very expensive equipment like that. Enormously expensive equipment in one hospital is sometimes duplicated in another. I should like to see the public hospitals having it in preference to the private hospitals; I think we will see that. I have been amazed at the efforts made by my Department before I came into office in the amount of funds provided for high-tech medicine. It is a tribute that we have such very expensive and sophisticated equipment installed in Beaumont. The cost of each of these MRI scans is £600, a fact often not realised.
What about a central board or authority?
I think we can enforce the charter and we will be able to monitor. What is the Deputy's point about a central authority?
Would the Minister not agree that there should be a central authority to handle all complaints from patients who want the terms of the charter applied?
The Ombudsman is available. In the booklet which I will have published it will be stated that patients have access to the Ombudsman and to the Medical Registration Council if they wish to complain about the professional conduct of a doctor. The complaint is best investigated in the hospital concerned because all the records are there. It could be claimed that it is not independent but there will never be a totally independent procedure. It would be much more time consuming if the complaint were submitted to a central body. We want complaints dealt with as quickly as possible in the interests of preventing litigation.
I would ask the Minister about some matters which do not seem to be explicitly covered in the charter. Does he believe that patients should have the right to a second opinion, the right of access to their own medical records, the right not to be treated on a trolley but in a bed and the right not to have to wait beyond a maximum time for a certain procedure?
The Deputy is putting these questions in omnibus form. I should prefer questions to be brief, succinct and relevant.
They are relevant.
I quite agree.
Regarding the right to a second opinion, this is normally done without reference to the patient; he or she is not given a choice. I am not sure whether we could guarantee that right. We could specify the right to a second opinion but the right to a particular second opinion would not be feasible. On that score, there is a right to a second opinion. Patients have a right of access to their records, which should be available. There would be aspects of their medical records which it would not be in the best interests of patients to see, but the full details of their records should be made available, not selected extracts.
Who would oversee that?
The persons consulted should provide that information and as full and accurate an extract from the records as is possible to give the patient, having regard to the best medical interests of the patient. For instance, if a patient with a terminal illness was not psychologically prepared for such information, there must be a certain reticence by the consultant to disclose that in full but he would be obliged to give it to the nearest relative; he would be obliged to tell the patient or his relative as the case may be.
Will the Minister, in the absence of legal underpinning of the rights to be published and bearing in mind the reports of the Ombudsman, who is totally overworked and understaffed, consider the establishment of a medical Ombudsman whose job would be to oversee and vindicate the rights to be established?
Yes, I would love to see that being done by statute but I am told it would create enormous problems. I have looked at the question of appointing a medical Ombudsman and I think this will have to be done. If a patient is dissatisfied, even about getting his report back from the doctor, he must have recourse to another body. At present, the Ombudsman has no right to intrude on clinical aspects of a patient's care, but we may have to look further at this and I would be one of the first to want to do this. The Deputy is right. It would make a sham of the charter of rights if a patient makes a complaint and does not get a satisfactory answer for one reason or another.
Is the Minister undertaking to look at that?
Yes, I will.
I want to bring these questions to finality. There are many other questions I hope to deal with today. I will call the two Deputies who have indicated they wish to put a question and then proceed to another question.
My question concerns the non-medical aspect of the charter of patients' rights. Would the Minister agree it is unacceptable in this day and age that patients should be kept sitting waiting on hard seats in a waiting room for up to seven hours without proper facilities being available? Will the Minister incorporate in the patients' charter the right to have access to rest rooms, a telephone, a coffee machine and facilities of that sort so that they will be treated as human beings when they have to wait in these waiting rooms for up to seven hours?
We are having an element of repetition.
I suggest that my very close friend, Deputy Mitchell——
That is the kiss of death.
——takes a trip around the hospitals because every hospital has some very modern coffee rooms and restaurants. It would be a good idea if the Deputy visited the hospitals to see the luxury——
I visited a hospital recently in the Minister's constituency and I can tell him that the facilities are not as the Minister said.
In St. James' Hospital they have a lovely restaurant, if I may say so. The Meath, the Adelaide, Beaumont and St. Vincents hospitals have very nice facilities. Every hospital I have visited in the city has both a very nice coffee room and a restaurant.
The charter was negotiated 18 months ago under the Programme for Economic and Social Progress. The Minister mentioned that one of the principles of the charter was the right to respect for religious and philosophical beliefs. Given the expressed fear of the board of the Adelaide Hospital, as announced yesterday, that the closure of their hospital is imminent, will the Minister explain how he intends to satisfy the needs of Protestant patients who wish to attend a hospital with a Protestant ethics committee should the Adelaide Hospital close?
The Deputy is raising a specific matter which is worthy of a separate question but it impinges on the question before us and the Minister is quite in order to reply.
I accept that problems can arise for the Protestant minority and for that reason the Adelaide Hospital must continue. I made this point very clear on radio yesterday in my assurances to the board and staff of the hospital. There are key elements in the practice of medicine in Protestant hospitals that Protestants would want to avail of and I will be seeing the board of the Adelaide Hospital to give them an assurance that their future is not in jeopardy and that the interests of the Protestant minority here will be protected. Where a Protestant may be admitted to a hospital of a different denomination where their beliefs with regard to specific procedures are not observed, they would have the right to be transferred to the hospital of their choice.
The Minister is talking about a charter of rights for all patients.
We cannot debate this matter now.
The charter of rights will be on display in the out patients department in every hospital and I hope every patient who is admitted will be given the booklet.
They will have plenty of time to read it while they are waiting.
My name will be printed on the front of the booklet——
Patients will have time to telephone the Minister.
I will ensure that every patient is given a copy of the booklet as soon as they are admitted to the hospital.
Protestant patients may have to be transferred from a hospital that does not observe their code of ethics.
Order. I am proceeding to another question. Deputy Byrne should conform.
I am sorry a Cheann Comhairle that I am delaying you unnecessarily. Health is an emotive subject and, as you can see, it arouses great interest.
As the former Taoiseach discovered.
