I propose to share time with Deputies Peter Mathews and Denis Naughten.
Health Identifiers Bill 2013 [Seanad]: Second Stage (Resumed)
That is agreed.
I welcome the opportunity to contribute to this debate. This Bill will improve the experience by patients of the health care system by introducing a unique identifier for every person in Ireland. The measures contained in the Bill will help to ensure quality and safety of care and correct patient identification. These provisions will reduce administration costs and, in the long term, prevent instances of unnecessary care, thereby avoiding the types of medical cock-ups that have resulted in legal cases being taken against the State in respect of patient misidentification and errors in regard to records.
The Bill proposes the introduction of two types of identifiers, namely, individual health identifiers for every patient and health service provider identifiers for the health professions and organisations. The Health Information and Quality Authority has highlighted the necessity of introducing a unique health identifier for patients and drawn attention to the very low proportion of health care funding that is spent on IT services relative to other European countries. Identifiers will not contain any personal or clinical data at the initial stage. Their introduction will ultimately lead to a more pleasant experience for patients, who will not have to give their details more than once, on their first admission to hospital.
The current system of storing patient records is antiquated and disjointed. Some documentation is stored in electronic format but the vast majority is held in files in various locations.
Obviously, this can result in files being mislaid. It can present difficulties for health care professionals who need the complete picture with all the relevant information if they are to make informed decisions and judgments. We often hear about health professionals who are not able to see the complete global history of a patient, but are instead confined to what are called "islands of information". The introduction of health identifiers is a step forward in that regard as it will make it easier for the movement of patients within the health system to be traced. The health providers register will be open to everyone to access. That will not be the case with individual records, obviously, but the issue of data protection arises nevertheless. People have relevant concerns about who will have access to the individual patient identifiers, as distinct from the health providers register.
Responsibility for this work has been allocated to the primary care reimbursement service. Does it have the resources and the capability to carry out the duties it is being given? Like other Deputies, I have had difficulties dealing with the medical cards office in Finglas. It has lost information, for example. One of my constituents had to send in the same information in support of a medical card application on three occasions. It was only when the office was challenged - a receipt was submitted to prove that the information had been sent by registered post - that the primary care reimbursement service accepted that it had received the application. That undermines the work of the service and underlines why there is genuine concern about the quality of its computer systems. Why does the service not scan these documents when they are received to safeguard the sensitive information contained in medical letters and payslips, etc.? I am concerned that the primary care reimbursement service does not act in a clever manner that ensures information is retained and stored safely. Can the Minister of State outline in his response what role the service will have in the implementation and roll-out of this system? Will training be provided to the staff of the service to ensure people's files and records are retained correctly?
No detailed costing or funding information regarding the implementation of the various systems is being given. Perhaps the Minister of State can give Deputies some information about how much it is estimated that this will cost to implement. Is it planned to upgrade the various information technology systems in the health service in due course to ensure the new system can be accessed in a timely fashion? Genuine issues have been raised regarding the decision to introduce a completely new identifier system when the PPS number system is already in operation. I understand the PPS system has been discounted on the basis that the necessary capability does not exist within it. Why is that the case? Are we incurring unnecessary additional costs in this instance? As I mentioned earlier, there are genuine data protection concerns about who will be able to access the individual health identifiers. Ultimately, this is a good system. An electronic health care system is the Government's end goal in this regard. I welcome the Bill and the Minister of State's initiative in this regard.
I welcome the Minister of State to the House. I thank the Minister of State and the Department for putting together this overall plan for a new era. I thank the Bills digest office for providing a helpful 46 page document. I do not intend to whinge about the fact that I am being allowed to speak for just three minutes. We need to remember a few things in this context. The modern scenario for individuals and families involves a great deal of traffic across continents and countries. If one has a sudden health setback while one is away, one might need to access one's records from Spain or France. The electronic element of this initiative is good. We need to watch out for a few areas of it, however. We should not allow some of its commercial dimensions to over-impose on the delivery of medical care at various stages including diagnosis, care and follow-up care. Medicine and nursing are primarily about the person. We need to be careful not to be dazzled by systems, and their perfections or imperfections, in the way that is depicted in Brave New World or Nineteen Eighty-Four.
The integrity, security and updating of information is crucial if we are to join up the islands of information. We must be careful to ensure medical practitioners and delivers - doctors and nurses - do not start to have a casual reliance on what is easily available on the data bank. The likely diagnostics cannot be determined solely on the basis of an examination of where the patient has come from, and where he or she was at during the most recent assessment, as set out in the patient history. The face-to-face presentation sometimes shows that all the history is irrelevant because a new germ, disease or situation has arrived. I know that because two of my brothers are general practitioners and three of my sisters are qualified nurses. There is a great temptation to rely on the file or the history. The Minister of State, and his colleague in the Department of Social Protection, will be aware that all assessments in cases of appeal are now being done on computers. The assessors do not even look at the patient. That is very wrong. There is a need to look at the patient. I believe in having electronic files as a backup, but I do not think it is a good idea to do one's diagnostics on a computer.
I welcome the opportunity to speak on this legislation. I will not confine my remarks to the issue of health identifiers. The Department of Health's electronic health initiative offers massive potential to bring services closer to the patient's home and to ramp up community services far more significantly than has been the case in the past. The introduction of this legislation is necessary if that is to happen.
When this Bill was initially published, I was concerned about the approach being taken with regard to PPS numbers. Having gone through the explanation in the briefing, I understand the justification for it. An argument has been made in favour of proceeding on the basis of a unique identifier. Nevertheless, I suggest that the facility could exist for this unique identifier to become the PPS number of the future at some stage. Up to now, we were looking at piggy-backing on the social welfare system. Perhaps the social welfare system should look to piggy-back on this particular identifier.
