Health Identifiers Bill

27th February 2014 - Olivia Mitchell TD

I welcome the Bill and the opportunity to speak on what on the face of it seems like a fairly simple and straightforward Bill. This Bill sets up a unique patient identifier for every citizen in the country, provides the legal framework for how it will operate and who will access it and deals with governance issues associated with data protection rules. The Bill was deemed necessary and recommended by the report of the Commission on Patient Safety and Quality Assurance. The Health Information and Quality Authority, HIQA, also had an input in suggesting there be an identifier for health professionals.

This Bill goes far beyond that in that it enables much more far-reaching effects than merely identifying the patient. As Deputy English mentioned, it is difficult to believe we have not had this in place for many years. It seems such an obvious precondition for patient safety. The Minister has referred to the main purpose as being patient safety, and indeed it is. It is not just about identifying but identifying is extremely important, particularly in an island country where we have a concentration of family names. Given that people can have the same surname, it is easy to see how there is potential for disastrous mistakes to be made in testing, communicating the results of tests, diagnosing, prescribing and treatment. The chances of having many Mary Murphys on a GP’s list are quite high. It is even possible to have two or three Mary Murphys in a hospital ward. It is not entirely improbable. I recall somebody telling me about her worry when she had a new baby because somebody in the same ward had the same name as her. She was never terribly sure if she was getting the right baby or not although I know that maternity hospitals go to great trouble to ensure one does get the right baby. It is amazing we have so few mistakes relating to identity with people consequently being given inappropriate treatments, particularly in hospitals.

Apart from treatments, the Minister gave an example of how identifiers can really improve the administration of our health service, which improves service to patients. He spoke of the problems relating to delays that were associated for a time with the granting of medical cards when we were switching from locally dispensed medical cards to centrally provided cards. In one example, the delay was due to 133 people with the same name applying simultaneously for a card. Again, it is easy to see how it might not be that easy to match all the medical and financial details to the correct person. Of course, it caused people enormous stress and disappointment when they were turned down after being assessed on details that applied to somebody else. It has great implications for this kind of administration. There could literally be dozens of John O’Briens but it does not take dozens, it just takes two people with the same name or even similar names for mistakes to happen. The unique identifier will deal with this particular problem.

I understand there was considerable debate as to whether a new identifier number was actually necessary when we already had a comprehensive personal public service number system. A single identifier does have its attraction as a cleaner, simpler and comprehensive way of serving all health and social needs, particularly those of large numbers of people and particularly because those kinds of services overlap. However, I understand that HIQA was against the use of the same number for a number of reasons. Of the two reasons I found most persuasive, one related to data protection and the fact that the PPS number contains personal information that one would not necessarily want to be accessible. The other reason was that the PPS number is not available on a 24 hour basis, which would be essential for a health service. People often need their health information instantly. These were compelling reasons for giving separate numbers despite the attraction of a single number.
Due to the fact that health and social welfare services overlap, it is very important that the two systems can be linked. I hope and expect that over time, both the health service and social services will become increasingly computerised. It is important the two systems are able to speak to one another accurately about the same patient. I welcome that as well as containing the name and address of the person, the health identifier will also contain their PPS number.

The main objective of this legislation is patient safety. Introducing a unique identifier for every citizen will increase efficiency in the administration of health. An important aspect of this development is that it will facilitate many other ICT improvements in prescribing and dispensing, in referrals, in consultations and in record keeping. The one matter on which everyone agrees is that we need a greater investment in ICT. It is scary to see the filing systems in place in some hospitals. To the casual observer, they look Dickensian – people queuing for files, files falling apart, files that cannot be found, people needing to return on another day because files have gone to other departments etc. Information is not always accessible instantly, as is the requirement in an emergency. A major investment in ICT would not just improve safety and quality in the health service, but also make it more efficient and cheaper, which is something we definitely need.

The Health Information and Quality Authority, HIQA, has estimated that a breathtaking 30% of the health budget is spent on handling, collecting, searching, filing and storing information. Even basic information on individuals is held across a range of social and health services, for example, by hospitals, general practitioners, GPs, laboratories, physios, etc. It is almost impossible to collate a complete health history based on a name alone, particularly where a person has a complex or long-term complaint. We must access and manage information more effectively.
Not to put a tooth in it, but a slightly worrying question is, if 30% of our budget is spent on filing, how much of a health professional’s time is wasted as a result. As we know, health professionals are not cheap. An even more serious question relates to the cost of, for example, lost files in terms of patient outcomes. Face-to-face contact with health professionals is also lost, even though this is what the health service should be all about.

Some 0.85% of our budget is spent on ICT, whereas the European norm is 2% to 3%. As part of a move to a more efficient and modern health system, we must have proper ICT systems. The value of this Bill is that identifiers facilitate such systems. Indeed, identifiers are a precondition for them. However, the main boon of an identifier is the extraction of population-wide information for epidemiology studies, which are vital to good health planning. The Minister mentioned vaccination and screening programmes, but identifiers will also allow for the tracking of increased or decreased instances of diseases and demographic or geographic differences in health status. I am referring to the types of information that are required for a focused health care response and future planning. Identifiers would also be a critical enabler of the e-health strategy.

I wish to make a couple of helpful points. First, there will be a system for putting in place a marker when people die. As mentioned in the legislation, dead people will have a number. No such system is in place currently, which has led to the scandal of GPs being paid in respect of people who had left their areas or died. This Bill represents an opportunity to put in place a foolproof marker system so we can know how many patients a GP has on his or her list, etc.

Second, when people contact Deputies, we often need their PPS number, but they do not have a clue what it is or how to go about getting it. We should run an information campaign to let people know, as a PPS number is important and unique and people must be able to access theirs.

Health Identifiers Bill

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