Dáil Éireann Debate, Tuesday - 12 July 2016
10. Deputy Maureen O'Sullivan asked the Minister for Health his views on whether proper protocols were followed in a case (details supplied); and his and the Health Service Executive's plans to amend guidelines and best practice standards to ensure persons at risk are dealt with promptly. [20612/16]
View answerThere are two aspects to my question, one of which relates to a particular individual. Because of what happened to the individual, the question is whether there is a need to amend the guidelines and best practice standards in order to ensure what happened to this individual will not happen to somebody else and that cases such as this which involve people at very high risk are dealt with more efficiently and promptly.
While it is the policy of the Health Service Executive not to comment on individual cases, I can confirm that the circumstances surrounding the case referred to by the Deputy are being examined by the HSE. On the specific issues raised by the Deputy, I am advised by the HSE that quality and patient safety are the responsibility of all staff and core to service provision across primary care services, including addiction services. The HSE addiction service is working towards implementation of the HIQA National Standards for Safer Better Healthcare, which provide for a strategic approach to improving safety, quality and reliability in national health services.
Services providing opioid substitution treatment operate from relevant clinical management guidelines and protocols, including the UK National Institute for Health and Care Excellence guidelines on methadone and buprenorphine for the management of opioid dependence, the relevant Irish College of General Practitioners guidelines and the national drugs rehabilitation framework. In line with these guidelines, the ongoing treatment of an individual involves regular assessment of risk and appropriate responses to any identified risk.
Arising from recommendations made in the introduction of the opioid treatment protocol of 2010, a clinical guideline for opiate substitution treatment has been drafted by a HSE-led committee which includes clinical expertise. These are the first national guidelines that specifically relate to opiate substitution treatment in HSE clinics and primary care settings. The guidelines are under consideration by the quality improvement division of the HSE and expected to be finalised shortly.
A national hospital discharge protocol for homelessness has been approved. The aim of the protocol is to ensure clear procedures are in place between health services, local authority homeless action teams and the voluntary sector. It is important that all discharges from acute and mental health care services of persons experiencing homelessness or at risk of homelessness are planned in order that the necessary accommodation and supports will be in place prior to discharge.
I thank the Minister of State. I have been trying to pursue the case for 18 months and obtain information. The answer I kept getting was that the services did not know where the person in question was. There is no doubt that the person was on a significant downward spiral and that her life was at major risk. However, she was attending various services, sometimes with extremely chaotic behaviour, for which I allow. She was in the care of the HSE from when she was aged under 18 years. Her two children were also in the care of the HSE. Given that she was registered as homeless, there were default addresses for her. She was attending a methadone clinic, a needle exchange clinic and her family doctor in Dublin 8. She was a regular patient at St. James's Hospital and James Connolly Memorial Hospital in Blanchardstown. She was in contact with her solicitor and although her solicitor was in touch with the HSE, it did not contact the solicitor to try to find out exactly where she was. Although nothing will bring her back, there must be reassurance that all measures were taken that could have averted her death. While there will always be questions of "what if" and "if only", her family needs to know that they have been covered and it needs the information.
As stated, this is being examined by the HSE. I understand the Deputy's frustration because I read some of the other notes on the case. Deputy O'Sullivan is right in that the person in question was receiving services in different centres throughout the city. Unfortunately, my reading of it is that she fell off the radar. There are certain circumstances surrounding this case that need to be examined. I hope the Deputy will be find it acceptable if I tell her that I will pursue it again with the HSE to try to get a further sense of the issues and of what exactly happened to this person. It is a very sad case.
I thank the Minister of State and note that I had a call from the HSE on this matter. It is important that we learn from this case. The lesson is about joined-up thinking. There has to be cohesion between HSE addiction services, The Drug Treatment Centre Board, primary care and homeless services, the family, and, if involved, the solicitor, particularly if it is a person who is at high risk and everyone knows it.
There is probably a need for a centralised database because people can go from one primary care area to another. There should be a record of where exactly they are to avoid confusion between the various areas. I accept this person was chaotic and moved about considerably. However, I believe - as I know the Minister of State does too - there is a possibility of recovery in every person who is in addiction. All the policies, plans and strategies sound great on paper but it is only when they are applied to a particular person that we see if they are working, can they work and where we need to go.