It is all well and good for people like me or the Minister of State - or even someone as senior as Deputy Mathews - to have to remember a PPS number, PINs for credit and debit cards, online banking numbers, the new IBAN numbers that will kick in at the end of this month, the new postcodes that will be introduced in the next 12 months and medical card numbers. Will one's medical card number be amalgamated into this new system, or will one still have a separate medical card number at the end of this process? Having to remember a series of numbers can cause significant problems for older people who might not be technologically literate.
I would like to refer to one of the issues I have with this unique identifier. It seems that no personal data associated with this number will be held. My understanding is that personal information, such as one's forename and surname, one's date and place of birth, one's sex and one's parents' names, will be associated with this number. Can the Minister of State clarify whether this is the case?
That information can be used to access bank accounts and so forth. However, older people arriving at a casualty department may not know their hospital number but will know their date of birth. If the two are not connected together, it will also cause problems. How do we deal with that double-edged problem?
Now that we are connecting medicine with technology in practical terms for the first time, I hope the Minister of State will be able to work with the Minister for Transport, Tourism and Sport, Deputy Varadkar, and allow for medical data to be held on a driving licence. The only data that can be held on a driving licence is to indicate whether the driver is an organ donor. The technology exists and a chip will be introduced on the credit card-type driving licences pretty soon.
That should contain basic information such as my blood group, my next of kin and if I have any allergies, so that if I am involved in a traffic accident the paramedic with a specific reader can read those data from the credit card-type driving licence and treat me at the scene rather than having to rush me into a casualty department, give me O negative blood because they do not know what my blood group is and gamble regarding the medicines they give me in case I have a particular allergy. That kind of basic connectivity should take place because it will save lives and assist paramedics at the scene of an accident.
There is potential to save significant amounts of money in the health budget by introducing this. HIQA has estimated that 30% of the health budget is being spent on handling data. Even the cost of storing those data must be significant, never mind the associated administrative costs. Streamlining this will make a big difference. However, while we have the legislation, we do not know how much it will cost. A significant amount of the investment will take place this year, but how much investment will be required to ensure this happens?
Significant amounts of money are wasted on diagnostic tests. If I go to my GP with a pain, he will carry out a battery of tests. If I ring him back at the end of the week, he might tell me I have an elevated indicator in my blood and might refer me to the county hospital. When I go to the county hospital, I have another battery of tests, many similar to the ones the GP has already done. If it cannot get to the bottom of the issue, I might be referred on to a specialist in St. Vincent's University Hospital in Dublin. When I go to St. Vincent's University Hospital in Dublin, the same tests are carried out because there is no connectivity between the GP and the local hospitals, and between the local hospitals and the regional centres.
I would have become a pincushion as a result of those three separate sets of tests, which is a relatively minor issue. However, there are significant costs in carrying out those tests. A recent edition of the Irish Medical Journal highlighted that most medical professionals are unaware of the high costs of these laboratory tests. I accept that the tests need to be carried out, but it is important that we do not carry out the same tests all over again.
I know the Minister of State has a particular problem at the moment - we met representatives of the IMO yesterday - regarding medical cards for children under six. I know there will be challenges in introducing it. I agree with the principle of it and I know the objective is to extend it to encompass the entire population. That will be a big challenge. As an interim measure, I ask the Minister of State to explore the possibility of giving every adult in the country a health check test similar to the NCT for cars. Every four years everybody should have a standard set of cost-effective tests. I am talking about urine analysis, blood analysis, and blood pressure and cholesterol checks. Those can act as an identifier, particularly for chronic diseases. As we all know if a chronic disease, particularly obesity, diabetes and so forth, is identified early, it can be more easily treated at that early stage and at a significant saving to the Exchequer.
At the moment diseases related to over-use of alcohol, smoking, bad diet and so forth are costing our health budget €7 billion per annum. By connecting all this up, we will be able to identify people in risk categories. We will also be able to ensure that when these chronic diseases are diagnosed, people can receive far more of the monitoring and supervision at home rather than continually having to travel to meet GPs or consultants. This can be a big issue for those living in rural areas, particularly in my constituency. For example, one third of pensioners in County Leitrim live on their own; it is just over 30% in County Roscommon; and just under 30% in County Galway. Some very useful technology has been introduced into Wales and England which uses the telephone line and the television screen to communicate directly with people and monitor their blood sugar levels, blood pressure, and deal with conditions such as COPD, at a greatly reduced cost than is the case at present.
I urge the Minister of State to take this technology and piggyback on the existing systems rather than introducing a completely new system. Our recent conference at the RDS was addressed by Mr. Andrew Murphy from Sláinte Healthcare. He is introducing this technology across the world and in some hospitals here. They are building on the existing IT infrastructure, rather than starting from scratch. We need to start with what we have, build on it and use it to create the best type of technology infrastructure we can.
I welcome the opportunity to speak on the issue. The Bill represents a key step in the Government's reform programme and will allow us to introduce a system of unique identifiers for the individual and those who provide health care services. It will lead to an improvement in the quality of care, better access to information and more joined-up thinking.
We all recognise the need to prioritise the safety of patient information. It is important to put things in context. The Acting Chairman and I share a common interest in the GAA. Within that organisation we have an ability to share information about club membership. I view the Bill's provisions as being similar to the club membership card. It allows for the streamlining of medical records, reducing duplication in things such as the diagnostic tests Deputy Naughten mentioned. Of course the Deputy should have concluded by saying that the Minister in introducing universal health insurance and free GP care for children under six is taking the first steps to allow us all have health check tests and access treatment fairly fast.
Tomorrow is rare diseases day and a unique conference on rare diseases will be held in Belfast.
