Information supplied to me in response to a parliamentary question to the Minister for Health revealed that, since 2010, the total cost to the State of defending medical negligence litigation against the HSE and Department of Health, including court settlements, had exceeded €3 billion. In fact, there had been a 400% increase in costs from 2010 to 2023, rising from €74 million to just over €350 million. The Minister will agree that these are staggering costs and a clear indication that there is something profoundly broken when a health system for such a small a country can generate these kinds of costs and settlements.

These costs relate to claims against all HSE locations, namely, acute and community settings, section 38 service providers and the national services and disability sector locations. Behind them, however, are traumatised patients, devastated families left with life-long care needs, and doctors and medical professionals who have been broken by the adversarial and lengthy nature of the litigation process. We know that doctors are leaving our system because of this. As Professor Gabrielle Colleran, vice-president of the Irish Hospital Consultants Association, pointed out on RTÉ on Monday in response to my parliamentary question, Ireland and the United States were top of the table internationally in terms of medical negligence litigation. As Professor Colleran pointed out, some of the major reasons for this had to do with the ongoing failure to optimise care, treatment delays, unfilled medical posts and overcrowding in emergency departments, which generates its own kinds of adverse outcomes, including death.

In response to queries from a journalist, Mr. John Drennan, on this issue, the Private Hospitals Association of Ireland also expressed concerns about Ireland’s outlier status when it came to the cost of medical negligence. The PHA stated: "The human and financial cost of the current clinical negligence claims system reveals a system that is not fit for purpose and has not been fit for purpose for some time."

What are the possible solutions? According to Professor Colleran, the first thing we need to do is be ambitious about the introduction of pre-action protocols, which emphasise a less adversarial mediation process. As I understand it, when such pre-action protocols were introduced in Australia, the cost of claims fell by 50% and the average cost of litigation fell by 20%.

Given the costs involved and the high likelihood that we will face €500 million in costs in 2024, will the Minister commit to establishing a high-level HSE and Department of Health working group to examine options such as those put forward by Professor Colleran around pre-action protocols?

At the outset, I will call out and condemn what happened to the Deputy’s constituency office. I am thinking of her and her staff and would encourage anyone with information to come forward to the Garda in Offaly. It was an utterly despicable act that should be called out and condemned by all.

I thank the Deputy for raising this important issue. She has made a number of constructive suggestions and interventions on it. The first action we need to take is to make our health service as safe as it can be. That requires additional capacity, as reducing overcrowding in EDs plays a part in helping us have a safe environment. It also requires putting structures in place so that, when something goes wrong, all of the facts are shared with patients in an upfront and frank manner and a safe environment for the sharing of that information can be provided. A great deal of work has been ongoing in health in recent years in terms of the establishment of the National Patient Safety Office and the passing by the Oireachtas of the landmark patient safety Act and the relevant provisions around open disclosure. From meeting many patients in my time as Minister for Health, I know that the failure to disclose often caused significant pain and people to feel like they had been forced into the legal system when all they wanted was answers and for someone to be upfront and talk to them. Equally, or perhaps not equally, the clinicians said that they did not know how to interact in that regard and there needed to be clear policies and laws.

The patient safety Act was an important step, but the Deputy is right about there being actions that need to be taken to reduce the costs arising from medical negligence. Of course, we need to reduce medical negligence as well, and to address Professor Colleran’s points, steps are being taken. Speaking from memory, the Government appointed in January of last year Dr. Rhona Mahony, an eminent individual, the former master of one of our maternity hospitals and a leading clinician, to chair a group to do exactly as the Deputy suggested, that being, to consider how to reduce the cost of health-related legal cases, with a particular focus on some of the higher cost cases as examples. My understanding is that that work is nearing conclusion. When it is concluded, its report will be considered by the Minister for Health and relevant Government colleagues, published and, I expect, brought to the Cabinet. We need a roadmap. It is important that we consider how to reduce the patient safety incidents in our health service that the Deputy referenced. It is also important that, when things go wrong, we have a system in place that is not an outlier in terms of legal costs and timelines compared with neighbouring jurisdictions.

I thank the Minister for his comments of support. They are appreciated.

There needs to be more accountability. While I acknowledge that there are patient safety measures in place, the model is failing and patients and medical professionals are getting caught up in a system that is not fit for purpose. The establishment of a working group between the HSE and the Department of Health would be a good approach. Along with other steps, I hope that such a measure can be put in place to ensure that Ireland is not an outlier, we can address the issues and, most importantly, there is accountability within our health system.

I assure the Deputy that the HSE, the Department, the State Claims Agency and, I believe, the Department of Finance are represented on the group chaired by Dr. Mahony. I have the terms of reference with me. The group will assess why the costs of claims are continuing to rise, develop a plan to implement risk management, recommend measures to address patient concerns, and receive updates on the implementation of recommendations that were set out in previous reviews of the law of tort. Fundamentally, the group needs to consider suggestions for what practical measures we can take to help reduce costs. I am pleased that there is a wide variety of expertise from government and outside of government in the group and my understanding is that it is due to report shortly. The Government can reflect on the Deputy’s suggestion at that stage in terms of what we need to do to consider and implement those recommendations. We are looking forward to the report and are grateful to Dr. Mahony for agreeing to chair the group and bring her significant healthcare experience to it and to the many other people sitting on it.