Private Members’ Business

Patient Safety: Motion (Resumed)

The following motion was moved by Deputy James Reilly on Tuesday, 29 June 2010:

That Dáil Éireann:

noting with concern:

that to date the Health Service Executive, HSE, has received almost 300 telephone calls from concerned women and their families about the treatment received in maternity hospitals around the country;

that to date approximately a dozen women have come forward with stories of having been wrongly told by maternity hospitals that their babies had miscarried, only to give birth later to healthy infants;

the failure of the Minister for Health and Children, Deputy Mary Harney, to take direct action on the miscarriage misdiagnosis scandal and to alleviate the concerns of many families facing the trauma of having their case reviewed;

that six months after Melissa Redmond's erroneous scan, the ultrasound machine at the hospital was still in use;

that a review carried out by staff at Our Lady of Lourdes Hospital, completed last December, found that the ultrasound machine displayed ‘evidence of fatigue' and that the image resolution was ‘not adequate to accurately assess early pregnancies and their complications';

that people's trust in the HSE has been shattered; and

that too many families have lost loved ones through various scandals that have emerged in our health services such as those in Portlaoise, the north east, Cork, Limerick, Galway and Ennis in recent years;

recognises the urgent need for the Health Information and Quality Authority, HIQA, to conduct an audit of antenatal and maternity services including the standard and safety of equipment, staff workloads, care protocols and training of personnel; and

calls on the Government to establish a dedicated independent patient safety authority, which will incorporate HIQA, to:

reassure patients that they have a safe place to go with their complaint;

act as an advocate for them; and

ensure that investigations take place when and where appropriate.

Debate resumed on amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"expresses sympathy with any woman who has been affected by misdiagnosis of miscarriage;

recognises that Ireland has achieved, and is maintaining, very high quality maternity services and has, by reference to international standards, maternal, perinatal and infant mortality rates that are among the lowest in the world;

welcomes the key actions that have been taken to address the issue of misdiagnosed miscarriages including:

the fact that the Chief Medical Officer of the Department of Health and Children and the director of quality and clinical care in the Health Service Executive, HSE, have jointly written to all obstetric units advising them to ensure that the decision to use drugs or surgical intervention in these circumstances must be approved by a consultant obstetrician;

the HSE's announcement of details of a miscarriage misdiagnosis review team, and its terms of reference, including the appointment as chair of an independent expert from outside the jurisdiction; and

the establishment, earlier this year, of a clinical programme for obstetric care by the HSE's national director of quality and clinical care which will define best practice care for early pregnancy loss and other aspects of obstetric care;

welcomes the actions that have been taken by the Minister for Health and Children, with the support of the Government, to improve the safety and quality of care for patients across the broad spectrum of health service activity including, in particular:

the establishment of the Health Information and Quality Authority, HIQA, as an independent authority to drive continuous improvement in Ireland's health and social care services; and

the work being done to implement the recommendations of the commission on patient safety and quality assurance;

recognises the effectiveness which HIQA has already demonstrated in carrying out its role as a regulatory authority, which already incorporates the role of a patient safety authority;

endorses the Minister for Health and Children's intention to bring forward legislative proposals that will include the mandatory licensing of private and public hospitals and welcomes, in this regard, the preparations currently being made by HIQA to initiate an early public consultation on draft national standards for better, safer health care; and

supports the other reforms currently under way to improve the quality and safety of our health and social care services including the introduction of competence assurance under the provisions of the Medical Practitioners Act 2007, the promotion of clinical leadership and the development of national care standards and protocols."

—(Minister for Health and Children).

Deputy Kathleen Lynch

I thank Deputy James Reilly for tabling the motion. Every second week, the health service seems to be the subject of a Private Members' motion, other type of motion or debate. I am not certain how long we can continue on this track. I am not certain people will stand for the type of rollover crises we experience in the health service virtually on a weekly basis. Given that the people who work in the health service such as gynaecologists, doctors, paediatricians, nurses, lab technicians or radiologists are all incredibly well qualified and dedicated people, one would ask why these things are continuing to happen. It is basically because there is no direct focus on management of the health service by the HSE.

Tonight's motion on patient safety arises as a result of the misdiagnoses of potential miscarriages. Most women understand that reproduction goes to the core of what we are. We may have some philosophical idea about why we are here. Some people may say it has a religious aspect to it. However, at the core it is about reproduction, which is why it is such a sensitive area and why women feel so deeply personal about it. I am sure, as I have done, all public representatives, male and female, have met many women who go to enormous lengths to have a child, including all sorts of fertility treatment. Even at the point when her specialist tells her nothing more can be done, she persists and continues because at the core our need to reproduce is fundamental to what we are.

We must consider the circumstances that bring us here tonight, which are that several women who were pregnant were told their babies were dead and that they would need to undergo a D and C to terminate the pregnancy. Only their gut instinct — I am a great believer in gut instinct — told them to seek a second opinion. Each of them then discovered she had a viable baby, who went on to become a healthy fully functioning human being. Any woman who has had such a diagnosis and went on to have a D and C must now be questioning that entire procedure. In 99% of the cases the diagnosis would have been correct. However, nomatter what we do, we will never reassure those women that what happened was right in their case.

I recently had cause to visit my GP to seek a referral to a different specialty. I asked to go to a particular person. My GP said "Why not Dr. Murphy?" I said that I just did not have great faith in him. He said that if I had lost faith in a doctor then I should change doctor. My GP was very quick in telling me that because he is a good GP and he recognises the person in the round. If the entire nation has lost faith in the health service, something is seriously wrong. It is not that we do not have good doctors, nurses, clinicians and specialists in every area. So why have the people lost faith in the health service? We have lost faith because of the continual almost rollover crisis I mentioned earlier. We need to carry out some research into what it would take to bring back confidence in the system. One thing it would take would be to ensure the machinery these people use is working and that there are second checks on virtually every important decision.

We also need to look at the elephant in the room, which is the two-tier health system. We have a private health service that covers a narrow range of functions, but operates magnificently. The only way for that private health service to operate well is by ensuring that the public health service does not operate as well. Why on earth would someone opt for private health care if the public health service was as good? People would not do that. They would go to the service that operates well and gives the treatment they need, and they would have confidence in that treatment. However, in the event that the public health service is not operating as it should and the perception is that the private health service operates better, people will naturally go to where the service is better. Why are we not taking a serious look at the fact that we have had a two-tier health service that does not give the type of service that is required? The amazing thing is that this service is provided to the least well off in our society. Do we allow it to continue because it is regarded as acceptable to treat people who have lesser means in that fashion? If that is the reason, we as politicians need to seriously consider what we are doing and need to carry out a fundamental review of how we deliver our healthservice.

I believe three women, who were incorrectly told their pregnancies were not viable, have come forward. I am sure other women have had the same misdiagnosis and sought a second opinion. They have probably not come forward because they are thanking their lucky stars that they went with their gut instinct and decided to seek a second opinion. How will we convince people that we have a health service in which they can have confidence? That is the Minister's job.

To convince people that they can have confidence in the health service it is incumbent on the HSE to ensure we do not have the types of crises we have now. We have had the cases of Susie Long and Rebecca O'Malley. We can all name them and it goes on and on. No one is accountable. Every report we get into such crises firstly must go to the person who ultimately was responsible so that he or she can whitewash out his or her name so that he or she is not in some way held liable for what happened. When will we grow up and put a tag on such people identifying them as responsible and needing to be monitored in what they do from here on in?

If we continue in this fashion the system will continue to rumble on and continue to have crises. We will continue to have misdiagnoses whether they be in miscarriages, breast cancer or bowel cancer. We need to be adult about this. We have a health service that can function properly provided that people are made responsible for their actions. That is the only way that we will instil confidence in the delivery of health care. If the Minister does nothing else she should take a serious look at the two-tier health system that has been allowed to develop and the reasons the public health service is not as good as the private one. If she does, she will be remembered as Noel Browne is remembered.