Having listened to delegates this morning at the Joint Committee on Health and Children who made wonderful presentations, there was a palpable feeling that the system does not talk to itself, so to speak, and the right hand does not know what the left hand is doing. I preface my next remark by saying that I am sure we are all aware of the tremendous work being done in our hospitals, but charts go missing, systems need to be upgraded and medical information needs to be shared. I understand the concerns of some people when they have seen what happened to Edward Snowden and others, but I give this example. If I were to walk into the emergency department of Cork University Hospital at 7 p.m. on Friday, I would have to fill out a form, get my chart, take my place in the queue and that is fine but if I have to go to the Mercy Hospital or the Bon Secours Hospital, which is a private hospital, the following day, there is no co-ordination in the sharing of information. In the context of this Bill, the sharing of information is important. The primary motivation for introducing this Bill is to bring about a better e-system of governance in our health system and make sure that medical and other information is shared, which is important.
The Bill lays out a clear framework for the setting up of a structure in regard to individual health identifiers for patients and service users while also setting up registered health service provider identifiers for health professionals and organisations. The idea behind this measure is about improving the quality and safety of care along with the modernisation, updating and reform of the system of record management and of the management of the system within our hospital network. Having listened to other speakers and the Minister, I note this measure will ensure there is a reduction in the repetitive and needless care, a reduction in organisational expenditure and that it will facilitate e-health projects which have been launched by the Government. On the same day this Bill was introduced in the Seanad, the Government launch its e-health initiative. That is an important step because it sets a target that must be attained and achieved on behalf of the patient or the service user. It indemnifies the staff in our hospitals who - as I know from talking to some of them - are looking for a change in terms of the system of operations.
Interestingly, the recent report from HIQA estimated that up to 30% of the health budget may be spent on handling, collecting, searching for and storing information. It is a large amount of money in the context of today's health budget of €13.2 billion. If one were to put the annual health budget under the microscope, this legislation would be welcome, necessary and considered to be innovative.
The health identifiers will form an integral part of the Government's planned e-health agenda, which was launched by the Ministers. The strategy sets out a roadmap for improving the health and well-being for each citizen of the country through simple and cost effective means, for example, through the introduction of e-prescribing. I have met different pharmacists and GPs who have set up this system in their practices and at the click of a button on the computer they can send a prescription to the pharmacist without the need for paper or unnecessary toing and froing.
The introduction of health identifiers will allow this planned system to work more efficiently. It will mean the same information does not need to be collected on numerous occasions, which can be frustrating for both the patients and the people who are working in the system. If we are serious about our e-health project and about bringing in reform, and we have created new hospital trusts, new hospital networks and moved forward with the reconfiguration process, we must ensure the experience of the patient and the health care provider is enhanced and positive.
Deputy Naughten's remarks regarding diagnostic testing needs to be followed through. If we are serious about reducing the cost of health care, this is one area we need to examine forensically in the context of all the different types of tests being carried out by different health providers. If we have a unique identifier linked to the patients' records the multiplicity of tests could be reduced. This audit that the Minister, Deputy Reilly, speaks about in terms of health insurance will be a positive step in the right direction.
We are 13 years on from when this measure was first spoken about and we are now putting in place the structures on which to develop and implement it. The work being done by the Minister, Deputy Reilly, the Minister of State, Deputy White, and the Department of Health is to be commended because it will ensure we will have a functioning and operative period within which to put the provisions of this Bill into practice, and the savings that will be made will be part of this process. We hear a good deal about reform of the health service inside and outside this House and this measure is another example of reform of the health system which will provide better value for money and ensure that the quality of care is improved and that the experience of the person using the health system is also improved.
The health identifier is an exclusive, non-transferable, lifetime number assigned to all citizens, which is to be welcomed. Its purpose is to identify accurately the individual and enable health and social care to be delivered to the patient at the right place at the right time. Protection of patient privacy within the development of this Bill is vital. Public confidence in the protection of personal data online and on file, as we know, is diminishing and shrinking almost daily. We have seen people's information being hacked into and used for many different purposes. Genuine concerns in this respect have been expressed by people about this Bill and to that end we must strike a balance and ensure when we provide a health care system and service that in tandem we also protect our people from the misuse of their personal information. People will not object in my opinion to being part of this new e-health strategy. It is about the provision of information. Once we explain and demonstrate to people the rationale for having a personal identifier number unique to them in a simplified and easy way this will be a positive development for the future of our health system.
We have demonstrated that we have a very professional health care system with the men and women who work in it providing an exemplary standard of health care on a daily basis. In implementing this Bill we must ensure we can provide the same level of health care in a far more effective and efficient manner and in a reduced time period. This Bill is about ensuring progression and modernisation of our health system but in tandem with that it also must be about the patient, service user and those who work in our hospital system.
I am thankful for the opportunity to contribute to the debate on this Bill. It is another important and practical piece of legislation to come through the House in recent time, which will enhance the delivery of greater reform of the health sector. It is a simple and straightforward Bill. It is a common sense measure. It is hard to believe that it was not brought in years ago. One would assume that this system was already in place but having worked in the health service I know that it is not in place. It is a basic system that should have been implemented a long time ago to ensure our modern health service is run as efficiently as possible. It is another measure on the list of reforms that the Government has said must be brought in and we will bring in those reforms. We have ticked this box and it will lead to greater reforms as we move forward.
The Bill, as passed by the Seanad earlier this month, will provide the legal framework for individual health identifiers for those using the health service and unique identifiers for those who work in the health service, irrespective of whether they are in the public or private sectors. It is important to note also that the Bill is another step in providing a more modern, efficient and safer health care system, and safer is the key word. Matching the right information with the right patient is basic and key but it does not always happen because there can be human error and mistakes can be made but systems must be put in place to ensure that does not happen. That is what this measure is. It is putting a simple system in place which will attach the right information to the right patient and that it can be found when it is needed. In that way we will know who everybody is in the system and when they go from one doctor to another they will not have to repeat themselves and fill in the same forms over and over again.
I am encouraged by the general support for the Bill on all sides - if I am correct on that - in both Houses. It is encouraging with all the party politics that have been going on in recent weeks that we are dealing with a Bill such as this on which everyone can agree and that makes common sense. In reforming the health service generally, most parties will agree with what has to be done. There might be slight ideological differences about certain aspects of it.
