Health Identifiers Bill 2013 [Seanad]: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

I welcome the opportunity to speak. We will be supporting the Bill. It was included in a health information Bill when the heads of that Bill were approved by the Government in 2009. This was clearly an issue that was discussed in the context of the troika to ensure health identifiers were put on a statutory basis. For that reason, we feel it is an appropriate Bill. In general, when one considers the need to ensure proper transparency and accountability in terms of identification throughout the health process, this is clearly a step in the right direction.

There are some issues of concern which the Minister of State, Deputy Alex White, might consider. Given the health information Bill is imminent, I received an e-mail from some people who are concerned, and I said I would quote it. The Minister of State can take it as a statement of views, rather than a point of dispute. The e-mail reads:

The Health Information Bill is imminent and Electronic Patient Records are being devised. Summary discharge records etc are already being devised by the HSE. Despite several expert papers showing how patient data can be compromised because of lack of privacy enhanced technology, we are the only country not discussing this in the public domain. Medical Confidentiality as we know it will be gone.

The Unique Health Identifier proposed will be linked to personal information which will be available to all HSE staff and researchers. These include medical researchers, epidemiologists, insurance personnel and companies such as Google. This is against Article 8 of the European Convention on Human Rights.

We may be told that the data will be anonymised. Dr Latanya Sweeney from Harvard University has proven in 2000, that date of birth, gender and zipcode can re-identify the medical records of about 90% of the American population.

These "researchers" will have access to these centralized medical records and facilitated by the unique identifier without an opt in or so far without even an opt out (which is illegal under European law) and because we have no HIPAA law or Anonymised code these personal records, including psychiatric, and reproductive records will easily be re-identified.

The NHS in the UK are presently selling patient records to Google. They are uploading GP records without consent, and selling them internationally.

As I said, that is from an e-mail I received from some very eminent people, who asked me to bring it to the Minister of State's attention, as I have done. On the broader issue, as I said, we welcome the fact this Bill is being brought forward.

We will be discussing e-medicine and the need for us to avail of technology in the whole area of diagnostics and the delivery of care in the community, for example. Anything that ensures a smooth transition of information and records is welcome. On the broader issue, while the Government has published a paper on e-medicine, I believe we should be more adventurous in how we go about developing e-medicine and e-care in communities. There has to be a seamless transition of information and monitoring of patient flow through the medical system from the GP to primary care, to referral to hospital, both with regard to the inpatient and the outpatient, right through to step-down facilities and back to home care and supports in the home. This issue is an important component of trying to deliver that care in the years ahead.

The software and technology to deliver e-medicine exists and should be availed of. It is very expensive to keep people in a hospital setting and we have difficulties in trying to transfer people from the acute hospital system into step-down care, into the community and back to their homes with supports. It is an issue we all agree needs to be progressed, primarily for the patient but also for the delivery of care itself, as it is more expensive to keep people in hospital. I know there is a certain roll-out in terms of home care packages and traditional home helps. However, we have to go beyond that in embracing other forms of technology. We need the software packages and infrastructure placed in the home in order that the public health nurse, or others who are employed or contracted by the HSE, such as GPs and so on, would be able to monitor a patient in the home, feed that information back to a centralised system and inform the system of what medications have been administered, blood pressure, diagnostics and all that goes with that. This centralised system would allow a monitoring of the information by clinicians or qualified nurse specialists who would be able to look at the patient's vital signs and know whether medication has been administered in time, and whether the person is improving or needs further assistance. If there are concerns, a clinician can be consulted, and if a callout is required, that will happen.

I believe this is something we have to embrace. I come in here and criticise the Government, which is my role, and I also come forward with proposals, from time to time. While they are never read, they are there all the same.

Including his party's manifestos. The Minister of State has read them too.

And the Deputy's party's manifestos too.

As we look into the future, and not too far into the future, we know health care will become very expensive in the years ahead. The idea of having people in the acute hospital setting for longer periods than they should be makes no economic sense and is certainly not good patient practice in terms of communicable diseases and other problems associated with people in high-density acute hospital settings.

In a previous life, when I was involved in trade a number of years ago, there was an amazing number of companies developing software packages for the monitoring of patients through the system and back into the home care setting.

