Seanad Éireann debate -
Friday, 23 Mar 2007

Vol. 186 No. 15

Health Bill 2006: Second Stage (Resumed).

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

Mr. Leyden

Members of local authorities have now been deemed ineligible to be a member of this board for no reason other than they are prepared to serve the public and go before the electorate. No person is in a better position to serve on this board than someone who has the experience of serving the public in public life. In a Fianna Fáil parliamentary party meeting, I put my name to a motion to ensure this type of provision would not be included in Bills in the future. The motion was agreed unanimously and the Minister for Foreign Affairs replied to that debate and said that he would never include such a provision in a Bill that he brought before the Oireachtas. I ask the Minister of State to ensure an amendment in the name of those of us on this side of the House is tabled to remove this exemption from the Bill.

In page 55 of the Bill, it states that if a member of the board becomes a candidate or a member of a local authority, he must resign from the board. Looking at this logically, the only people excluded are prisoners and public representatives. Both are ineligible to be members of this board. I served on a local authority for 22 years and I take grave exception to this provision. I put forward my views to the members of my electorate and it would be remiss of me if I did not make this point today. As a member of the Fianna Fáil Party and the Fianna Fáil Senators' group, I will do my utmost to have an amendment tabled on this Bill.

I ask the Minister of State and the Minister to have this exemption removed from the Bill. If these representatives are not excluded, it does not necessarily mean that they will be included, which is a matter for the Minister and the particular authority. However, where somebody is suitably qualified, he or she could serve well on that board. The person could have his or her ear to the ground, so to speak, regarding the management of these homes in the region. The person could be a member of the new health consultative forum. I rest my case on that issue.

I welcome the amendment in this Bill to the Civil Registration Act 2004. It relates to marriages being conducted in a home or private dwelling for medical reasons when certified by a general practitioner. I am not sure if it applies to other institutions of the State such as prisons. Seeing that the amendment is in the Bill, it is an opportunity for the Minister to look at this from a civil rights point of view. A right to marry is something that is very special and someone in prison who wishes to marry might be able to avail of this.

This is a timely Bill. I commend the Minister of State and the Minister for Health and Children on bringing it before the House. It is very important we protect our elderly people. We have a duty and a responsibility to ensure they live in proper conditions with proper services, food and heating. This inspectorate certainly will ensure that, from now on, we will have a transparent approach to the management of private and public residential nursing homes.

Ms Tuffy

I welcome the Bill because it improves the situation in our health system. The problem with the Bill is that it does not go far enough. It does the minimum in providing for the Health Information and Quality Authority and the Office of the Chief Inspector of Social Services However, it does not go as far as it should in terms of placing patients and their needs to the fore.

What is needed is the Labour Party-Fine Gael proposal for a patient safety authority. The Minister of State will be aware that Labour and Fine Gael recently launched a policy document, Patients First, which provides for a new approach to regulating and monitoring patient care and which calls for the establishment of an independent body — the patient safety authority — with a strong legislative base. The remit of the patient safety authority would be entirely patient-focused, which is what is needed. In addition, it would bring together the various regulatory bodies and work in conjunction with other statutory bodies or professional bodies that have a regulatory function.

No one is charged at present with ensuring patient safety in our health care facilities. The difficulty with the Bill is that it makes no provision in respect of the licensing of hospitals — this would lead to their being properly inspected — or the regulation of private hospitals. There are limited avenues through which patients can seek redress for substandard care. Labour and Fine Gael's proposal for the establishment of a patient safety authority would provide people with a much needed avenue of complaint. The authority would be the patient's watchdog, it would independently review, inspect and assess the management, provision and quality of health and social care and, most importantly, it would promote human rights.

I heard a recent edition of "Today with Pat Kenny" and I was extremely impressed by an interview given by an Irish priest who had come home to Ireland on holiday. What he said echoed much of what I hear when I knock on doors and talk to people about the health system, the issue of MRSA, etc. While the priest to whom I refer was in Ireland, his sister fell ill and had to be admitted to hospital for treatment. When in hospital, she unfortunately contracted MRSA. Following her treatment, the woman, who was only in her early 60s, passed away. The point the priest made to Pat Kenny was that there is a great deal of talk about charity in this country but he asked what is the position as regards people's fundamental rights. He stated that the most vulnerable people in society are those who require hospital treatment. These individuals have a right to receive the best care. They also have a right not to emerge from hospital with their health in a worse state than it was when they were admitted. It is not acceptable that people are dying because their health deteriorates following a stay in hospital. We must do whatever we can to eradicate MRSA from our hospitals. Other countries have done so and we have a duty to follow suit.

