Martin Daly: 'Worst of the Worst' on Health Digitalisation

Deputy Daly. Thanks, Cahir, look. Thank you, Mr McCallion, thank you, Mr Cheney, for coming in here. It was really important that you come in. This is absolutely critical, and I'm conscious of my time here. So I'm going to say something here. We don't need imagination to understand what digitalisation in healthcare means. We don't, we're gone from the age where we don't leave our own parishes, our own counties, and our own country. We go to Spain, we go to Portugal, we go to the United States, we go to the UK. It's digitalisation of healthcare. So why are you asking us to imagine a situation? We don't have to imagine it. Ireland, starting from a relatively low base, my God almighty, we would be a non-league side in soccer terms. We are so far off the charts. We have no chance of meeting the digital compass target of all citizens, getting access to electronic health records by 2030. We are so far off the league that we are the worst of the worst. And it really is difficult. So I think, Mr McCallion, you gave an example of someone having an X-ray read in one part of the country, and a specialist, a CT scan or an MRI being let with us. I'll give you a patient experience very quickly. A woman with a retinal bleed, that's a bleed at the back of the eye, lasts her as it goes to UHG, two and a half hours wait, sent home because there wasn't a senior doctor to see her, seen by a junior doctor, seen at 2pm on Friday, waited four and a half hours, at quarter to six in the evening, was told by a junior doctor that nothing could be done at the weekend, it was over. Now, she had travelled an hour in to the hospital. She then, in desperation, they rang every private hospital, they don't have the resources to do that. They eventually went to the optician who said, yes, you have a bleed at the back of the eye, this is urgent, you need to see a consultant ophthalmologist. They go back in on Monday morning, no one knew where their charts were. She's eventually waited for nearly eight hours and went home in frustration. I spoke to her on Monday afternoon to her daughter. I said, I insisted that she go back into the hospital. It was too late to go in at six o'clock in the evening because it's clear to me she wasn't going to get a satisfactory service. She goes in and eventually, eventually, a senior doctor, firstly, no one could find her chart when she went in. Eventually, after insisting and saying that I would write a complaint, me, her GP, would write a complaint to hospital management, she was brought to see a doctor who was very, very kind to her and dealt with her problem. But he had to start all over again. Why? Her chart had been left in a van and gone to Merlin Park Hospital across the city to be scanned into the system and was not available for her to be seen to her exam again. That's the reality of the level that we are starting with, with our digitalisation of the health service. So, all the fine words around the lead-in about aspiration, imagination, security, none of it means anything to the patient on the ground. Because we now have a system that we can throw as much money as we like at the health service. But unless we digitalise our health service, we will not get the commensurate productivity. So, asking number one question, and these will be simple questions, do you think we will meet the aspiration of 2030, the digital compass target for the European Union? I suppose I'll ask Mr McCallie and Mr Tierney to answer that. And briefly, please. Sure. First, Deputy Duke, for any patient of that experience, just to apologise, obviously, we would not want that to happen. And where we want to get to is where the patient's chart will be there. We have a project called the Shared Care Record, which we believe will enable that to happen by taking information from hospitals and GPs. So, that information would be available in a manner which you've talked about there in Galway for that patient's experience, where it shouldn't have happened on the opposite side of the city. So, my colleague Derek Maywish to comment as well, but the Shared Care Record, essentially, Deputy, will pull information. It's gone live in Waterford and Wexford just in the last week. It will take information from GPs. It will take information from hospitals. Initially, it is information such as discharge letters, laboratory results, radiation results. I understand that. Have we a budget? Is there an adequate budget? Is there an adequate budget to deliver on this in the next four years? I'm confident, Deputy, in terms of the funding stream that we have at the moment, that we can deliver that. In terms of the Shared Care Record, we have a budget for that project. And I'm confident that we can achieve that. Mr Tierney. I'll be a bit more categorical. The answer is yes. Okay. Yes. That's good. Okay. Looking at the frailty of what happened in the attack on the HSE IT, what have we done to improve the resilience of the system? I mean, it's clear that our system was, by the way, that doctor who was very kind and saw the patient at the last moment, described the system as archaic. Archaic. So what has been done to improve the resilience of our systems in case of another attack, a cyber attack? So two things, Deputy, maybe. Just in terms of, from a cyber perspective, in 2021, we didn't have a Chief Information Security Officer in the HSE, and we had about 10 staff working in this area and no dedicated budget. We now have a senior person, Chief Information Security Officer, recruited externally. We have 70 staff, and we have over 70 million invested. And we're working through, as well, it's not just the money and the resource, trying to modernise and lift up a lot of the systems that, as you described. And I do accept your point that we are at the bottom of the league table, but I do believe with these steps we've set out, we can move ourselves up that league table. Well, we're not even bottom of the league table. So we have four divisions in the English Football League. We are non-league. That's where we are. And we are the only one. And in every single report I've read from the European Court auditors, Ireland is mentioned as an absolute outlier. I'm just going to make that... Mr Tierney, could you make a comment, please? Well, maybe I'll deal with where we are in terms of digital maturity. I accept all the criticism, and it's fair. We are coming from a low base. We are the most extensive ICT network in the country. However, I would say we will meet the digital decade substantially by 2030. Our ambition, by the way, is to go beyond that and get there sooner. The SureCare record is the way we unlock that ambition and actually move us up the league table. I'll be very confident by even within the next two years we'll start surpassing some of our European peers in terms of our digital maturity. When I look at the cybersecurity and the arrangements we've put in place since 2012, just let me break it down. So we've mandated the HSE to make a senior appointment at the highest level available in terms of professionalisation. We've established what we call a security operations centre to give a dedicated focus. We are now building our cybersecurity maturity in line with an international best practice standard called NIST, and we're moving up that maturity curve, and we've ring-fenced annual funding. It's protected to build our security. We recognise we have to secure our foundation to deliver on our ambition, and that is what we're doing with intent. The only guarantee you have in cybersecurity is you will get another attack. So the other part of that is to make sure that you're prepared and you can deal with it. So even yesterday we had a session with all of our hospitals around having continuity plans, so where you are more digital dependent that they know how to function when that happens. Thank you for your answers. Sorry, Mr Tierney. Like, it's well understood now that health data is more lucrative in terms of criminally motivated attack than financial data, and we recognise that, and we are protecting our systems on that basis. I appreciate you having us.