I believe there is a strong need to embrace that issue. I know the Government has published a paper on it, which I have read, but we need to go beyond that and ensure we have a meaningful virtual hospital in the community, if the Minister of State understands what I am trying to say. This is a requirement as well. We must ensure we have proper health identifiers in it so that one has guaranteed access to patient information and it is concise and clear.

When one talks about health identifiers, data protection and individuals' details being placed with other people, there is always concern that it can lead to people accessing information for other reasons or ulterior motives. This is why I said I would raise the issue regarding Article 8 of the European Convention on Human Rights. In general, this Bill is a positive step and we will be supporting it.

Generally speaking, the advances in information technology coupled with advances in medicine are key areas we should explore and exploit. Remote diagnostics is one area towards which we are moving. When we talk about reconfiguring hospitals, which is always a contentious issue, rather than just diminishing services in a community, we need to complement services in hospitals by using remote diagnostics in a proper structured way. A radiographer and others could do the X-rays and CT scans and people could be diagnosed elsewhere. A group of clinicians with competence and expertise would be able centrally to look at these X-rays or scans remotely and make an informed decision. We are looking at this area but much more could be done. I urge the Minister of State to look at that issue again.

The question of how we come up with imaginative solutions to providing and complementing services rather than just using reconfiguration as a means to reduce services is the key issue in terms of e-health over the next few years. That is why people are very wary when the Minister of State raises issues regarding reconfiguration and assessing capacity in our health system. The perception is that the quid pro quo is normally a reduction in services. We have had that case in the context of the reconfiguration in the mid-west with regard to Nenagh, Ennis and Dooradoyle in Limerick. There was meant to have been a transfer out of Dooradoyle to Ennis and Nenagh, but that has not happened with the speed with which it should have happened to give people confidence that while they will sacrifice one service, another meaningful one will be provided in their community not just for the sake of putting a service into the community but to complement the overall health service.

The Health Information and Quality Authority today pointed out that many common causes of adverse events such as incorrect administration of medicines or transfusion of the wrong blood into a patient can be due to poor patient identification processes, basic human error, incorrect filing or a failure in communication. That is something that has caused major difficulties in previous times, and we have had inquiries and tribunals in that context from time to time. Certainly, this Bill is a step forward in that context. It is about efficiency and traceability, ensuring proper procedures are in place and being able quickly to identify a breakdown in those procedures. The Bill in general has looked at those key areas to ensure this does not happen and that if it does happen, it can be rectified very quickly. In his two hats as Minister of State and barrister, the Minister of State might refer to some of the issues raised in the context of concerns e-mailed to me by some people who raised the issue that because of the glut of information available, there could be some way of identifying individuals through the system. That would be a very worrying development.

Last year, the Government published the e-health strategy and eHealth Ireland will be established to implement it. A new IT system for the health system as a whole will be published in early 2014 by eHealth Ireland. Priority projects for eHealth Ireland include a national health identifier infrastructure, e-prescribing systems, online referrals and scheduling, tele-health care, development of patient summary records, online access to health information and a national patient portal. It is a seven year strategy that is divided into two phases - years one to four and years five to seven. One of the aims for the first four years is patients being able to access their own health records, which is clearly a very important issue.

I do not expect the State to roll over easily when people consider that harm is being done to them by it. Obviously, the State has an obligation to protect itself and the integrity of the institutions under it. However, at times when there is obvious liability, we see situations where people who have been damaged by the State or State institutions must go to extraordinary lengths not only to vindicate their good name but just to get access to records. That is an area where we must be conscious of the need to be open and transparent in ensuring people can access information about themselves. For example, there were issues in Portlaoise regarding information that was sought not being made available with regard to the very tragic cases in the maternity hospital there in recent times. That in itself feeds suspicion and undermines people's confidence in our health services. When we have proper records and details whereby one can trace all procedures for an individual right through the health system because of this and other legislation, the records should be opened up and made freely available rather than making people go to extraordinary lengths to access them.

I have tabled some parliamentary questions on Dignity 4 Patients in Drogheda. The State is involved in taking on the Information Commissioner because of his findings that the information should have been made available. I am not blaming the Minister of State personally. Obviously, he takes advice from the legal apparatus available to Government, but at the same time, it leaves people with a sense of distaste that organs of the State are acting aggressively as if they are trying to prevent information from flowing to citizens. As we all know, openness, making as much information as possible available and allowing individuals to vindicate their rights if they have been damaged in some way are healthy in the context of a broader democracy and individuals' rights. That is an aside but it is a critical component.