Deputy Margaret Conlon

I wish to share time with Deputies Dooley, Fleming, O'Rourke, O'Brien and O'Connor.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Deputy Margaret Conlon

I will reiterate some of what Deputy Kathleen Lynch said. For any of us women fortunate enough to have had healthy pregnancies and deliver healthy babies, it is a life-changing experience. The other side of the coin is the traumatic experience for those who have had miscarriages. It can be very distressing and sad for such people and mistakes should not have happened.

Women build up very personal and intimate relationships with their doctors and obstetricians and rely on these professionals to guide and reassure them and to answer their questions. Women experience significant physical and emotional changes when pregnant and they need to be reassured and have confidence in the medical professionals with whom they deal. The day when women presented to a doctor — be it an obstetrician, gynaecologist or another medical professional — and listened without asking a question or saying anything is long gone. We should thank God for that. In most cases those professionals were men — this is not to show disrespect to them — but they thought they were God. I recall the story of a lady who was worried because she felt she was having a miscarriage. She presented to an obstetrician and explained her concerns, as she had already suffered a number of miscarriages. The obstetrician said, "My good woman, if you were on a plane going somewhere would you go up to the pilot and ask him if he knew how to fly the plane?" I wondered who he thought he was, and how dare he speak in that manner to any woman seeking reassurance. Thank God that attitude has changed and women are now asking questions and seeking the reassurance to which they are entitled.

I had my babies in Our Lady of Lourdes Hospital in Drogheda and the treatment, care and attention I received was second to none. I know many people who had similar experiences. However, I know some people who did not have such happy experiences. That the hospital is now introducing a requirement for a second scan when a miscarriage is initially diagnosed is to be welcomed and perhaps it should always have been the practice. A decision on drugs or surgery must be signed off on by a consultant obstetrician, another welcome decision. I echo Deputy Kathleen Lynch's comments. Women have a gut instinct for when something is wrong and if there is a doubt, they should seek a second opinion.

Unfortunately, medicine is not an exact science; human errors occur and mistakes are made. As the Minister said last night, many years ago misdiagnoses and mistakes were covered up and swept under the carpet. People were afraid to speak out, which was not right. We must ensure we have expert clinical examination in all hospitals to reduce the element of misdiagnosis. It is not something unique to Ireland; it happens the world over but we must reduce the risks to patients.

Since I came to the House there have been many debates on health matters. Every time we have one, the finger is pointed at the Minister and questions are asked as to why she acted in such a way. We should be clear that the Minister is not reading X-rays, doing ultrasounds, looking at scans or diagnosing conditions. Where there are errors which are highlighted and brought to her attention, measures are put in place to correct them. We must put in place protocols to ensure they do not happen again and patient safety must be at the heart of everything we do.

We can be critical of the HSE — I have been known to be critical of it — but I welcome the setting up of the HIQA. People agree that it is working well and independently setting standards, monitoring and enforcing them and ensuring they are implemented. I also welcome the legislation on whistleblowing introduced a number of years ago. For far too long people were afraid to do this and there is an onus on people working in the health profession in this regard. If there is something wrong and a person sees an action being taken in an incorrect or unsafe manner that puts patients at risk, there is an onus on that person to report it. There must be protection for such a whistleblower. I agree with Deputy Flynn's comments last night that an audit of machines should be carried out to ensure they are working properly. After a number of years a car must go through the national car test and why should machines being used to diagnose conditions be any different?

I will conclude by expressing my sympathy to those women affected by the misdiagnoses and who endured unnecessary trauma and upset. The Minister is committed to patient safety and will continue to place it at the heart of her work.

Deputy Timmy Dooley

I welcome the opportunity to contribute to this debate. At the outset I express my sincere sympathies to all those affected by the recent revelations; not just those about whom we have heard but those who continue to suffer in silence. There are some who will never find closure because there is no effective methodology to provide such people with the ultimate answer to the hanging question arising from what we have come to learn in recent times.

All these incidents are serious and they must be treated as such. They are extremely distressing for prospective parents and extended families. Deputy Conlon spoke about the trauma of so many people who yearn for a family and are unable to conceive for various reasons. We have heard about this in the debate on foreign adoptions and the distress, trauma and pain that such desire can inflict on so many people. Adding the complexities associated with miscarriage where there could have been a family for prospective parents, one can understand the distress and pressure that will exist forever in some cases. There is no resolution in such a case. I compliment the Minister and the Department on what I believe is an effective methodology to deal with this crisis. The miscarriage misdiagnosis review team has been set up and we look forward to a report being published within the next six months. As I stated at the outset, this will not provide the answers but I hope it will provide enough information and insight into what happened so that we can devise a system that ensures not just patient safety in future but, more importantly, patient confidence in the system.

I was taken to some extent by what Deputy Kathleen Lynch said about confidence in our health system and equipment, as referred to by Deputy Conlon. There should be overall confidence in the health system. I am bemused by some people in the Opposition who speak about needing to build that confidence but who continue to come to this House on an ongoing basis and for political purposes seek to highlight a particular issue, not accepting that there is a standard across international best practice recognising that mistakes are made and are an inherent part of the health service. I do not refer specifically to Deputy Lynch in this regard.

I was taken by recent comments by Professor Tom Keane, who has moved on from his role as head of the national cancer strategy. He has developed a very successful model for cancer treatment and care in Canada but never had to go before a parliamentary committee there. There was never a question in the Canadian Parliament on the work he did and never was there a continuous politicisation of cancer care. This case is slightly different but if we are to build confidence in the mind of the public we must put away the political sword and build confidence, although recognising that mistakes will be made. We seek through general political dialogue to deal with issues within our control rather than outside it.

There is also an emerging trend where medical professionals want to work in areas that do not lend themselves to becoming involved in diagnosis because of the potential for mistakes and to be pilloried in society. We have seen this with anaesthesiologists, those reading scans and involved in various other such areas. While it might appear correct to be upset in this House about an issue we must be careful not to undermine confidence in the system or prevent professionals involving themselves in cases in the future.

Deputy Seán Fleming

I welcome the opportunity to speak on this important motion. I am pleased to support what has been said by the Minister and my parliamentary colleagues during the debate so far. It goes without saying that we must first express sympathy with any woman affected by the misdiagnosis of miscarriage. Most of us who saw the various reports on television in recent weeks were immediately affected by it. I believe they struck a chord with every family in Ireland.

I am pleased that the HSE has moved quickly on this issue and has been in contact, through its chief medical officer in the Department, with all clinical care units throughout the country to ensure the decision to use drugs or surgical intervention in such circumstances is in future approved by a consultant. I welcome the establishment of the misdiagnosis review team, the make-up of which I will comment on later in my contribution.

I believe the establishment of the Health Information and Quality Authority has provided assurance for the public in respect of the Health Service Executive. While it has been in existence for only a short time it has made its mark. HSE staff are at the front line in terms of service delivery. While I initially queried the need for a group to check whether the HSE is doing its job properly I now believe that the Health Information and Quality Authority, given its independence, was a good idea. The authority has the power to make recommendations and is often uncompromising in this regard. People often query the reason we must implement all that it recommends. However, the authority is acting in the best interests of patient care and has no other agenda. Its independence is to be welcomed and encouraged even though on occasions this makes life difficult for individuals within the HSE. I am happy that work on implementation of the recommendations of the commission on patient safety and quality assurance is ongoing.

The terms of reference of the misdiagnosis review team were set out on 17 June, which was prompt. In terms of the make up of this team, I want to refer in particular to a lady, Ms Caitriona Molloy of Patient Focus, who is the general public interest representative in the management of this incident. While I do not know this woman's background, I am pleased one of the members of the misdiagnosis review team is a person whose sole responsibility is patient focus. The review team has much to do in terms of its look-back over the past five years. I am pleased it will investigate cases, seek to determine the causes and responses to the cases and make recommendations as required, which is important.

When something goes wrong in a hospital the first policy of the Health Service Executive is to deny it happened and to not provide information or allow people access to their files for fear of litigation. It should instead seek to be fully open and frank with patients because not doing so results in a much bigger problem and often leaves people believing there is a conspiracy to hide information from them. Where an accident or misdiagnosis occurs it is important first that a lesson is learned and second that the person is dealt with in a humane manner. What has been happening in the HSE up to now is that the corporate shutters have been pulled down to deny all liability. That is my biggest gripe with the HSE.

