Opening Statement by Minister for Health Simon Harris TD at the Joint Committee on Health – 9th May 2018
I thank the Chairman and committee members for inviting me to attend today. I am joined by my ministerial colleague, the Minister of State with responsibility for mental health and older people, Deputy Jim Daly. I am also accompanied by Mr. Jim Breslin, Secretary General of the Department of Health. I would also like to welcome Mr. Dean Sullivan, deputy director general of the HSE, Mr. Tony O’Brien, director general of the HSE and other officials from the HSE.
The Chairman and the members of the committee asked me here today to brief to them on Sláintecare and I know that they are also interested in hearing about the targets set out in the national development plan and the results of the mid-term review of the capital plan.
However, before I go any further, I would like to say a few words about current events. This has been an intensely difficult time for everyone involved, most importantly the individuals, the women, and their families. The events of the last ten days in relation to CervicalCheck have shaken the confidence of the public and me, as Minister, in the very fundamentals of our healthcare system. Fundamental values of honesty, truth and openness have been questioned. Our commitment to these vital principles and values has rightly been questioned.
We have a long road to travel to restore public confidence but I am determined as Minister to get to the bottom of what happened here and why such a crisis of confidence and trust came to pass. I want to briefly outline for the committee the steps I propose to take, first, in regard to examining issues relating to the CervicalCheck issue itself, and second, in regard to the broader issues of open disclosure, of the approach to medical negligence claims, and of accountability. First, however, I want to put on the record of this committee my thanks and gratitude to Ms Vicky Phelan, who has played a central role in bringing these issues to light. I want to take this opportunity to thank her again for her courage in doing so.
I want to see all issues relating to CervicalCheck examined and dealt with without delay. Accordingly, the Government is establishing two strands of investigation. The first strand of investigation is the scoping inquiry. Yesterday, I announced that Dr. Gabriel Scally has agreed to lead this inquiry. He will be joined by Dr. Karin Denton, who is a leading expert in women’s health. Yesterday I also published the terms of reference for the inquiry. These reflect the cross-party engagement that has taken place. I want at this committee today to thank all the Opposition spokespeople on health for their assistance and constructive engagement on this. I believe that, as a result of that cross-party approach, we have terms of reference that are comprehensive and allow for the full examination of all of the issues arising and the concerns raised by other parties in the Oireachtas and other groupings as well as the concerns of the Government.
However, what is most essential is that the inquiry deals with the concerns of Ms Phelan and the other women affected or their family members. Dr. Scally has already spoken with Vicky Phelan, and will continue to engage directly with her and with other women and their next of kin who are willing to and wish to do so. I anticipate and expect the scoping inquiry to report by the end of June and have asked that it provide a progress update in the first week of June.
The second strand of the investigation is the clinical strand. This is an international clinical expert review to be carried out by a panel established from representatives of the British Society for Colposcopy and Cervical Pathology and the Royal College of Obstetricians and Gynaecologists in the UK. This panel will comprise a full team of senior independent medical experts from outside Ireland. Their review will ensure that each woman with a diagnosis of cervical cancer who had a previous smear through the CervicalCheck will have her case reviewed so that her concerns can be addressed, including in respect of the timing of her diagnosis, the nature of her treatment and the outcome of her care. These two strands of investigation are crucial to, first, establish the facts; second, determine what action is needed to address the issues; and, third, help to restore trust and confidence of women in CervicalCheck. This will lead then to a commission of investigation. I acknowledge that Deputy Alan Kelly pointed out to us the need for this. The Government has committed to that in principle, but it is important that we gather all the facts and the data through the scoping inquiry process between now and the end of June. This is essential because, despite its failings in regard to disclosure, the CervicalCheck programme works and it is important we are clear on this. Since the inception of the programme, more than 1,200 invasive cancers have been detected by CervicalCheck.
In addition, 30,000 low-grade abnormalities have been detected and more than 50,000 women with high-grade abnormalities have been diagnosed and treated, considerably reducing their risk of developing cervical cancer. The incidence of cervical cancer has been falling and there has been an increase in earlier stage diagnoses. We all want this progress to continue.
It is particularly concerning that the events of the past ten days have undermined people’s confidence in the clinical performance of screening programmes. The facts available do not give any reason to believe the screening programmes have operated outside or below international benchmarks for screening programmes. I very much hope that as we move forward with these two strands of independent investigation, led by international experts, women will begin to feel reassured about the programme’s effectiveness. Women can consult with their GPs if they want to discuss their concerns and arrange a repeat smear test if necessary without charge. An agreement has been reached with general practitioners in that regard.
There are a number of broader issues which have come to the fore as part of the CervicalCheck issue. These are, first, open disclosure; second, the way we approach medical negligence claims; and, third, accountability. I believe addressing these issues to ensure that we do as much as possible to improve this system and patients’ experience of it are absolutely essential if we are to restore trust and confidence that has been so badly eroded in recent weeks. I intend to focus on these as a priority.
It is clear that the delayed communication to Vicky Phelan of the results of the clinical audit of her case and the absence of communication of results to many other women following clinical audit is significantly out of step with the standards rightly expected by the public and with best practice in regard to open disclosure. I am pleased that yesterday the Government approved the drafting of a patient safety Bill, which will provide for mandatory open disclosure to patients of those serious events which will be the subject of mandatory external notification. It is part of a major programme of patient safety and patient centred reform under way. It is led by my Department and includes a range of measures to increase openness and transparency, including patient safety statements, annual quality reporting and the national patient experience survey, the second round of which is under way in our hospitals this month. It also includes major legislation to provide for licensing, clinical audit and the extension of HIQA’s powers to the private sector as an important step on the journey to full licensing of our health service.