The quid pro quo is that if the State is entitled to gather as much information about people as possible, it should equally be obliged to release as much information as possible to those individuals when they request it. It is fair. With responsibilities come rights, but it works the other way as well. That is something I urge the Minister of State to look at in terms of the broader policy of making information available. The cases at the maternity unit in the Midlands Regional Hospital in Portlaoise were very tragic and we know a review is being carried out. Families have been very hurt and damaged by the tragic loss of life, but there was also the issue of how it was handled. I do not want to prejudge anybody or point fingers at any individuals but having met with some of the people involved, their major concern after the tragic events was the way they were handled in terms of information flow. Trying to gather records and seek information was almost impossible. That does not augur well for openness and people being able to find out what went wrong and to right that wrong as best they can in terms of reaching conclusions.

Turning again to the e-strategy as part of the broader health strategy in the years ahead, the Digital Hub and software conferences that are continually held in Ireland display the world's most dynamic companies. They provide wonderful quality products, software designs, etc. The State should embrace them more by using their cutting edge technologies, which they export all over the world from Ireland. Although some of those companies export their products for use in government agencies and departments, it used to be the case that we did not engage with them as efficiently and effectively as we should have. One would like to believe that a company has been supplying the Department of Health or so on with a product, but we often find that the opposite is the case and the company has been convincing other countries to embrace their products before relaying that information back. This is not a criticism of any Irish Government, but we should be more proactive in considering what is in Ireland. The areas of e-health and e-medicine are clearly ones in which we have an advantage over other countries, given what companies in this country have developed.

By and large, I welcome the Bill. A commitment was given to the troika to publish legislation on health identifiers. Obviously, it is not one of the conditions the current Government renegotiated, but there was no need to anyway, as it is a positive step. We support the broad thrust of the Bill and look forward to some of the discussions that may be held on Committee Stage.

Could I get further information on the questions of information, the dissemination of same and medical confidentiality? These are issues of concern, but if they could be alleviated, even through a statement as opposed to an addition, that would be fine by me, but when one sees a state that is gathering information afraid for whatever reason to disseminate that information, it leads to suspicions of Big Brother watching and being in control. It undermines what is being done to a certain extent.

On behalf of Sinn Féin, I welcome this Bill. It is a very long overdue and necessary development to improve the delivery of health services. The allocation of an individual number or unique identifier to each individual for the purpose of health services has been talked about for a very long time. At least now we are finally seeing progress, which is welcome.

It is a pity this development is not coming in the context of real and comprehensive overall reform of our health services, but the fact is this Government's health reform programme - the Minister of State may not recognise or accept what I am about to say - now appears to be in a shambles. The past fortnight has been dominated by the Garda Síochána Ombudsman Commission, GSOC, scandal, with the Minister for Justice and Equality, Deputy Shatter, at its epicentre. This has diverted attention from a situation that is also extremely serious and in which two Ministers are embroiled. The Minister for Health, Deputy Reilly, and the Minister for Public Expenditure and Reform, Deputy Howlin, are at loggerheads in respect of the draft White Paper on universal health insurance. Like the GSOC scandal, leaks have played a central role in this row. In this case, we have two Ministers leaking and spinning against each other. It has become a war of leaks and spin. We have the extraordinary sight of one Minister, the Minister of State's party colleague, Deputy Howlin, accusing another Minister, Deputy Reilly, of proposing a plan that would pose a risk to the State's financial stability.

Universal health insurance is supposed to be a cornerstone of this Government's policy and the White Paper was promised early in its term. The last promised publication date was 2013, but we still have not seen it. I repeat: we still have not seen it. The contents of the White Paper have been extensively leaked to sections of the media while Oireachtas Members and the public at large are left in the dark, all but for the little snippets that make their way into, by and large, the pages of the print media. Our health services are in crisis and plans for their future must be fully and openly debated, not the subject of a dog fight between rival Ministers.