An Leas-Cheann Comhairle

I am loth to interrupt the Deputy but Deputies Darragh O'Brien and Charlie O'Connor are listed as Deputies with whom Deputy Conlon is sharing time. I assume they will be turning up to make their contribution. Deputy Mary O'Rourke is listed as the next speaker and there are 15 minutes remaining in this slot.

Deputy Seán Fleming

I will not run over time.

An Leas-Cheann Comhairle

The Deputy has one minute remaining.

Deputy Seán Fleming

I am sure Deputy O'Rourke has important points to make and as such I will not run over time. I will concentrate in my final minute on a point I have made previously. I have had to deal with many traumatic issues during my time as a public representative. While I have not had to deal with large volumes of cases I have had to deal with some cases involving serious issues which upset families and, in particular, women. These people were upset by the denial, lack of information, cover-up and failure of persons in the medical field to come forward to back up their original instincts. I welcome that a member of the review team is a person with patient focus. I look forward to its input.

Deputy Mary O’Rourke

I welcome the opportunity to contribute to this important debate. I am glad the Fine Gael Party tabled this motion which provides me with an opportunity to speak on this issue.

When news of this issue broke one immediately felt a rush of sympathy for the women to whom this had happened. Like Deputy Kathleen Lynch I too believe there are many women throughout the country who are wondering if this happened to them or who feel quite sure it happened to them. Any woman of my age will recall when such matters were part and parcel of everyday life. One is immediately suffused with sympathy for women who endured this trauma or who remain perplexed wondering "if" or "Could it have been so?" This would be particularly acute where a woman had not had other children or, perhaps, a child of a particular sex. It is a sad story. The women and, perhaps, men involved are I am sure wrought with sorrow at what happened to them.

Deputy Conlon stated earlier that there were women who shouted "Stop, I think I am still pregnant; I know I am still pregnant" and who demanded somebody listen to them. One woman attended a third specialist for a scan which showed her baby had not been miscarried. I am sure she and her husband or partner were thrilled and delighted to learn the baby they had conceived had not been miscarried. What that woman did took some guts.

Deputy Conlon was correct when she said that there was a time when whatever one's gynaecologist said was considered gospel. One just listened, bowed one's head and was glad to have such a noble person, always a man, to guide one through the labyrinth path to child birth. One always believed one was a lucky soul to have such a wonderful man — I was lucky as I am sure were other women so there is no point putting down all men — taking care of one's gynaecological explorations.

I am taken by the fact that maternity services in Ireland are, by international standards, of high quality. Maternal prenatal mortality and infant mortality are low by comparison with other jurisdictions. Women can be satisfied and confident, as they come to use this service and move through their gestation period that they are operating in an environment which is by international standards safe and sure.

Questions were raised in the House this evening in regard to the role of the Health Service Executive. I accept there are many great people in the HSE who provide a really good service. I am sure that at a local or regional level we all know some of them. However, the HSE is too large to manage. When issues such as this arise people immediately blame the HSE, which is unfair in terms of the good service it provides. Its name does not instil trust in people, perhaps because it is too vast as an organisation. Although we all had trouble with the old health boards — people used to complain about specific boards — at least we used to be able to deal with local people at specific locations.

I hope we will never again have incidents like those mentioned in the motion that has been tabled, which we have had an opportunity to discuss. I do not think we will. Women should never again have to feel they have been dreadfully sort-changed in some way. I applaud those who came forward with good and bad stories. The good stories were uplifting, especially when they were accompanied by delightful photographs of children between the ages of two and five, who are here by the grace of God. I salute the character of those women who pursued their correct suspicions that they remained pregnant.

Deputy Darragh O’Brien

I am pleased to have an opportunity to speak on this motion. All of us will agree that the cases which have emerged in the media — those of Melissa Redmond and other women who were incorrectly diagnosed as having miscarried — have led to a great deal of anger and fear and caused many questions to be asked. My heart genuinely goes out to Melissa and the other people who have endured such traumatic experiences. Like many other Deputies, I commend Melissa on following her own instincts and, most importantly, helping to publicise this matter. The news of this case will have caused great upset to women who have recently suffered miscarriages. I do not doubt that some women are now second-guessing the medical treatment they received and wondering if their miscarriages were also misdiagnosed. In recent weeks, people in my family have questioned the advice they were given. That is not a good position to be in.

I understand the helpline that was established in the wake of these revelations has received over 350 calls. Given that over 70,000 children are born in Ireland every year, it is clear that these cases do not represent the experiences of the vast majority of pregnant women in this country, thankfully. As Deputy O'Rourke said earlier, we have high-quality maternity services by international standards. Our rates of infant and maternal mortality are low by comparison with other countries. Approximately 20% of confirmed pregnancies end in miscarriage in the first 12 to 14 weeks. The 14,000 miscarriages that take place in Ireland each year are hugely distressing experiences for women. Early pregnancy units are in place to provide care for women who experience pain or complications in early pregnancy. I hope we will not be in this position again in a number of years' time. Serious lessons need to be learnt from this case. We are talking about the lives of children and the physical and mental well-being of mothers and their partners or husbands. While this issue relates predominantly to mothers, obviously, prospective fathers have also had to deal with great upset over recent weeks.

The Oireachtas needs to ensure that standards and procedures are in place to ensure this never happens again. The HSE and the Department of Health and Children have agreed that a series of measures will be put in place to that end. The miscarriage diagnosis review team, which was alluded to earlier by Deputy Fleming, will look back at cases in which a diagnosis of miscarriage was made in error over the last five years. It will also seek to determine the causes of such cases, examine the responses to them and make recommendations to Dr. Barry White, who is the national director of the HSE's quality and clinical care unit. The team's report will be published to ensure full openness and transparency. As Deputy Fleming said, it is important that there is a strong patient focus in this regard. We need this process to be as open and transparent as possible to ensure people are satisfied that what happened in these terrible cases of misdiagnosis can never again happen on such a widespread basis. I will not go through the steps that have been taken by various Governments to improve services over the years. I am sure all Members of the Oireachtas are keen to extend their sympathies to the women and families who have been affected by this matter. We need to make sure it does not happen again. I do not see this as a politically divisive issue — it is about life, children, mothers and families. I hope the review team's work ensures that as this House moves on, it will never again be in a position to have to discuss such a terrible situation.

Deputy Charlie O’Connor

I welcome the opportunity to make a brief contribution to this important debate. It is my tradition on these occasions to compliment the Deputy who moved the original motion. In this case, it was moved by my former health board colleague, Deputy James Reilly. As others have said, he has given us an opportunity to express our support for those families which have been affected by this news. I listened carefully to the thoughtful address on this issue that was made by the Minister for Health and Children in the House last night. I join the Minister, Deputy Mary Harney, in sympathising with the various families.

I listened carefully, as I always do, to the speech that was made by my colleague, Deputy Mary O'Rourke. As she expressed her views, which I do not contest, I was reminded that one of my sisters had several miscarriages before she had her four children. It is good to draw on such experiences during a debate of this nature. Members might be interested to know that my local newspaper in Tallaght, The Echo, published a heart-warming story two weeks ago about a young woman I know well, Olivia Blanch-Dunne, and her two year old daughter, Ciara. The front page headline used by the newspaper was “They told me my baby had died” and the headline used inside the newspaper was “Birthday joy for ‘dead baby’ Ciara”. It is an amazing story. Anyone who is not affected by these issues is not in the real world. I do not know the people who were involved in the first story that was broken in this case. I know the young woman in my constituency whose case I have mentioned.

As a Member of the Oireachtas, one is often affected by things that come to one's notice. As Deputy Darragh O'Brien said, it is important to support this situation. We could have a long debate about the HSE, which was mentioned by Deputy O'Rourke. I have views about where the HSE has come from and where it has gone. Like many Deputies, I come from a health board background as a former member of the old Eastern Health Board. Before I became a Deputy, I was the founding chairman of the old South-Western Area Health Board. I always took the view that the kind of model used in the case of Eastern Regional Health Authority should be strongly supported. I am sure Deputy O'Rourke does not mind me repeating her assertion that such bodies were capable of dealing with issues of this nature, which represent a particular challenge for the HSE. While I do not intend to kick the HSE this evening, it is important for the HSE authorities to understand the concerns of many communities in this regard.

