Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

Dr. Scally talked about open disclosure and the need for legislative underpinning. I absolutely welcome that. People had the opportunity to vote for that twice in the recent past. They did not do so but the unfortunate events we are discussing will, I hope, put a bit of focus on open disclosure. It is regrettable that it will take legislative underpinning to make it happen but if it does, that is fair enough. There were descriptions of a paternalistic attitude in how the women were spoken to, which takes away from much of the good work done in the health service. I would love to be in a position to say I was wildly shocked by this attitude but, as a woman who uses the health service, I was not shocked. Is Dr. Scally confident that we can address that situation and change it?

I remember that the decision taken to outsource services was purely political and no clinician advised that outsourcing should happen. When the then Minister was questioned about it she said it was good value for money but nobody ever said there was a good, sound, clinical reason for it. It was outsourced and then re-outsourced. Dr. Scally talked about the medical advisory committee not meeting. He expressed surprise at the level of quality assurance and said it was not in line with best international practice. Presumably, according to best international practice the person in charge would have sight or knowledge of the slide and would know where it was. Slides appear to have been sent to one site in the United States and then outsourced to another site.

Honolulu is more widely recognised as a holiday destination than a centre of excellence for medicine or laboratories. How can Dr. Scally and members have confidence that everything was in order when the laboratory there does not apply the ISO standard which I understand to be a benchmark and we do not know how many tests were outsourced to it? Members have asked that question on several occasions. The first time it was put to representatives of the HSE was at a Wednesday meeting of this committee, and the impression was given that we would have the results by the following Friday and that it was simply a case of someone in the HSE pressing a button to give us the breakdown of which labs were doing what. We still do not have that information.

While the average standard in the laboratories may be acceptable, some of the labs could be out of line. We have no way of knowing whether the lab in Honolulu was out of line with what is considered international best practice or international norms. Has Dr. Scally tried to ascertain the figures on what slides went where, who looked at them and whether there were any outliers in that regard? We have asked for that information but, unfortunately, we have not been given it. We want a detailed lab-by-lab breakdown which we can examine. I am not comfortable relying on averages. As a colleague of mine used to say, if a person has one foot in a bucket of boiling water and the other in a bucket of ice, the person’s two feet are wrecked but, on average, the temperature is fine. Averages do not tell us anything. We are seeking a detailed breakdown for each lab. Is it possible for Dr. Scally to obtain that?

On contract governance and the shredding of contracts after ten years, I too was quite taken by the efficiency with which that was done. As one quite familiar with the HSE, I can state that it does not have a reputation for being hugely efficient. However, it certainly was efficient in this aspect. Is it possible to get copies of the contracts from the laboratories in the United States? The contracts could be examined in regard to the re-outsourcing. I am concerned that, while there does not appear to have been a very deep and meaningful relationship with the contracted labs in the US, there was no relationship with the labs to which the tests were subsequently outsourced.