Overall, the majority of us want this system reformed as much as possible. We recognise there are outstanding people working in all parts of it. However, we need to have a system that allows them to do their work to the best of their ability, efficiently and at the lowest cost to the taxpayer and the insurance payer.
The Bill does deal with privacy concerns, so I hope that issue will be put to bed and that everybody will accept this and use the number. It is important that we find some way to encourage those who might have doubts and might not want to use the number. I also spoke about what information will be attached to this. However, I hope it will be realised that the system is there to help people and make sure they get the best health care. They will buy into it once it is explained properly and there is help for them in using it. I have no doubt there will be a great take-up of this.
The Bill is about safety and quality of care. It will enable better promotion of patient safety to include clinical audit and investigation, reporting of patient safety incidents, management of the health services, including planning, monitoring, delivering, improving and evaluating health services, and also investigating and resolving complaints. During his speech in the Seanad, the Minister said this would take away some of the duplication of diagnostics. This should not be necessary because the information should be attached and there should be no need to repeat the same test again a few months later or in a different part of the health service, be it private or public. That is what we are told and I believe it is outlined in the Bill that previous test results can be attached and used again. I hope that is the case and is what will happen in practice.
With regard to the management of the service, when I worked in the payroll end of the service, it was a nightmare, with all the different grades and people who worked half-time, full-time, quarter-time and so on. For someone who was just in college trying to learn accountancy, it was a pure nightmare trying to put a system in place that would work out people's wages and pay them properly. A couple of years later, when I was in the Dáil, the Taoiseach of the time was Bertie Ahern, the Minister for Finance was Brian Cowen and the Minister for Health and Children was Mary Harney. On the same day, in three different speeches, although I could be wrong on who gave which figures, one member of the Cabinet referred to the HSE and the health service employing 140,000 people. That evening, another Minister, possibly Mary Harney, referred to the service employing 110,000. Lo and behold, before the night was out, Brian Cowen referred to the figure as 120,000. Therefore, the Government of the day did not even know how many people it employed and paid in the health service.
That alone shows that a basic system like this, which would show who is who and who is working on what patient, is fundamental to bringing reform and managing the health service. There is so much money and so many people involved in this area that it is important we get it right. Therefore, while this is not a large Bill, it is essential. We have been talking about it for years and I am glad to see it happen.
It goes back to the reform agenda, which states that we will not just talk about reform but that we will go and do it. I accept that reform can take time. In any reforming agenda, especially in regard to health, any given Minister, such as the Minister, Deputy Reilly, or the Minister of State, Deputy White, will be picked on at certain times because a certain part of the health service is not performing. It cannot all be fixed overnight and it will take time. However, it is possible to pick off the bits we can do and say, for example, that this year we will do X, Y and Z, and, over a period of time, we can get it fixed.
To be fair, when it comes to health, both Labour and Fine Gael very clearly said before and after the election that it would take time to fix it. There was no false promise that we would fix this in seven months, a year or two years. In fact, seven years was the general figure talked about and it was said that it would take two terms of Government to completely reform the health service. I believe we are on track to achieve that and I have no doubt we will do so. It is not the end of the world if we are six or eight months behind in our schedule provided we have most of it on track, know where we are going and have a plan of action.
Measures such as this small Bill feed into the idea that money follows the patient and into universal health care, which will reform the health service. I totally believe universal health care will solve our problems. Yes, we will have to tease it out and work out the details but if we get it right the first time, it will work. It will level the playing field and will give a genuinely single-tier health service, once it is implemented correctly. I have no doubt about that.
I presume that, at end of the day, the Government will provide the basic cover that will get people equal access to health treatment and to an operation, which is what is fundamentally important. If people want to have a room of their own, have more flowers in the room or have a nicer dinner, they will pay more for that, which is their choice. However, the access to treatment is what we must have equality on, and I have no doubt that will be achieved if we see this through correctly.
It has been said that this is the key to the money follows the patient approach and the whole e-health agenda. Money follows the patient is another simple concept that has worked very well in the last year or two while on trial, and it has been rolled out much further this year. No hospital has been penalised due to this and the money still stays in the system but, eventually, hospitals will be rewarded for activity. This works very well and has driven huge change and efficiencies in the orthopaedic unit of my own hospital. The results speak for themselves. There has to be a system of reward as well as penalty. If someone does well and benefits from the money follows the patient approach, which is a form of activity-based costing, there is a reward for that in terms of extra resources, which hospitals will get to keep. If a hospital is three months ahead of its target towards the end of the year, it will get extra money to do more work. Ideally, if the money follows the patient concept provides efficiencies and frees up time, we should be able to use that extra space to carry out more operations. I presume that is the overall agenda.
As I said, the sooner we have universal health insurance, the better. Across the board, the e-health agenda will make it much easier for health practitioners and all those involved in the service to deal with people and make judgments. If they can use IT systems at the highest level, they can give a judgment no matter where they are based, and a consultant based in Cork can give an opinion on a case in Dublin. That is what we need. It is partly in place already but we need more of that, and it can only happen if systems such as this are rolled out. I am all for that. The sooner we get it, the better.
This area is part of a wider overall reform. The Minister in his speech in the Seanad referred to the medical card situation. Even a Bill as simple as this should help the situation because information is getting lost at present. This happens in other Departments also, although it should not happen. It means that, while people eventually get their medical card in any case, there is the trauma of trudging through the system, repeating the information and asking Deputies to send the information again. It is embarrassing and should not happen. I trust a Bill like this will help with the reform of the system, ensuring that information flows more easily and will not get lost or attached to the wrong file. Departments should not lose information, in the same way that the private sector should not lose it. It should not happen and I hope this Bill is the beginning of the end of that.
