Dáil debates

Wednesday, 7 November 2007

Cancer Services: Statements (Resumed)

 

1:00 pm

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

People throughout the country have been appalled at the plight of the women who were given the all clear after breast cancer screening but who have now been diagnosed with cancer. Many more women may well be affected. Our sympathy and solidarity goes out to all of them.

It is scandalous that so many women should have been let down so badly. A total of 3,000 mammograms have been reviewed in the Midland Regional Hospital in Portlaoise alone. The same may be required in other hospitals. There are now conflicting claims regarding what lies at the root of the mammography scandal at Portlaoise. There is an urgent need for a thorough investigation. Any investigation must be open and transparent.

Thousands of women must feel betrayed and bewildered as they listen to the conflicting claims. Neither the Health Service Executive nor the Minister can shirk their responsibility for this situation. The HSE is directly responsible for public hospital services and it has a duty to ensure that proper standards are maintained. It is disgraceful for the HSE's chief executive, Professor Brendan Drumm, to try to shift the blame for this situation onto the people of Portlaoise and the midlands because, like those in other regions, they opposed any threatened downgrading and loss of services at their hospital.

The claims of the Minister and Professor Drumm in respect of the mammography scandal have been totally undermined by the letter revealed yesterday. The letter to management at the Midland Regional Hospital, Portlaoise, dated 13 December 2006, from the radiology department advised that to deliver the highest standard of patient care an imaging system that could produce mammograms of the best possible diagnostic quality was required. The correspondence expressed concern regarding the age of the mammography machine and advised that a digital system was needed instead of the film system, which at times was affected by dirt from the dark room environment.

This morning, another radiologist, David O'Keeffe of Galway, stated that there is inadequate regulation of radiological equipment in our hospitals. He pointed out that it has been recognised since 2002 that standards were required but that there had been no agreement in respect of them. Most damningly, he claimed that agreement is still being delayed as a result of the reluctance of the HSE and the Department of Health and Children to replace old equipment. I want to hear the Minister's response to Dr. O'Keeffe's remarks. If his claim is true, it is a great scandal in itself. Are patients being denied proper screening because the Government and HSE will not spend the required money on new equipment?

So much for the claim made by the Minister for Health and Children that the problem in Portlaoise arises from the absence of centres of excellence. So much for Professor Drumm's disgraceful attempt to blame the people of Portlaoise and the midlands for this scandal. One can only gasp with astonishment at the Minister's statement in response to this crisis. I remind her that she stated, "It has happened because of our failure in the past to put in place centres of excellence, which could never have happened under the old health board regime". The Minister referred to "our failure" as if it were the failure of Irish society as a whole. However, she and the Taoiseach have been in Government continuously for over a decade. They have had at their disposal resources undreamed of by any previous Administration. Those resources are the fruit of the most prosperous era in the history of the Irish economy. Yet the Minister has presided over failing, chaotic and inequitable health services. She failed to meet the needs of the people at national, regional and local levels. She promised us a world-class health service but we have a two-tiered, disorganised, disjointed and ailing health service, and the Government's so-called solution is privatisation.

I totally refute the gross misrepresentation by the Minister and the HSE chief when they claim that people are opposed to centres of excellence. I have not heard anyone speaking in opposition to such centres or heard anyone say that there should be centres of excellence for cancer at every hospital in the country. What has been said and rightly so is that properly resourced existing cancer services cannot and must not be taken away in the absence of centres of excellence, which is what the Government and the HSE are trying to do.

Consider the debacle over the provision of radiotherapy, a key component in centres of excellence. The Minister wanted these provided by public private partnership. A report to the HSE stated this process would take until 2015. We then heard a series of conflicting statements from the Minister and Professor Drumm, with the HSE chief stating that the public system can provide the radiotherapy facilities — agreement with him at last. We heard conflicting dates for the provision of centres of excellence, including 2009, 2011 and 2015. The need for these centres was clearly established and officially identified in the millennium year.

The Minister for Health and Children, Deputy Harney, and Professor Drumm castigated local campaigners, but I applaud these people. A year ago, I stood on a platform with Co-Operating for Cancer Care North West in County Donegal. It demanded a cross-Border centre of excellence for cancer care in the north west which had been completely left out of the Government's plan. It rightly pointed out that Donegal people could not be expected to rely on a tentative arrangement with already hard-pressed services in Belfast.

