Dáil Éireann debate -
Wednesday, 8 Mar 2006

Vol. 616 No. 2

Lourdes Hospital Inquiry: Statements (Resumed).

Mr. Neville

I appreciate that the Minister of State is not present; I am sure he is on his way. I appreciate the opportunity to discuss this frightening and important report. I congratulate those involved in drawing up the report, including Judge Harding Clark SC, and Patient Focus for its energy and persistence in ensuring that the issue, which was delicate and serious, was exposed. The culture this has exposed of power within the health services almost generating fear is as serious as the damage done to the people involved. It exposes a culture in the Health Service Executive of a lack of involvement by people operating the system.

We have known this for some time. A culture of fear, control and, to some extent, bullying by those on different levels of authority within hospitals is not new. Too often I have seen nurses who have decided to leave their work because of difficulties experienced or attitudes and approaches by those in authority, be they consultants, senior nursing staff or other senior personnel in hospitals. This culture and approach fostered over time this extraordinary and terrible scenario in Our Lady of Lourdes Hospital. Others have pointed out the desperate situation for those involved. I will not repeat that, other than to acknowledge that what happened in this hospital was traumatic beyond words for those who experienced it. Nothing we can say and no compensation the State can give will make up for such an experience, which cannot be rolled back. We must acknowledge that in this debate and try to alleviate the extreme physical, psychological, emotional and social damage that has been visited on people who trusted a health system to protect them and operate in the best interests of their future health. The system did not do that and I do not believe it was an isolated incident. It may not happen to the same extent or in the same field of practice but there is a hidden culture of unquestioning acceptance of authority in the health system which must be recognised and challenged. I have experience of such a culture in the psychiatric services, where there is silence on the treatment of psychiatric patients. There is a barrier to discussing any aspect of the delivery of services, either with patients or their families. Too often people come to me frightened because a family member with suicidal ideation has been discharged from a hospital. We know hospitals are overcrowded and another patient is waiting for every bed but the hospital will not even discuss the patient's aftercare with the family.

I welcome the fact that the report of the expert group on mental health policy, A Vision for Change, outlined and challenged that culture of silence, in its chapter 3. The report clearly stated that professionals needed to be willing to accept that patients had a right to be involved in their care and treatment and to be consulted accordingly, and that acceptance should be automatically built in to the operation of the system. It also recommended that imbalances of power between service users and professionals must be acknowledged and addressed. The imbalance of power, between patients and consultant in the case of Mr. Neary, and between nursing staff and consultants in a hospital, was one of the key problems that allowed this situation to develop. The message should be sent that this imbalance of power must be challenged. Those who are aware of wrongdoing or who even feel something should be investigated should be encouraged to ask questions as a positive advantage to the service in its entirety.

There is a culture among all but the most progressive psychiatrists which dictates that under no circumstances will a patient's condition or treatment be discussed with any family member or any future carer after they have been discharged, for reasons of professional confidentiality. That is not accepted best practice anywhere in the world. I have spoken with people who have delivered such services at a very senior level in the US and who said it was more important to save a life if there was a danger of suicide than to stand on one's professional confidentiality. If patients were consulted by their psychiatrists for their permission to speak to their families about their condition, especially with regard to care after discharge, at least 95% would fully welcome it but it does not happen because consultants do not want it to happen. They want the power their silence affords them and which creates an aura of mystery over their profession, making their decisions exclusive to them. As a result the patient, the family or the future carer does not become involved and that is wrong and should be changed.

There have been serious consequences arising from the denial of what happens within the psychiatric services. In June 2004 a report on deaths in the Mid West Regional Hospital in Limerick included an account of the suicide by hanging of a 21 year old girl, who had been in the hospital for less than 24 hours, because of absolute neglect on the part of the health services. That independent report was sent to the Minister in June 2004 but was never published. Why is it rightly acceptable that reports on the general health services are published but a strong, serious report on deficiencies in the psychiatric services is not? It is because the public and the press demand that the former are published. Due to the stigma and the historical and cultural burying of psychiatric illness the Minister gets away with not publishing a very serious report that would encourage a public discussion to shed light on a problem which I believe is rampant throughout the psychiatric services, because this is not the only case of which I know.

I ask the Minister again to ask his senior, the Tánaiste and Minister for Health and Children, who is responsible for psychiatric services, to publish the review of the care and treatment of Anne O'Rahilly, deceased, in the course of her admission to the acute psychiatric inpatient unit at the Mid West Regional Hospital in September 2002, which was produced in June 2004.

Dr. Devins

I thank the Chair for allowing me to speak on the Lourdes hospital inquiry report by Judge Maureen Harding Clark. Our thanks go to the author, who has presented her findings in a clear an unambiguous way. The report is a model of how such an inquiry should be carried out. There has been much comment on the report both in the House and the media and, in the limited time available, I do not wish to repeat what has been said already. I will focus on the future and on the recommendations made by the judge. Nobody here wants a repeat of what happened at this hospital. Our thoughts are with the women who had to undergo the trauma of a peripartum hysterectomy without any medical justification for such a radical procedure. These women have endured horrendous consequences and must live with the reality that they will not be able to bear any more children. For any woman to be told she cannot have more children for whatever reason is very difficult, but for it to happen without a medical reason is especially difficult. I urge the Minister of State to establish the redress scheme as quickly as possible and congratulate him on his speedy acceptance of this report.

I refer the House to recommendation No. 4 of term 7 of the report on page 322. The author makes the point that what happened in the hospital in question may have happened elsewhere, particularly in similar size hospitals. I do not know if it is so and sincerely hope it is not the case. In this regard, it is worth pointing out that most maternity units, with the exception of the teaching hospitals and the three Dublin maternity hospitals, have operated, by and large, with two obstetric consultants or, in some cases, only one consultant each for many years.

As we all know, babies have the habit of arriving at any time. As a result, the 40-hour working week that is the norm for most people has no relevance to the consultant staff of smaller maternity units across the State who work on a one-in-two rota. Tiredness is a common feature for most of these consultants and contributes to stressful working conditions. I strongly believe that all maternity units should have a minimum of four consultants. Not only would it allow the staff to have a more normal life, but, more importantly, would allow peer audits and professional interactions.

Judge Harding Clark's report states: "Fresh ideas must circulate; education must continue and review of outcomes must take place on a regular and continuous basis". This can only happen if there are sufficient numbers of medical and nursing staff to allow for robust analyses of case work. If there are too few consultants in the discipline, time to engage in the above process will not be available. Likewise, due to the hierarchical nature of consultant-led services, the necessary detailed questioning and analysis may not be engaged in, as was obviously the case in Our Lady of Lourdes Hospital.

I want to discuss competence assurance in the limited time available. In effect, this means that a doctor or nurse has a sufficient level of competence to carry out the duty or procedure to be embarked upon. It may appear blindingly obvious that nobody, least of all in the practice of medicine, should attempt to advise on or carry out procedures they are not qualified to do. However, once a doctor is qualified in his or her specialty, there is no further requirement to keep up to date on the latest advances.

In recent years, there has been a large explosion in the amount of new medical knowledge available as new drugs and investigative methods are discovered. It is not an exaggeration to state that such is the rate of new knowledge in health matters, medical textbooks can be out of date a year or two after they have been published. Imagine the situation of a doctor or nurse who does not keep up to date, attend conferences or engage in continuing medical education. While he or she may be practising conscientiously, the gaps in his or her knowledge will increase so that the patient, who is the single most important person in the health service, will eventually be exposed to less than adequate health care.

It is to prevent this dreadful scenario occurring that the Medical Council is seeking the establishment of a structured competence assurance programme. Under this, doctors will need to not only display their continuing medical education skills, but have them regularly undergo audits. In this way, the public can be reassured that the doctors looking after them have the necessary skills and education needed. There is no doubt that there are some within the medical profession who do not look on the assessment of competence as a positive development. They should not be afraid but should embrace it.

In my previous occupation as a general practitioner, I was involved in GP training for many years. In that capacity, regular audits were carried out on me so that my assigned training doctor could be assured of my competence. On superficial examination, the first audit was potentially threatening but the benefits that accrued to me, the training doctor, and by extension the practice, was such that regular audits and examinations were embraced by all. I urge the Minister of State to progress the competence assurance proposals as formulated by the Medical Council as quickly as possible and look forward to the medical practitioners Bill as a vehicle to drive continuous assessment of doctors' competences.

It is easy to be wise in hindsight. If the obstetrician at the centre of the debacle in Our Lady of Lourdes Hospital had been subjected to regular competence assessments and audits by his peers, perhaps the litany of disasters that occurred could have been prevented. By recognising the mistakes and faults of the past, we can learn for the present and protect and service the future well-being of patients and users of the health service. This report is shocking but timely. Let us adopt its recommendations so that the calamitous occurrences in that Drogheda hospital may never recur.

Mr. English

I welcome this opportunity to say a few words on the Our Lady of Lourdes Hospital inquiry. As a Deputy from County Meath, it would be remiss of me not to speak on the issue of the inquiry report compiled by Judge Maureen Harding Clark. Since the closing of the maternity unit in Trim, County Meath, long before I was born, Our Lady of Lourdes Hospital was and still remains the core maternity unit for the county.

I had not been a Deputy for long when a near neighbour arrived at my office, told me her story and explained what had happened to her as a patient of Dr. Neary. As a young and new politician I wanted to have an open mind in terms of believing that this could happen, but I found it horrific. I am glad I listened to her story and believed her, but it would have been easy to turn someone away and say that such could not have happened. Sadly, it still happens every day of the week that people bring their stories to Deputies, local councillors and others, and we doubt they are true. We often do not follow the matters through to the end. Reports such as this highlight how important it is for all of us to investigate and believe every story we hear.

The Acting Chairman is dealing with a gentleman in County Sligo who, after his daughter was killed on a certain road surface, told as many people as he could for a number of years that the bad road surface was at fault. However, no one wanted to listen. Sadly, they are now listening because five more young girls were killed on the same road surface in County Meath last year. It often takes many tragedies for people to listen and we all have a responsibility, especially those of us in the House, to listen to people with stories to tell, who want to highlight something that is wrong, tragic and should never have happened.