While I could address other areas of reform, I am happy when I see a Minister outline that, this year, we will fix X, Y and Z. The plan for this year was to tackle the outpatient waiting list. It was embarrassing to admit at the start of last year that there were 350,000 people on outpatient waiting lists. However, we had to admit that, count the figure and then say that we would bring it down. That figure has now been reduced, and instead of the 100,000 people who were waiting more than one year, the figure is now 4,000 or 5,000, which is a massive achievement. The Government has to be strong at the start and admit how bad the situation is, and then say "Give us a year or two and we will fix it". We did not have that in the past. People were afraid to admit to things. I am glad we are on the right track. While it will take more time to fix everything in the health service, we will get there. There is no doubt about that.
I wish to share time with Deputy Olivia Mitchell.
Is that agreed? Agreed.
I welcome this Bill and thank the Minister of State for attending. The Bill introduces a very practical system of a unique health identifier, which is essentially an ID number for each and every person in the country who accesses health care. This is a welcome step in the Government's reform programme, moving towards a modern, integrated health service which focuses on patient care and safety. This new system will play a critical role in managing the health service more efficiently and effectively. HIQA has stated that the absence of a universal health identifier is the single most important deficiency in our health information infrastructure.
The Bill provides for a national register of individual health identifiers, IHIs, containing an individual's IHI and other identifying particulars, but will contain no personal or clinical data at present. Health service providers, health professionals and organisations will use this number to identify patients. Health service providers, health professionals, organisations and some employees will also have a unique identifier.
Providers will have to use their identifier on their patient records and relevant communications. This will clearly identify the person and organisation involved at each stage of care. I am pleased to see the Data Protection Commission has been consulted on this project to ensure there are no issues with regard to a person's private data. The identifiers for health care providers will be open to everyone but, understandably, access to identifiers for patients will be strictly limited. Access to the national individual health identifier, IHI register will be restricted to health service providers and other entities under the Bill. The Bill provides for offences and penalties for inappropriate access to the national IHI register or use of the IHI.
At the moment, there are gaps in information right across the board when it comes to health care and follow-up care. The majority of speakers have spoken about this issue this morning. This is why this new system is so badly needed. It will tie into the Government's e-health strategy which aims to enable the health service to modernise in line with information and communications technology advances as well as modernise the way we treat patients, particularly in providing care in the most appropriate setting and at the most appropriate level within the health services.
Priority areas for initial development include e-prescribing, online referrals and scheduling, tele-health, particularly relating to the management of chronic disease, and the development of summary patient records. A new body called eHealth Ireland will be established and the IHI provided for in this Bill will be essential to all of these developments.
Further benefits of this new system include the streamlining of records management and reducing repetitive and unnecessary care and administrative costs. We all live in the age of technology and appreciate the need to record data electronically. The health identifiers will allow all care to be traced to the health care provider. At the end of the day, IHIs are primarily about patient safety and ensuring the right information is associated with the right individual at the point of care. The IHI will also help in managing our health service more efficiently and will be a building block for health reform initiatives, including the money follows the patient concept. I commend the Minister on moving forward with this project as I think it has great merit. It is the first step in making patients' needs more accessible through proper management and medical care.
Perhaps in the future it will be possible to include within this system reference to medication for people attending hospitals and accessing outpatient services, especially when people, particularly older people, are being rushed to hospital in an ambulance and bags of medication have to be brought to them. There can be a lot of confusion when they reach hospital as to what medication they are on. Perhaps this could be looked at in the future. Perhaps this Bill and the IHI will make the medical profession more accountable and responsible when prescribing medicines for older people and others. I often find not only through my own family but through relatives and neighbours that some people are prescribed medication three or four times but might never actually use it. Perhaps it might be possible to ensure through the IHI system that medication is responsibly issued and looked after. I thank the Minister for bringing the Bill, which I welcome, to the Dáil and hope it is introduced quickly.
I also welcome the Bill and the opportunity to speak on what on the face of it seems like a fairly simple and straightforward Bill. This Bill sets up a unique patient identifier for every citizen in the country, provides the legal framework for how it will operate and who will access it and deals with governance issues associated with data protection rules. The Bill was deemed necessary and recommended by the report of the Commission on Patient Safety and Quality Assurance. The Health Information and Quality Authority, HIQA, also had an input in suggesting there be an identifier for health professionals.
This Bill goes far beyond that in that it enables much more far-reaching effects than merely identifying the patient. As Deputy English mentioned, it is difficult to believe we have not had this in place for many years. It seems such an obvious precondition for patient safety. The Minister has referred to the main purpose as being patient safety, and indeed it is. It is not just about identifying but identifying is extremely important, particularly in an island country where we have a concentration of family names. Given that people can have the same surname, it is easy to see how there is potential for disastrous mistakes to be made in testing, communicating the results of tests, diagnosing, prescribing and treatment. The chances of having many Mary Murphys on a GP's list are quite high. It is even possible to have two or three Mary Murphys in a hospital ward. It is not entirely improbable. I recall somebody telling me about her worry when she had a new baby because somebody in the same ward had the same name as her. She was never terribly sure if she was getting the right baby or not although I know that maternity hospitals go to great trouble to ensure one does get the right baby. It is amazing we have so few mistakes relating to identity with people consequently being given inappropriate treatments, particularly in hospitals.
Apart from treatments, the Minister gave an example of how identifiers can really improve the administration of our health service, which improves service to patients. He spoke of the problems relating to delays that were associated for a time with the granting of medical cards when we were switching from locally dispensed medical cards to centrally provided cards. In one example, the delay was due to 133 people with the same name applying simultaneously for a card. Again, it is easy to see how it might not be that easy to match all the medical and financial details to the correct person. Of course, it caused people enormous stress and disappointment when they were turned down after being assessed on details that applied to somebody else. It has great implications for this kind of administration. There could literally be dozens of John O'Briens but it does not take dozens, it just takes two people with the same name or even similar names for mistakes to happen. The unique identifier will deal with this particular problem.