Yesterday, the group met the Minister for Health and Children and, as is reported in The Irish Times and other print media today, it was positive afterwards that progress would be made on delivering such a centre in the north west. I hope this is the case and that the Minister will clarify that in certain terms in her closing address today. This emphasises very strongly the need for local and national campaigns to vindicate the health care rights of communities. It is only because of the heroic efforts of people such as Noelle Duddy and those campaigners in the north west that the prospect of siting such a facility in the north west, it is hoped in Donegal, will be realised. The Minister should state clearly exactly what she intends.

The Minister's plan for the location of centres of excellence with radiotherapy only in Dublin, Waterford, Cork and Galway is not sufficient. It leaves the northern half of the country very badly served. I have repeatedly stated and I repeat again that nobody seeks these facilities at every crossroads. We seek regional coverage and not discrimination based on where one lives. I urge the Minister to proceed with the centre in the north west and to re-examine the gap in the HSE north-east region and in the adjacent areas north of the Border. As a representative of the people of Cavan and Monaghan I state that we, and the people of Louth and Meath, need a similar cross-Border solution to that proposed for the north west.

This latest crisis over mammography exposes the overall lack of coherent policy and planning by Government and the gross mismanagement at HSE level. Hospitals such as Portlaoise have out-dated equipment while in hospitals such as Dundalk the HSE has allowed the new CT scanner to lie idle for months. This CT scanner was unveiled by the Minister in the period immediately before the general election. Where is the coherence and good management that we were promised in the brave new world of the HSE heralded by the Minister on the floor of the Chamber?

The crisis in mammography is mirrored in the situation with cervical screening. The Well Woman organisation expressed concern over the ongoing outsourcing of smear tests to the United States for analysis and at the absence of clear information as to what cytology laboratories will be used to underpin the national cervical screening programme from January 2008. The outsourcing of cervical smear tests for analysis to private laboratories in the USA could lead to inconsistencies in the interpretation of results by Irish doctors, which could have ramifications for women with abnormal smears.

Before any roll-out of the national cervical screening programme, the Well Woman organisation is anxious to have the following questions on smear analysis answered and I urge the Minister to do so as part of her response today. If United States laboratories are used who will take responsibility In Ireland for making judgment calls in borderline cases? Will that person be a suitably qualified and experienced cytologist?

Well Woman takes more than 9,500 cervical smears each year. In the key age group of women aged 25 to 40, it estimates that 8% of these patients will need to be referred to the hospital system for further investigation and colposcopy. It points out that the colposcopy service in Dublin is patchy. The service in Tallaght hospital operates efficiently with acceptable waiting times whereas the north side of Dublin is extremely poorly served, with entirely unacceptable delays before women with potentially significant cervical pathology can be seen.

This pressure on the north side was made worse recently by the ending of colposcopy services in Beaumont Hospital, putting added pressure on the colposcopy clinics offered in the Rotunda and the Mater hospitals, which have not increased their capacity sufficiently to meet this extra demand on services. Well Woman perceives a greater need for colposcopy services in areas of social and economic deprivation, as can be illustrated by statistics from Well Woman's Coolock clinic. I ask the Minister to take note of all that detail, which is hugely important. That information proves a significantly higher rate of referral for GMS patients as opposed to private patients, including those who live in the same geographic area.

Well Woman informs us that to date it is unaware of any communication from the national cervical screening service to primary care doctors over details of the service contract, payment to smear takers, reporting requirements, compilation of the population register, start date, how women will be contacted and so on. Well Woman believes that at this stage, this makes the quoted roll-out date of January 2008 unrealistic. I ask the Minister to address that problem also. All this is very worrying and must be addressed as a matter of urgency if we are to avoid a repeat of the mammography scandal in cervical cancer screening.

I also ask the Minister to address the issue of cancer services in Tallaght hospital. I am told the hospital features in a referral guide issued by the HSE in May 2007 as a hospital for patients to be referred to from general practice. The document is called General Practitioners Cancer Referral Guides and was issued after extensive consultation by the regional oncology director of the HSE. The hospital is trying to ascertain the position — the Minister should note this — as it was part of the regional cancer plan in May and was removed from the plan in September. What is the position? Why, as we advance towards mid-November, does the administration in that hospital not know the full detail of same?

The current crisis in mammography is being used by the Minister and the HSE to justify their drive to over-centralise our hospital services and downgrade local hospitals. That is a disgrace and is the opposite of what is needed. The women concerned need answers as to what went wrong. Women need these services to work and be seen to work. Our whole population needs comprehensive cancer care provided in the public health care system and available to all based on need, regardless of their ability to pay or geographic location. I have made that point repeatedly and make it again to the Minister because I do not believe it can be raised with her often enough. There can be no discrimination. We want a service that is equitably delivered and accessible by all.

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