Recent years have been a rollercoaster and this report is a milestone for the Patient Focus group and the women and families involved. It is a reality check for the health service and the country at large. In recent years there have been illusions of safety and the belief in our health service has been shattered like never before, mainly because of the malpractice of people such as Dr. Neary in Drogheda. In this report, we are confronted with people who through their manner, experience and training, felt they had earned the right to expect — indeed, took on themselves — the mantle of being above question and whose decisions were final. No one is above question and everyone should be accordingly monitored.

Our health is our wealth and we should be able to entrust to doctors our lives and the lives of our families. Sadly, this report highlights and proves that the trust we place in doctors can be and often is abused by the likes of Dr. Neary and others. To give some meaning and add quality to life, we all need something to believe in. For some it is God, for others it is the seasons and for others it is faith in humanity. We have the right to a health system that will serve our best interests and an authority we can trust which should protect nobody but the patient.

The Government must act quickly to restore faith in the health service. Recommendations from this report must be implemented immediately. Merely complimenting and acknowledging the report and then leaving it to gather dust is not enough. Investigations serve no purpose if changes are not made. This report is essential to those who were hurt and also to ensure nothing like this happens again.

I compliment Patient Focus, which worked tirelessly for over eight years. I urge the group, many of whose members were in Leinster House today, to keep up the fight. Without the group's efforts this report would not be before us. Unless someone campaigns for them, necessary inquiries into the health service will not take place.

Members of this House must ensure the doors remain open. Inquiries such as this provide an opportunity and we must give groups such as Patient Focus a better hearing. The Government and the Tánaiste must learn from this and must open doors for other groups with stories to tell and cases to fight. The Parents for Justice group, whose members' lives are also on hold during the quest for answers, needs to know why children's organs were removed without parents' consent.

Another group looking for answers in the north-eastern area is the birth asphyxia group. It seeks answers to how new-born babies suffer from a lack of oxygen but its questions are not being answered. The Government should learn from this case. Why did it take eight years to reach this stage? Is it because doors were closed and people were in the way? Members do not have an open mind to hear everyone's stories.

Over the years, Governments — I refer to no specific party — have relinquished their duty of care to the citizens. The failure of Government and the State in this case is obvious. It never ensured its duty of care was being exercised. The most important job of Government is to care for the people it is elected to serve. Any breach of this duty of care, whether it affects the old, young, healthy or sick, is one of the greatest crimes of which a Government could be guilty. We must act on inquiries such as this and make changes. We should also listen to parents who have been hurt.

In 1979 the matron of Our Lady of Lourdes Hospital, where I was born, reported to the authorities what she considered unusual activity in the maternity unit. Almost 20 years later, in 1998, these activities resurfaced. Full credit must be given to those in the former North Eastern Health Board who investigated the allegations. A midwife and Dr. Ambrose McLoughlin, as well as parents and concerned families, were instrumental in exposing this scandal. Without the efforts of these people we would not be discussing this report. Rather, we would be meeting such groups in Buswells Hotel or having quiet chats in County Louth or County Meath. We fail when we do not help such groups to fight their cause.

What were the authorities doing for the previous 20 years? How could the three eminent physicians sent to investigate have reported a clean bill of health? Without wishing to sound vindictive, these three physicians and their colleagues should face an inquiry to establish their role in this matter and determine whether it is necessary to investigate other hospitals. Did similar events occur in other hospitals? The Lourdes hospital inquiry report has been acclaimed as fine work from which many lessons can be taken but it raises as many questions as it answers. The report does not bring closure to the cases and we must finish this process.

If Dr. Neary was neither bad nor evil, what was he?

Ms Lynch

A sociopath.

Mr. English

Was he incompetent or did he practise the wrong specialty? Is he sick or evil? For the sake of the women involved this question needs to be answered. This report does not address the reasons Dr. Neary acted in this way. The women and their families have a right to know these reasons. According to some media reports he is Dr. Death with a master plan to sterilise the world. Others hail him as a hero, including one woman I met who would not believe the reports of what Dr. Neary did. People must realise that doctors such as Dr. Neary can do considerable damage if left unchecked. We need answers. Did this man let himself down? Did he lose the plot, was he let down by the system, or was he allowed to operate in an environment where those who knew better chose to ignore events? Was he simply evil?

All those involved in the Lourdes hospital at the time, like Dr. Neary himself, must now come clean for the sake of the women and the future of the medical profession. We must hear from Dr. Neary and this could open the doors for others to explain events.

Deputy Twomey referred to the fear junior staff have of consultants. It is unacceptable that people in the health services are afraid to tell their story. Deputy Johnny Brady knows about receiving information in late night phone calls. A health system in which people are afraid to speak is one in danger of creating another Dr. Neary.

Mr. J. Brady

Our thoughts are with the women who were patients of the maternity unit at Our Lady of Lourdes Hospital in Drogheda during the period covered by the report. Patient Focus had a constructive meeting with the Tánaiste last week. The group is confident the needs of its members will be met and they deserve this.

I congratulate this group of women. Eight years ago I attended one of its first meetings in the Boyne Valley Hotel, Drogheda. The cases we heard that night were frightening and I compliment the group on its tireless work. Members of this group had to work under severe stress because of what they had endured. These people need a hearing. The level of damages should be similar to those in the Alison Gough case. I congratulate Judge Maureen Harding Clark on her report which has been recognised as incisive and thorough as well as damning and shocking. It is obvious from the findings that many lessons need to be learned and changes made to ensure that what took place in Drogheda can never happen again in any hospital.

What happened in the hospital in Drogheda was horrific and heartbreaking. The report regards it as a story set in a time of unquestioning submission to religious and civil authority when nurses and doctors were in abundant supply and permanent jobs were few and to be treasured. It is clear the hospital operated under a separate and unique set of rules and did not hold itself accountable to objective medical standards. It is necessary to learn from what happened in Our Lady of Lourdes Hospital in order that hospital staff and obstetric communities in all similar units never repeat the same mistakes.

While the report acknowledges that no one died and that it is highly probable that some mothers' lives were saved when hysterectomy was the only procedure to stop haemorrhage, this does not diminish the impact of the report. What is truly remarkable is the silence; few complained or questioned. Neither the patients, their partners nor their families; neither the obstetricians who worked in the maternity unity nor the junior doctors nor the post-membership registrars; neither the anaesthetists, nor the surgical nurses; neither the midwives nor the pathologists and technicians; neither the matrons nor the Medical Missionaries of Mary sisters and not one of the various GPs whose patients attended the hospital. No one made a formal complaint nor asked questions openly.

No person or institution raised any concerns until October 1998 when two experienced midwives consulting the health board solicitor on an unrelated matter sought his advice about the serious concerns of one of the midwives with regard to Dr. Neary's practice. It seems that what was happening in Drogheda appeared to be normal.

The report states that this is not a simple story of an evil man or a bad doctor nor is it the story of a cover-up because the facts were there for all to see. No attempt was made to disguise the procedures or pretend they were anything other than what they were. The operations were carried out in the presence of consultant anaesthetists, assisted by trainee obstetricians who had all the textbooks available to them and spouses and partners were frequently in attendance. The operations were openly recorded without secrecy. It is clear the situation which existed was one where systemic malpractice went unobserved and the unusual slowly became the norm. It is unbelievable and astonishing that this situation carried on for so long.

Judge Harding Clark's recommendations confirm the appropriate nature of the actions being taken in the preparation of the new medical practitioners Bill, the reform of the current consultants' contract and the changes in hospital management systems. The medical practitioners Bill will allow for compulsory continuing professional development and education and will ensure that competence assurance will be given a statutory basis. In the current talks on the consultants' contract, the management side has put forward proposals to ensure consultants work in teams with designated clinical leaders who will ensure individual clinical practice is in line with best practice. The report confirms the necessity of introducing an exacting clinical assessment of a doctor's performance in all aspects of medical care. Such assessment will be required to be a regular feature of medical life. One of the most significant shortcomings highlighted in the report was the absence of orderly oversight of medical practice in the hospital.

Dr. Neary's colleagues either did not realise there was a problem or appeared unwilling to question a colleague's clinical judgment. Junior doctors had serious qualms about Dr. Neary's practices but were fearful of bringing the matter to the attention of others as they were concerned this could have negative consequences for their professional careers.

One of Dr. Neary's patients is of the view that hospitals should be subjected to unannounced clinical inspections, similar to the unannounced health service inspections of child care facilities. I ask the Minister of State to consider this proposal.

The Tánaiste yesterday announced the establishment on a statutory basis of the Health Information and Quality Authority, HIQA. This legislation will deal with the subject of accreditation. I ask the Minister of State to consider implementing some of the report's recommendations by means of this legislation.

The medical profession has been calling for more regulatory powers for many years. I agree with the Irish Medical News that Judge Maureen Harding Clark’s report shows that critical external and self-assessment of medical practice must become the norm. It states the culture in the past failed the medical profession and failed patients.

One of the most sinister findings in the report is that the obstetric hysterectomy records of 44 patients have gone astray and that they were deliberately, wilfully and illegally removed from the hospital for the purpose of protecting those involved in carrying out the hysterectomies or protecting the reputation of the hospital.

I am pleased the Tánaiste has asked the Garda Síochána to examine the report in order to determine whether further investigation of this systematic misappropriation of documents is warranted.

I welcome the announcement of a redress scheme and the appointment of Judge Harding Clark to advise on an appropriate scheme. Everyone acknowledges that Judge Harding Clark has done an excellent job in making her report and that she is the best person to deal with the question of redress. Such a scheme will be costly and a method must be devised to ensure recoupment of the maximum amount of costs from wrongdoers or indemnifiers.

It is heartening to note that although many of the patients were initially sceptical of the inquiry and its private, non-statutory nature, Judge Harding Clark has earned the respect and confidence of the women. This has been a wretched, heart-rending and traumatic affair and the devastation experienced by the women involved can only be imagined. It is our duty as Members of this House to put in place measures to address the risk of such a level of malpractice ever happening again in the future. It is our duty to recognise and tackle flaws in any part of the health system.

