Bernard Durkan (Kildare North, Fine Gael)
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I listened as carefully as I could to the various points. We need to think about the situation a few months ago, when the issue first became public. If I was the Minister, I would want to know what went wrong. The Minister quite correctly did everything possible to ensure that all the available buttons were pushed to begin a new era with a new confidence into the system. As the Chair knows I have been a critic of the structure of the HSE, though not its personnel. I do not and will never agree with the structures because to my mind they are not workable. I asked a question at this meeting; who is the boss, the Minister, or the HSE? I have to raise that question again. The Minister quite correctly made the decision to reassure those women who might have been under the illusion that they either were or were not cancer-free, in order to address their anxiety.

I fully accept Dr. Doherty's response on responding and dealing with a situation as it arises, but however this situation was dealt with was not adequate. It did not work correctly. If it did, there would not have been a problem in the first place. Somebody said that a clinical decision was made. A clinical decision was not made; a management decision was made by a clinician on the basis of experience suggesting things might happen in a certain way. The critical issue at that stage was the need to reassure the public that the system in place was adequate and those who had gone through screening, whether they got a negative or positive result, would receive another test. The issue then was to separate the two and create a second line. The solution could not add to a waiting list or to the problem that was already there. A second channel was needed to deal with that review for women who might or might not have a concern or might or might not have a condition. That was where the problem arose. That is what needed to be done at that particular stage. That is a management problem too. It concerns how to manage a situation.

I am not being critical at all. We have a lot of experts. Somebody mentioned that we are not clinicians. That is right. However, we have a duty to raise the issues and to ask whether the system is fit for purpose and does the job. That is also essential if we are to be fair to the clinicians. If we do not have a system that is adequate to the caseload, the clinicians' job will become impossible. No matter what they do, a problem will come down the tracks at some time in the very near future. It is very easy to pick out a scapegoat and say that he or she is responsible for this, be it a clinician, a Minister or somebody else. The fact is that the situation arose that was totally unacceptable. That is a fact. That is not a theory. It was there, plain as a pikestaff, in front of everybody.

The system had not worked. There was confusion over whether it was a diagnostic system, a smear system or simply a check system, and we knew what that meant with 80% accuracy and so on. Some people acted on the basis that it was 100% accurate. Of course it was not. We came to the conclusion early on that it was the wrong system and that we need a more accurate system. We cannot put our political or medical reputation on the line unless we have a reasonable degree of reliance on whatever we are dealing with.

It goes back to capacity - this has come up again and again. Sadly, the necessary capacity was not in place to do the job as it should have been done. There are various reasons for that, whether it was a lack of money or personnel or a failure to attract clinicians from abroad and so on. Whatever it was, it was there then and it is still there.

We should be fair to all concerned. I can play politics with this as much as anyone else. I am sure the Minister could do so if he were here as well. Playing politics does not address the issues or concerns of the women. It is easy to do that with sound bites left, right and centre. We can accommodate that and I can accommodate that too.

I am keen to emphasise one point now as I did at the beginning. I believe we now need a clear indication that we are attacking the problem at both ends. We need to contain the existing problem and make inroads insofar as waiting lists are concerned.

I received a reply to a parliamentary question last week in another context. I nearly had a seizure when I read it. It related to a condition that was progressive and serious. Whoever dictated the reply decided that the question was submitted by a stupid ridiculous politician who would not know the difference. We do know the difference. We know cynicism when it is incorporated in a reply. We know the mind-your-own-business mindset when it is incorporated in a reply. This is our business. This is what we are here for. When we ask a question it would not necessarily be a good idea to come to the conclusion that the stupid idiot who raised the question in the first place does not know what he or she is talking about. We have to be alert, on-the-ball and able to do the job. That is why I have said many times in the past that when the health boards were in existence what happened in a crisis situation was that there would be a meeting on the same evening or same day – not a week afterwards or anything else. By the following morning we all knew what was happening.