Jan O'Sullivan (Limerick East, Labour)

I acknowledge the Minister's apology in the Chamber to the women who were affected so appallingly. I agree that it is a day to put patients first. The problem with the Minister's speech and the Taoiseach's response to Deputies Kenny and Gilmore is that there is no evidence of the Government taking responsibility as opposed to apologising and examining what happened.

There is no evidence that the Government is making the necessary links between the events that have eroded confidence in the service. Listening to the airwaves over the past few days and from the phone calls to Members recently, there is a genuine crisis of confidence in diagnosis, particularly with regard to breast disease. Women are wondering if their local facility will be the next on the list. This morning we heard about concerns in Cork University Hospital. I do not know if these concerns are justified. People have lost confidence and the only people who can restore confidence are those who are charged with responsibility for policy and resources in the health services, namely, the Government, particularly the Minister for Health and Children. I have not heard that this responsibility is being taken on. Instead of trying to find a way to restore confidence, the Taoiseach was defensive in the argument, particularly with my party leader.

The issues in Portlaoise are not isolated. The Minister has outlined the events in so far as she knows but we cannot isolate it from what Susie Long and Rebecca O'Malley have said to us, the Barrington's Hospital affair and testing in University College Hospital Galway. All are connected and together they have eroded confidence. One cannot deal with situations in isolation.There is a suggestion that those in opposition are opposed to the centres of excellence, but we have fully supported the concept and will continue to do so. They will not be established for some time to come. We do not know what resources are available, nor the timescale.

In the meantime, we see a rundown of services, as was the case in Portlaoise, based on what I have heard so far. Someone brought attention to the age of the equipment in the hospital. The issue was first raised by someone in Portlaoise on 5 July 2005. The Department responded but it was not adequate, otherwise what happened would not have happened. On behalf of the people, Members cannot be satisfied with the answers we are getting. We must know how and when resources will be available to the centres of excellence. Otherwise, Members are not doing their job of being responsible to the people who elected. We must ensure they can have confidence in the system to the extent that if someone finds a lump in her breast tomorrow, there must be a service that tests properly and provides an accurate result and timely treatment in an appropriate setting.

I am not just making this up, nor is it merely what the Opposition is stating. People throughout the country, including highly respected medical people such as Dr. Maurice Nelligan and Dr. John Crown, believe this. Some are not going public but are concerned, as the Minister knows. One cannot respond by saying that these people have a political agenda. Those in the medical services do not speak with a political agenda. We support what is said to us.

The series of failures of the health services to deliver safe, reliable and timely diagnosis and treatment to cancer sufferers, culminating in the fiasco at Portlaoise hospital, has caused enormous trauma and suffering to the women concerned and their families. Furthermore, there is now no public confidence in the system and that is a national crisis that must be addressed. I can only imagine how it must feel to have symptoms of breast cancer; to go through the testing process and the anxious wait for results; then to experience the relief of being given the all clear only to find out months later that the whole thing was an awful mistake and that one must go through the whole experience all over again. In addition, as one of the unfortunate ones facing a diagnosis of cancer, a patient would be doing so having lost those vital weeks when early treatment could have improved the likely outcome and recovery. Eight women in the midlands have gone through this awful trauma and others still do not know their fate. Women all over the country are wondering if their hospital will be the next one in the news. Already this morning there are suggestions in the media that Cork University Hospital is recalling a number of patients.

I am disturbed at the blame transferred to the public and patients who are campaigning. How is the patient who is referred for testing to know how many experts are judging the case, if the testing equipment is up to scratch, if the images the experts are examining are clear enough to read or if the resources have been provided for a hospital such as Portlaoise? The public must trust the system when people are sick or fear they are sick. I call on the Minister for Health and Children to take responsibility to restore people's trust. She cannot devolve responsibility to anyone else, such as the CEO of the HSE. We cannot continue to lurch from crisis to crisis and see the spectacle of everyone involved apportioning blame but taking no responsibility for doing something about it. How do we get from the current situation to the concept of centres of excellence? I accept the Minister's point that we should already have centres of excellence in Ireland. The O'Higgins report in 2001 recommended centres of excellence. People working in the so-called centres of excellence are not satisfied with the resources provided.

Professor Gupta, who does excellent work, publicly stated that his unit is not adequately resourced to address the needs of the region in a timely fashion. As I do not wish to cause fear, I must state that the centre is doing excellent work but it does not have adequate resources. People choose to have mammographies in private hospitals because they are done quicker. We know that private facilities do not have the necessary throughput or the triple assessment to which Deputy Reilly referred. People choose private health insurance because of the wait in the public system. We must provide resources for the centres.