Ms Lynch

It is very appropriate the House is having this debate on International Women's Day. It seems women have always been the victims in cases such as this where groups of people have been hurt by others. I will not give a litany of those people. This report is not just about a man but also about an ethos, a culture and an organisation that allowed things to happen because there was such deference shown towards a profession and people could not envisage raising their hands and saying, "Hold on a minute, I think you are doing something wrong and we should take a look at this". Deputy English asked what this man was if he was not an evil or bad man. He would be clinically defined as a sociopath, a person who does awful deeds with no conscience. That describes what he did.

I would like to discuss what it feels like to be in the last stages of pregnancy. Despite the glorious aura around pregnancy and childbirth, 97% of women have a great fear of pregnancy and childbirth. It is a worrying time in one's life during which one is most vulnerable because an event is about to happen over which one has no control. Others have complete control.

Acting Chairman

Will Deputy Lynch refrain from referring to Dr. Neary as a sociopath? That has not been proven.

Ms Lynch

I withdraw that. We must seriously examine how pregnancy is managed, and Judge Harding Clark referred to this. Unless one is very determined and makes out a plan before approaching the gynaecologist or hospital, somebody else takes over. That person specifies the date on which one attends hospital regardless of one's delivery date, and induces labour regardless of one's wishes. Due to the fear and vulnerability, one puts one's life and one's baby's life in the hands of the person one considers to be the specialist. Unfortunately the specialist in this case is usually a man. There are few female gynaecologists in this country. Although I am not sexist, that is peculiar and unusual, and it must be changed. More women than men get the leaving certificate points to study medicine and I do not understand why there are more male than female gynaecologists.

We are here to discuss a particular situation. It is easy for people to ask why one of these women did not say "stop". When a woman has given birth to a lovely, health baby, her partner and family visit and she is told that she almost died and was lucky to have the specialist she had, how can she complain? What can she say? It is too late and would sound ungrateful to say that the specialist did the wrong thing. It is striking that nobody but the midwife had the courage to say there was something wrong.

There is a frightening chart in the report and the age of the women involved is frightening. Dr. Lynch is widely reported in it but it appears that his patients who had hysterectomies were of a different age group, although it is incredible that so many hysterectomies took place. I still do not understand it. This report is good because it makes the facts understandable and shows the comparisons in chart format. It deals with other general hospitals in Ireland and overseas, including southern California and Milan. In every comparison Our Lady of Lourdes Hospital had the highest rate of hysterectomies connected to Caesarian sections.

Section 15.1 of the report is pivotal and includes the following:

There are other issues that you can't really put your finger on when you talk about cultures in a hospital and values in a hospital and when you look at the role being played by religious orders in running institutions they were very respectful of authorities and clinical authorities in particular ... a non-questioning — that you find this deference and respect that didn't allow a lot of questioning to happen — and good service — everybody was looked up to but I would say there was a culture there that needs to be appreciated.

I spent a number of years in hospitals 20 years ago and when the consultant did the rounds, cleaners, visitors and junior nurses had to leave and everything stopped. If the consultant was visiting a patient six beds up from me I had to turn off my radio despite the fact that it was not loud. Consultants came through the wards, usually with staff nurses and nuns in tow, like little gods. Many of them were decent people and did not want that to happen, but they were sucked into this culture and were expected to behave in this way. No explanation was given as to what was wrong with one or what they intended to do about it. Much of that deference still exists in hospitals.

We could go on all day talking about this report and the awful events that happened. These women were abused. Women from 19 years up, who may or may not have wanted to have further children, had that choice taken from them without consultation. Consider the implications of 166 men going into Our Lady of Lourdes Hospital and coming out sterile. It is such an appalling vista as to be unimaginable, and then files were altered and stolen.

Other events have happened in Ireland. One case that strikes me is of a man who received a letter from Glasgow University Hospital informing him that there was something other than hepatitis A and B in the blood. He threw the letter in a drawer and never looked at it. He got a golden handshake and still works in a laboratory. These women do not need to be told the contents of the report — they are aware of that — or how much money they will receive, although that is important because in some cases revenge is important. Telling the story does not always give closure. They want to know what will happen next, who will be held to account and the price those responsible will pay for this terrible crime. Many times I have seen people walk away with golden handshakes and drift off into the sunset as if in some way they did not know what they were doing. They did, and this report makes it clear that they knew what they were doing. I want to know from the Government what happens next. What sanction, action and charges are going to be brought?

Ms Hoctor

I wish to share time with Deputy Keaveney.

Acting Chairman

Is that agreed? Agreed.

Ms Hoctor

I am grateful for the opportunity, however brief, to address the House on this appalling issue. This is International Women's Day. It celebrates the glory of womanhood and the beauty of the feminine. It is poignant that this report is being debated today. It is a refreshening initiative by Parliament to redress the issue, once and for all.

I extend my deepest sympathy to the women who suffered along with their families. What happened in Drogheda was an absolute disgrace and has angered many people right across the country. Indeed, it has angered those who never knew the women but who nonetheless share their pain, silently. This terrible case has highlighted the fact that there are inherent deficiencies in how our hospitals monitor their most senior doctors and consultants. The case has seriously undermined the confidence of the people in the health system. The doctors and consultants, on whom we have depended greatly down through the years, have enjoyed tremendous respect and been held in the highest regard. In return we expected from them strict adherence to the medical code of practice at all times. That was not so in this case.

People were trained to the highest level in nursing and medical care at Our Lady of Lourdes Hospital, Drogheda, and many of those who took on the religious life prepared for the missions within the same walls where this carry-on was being perpetrated. Those who were either aware and afraid to say anything, or else totally indifferent to what was going on, must now examine their consciences and look back on those years. Thankfully, two people of great courage decided this could not remain a secret any longer. They came forward and unveiled what is now in the public domain and, most importantly, must be addressed for the future.

There are too few women in medicine, although that is changing. In UCD, for example, more than 60% of medical students are female. This issue has been an absolute indictment to humanity, both male and female. Families were deprived of sons and daughters because of these outrageous acts. I pay tribute to Patient Focus. Although I have not met its representatives I have followed, admired and support their work. It is most important when redress is being considered that all of the cases of the women in question are addressed. By this I mean that all the necessary supports, psychological, psychiatric and of course financial, must be put in place. No figure can quantify the harm and the grief involved. The mutilation that took place can never be sufficiently compensated. However, they are owed at least some measure of compensation at this stage.

I am aware that some women would have lived through those years without being fully aware of the nature of their ailments. They would have incurred enormous hospital bills as well as costly bills from GPs. All of that must be examined in the redress process.

I welcome the Tánaiste's announcement that a national perinatal epidemiological centre is to be set up at Cork University Hospital. Based on the models being proposed, we recognise this is a positive step, and will ensure that atrocious acts such as these can never be repeated. In the brief time remaining I want to emphasise that it is important that a patient charter should be drawn up and furnished to every citizen, male and female, so they are not afraid to ask any question as regards medical practice, whether in the GP's or the consultant's clinic. Sometimes even people who have attained high levels of education are afraid to ask a simple question. The bottom line for the future, however, must be that no question is foolish. The only foolish question is the one not asked.

Cecilia Keaveney

I recall going to London with the former Senator Mary Jackman, to look at the issue of Europa Donna and breast cancer. We visited many different hospitals and got one message, namely, that we, as politicians, should never play politics with people's lives. This case is a classic example where consultants should not play God with people's lives, either. I had the sad, daunting or inspiring experience of being on the Joint Committee on Health and Children in the last Dáil, when Patient Focus attended a meeting to outline its case. I have been moved very few times by a committee presentation as I was on that day. One of the contributions to a committee that came anyway close to it in my experience was the presentation by Women's Aid recently about domestic violence. Its representatives described how women were being subjected to domestic violence and said that at least 71% of such cases were alcohol-related. In a sense we were dealing with the alcohol issue and could agree that this was part of the problem, part of the cause. The question here, ultimately, is what was the cause. What can be remedied and what can we learn?

At least we have to learn that it must never happen again. I accept the importance of the new national perinatal epidemiology centre at Cork University Hospital. It is more important than registering births and outcomes. The most important feature is examining how to re-establish trust and ensuring the services given to mothers and their babies born are based on the best possible research. Countries such as Australia have wide experience in looking at both pre-natal and post-natal issues. I know from my role as Chairman of the Joint Committee on Arts, Sport, Tourism, Community, Rural and Gaeltacht Affairs that they put a good deal of effort into music at the pre-natal stage, which helps in childbirth etc.

I have heard, first-hand, the gory details, and indeed the lack of gory details, that is, the lack of the files. I accept that pregnancy is a woman's most vulnerable time. I always thought a woman just got pregnant, had a baby and that was it. However, a close friend recently had a very sad loss. When one is that close to someone and sees the implications of a natural sad loss, it puts in perspective how an unnatural sad loss or the removal of the potential ever to have a child again, through no fault of one's own, must be absolutely awful.

I congratulate Patient Focus. It has been ultra brave. It was at the core of this campaign and was not believed. It was challenging the unchallengeable. I applaud Judge Maureen Harding Clark for what is seen to be a very important piece of literature, her report. People on a professional career path are sometimes loathe to question matters because it might ruin their chances of advancement. There was nothing professional about what happened in these cases. There was nothing to be proud of. This pain must be addressed financially, although money will not heal it.

Speakers have noted that today is International Women's Day but this issue is not a woman's issue. The issue concerns both women and families. We miss the point when we separate issues into those that relate to women or men. This is the most intimate of family issues, involving as it does the creation of another human being.

One speaker asked about what should happen next. We can introduce legislation, examine procedures and establish centres to track and monitor, which is important. The perpetrators must be brought to justice. It is as simple as that. The Medical Practitioners Bill will be very important and put a new focus on the practice of medicine because, ultimately, medical practitioners should not play God or politics but put patients first.

The Tánaiste and Minister for Health and Children stated that this report tells the victims' stories, how the health system continually failed them and how women were robbed of their ability to bear children. This is not a story I would wish see written about me and others would not wish to see it written about them. Therefore, I congratulate those who made the matter public and pursued it. I welcome the report, which should be a beginning, rather than an end.

