A report on standards of care and patient safety in the health service has recommended the introduction of a mandatory licensing system for all health services in the State, both public and private.
The report of the Commission on Patient Safety and Quality Assurance today outlined its proposals for greater accountability in the health service in relation to patient safety.
The Building a Culture of Patient Safetyreport says the licensing system should begin with the acute hospitals and other facilities "based on analysis of potential risk to patient safety". Hospitals providing a range of medical treatment, including any treatment under anaesthesia, dental services, cosmetic surgery, obstetric services, dialysis and fertility treatment would all be required to register.
The licensing system would be financed by a licence fee, to be paid according to the size of the health facility. It would be administered by the Health Information and Quality Authority (HIQA), which welcomed the report today.
Key recommendations in the report include the creation of a national network of patient advocates who will work with healthcare organisations, and the development of a public information service to make information readily available to patients and carers when dealing with illness.
It also calls on HIQA and Health Service Executive (HSE) to implement national standards for open disclosure of "adverse events" affecting patients and for existing senior professional roles such as that of chief medical officer within the Department of Health to be strengthened.
In addition, the report recommends the establishment of a single database recording potential healthcare employees' qualifications. It says professional regulatory codes of conduct must prioritise patient safety as the primary duty of all healthcare professionals.
Minister for Health Mary Harney said she hoped to bring the recommendations to Government next month.
Chaired by Dr Deirdre Madden, a barrister and expert on medical law and ethics, the commission was established by Ms Harney in January last year.
Her 228-page report calls for the drafting of legislation as soon as possible to implement all of the recommendations. It also recommends the immediate establishment of an implementation steering group, supported by a full-time executive, within the Department of Health. The steering group would be required to report to the Minister every three months.
"This piece of legislation will undoubtedly be very complex and it will take some time to introduce," Dr Madden said. "We would envisage that the Department of Health should be able to publish this Bill in late 2009 at the latest, with a passage through the Oireachtas in early 2010."
Dr Madden said reports already in the public domain in relation to adverse events affecting patients "clearly point to certain deficits in relation to governance and accountability and reporting relationships".
"The commission has benefited from those reports that are already in the system and is trying to put forward a plan for the future which will ensure that those sorts of adverse events can't happen again.
"But I think it also has to be borne in mind that medicine is not a risk-free enterprise. Errors happen in every healthcare system in the world and Ireland is no different.
"What we want to do is to try to develop a framework for the future that will minimise those adverse events, or the likelihood of those events occurring, to the greatest extent possible and to ensure that if adverse events do occur that patients and their families are cared for and informed and that there is analysis of the events and that learning takes place throughout the system."
Ms Harney said today the report made "far-reaching recommendations which when implemented will impact very positively on patients and their families".
"Perhaps the most significant recommendation of the report is the introduction of a licensing system for all health services whether they are delivered publicly or privately," she said.
"The current system whereby anybody can open a hospital for example, does not adequately offer patients the protection they need and deserve."
Ms Harney accepted that the health system will "always be open to the possibility of human error" but added: "All of us working in the delivery of health must make every effort to minimise error and maximise quality. A blame-free reporting and management culture is undoubtedly in the best interests of patients."
HIQA said the changes outlined in today's report were "essential to further improve the quality and safety of care that patients should receive throughout Ireland". It said the board will meet next month and give "careful consideration" to the recommendations.