I do not direct my comments at any Member in particular, but I ask that all who ask and answer questions observe the three-minute rule.
Leaders' Questions
Last night, the Minister for Health revealed that there were more than 1,500 additional cervical cases which had not been audited. This shocking and out-of-the-blue revelation confirms that the response to this crisis to date from the Minister and the Department of Health has been neither competent nor comprehensive. It is now two weeks since the Minister was told about the issue and nearly a week since it became public, yet we are still discovering shocking and unsettling new information. The Taoiseach and the Government have had enough time to get on top of this issue and they need to do so urgently.
As Vicky Phelan said last night on "Prime Time", there is no one leading this and the news is changing daily. Ministers have run to the hills and TV programmes have been absent of senior Ministers to explain things to the public. Calm, competent authority is required in response to this crisis. Confidence in the cervical cancer screening programme is being undermined and women throughout the country are fearful and worried. They have been let down. Despite everything, it is worth reminding people that this cervical cancer screening programme has identified up to 50,000 precancerous changes in women without symptoms and has made a very positive contribution to women's health. The most effective route to restoring confidence is to have a competent, comprehensive inquiry that will get to the truth. The precise model is not actually the key. The key is the chair, the personnel and the terms of reference. Yesterday there was more uncertainty. The Government had spoken about a HIQA inquiry while, last night in the middle of a debate, we apparently moved to a commission of inquiry. We urgently need clarity.
This morning we learn from a story in The Irish Times that the Minister for Health, Deputy Harris, approved in writing that the director general of the HSE be allowed to take up a lucrative role at a US contraceptive manufacturer. I have no personal axe to grind with Mr. O'Brien, though I did have issues with the manner of his appointment by the then Minister, now Senator James Reilly, in the absence of a public competition. I believe the Minister made a serious error in consenting to this because if there is not a conflict of interest, there is a potential conflict of interest. I do not believe one can be director of the HSE and a member of the board of a health product manufacturer. In addition, the chairman of Evofem, the company in question, is Thomas Lynch who is chair of the board of Ireland East hospital group and the Mater Hospital. It is reasonable to say that a HSE director should devote the whole of his working time to his job as director, as per HSE policy and earlier statements.
Does the Taoiseach believe both positions are reconcilable? Does he agree that the Minister erred in making the decision to give consent to Mr. O'Brien taking this up, two months before he announced that he was going to retire as director general of the HSE in August? What steps is the Taoiseach now going to take to authoritatively deal with this crisis? Could we have some clarity, which is badly needed, on the form of the inquiry being proposed by the Government?
Once again, I want to say how deeply concerned and upset I and the whole Government are at the situation with which we are now grappling. We still do not know all the facts, and last night, as Members will be aware, new information was given to the Minister only a short time before he came into this House to make a statement and answer questions. He was put in the unenviable position of disclosing information to the House without having all the information himself, and we certainly do not have all the information.
I ask for some time and space to allow us to establish the facts and space for calm and for facts, which the Leader of the Opposition mentioned. There is an old piece of wisdom, which is, "Act in haste, repent at leisure." Whatever we do, I want to make sure we do the right thing. I do not want us to act in haste, make the wrong decision collectively, and then be sorry for it into the future. I know that many women in Ireland are very worried about this and many are feeling very vulnerable today.
As a Taoiseach, as a doctor, and as a brother of two sisters, I want to say a few things. First, this controversy relates to women who were already diagnosed with cervical cancer and are receiving treatment. There are many women in the country at the moment who are worried that they might have cancer and worried that the HSE and CervicalCheck know that and have not told them. That is not the case. Nobody is going to get a phone call or letter in the next few days to tell them that they have cancer and that it had been concealed from them in some way.