One of the duties of the patient safety authority proposed by Labour and Fine Gael would be to carry out regular external hygiene audits and ensure that hospitals have effective cleaning procedures and follow good hygiene practice. Members of the public are of the view that hospitals should be clean. People believe — they are right — that hospitals used to be cleaner in the past. I have not had a huge amount of experience of hospitals. However, I am aware that hospital toilets are often dirty. In fact, they are dirtier than those one would see in many other public places. I once had to visit hospital late at night and was obliged to provide a urine sample. I went into the public toilet in the hospital but there were no lights on other than those used to deter heroin users. I could not see what I was doing, it was not possible to close the door and the toilets were dirty and could not be flushed. Needless to say, I did not have a very good experience.

There has been much negative publicity about maternity units in recent times. The Evening Herald has been running stories on the matter and printed a letter from a patient in the Rotunda who had the unfortunate experience of miscarrying. I am of the opinion that if one visited any of our maternity hospitals, one would find other women with similar stories to tell. Even though quite a few people have miscarriages, many of them do not discuss their experiences with others. The woman to whom I refer who wrote to the Evening Herald did so anonymously and later others came forward with similar stories.

When one enters hospital to give birth, the overall experience, particularly if one has a healthy baby, is good. The only occasion on which I was obliged to stay in hospital was when I gave birth. I had many good experiences while there but I was also unhappy with certain aspects of my stay. Some of my disappointment related to problems with hygiene and the remainder related to how I was treated by particular members of staff, etc. Hospital authorities — particularly those in maternity hospitals — should consult patients after their stay in hospital and inquire with regard to what was good and bad about their experience and where they think improvements might be made. To my knowledge — it certainly did not happen to me — hospital authorities do not engage in such activity.

A recent study carried out by obstetricians in which maternity services were evaluated and in which patients who had experience of such services were surveyed indicated a great deal of dissatisfaction regarding the quality of care in our maternity hospitals. Issues arise in respect of how people are treated in hospital, including those who are admitted to have babies. Hospital authorities must be much more proactive with regard to discovering what is wrong with the services on offer, what needs to be improved, what are the good things, etc. I am not saying that it is all doom and gloom in our hospitals but there are problems that need to be addressed. The patient safety authority would be one forum through which this might be achieved.

I hope the Health Information and Quality Authority will carry out the type of research to which I refer. The Minister of State indicated that the authority will carry out investigations on its own initiative into safety, quality and standards of services where it believes there is a serious risk to the health or welfare of a person receiving services. In my view it should go much further than that and carry out surveys among patients who access services in different parts of the health system and discover where problems exist. People do not necessarily complain about inadequate services because they might perhaps be satisfied with the overall level of care they receive. I hope the Health Information and Quality Authority will be proactive in that regard and will try to discover what needs to be done. The most obvious avenue it should explore first is what needs to be done to improve maternity services.

The majority of those who work in the health service are good people and they do a good job and work very hard. In many instances they operate under pressure, particularly in circumstances where the proper resources and staffing levels are lacking. Such issues must be addressed. It is important that patients should be placed to the fore in the context of the health system. They should be treated with dignity and respect and should be able to have their say on how the health service should be run. This is not the case at present within the health system but provision should be made to bring about that which I am suggesting. I do not know whether it is the fault of individuals or the system but when one is admitted to hospital, one is often treated as almost sub-human. It is almost as if one does not have the same rights as one had before entering hospital. This relates to the overall focus of the health system. We introduced patient charters in the past but I do not believe we have gone far enough. We must put the patients to the forefront of the health system so that they are the primary people in the health system. It is important that all the different interests have their say, are respected and get proper resourcing, but the patient is the most important person in the health service and we must ensure that is so in future.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

I thank the Senators for the broad welcome they extended to this legislation. Although Senator Coghlan was careful to point out his party had a distinct philosophical position on the legislation,——

Mr. Coghlan

I ask the Minister of State not to shoot the substitute.

Mr. B. Lenihan

——most Senators recognised the need for legislation of this character.

Senator Coghlan referred to the scourge of MRSA. Of course, the authority will set standards on safety and quality in health care and, as part of that function, has been asked to address the issue of MRSA.

Senator Coghlan also raised the question of whether mental health services could be included in the legislation, but the view the Minister took was that it would be inappropriate to include mental health services in view of the establishment of the mental health commission and to give HIQA a role in these services would give rise to confusion as to what organisation was responsible for the mental health services.