I am reminded of my previous comments about the operation of the HSE at Tallaght hospital. I reiterate that it is important to restore public confidence in the health service. The Leas-Cheann Comhairle knows I could talk for a long time about issues that have arisen recently. Public confidence needed to be restored after problems emerged with X-rays at Tallaght hospital, for example. People were very upset when it was revealed that GP letters had somehow been lost. I am sure the Minister of State, Deputy John Moloney, will not mind me saying that people are similarly concerned about the issue under discussion this evening. People in every family in the country, regardless of whether they have had children recently, are bound to be upset about this matter. There is a responsibility on the HSE to take whatever action is necessary to reassure every mother who, as other speakers have said, is probably wondering about the diagnosis she was given. While I do not refer specifically to my sister in that regard, I suspect that she, like others, is asking "if only" and "what if".

It is important that this debate is taking place. I thank Fine Gael for giving us the opportunity to discuss the matter. I ask the Minister of State to ensure the Minister knows she has our support in this regard. Action is needed if we are to reassure the public once more.

Deputy Dan Neville

With the permission of the House, I will share my time with Deputies Denis Naughten, Pat Breen, Michael Ring, Ulick Burke, Joe Carey and Deirdre Clune.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Deputy Dan Neville

I support the Fine Gael motion on patient safety and, with my colleagues, I call on the Government to establish a dedicated independent patient safety authority which would incorporate HIQA, reassure patients that they have a safe place to go with their complaints, act as an advocate for them and ensure that investigations take place when and where necessary.

Our proposed patient safety authority should take on the functions currently under the remit of the Mental Health Commission. Our purpose in proposing to bring the Mental Health Commission within the remit of the patient safety authority is two-fold. First, many of the functions of the patient safety authority will be similar to those of the Mental Health Commission, which currently registers centres and inspects services for persons with a mental illness. Second, this will further help to integrate services for people with mental illness and those receiving care from other parts of the health service. In other words, it will reduce the isolation of the mental health services and will allow each specialist area of health and social care to support and learn from one another in pursuit of the patient safety agenda.

I now refer to the difficulties and challenges for patient safety within the mental health services. The sixth report on the mental health services for 2009 was published in the last week. The inspector was extremely concerned about the number of people residing in old and unsuitable dilapidated buildings and the fact that vulnerable people reside in these conditions. The report used the word "deplorable" in referring to this. The report was scathing about admitting, for the first time, individuals in acute crisis to such surroundings. The report recommended, as a first step in the closure of these types of buildings, a decrease in new acute admissions and that all such acute admissions should cease in St. Ita's, St. Brendan's and St. Senan's hospitals. However, the Health Service Executive has not said where these individuals in acute crisis being admitted for the first time will go, or how many beds will be taken out of the system by the progressive closure of the three hospitals and others whose closure will be recommended.

It is estimated that approximately 10% of psychiatric nursing staff left the mental health service in 2009. The precipitous decline in numbers associated with delays in recruiting health and social care professionals adversely impacts on the delivery of high quality care and treatment. When cuts are made it is the progressive community services that are culled, thus causing a reversion to the more custodial form of mental health services. We were promoting the idea of developing community mental health services. We are now reversing that development. A Vision for Change strongly recommended fully multidisciplinary mental health services to facilitate patients being treated in the community rather than in mental health institutions. This is now being reversed. There are excessive admissions to approved centres and outpatient clinics are populated by many with minor mental illness. These patients, who should be dealt with at a primary care level are now dealt with in hospital.

We continue to place in inappropriate mental health institutions individuals with intellectual disability, without access to specialist intellectual disability mental health services. The inspector expressed concern at the occupation of scarce child and adolescent mental health service beds by individuals with no diagnosis of mental disorder, often with social problems, who have nowhere else to go. This is inappropriate and potentially damaging to these individuals, as well as depriving others of the needed beds.

The practice of admitting children to adult approved centres continues. Recent HSE child and mental health service audits show that a large percentage of these admissions are 16 and 17 years old, an age group with a traditional pattern of short-term crisis.

I am concerned at the reported 25% increase in suicide in 2009. I asked for a debate on this matter this morning under Standing Order 32, but the Ceann Comhairle ruled that it is not an issue of national importance. A 25% increase in suicide is not of national importance.

Deputy Pat Breen

That is a disgrace.

Deputy Dan Neville

I hope the Minister of State will discuss this issue with me over the coming months.

Deputy Denis Naughten

In January 2007, a new statutory complaints system was established by the HSE. As part of the system, the HSE appointed trained complaints officers to deal with the complaints received. However the system is not working and I commend Deputy Reilly on proposing this evening's motion.

Lack of independence is undermining the system that is in place. In the vast majority of cases, patients do not want compensation. There is an impression that the only reason someone complains is to get money. Most people simply want the truth. They just want answers, and to be assured that if mistakes were made they will not be repeated in the future.

This did not happen in the case of the maternity misdiagnosis scandal. Even when Melissa Redmond went public regarding her misread scan of July 2009, the HSE said the wrong diagnosis of the miscarriage in Our Lady of Lourdes Hospital in Drogheda was an extremely rare case. Since then, a dozen women have come forward with their stories of having been wrongly told by maternity hospitals that their babies had been miscarried, only to give birth later to healthy infants. That put a shiver down the spine of every parent and every woman who had a miscarriage in the last number of years.

On foot of that scandal, the HSE received almost 300 telephone calls from concerned women and their families. Here again, health management closes its ranks and lets patients believe it is "all in their heads". Patients would not have the ability to understand the complexities of the procedures involved. People, in the main, are looking for answers and an acknowledgment that they are right. Instead, they are always one explanation away from the truth and, as a result, their own resolve comes into question.

How can our health service improve if there is no acknowledgment of mistakes? Mistakes will happen. People are only human but the failure to accept that medical professionals are human has serious consequences in some instances. A different attitude to complaints within the health system, especially to minor ones, might help to identify serious system errors before they have fatal consequences. Instead of that, someone who complains about the system is considered to be a freak.

A group of parents have been claiming since the 1970s that their children were damaged by State-run vaccination programmes. Eventually, before the last general election and after a long campaign, the then Minister for Health, Deputy Micheál Martin, put a group in place to look at this matter. This led to a report of the vaccine damage steering group. The report has been on Deputy Mary Harney's desk for the last 15 months and she still has not decided if she will implement any of its recommendations. I am talking about elderly parents of children who were profoundly damaged by State-run vaccination programmes. Will the Minister for Health and Children come to the House and acknowledge that the State had some role in this matter? The State was prepared to buy off some of those parents by giving them £10,000 to keep their mouths shut in the early 1980s. Surely it is time the Government honoured those parents and their commitment to their children.

Deputy Pat Breen

Every time a case of misdiagnosis reaches the public domain or questions are raised in regard to the systemic failures in our health system it should be remembered that behind the headlines there are real headaches for the patients involved and their families. That is the most important thing to remember tonight. Very often medical errors become public knowledge only because of the courage of patients and their next of kin in speaking out. I think of a number of cases in my constituency — of Karl Henry in Ennis who spoke out following the death of his wife, Ann Moriarty, the Kelly family in Kilrush who spoke following the death of Edel, and Rebecca O'Malley, a victim of diagnosis, who continues to give courage and hope to others in a similar situation.

There is no doubt that confidence in the health system has been eroded by the mishandling of errors which, sadly, have cost lives and left people with lifelong scars. The very least these families deserve is to get answers. However, very often the experience of patient is that when they speak out or raise questions they are met with a wall of silence. There must be a sea change in this culture of institutional protection and silence.

Fear of litigation has often been blamed for the failure of the health care system to respond to such mistakes but that is no excuse. According to an article I read recently in the Irish Medical News, the health committee of the UK House of Commons considered introducing a legal duty of candour which would make it legally necessary for the medical profession to admit mistakes to patients or next of kin. There is no such legal structure in Ireland. The Medical Council has recognised that a problem exists and has introduced a guide to professional conduct and ethics which states that doctors should acknowledge their mistakes to patients. This does not go far enough. The lack of facilities and the understaffing of our hospitals have compounded the problem. The management and staff of Ennis General Hospital, for example, have been starved of resources for years. I hope the Minister for Health and Children will now support the hospital’s new manager. I congratulate Frank Keane on his appointment and hope he is given the necessary resources to put into place the facilities that are required in a general hospital.