There are also many women who are worried about their smear tests, many of whom I have met in recent days. They are women who have a had a smear test recently, been given the all-clear, and are now wondering if that is true. I can reassure them that if they have been given the all-clear, it is true. There is a margin of error in these tests but it is under 1%, as is the case with all screening programmes internationally. We have no reason to believe that the information people have been given, to the effect that their tests are clear, is untrue. If anybody is concerned, we invite them to visit their GP to discuss the situation and we will meet the cost of the consultation and the repeat smear test. I thank the National Association of General Practitioners, NAGP, and the Irish Medical Organisation, IMO for their co-operation in this regard.
To the women of Ireland, I want to say that I am determined to get to the bottom of this, to establish the facts and to restore confidence in our cancer screening system. A number of actions have been agreed this morning. First, we are going to ask a team of expert international cytopathologists to carry out a clinical review and to look again at the smears of all the women who were diagnosed with cancer in the past ten years. We do not have the exact figure but it is between 2,000 and 3,000. We will most likely find out that the majority of the additional 1,500, of whom we spoke yesterday, never had a smear test. The review will be led by the Royal College of Obstetricians and Gynaecologists and will try to identify the genuine false negatives and those cases which should have been reported differently. We believe this can be completed by the end of May.
Later this year, we are also going to bring in a new, more accurate smear test and we will be among the first countries in the world to do this. There will still be false negatives but not as many as in the past.
This test will be available to all women who want it. They will not have to wait three years for their routine appointment. This will be expensive and logistically difficult but it is something we need to do. There will be a statutory inquiry. There are limitations to a HIQA inquiry. We know what they are. There are problems also with a commission of inquiry and we know what they are as well.
There is a committee hearing today. We would like that committee hearing to take place as it provides an opportunity for many of the senior officials and senior doctors to answer some questions. Following the hearing, the Minister for Health will invite the spokespeople to meet him to discuss the best form of inquiry that should take place.
I call Deputy Micheál Martin. The Taoiseach will have another opportunity to come in.
We will need a scheme of redress for women whose cancer was missed and should have been detected beyond normal error and for women where there was a breach of duty to inform them of the audit results. We will need to have a scheme of redress but we will need to establish the facts before we do that.
The House will be aware that Dr. Gráinne Flannelly, the clinical director of CervicalCheck, stepped down some days ago. I would like to inform the House that the senior official in charge in CervicalCheck, the director of CervicalCheck, is no longer in charge. Damien McCallion has been assigned to take over operations at CervicalCheck.
I allowed the Taoiseach to continue beyond the time allocated because of the importance of the topic. I ask for Members' co-operation on time.
I asked the Taoiseach the serious question of whether or not he agreed that the Minister for Health had made a serious error in facilitating and consenting in writing to the director general of the HSE serving on a board of a company and he studiously avoided dealing with it. I would like an answer from the Taoiseach, first, on whether he believes the Minister made the correct decision in consenting to this and, second, if he thinks Mr. O'Brien's position on that board is reconcilable with his being a director general of the HSE, with all the inevitable potential conflict of interests that arise from such membership of that board, the personnel involved and so forth?
I put it to the Taoiseach that confidence in the cervical cancer screening programme has been undermined by the drip, drip feed of information and shocking new revelations. I do not think anyone on this side of the House could accuse the Taoiseach of acting in haste; the opposite is the case. I agree with Vicky Phelan that no one seems to be leading on this issue. There is no calm authority getting to grips with this crisis, and there has not been for the last two weeks, unfortunately. The only way we can get confidence in the cervical cancer screening programme is to exercise such authority and make clear decisions. I welcome the peer review of the cytology tests and so on but the Government needs to make clear decisions and to operate on the basis of being totally in charge of this issue, such that it is not going in all directions, as it was over the last two weeks. We need to get to grips with this issue.
On the director general's contract of employment, his contract allows him to serve on boards if there is no conflict of interest, and with ministerial consent. There is no conflict of interest with this appointment as the company does not have a relationship with the HSE and it does not trade in Ireland. Also, the Minister in approving it was aware that Mr. O'Brien was coming to the end of his term of office, which ends in 12 weeks' time. It is on that basis that the Minister approved it. I have no reason to question the validity of that decision. The work he is doing for that company, I am told, is five hours per month and this will be done in his own time and any board meetings he will be on annual leave.