Brave women like Rebecca O'Malley and Susie Long went public on their personal pain because they wanted to make a difference and bring about change. The responses I have heard from those who are charged with running the country and running the health services give me no hope that they have been listened to. The Minister provided an account of the situation at Portlaoise but questions remain. We must know what was going on, why only one person read mammographies and why those read for a second time gave a different result. Clearly there was concern about what was happening, which was not in accordance with best practice or the original intention in setting up that centre.

A specialist radiographer stated on radio this morning that national standards had been under discussion since 2002. One of the implications of what he said is that such standards have not been adopted because of the serious cost implications involved. If that is the case, then the situation is extraordinarily serious. We must have national standards and also standards relating to laboratories and quality assurance. If such standards do not already exist, they must be put in place as quickly as possible.

We must go beyond simply carrying out a thorough investigation of what went wrong and why at Portlaoise. We must be informed as to what will be done, when it will be done and how it will be resourced and funded.

The term "centre of excellence" sounds very good and reassuring but this particular emperor has no clothes. How are we supposed to believe that what is envisaged will happen, particularly in light of the track record to date? Centres of excellence were proposed by Professor O'Higgins in 2001. We debated this matter with the Minister a couple of weeks ago when she announced the plans but she did not provide any information regarding how the centres will be established, not to mention indicating when they will be in place and fully operational. If people who are being asked to give up their local services were informed of the latter, they could at least believe that something better will be established to take their place.

I wish to add to what Deputy Reilly said in respect of patients in various parts of the country who do not know what lies ahead for them. People in Clare have been informed that they will be obliged to travel to Galway for treatment but a reduction in services has taken place there. How will these individuals be accommodated? I was also contacted by the Cancer Care Alliance, whose members are extremely disturbed by the fact that they were considered to have obstructed a process of moving towards establishing centres of excellence. The alliance has been campaigning strenuously and successfully in respect of Waterford and Limerick regarding centres of excellence, radiotherapy treatment, etc. The Minister must address this matter because the organisation in question is of the view that it has been wronged.

Instead of obtaining the information we need, we are faced with a situation where high expectations have been placed on Dr. Keane, who is returning to Ireland from British Columbia, to resolve this matter. Members of the public require far more information. We, their representatives in Parliament, cannot accept that responsibility for this matter will be given to one person, expert though he may be, with no commitment of resources. If we accept this, we will be informed, when we raise questions in the years ahead, that the Minister and the HSE are not responsible. Responsibility has been shifted to a gentleman, Dr. Keane, whom I have never met. That is not good enough. We must know, before responsibility is transferred, how the Minister proposes to resource and fund the centres of excellence.

The Minister must provide a commitment today in respect of resources. I do not believe that the centres can be established in the way she outlined on last night's "Prime Time", namely, through a redistribution of existing resources. What are those resources and have they been audited? Can staff be transferred? What are the building requirements? The Minister stated that fewer than 56 procedures are being undertaken at the 13 locations that are being closed. Surely this does not indicate that there is a significant level of resources available to be transferred from those hospitals. I imagine that many of the surgeons involved are doing other work and cannot simply be transferred.

We do not know the answers to any of the questions I have posed. We are aware, however, from the information provided by the radiologist who spoke on radio this morning, that national standards do not exist. Such standards must be put in place as a matter of urgency.

The Minister must engage with us in dealing with these matters. It is her responsibility to restore trust. It is not enough to say that an expert will come here from British Columbia and resolve everything. I lived in British Columbia for one year and I am aware that it has a completely different population distribution to Ireland. When I was there, it also had a much more advanced health service than that which existed in Ireland at the time. One cannot simply transfer what may have worked there to a totally different and very complex system here. Before the centres come into being, we must be informed as to how their establishment is going to be achieved.

We are not going to let Deputy Harney off the hook regarding her responsibilities as Minister for Health and Children. This is not about placing blame, it is about taking responsibility. Unless credible answers are supplied in respect of the questions raised by Rebecca O'Malley, Susie Long, the women from the midlands, the professionals who work in the health service and Members who will contribute to this debate on behalf of those who elected them, this issue will remain on the Dáil agenda.

In the question and answer session to take place at the conclusion of this debate, I hope the Minister will address the question of resourcing and indicate how we will put in place the system she is proposing. That system is merely a concept at present and we do not know how it is going to come into being. People, particularly those who have been campaigning for cancer services, are not willing to accept something that is just a concept; they want to know exactly how the system will be put in place. We will not allow the Minister to wash her hands of the matter. We want to know exactly how the system will be established.

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