Dr. Cowley

I wish to share time with Deputies Sargent and Morgan.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Dr. Cowley

I congratulate Judge Maureen Harding Clark on her very clear and comprehensive report, which outlined shocking and disgraceful practices. It is unacceptable that such practices were allowed to continue. The report screams for justice for these women. I agree with the Tánaiste and Minister for Health and Children's assertion that safety in hospitals should be as rigorous as passenger safety in airlines. This is the least people can expect from a hospital. They should not expect to emerge from hospital in such terrible condition. Even today, people can go into hospital and become infected with MRSA.

I wonder whether it would be foolish to think that examples of bad and dangerous practice would not be found in other hospitals if they were put under the same spotlight. I understand the report says as much. The team behind the report found it extraordinary how many of the cases, when taken on their own, appeared to be acceptable medical practice and had to remind themselves that the number of such procedures was extraordinary. If it was difficult for Judge Harding Clark's team to comprehend that this behaviour was immediately abnormal, it is understandable how it continued undetected for so long. Where better to hide a tree than a forest? While what happened was completely unacceptable, the lack of a system of peer review meant that it was impossible to detect it. I congratulate Judge Harding Clark and the whistleblowers who were brave enough to bring this issue to the fore.

It is not for me to judge Mr. Neary but I blame the system which allowed him to practise unsupervised even though he was bucking national trends. The line that good hardworking people can unwittingly allow bad practice to occur is both powerful and true. However, Our Lady of Lourdes Hospital still does not possess a computerised data collection system, which is disgraceful. According to the report, the hospital was very busy, with perpetual funding and staffing problems. However, the situation that pertained when Mr. Neary worked at the hospital persists. The report concludes that the hospital is still understaffed, with two consultants absent over extended periods and no sign of replacements for them.

How much of this is due to an ostrich-like attitude in respect of the health service? A considerable number of reports on the health service, including the health strategy and the primary care report, have been produced but not enforced and are gathering dust. I hope this report will not meet a similar fate.

I agree that patient safety in hospitals should be as rigorous as passenger safety in airlines. However, on International Women's Day, I calculate that 260 women will die in the south and west of the country because they will only be scheduled to be screened under the BreastCheck programme in 2009. These women will have died by then. The Government could use the services of the Galway Clinic to screen these women with the help of the National Treatment Purchase Fund. On 22 February 2003, the clinic told the Tánaiste that it was prepared to offer such a service. If she had accepted its offer, hundreds of women would not have died. Money could be made available to allow the clinic to provide the service. The excuse given for declining the clinic's offer in 2003 was that it used a digital service while BreastCheck was an analogue service. However, BreastCheck has now switched over to a digital service so there is no excuse for not using the service that could be provided by the clinic.

A total of 100 women with hepatitis C were infected by Anti-D product but have not tested positive for the disease despite the fact that every other hepatologist or consultant hepatologist claims he or she can prove they have hepatitis C. These women cannot avail of free medical care.

What took place in Our Lady of Lourdes Hospital was shocking and I feel for every woman affected by it. I am glad they will receive compensation but it can never make up for what they have endured. The prospect of it happening again is unacceptable. There appears to be a major problem with computers in the health system and it is time proper systems were put in place. I welcome the move towards comprehensive insurance. It is easy to blame the doctors but these practices obviously took place in the unit itself. The situation is not straightforward. In the absence of proper systems, these practices will recur, which is unacceptable.

Mr. Sargent

I also thank Judge Harding Clark and all those involved in putting together a very important report. It tells a story of criminal abuse, although it does not tell the entire story. Questions still remain regarding the motivation behind these practices. This is work that remains to be done.

The report also holds up a very important mirror to a culture of unaccountability, power and deference to those in positions of power. When one reads in the report that the nuns thought Mr. Neary walked on water it highlights how flawed our health system has been to allow this type of unquestioning attitude towards people in authority to prevail. During questions to the Taoiseach, I stated that we needed to address this tendency to see consultants as gods. In my constituency of Dublin North, Meath, Drogheda and the rest of Louth, I still meet people who will not hear a bad word said against Mr. Neary. I ask people who have any doubts about Mr. Neary's culpability or an interest in the matter to read the report. Although not every action of consultants named in the report, including Mr. Neary, was wrong, the report uncovered a considerable amount of very bad judgment and very serious malpractice. This must be dealt with and people must read the report to come to terms with it.

I congratulate Patient Focus, which was forced to face counter-campaigns. It was forced to face the fear within the medical profession, particularly among midwives who initially did not want to become involved but were invaluable to the inquiry once they did. State inertia was crippling at the beginning and people needed to pull the Government up by its bootstraps.

The scandalous theft of medical files must be investigated by the Garda. The report's recommendations, many of which are long overdue, must be put into practice. One of the report's recommendations is that medical practitioners be required to attend training on governance, which is very important. It also recommended that junior doctors be enabled to voice complaints. Whistleblowing legislation must apply to junior doctors. At the moment they believe they will put their career path at risk if they voice complaints. The training of nurses also needs to be reformed.

It is very significant that Dr. Michael Maresh came over from Manchester to take the lid off this scandal and that it was a midwife trained outside this jurisdiction who brought the necessary information into the professional domain. The matter of a redress board must be dealt with expeditiously. I take on board what the Tánaiste said. The Government has, at last, tried to make up ground. However, much ground must be made up because the neglect in this area over 25 years is scandalous.

Mr. Morgan

I welcome Judge Harding Clark's report. I particularly welcome the frankness of the report. It is clear that Judge Harding Clark did not pull any punches in constructing the report and outlined the case elaborately. It unveils a nightmare that will torment families and women, in particular, in the whole north east region for many decades. The report refers to a culture of authoritarianism in Our Lady of Lourdes Hospital, to which all Deputies from the region can attest through representations they have made.

I want to address the issue of symphysiotomy because there are no public representatives from the area who will not have dealt with the issue. This is a process whereby the gynaecologist would have sawn through the pelvis of the patient to widen the birth canal. This practice was introduced around 1920 and was supposed to have ended in 1960. However, in the case of Our Lady of Lourdes Hospital, it was still the practice in 1983. People knew this was going on and turned a blind eye. Others should have known it was going on. We talk about examples of bad practice. This is an example of something close to what went on in Bergen-Belsen Prison, which was going on just up the road. While the Department of Health and Children knew about the practice and the consequences of it for five or six years, together with successive Ministers for Health, it did absolutely nothing about it. There were one or two token meetings with the survivors of this symphysiotomy procedure, the representative group for the women victims of this brutal process but, unfortunately, nothing practicable has been done to deal with the issue. There has been much hand-wringing at senior level within the Department and at ministerial level over the Neary case, but what about the victims of the people who carried out symphysiotomies on these women? These women will be on morphine for the rest of their lives. They will be barely able to move about or walk. In some instances, people are already wheelchair bound or will be shortly, yet the Department and the Minister are doing nothing to meet the needs of these women.

On 18 June 2003, I received a letter from the chairperson of the competent authority, the Institute of Public Obstetricians and Gynaecologists. It reads as follows:

In view of the considerable disquiet expressed by both the elected representatives and the media, I believe that all the clinical details, or as many as possible, should be sought about these cases, and with this data, the women should be given full explanation by an informed medical practitioner as to what happened to them. They are certainly entitled to that.

This was in 2003 and nothing significant has happened to-date, which is a scandal.

Minister of State at the Department of Agriculture and Food (Ms M. Wallace)

Like all the other Deputies representing constituents of the north eastern counties, I was devastated on many occasions when attending meetings with the women involved in this terrible saga. I heard many stressful and harrowing stories of individual women. I very much appreciate the openness of the women involved. I appreciate the Patient Focus support group which provided the environment in which the women could come forward, work together and work with us as representatives in the area to highlight the case. Most Members who contributed to the debate referred to the work of the Patient Focus group. Like other Members, I say they are a wonderful group of people who worked for the families and victims who suffered such trauma. Our hearts went out to them, and today we express our heartfelt thanks to them for what has been achieved because of their bravery.

I am well aware of the courage of the women who were affected by the actions of Mr. Neary, and the inaction of others at the time. The women involved had their future robbed by a system and a culture that was allowed to exist at Our Lady of Lourdes Hospital in Drogheda. The inquiry carried out by Judge Harding Clark found that a total of 188 peripartum hysterectomies were carried out at Drogheda over a 25 year period from 1974 to 1998. As we look back, we all realise how long this practice went on and how wrong it was. When one examines the 129 cases attributed to Mr. Neary, one must not forget the 42 cases attributed to Dr. Lynch and the 17 cases attributed to registrars and others, and the wider group affected by the action in the unit during that time.

The number of Caesarean hysterectomies has been spoken about by other Members. One in 250 such procedures compared to one in 37 procedures in other hospitals with a similar ethos throughout the country at the time is an extraordinary statistic. It is extraordinary that the scandalous nature of this figure was not highlighted. It is even more upsetting because those involved included teenagers, women in their 20s, women with no other children and some with a small number of children who would have liked to have other children. The trauma experienced by these women is horrendous. Harrowing stories have been told. We must remember today all the tragedies surrounding these horrific events.

The report and the stories of the women clearly indicate that a hierarchical culture was allowed to exist in the hospital with the consultants being treated as gods. It appears that the well-being of patients, which should have been the first priority, was not the priority. Egos and misplaced loyalty or fear of the consultant body appeared to prevail. That should not be allowed to be repeated. What happened at Our Lady of Lourdes Hospital should not happen again. But for the bravery of the midwife who had the courage and confidence to bring to light what was going on in the hospital, the ethos might have continued. This person, and the women about whom we have spoken, have done a tremendous service to patients of the future, for which we thank them.

I welcome the commitment of the Tánaiste to address the need to identify and tackle weaknesses in any part of the health system, regardless of whether they are regulatory, governance, organisational, managerial or clinical. She intends to bring proposals to Government to establish a process to ensure the lessons of what happened are built into stronger clinical governance arrangements throughout the health service. This will be an important outcome for all patients. I thank the women for this ground-breaking change in the entire health system.