On the drip, drip of information, I appreciate what the Deputy says. I do not want to be in a situation whereby my Ministers and I do not have all of the information to hand. We are working as hard as we can on this matter. The Government has been focused in the last number of days on getting all of the information together so that we can make the right decisions.
When I referred to "haste", I was referring to something different. I was referring to something which I think we should not do as a House, or as a Government, which is to make decisions without having all the information. I would ask the House for some calm and the time and space to establish all of the facts in order that we can take charge of this situation. I have listed a number of actions that we are taking.
Vicky Phelan's solicitor has been adamant in his description of the behaviour of the HSE in regard to his client. He has described it as a cover-up. To be honest, I was not 100% sure if that was the right description but I am now. I am now convinced that we are faced with a cover-up by the HSE and for the following reasons. We and the general public were previously led to believe that all smear tests were subjected to a review where a woman later developed cervical cancer having had a clear smear. Some 208 women was the final number put into the public domain. Then last night the Minister, Deputy Harris, came into the Dáil and told us that "a potentially considerable number of cases were not subjected to audit". We are now advised that approximately 1,500 more women, who may have been put at risk because of errors in the reading of their smear tests, are now affected. Another 1,500 women potentially were left in the dark just as Vicky Phelan was.
In the midst of a debacle centred on the withholding of vital information by the HSE - life and death information - we are now told that there was more misinformation and that more women are potentially caught up in this scandal. This is breathtaking, Taoiseach. It is increasing evidence that this controversy is not simply a case of catastrophic dysfunction; it is a case study of deceit of the gravest nature. Simply put, Taoiseach, this is a national scandal. It is a national scandal enabled by a toxic culture within the HSE. Notwithstanding any inquiry, if we are to ensure that this does not happen again there must be accountability and wide-ranging change in the HSE and this needs to start at the top. Notwithstanding the fact that we do not as of yet have not only all of the information but some of the most basic information that one might expect, we know that Tony O'Brien has presided over negligence, concealment and misinformation, with the most serious consequences for women and their families and so he cannot remain on as director general of the HSE. This is the very least that women affected and their families need to see happening.
Let us be clear. This was not a communications mess-up or, as Mr. O'Brien put it, a failure to close a communications loop. This was a deliberate and devastating concealment of vital information to protect the management of the HSE and, ultimately, the State in court. Women had a medical test read incorrectly. This information was known to the HSE yet these women were kept in the dark for years, deliberately. This organisational mindset does not develop by accident; it is the product of toxic leadership. In any other walk of life, the person ultimately responsible for any such scandal would lose his or her job.
The Taoiseach is the boss and the buck stops with him. I put it to the Taoiseach, as I did yesterday, that he must remove Tony O'Brien from his post.
Deputies
Hear, hear.
I remind members that they should not comment on, criticise or make charges against persons not in the House. I do not believe that we should be an adjudicating body.
My experience, unfortunately, is that cock ups are more common than conspiracies and incompetence more common than collusion. Nonetheless, we need to restore confidence in cancer screening in Ireland and in CervicalCheck. As a result of this, there will be a statutory inquiry. We are inviting the spokespeople to meet this evening following the committee hearing this afternoon to discuss what form that inquiry will take. The inquiry will be able to establish whether the allegations Deputy McDonald makes are true, as is the purpose of any inquiry. One needs to have an inquiry before one can make findings of fact, in my opinion and, I hope, in the opinion of most people in this House.
The clinical director of CervicalCheck has already stepped down and the director, the official who runs CervicalCheck, is no longer in charge. Damien McCallion has replaced him. This means we already have individual accountability, at least, on two accounts.