I understand there was considerable debate as to whether a new identifier number was actually necessary when we already had a comprehensive personal public service number system. A single identifier does have its attraction as a cleaner, simpler and comprehensive way of serving all health and social needs, particularly those of large numbers of people and particularly because those kinds of services overlap. However, I understand that HIQA was against the use of the same number for a number of reasons. Of the two reasons I found most persuasive, one related to data protection and the fact that the PPS number contains personal information that one would not necessarily want to be accessible. The other reason was that the PPS number is not available on a 24 hour basis, which would be essential for a health service. People often need their health information instantly. These were compelling reasons for giving separate numbers despite the attraction of a single number.
Due to the fact that health and social welfare services overlap, it is very important that the two systems can be linked. I hope and expect that over time, both the health service and social services will become increasingly computerised. It is important the two systems are able to speak to one another accurately about the same patient. I welcome that as well as containing the name and address of the person, the health identifier will also contain their PPS number.
The main objective of this legislation is patient safety. Introducing a unique identifier for every citizen will increase efficiency in the administration of health. An important aspect of this development is that it will facilitate many other ICT improvements in prescribing and dispensing, in referrals, in consultations and in record keeping. The one matter on which everyone agrees is that we need a greater investment in ICT. It is scary to see the filing systems in place in some hospitals. To the casual observer, they look Dickensian - people queuing for files, files falling apart, files that cannot be found, people needing to return on another day because files have gone to other departments etc. Information is not always accessible instantly, as is the requirement in an emergency. A major investment in ICT would not just improve safety and quality in the health service, but also make it more efficient and cheaper, which is something we definitely need.
The Health Information and Quality Authority, HIQA, has estimated that a breathtaking 30% of the health budget is spent on handling, collecting, searching, filing and storing information. Even basic information on individuals is held across a range of social and health services, for example, by hospitals, general practitioners, GPs, laboratories, physios, etc. It is almost impossible to collate a complete health history based on a name alone, particularly where a person has a complex or long-term complaint. We must access and manage information more effectively.
Not to put a tooth in it, but a slightly worrying question is, if 30% of our budget is spent on filing, how much of a health professional's time is wasted as a result. As we know, health professionals are not cheap. An even more serious question relates to the cost of, for example, lost files in terms of patient outcomes. Face-to-face contact with health professionals is also lost, even though this is what the health service should be all about.
Some 0.85% of our budget is spent on ICT, whereas the European norm is 2% to 3%. As part of a move to a more efficient and modern health system, we must have proper ICT systems. The value of this Bill is that identifiers facilitate such systems. Indeed, identifiers are a precondition for them. However, the main boon of an identifier is the extraction of population-wide information for epidemiology studies, which are vital to good health planning. The Minister mentioned vaccination and screening programmes, but identifiers will also allow for the tracking of increased or decreased instances of diseases and demographic or geographic differences in health status. I am referring to the types of information that are required for a focused health care response and future planning. Identifiers would also be a critical enabler of the e-health strategy.
I wish to make a couple of helpful points. First, there will be a system for putting in place a marker when people die. As mentioned in the legislation, dead people will have a number. No such system is in place currently, which has led to the scandal of GPs being paid in respect of people who had left their areas or died. This Bill represents an opportunity to put in place a foolproof marker system so we can know how many patients a GP has on his or her list, etc.
Second, when people contact Deputies, we often need their PPS number, but they do not have a clue what it is or how to go about getting it. We should run an information campaign to let people know, as a PPS number is important and unique and people must be able to access theirs.
I understand that Deputy Feighan was to share time, but no one else is present. If they appear, I will allow them to contribute.
How many minutes do I have?
I suppose I had better speak slowly, then.
That is entirely up to the Deputy.
I am delighted to contribute on this important Bill. Once again, the Minister and the Ministers of State, Deputies White and Kathleen Lynch, have introduced innovative legislation. This Bill is appreciated and supported by the majority of Deputies regardless of their side of the House. This is to be welcomed.
Last week, I took great pleasure in speaking on the opt-out clause - or opt-in clause, however one views it - for organ donations. That provision was innovative. I am a member of the Irish Kidney Association. Every week, we try to raise awareness of kidney donations. Having told people for years that they should carry their cards, however, I did not even have mine in my wallet.
The question of health identifiers is one of patient safety. We must ensure the right information is associated with the right individual who is receiving care. Identifiers will allow our health services to be managed more efficiently. Deputy Olivia Mitchell is correct about how horrific it is to see that 30% of the health budget is spent on administration. We seem to have a love affair with files. I probably visit Roscommon hospital once per week. Each time, I see someone carrying a file or the files office is busy.
Contrary to what people might believe, Roscommon hospital is certainly not closed. It is actually twice as busy as it was in 2011 before the famous downgrading of its accident and emergency department. What is important is that its patients are much safer. At the time, everyone claimed that the hospital would close. This Government claimed otherwise, and now the hospital is still open. People claimed there would be job losses, but not one person has lost his or her job. In fact, more people are working there now. It was also claimed that patients would die, but not one patient has died and at least 50 lives have been saved through the use of advanced paramedics and air ambulances. Previously, if one was in an accident or suffered a cardiac arrest, an ambulance came to collect one and brought one to Roscommon's accident and emergency department to be stabilised before being sent on to Galway. People called Roscommon's accident and emergency department a real one, but it was not. It did not have a cardiac surgeon or a paediatric surgeon, someone to intubate or someone to provide night-time cover. Let us dispel the myths. The Government took HIQA's advice. Ms Tracey Cooper of HIQA stated that the department was unsafe because fewer than 20 people used it per day.
The population of County Roscommon is a little over 50,000. Where Deputy Naughten comes from in south Roscommon, people have always used the accident and emergency department in Ballinasloe. Where I come from in north Roscommon, we have always used the department in Sligo. Roscommon town has a population of 5,000 people. The days of having an accident and emergency department in every provincial or large town are a thing of the past.
