Charles Flanagan (Laois-Offaly, Fine Gael)

I wish to share time with Deputy Kieran O'Donnell.

I call on the Minister for Health and Children to ensure that the Portlaoise inquiry is independent because what is happening is not sufficient. An appalling wrong has been perpetrated on the women of the midlands and their concerns and welfare must remain paramount throughout this debate.

Seeking answers as to why some mammography screenings failed at the Midland Regional Hospital is not about identifying a scapegoat but about finding out what went wrong, why it went wrong and taking lessons from this appalling situation to ensure that nothing like this will happen again. Professor Drumm's recent outburst, blaming the people and scapegoating professionals and health care workers is unbecoming of a man of his position. To blame the public is to miss the point. People and health care professionals are not trying to hamper progress. All they want is a decent health service. The HSE has been critical of people for not accepting the rationalisation of local hospitals in exchange for so-called centres of excellence that are not in place. In such circumstances, who would not object to the removal of services? The responsibility to deliver health care services to the taxpayers of Ireland lies with the HSE, an agency that is funded entirely at the taxpayers' expense.

In 2002, the Minister for Health and Children, Deputy Micheál Martin, designated the hospital in Portlaoise as a centre of excellence for symptomatic breast diseases in the midlands. The cynicism of the Government in making that decision has only now been revealed to the public. It has become clear that the funding to meet that commitment never materialised. It turned out to be an empty gesture with appalling consequences.

The recent situation in Portlaoise has captivated the attention of many people because we are all well aware that the situation there is not unique. It is not the only hospital in the State that has no system for the independent auditing of mammograms. In a majority of hospitals, quality control and maintaining adequate standards have become serious issues due to the absence of a commitment to appropriate funding by the Government and the failure of the Minister and the HSE to engage constructively with radiologists. The chain of responsibility for what happened in Portlaoise goes right to the top. In the past seven years the former Midland Health Board, the HSE and, ultimately, the Department of Health and Children were responsible for budgets and staffing. Fundamental questions must be addressed about the impact of decisions taken at senior management level at the coalface.

I have a number of specific questions for the Minister for Health and Children which I will put to her now in order that her officials will have the opportunity to seek some answers before she responds to this debate.

Contrary to best practice, why was the sole radiologist frequently responsible for interpreting mammograms in Portlaoise on her own? Who sanctioned that situation? Is the internal inquiry focusing on the work of one person or of all those working in the radiology department at the hospital? What of X-rays other than mammograms carried out by radiologists, having regard to the fact that mammograms only comprise some of the work of radiologists? What of the qualifications, academic and professional, experience and accreditation of those attached to the X-ray unit in Portlaoise? What are the terms of reference of the inquiry under way?

It is on the record that the radiology department formally wrote to the hospital warning of the "potential of misdiagnosis" and "delayed diagnosis of tumours", but it appears that no action was taken by management. Why was the letter not acted upon? Where is the response to it? What action was taken? When was the letter received by the HSE in Tullamore? What action was taken by the HSE following receipt of the letter? Will the report detail the many pleas for resources from consultants, public representatives — I listened to Deputy Seán Fleming and agreed with most of what he said — and the public?

Concerns about chronic under-resourcing at the Midland Regional Hospital were expressed on a regular basis and early warnings were ignored. True to form, we have waited for a crisis before taking action. The gross bureaucracy and labyrinthine structures of the HSE which undermine our services have been highlighted yet again by what has happened in Portlaoise. Vital letters went nowhere and no one was willing to take responsibility. We know that a consultant surgeon wrote directly to the Minister for Health and Children in July 2005 informing her, in fairly strong terms, as she disclosed to the House this morning, of his concerns about the situation in Portlaoise hospital and raising specific issues of a type that are now central to the current debacle. It is astounding that the Minister was informed more than two and a half years ago that "radiological services at Portlaoise are being provided by people with no expertise in this area". While the Minister referred the letter down the line, the failure to follow through and adopt a position of leadership and interest in this matter has shown that the Department of Health and Children-HSE model simply does not work.

I fully agree with the concept of centres of excellence which are accessible and well equipped. However, as Deputy Fleming pointed out, a centre of excellence means different things to different people. A centre of excellence means proper hospital management and delivery of a service. I urge the Minister for Health and Children to set up her centres of excellence and then convince the people that they are a superior option. Without an accessible, physical, functioning centre of excellence providing appropriate cancer services, no one will support the removal of cancer services from regional hospitals.

The Government has promised the centres will be in place by the end of 2009, but what will happen in the interim? St. Vincent's hospital is designated to deal with people who would ordinarily attend Portlaoise hospital. How will St. Vincent's hospital, which is already one of the busiest hospitals in the country, cope with an influx of new patients from the midlands? Is there adequate capacity, beds, staff and day care facilities in St. Vincent's hospital? Only this morning a woman detained me on the telephone for more than 15 minutes telling me about her experience in St. Vincent's hospital on Monday. She was left walking around Dublin for most of the afternoon, having left St. Vincent's hospital and missed her train home. She had no acknowledgement from the Health Service Executive and no assistance by way of transport.

The modus operandi of the Department of Health and Children and the HSE in recent years has been to shift the entire blame for anything that goes wrong on to somebody else. In this instance there has been an attempt by senior management in the former Midland Health Board, now the HSE, and the Department of Health and Children to lay the blame at the door of the radiography unit in Portlaoise hospital, but that is not the full picture. What has happened in Portlaoise is the inevitable result of consistent neglect in respect of funding and neglect by those with decision-making capacity in the HSE, the Department of Health and Children and the former Midland Health Board. They chose to look the other way when those at the coalface in the hospital attempted to draw their attention to the problems.

As Deputy Fleming said, there are many diligent and committed people working in the Midland Regional Hospital, and I agree with him, but an internal inquiry is neither sufficient nor appropriate at this time. A narrowly focused internal inquiry on one person is unlikely to uncover the complex chain of events that has led to the current crisis in the radiography unit at the hospital. It is essential that a broad-ranging, independent inquiry is established so that what exactly went wrong and why can be made abundantly clear. Without such clarity we will not be able to ensure that such failures will not take place again.

There is real anxiety, concern and fear on the part of women and their families, not just in the midlands but far beyond. Recent events have sparked a crisis in public confidence in our health care system. The first step to be taken in addressing these fears is to establish a transparent inquiry in Portlaoise that will answer the people's questions. Hiding behind an internal review will only erode public confidence further. The Minister owes it to the women of Portlaoise who, with their families, must remain the primary focus in this debate.

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