Mr. O'Brien's term as director general of the HSE ends in 12 weeks' time and we are in the process of finding a replacement. We have also indicated that we will re-establish a board for the HSE to enhance accountability.
I am aware that this is an enormously difficult issue and that people are very worried about it, but we need to make sure we do not lose sight of a wider truth. Cancer care in Ireland has improved dramatically in recent years. We have better diagnoses, better treatment and better prevention. Screening does work. The incidence of cervical cancer has gone down from 14 per 100,000 in 2011 to ten per 100,000, a very significant reduction. It is about 7% per year of the number of cases of cervical cancer. Because of CervicalCheck, women are going for smear tests and screening and some 50,000 abnormalities have been identified. That is 50,000 women for whom we have been able to prevent cervical cancer or ensure they received earlier treatment and had a better outcome. It is 50,000 women whose lives, potentially, have been saved and whose treatment was instituted earlier because of CervicalCheck. We should not forget that figure. It is 50,000 women who have benefited from the programme. The biggest travesty of all would be if women were to stop going for smear tests. It is important that we get that message out to the general public.
As a woman, there is absolutely no chance of me not going for a cervical smear test. I believe this reflects the view of the majority of women who are very well versed in the necessity to care for their health and the efficacy and value of screening. The Taoiseach should not repeat that again to avoid answering the questions that have been put. He said it might have been a cock-up. That might be his view, but it was some cock-up that left women without information to which they were entitled, information that affected their lives and the medical treatment they might seek. It was subsequently kept from families when women deceased. We know of 17 women so far, but I dare say there were more. It is quite a cock-up. The withholding of the information was not accidental. It was clearly the policy and the strategy of the HSE to keep it from women and their families. How do we know this? We know it because Vicky Phelan and her legal representatives painstakingly and painfully established the facts in her case via the courts. She is not on her own and not unique.
Mr. Tony O'Brien's contract finishes in a couple of weeks. I put it to the Taoiseach as head of the Government that it is a scandal that Mr. O'Brien will be left in his post for those weeks to sail off into the sunset with a large pension and a hefty gratuity, leaving a scene of devastation, upset and trauma behind him. If the Taoiseach is serious about providing leadership on this matter and reassuring women across the State, he would do the first thing that needs to happen - to remove that incompetent man from the position he holds.
I am sorry, but I have to remind the House again that persons outside are entitled to fair procedure. It is not the role of this House to act as a body which adjudicates.
What about the women involved?
That is what is stated in Standing Orders.
In Ireland we have an 80% take-up rate of cervical screening. I really hope Deputy Mary Lou McDonald is correct and that this figure will not go down. I am, however, concerned that it will and that lives may be lost as a result. It is important that we get across the message again and again that cervical screening saves lives. In the past ten years there were some 50,000 anomalies identified. I will not be told to stop saying that; I will keep saying it because I care about women's health and women's lives. A lot of allegations have been made and they need to be investigated. I can guarantee that there will be a statutory inquiry to investigate whether the allegations being made are true. This is not just about targeting individuals or looking for heads to roll. I have mentioned that there has already been a resignation of one person who is no longer in their position. This is not about targeting one head, another head and then another. It is about the women who have been affected and their health. That is why the first and most important thing we are doing is getting a team of expert cytopathologists, led by the Royal College of Obstetricians, to look again at all of the smear tests of all of the women who have been diagnosed with cervical cancer in the past ten years. This clinical review will be carried out and done by the end of May.
I agree that the process needs time. I am happy that the Government is not going down the route of a HIQA report which was rushed into, although it was inappropriate. We do not have the facts before us. Many comments have been made on tribunals, what they cost and how they can go on. What is ignored is that tribunals come about because we do not have the facts before us in the Dáil, Members are not allowed to ask questions and when we do, we do not receive replies. I suggest the Taoiseach come back with a comprehensive report on the knowledge that he, his Minister and the Department has. We can then discuss that information in the Dáil, with a view to deciding on what is the appropriate form of inquiry.