It is very important to have confidence in a system on which we must rely when we are most vulnerable. Autonomy without appropriate audits should not be allowed in any aspect of hospital life, including consultants, nurses and those responsible for hygiene. I know from my involvement as chairperson of the Patient Focus all-party Oireachtas support group that the Tánaiste has given considerable time and is taking a personal interest in addressing the difficulties experienced by the patients. I thank the Tánaiste for honouring her commitment to the all-party Oireachtas support group on the timing and mechanics of the publication of the report. The group was anxious to have as much time as possible, a promise which was honoured by the Tánaiste. We would go further than the group in terms of our concerns about the establishment of a package of redress to deal with all claims of medical negligence by the women who were in the care of the consultants and staff of the maternity unit in Our Lady of Lourdes Hospital between 1974 and 1998. Indeed, the cases impacted by lapse of time are of concern to us, as are the cases impacted by the withdrawal of the Medical Defence Union and the case of the missing files.

We welcome the appointment by the Tánaiste and Minister for Health and Children of Judge Harding Clark to advise on the appropriate form of redress for the women concerned. We are reminded of what happened in the case brought before the High Court and appealed to the Supreme Court. It is our hope this will be dealt with as quickly as possible in terms of the appropriateness of the form of redress brought forward. The women who have suffered so much already need to be able to bring closure to this episode of their lives. We are concerned to ensure that their cases are heard and that they receive a satisfactory level of redress. We have great confidence and faith in Judge Harding Clark in this respect.

Many of the women concerned were reluctantly launched into the limelight and were forced to make a stand in respect of the injustices levied against them. In thanking them for coming forward and for all they have done, we want to ensure the appropriate form of redress is put in place.

As other Members said, it is poignant that we are discussing this issue on International Women's Day. We would not have arrived at this stage were it not for the courage of the women who were directly involved. They are the victims in this saga. The midwife was pivotal in highlighting the scandalous situation. Judge Harding Clark has produced a caring and comprehensive report. All the foregoing are to be admired and commended on their bravery. I hope we will never have to deal with a situation such as this again. We have confidence in the Tánaiste and Minister for Health and Children in terms of what needs to be done to address the issues which have arisen in the report.

Mr. O’Dowd

This is an important debate. We are all ad idem in this House in respect of the appalling situation which arose whereby these women and their partners who wanted to have more children will never be able to have them given what happened at the hands of Dr. Neary. No sympathies expressed by us are enough. No money could ever compensate for that cruel and awful loss. I congratulate the women involved who had the courage to campaign and to bring this matter to the attention of politicians, particularly in the north-eastern area. The leader of Patient Focus, Sheila O’Connor, brought this matter to the attention of all political parties and ensured we were fully informed at all stages.

Judge Harding Clark's report is an excellent one in all respects and I fully support the findings therein. A person mentioned specifically for praise in the report is the health board official, Dr. Ambrose McLoughlin, a former deputy chief executive officer. Mary Duff, the nursing officer, and Finbarr Lennon, the medical director of the hospital, were also mentioned. In the face of extreme pressure from consultants in the hospital, they undertook to ensure the matter was fully resolved. They pursued that in a determined and committed way and they suffered gravely. As the report states, they suffered much ignominy and distress as a result of what was said about them but they pursued the matter to ensure the Dr. Neary case was brought to a finality. The truth of the situation is now known to us all. Were it not for their determination, the whitewash of the three professional obstetricians who reviewed some of Dr. Neary's cases and who gave him a clean bill of health for his actions would have stood.

At the core of this debate and what happened was the lack of accountability in the medical professional in Our Lady of Lourdes Hospital and within the professional bodies and the fact they did not see fit to tell Dr. Neary that he had erred grievously in his actions. That an English independent consultant examined the facts and found the opposite begs the question as to what will happen in future. How can we trust these professional medical bodies if they can so clearly whitewash the actions of a consultant who is a member of their group?

Also at the heart this issue was the way public and private patients were treated, especially in maternity hospitals. This came out in the report. Often a consultant never visited some of the patients having children but I presume that has changed. It is a practice I find unacceptable. Every patient who delivers a baby in a hospital should be visited by the consultant on duty.

I have three children and live in Drogheda. My wife had an emergency Caesarean section with our first child. When we saw this report, we said how fortunate we were that Dr. Neary was not on duty that night and how unfortunate the women who had the hysterectomies were. No argument or facts support the need for so many Caesarean hysterectomies in Our Lady of Lourdes Hospital during those years. The report states quite clearly that on average, a consultant would perform perhaps ten of these operations in a lifetime, but at least ten per year were performed in this case, which was shameful and unacceptable. The report points out that people who worked in Our Lady of Lourdes Hospital — it does not name them but mentions the jobs they held — said nothing and this abuse continued.

It is amazing there was no professional review of all the standards operating in the hospital. In her report, Judge Harding Clark makes it clear she is not convinced that this has not happened, or could not happen, elsewhere in the health service. How do we know this has not happened, or is not happening, elsewhere? It is important the Government ensures there is transparency in respect of the bodies which regulate the medical profession. We can no longer assume these professional bodies will act in the best interests of patients when they clearly did not do so when they examined Dr. Neary's nine cases. That is a critical issue. We need to ensure this never happens again.

At the heart of our hospital service must be a transparent and tough regime which reviews how these consultants operate, how they retrain and how we ensure they do so. Every few years, they should be required to undergo an assessment in the hospital and perhaps even a written examination to ensure they are up to date with the best and most progressive knowledge available.

It is an absolute shame that people who knew what was going on did not speak and those reviewing what this man did gave him a clean bill of health. That is the most profound and awful finding of all and which shocks us all. The hospital is, and has always been, a core part of everything which happens in the town of Drogheda. More than 1,800 people work in the hospital which is probably the largest employer in the county. We have a major interest in ensuring the services provided in the hospital are the best.

This day would never have come were it not for the commitment of the midwife who brought this issue to the attention of the health board, its officials and some of the hospital management who insisted on ensuring the truth and all the facts came out, for the campaign of the women involved, and for Patient Focus. I am glad we have had this debate and that there is clarity about what happened.

I am a great admirer of the work the Medical Missionaries of Mary have done for many years in Ireland and abroad. The order is clearly exonerated in this report. The Catholic ethos of the hospital was not found wanting and was shown not to be the reason Dr. Neary carried out the operations. I am happy with that. Views will be expressed about Catholic morality and so on but the report rules out its influence on what happened in the hospital.

We are all agreed that change is required and it is forthcoming. I welcome the report which is a watershed that signals the end of bad medicine, bad hospitals, and a lack of investigation and vigilance into the medical profession. I am pleased the redress scheme has been introduced but it will never compensate the women and their partners for what they have been through.

Mr. Kirk

I am pleased to have an opportunity to make a short contribution to this debate, one of the most important we have had in the House for some time. There is an underlying consensus in the observations of Members in the range of contributions from both sides of the House.

The starting point for an examination of the issues that arise from the traumatic cases that took place in Drogheda, County Louth, is to consider the plight of the women who have been traumatised and severely affected by the unnecessary hysterectomies carried out over a long period in Our Lady of Lourdes Hospital. Let us consider the trauma of the individuals concerned and their families. The trauma of the wider family network must also be considered. We must also bear in mind the personal loss of the individuals involved. In some cases women may have had one child and have planned to have additional children but they were unable to fulfil their ambitions in this regard due to the unnecessary operations carried out in Our Lady of Lourdes Hospital. A high emotional price was paid by the individuals involved during the protracted 20-year period.

We have an opportunity today to pay tribute to the resilience, tenacity and hard work of those involved in Patient Focus in representing the interests of those directly affected. A number of people co-ordinated the campaign and worked diligently to identify those women who were severely affected. They also worked closely with all the public representatives of all the different parties in the north east. They are to be congratulated on their endeavours.

We also have an opportunity to pay tribute to that most courageous person — the midwife whose conscience told her that the practices in the hospital were unacceptable and who was no longer prepared to allow them to continue. She decided to do what should have been done much earlier and reported what was happening.

I welcome the Tánaiste's announcement on the establishment of a compensation structure for those who have been severely affected. I also welcome her decision to involve Judge Harding Clark who has examined each individual case over the period in question. She is in the best position to make the necessary recommendations on redress.

We must ensure that the unsatisfactory decision making which this inquiry has revealed is never repeated in our health service. Above all else, the case proves that even the most confident, able and highly motivated of individuals is not infallible. Humanity is revealed with all its foibles and weaknesses. This case graphically illustrates the dangers attached to insufficient cross-checking and scrutiny at every level of decision making in our health service. Some of the Tánaiste's announcements today clearly emerge from the manifestation in the report of the serious errors that were made. Let us hope these announcements will result in a template for a more open, accountable, balanced and trustworthy health service.

Our Lady of Lourdes Hospital has been in a pivotal position in terms of the delivery of health services in County Louth and the north east region in general for many years. Its reputation has taken a severe battering in this case, which may be proven to be unfair in the long run. The hospital is needed by the growing population in County Louth, County Meath and further afield. The HSE and the Department of Health and Children must set in train a process to re-establish public confidence in the hospital's provision of health care. No doubt the HSE will reflect on the recommendations in the Harding Clark report and resolve to restore public trust as quickly as possible.

We all welcome the Tánaiste's decision to set up the national perinatal epidemiology centre in Cork. This is a welcome move that is designed to reassure the public which is punch drunk from what it has read and gleaned from this report. It is the minimum necessary to make a start on rebuilding trust in our health service.

Times have moved on and some of the legislation on the Statute Book requires updating. A revision of the legislation relating to medical practitioners is due. The Ireland of 2006 is different to the Ireland of the 1940s or 1950s and there is an obvious need to update legislation in this area. The Tánaiste has clearly indicated her intention to introduce new legislation or amend existing legislation to consolidate the position and update many of the practices on which the health service is based. We must ensure that the balance of accountability in the health service is restored and that we have the necessary equilibrium within that matrix of decision making.

There is no place for misguided collegiality in situations such as the one under discussion. It emerges from the report that hospital consultants are human and errors can occur in maternity or other hospital units. The report outlines the importance for all cases to be open to examination and where practices are found to be unsatisfactory they must be rooted out as quickly as possible. We require a new safety culture in our health service. A culture of openness is required, in addition to an oversight mechanism for the analysis of clinical practice by the health service.

A heavy price has been paid by the unfortunate women who were caught up in this sorry saga over the 20-year period. As legislators we must learn lessons from this episode. We must ensure it will never happen again and underpin this in our legislative framework. Today is as good a day as any to make a start on that resolution.