However, I am happy to say that in less than two months, the turning of the sod for the new endoscopy unit will take place. That is a €5 million development and another €5 million will be provided for a palliative care wing. I hope we will have a rehabilitation consultant for the west as well. What is happening is fantastic, but patient safety is there.
It was said we would not get an air ambulance, but it has saved lives. Instead of going to any accident and emergency department, a paramedic comes out, deals with people who have heart attacks or who are in car crashes and gets them as quickly as possible to a real accident and emergency department. This issue of being more than an hour and a half from Galway is simply untrue. At least 50 lives have been saved in County Roscommon, and I ask people to call into the hospital and ask the consultants - Gerry O'Meara and Liam McMullen - if this hospital is safer, if it is busier, and whether they are satisfied with the hospital, and they will tell them. For two and a half years I have asked the local newspapers, the national media and the local radio station to make a telephone call to or to call into the hospital, but they do not want to do so. I have asked politicians to go and talk to the consultants who wrote the letter to say the accident and emergency department was unsafe, yet they still do not want to go in. It is not a race to the bottom. If politicians make a mistake, we put up our hands and say so. However, this was a good news story so people should talk to those consultants and they will tell them. For two and a half years, no one wanted to go in because when they get it wrong, they are afraid to put up their hands and say they got it wrong. I am sick and tired of everybody going on to the radio and saying that the hospital will close, people will lose their jobs, and people will die, because none of these things has happened.
I was there seven days before that famous vote. Tracey Cooper stated she would not allow the accident and emergency department to remain open because it was unsafe. It was unsafe because when only 20 people were using it per day, a cardiac surgeon there would become deskilled. People did not listen and they said that HIQA did not come to inspect it. I was there and I know what went on, and if I had to make the same decision again, there is only one decision I could make, which was the right decision.
We were talking about putting a new endoscopy unit in Roscommon, and we were talking about putting it over the current urgent care centre, which was the accident and emergency centre. It could not be done because we would have had to move the files office, and there were so many files that it would be ridiculous. It was proposed to leave the files office where it was and to move the endoscopy into a portakabin outside, which was going to cost almost as much as the building. This was more HSE madness. What were they doing in the past 15 years to look at health identifiers for patient safety? They did nothing and now it is all about files.
I pay tribute to the Minister of State and his team. We are working in a health system where there is 20% less in the budget and 10% fewer staff. In the face of some outrageous, sometimes misinformed and sometimes informed debate, we have kept the system going. Not everything is perfect, but this is another step in the right direction and I congratulate the Minister of State.
Employees, health professionals and service providers will have a unique identifier, and that is very welcome because, over the years, we had a reverence for doctors and consultants who we feel should know everything. They do not know everything. When I was growing up, if a person liked the drink, then he was an alcoholic but a great doctor. How could someone be a great doctor and an alcoholic at the same time? However, if someone was a tradesman and an alcoholic, he was a low-life. We had that kind of admiration of the professional classes. What is the difference between God and a consultant? God does not think he is a consultant. That is the thing with these consultants and rightly so perhaps, because they save people's lives and they work extremely hard. Between the doctors and the nurses in the hospitals, they have saved lives, but that is what health professionals are supposed to do and that is what they get paid for. They work in very difficult times, but we must cut down this love affair with professionals. With the increase in social media outlets and even being able to ask questions in the Dáil, we have broken down those mysteries that people were able to work behind.
I agree with the 2008 report of the commission on patient safety. It is building a culture of patient safety, and the development and implementation of a unique identifier for the health service was recommended. We need to look at what has happened in Scandinavian countries. They are certainly the role model and I hope the Minister of State and his team examined that model. It is much less complicated, and we always seem to like to complicate things. We need to look at the data protection issue as well. We did not have a data protection culture in this country, because a person could be tipped off by someone they knew that this or that was happening. I remember people not wanting to go to an automatic system with telephone exchanges years ago, because we wanted to keep our local operators in the telephone exchange, but then they often listened into conversations. We did not know about data protection, and now we have a much better awareness of it.
This could be a case for introducing a national identity card, because it should not stop with medical records. I can understand why medical records are separate from this, but I do not think a national identity card is an intrusion on rights or a form of Big Brother, but rather a welcome requirement. We should have nothing to fear from identity cards. They are not an infringement on our rights. They ensure the process of administration is simplified. Deputy Mitchell pointed out that 30% of the health budget is spent on administration and I think this is a great case. Health care reform has faced many obstacles but what has gone on has been very good for the country. The health identifier system will improve access and quality of health care, and that must be welcomed.
When people make statements about hospitals and health care, they should be conscious that when they undermine a hospital or health service, they drive the fear of God into people. For two years, signs were erected in County Roscommon with slogans such as "People will die" and "Nearest A&E - 150 km". Roscommon County Council applied the law in two different ways. It allowed these signs to remain in place for two years without imposing one fine on the sponsors who were local businesses. I did not press for fines to be imposed. However, when Fine Gael Party signs supporting Gay Mitchell were not removed within one week of the presidential election, the council issued the party with two fines of €150. What was the public servant in the relevant office doing? Was this a fair approach? While I did not do anything about it, some public servants need to remember that they must be impartial and must not take action on the basis of a dislike of a political party.
I accept that the Fine Gael Party should have been fined but in the past we would have received a telephone call about election posters. How can one prevent someone from taking down a sign, putting it up one week later and calling the county council to ask that the relevant party, whether Fine Gael, Fianna Fáil, the Labour Party or Sinn Féin, be fined for not removing election material? The law was not applied fairly in this case because people in positions of authority decided not to take action in a case where the issue was emotive and related to health. While I accept that fines can be imposed for not removing election posters, there is nothing to prevent someone from removing a poster for a Fine Gael local election candidate and subsequently erecting it again a week later before mischievously telephoning the council to express outrage and ask that the party be fined. There were more than 900 signs in place for at least four months before the two fines were imposed on my party. The decisions taken by the council on this matter do not reflect well on its fairness or otherwise. I have not raised this issue previously but do so now because it needs to be noted.