The Taoiseach mentioned the Grace case as an a example of how long an inquiry could take. The delay was due completely to the previous Government. It was decided in February 2016 to have an inquiry, but it took until last year to set it up and a little longer again because the Government did not give the senior counsel an office from which to work.
The Taoiseach referred to Galway and HIQA. That is not what established the facts in Galway but an independent review with an independent chairperson from London who carried out a very effective inquiry. I say all of this in coming to the health board and the case of three children who were raped systematically. It was exposed on the "Prime Time" programme almost two weeks ago and has been raised by the leader of Sinn Féin and the Fianna Fáil spokesperson on health. It is concerning that we have the facts about these three women. The Taoiseach gave an answer in the Dáil and waffled on about something as serious as an independent inquiry. There will be an independent investigation. He then went on to say there was an investigation, that it had been established in April 2016 and that he hoped it would be completed by the end of this year. However, he did not have the terms of reference and knew nothing about it. The first girl made a disclosure in 2009, the second in 2011 and the third in 2013, yet the Taoiseach came into the Dáil and waffled about an independent review that would be set up or had been set up. In April 2016 the referral was made to the independent review panel. There was no explanation for how it had taken until April 2016 to be referred. There was no explanation of the terms of reference and no commitment to learn anything from the case, except empty reassurances such as the ones the Taoiseach has given to the people on cervical smear tests. He is not in a position to give reassurance, but he is in a position to give us the facts. Will he explain to the House why it took until April 2016 to refer the matter to the independent review panel? Who made the decision? Why had there been no inquiry at that point? The first girl came forward to disclose in 2009. We are now in 2018, but we have no answers for her. Before coming to the Chamber today, I took the trouble to re-read the Official Report and listen to the programme. The girl has asked what was the point of her coming out and saying what she said. Perhaps the Taoiseach might answer her today. All I want from the Government is for it to state it does not know, that it will make inquiries and that it will then come and tell us. The Dáil could then make a decision.
I appreciate the Deputy's initial remarks and her acknowledgement that we do need a little time, calm and some facts before we make decisions on this matter. It is the intention of the Minister for Health after the hearings this afternoon to call together the health spokespersons for the main parties to discuss with them the appropriate form of inquiry that should take place with reference to CervicalCheck.
On the other concern raised by the Deputy, the information I have is that the independent review panel is investigating the matters mentioned. It has not yet reported.
The Minister for Children and Youth Affairs is the line Minister. I will ask her to make contact with the Deputy and give her any information that she may seek.
That is not good enough. The Taoiseach is in charge. What knowledge does the Taoiseach have about the delay from when the first girl disclosed, the second girl in 2011, the third girl in 2013, to April 2016, when a referral was made to an independent review panel? What investigation has the Taoiseach done? What has his Department said to him? What has the head of the Health Service Executive, Mr. O'Brien, said? When was it set up? How was this the choice relating to the systematic rape of three young girls under the watch of the Health Service Executive? The Taoiseach came in and reassured us, when he is not in a position to reassure us. The committee that looked at foster care in Ireland raised serious concerns about the absence of comprehensive data. There is no way the Taoiseach can reassure us. What is the number of children in Ireland without an allocated social worker? What knowledge does the Taoiseach have of the delay? What did the Health Service Executive do internally when it discovered the systematic rape of three young children? What decisions were made? Who accounted to whom? Perhaps we would not need inquiries if the Taoiseach simply found out information and brought it to us so that we could learn, improve and give reassurance at that point.
I do not have any knowledge of it. My understanding is that these matters relating to the regulation of foster care and child protection were assigned to Tusla from the HSE in 2014, if not before that. This is a matter that falls to the Minister for Children and Youth Affairs. My Department does not have direct involvement in it but I will mention to the Minister that Deputy Connolly has raised this matter again. I will ask the Minister to contact Deputy Connolly and provide any information that she can.