Ms O’Sullivan

I welcome the opportunity to participate in this debate. The members of Patient Focus in the Public Gallery must be hoping all the words they have heard here will lead to results. We should pay tribute to the work they have done, which has been enormously important not just for their cases and for that of the hospital involved but for the health service and society generally. We must learn from this and ensure it never happens again.

Hierarchical structures cannot be so powerful that it takes so long for people to break them down to reach the heart of an injustice. What happened was obvious for many people to see but no one was able to do anything about it. The lessons learned must be implemented in health services structures and in other aspects of our society. We are still very hierarchical, we still doff the cap to those considered to be on a higher professional or social level. This attitude is alive and well in our hospitals still. We must develop a culture that fosters teamwork instead of placing people at the top of the pile in terms of power and decision making.

As others have noted, today is International Women's Day. If there was ever a group of women who were abused and had power exercised over them, it is the members of Patient Focus. The right to bear children is a basic right for all women and to have that right taken away unnecessarily by members of a profession held in high esteem who were abusing their powers is one of the greatest abuses possible. It is fitting, therefore, that we are discussing this topic today of all days. We owe it to those women to address their needs and to make certain that trust and power cannot be abused again in any context.

The hierarchical structure of the medical profession and the health services in Ireland is out of step with other countries where the team work ethos exists. People who have worked in the medical profession abroad know they treat each other as equals, whereas we still have an attitude that consultants are the gods of the system. That attitude is gradually disappearing but it is still necessary to confront the consultants and ensure they cannot exercise such power in the hospitals. It is not good for them, the system or the patients. Deputy Gormley referred to a newspaper article which claimed there is evidence still of discrepancies in obstetric practice in different areas; that shows some individual consultants are still very powerful. Induction of child birth is dependent on the culture brought by a consultant to an obstetric unit. There was a time in the past when this only happened for very good reasons. We must give the power back to those at the centre of this — the women who are giving birth.

Self-regulation does not work, not just in the medical field but in the legal and other areas, something those directly involved strenuously deny. The medical, legal and teaching professions, however, should not regulate themselves. We saw this clearly in the behaviour of the Royal College of Obstetricians and Gynaecologists, which exonerated Dr. Neary. He was allowed to select the nine cases to go before it. I am still unclear how that happened. It was never going to produce a fair examination of the practice and should never have happened.

I agree with the comments made this morning by Deputy McManus when she called for a health service inspectorate. There should be a regular monitoring and inspection system for all aspects of the health service. It is clear from this report that there was an appalling lack of regulation. Even when the hospital did not submit reports for years, no one asked why. The college in London admitted it received the reports, placed them in an archive and never read them. Even when reports were published, there was no proper monitoring of the situation.

whistleblowing is an important issue. The Labour Party has published a Bill on whistleblower protection that is currently being debated in Private Members' business but it will be voted down by the Government, which will continue with its piecemeal approach. What if there is no legislation in this area for ten years? Will whistleblowers be covered? I cannot imagine any major legislation to cover whistleblowers in education because a recent Education Act covers the general system. We need all embracing whistleblowers legislation that people can use for protection when they have concerns.

The report details how the midwives became concerned. One of them decided to have her child outside the hospital because she was worried about the number of Caesarean hysterectomies. A midwife who had the procedure carried out on her asked what was going on and it was shortly afterwards that another midwife blew the whistle. Those people are still powerless in the face of the system. The obstetricians call the shots and it would still be difficult for a midwife to decide to go to the authorities to say something like this was going on. That is the structure in operation.

There must be a cultural change in our hospitals and a teamwork strategy put in place. There are areas where teams work together and all members are treated equally no matter what their specialty. They all enjoy parity of esteem, something we need across the health system.

The "deliberate and malicious removal of information" detailed in the report is extremely serious. I hope it will be addressed rather than swept aside. It is incredible that so many charts, reports and files were deliberately removed to prevent a proper investigation.

I hope the many serious questions arising from Judge Harding Clark's inquiry will be addressed. What action will be taken with regard to the missing files? One cannot give back to the women affected by malpractice that which they have lost but what will be done to address their needs? What will happen to Dr. Neary and the system in which he operated?

Mr. Nolan

I wish to share time with Deputy Fiona O'Malley. It is important that the House debate this important report on which I commend and congratulate Judge Maureen Harding Clark. The report highlights serious shortcomings in Our Lady of Lourdes Hospital in Drogheda and I suspect the issues it addresses may not be once-off difficulties. This is a tragic case and the report's contents must be heart-breaking, painful and distressing for the women who were subject to the practice into which Judge Harding Clark inquired.

The Lourdes hospital inquiry has shown that our health system has shortcomings. While criticisms may have been voiced in certain quarters about the manner in which the issue was highlighted — some described it as sensationalist — it is vital the Government has the power to investigate reports or evidence of failures in the health system. I commend the individual who took it upon herself to express concerns about practices in Our Lady of Lourdes Hospital, Drogheda. It is possible the problem was known to other individuals or groups in the hospital but they failed to raise their concerns or specific shortcomings. Procedures need to be established to allow individuals who have concerns about practices in certain institutions — not necessarily hospitals — to raise their misgivings with the relevant authorities.

The Minister did not need to be persuaded to provide a means of redress for the women affected by malpractice. The Government has agreed that Judge Harding Clark should be asked to advise on the appropriate scheme for redress, following the findings in her report, and I am pleased she has agreed to this proposal.

The report highlights shortcomings in the system for securing records in hospitals, a problem which undoubtedly extends beyond Our Lady of Lourdes Hospital. On a recent visit to a patient in a busy Dublin hospital, I was amazed at the amount of record-keeping undertaken in hospitals. While I understand how genuine mistakes can occur and files can be mislaid, the loss of 44 files related to a controversial issue is too much of a coincidence and rules out the possibility that they were mislaid. I hope the Garda investigation into this matter will have a successful outcome.

The pain and distress suffered by the women involved in this case can only be imagined. They are the victims of an imperfect health system and administration. I hope lessons will be learned from the report. The Minister indicated that any isolated institution which does not have in place a process of outcome review by peers and benchmark comparators could produce a similar outcome to that which occurred in Our Lady of Lourdes Hospital. This must not be allowed to happen. She also stated that support systems must be in place to conduct regular and obligatory audits. These systems must be established immediately. We cannot wait for another problem to occur.

A further lesson, according to the Minister, is that "there must be mandatory continuing professional development and skills assessment at all levels of health care". This must apply across the board, from top management down to nurses. She also stated that staff need to attend updating of skills and methods programmes and should be able to recognise that procedures change in accordance with evidence-based research. National and international best practice must apply in all our hospitals.

As I stated, this is an important debate. I hope lessons will be learned from this report and acted upon immediately.

Ms F. O’Malley

It is poignant that the House is discussing the Lourdes Hospital inquiry on International Women's Day, given that so many women, the victims and focus of this inquiry, were deprived of the essence of what it is to be a woman. As the Tánaiste noted, anyone who reads the Lourdes hospital inquiry report will be deeply moved. Patient Focus deserves much credit and we could all learn lessons from its tenacity, resilience and sensitivity.

Judge Maureen Harding Clark has produced an outstanding report which has met with universal approval. Despite having been published for just a short period, the Tánaiste has already taken action. We must learn from this case to ensure the events which took place in Our Lady of Lourdes Hospital in Drogheda cannot recur.

It is also important that the question of redress has been quickly addressed. While the victims are not necessarily concerned about money, they need to have the hurt and deprivation visited on them recognised in some way. The Government has responded in a responsible manner and it is appropriate that it should seek to obtain moneys from insurers as the financial burden arising from such cases should not always be placed on taxpayers. It is important that the women affected are looked after and compensated quickly and sensitively.

As the report indicates, an isolated hospital and practitioner breeds ignorance and puts patients' lives at risk. In this case a consultant was able to operate in isolation. It is alarming that the practices referred to in the report continued until very recently. I hope the culture change in hospitals will result in people being prepared to question procedures and practices.

We need to learn from best international practice and the announcement by the Tánaiste and Minister for Health and Children that a national perinatal epidemiology centre will be established in Cork University Hospital is an important step. The new centre will hold records on all births and operate a database or information bank which will ensure there is no repetition of this case. This is evidence of the Tánaiste's style of dealing immediately with problems and it represents the appropriate response.

It is worrying that files were stolen because there will now be no opportunity for 44 women to establish the facts in a court of law. Given the theft was known about for some time, I am sorry the Garda did not move sooner. It is incumbent on the Garda to investigate the matter and people will watch its reaction closely. It is a serious matter that people colluded in a cover up and the perpetrators must face the rigours of the law.

Mr. McHugh

I wish to share time with Deputies Boyle and Ó Snodaigh, by agreement.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Mr. McHugh

The Lourdes inquiry is a frightening indictment of the blinkered treatment of the patients of Dr. Michael Neary in the maternity unit of Our Lady of Lourdes Hospital. I am sure this is not the only hospital and he is not the only consultant to have engaged in dubious practices. The women who suffered unnecessary procedures have gone to hell and back. Not only have women from County Louth been affected but women from my constituency of Galway East have also been involved.

I cannot help but draw the conclusion that the main reason for this devastation was, as Judge Harding Clark noted, an unquestioning respect for consultants. Some consultants are walking gods in our hospitals, with opinions that cannot be questioned. They act as if they believe they are superior to ordinary citizens. While I am aware many consultants are decent, professional and kind people, some have such a high self-regard they find it a chore to talk to ordinary folk. The report relates how some midwives were filled with fear and dread by a certain consultant who did not tolerate conversation. His patients had to sit up in their beds, with tables tidied and bed linen turned down in advance of his ward rounds. Such pomposity is revolting. This being's superiority was further underlined by the use of titles such as "mister" or "doctor", titles which are used as weapons of domination and devices of self-promotion. Even in the Dáil, the archaic and domineering titles of "Deputy" or "Doctor Dum Dum" are used. We come here as servants of the people, elected by the people on the basis of equality and nobody should bring titles which are not relevant to membership of this House.