A case was highlighted recently in the maternity hospital in Limerick in regard to the recent scandals. Since 1999 a majority of County Clare babies are born in County Limerick. The infrastructure at the hospital in Limerick is entirely inadequate to cope with the current situation. The hospital is designed to cater for 3,500 babies a year but last year 5,400 were born there. The Minister, Deputy Harney, has told us on a number of occasions that best international practice recommends that a maternity hospital should be located adjacent to an acute hospital. The intention of the HSE is to relocate the Midwestern Regional Hospital at the acute hospital but there is no funding for this.

When he succeeded in getting agreement on health care reforms in the United States President Barack Obama said that as soon as he signed the Bill the core principle guaranteeing everybody the same basic security in health care was enshrined. Every patient in this country must have basic security when it comes to our health care system. Putting into place a dedicated patient safety authority is the only way forward. Otherwise patients and their families will continue to suffer. As a woman said to me recently, "Our family was handed a death sentence the day my father died because he was misdiagnosed".

I urge Deputies, of whom there are very few in the Chamber at present, to support the motion and show the same expression of concern for victims of misdiagnosis as they did in recent days in the stag hunting debate.

Deputy Michael Ring

I compliment my colleague, Deputy Reilly, for bringing this motion before the Dáil. It concerns one of the most awful situations to have happened in this country. There have been very many serious incidents in the health service over the years but this is the worst, particularly for women. When a woman is told she is expecting a baby it is a very joyous time for the husband and wife, or for that woman. However, when she is told the following week that this will not happen it is dreadful. I am sure there are women who listened to their doctor, took the diagnosis and dealt with the situation. Today I am sure they regret not getting further advice or opinion.

It is an outrageous situation. The time has come for people to take responsibility for their actions. There have been very many serious situations. Nobody takes responsibility for them and in this case, again nobody is taking responsibility, whether from among the medical profession, in the Department of Heath and Children or the actual Minister. Nobody takes responsibility but somebody must do so. We have put people into positions of trust, whether as politicians, in the Department of Health and Children or in the medical profession and if something goes wrong ultimately somebody is to blame. We now have health and safety legislation which makes it clear there must be ultimate responsibility in regard to whichever case is in question.

This was terrible for women and for families. I hope we never again see a situation such as that which happened to these women. We were told the misdiagnosis may have been because of machinery error, or whatever. We are putting resources in health where there are very professional people who are well trained and well paid to do the job. If they do not take the responsibility that goes with the job then something must happen.

I have a question and the Minister of State, Deputy Moloney, might respond to it when he concludes the debate. Will anybody take responsibility for this? Who will comfort the mothers who today do not know whether their child was dead or alive? It is terrible that this has happened to women and it is a terrible indictment of our health service that it could and did happen, yet again without anybody taking responsibility.

I hope when the Minister of State responds he will tell us that some action will be taken, that there will be an inquiry and that when it is finished somebody will pay a price. I do not care who pays the price but somebody should pay it because the mothers who are at home tonight with their families still wonder about what they did and whether their child was alive. Is that not a terrible situation to face for the rest of one's life?

Deputy Ulick Burke

I commend Deputy Reilly for bringing this motion before the House and I am glad to have the opportunity to support it.

It is wrong that people have to go public in order to get a response from the HSE. Were it not for the 12 women who came forward and the 300 others who went to the HSE to report their stories all of this would have been swept under the carpet. The contribution made by a Fianna Fáil Deputy some moments ago was outrageous. He said the situation was not unique to Ireland but happens all over the world. That is typical of what a response from the HSE would say. When the story broke the HSE stated that the wrong diagnosis of miscarriage given at Our Lady of Lourdes Hospital in Drogheda was extremely rare. If 312 people have come forward already how many others are there who have had that devastating experience but are keeping it under wraps? That is the tragedy.

For this reason it is very important that we support the particular proposal made by Deputy Reilly, which calls on the Government to establish a dedicated, independent patient safety authority that will incorporate HIQA and give reassurance to patients who have suffered with this devastating news. It is important that an internal investigation, through HIQA, is not deemed to be acceptable. I hope the Government and the Minister accept that.

There is one exception to the many centres which have misdiagnosed in the past. Portiuncula Hospital in Ballinasloe is that exception. The hospital has a well established and long-standing tradition and reputation in providing maternity services to the highest standard in the country. It is also one of the busiest hospitals. In the past five years, on average it has recorded a 9% increase in births each year, from 21,080 in 2008, to 2,229 in 2009. From all indications at present this trend of increase continues.

Portiuncula Hospital's maternity unit is a centre of excellence, a title earned as a result of its good practice and excellent professional staff. It has an ethos of care, friendliness, comfort and reliability. These qualities are not always available in the other centres.

I call on the Minister of State or the Minister for Health and Children to give an unequivocal assurance tonight that the maternity services will continue at Portiuncula into the future, and that the unpublished report commissioned by the HSE regarding the reconfiguration of maternity services will not be implemented as reported. It was reported that a new maternity centre for the midlands at Tullamore will encroach on the catchment area of Portiuncula and that will provide an excuse for the reconfiguration to continue. This includes the Minister of State's own maternity unit in Portlaoise, which probably will be brought to Dublin or some place like that. I ask that this report, which is currently under wraps, be published and that its implementation not take place as reported.

Deputy Joe Carey

I strongly support the motion before us this evening and congratulate Deputy Reilly on bringing it forward for debate.

I listened to the Minister's contribution last evening when trying to justify her position. I listened to her make yet another apology to this House. The most disturbing part of the latest health scandal is that of equipment failure. Machines that were supposed to be doing a job were not capable of doing the job. In the case of Ms Melissa Redmond, the ultrasound machine used for the second diagnosis had been showing signs of sub-optimal functioning and was not producing pictures with adequate contrast, to be reliable in early pregnancy diagnosis, yet the machine was not replaced. Six months after Melissa Redmond's false scan, the faulty machine was still in use. This mistake was compounded as the wrong diagnosis was not confirmed by a trained ultrasonographer.

The issue of miscarriage is a most difficult subject to address. Nobody wants to give false hope to a woman who is really having a miscarriage. Nobody wants to give false hope to a woman who is advised to undergo a D&C procedure or other procedures. It is clear from the 12 brave women, who have come out publicly about their experience of miscarriage misdiagnosis, that an accurate diagnosis of pregnancy, particularly in the early stages, takes longer in some women than others. Uncertainty about dates has a huge impact on what the tests mean and what the ultrasound images are supposed to show.

There can be no excuse for the failure of the HSE and the Government to invest in proper equipment in our hospitals. There can be no excuse for the failure of the Minister to take direct action on the miscarriage scandal and to alleviate the genuine concerns of many families facing trauma of having their case reviewed. What we got from the Minister last night was the usual public washing of her hands together with the self-congratulations of the counter Government motion.

It is simply incredible that the Minister would not take on board the proposals put forward in this motion. What argument could any reasonable person make against the need for an urgent audit by HIQA of maternity services in light of what has gone on in this country? What argument can be made against checking the standard and safety of equipment? What argument can be made against examining staff workloads, care protocols and training of personnel? What argument can be made against the reasonable suggestion that a dedicated independent patient safety authority be established?

The Minister cannot merely sweep this serious issue under the carpet. Trust in the HSE and the Department of Health and Children has yet again been shattered by a misdiagnosis scandal. Acceptance of this Fine Gael motion will go some way to ensuring that the mistakes of the past are not repeated again. That is the least the Minister owes to the children who survived these misdiagnoses in spite of the shocking failures of the systems that are in place.

Deputy Deirdre Clune

This is a very important debate as it highlights the need to put patients, patient care and patient access to some form of redress, if that is what is needed, at the heart of our health services. Patients are major stakeholders and that is what the HSE, the Department of Health and Children, health forums and legislative bodies such as this House should always bear in mind. Unfortunately, the incidents that have triggered this debate are stories that have sent a chill through many women.