The Fine Gael-Labour Party coalition's concept of universal health insurance based on competing private health insurance companies is one that we in Sinn Féin have criticised as fundamentally flawed. We have also criticised the lack of detail about the coalition's plan and have been vindicated in that respect. I am surprised, though perhaps after three years of this coalition I should not be. It still puzzles me that the Labour Party would be a party to a proposal to develop universal health care based on, as I have said, competing private health insurance companies. I find it bizarre and I do not believe that all the party's number are enthusiasts for it. They could not be.

Arising from this row that I have described, we had the speculation last week on the part of the Minister of State, Deputy White's good self that the promised free general practitioner, GP, care for all would not be free at all, in that a fee might apply. I believe the Minister of State is sincere in his wish to see free GP care introduced, but his comments raise the question, and perhaps he would like to take the opportunity in responding at the end of Second Stage to clarify-----

-----for my purposes, when free GP care is not free. That is my question. It certainly has suggested to me at least a lack of clarity and lack of coherence in this coalition's approach to health care.

The White Paper on universal health insurance should be published immediately. I wonder whether the Minister of State has anything to tell us in that regard, given that it was before the sub-committee yesterday and, I would expect, perhaps before Cabinet today, but I could be wrong in that regard. I again ask that the Minister of State use his good offices with his senior Minister to ensure it is published and that everyone can judge its merits for himself or herself. We can then commence a real debate focused on the facts of the document's content and on the needs of health service users as we each individually believe.

We need such an informed debate. At the moment, what we have is, as I have described, an internal row within this coalition Government, with the people and the people's representatives in these Houses of the Oireachtas excluded. That is unacceptable.

As I said in the context of another health Bill recently, the Bill before us today may be part of a bigger picture, but I have yet to see that picture. I have to judge it on its own merits, not as part of a process or a package of measures that will result in a reformed health system.

The Bill provides for what I believe is a positive and useful development in our health services. Most of us have had the experience of the difficulties caused by the disconnection between the different elements of our health services. There is little co­ordination between the records of patients kept by GPs and other providers of primary care, including the HSE, and between them and acute hospitals and other providers at secondary and tertiary levels. Even within hospitals, there are often difficulties because of the absence of a single patient number for each patient. Many of us have experienced the repeated filling out of forms with basic patient information even during the course of one hospital visit and even when the hospital already has our records.

The purpose of the Bill is to assign a unique number - the individual health identifier - to each individual to whom a health service is being, has been or may be provided. The focus needs to be kept on that simple and straightforward aim. We need to ensure that maximum benefit from this change is assured for all users of our health services and for health service providers. That said, we need to put this major change in place very carefully to protect people's personal data and to prevent abuse of what will be a very important and valuable database on our population. We have seen in recent years how certain state agencies - notably US agencies - have grossly abused people's right to have their personal data protected. The current controversy in this State regarding surveillance provides another reminder of the need for robust data protection.

The introduction of the individual health identifier will require wide public consultation and information to ensure it can work effectively and that all necessary safeguards are put in place. I strongly urge the Minister to ensure this is done and that people are informed in a clear and coherent manner about this new development in our health system. I also urge the Minister to ensure constructive suggestions and contributions, both by way of amendments to the Bill from Members and by way of relevant comment in the public domain, are taken on board. Too often it has been the experience of the Opposition that little attention is paid to important observations and to key amendments.

This Bill will require careful scrutiny on Committee Stage. I wish to notify my intention to object to section 5(3) which reads: "The assigning of an individual health identifier shall not be regarded in any way as indicating, in and of itself, an entitlement to, or eligibility for, the provision of a health service to the individual." I can understand some of the arguments for the inclusion of such a provision in the Bill. However, the reality is that while this provision states that the individual health identifier shall not be regarded as indicating entitlement to health services, there is a consequential lack of clarity in the overall body of health legislation about exactly what health services people are entitled to. We just do not know. The allocation of an identifier number for each of us does not of itself underscore entitlement, according to this section of the Bill. I think it is offensive for that very reason.

The Minister will recall that in the previous Dáil - I think it even went further back than that - the eligibility for health and personal social services Bill was repeatedly promised year after year, but it never appeared. The current Minister and I probably competed at various stages to pose the question to a former Taoiseach and the Minister for Health of the day on the progress of that Bill. We all know what happened to that Bill. It was allowed to fall off the promised legislative list, yet its importance was clear in its stated intent. The Bill was supposed to clarify and update current provisions relating to eligibility for health and personal social services. That was and is a very important Bill. That affirmation of our right and entitlement to specified health services and personal social services should have been progressed in legislation. I again ask the Minister of State to re-examine all that and inform himself as to why it was allowed to fall off the table, so to speak.