Irrespective of how one wishes to artificially inflate his or her social importance, checks and controls must be in place. Regulatory authorities should take full blame for the fact that these were missing in this case. The Government also deserves blame for its refusal to accept or introduce whistleblower legislation. The report states the "consequences for his patients and for Dr. Neary himself make it poignantly obvious to the Inquiry that it is vital to have an objective review system in place in every hospital where outcomes are measured against accepted norms, and serious deviations are examined dispassionately for explanations". This is a powerful statement and the immediate implementation of such controls is vital for the future well-being of patients and the integrity of the health service.

If continuing professional development was made obligatory for consultants, this diabolic situation could have been avoided. It is unacceptable that after qualification, a consultant can operate for 30 years without any obligation to remain well versed in the most up-to-date methods of treating conditions. Medical bodies are to blame for this.

A number of factors converged to allow these appalling events to take place. The awe in which consultants were held, the absence of protection for whistleblowers, the lack of obligations on consultants to continue their professional development and the absence of an objective review system in hospitals all contributed to this situation.

Mr. Boyle

When the social history of this country comes to be written by future generations, it will ignore the incessant roar of the Celtic tiger to reveal that we are living through a tragic period with a number of health crises that have especially affected women, of which the report by Judge Harding Clark is the latest manifestation. That is something for which the political system and, in particular, the apparatus of Government bear collective responsibility. We are living through a time in which we have failed to deal with the power hierarchies of our medical systems. The division of that power among different classes of medical practitioners has percolated down through the system with the result that patients are treated as statistics and are not involved in real consultation on the natures of their conditions or understanding, as in this case, of what has been done to them.

Judge Harding Clark's comprehensive report answers some of our questions on the tragedies arising from Our Lady of Lourdes Hospital. It tells us how, what and when but it does not and probably cannot tell us why. The report's introduction describes Dr. Neary as a Dr. Jekyll and Mr. Hyde character and suggests reasons for his actions in terms of his personal history and a possible dislike of women, while also pointing out that he may have held his hospital unit together over a long period. While we may never find out the ultimate reason for these events, we can certainly learn from them and ensure they are never repeated.

The Government seems to have learned from previous health crises the need to properly provide for redress. This House needs to see that redress is dealt with promptly and without complications. The women whose files were stolen should be treated sympathetically and the State should not put up barriers to their redress. Ultimately, if we are to be of service to the women concerned and their families, we should accept our collective responsibility in ensuring such incidents are not repeated.

Aengus Ó Snodaigh

Tá mo chomhghleacaithe, na TeachtaíÓ Caoláin agus Morgan, tar éis déileáil le ceist ospidéal Lourdes cheana féin. Tá an fiosrúchán ar imeachtaí san ospidéal tar éis aird a dhíriú chomh maith ar theip an Stáit maidir le réimse chúrsaí sláinte eile. Ina measc, tá diúltú do chearta ban atá bainteach le cinntí a bhaineann lena sláinte. Tá an cheist seo fite fuaite chomh maith le diúltú rannpháirtíocht na mban i gcúrsaí pholasaí sláinte a bhuanú ina iomláine agus a chothú.

Tá sé de dhualgas ag an Stát de réir Ailt 11 de Chairt Shóisialta na hEorpa áiseanna comhairleacha agus oideachasúla a chur ar fáil ar mhaithe le sláinte a chur chun cinn agus gríosú a thabhairt i dtaobh fhreagracht aonaraigh i gceisteanna sláinte. Is éard atá i gceist le freagracht aonaraigh i gceisteanna sláinte ná go dtugtar an chumhacht do mhná trí eolas, fios agus tacaíocht le cinntiú go mbeadh ionchur ceart acu i leith cinntí a dhéantar maidir lena sláinte.

Ciallaíonn sé seo ná go gcaithfear tacaíocht a thabhairt do mhná a bhfuil sé de dhánaíocht acu dúshlán a thabhairt don chleachtas seanghlactha go mbíonn an ceart ag an dochtúir i gcónaí. Ciallaíonn sé seo dúshlán a thabhairt do mhúnlaí leigheas foirne i leith breithe agus tacaíocht a thabhairt do mhúnla ina mbíonn mná lárnach, ina measc, cearta cúraim atá bunaithe ar chnáimhseachas agus an ceart breith baile a bheith acu, más rud é go bhfuil an cinneadh sin déanta ag an bhean féin agus é bunaithe ar an eolas.

Ceann de na rudaí is measa faoin scannal seo ar fad ná gadaíocht chomhaid sláinte na mban agus chláir bhreithe san ospidéal, le cinntiú nach mbeimis in ann teacht ar an fhírinne iomlán sa scéal seo. Tá sé ríthábhachtach go dtéann na gardaí sa tóir orthu siúd a rinne é sin go bríomhar. Tugann an scannal seo léiriú ar an ghá othair a chur ar an eolas maidir leis an cheart atá acu teacht ar a gcomhad nó a dtaifead sláinte féin. Ní bhaineann daoine úsáid as an cheart sin. Caithfidh sé sin athrú go radacach, agus ba chóir go mbeadh sé mar ghnáthchleachtas go mbíonn fáil ag othair ar a gcomhaid féin.

Níl dabht ar bith ach gur cuid mhór den fhadhb i dtaobh an oirdéil ghránna ar cuireadh mná tríd san ospidéal seo ná an ethos Caitliceach a bhí agus atá in ospidéal Lourdes. Maidir le bainistíocht an ospidéil agus cleachtais chliniciúla, chúngaigh sé seo na roghanna a bhí ar fáil do na mná. De réir nádúr na gcléireach agus an élite san ethos Caitliceach, rinne siad iarracht mná a choimeád dall ar na nithe seo, agus bhíodar in ainm i gcónaí bheith ullamh dóibh siúd ar glacadh leis a bheith eolach ar na ceisteanna seo, fíor den chuid is mó. Níor chóir go dtarlódh a leithéid seo aríst sa tír seo nó in aon tír ar domhan. Tá sé ceart agus cóir go bhfuil an díospóireacht seo ar siúl againn ar lá idirnáisiúnta na mban. Beannaím do chrógacht na mban a bhí gafa agus a cuireadh tríd oirdéal san ospidéal seo. Tá súil agam, mar a dúirt mé, nach dtarlóidh a leithéid arís.

Mr. O’Connor

I wish to share time with Deputy Cooper-Flynn.

I join colleagues, to whose contributions I have been listening, in commenting on this important matter. Of the many debates we have had in the Dáil since I was first elected three and a half years ago, this is one of the more profound. Many contributions have reflected that fact. Some colleagues may need to make political points, which is fair.

I listened carefully to Deputy Boyle's contribution regarding the social history of Ireland. The Deputy made a valid point. However, it is reasonable to suggest there was a time in Irish history, in the last century, when many of these issues would not have been revealed or expressed. They certainly would not have been the subject of a major debate in the national Parliament. We should engage in such debates and not be afraid to do so. There was a time, however, when we did not engage in debates of this nature. Issues have come into the public eye over a period that had previously remained hidden for a long time. Each day we pass by the front gate of Leinster House we see proof of this. We live, as should be the case, in a different and more enlightened Ireland. The Minister of State, Deputy Tim O'Malley, will understand the sentiments I express in this regard.

I wish to pay tribute to the Tánaiste and Minister for Health and Children, Deputy Harney, for facilitating this debate. I listened carefully to her contribution. People are entitled to make political points, which will always be the case, but this is a serious issue. Speaking as a man, we should show solidarity on International Women's Day, not only with the women who suffered or were involved in this terrible sequence of events but also with the many women throughout Ireland and further afield who are seriously upset and concerned about this issue. They are watching this debate. I was dealing with some other matter with a US Congressmen earlier and he had heard about this issue. In these times of technology, with websites and e-mail, that is probably not surprising. It is an important debate, however, and people will see it in that regard.

I support the Tánaiste in what she is seeking to achieve. I am glad the Government, through her proposal, has agreed that Judge Harding Clark will advise on the appropriate redress scheme following the inquiry. All eyes will be on what is achieved. Our Lady of Lourdes Hospital will enter a folklore that contains many episodes. It is important to indicate to the Tánaiste that she will have much support throughout the country in having Judge Harding Clark advise on the cost of such a scheme and a mechanism for ensuring the maximum recoupment of such costs from wrongdoers and indemnifiers.

There was a time when we all felt quite safe going to our doctors and hospitals, thinking they were the safest place to be. I hope this has not changed. This inquiry is indicative of challenges and difficulties and should stand as a lesson to everyone.

Ms Cooper-Flynn

Like previous speakers, I welcome the opportunity to speak on this shocking report. It is a shame that we are obliged to discuss a report of this nature on International Women's Day. All we can hope is that lessons will be learned from the horrific experiences outlined in the report.

Before discussing the detail of the report, I compliment Patient Focus, which represents the patients involved who outlined their personal experiences, and Judge Maureen Harding Clark who produced the report. It must have been a difficult experience for the women involved and what they endured should not be underestimated. I compliment the Government on having moved quickly to establish a redress mechanism for the victims in this report. It is important that the issue be dealt with swiftly and that adequate compensation be paid to all the victims involved in a sensitive manner. I welcome the fact that Judge Harding Clark will ensure that this happens.

One need not delve deeply into the report to be quite shocked at the history and background to the events. The historical part of the report points out that 15 complaints were made to the Medical Council between 1986 and 1998. However, it took until June 2000 before an inquiry began. Considering the length of time involved and the fact that complaints were being made in respect of a matter of such a serious nature, that delay is shocking. It took three more years, until July 2003, for the fitness to practice committee to find the case against Dr. Neary proven and to find him guilty of professional misconduct. The delay covers almost 17 years from the first complaint. A number of hysterectomies carried out in the years afterwards may have been avoided if action had been taken sooner.

In this regard, I welcome the fact that a new medical practitioners Bill will be introduced. I welcome the Tánaiste's indication that she will make the heads of this Bill available to all interested stakeholders as soon as possible in order that a complete overhaul of the Medical Practitioners Act can be carried out and the new Bill can come before the House. The new legislation will introduce more streamlined and transparent procedures for the processing of complaints. Given the length of time it took to investigate in this particular case, that is necessary. Another scandal is the missing charts, which are referred to in the report and give cause for concern. The last page of the report states the removal of old maternity theatre registers, the selective removal of master cards and birth registers, which contained details of 40 Caesarean hysterectomies, and the culling of corresponding charts are attributable to a deliberate removal of information on those hysterectomies. The sad result of that is there are over 40 women looking for details on their own cases who may never know the truth about their personal situation. It is an absolute scandal that, as is clear from the report, this was a deliberate act to misrepresent the situation and blot out the truth. Fortunately the judge has revealed it and the truth will not be obliterated. Hopefully a Garda criminal investigation will get to the bottom of it.