Many women were told that the foetus they were carrying was no longer viable and that they needed a D&C. We must thank Ms Melissa Redmond and Ms Martha O'Neill Brennan who have come forward with their story. They were brave today and they were very brave at the time that they trusted their instincts that they were still pregnant and they questioned the opinion given to them from an early pregnancy scan. Both women sought a second opinion and today they have healthy and happy children. It is a good story but it is also an alarming story. We need to put structures in place to give reassurances that this cannot happen again.

In June 2009, Ms Redmond went to Our Lady of Lourdes Hospital and her story was made public recently. The response from the HSE was that the situation was extremely rare, yet since then we have seen many women come forward with similar experiences. To date, about 12 women have made their stories public and there have been reports of 300 phone calls from concerned women across the country.

We now know that there was faulty equipment involved, such as the ultrasound machine at Our Lady of Lourdes Hospital. Alarmingly, this machine was still being used almost six months after the misdiagnosis took place. The internal review also recommended a dedicated ultrasonographer be recruited to this unit, yet, one year later, this position has not been filled. The message from the HSE to the women and patients who depend on our health services is stark — the HSE will not serve them. They have no confidence in the HSE and this story is further alienating the public and patients, who are major stakeholders in the health services. They have lost confidence in those who are charged with their care.

I acknowledge that national guidelines are now to be developed and a review to identify all cases of known misdiagnoses is under way. However, would this have happened if the two women had not come forward and used the resources of the media to bring their story to the public? That is why Fine Gael's motion calls for a dedicated independent safety authority. Such an authority could assure patients that there is a safe place to make their complaint, to voice their concerns and to be supported in that process.

HIQA is not a patient safety authority. It sets standards and inspects facilities to ensure that those standards are met. It publishes the findings of their inspections and it takes follow up action if there is a risk to safety. However, it does not have the remit to be a complaints body and it does not have the capacity or the mechanisms to be a complaints body. The creation of a patient safety authority has been recommended by Fine Gael for a long time. It was part of our policy in a previous administration and I strongly support it tonight.

Having a baby is a major part of a woman's life. For many of them, it may be their first brush with the health services and they want their baby's health to be protected during their pregnancy. They want to trust their health services. I acknowledge that we have excellent maternity care. The figures on mortality rates are proof of that. Nonetheless, we have a growing population and the number of births is increasing year on year. We will have 80,000 births this year, whereas last year it was 75,000. It is estimated they are 7,000 births a year in Cork University Maternity Hospital, which was opened in 2007, but last year there were 9,000 births in that hospital. That highlights that in the short time since that hospital was opened there is already a capacity issue in it.

Minister of State at the Department of Health and Children (Deputy John Moloney)

I would like to express my sincere sympathy to all the women and their families who have been affected by these incidents.

I wish I had the time to respond to some of the queries put to me that fall outside the realm of the specific subject of this motion. I will respond briefly to a number of them. I advise Deputy Burke that I am not in a position to give a commitment regarding the retention of services at Portiuncula Hospital. I have not seen the report commissioned but when I have I might have an opportunity to speak to the Deputy next week. I am not trying to evade the Deputy's question, but I am not in a position to answer it.

I support Deputy Neville's call for a debate on the increase in the incidence of suicide and I will take up his request and see if I can be assistance in that regard. I note the issues he has raised and I recognise his commitment to this issue over many years.

Deputy Ring called for an independent inquiry into this matter. The chairperson of the miscarriage misdiagnosis review team is an independent expert in obstetrics and gynaecology, Professor William Ledger, and that in itself lends to the review having a layer of independence.

In the few minutes I have available, I will speak about the issue of patient safety. The priority at present is to ensure that the concerns of women who may have been affected are addressed comprehensively. I welcome this opportunity to state that the Government also recognises the concerns raised in the motion.

It is important to point out that the HSE has been working with all 19 maternity facilities nationwide to ensure that women with concerns about their care or treatment have access to information, reassurance and that appropriate follow-up support is provided. A commitment on that was given by the Minister yesterday evening.

I welcome the involvement of HIQA. I also welcome the instruction that issued to all public and private obstetrics facilities advising them to put in place immediate measures to ensure that the decision to use drugs or surgical intervention in women who have had a miscarriage diagnosed must be approved by a consultant obstetrician. This should provide clinical assurance to women in regard to any follow-up actions, where necessary, and ensure the safe management of early pregnancy loss across the country.

With regard to the composition of the miscarriage misdiagnosis review team, it is chaired by an independent expert in obstetrics and gynaecology, Professor William Ledger, Vice President of the Royal College of Obstetrics in the UK, and he is joined by Professor Michael Turner, the national clinical lead of the HSE's obstetrics programme.

The information gathered from the review, the subsequent report and recommendations can inform the standards national guidelines for obstetrics — which are currently being developed by Professor Turner — which will provide essential evidence-based good practice guidelines which can be implemented and audited to ultimately improve patient care in the future. I am confident that these guidelines will go a long way to help prevent incidents such as those that have occurred and which are the subject of this debate.

It is also important to point out that careful attention will be given by the Department of Health and Children and the HSE to promoting learning from these incidents to improve patient experiences and outcomes.

Improving the safety and quality of care for all patients has been to the forefront of health initiatives introduced by the Minister. She has been criticised for not showing a lead in this particular area. It is important to note her involvement in the establishment of the Commission on Patient Safety and Quality Assurance, the establishment of the Health Information and Quality Authority, and legislative proposals for standards-based licensing of public and private health care providers.

It is important to acknowledge the fact that HIQA is a key driver of patient safety and quality care in the health system. It continues to enhance its role through its work in setting standards that will drive the quality of care into the future. The soon to be launched draft standards on quality and safety for all health care providers will be a fundamental building block for a safer health system delivering consistently higher quality care.

HIQA is an organisation fundamentally centred on the patient and its work is key in advocating on behalf of patients. All its work in standard setting and monitoring performance against standards is designed to improve the patient experience. It involves patient representatives in all the work it does, both in developing the standards and in ensuring they are implemented.

There are many challenges facing the health services, as has been acknowledged throughout the debate. The Minister, Deputy Harney, is facing up to these challenges with determination and resolve. Ireland can be justifiably proud of its maternity services. As was said yesterday, and it is worth repeating, maternal mortality, perinatal mortality and infant mortality are all low by comparison to other jurisdictions. Women can be confident and satisfied as they come to use maternity services in this country.

In response to points raised by Deputy Neville, I advise that the number of child and adolescent mental health beds have increased from 20, some four years ago, to 55. The issue of misappropriate placements of individuals in psychiatric hospitals is an issue of great concern in terms of patient safety. The Deputy is concerned about that issue but I wish to confirm that by the end of 2011 there will be no further such placements of people under the age of 18. That is a move forward and it enhances patient safety.

I thank the Ceann Comhairle for this opportunity to contribute to the debate.

An Ceann Comhairle

I note that Deputies Connaughton, Crawford and Reilly are sharing time in the next time slot of 15 minutes and they will have five minutes each.

Deputy Paul Connaughton

I support the motion tabled by my colleague, Deputy Reilly, on behalf of the Fine Gael Party. I strongly believe an independent complaints procedure such as a dedicated independent patient safety authority should be established in which people would have confidence and belief in the results of its findings. It would give people who are let down by the health system an opportunity to put their side of the case to people who are not the deliverers of the service. That is an important aspect of this debate.

Hardly a week passes that there is not a national media story concerning wrongs committed in general hospitals, maternity hospitals, child care services, cancer care, mental health facilities and the list goes on. Most people I know do not trust the HSE to independently and impartially carry out investigations into these happenings. There are people of the highest integrity and honour in the HSE at all levels, but society now demands that serious cases of bad practice and procedure should not be judged by the suppliers of the service. I noted that most of the Fianna Fáil contributors to the debate tonight believe in that concept. While their arguments were not in favour of Deputy Reilly's proposal, they were certainly not against the concept.

