Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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2. To ask the Minister for Health the reason the Government decided to drop plans by the former Minister for Health, Deputy Reilly, to establish a patient safety authority and who described the proposal as a critical part of any new health service, stating that it must be underpinned by legislation; his views that a patient advocacy agency, as is now suggested, would operate to complement to a patient safety authority that would be equipped to ensure enforcement of the Health Information and Quality Authority, HIQA, standards and recommendations; and if he will make a statement on the matter. [20886/15]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Despite the fact that the former Minister, Deputy Reilly, described the commitment in the coalition programme for Government to establish a patient safety authority as a critical part of any new health service, why did An Taoiseach announce in October 2014 that the Government was not proceeding to establish a patient safety authority on a statutory basis, opting instead for a patient advocacy agency?

Leo Varadkar (Dublin West, Fine Gael)
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I am strongly of the view that any new patient advocacy service should be set up independently of the HSE from the outset. For this reason, the HSE removed reference to the establishment of an interim patient advocacy agency from its service plan for 2015. My view has been supported by the recent recommendation made in the HIQA investigation report on services at Portlaoise hospital on the need to establish an independent patient advocacy service. HIQA's recommendation is that an independent patient advocacy service should be in place by May 2016. I fully agree with the recommendation and intend to see it implemented in advance of the timeline provided by HIQA.

The scope, role and functions of the independent advocacy service will be considered, with the appropriate structural, governance and funding arrangements that need to be put in place. My Department will be consulting widely on the best way to get the service up and running in the shortest possible timeframe. The role of the independent patient advocacy service will be to support and advocate for patients in their dealings with the health service. Regrettably, the health service has not been as responsive to patients who have had bad experiences as is required. A patient advocacy service can assist in redressing the balance in the relationship between patients and service providers.

Enforcement and implementation of HIQA recommendations are also essential. Creation of a further body, with a potentially overlapping role with existing statutory bodies such as HIQA, is not my preferred solution. In many ways, HIQA is already a patient advocacy agency and has very strong powers to monitor service providers' compliance with national standards, conduct targeted inspections and make recommendations. As part of my 2015 priorities, I committed to developing a new mechanism for demonstrating that HIQA's recommendations were being implemented by the HSE. Discussions are under way between my Department, HIQA and the HSE to finalise this mechanism which will see action plans to implement HIQA's recommendations transparently reported on and monitored. In the meantime, I have put in place a specific oversight mechanism for the implementation of the recommendations made in the Portlaoise hospital report. This process will be chaired by the Chief Medical Officer and will submit monthly reports to me which I will publish on a quarterly basis.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister did not address my question at all. I understand he is not the author of what he has just read, but, not only in the question I posed to him but also in the brief introduction I delivered orally, I asked why a key component of the plan announced by the former Minister in respect of the Government's policy on health, namely, the patient safety authority, had been dropped. It was announced by the Taoiseach in October 2014 that there were no plans to proceed to introduce a patient safety authority. Surely it should not be a case of either-or between a patient safety authority and a patient advocacy agency. When the matter of patient health and safety is involved, one should complement the other. It is interesting that within two months of Deputy James Reilly's removal as Minister of Health this was the position articulated. I note this followed a statement from the Department of Public Expenditure and Reform on new structures, including the patient safety authority, describing them as being part of the proliferation of quangos. The Department of Public Expenditure and Reform is not known for its caring nature, let alone its knowledge and appreciation of the reforms necessary in the health service. Did the Minister, Deputy Brendan Howlin, play a role in influencing the decision not to proceed with the establishment of a patient safety authority?

Leo Varadkar (Dublin West, Fine Gael)
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No. The Minister, Deputy Brendan Howlin, and the Department of Public Expenditure and Reform had no role to play in the decision, rather it was a policy decision taken by me. The plan before I took office was to establish a patient safety agency as a sub-agency of the HSE and the post of CEO of that sub-agency was advertised. The CEO would have been an employee of the HSE. I decided, however, that the original plan was wrong on two counts. First, a patient advocacy function should be independent of the HSE from day one. Staff should not be employed by the HSE; its budget should not be controlled by the HSE and it should be a separate entity, funded by my Department, for obvious reasons to avoid conflicts of interest. Second, the previous plan was to establish a patient safety agency that would, in fact, duplicate the functions of HIQA. HIQA has extensive patient safety agency functions. It is a patient safety agency which will have additional functions, including licensing, to enforce its recommendations in the future. Therefore, something different was needed. We did not need a duplicate HIQA as a sub-agency of the HSE but a totally independent patient advocacy service. That was my thinking, which has now been confirmed by the recommendations made by HIQA. My understanding is that the Deputy accepts HIQA's recommendations and supports the establishment of a patient advocacy service. Therefore, we agree on that point. Perhaps the Deputy might tell me what a separate and additional patient advocacy agency would add that is not already provided for.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister is a very confused holder of his portfolio this morning. He should play back what he has just said. I fully accept that a patient advocacy agency is a requirement and the subject of one of the recommendations made in the Portlaoise hospital report. I also agree that it should be independent of the HSE. The current position where Patient Focus has performed this role and performed it well for many years is that it is directly funded by the HSE, which is inappropriate. We are ad idemin that respect. However, a patient safety authority is an entirely separate proposition.

Leo Varadkar (Dublin West, Fine Gael)
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How?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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If the Minister allows me to answer, perhaps he might learn a little. The point is - the Minister knows it as well as any other voice in this House - that HIQA's reports, findings and recommendations are continuously ignored by the HSE. The Minister's Department is not playing the role it should have been in insisting on recommendations being acted on and implemented. We have report after report from HIQA with recommendations that have been ignored. We need a patient safety authority, acting not only on HIQA's recommendations but also the findings of reviews commissioned by the HSE, many of which have been completely ignored. We need a body with the power to act and ensure health and safety are always the critical factors, rather than budgetary considerations at the expense of people's lives.

Leo Varadkar (Dublin West, Fine Gael)
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I am very glad that we agree that a patient advocacy service is needed and that it should be independent. It is not the case that HIQA's recommendations are ignored, as significant numbers are implemented. That has been the case, particularly in matters around hospital hygiene. The reports show that we now have the lowest MRSA rates in years. For example the rates for Clostridium difficile are falling. We have put an extra €5 million or €6 million into the ambulance service this year in response to HIQA's recommendations. However, not all of HIQA's recommendations can be implemented immediately. Some require spending, for which we do not have the capacity, while others are unlawful. For example, HIQA made a recommendation regarding the ambulance service, the implementation of which would have been unlawful. We would have had to change European law to implement it. It is not the case that HIQA is right about everything. If the Deputy talks to people who run nursing homes or nurses who work on a ward, they will give him chapter and verse. I agree with him, however, that we need to make HIQA's recommendations more enforceable. The way to do that is to give it the power to license hospitals. It would then have an added licensing function, to license hospitals to do X, Y and Z and if hospitals did not implement its recommendations, they would lose their licences. There is already that power in the case of nursing homes and care facilities, where HIQA can go to court to have them deregistered. I want to give it that power in the case of hospitals also. We do not need an extra agency to do this.