The table of clusters of procedures on page 62 of the report shows a shocking number of hysterectomies. For example, on 3 October there were two on one day. This happened on three separate occasions, the others being 3 December 1983 and in October 1980. Obstetricians might only carry out between two and ten hysterectomies of this type during their entire career. In this case, on three separate occasions from 1976 to 1998 there were two on one day.

The report also highlights the complete lack of communication between the anaesthetist and the pathologist and among the various categories of consultants that allowed the situation to develop. A doctor might carry out a Caesarean hysterectomy but not communicate with the pathology department to ascertain the reasons for it. We know from an analysis of the various files that many of these hysterectomies could have been avoided. It is nothing short of an absolute scandal that consultants with God complexes made it virtually impossible, certainly for a lower ranking member of staff, to even question their activities. Let nobody be under any illusion, God complexes still exist in hospitals today. That is why I also welcome the announcement this morning by the Tánaiste of the setting up of the perinatal epidemiology centre in Cork, which will bring together statistical information from all the different units throughout the country to identify unusual trends so this can never happen again. The devising of a single maternity chart for all maternity hospitals is also critically important.

When something like this comes into the public domain people start asking questions. Gone are the days when they take the word of a doctor on anything. Now people have the right to question, which is as it should be. In my local hospital the obstetricians meet on a weekly basis to discuss the various outcomes in their cases and an independent audit is critically important.

Mr. Crawford

I welcome the opportunity to speak on this but I wish we did not have to. There have been some comments about political issues but there were no political issues for the Deputies and Senators of the north east and we worked very closely together. The committee was chaired by Deputy Mary Wallace, now Minister of State at the Department of Agriculture and Food, with Deputy Ó Caoláin as secretary. There was total unanimity in our efforts to work with Patient Focus and all the women affected.

I will never forget the first night I went to the Ardboyne Hotel in Drogheda and listened to the individual accounts of those who suffered under Mr. Neary and others. It was clear from their life situation what they and their families had suffered. Whatever money is paid to them will never recompense them for what they have endured. I give my sincere thanks to Patient Focus and all the women who brought their case into the open, which was not easy.

The inquiry is extremely important and Judge Harding Clark must be congratulated and thanked for her work. The inquiry concentrated on the practices of Mr. Neary but there may be not enough on Dr. Lynch's practices, which cannot be ignored and must also be dealt with. This is the biggest medical scandal in the history of the State after hepatitis C and the report goes a long way to explain how the appalling practices went on over a 25-year period. Some 188 hysterectomies were carried out over that period of which 129 were by Mr. Neary. There are no details in the report of the numbers of ovaries or Fallopian tubes removed, babies that died or the scars that women will take with them to their grave. The obstetricians, junior doctors, anaesthetists, surgical nurses, midwives, pathologists and technicians all failed to bring this to somebody's notice. If it had not been for a midwife trained at the Royal Victoria Hospital, God knows if it would ever have come out. She, like Patient Focus and others, must be thanked for what she did.

The Royal College of Obstetricians and Gynaecologists inspected the unit twice in those years and found it suitable for training registrars. The Royal College of Surgeons approved the unit for undergraduate training and An Bord Altranais carried out periodic assessments of the midwifery school at the hospital. Those names ring very hollow with those of us who represent Cavan and Monaghan. Those are the bodies which decided that, notwithstanding the good service given in Monaghan Hospital, the maternity unit there should be closed. They decided for whatever reason that they would shut it down as if they were God almighty. Now we learn that they inspected the unit twice in those years and found nothing wrong. The management said there was no problem with the maternity unit and Mr. Neary was obviously regarded as the dominant figure. We only have to compare the figures for hysterectomies in the Lourdes hospital to national deliveries to see the extraordinary difference. The ratio is one to every 166 in Lourdes hospital but one to 1,669 elsewhere.

The record keeping was another problem. Birth registers were missing, as were 38 charts. Reports connected with the maternity unit were not included in the Lourdes hospital annual report. This doctor was famous for saying "He saved your life", which sums up the situation. The nurse that exposed the scandal was appalled by many practices that have long since been abandoned. There was no forum in which to express those concerns. Her colleagues told her that nothing could be done until a patient complained but she did a good job. I was born in the Lourdes hospital so I have nothing against the hospital, though many others might, for that reason.

I pay tribute to Dr. Ambrose McLoughlin. He was the first person to give me details of this and I recognise the fact his work is recorded in the report. He highlighted the difficulties at a time others were trying to get us to back Mr. Neary and ensure no action was taken against him.

I appreciate that many mothers would tell us that they have much for which to thank Dr. Neary. I welcome that Judge Harding Clark has published this report and agreed to advise the Government in respect of compensation. It is vital that she be given the wherewithal to deal with this matter properly. We do not want a situation in which she is curtailed in terms of how she can deal with the matter or in respect of the finances that are available to her. This issue must be dealt with quickly and openly.

It is vital that people be allowed to put their cases forward in an open forum and that they be given the opportunity to be heard because of what they endured. It is also vital that cases such as that of Dr. Lynch and others be addressed and that there be complete closure in respect of this dreadful ordeal for the people concerned and for Patient Focus.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I thank Members on all sides for their contributions.

Judge Harding Clark has produced a comprehensive and fair assessment of the events at Drogheda. The challenge before us is to ensure that the various lessons are quickly taken on board by the health system as a whole and not just in respect of maternity services.

I express my deepest regret and apologise to those women and their families for what happened. I particularly wish to welcome the members of Patient Focus who attended the House today. I wish to assure the women involved that many lessons will be learned from this report and that the Government will respond fully to its findings, which indicate that any isolated institution that fails to have in place a process of outcome review can produce a similar outcome to that at Our Lady of Lourdes Hospital. They also indicate that support systems to conduct regular and obligatory audits and mandatory continuing professional development and skills assessment at all levels of health care must be in place.

As the Tánaiste stated, action is being taken to learn the lessons and implement the recommendations of the report in order to ensure the safety of every patient and prevent a recurrence of such events. The Tánaiste announced the establishment of a new national perinatal epidemiology centre at Cork University Hospital, with annual funding of €630,000, which will be up and running in the autumn. Every time a mother gives birth, the important interventions, good outcomes and complications will be recorded and analysed at a national specialist centre. Unusual trends will be easily and quickly observed and, most importantly, acted upon.

Several Deputies asked about the peer review of a number of Dr. Neary's cases, which was carried out by three consultant obstetricians and which concluded that his practices presented no danger to patients. This part of the report is particularly disturbing and asks serious questions about the methodology employed in undertaking the review. My Department understands that the three consultants were asked, on Dr. Neary's behalf, to review a number of his cases, as selected by him, on a confidential basis. At that time, Dr. Neary had taken leave at the request of the management of the North Eastern Health Board. Judge Harding Clark concluded that it may have been the intention of Dr. Neary's union advisers and three colleagues to prepare their subsequent report to enable Dr. Neary to continue working, pending the outcome of a review of his practice by the Institute of Obstetricians and Gynaecologists.

The position of those most affected by the report, that is, the women involved and their families, remains uppermost in our minds in light of the report. The House is aware that the Government has agreed to ask Judge Harding Clark to advise on an appropriate scheme of redress arising from her report's findings. She will also advise on the cost of such a scheme and on a mechanism for ensuring the maximum recoupment of such costs from wrongdoers and indemnifiers. Judge Harding Clark is well placed in light of her work to advise the Government on the issue of an appropriate redress scheme. Her work and the report have been widely acknowledged and I am confident that she will bring a valuable and unique perspective to bear on the issue of redress. She has won the respect and confidence of the women affected and other parties involved. She will commence her work immediately and bring her proposals to the Tánaiste as soon as possible.

The report has heightened the determination of the Government that patients and the general public must be the primary focus of all decisions relating to health policy. The report will act as a significant catalyst in the reform agenda, in the strengthening of clinical audits, in the preparation of the medical practitioners Bill, in the reform of the current consultant contract and in improving management systems within our hospitals. The Tánaiste will bring proposals to Government to establish a mechanism to ensure that clinical governance arrangements throughout the health system will be strengthened. This will entail the fostering of a continuing culture of openness, preparedness to acknowledge errors and an ability to analyse clinical practice in an environment that does not always resort to blame and recrimination.

The Tánaiste has announced her plans in respect of the medical practitioners Bill. It is clear that systems and procedures relating to the supervision of the medical profession must be modernised to allow for increased transparency, efficiency and flexibility and to ensure that all doctors are competent to continue in practice.

The report has affirmed the approach pursued by the Government in the context of negotiations for a new contract for hospital consultants. The days of consultants working in splendid isolation, without effective clinical leadership, are at an end.

Mr. O’Dowd

We hope so.

Mr. T. O’Malley

Yesterday, the Government approved the publication of the general scheme of the Bill providing for the establishment of the Health Information and Quality Authority on a statutory basis. Deputies are aware of the Tánaiste's opinion that there should be a licensing system in place for all hospitals. The Department will consider the mechanisms required to put it and, at a later stage, an associated enforcement regime in place.

The inquiry found that the possibility of the maternity unit in Drogheda falling behind current practice was remote. However, we cannot be complacent in respect of this finding and the national hospitals office of the Health Service Executive is working to ensure that all necessary measures are taken on foot of the report's findings. The report acknowledges that significant changes in practice in the maternity unit were made to minimise or entirely remove the climate of isolation referred to in the Medical Council's report. The incidence of peripartum hysterectomies has fallen precipitously and now accords with national rates.

Members will agree that this is a most comprehensive and fair report but it is also clear that many lessons must be learned and changes made to ensure that such events do not recur in any Irish hospital. The findings and recommendations are being examined in detail by the Department in consultation with the Health Service Executive, the Medical Council and other professional regulatory bodies. Actions are being taken and there is a clear determination on the Government's part that we must prevent anything of this nature happening again.