I have noticed down through the years that where a family member dies suddenly in hospital and the family of the deceased genuinely believe something went wrong in the treatment of that family member, they cannot not get an answer to their inquiry concerning the death from the hospital and when they do, say, 18 months later it was backed up with legal jargon that they did not understand. Having regard to what is covered by Deputy Reilly's proposal, I would like an independent authority established, to which ordinary people could go cap in hand and ask it to tell them exactly what happened to their relative in the hospital concerned before he or she died. It is as simple as that. Until we have such authority, people rightly or wrongly will say that something happened to their relative that was not right in that particular hospital.

Deputy Seymour Crawford

I thank my colleague, Deputy Reilly, for bringing forward this important motion. He and many of my colleagues have dealt with most of the individual sections of the motion, so I propose to focus mainly on the issue of people's trust in the Health Service Executive having been shattered.

The motion deals in the main with the lack of treatment or mistreatment of women in maternity services, especially at Our Lady of Lourdes Hospital. I, as one Oireachtas Member in an all-party group representing the area served by that hospital, have had to deal with hundreds of cases regarding mistreatment or, more accurately, abuse. The Minister, Deputy Harney, brought forward a scheme to provide some compensation for the group but, unfortunately, on a technicality, some people have fallen outside that benefit. Although the Minister agreed this was unfair and undertook to address the matter, nothing has happened to date. We in County Monaghan were told that our maternity unit must be closed because there were insufficient numbers being dealt with to maintain the proper expertise necessary to ensure a safe service. When one compares the record of Monaghan hospital with the alternatives to which women are now resigned, there is no comparison.

The Minister and the HSE gave us further assurance that no services would be removed from Monaghan hospital until as good or better were made available elsewhere, but this promise has been ignored. Our trust in the HSE is shattered. Only last Monday Deputy Reilly and others were advised that everything in the surgical section of Cavan hospital was perfect, that very few beds were needed for surgery in the hospital and that one of the surgical wards had been switched over to medical services. People have lost faith in the surgery service and are going elsewhere, to Dublin, Northern Ireland or to the excellent former surgeons of the Cavan-Monaghan Hospital Group who are now working in private clinics in Galway. It is accepted by the HSE that there are problems in Cavan and even more acutely in the orthopaedic section of the hospital in Drogheda, yet it has gone ahead and closed down the excellent acute services that were provided in the Louth hospital. Clearly the Wildlife (Amendment) Bill is more important to this Government than the safety of our sick, disabled and elderly.

Another service the HSE has curtailed is day care provision for the elderly. For instance, two days of day care services per week have been closed down at St. Mary's Hospital, Castleblayney, affecting 131 patients. This unit was provided in difficult financial times by the then Minister for Health, Deputy Noonan, with two wards that had been closed for years being reopened as a special care unit for those with Alzheimer's disease. The day care ward is now being restricted. Clearly it is more important for the HSE to maintain its 700 or more grade eight administrators, in respect of whom Professor Drumm acknowledged he was unsure of some of their functions, than to maintain services for the disabled and elderly. While there is much talk about the greater numbers of patients being assisted through the home help and home carer schemes, there is no acknowledgement of the fact that the hours are severely restricted, with some patients down to half an hour per day or one and a half hours per week.

What is required is an independent body to oversee patient safety. Patient Focus did a great job for the women of Drogheda and something similar is required on a nationwide basis. I understand the Minister, Deputy Harney, made an apology in the Chamber yesterday. It is not enough. Her record in the health service can easily be challenged and she should consider her position.

Deputy James Reilly

I take this opportunity to sympathise again with the women, their spouses and their families affected by the misdiagnoses at Our Lady of Lourdes Hospital. The Minister referred last night to being serious about patient safety. If she is serious, how can she stand over overcrowded accident and emergency units, a situation she promised four years ago to treat as a national emergency? This year we saw 500 people lying on trolleys in a single day. How can she stand over the 20,000 cancelled operations last year? Behind those figures are real people in pain waiting for treatment. Their families make arrangements to look after children and so on so that their loved one can undergo treatment only to have their appointment cancelled at the last moment. How can she stand over an increase of 70% in delayed discharges? People are lying in hospital beds who do not require treatment. They will miss out on the opportunity to avail of rehabilitation which would have allowed them to go home eventually. Instead they are destined to remain in long-term care.

Louth County Hospital has been downgraded and Monaghan and Cavan hospitals closed, with all patients shoehorned into Drogheda, an area that is a natural commuter belt for Dublin and has seen the attendant huge population increase in recent years. It is an insult to the people of Monaghan. People in Monaghan who suffer a multiple trauma are taken by ambulance to Drogheda hospital and because they were not treated in Cavan hospital, they cannot avail of the remaining rehabilitation services at Monaghan hospital. That is the final insult.

The Minister spoke last night about whistleblower legislation, but the reality is that the provisions of that Bill are contradicted by the gagging clauses in the consultant contract. People do not feel safe reporting their concerns because in doing so they will find themselves isolated and in difficulty with their employer. The Minister stated last night that the scanner in question was not clapped out, but that is precisely what the report indicates when it refers to "evidence of fatigue". The Minister said such machines should have a seven-year life span, but that depends on usage. A machine that is used as much as this particular one was is bound to be fatigued. The Minister assured us the review will tell us the full story. It cannot do so because it can look only at notes and files; it cannot review the live ultrasound examination that took place. A picture cannot identify a heartbeat; only a living image can do so. Second, if that picture was taken from the wrong part of the womb and the foetal sac was in another part, all we will see is an empty womb.

The Minister spoke about creating a system that will be safer for patients. Rather than minimising the impact of human error on patients, we have a system that seems to maximise it. We are all aware that human error is unavoidable and inevitable, but a good system minimises its impact on the patient. It is commonplace in industry to have maintenance contracts on machinery. Where was the maintenance contract for machines which can potentially determine the termination of a live foetus and deprive people who have waited years for a family? That is simply not acceptable. Add to these deficiencies the pressure on doctors, sonographers and nurses in Our Lady of Lourdes Hospital and other hospitals throughout the State and one is faced with a disaster. I spoke to one woman who told me that the sonographer's pager bleeped three times in the course of her ultrasound. That is bound to lead to errors.

The solution we are offered is the provision of a sonographer for four hours per day to a unit in the Ceann Comhairle's constituency where more than 4,000 babies are delivered per year. By any international standard there should be two if not four full-time sonographers working in that unit. The necessary balances and checks are not in place. We are reacting rather than being proactive, which is what a patient safety authority would do. Where a single incident is reported to such an authority, action could be taken. Instead people have no choice but to revert to the courts or to forgo their privacy by approaching the media. We may complain about the media but thank God it has at least exposed this and other problems.

I congratulate Melissa and Michael Redmond on opening the flood gates on this issue. Unsurprisingly, the initial response from the HSE was to claim it was a rare occurrence. We now know it was not. If we had a patient safety authority these issues would be acted upon as soon as the patient made a complaint or expressed a concern. The Minister said last night that the Health Information and Quality Authority can play this role. A representative of that body has expressly told me that it cannot be an advocate for patient safety. I challenge the Minister to ask Tracey Cooper whether or not she told me in a conversation that the authority cannot fulfil that role.

Before Members opposite vote down this motion, I ask them to consider the €60 million paid out last year in medical and legal fees, of which €20 million went to the legal profession. I have nothing against the profession but that money should have gone towards compensation of patients. People revert to the courts because they do not have a safe place to go. Members opposite should remember the late Ann Moriarty from Clare. They should recall the words of Rebecca O'Malley and the advocacy of Patient Focus, Dignity for Patients and other groups. They should consider the safety of their own loved ones and people in their own communities. Let us ensure there is a safe place to which everybody can take their complaints, worries and concerns. Nobody should be forced to go to the judicial system or the media. Let us afford all our citizens — women, men, children, those with mental health issues, those with disabilities, whether physical or intellectual — the comfort of a patient safety authority. We can estimate the cost of a patient safety authority but we can never underestimate its value.

Amendment put.

The Dáil divided: Tá, 74; Níl, 70.