This brings me back to my opening points on the Government's health programme now being in a shambles. One would expect that legislation along the lines of the Bill that never saw the light of day might form part of the Government's reform programme. It does not. I contend that it should and I ask that the Minister of State enlighten us on the conclusion of Second Stage. In the absence of explicit legislation setting out what people are entitled to, we are all in limbo with great uncertainty. I hope he accepts the arguments I have made for why I will oppose section 5(3) of the Bill when we get the opportunity on Committee Stage and Report Stage, if it still survives at that point. I urge the deletion of section 5(3), but I record my support for the passage of the Bill.

I welcome the opportunity to speak on this Bill. I also welcome the debate, as we all want to see a modern, efficient and safe health service. That is the bottom line. We need to get on with the reform agenda, as many of us promised during the previous general election.

Professionalism and accountability are also required to ensure all patients are safe and their rights and files are protected and guarded. In recent weeks, health has been the subject of many Bills and debates in the House. It is time to move on and take immediate action. Delays are not an option as reform of the health service is essential. The faults and weaknesses in the sector must be faced and addressed. The time for talking is over. I welcome and support the legislation as it has many positive features.

It is important to closely examine the Bill. It seeks to introduce systems of health identifiers for individuals, patients and clients of health care providers and for health care professionals and organisations and their employees and agents. Separate registers will be created for individual and provider identifiers. Access to the individual identifiers register will be strictly limited and unauthorised access will be considered an offence. This is an important provision as it is relevant to some of the comments we have heard.

We must go further by developing new and radical ideas for the health service. We must listen to health professionals and front-line staff who have daily experience of the problems in the health service.

The Health Information and Quality Authority, HIQA, has stated that the absence of a unique health identifier for individuals is the single most important deficiency in the health information infrastructure. The Bill provides for the assignment of two new systems of health identifiers, namely, individual health identifiers for patients and service users and health service provider identifiers for health professionals and organisations and their employees and agencies. In keeping with the HIQA recommendations, the new system and numbers will be exclusive to health care, which is broadly understood to mean the public and private health sectors. The individual health identifier system will contain identifier numbers only and will not include any personal or clinical data. They are, however, underpinned by an identifier data set designed for the purpose of helping to ensure unique identification. The Bill will also establish national registers for the identifier numbers and a related governance framework. These measures will deliver greater efficiency and modernisation in the health service and will, I hope, result in better patient care.

In 2008, the Department of Health and Children, as it was known at the time, carried out a consultation on this issue and found a broad consensus in favour of the introduction of unique health identifiers for individuals and health care providers. The consultation also highlighted differences of opinion on the approach to be taken, with some stakeholders supporting the use of personal public service numbers, PPS, in the health sector, as was recommended by the health information strategy in 2004. This approach was rejected owing to limitations in the PPS system and concerns about privacy, among other reasons. A survey of public opinion also found a high degree of public support for the use of health identifiers and the making of health records available across health care settings. The survey also found that people were concerned about their health information, although a large majority indicated they trusted medical institutions with their data. The question that arises is whether the position has changed since the survey was carried out. It is important to answer this question because it is vital that people trust the health service. Professionalism and care in the health service are also important. Confidence and trust in the health service have been damaged in recent years. We must face this issue and the issue of competence.

Many Deputies appear to believe that the problem of people waiting on trolleys in our hospitals has gone away. This is still a major crisis and the Minister must be brave when nurses and other professionals on the front line in our accident and emergency units tell us that the number of beds in hospitals is a problem. He must ensure a sufficient number of beds is provided.

HIQA states that it is difficult to separate out the benefits of implementing individual health identifiers from e-health projects that would make use of the identifiers. It notes the benefits include improved patient safety and quality of care, the streamlining of records management, a reduction in repetitive and unnecessary care and reduced administration costs. HIQA also notes the benefits that can be derived from health care practitioner and organisation identifiers. These identifiers enhance the quality and safety of patient care, reduce the possibility of administrative and clinical errors, reduce duplication, enhance communications between health care practitioners and organisations and accelerate care pathways for patients. The ability of health identifiers to enhance quality and safety in patient care will be a positive development and it is one for which all of us have called for many years. It also forms part of the reform agenda.

