I thank the Deputy for raising this important issue, which is a cause of grave concern to me. As an underlying principle, compensation moneys should go to those who have suffered harm, not to members of the legal profession.
The cost of clinical indemnity scheme claims under management with the State Claims Agency, SCA, in 2013 was €119.3 million in total. This figure relates to costs transacted during the period and includes damages paid, legal fees and other expert costs such as medical expert fees. Breaking down the total cost, damages to patients accounted for €81.6 million, State Claims Agency legal costs and expert costs were €17.1 million, and plaintiffs' legal costs and expert costs amounted to €20.6 million.
The management of clinical negligence cases taken against the Health Service Executive is delegated to the SCA, which has a statutory mandate to investigate and manage these cases to completion. I am advised that the SCA, wherever it is proper to do so based on expert medical and legal advice, admits breach of duty at the earliest possible opportunity to avoid distress to patients and their families. Many of these cases, however, particularly those involving catastrophic injuries, are very complex in nature and require time to investigate the liability and causation issues. This inevitably involves some delay before a formal admission of liability, if appropriate, can be made.
A national policy on open disclosure was developed jointly by the HSE and the State Claims Agency and launched in November 2013. The policy is designed to ensure an open, consistent approach to communicating with patients and their families when things go wrong in health care. This includes expressing regret for what has happened, keeping the patient informed, providing feedback on investigations and the steps taken to prevent a recurrence of the adverse event. Implementation of the policy across all health and social services has now commenced by the HSE.
Ireland currently has no express protective legislation to assist the open disclosure process. However, it is intended that this situation will change with the upcoming health information Bill which I expect to publish in early 2015. That legislation will contain a number of measures to promote patient safety, including a provision to encourage open disclosure by affording some degree of protection for health care personnel. This is consistent with the report of the commission on patient safety and quality assurance of 2008. It is also in line with the recommendation in a consultation paper published by the Law Reform Commission in 2008 that "a statutory provision be considered which would allow medical practitioners to make an apology and explanation without these being construed as an admission of liability in a medical negligence claim".