Earlier this year, the Committee of Public Accounts, of which I am a member, was presented with a briefing note on the HSE's spending on legal services and its open disclosure policy. We were also told that a contingent liability of €2 billion is needed by the HSE to fund claims into the future. The briefing note goes on to say that international evidence has demonstrated that patients are often forced down the legal route to get answers, acknowledgement and apologies when things go wrong with their care. Here we are, ten years on, and a woman in the worst of circumstances has been dragged through the courts to get answers. Indeed, had Vicky Phelan not been so brave to do what she did, then none of us would be any the wiser. Even if open disclosure is in place and these issues are mediated, what assurances are there that the identified failures will be remedied for others in the future? It takes people going public and not signing confidentiality agreements to force this into the public domain. How many other scandals have fallen under the radar because someone has agreed to a confidentiality clause? At what point do these repeated failings lead to system reform? The State Claims Agency alone has the legal authority to determine the management of claims made against the HSE. On the RTÉ news last night, the State Claims Agency said that in the case of medical negligence, the agency's policy is to admit liability. That is a direct contradiction to the statement of Caoimhe Haughey of C.M. Haughey Solicitors on the same programme, who said that, in her experience, the State Claims Agency robustly defends every case and shows little or no compassion. Her comments are played out week after week when we see the HSE apologise after a settlement is made in the courts for medical negligence.
There is a litany of cases we could point to, including the one to which Deputy Connolly has drawn attention. Last week, we had the "Prime Time" programme relating to child and youth mental health services and the failures there. Do we have to continuously have high profile failures or force people to lay themselves and their personal stories bare in the media or courtroom for our systems to be overhauled? The Taoiseach was Minister for Health when the proposed legislation to make open disclosure mandatory was rejected. He made a decision to establish a patient safety office within his Department rather than the impartial office which leading health experts said was required. Does the Taoiseach accept that, in doing so, he removed any hope of true impartiality within that office and by failing to heed the World Health Organization's advice to implement mandatory open disclosure? His actions in 2014 have directly contributed to the current scandal. At the time, his now Minister for Communications, Climate Action and Environment, Deputy Denis Naughten, said that in failing to legislate for mandatory open disclosure, all the Taoiseach was doing was maintaining a lawyer's slush fund. He also described the Taoiseach's comments as absolute nonsense. Does the Taoiseach accept that he was right?
Nobody in the Government, whether me personally, or anybody in this House, wants to see sick or terminally ill people dragged through the courts. Nobody wants to see prolonged legal cases going on for years. The public does not want that either. It is not in anyone's interest. It is not in the interest of taxpayers in the long run. It is not in the interest of the health service when it comes to confidence in the health service, and it is not in the interests of patients or citizens. I have looked into this and am told by the National Treasury Management Agency, NTMA, and the State Claims Agency that 98% of medical negligence cases are settled or dropped and do not go to trial. Only about 2% go to a contested court hearing and those 2% often go to court because facts or claims are contested. There will always be a certain percentage where the facts or claims are contested. In Vicky Phelan's case, as the Deputy knows, the case against the HSE was struck out but the laboratory settled for €2.5 million without accepting liability. While there may not have been legal liability on the State, I think there was moral liability on the State to ensure that she got the information about the case that she should have got. There was a breach of duty to ensure that occurred.