Tá

Ahern, Bertie.
Ahern, Dermot.
Ahern, Michael.
Ahern, Noel.
Andrews, Barry.
Andrews, Chris.
Aylward, Bobby.
Blaney, Niall.
Brady, Áine.
Brady, Cyprian.
Brady, Johnny.
Browne, John.
Byrne, Thomas.
Calleary, Dara.
Carey, Pat.
Collins, Niall.
Conlon, Margaret.
Connick, Seán.
Coughlan, Mary.
Cregan, John.
Cuffe, Ciarán.
Curran, John.
Dempsey, Noel.
Devins, Jimmy.
Dooley, Timmy.
Fahey, Frank.
Finneran, Michael.
Fitzpatrick, Michael.
Fleming, Seán.
Flynn, Beverley.
Gogarty, Paul.
Gormley, John.
Grealish, Noel.
Hanafin, Mary.
Harney, Mary.
Haughey, Seán.
Healy-Rae, Jackie.
Hoctor, Máire.
Kelleher, Billy.
Kelly, Peter.
Kenneally, Brendan.
Kennedy, Michael.
Killeen, Tony.
Kitt, Michael P.
Kitt, Tom.
Lenihan, Conor.
Lowry, Michael.
McEllistrim, Thomas.
McGrath, Mattie.
McGrath, Michael.
McGuinness, John.
Mansergh, Martin.
Moloney, John.
Moynihan, Michael.
Mulcahy, Michael.
Nolan, M.J.
Ó Cuív, Éamon.
Ó Fearghaíl, Seán.
O’Brien, Darragh.
O’Connor, Charlie.
O’Dea, Willie.
O’Flynn, Noel.
O’Keeffe, Batt.
O’Keeffe, Edward.
O’Rourke, Mary.
Power, Peter.
Power, Seán.
Roche, Dick.
Ryan, Eamon.
Sargent, Trevor.
Scanlon, Eamon.
Smith, Brendan.
Wallace, Mary.
Woods, Michael.

Níl

Allen, Bernard.
Bannon, James.
Barrett, Seán.
Behan, Joe.
Breen, Pat.
Broughan, Thomas P.
Burke, Ulick.
Burton, Joan.
Carey, Joe.
Clune, Deirdre.
Connaughton, Paul.
Coonan, Noel J.
Costello, Joe.
Coveney, Simon.
Crawford, Seymour.
Creed, Michael.
Creighton, Lucinda.
D’Arcy, Michael.
Deenihan, Jimmy.
Doyle, Andrew.
Durkan, Bernard J.
English, Damien.
Enright, Olwyn.
Feighan, Frank.
Ferris, Martin.
Flanagan, Terence.
Gilmore, Eamon.
Hayes, Brian.
Hayes, Tom.
Higgins, Michael D.
Hogan, Phil.
Howlin, Brendan.
Kehoe, Paul.
Kenny, Enda.
Lynch, Ciarán.
Lynch, Kathleen.
McCormack, Pádraic.
McEntee, Shane.
McGinley, Dinny.
McGrath, Finian.
McHugh, Joe.
McManus, Liz.
Mitchell, Olivia.
Naughten, Denis.
Neville, Dan.
Noonan, Michael.
Ó Caoláin, Caoimhghín.
O’Donnell, Kieran.
O’Dowd, Fergus.
O’Keeffe, Jim.
O’Mahony, John.
O’Shea, Brian.
O’Sullivan, Jan.
Penrose, Willie.
Perry, John.
Quinn, Ruairí.
Rabbitte, Pat.
Reilly, James.
Ring, Michael.
Sheahan, Tom.
Sheehan, P.J.
Sherlock, Seán.
Shortall, Róisín.
Stagg, Emmet.
Stanton, David.
Timmins, Billy.
Tuffy, Joanna.
Upton, Mary.
Varadkar, Leo.
Wall, Jack.

Tellers: Tá, Deputies John Cregan and John Curran; Níl, Deputies Emmet Stagg and Paul Kehoe.

Amendment declared carried.

Question put: "That the motion, as amended, be agreed to."

The Dáil divided: Tá, 74; Níl, 70.

Tá

Ahern, Bertie.
Ahern, Dermot.
Ahern, Michael.
Ahern, Noel.
Andrews, Barry.
Andrews, Chris.
Aylward, Bobby.
Blaney, Niall.
Brady, Áine.
Brady, Cyprian.
Brady, Johnny.
Browne, John.
Byrne, Thomas.
Calleary, Dara.
Carey, Pat.
Collins, Niall.
Conlon, Margaret.
Connick, Seán.
Coughlan, Mary.
Cregan, John.
Cuffe, Ciarán.
Curran, John.
Dempsey, Noel.
Devins, Jimmy.
Dooley, Timmy.
Fahey, Frank.
Finneran, Michael.
Fitzpatrick, Michael.
Fleming, Seán.
Flynn, Beverley.
Gogarty, Paul.
Gormley, John.
Grealish, Noel.
Hanafin, Mary.
Harney, Mary.
Haughey, Seán.
Healy-Rae, Jackie.
Hoctor, Máire.
Kelleher, Billy.
Kelly, Peter.
Kenneally, Brendan.
Kennedy, Michael.
Killeen, Tony.
Kitt, Michael P.
Kitt, Tom.
Lenihan, Conor.
Lowry, Michael.
Mansergh, Martin.
McEllistrim, Thomas.
McGrath, Mattie.
McGrath, Michael.
McGuinness, John.
Moloney, John.
Moynihan, Michael.
Mulcahy, Michael.
Nolan, M.J.
Ó Cuív, Éamon.
Ó Fearghaíl, Seán.
O’Brien, Darragh.
O’Connor, Charlie.
O’Dea, Willie.
O’Flynn, Noel.
O’Keeffe, Batt.
O’Keeffe, Edward.
O’Rourke, Mary.
Power, Peter.
Power, Seán.
Roche, Dick.
Ryan, Eamon.
Sargent, Trevor.
Scanlon, Eamon.
Smith, Brendan.
Wallace, Mary.
Woods, Michael.

Níl

Allen, Bernard.
Bannon, James.
Barrett, Seán.
Behan, Joe.
Breen, Pat.
Broughan, Thomas P.
Burke, Ulick.
Burton, Joan.
Carey, Joe.
Clune, Deirdre.
Connaughton, Paul.
Coonan, Noel J.
Costello, Joe.
Coveney, Simon.
Crawford, Seymour.
Creed, Michael.
Creighton, Lucinda.
D’Arcy, Michael.
Deenihan, Jimmy.
Doyle, Andrew.
Durkan, Bernard J.
English, Damien.
Enright, Olwyn.
Feighan, Frank.
Ferris, Martin.
Flanagan, Terence.
Gilmore, Eamon.
Hayes, Brian.
Hayes, Tom.
Higgins, Michael D.
Hogan, Phil.
Howlin, Brendan.
Kehoe, Paul.
Kenny, Enda.
Lynch, Ciarán.
Lynch, Kathleen.
McCormack, Pádraic.
McEntee, Shane.
McGinley, Dinny.
McGrath, Finian.
McHugh, Joe.
McManus, Liz.
Mitchell, Olivia.
Naughten, Denis.
Neville, Dan.
Noonan, Michael.
Ó Caoláin, Caoimhghín.
O’Donnell, Kieran.
O’Dowd, Fergus.
O’Keeffe, Jim.
O’Mahony, John.
O’Shea, Brian.
O’Sullivan, Jan.
Penrose, Willie.
Perry, John.
Quinn, Ruairí.
Rabbitte, Pat.
Reilly, James.
Ring, Michael.
Sheahan, Tom.
Sheehan, P.J.
Sherlock, Seán.
Shortall, Róisín.
Stagg, Emmet.
Stanton, David.
Timmins, Billy.
Tuffy, Joanna.
Upton, Mary.
Varadkar, Leo.
Wall, Jack.

Tellers: Tá, Deputies John Cregan and John Curran; Níl, Deputies Emmet Stagg and Paul Kehoe.

Question declared carried.

Dáil Éireann díospóireacht - Wednesday, 30 Jun 2010

Private Members’ Business

Patient Safety: Motion (Resumed)

Tá

Níl

Tá

Níl

Dáil Éireann díospóireacht -
Wednesday, 30 Jun 2010