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.