In February of this year I raised the need for reform of the entire process surrounding medical negligence litigation. In general, when a person accesses the healthcare system, the reasonable expectation is that the care and treatment received will be provided by competent and qualified professionals. There is also an expectation that treatment will take place in a safe environment and that no unnecessary harm will come to the person. By and large, this expectation is realised but there are situations where unintentional complications can arise. Things can and do go wrong. If problems arise, the results can cause devastating emotional, and sometimes physical, consequences. These consequences can be life-changing. Ultimately, there is a strong possibility that the circumstances surrounding the events will lead to a claim for medical negligence.

Over the past ten years, damages paid by Irish hospitals in medical negligence claims have run to a whopping €1.8 billion, and they are rising rapidly. This escalation in the number of claims is disturbing and will be a major drain on the economy. If a person has suffered harm as a result of negligent treatment by a medical professional, he or she is entitled to be compensated for the suffering and impact it has caused. This is an unquestionable fact. The process of securing this compensation can and often does prove extremely arduous. The process is insufferable and agonising in a significant number of cases. According to a report from 2021, the adversarial nature of litigation makes the process conducive to "a protracted, contentious, emotionally draining and expensive legal battle".

Part of the reason for this is that the vast majority of people cannot undertake proceedings without legal supports. If you search online for information on medical negligence, you will find numerous pages of legal firms all claiming to offer the best possible advice and service to misfortunate patients. Once the patient enters legal doors, the protracted battle begins. Many of these cases drag on for years with mounting legal costs. The patients may win the case but at what cost financially and emotionally? Meanwhile, on the flip side, there is a medical professional who has a case hanging over his or her head, a dark cloud that hangs over him or her for the prolonged duration of the case. Due to the prevalence and fear of litigation we have reached a situation where many consultants are reluctant to make a surgical intervention in a borderline case.

By way of information, could the Minister advise if this compensation is coming from the HSE budget or the State Claims Agency? The most effective way to reduce and constrain soaring medical litigation is to invest in the health service. We should invest in accommodation, facilities, technology and staffing levels. We are spending millions on settling compensation claims because of neglect arising from understaffing, a lack of beds and a lack of facilities, which leads to overcrowding, delays and pressurised situations which result in human error.

I thank the Deputy for raising this issue and there are a number of different strands to this. Where a case is taken, we need to ensure that case and claim are dealt with as efficiently as possible. None of us want to see instances where, especially in the case of catastrophic injuries, it takes many years and eventually on the steps of a court a settlement is agreed. We are seeing an increasing role for mediation in the settlement of these cases. The State Claims Agency has a difficult job to do in managing clinical negligence cases on behalf of the State but we also have a duty to the people who are bringing the claims and who, in many instances, have an entitlement to compensation as a result of what has happened. Looking at mediation, for example, 59% of claims resolved by the State Claims Agency in 2021 were resolved without court proceedings being served. That is a good start but we need to build on that and go further. Mediation is particularly suitable for complex clinical claims. Some 37% of claims were concluded by the clinical claims team in 2021 where damages were paid in the mediation process, compared with 25% of claims in 2020.

The Deputy touches on the root cause of the issue and we have to ensure we reduce the number of incidents where reason is given for claims to be brought in the first place. As would be expected, the HSE is placing an enormous focus on this through the patient safety strategy, which is being implemented. We expect that to have an impact over time. The Deputy is right to point to the dramatic increase in the cost of such claims. That is why in January of this year the Government approved the establishment of a new working group to examine the rising cost of health-related claims and to consider mechanisms to reduce costs. It will examine the rising cost of clinical negligence claims in the health system with a focus on high-value claims, and it will identify measures that could be put in place to reduce future costs. It is being chaired independently by Dr. Rhona Mahony and is comprised of membership from across key Departments and Government agencies. That also builds on the work of Mr. Justice Meenan's expert group on tort reform and the management of clinical negligence claims and its report, which identified a number of key issues that are being worked on by the Department of Justice. This includes the issue of the real rate of return and the volatility in some of the catastrophic birth injury settlements we are seeing.

We need to remove the incentive for cases to have to go that far and then have a system that ensures cases are settled far earlier. In addition to all of that, we must try to deal with the root causes and the issue the Deputy has referred to, namely, the response of the medical profession and the impact that may have on patients due to the fear of a claim being brought.

I welcome the fact that the Government established the interdepartmental working group. However, it does not go far enough. The Minister referred to the mediation process and there are many instances where an independent early mediation between the patient and medical professional can resolve a situation in a cost-effective manner. There is merit in having a cap on compensation amounts for certain specified cases, which would lead to prompt settlement at such mediation. Such systems work effectively in other jurisdictions. There are advantages to eliminating costly court hearings that take forever to resolve. The Government needs to be conscious that the HSE has a tendency to run costly legal battles and ultimately settle at the last moment on the steps of the court. This seems to be the norm with it. Why can it not settle without the legal costs? We understand that medical litigation is a complex matter but our system in Ireland has created a minefield and a money pit. It is time to scrutinise and revise that system because it is costing taxpayers and the Exchequer a fortune every year.

There will be individual cases that go all the way to court or to the steps of the court. That is unavoidable. There are two parties involved and there are lawyers providing legal advice to their clients and some people will want to have their day in court, but they are a small minority. The vast majority of claimants want to reach a settlement as early as possible in the process, and that is the most cost-effective way from the State's point of view because, looking at the figures in 2020, legal costs for clinical claims represented 18% of the total cost of all claims. It stands to reason that the earlier in the process a settlement is reached, the lower the percentage of the overall cost of the claim that will be attributable to legal costs. It is in the State's interest and the claimant's generally for cases to be settled early. I assure the Deputy that this is an area of focus across Government and a number of Departments from the point of view of costs, which are rising very significantly, and we have to be alive to that and address that, but also because, in the case of genuine claims where there is a settlement due, we want that to happen earlier in the process.