Figures were published several weeks ago on the safety of cardiac patients in hospitals. The figures were not used as a reason for closing the accident and emergency unit in Roscommon hospital. They served as a signpost and I invite people to read the relevant report and make up their own minds on them. The figures were twisted to suggest the Minister had used incorrect information in the Dáil and resulted in calls for him to resign. I pointed out in a radio interview that certain Deputies had cited the most outlandish figures in the House, twisted stories and made erroneous statements in newspapers and on radio without being once asked whether they had been wrong. Two years ago, the Deputies in question stated this or that facility would close. Perhaps it is time to ask them whether they were wrong.
When I was in opposition, I used to compliment and support the Government when it had good ideas. If we are honourable, we should put up our hands and admit when we are wrong. I do not want to tell people they were wrong but they were. If they have any backbone, they should admit that Roscommon hospital is safer than it was two years ago and will be twice as big and five times busier when the current plans have been implemented. Most important, people in County Roscommon, especially Roscommon town, are safer than they were as a result of the action taken by the Government.
I congratulate the Minister of State, Deputy Alex White, on introducing this Bill, which enjoys cross-party support.
I thank Deputies for their contributions to the debate on the Health Identifiers Bill and welcome their support for what is proposed.
This Government is committed to a very ambitious programme of reform, at the heart of which is the care and safety of the patient. The focus of this debate is the Health Identifiers Bill which, as the Minister set out in his statement, is an initiative that has the potential to support health reform goals and bring a range of benefits across the health system in a number of areas. The principal benefit of the identifier system will be in individual patient care and safety and ensuring the right information is associated with the right individual at the point of care.
I propose to address briefly some general and specific points made by Deputies in their contributions. Speakers raised the matter of the Bill and patient information. Deputy Kelleher read into the record an e-mail he received from persons with concerns regarding the disclosure of personal health data for research and other purposes and recording their apprehension or fear about access to centralised medical records. It is important to clarify that while the Bill introduces a framework for using the individual health identifier or IHI, it does not change the existing law on the collection, use, sharing or disclosure of personal health data or the creation of medical records databases.
I am aware there is some controversy in England about the establishment of a national medical records database by the National Health Service, the uses to which the data involved can be put and the persons to whom the data can be disclosed. This Bill is not about such databases. The only national registers created under the Bill are the registers to hold the individual health identifiers and provider identifiers and the appropriate related identifying particulars, such as name, address and date of birth. The Bill specifically provides that the identifying particulars relating to an individual's health identifier cannot contain clinical data relating to the individual.
The law on the sharing of personal health data continues to be governed by the Data Protection Acts. The Health Identifiers Bill, which has been discussed with the Office of the Data Protection Commission, is designed to ensure the individual health identifier is associated with an individual's medical records and related medical correspondence. This will help ensure the individual can be uniquely and quickly identified during each engagement with the health system. Furthermore, the persons who can access the IHI register and the purposes for which they can access it and use the IHI and the identifying particulars in the register are set out fully in the Bill, as are the persons to whom they can disclose such information.
Deputies mentioned access by individuals to their medical records. The Data Protection Acts and freedom of information legislation provide a statutory framework for an individual to seek access to his or her personal health data. The requirement under the Bill to associate the individual health identifier with a patient's medical record and related correspondence should facilitate such access, as it will ensure that records associated with the individual can be identified more readily and made available to the individual concerned where he or she seeks them.
As I stated, the Bill was discussed with the Office of the Data Protection Commissioner. This reflects our concern to address privacy considerations fully in the governance structure. In that regard, it is important to make clear that the Bill gives an express role to the commissioner in a number of areas, for example, where the Minister proposes to add to the number of specified persons or the identifying particulars for the individual health identifier. This is in addition to the Data Protection Commissioner's general role, under the Data Protection Acts, in regulating the processing of personal data.
I note Deputy Ó Caoláin's views on section 5(3). This subsection is included in the Bill to make clear that the assigning of an individual health identifier to an individual shall not be regarded in any way as indicating in itself an entitlement to, or eligibility for, the provision of a health service to the individual. As stated by the Minister in his opening speech, the main purpose of the Health Identifiers Bill 2013 is to put in place a legislative framework for individual health identifiers. Eligibility for health services is a separate issue. While it has been canvassed by Deputy Ó Caoláin as issue for this legislation, it is provided for in other legislation. In so far as there is necessity for a debate in that regard, that ought to happen in the context of that other legislation or new legislation that a Deputy might wish to propose for introduction to the House.
I agree with Deputy Kelleher's remarks in the earlier part of this debate in regard to the potential of e-medicine and e-health for Ireland. The scope of the potential of e-health includes improving the health and quality of life of our population and better quality health services at lower cost. It also extends beyond the health sector to improving the economic health of the nation through its potential for job creation.
The Minister published the e-health strategy for Ireland last December. It identifies a series of high level actions to achieve these objectives. It will bring all stakeholders together, including Government, industry, health care providers and academia, under the umbrella of e-Health Ireland, which will be established initially in the HSE to move Ireland towards the vanguard of e-enabled health care. Health identifiers will be another enabler of e-health. I am sure Deputies will agree that the assurances the new identifier system will bring to the identification of patients will be of considerable importance in enhancing patient safety in the excellent potential real world examples of e-health applications, as described by Deputy Kelleher in his contribution to the debate on the Bill.
Health care in Ireland is changing radically and future health care systems will need to be radically different to respond efficiently and effectively to forecasted demand. A unique identifier system is an essential element underpinning the changes that are being, and will continue to be, introduced to address those challenges and to ensure the patient stays where he or she belongs, which is at the centre of the health system. The Bill before the House is about making that happen.