Our tort laws have rightly been criticised for being adversarial and slow to provide for persons who have suffered harm within the healthcare system and there has been a growing recognition of the need for reform in this area. My Department has collaborated with the Department of Justice and Equality on a suite of reforming legislation including on pre-action protocols, mediation and periodic payment orders. I also intend to engage with the Minister for Justice and Equality, the Minister for Finance and the State Claims Agency on whether further improvements can be made to the legal framework and the management of medical negligence. Such an approach should complement and inform the major programme of patient safety and advocacy under way.
The Sláintecare report placed an emphasis on the need for both clinical and managerial accountability and states:
The Committee strongly believes there is a requirement for clearer clinical and managerial accountability and governance throughout the system. This includes clarity at all levels, from the Minister for Health, the Department of Health, the HSE and healthcare providers.
I intend to bring forward legislative proposals next week to provide for the appointment of a new HSE board. In addition, as part of my Department’s response to Sláintecare, it is proposed to consider how best to further strengthen clinical governance and managerial accountability in healthcare. I mentioned last night in the Dáil that I have met Róisín and Mark Molloy who pointed out what other jurisdictions have done on this, particularly Australia. We need to look at how other jurisdictions have managed to crack this. It is possible to do it. It has happened in other countries.
Returning to business, I will start by talking about an ambition we all share, which is to reform our health service. Among the recommendations put forward in the Sláintecare report are accountability legislation setting out the requirements on the Minister and staff at all levels of the health service; the introduction of a board for the HSE, with the chair accountable to the Minister and the CEO accountable to the board; the development of a strategic national centre complemented by regional integrated structures that would be accountable for delivering integrated care; and the development of a blueprint for clinical governance across the health system, underpinned by legislation which specifies standards and structures. These recommendations are central to delivering meaningful reform of our health service.
I have said it many times in this committee, in the Dáil and elsewhere but it is important to state it for the record again. The Sláintecare report and the cross-party support it enjoys presents us with a unique opportunity to deliver long-lasting reform that will fundamentally change the way we deliver healthcare to provide fairer, better and more accountable healthcare for all our citizens. The Government is fully committed to leveraging the support and momentum of the Sláintecare report to put in place a robust programme of reform and associated implementation arrangements. Just as cross-party co-operation and support was required to bring forward the Sláintecare report, similar cross-party co-operation and the support of all stakeholders will be required to implement the recommendations.
I am pleased to say I have already been able to take action on a number of the recommendations in the Sláintecare report. I have already outlined to the committee the Bill I will bring forward on reinstating a HSE board. I ask for the co-operation, which I know will be forthcoming, of the committee in getting the legislation through the Oireachtas as an absolute priority to send out a very concrete message on accountability. We all agree on the need to ensure more robust and transparent structures of accountability and the appointment of a strong, skills-based board is essential to achieving this. I also prioritised the Sláintecare committee’s recommendation to consider the impact of removing private practice from public acute hospitals. This is a far-reaching, complex reform but, let me be clear, it is absolutely fundamental to achieving a fairer, more equitable health service. I have established, in line with the Sláintecare committee’s recommendations, an independent review group, chaired by Dr. Donal de Buitléir, to examine the impact of separating private practice from the public hospital system and to outline the roadmap to follow to bring that about. The group has advanced its work very well and will conclude its work this year. This will provide valuable guidance on how we go about implementing this major, fundamental recommendation and eliminate private practice from our public hospitals on a phased basis.
My Department has also commenced work on the committee’s recommendations on changing the HSE structure itself. As members will be aware, this is an area I addressed when I appeared before the Sláintecare committee. We have a HSE that is overly centralised when it comes to decision-making, responsibility and accountability. With governance too far removed from the front line, the HSE has become too big to fail and too big to succeed. Real accountability requires more local ownership and decision-making. An important component of this will be the development of regional structures to support the delivery of integrated care. The first step in this process is to better align our current regional structures – our hospital groups and community healthcare organisations.
Developing more comprehensive and integrated community care is at the heart of the Sláintecare vision. A public consultation has opened on the geo-alignment of hospital groups and community healthcare organisations. Alignment can go some way to delivering and being a key enabler of delivering integrated care. The role that general practice will play within this is absolutely vital. I have now secured Government approval to move forward with contract negotiations with general practitioners and I expect to see progress on this in the coming months. The engagement has commenced and there is Government commitment to supporting the negotiations with a multi-annual programme of funding. It is a game-changer for delivering identifiable improvements in general practice. It is a different space for me as Minister for Health saying I want to negotiate a new contract because it is backed up with resources from right across Government.
The Government has already committed to the establishment of a Sláintecare programme office and the recruitment process for the executive director of the office has been carried out through a very thorough process by the Public Appointments Service, involving a national and international executive search. I expect to have an announcement on the name from the Public Appointments Service very shortly. The final interviews have concluded.
While all reform is important, we know it must also be matched by increased investment, particularly with regard to capacity. I touched on a number of these issues last night so I do not propose to do so again unless the committee wishes me to do so. They are the capital plan developments; the additional 2,600 hospital beds to replace the failed policy of the past of cutting hospital beds in our health service, long before the troika ever arrived in town; the need for 4,500 more community beds to deal with our older population; the need to build three new elective hospitals, one in Dublin, one in Galway and one in Cork; the need to co-locate all stand-alone maternity hospitals with acute adult teaching hospitals; and the fact that is now funded. In terms of Sláintecare, we are providing €1.6 billion in our capital plan to fully deliver the e-health agenda and the ICT programme. The committee highlighted that it is not a discretionary extra and if we wanted a reformed health service we needed a proper e-health system and an ICT system.
I will conclude on that point. I look forward to having the opportunity to brief the committee further, to hear its views and take any questions.