On regulations, while the Bill contains details on the establishment and maintenance of registers, it does not provide detailed information on every operational aspect of the legislation. Section 3 gives the Minister the power to make regulations to provide for any matter referred to in the Bill. The regulations may contain any incidental supplementary and consequential provisions which the Minister considers to be necessary or expedient for the purposes of the regulations. However, some regulations can be made only when they are in the public interest.

Section 3(3) provides that a person or class of persons cannot be prescribed as an authorised disclosee except where the Minister is satisfied that it is in the public interest to do so. These are important issues to be teased out in the debate.

The Minister for Health, Deputy James Reilly, stated that individual health identifiers "are about patient safety and ensuring that the right information is associated with the right individual at the point of care." If the Government delivers on this, I will be strongly supportive of the measure. Individual health identifiers will, the Minister added, "help in managing the health service more efficiently and will be a building block for health reform initiatives outlined in Future Health, including Money Follows the Patient". This, too, is important because we must ensure the patient is always placed at the top of the agenda. We have seen the faults, mistakes and weaknesses in the health service. Structural and administrative weaknesses must be eliminated through legislation and competent management. Human error is inevitable in the health service and we all have experience of cases that were extremely upsetting for patients and their families.

Section 21, which relates to offences relating to the assignment of individual health identifiers, states:

(1) A person shall be guilty of an offence if, for the purposes of the assigning of an individual health identifier to him or her or to another person—

(a) he or she makes a statement or representation, whether orally or in writing, that is false or misleading in a material particular, knowing the statement or representation, as the case may be, to be so false or misleading or being reckless as to whether it is so false or misleading,

(b) he or she conceals a material fact, or

(c) he or she gives, or causes or knowingly allows to be given, any information, in purported compliance with a provision of this Act, that is false or misleading in a material particular, knowing the information to be so false or misleading or being reckless as to whether it is so false or misleading.

(2) A person guilty of an offence under subsection (1) shall be liable—

(a) on summary conviction, to a class B fine, or

(b) on conviction on indictment, to a fine not exceeding €100,000.

It is important we are seen to be tough. I urge the Government and the Minister to be careful in the protection of people's personal data. We have seen examples of abuse in this regard in the past. Data protection is essential. As legislators, we have a duty to bring the public with us. The only way to do so is to ensure confidence and trust in the health service. It is important, therefore, that any proposed amendments are given careful consideration and, if sensible, supported.

The e-health strategy highlights that Ireland's spend on ICT in health care, at 0.85% of the total health care budget in comparison with the EU average of 2% to 3%, is low by international standards. It also states that developments will be funded through a realignment of the national health care budget as well as an increased investment in e-health systems and changed management, process re-engineering and implementation support infrastructure. I again emphasise that with reform must come investment. In general, there is a recognised technology deficit in the public service, with continued constraints over many years resulting in a maintenance-only approach to ICT spend. This must be taken into account in the context of this legislation. Overall, e-health strategies seek to save money. The Health Information and Quality Authority estimates that current spend in respect of patient records is 30% of total budget, which is positive.

The Bill provides for:

the Minister to assign an Individual Health Identifier, (IHI) — a unique number — to an individual to whom a health service is being, has been or may be provided,

the Minister to assign a Health Services Provider Identifier — a unique number — to a person (a natural person or a legal person) who provides a health service,

the Minister to establish and maintain National Registers in respect of the IHI and Health Services Provider Identifiers which will contain the identifiers and other identifying particulars of those to whom the numbers are assigned,

the association of the identifiers with medical records and related communications,

the basis on which the IHI Register and the Provider Identifier may be accessed,

the basis on which the information in the IHI Register may be processed and by whom,


related matters including offences, complaints and the consequential amendment of other enactments.

I welcome this debate and the legislation, although as stated I have concerns about particular sections. We all want a modern, efficient and quality health service that delivers for patients. Staff in our health services are magnificent, be they people who work with children and adults with intellectual disabilities, on the front-line or who work with people who have cystic fibrosis or cancer. Our staff are excellent but they need resources and structural change to assist them.

We have a long way to go but if the reforms and changes are good for patients and there is sensible and efficient use of resources, the Minister will have my support.