Health technology assessment was also raised by Senator Coghlan. Clearly, health technology assessment is important and a critical part of HIQA's functions is to promote quality care. The role of HIQA here will be to support evidence-based decision-making and the availability of expert evaluation of health technologies will be a valuable resource for the HSE and for service providers. HIQA adds further value to the health chain by having an advisory function in that regard. That role in health technology assessment will be important in the future and I appreciate why Fine Gael has raised this issue because health technology assessment is widely regarded as able to deliver succinct, high-quality and trusted evidence to decision-makers at all levels of the health care system.

It is envisaged that the HIQA health technology assessment function will support those evidence-based decisions and that the availability of impartial evaluations of the clinical value and cost-effectiveness of complex health technologies, including drugs, would be very valuable for service providers, health care practitioners and policy-makers. The role of HIQA in this context will be to advise the Minister and the HSE in this regard.

Senator Glynn warmly welcomed the Bill and made the point that the Government is responsible for legislation and for the overall funding allocated to the HSE, but of course operational decisions on matters are the responsibility of those who carry them out. As we approach the next few weeks when there will be a great deal of debate about the quality and fairness of the health service, it is a point worth making in the public debate that the Minister for Health and Children presides at the top of a pyramid, which employs in excess of 100,000 persons and which is involved in the expenditure of over €15 billion. Clearly, critical responsibilities exist at every level of this system.

Senator Henry was anxious to inquire as to how quickly and effectively the Bill would be implemented. The interim HIQA was established in 2005. That body already recruited a chief executive officer and recruitment of the other staff is being undertaken, and the existing staff in the Irish Health Service Accreditation Board and the Social Services Inspectorate will join HIQA on the establishment day. Clearly, a considerable amount of work has already been done. The health technology assessment was also raised by Senator Henry and I restate the point that of course the function here is advisory in character to the HSE and to the Government.

In carrying out its functions HIQA must co-operate with other public authorities and this would include the Health Research Board. That is quite clear from section 8(2)(b). The Bill, therefore, gives wide scope to HIQA to carry out work with other bodies.

Senator Henry also raised the question of the patient safety commission. Legislation will be required to implement the licensing of hospitals and health facilities, either by way of new legislation or by way of an amendment to this legislation, depending on the recommendation of the patient safety commission.

Senator White raised the important question of enforcement. Clearly, this new independent inspection system established under the legislation will ensure that regulations and standards in designated centres will be enforced.

Senator Leyden turned to the important question of the inspection system, that it now covers both public and private nursing homes. I agree with him that a critical feature of this legislation is that it applies equally to both. He also referred to the licensing of homes and, as I stated earlier, the question of licensing is being addressed by the patient safety commission. Depending on what the commission recommends, we must make a decision as to whether to amend this legislation or introduce separate legislation to deal with it.

Senator Leyden also raised the question of the membership of members of local authorities of boards such as the one established in this legislation. He stated that it is an issue about which he has had considerable concerns for a period of time and despite receiving some favourable assurances from a member of the Government, the matter does not seem to have been followed up at the drafting level where the standard clauses are being introduced. I will draw the attention of the Minister to this matter. Senator Leyden indicated he may well table an amendment to the Bill in this connection.

Senator Tuffy raised the question of redress for substandard care. A new complaints system was established by the 2004 Health Act and it was brought into operation at the beginning of this year. It provides a statutory system for making complaints and seeking reviews on a wide range of issues other than clinical decisions and actions. Complaints about clinical decisions and actions are dealt with by the professional regulatory bodies such as the Medical Council in the case of doctors and the analogous bodies in nursing and pharmacy. The position on attitudes is that a complaints framework can provide for dealing with complaints issues such as staff attitudes and hygiene.

The Bill is an important part of the health reform programme introduced by the Government. There are those who will argue the Bill does not go far enough, but we must be practical and look at what has been worked up within the system. Looking to the future, the authority established by this system will provide a valuable external audit on an area which, as I stated at the beginning, involves the expenditure of a significant amount of public money and the deployment of a considerable number of personnel. It is important in considering legislation of this type that we appreciate that fact and, given the amounts involved, that we put in a system of external evaluation such as is envisaged by this legislation. I thank the Senators for their help in the debate.

Question put and agreed to.

An Leas-Chathaoirleach

When is it proposed to take Committee Stage?

Mr. Dardis

On Tuesday next.

Committee Stage ordered for Tuesday, 27 March 2007.