How will we deal with these matters? The first thing is to ensure that more cases do not go to court at all. We can do that by building a culture of truth in our health service. That means open disclosure and many other things. Bear in mind that this is the Government that legislated for open disclosure in the Civil Liability (Amendment) Act 2017. That will be commenced before June this year. We will also legislate, as we indicated last year and in the programme for Government in 2016, for mandatory open disclosure in the most serious incidents, which are those that are considered to be serious reportable incidents. We need to reform our laws to make sure that legal cases proceed more quickly. Let us not forget that the legal profession can help with this too. Where something goes legal, there are two sides, and both sides need to work together to make sure that cases are not prolonged. We can do that in a number of ways. For example, pre-action protocols, periodic payment orders and mediation have been legislated for by this Government. In the past year or two there have been three major Acts, designed to do exactly what the Deputy says should be done, namely, the Civil Liability (Amendment) Act, Legal Services Regulation Act and Mediation Act, which were passed in the last few months. I saw an example described yesterday in the news of a case which was handled very differently, that is, the case of a young boy who had a birth injury who settled for €5 million. That was done by mediation. The sister described on "Six One News" last night how things can be and often are done differently.
On that patient safety office, I was the Minister for Health who set it up. There was not one before. When one does things, one needs to do them in a stepwise manner. It is not possible to make all reforms happen overnight but we are making those reforms happen.
When the Taoiseach says that 98% of claims are not pursued through the courts, there are many different things that can happen. People can be afraid of the might of the State and the consequences for themselves. We know that settlements are routinely made on the steps of the court. We do not know what gagging orders or confidentiality agreements hide some of what we see.
There seems to be a conflict between the approach of the State Claims Agency and that of the HSE. That conflict must be resolved because if it is not, we will continue to see cases going through the courts. The Taoiseach set up a voluntary as opposed to a mandatory arrangement, which is not yet in force. Does he regret not setting it up as a mandatory arrangement? He said that he has set up an office within his Department, rather than the independent office recommended by health experts. Why did he do that? Why was his approach the better of the two approaches? What information did he have that it would produce a better result?
These issues are not new. Over the past ten or 20 years, there have been any number of Ministers for Health and any number of Ministers for Justice and Equality, bearing in mind that this concerns justice rather than health legislation. Any of those Ministers could have acted on these matters. I established the patient safety office and-----
That is not legislation.
-----am head of the Government which brought in legislation providing for open disclosure. Any number of Ministers for Health or Justice and Equality could have done those things in the past. We are the ones who did it - the Civil Liability (Amendment) Act, the Legal Services Regulation Act-------
That is voluntary, not mandatory.
The Government also abolished the board of the HSE.
The legislation does not provide for mandatory open disclosure.
------the Mediation Act and the establishment of the patient safety office. I went through the issue of open disclosure yesterday and am happy to do so again and explain it in detail. Open disclosure and duty of candour already form part of the guidelines of the Medical Council for ethical practice by doctors.
Those are guidelines, not legislation.
The guidelines are not optional and doctors can be struck off for not following them. Open disclosure has been policy for all HSE staff since 2013 and staff can be disciplined for not following open disclosure. The decision we made - it is in the programme for Government in black and white - is to proceed with voluntary open disclosure for all errors and mandatory open disclosure for those most serious errors, what are called serious reportable errors. That is also explained. The Civil Liability (Amendment) Act supports voluntary open disclosure and puts it on a statutory footing. We enacted that in this Dáil in the past couple of months. I, as Taoiseach, led the Government that did that. People have been talking about that for ten or 20 years but this Government got it done.
It is all about "I".
The Act will be commenced by June and is designed to create a culture of truth in which doctors, nurses, midwives, scientists and others feel they can make an apology without it being seen as an admission of guilt and admit a mistake without it being used against them. We need to create a culture of truth in the health service where people operate in that space. The next step is to legislate for mandatory open disclosure of serious reportable incidents. We indicated we would do that at the time. But it is a mistake if people believe it is as simple as passing a law.
Taoiseach, we have exceeded the time.
We need to change the culture in the health service so that people change their attitudes towards these things.
Irrespective of who is speaking, be it the Taoiseach, a party leader or another Member, Standing Orders must be respected. It is now almost 12.45 p.m. and the House should have been dealing with questions on promised legislation for the past 12 minutes. I acknowledge the House has been discussing an important issue but if people are unhappy with Standing Orders, I suggest their representatives request a change to them.