The next speaker is Deputy Peter Fitzpatrick, who is sharing time with Deputies Seán Kyne and John Paul Phelan.

The Health Information and Quality Authority, HIQA, has stated that the absence of a unique health identifier for individuals is the single most important deficiency in the health information infrastructure in Ireland. The Bill provides for assignment of two systems of health identifiers, namely, individual health identifiers, IHIs, for patients-service users and health service identifiers for health professionals and organisations, their employees and agents.

In keeping with HIQA recommendations, the new system of numbers will be exclusive to health care, broadly understood and be used in the public and private sector. The individual health identifiers will be made up of numbers only and contain no personal or clinical data. However, they will be underpinned by an identifier data set designed for the purpose of ensuring unique identification. The Bill also establishes national registers for these numbers and data sets and a related governance framework.

The principal reason for the introduction of identifiers is to improve the quality and safety of care, in particular through correct patient identification. Other anticipated benefits include streamlining of record management, a reduction in repetitive and unnecessary care, facilitating e-health projects and reduced administration costs. HIQA estimates that up to 30% of the health budget may be spent on handling, collecting, searching for and storing information. Many of the benefits of introducing this scheme arise from its application in information and communication technology, ICT, improvements in the sector, known as, e-health initiatives or strategies. E-prescribing is a priority e-health project promoted by the troika and thought to have the potential to reduce public spend on drugs.

The health service provider identifier will allow all episodes of care to be traced to the provider, including the organisation and professional involved. Professionals will be assigned a unique number which will move with them if they change job or location, allowing for greater traceability. The regulatory body for the professions will provide the data necessary to populate the register. An individual health identifier is a unique, non-transferable, life-time number assigned to all individuals accessing health and social care in Ireland. Its purpose is to accurately identify the individual enabling health and social care to be delivered to the right patient in the right place at the right time. A health service provider identifier is a unique, non-transferable, life-time number assigned by the Minister to a person who provides a health service. Its purpose is to identify the individual as one and the same person and to allow attachment to them of other information such as name, address, contact details. A health care organisation identifier is a unique, non-transferable number assigned to health care organisations in Ireland. It will allow for attachment to a database of their identity, contact details and operational sites.

Currently, there are no national systems in Ireland for patient identifiers and provider identification in health care is not universal, in that some professions can be traced back to their professional registers while for others no register exists. Health information is held in multiple disparate health information systems, including GP practices, hospitals and so on, with each having its own system, either paper based or electronic. Related to the lack of a common identification system for individuals is the absence of adequate information technology which the Department of Health has said means patient records cannot be accessed in a timely fashion and, therefore, points of medical contact become islands of information increasing the risk for patients.

I welcome the opportunity to contribute to the debate on the Health Identifiers Bill 2013. We all appreciate that in the past few decades, and with an increasing intensity, technology has revolutionised the way we live and work. Some sectors have been able to adapt and harness the opportunities much more readily than others, a prime example being the difference between new private sector companies and the older more established entities such as Departments. There is a need for some level of "bureaucracy", a word which has long since lost its intended meaning, namely, to confer a formal hierarchical organisation with many levels on which tasks, responsibilities and authority are delegated among individuals, offices and Departments.

The word has evolved. It now has a negative connotation and is used to indicate red tape and excessive routine. Any system, however, requires planning, organising, transparency and clearly developed procedures to ensure the proper delivery of services. In many instances this has occurred in a way which has not put technology to best use and has, therefore, resulted in higher levels of spending on processes and systems at a time when resources are stretched. For example, it is only recently that contacting the Department of Social Protection by e-mail has been possible. Similarly, it is less than five years since one has been able to apply for social welfare schemes online and even then the service is restricted to a small number of schemes. Other examples include the relative infancy of the public services card and the integrated travel card or leap card.

All in all, it seems to take an inordinate amount of time with significant resources to utilise technology in the provision of services in our country. From a different perspective the Health Identifiers Bill is significant in respect of the absolute necessity for every patient in the health system to have a unique identification. The Minister for Health, Deputy Reilly, has emphasised that first and foremost individual health identifiers are about patient safety and ensuring that the right information is associated with the right individual at the point of care. This should be of paramount importance in any system but especially given the reforms under way in the health service. One such reform is the establishment of the new hospital groups, a measure trialled successfully in my area of the west with the Galway Roscommon hospital group. The use of technology, underpinned by health identifiers, will be essential in hospital groups since each hospital will carry out different treatments and procedures. For example, a patient might undergo tests and scans in a hospital in Roscommon but undergo surgery in University Hospital Galway. It is not difficult to appreciate the benefits of having an information technology system in which the health professionals can input a unique identifier and access all the relevant information about a patient, including medical history, allergy information, special care requests and so forth.

