Seán Fleming (Laois-Offaly, Fianna Fail)

As a representative of Laois-Offaly, it is with a heavy heart that I speak on this matter. The past week has been a sad time for us. The women affected as a result of the misdiagnosis are our friends, family, relations and neighbours. Some seven patients who were given the all clear have been diagnosed with cancer. Some six women live in fear for their lives. Although there is overall political responsibility, the debate must be patient centred rather than an exercise in political point scoring. We must speak more about the patient than politics. Those who are suffering from cancer live in fear of it, which causes stress, which in turn causes cancer. It is a vicious circle. The sooner the six women are put out of the fear they suffer at present, the better.

The three most important aspects of health services are the patient, the patient and the patient. I thank the Tánaiste for being honourable and courageous in issuing an apology to those who have suffered as a result of late diagnosis. I hope the treatment will not be too late, that they will make a full recovery and receive counselling. There is an additional trauma to carry. Every cancer patient considers what would have happened if it had been detected earlier. These people have this doubt proved positive.

The Minister for Health and Children, Deputy Mary Harney, was very good to the patients of Dr. Michael Neary in Louth. She learned lessons in that process, as we all did. The humanity she displayed at that time is present now. I can understand the families telling us where to go with our apologies. They are suffering and are right to be angry. I understand that people vent their anger at those elected to run the country, who are ultimately responsible for delivering health services. We must accept that there are good times and difficult times in politics and we must endure the latter as well as enjoy the former.

I am sickened by the use of the hackneyed phrase "centre of excellence" in this debate. Each health facility should be a centre of excellence. If one's local GP cannot provide an excellent service, he or she should not be in business. The concept that there can be eight centres of excellence and that every other facility is somehow operating to a lower standard is wrong. The phrase "centre of excellence", which should be banned from the medical lexicon, demonstrates the hierarchical approach taken by those who use it, namely, that what is done in the main centres is better than what is done at smaller centres. As a result, those who work in the former look down on their counterparts in the latter. I address my comments in this regard to the medical profession because phrases such as that to which I refer emanate from medical reports — they are not invented by members of the public. If one attends one's dentist, one expects to be provided with an excellent service. We expect the same level of service provision from the entire health service and not just from the eight regional centres.

Members of the medical profession have been at odds with one another on this issue. As the Minister stated, in 2001 Professor Niall O'Higgins, who was involved in the overall national service, suggested that the midland region should have one centre of excellence and that this should be based, for geographical reasons, in Tullamore. Not long after and having discussed the matter, the then Midland Health Board decided to locate the breast service in Portlaoise and other services in Tullamore. In recent times Professor Drumm scrapped the entire approach and essentially stated that there should be no such centre whatever in the midlands. Tullamore was subsequently removed from the list of the centres of excellence.

I represent County Laois, which is situated not much more than one hour's journey from Dublin. If a better and more comprehensive service can be availed of in Dublin, patients will travel to the capital. Most of the complaints I receive about cases where people are obliged to travel long distances to avail of hospital treatment involve the difficulties, particularly those relating to parking, experienced by families and friends trying to visit these individuals. It is only on occasion that a patient will complain and this is usually in circumstances where he or she is obliged to attend for regular blood tests or check-up. People would be happy to have their treatment in Dublin and if they are obliged to have some of their follow-up treatment here, well and good. I accept that families, relations and friends have been discommoded and have dominated the debate relating to transport and access. If these individuals asked their relatives or friends suffering from cancer how they felt, their opinion would change.

We cannot flinch. Professor Brendan Drumm has been charged with delivering the service. He employs his staff and has been running the service for a number of years. In addition, the HSE has been in place for some time and responsibility lies with Professor Drumm. I will put it as mildly as possible by saying that he made a sad choice in the words he used when blaming members of the public and patients for causing this problem. The responsibility lies with Professor Drumm and the staff are his. The Taoiseach stated that a systems error was not involved. I can only take that to mean that there was human error somewhere along the line. If that is what the report shows, then we must accept it. One cannot blame the public for mistakes made by one's staff.

I praise the consultant and other staff at Portlaoise hospital who highlighted the problems that came to light. They did their best, within the structures of the HSE, to ensure that information was passed up the line.

I am pleased that the recovery or survival rates relating to breast cancer improved from 73% to 78% between 1994 and the early years of this decade. I would like to see a breakdown of these survival rates on a hospital-by-hospital basis because I want to be sure that the rates at the new centres of excellence will be much higher than those which obtain in the facilities that are being closed. I am not pleading for a local service, I am seeking the best service to be provided for all. Location is not the issue. Perhaps information in this regard is already available. However, I have never seen it. If it is available, I would like to be directed to where I can obtain it.

I am not in favour of the provision of overall national statistics. It must be remembered that hospitals such as that in Portlaoise contributed to the improvement in breast cancer survival rates during the period in question. It is not fair to scapegoat Portlaoise on foot of human error. There are many dedicated staff in Portlaoise hospital and some of them are extremely upset about this matter. There is much good activity taking place in the context of the maternity, paediatric and psychiatric services on offer at the hospital. This matter will be a blow to the morale of everyone involved in the health service and the sooner the cloud hanging over Portlaoise hospital is lifted the better.

I wish to follow up on the point raised by Deputy Enright, namely, why the post of a third consultant radiologist at the hospital, which was advertised in July 2005, has not been filled. Perhaps it is difficult to recruit staff to some of the smaller hospitals because they do not offer the same range of training and promotional prospects or the opportunity to deal with as varied a caseload as bigger hospitals. Those issues will have to be addressed, not only in the context of cancer services but also in respect of the appointment of further consultants. If we progress matters relating to the new consultants' contract and move towards a consultant-led service, perhaps there will be more consultants working in our smaller hospitals. I am not saying that Portlaoise is a poor hospital but it does not compare to some of its larger counterparts.

Funding was provided a number of years ago in respect of investment in breast cancer services in the region. I suspect that more money has been spent on the PPARS system than on cancer services in Portlaoise hospital. Staff in the midland region are included under the 40% of staff in the PPARS system. I understand that it cost €158 million to put the system in place in respect of those staff. I am an accountant but I will not break down this figure because I am fearful of the answer I will obtain. However, I reiterate my suspicion that more money has been spent on PPARS than on breast cancer services at Portlaoise hospital. Perhaps information relating to this matter could be provided at some stage.

Debates of this nature are no good unless lessons are learned. It is in that context that the Minister will do well. We are undergoing a difficult and traumatic period of change as regards the delivery of health services. The Minister will have the support of Deputies in respect of this matter. I do not want Deputies to fly the flag on behalf of their local areas just for the sake of doing so. We want people in the midlands to receive a service that is similar to that received by everyone else. Results tend to be better on the east coast. I do not know why but perhaps it is that there are better facilities in the Dublin region. I would also like to see figures in this regard.

I hope all the women who were diagnosed with breast cancer make a full recovery.

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