Such capability is essential for another key component of the Government's reform strategy, that is, the implementation of the money-follows-the-patient system. Under this system, we will move away from the block grant system which provides a substantial level of public money to a hospital with little in the way of performance indicators or monitoring. Under the new system, once the need for treatment is established hospitals will be funded only for those patients who they treat. This will act as an incentive, patients will receive treatment more speedily and, as long as appropriate safeguards are in place, more readily and more efficiently with regard to standards of care. Within such a system a unique identifier will be critical. The Minister put it best when outlining the case for the health identifier. He suggested it was about better patient safety and care, he noted that the case has been established internationally and he pointed out that it would ensure the right information would be associated with the right person.

As far back as 2008 the report of the Commission on Patient Safety and Quality Assurance recommended this measure, as has the Health Information and Quality Authority, which has advocated that identifiers should be used and provided for health care providers as well as individuals accessing the health care system. This is of great importance. One of the most surprising things is that this measure has not been introduced heretofore or that it is not already part of the system, especially since everyone has a PPS number. It could have been introduced far earlier. Perhaps there is the case for the PPS number to be used as it is, rather than embarking on the initial cost of a new health identifier card. I presume there may be reasons why that is not possible.

I imagine there will be a register which the Minister or the Department of Health will be responsible for maintaining and that it will include all the usual information, including name, address, PPS number, date of birth and so forth as well as a health identifier number. This is most important. The Data Protection Commissioner has been consulted and I emphasise that the lists of identifying information cannot include an individual's clinical information. All in all, this is positive. It will help with patient safety, it will improve the ease of identity of patients and it will ensure that no mistakes are made in terms of their care, which is of paramount importance.

I almost needed some health identification myself after running to the Chamber. I am pleased to have the opportunity to speak in support of the Bill, which is a further significant reform of the health service. Last week, similar legislation was introduced by the Minister. These are necessary reforms of the health services as provided for in the programme for Government. As Deputy Kyne noted, this particular reform has been spoken of for seven or eight years. The idea is that health professionals would have at their disposal all relevant information on the patient they are seeking to treat, including in an emergency situation, and this is most welcome.

This proposal must take into consideration a significant area of difficulty, namely, the requirements of data protection and the rights of any individual or citizen to have his information protected, while, at the same time, ensuring that he can get access to necessary medical treatment. This could produce a conflict but, as I understand it, the Bill has been approved by the Office of the Data Protection Commissioner with regard to ensuring that only essential information that is required for health professionals is made available to them when they need it.

This is part of an ongoing list of proposals from the Minister aimed at reforming how our health services are delivered. Last week's legislation was essentially the first step in dismantling the HSE and changing the way the HSE is funded, by ensuring that the executive is funded directly from the Department of Health, as it should be. This was a significant step in the right direction.

Last year, the Minister for Health embarked on significant reform of the way our acute medical services are operated throughout the country. This involved the realignment of hospital services throughout the country. We have moved from a position where 30 years ago each local authority had a health committee to a regional-based system, which was replaced, in turn, by the HSE when Deputy Martin was the Minister for Health.

For the most part and despite the many excellent people who work in the HSE on the front line and in administration, the executive has been an unmitigated disaster for the delivery of health services in the country. This is why last week's legislation to dismantle the organisation in respect of its funding was a significant step in the right direction.

The establishment of the new hospital groups and the Minister's commitment to a new system of money following the patient has become something of a cliché but it holds out the prospect for significant improvements in how our acute hospitals are funded in future and it represents a further significant positive step for the Department of Health.

The Minister for Health is often much-maligned in certain quarters but he has shown vigour in reforming how the service is delivered and that is to be welcomed. I fully support this important legislation which he has introduced to ensure that medical professionals have access to essential information about the patients they seek to treat. This is why I am supporting the Bill.

Debate adjourned.