Liz McManus (Wicklow, Labour)

I welcome the fact that we have an extended debate. It is such an important matter that Members wish to contribute. The one thing we know about breast cancer — it is a lesson we are given continually — is that the earlier it is diagnosed the better chance there is for survival. As others have said, today as we speak in this House, there are women we need to think of who are sitting in their kitchens, at their workplace, having to grapple with a terrible and unnecessary anxiety and suffering. They did the right thing. They underwent the necessary test to find out whether they had cancer. Their trust in the health service was understandable. Any one of us advised to go for a test when there was a chance of cancer would have done what they did. Even in the best of circumstances it is a stressful experience. In the instance of the women we are talking about, their betrayal and anguish is unimaginable. The terrible truth is they are not alone. It is not just in the area of misdiagnosis that injustice is being done to sick patients.

I was rather taken aback to receive correspondence today about a patient who was diagnosed through BreastCheck. She said she got very good quality care from BreastCheck and within a week was able to have surgery for the cancer. After surgery I understand that best medical practice in a case such as this is that one would have radiation treatment within six weeks. In the case of this particular patient she was shocked to find that when she sought an appointment for radiation treatment at St. Luke's Hospital a date 26 weeks later was given to her. When she said she had private health insurance that transformed her access to getting the treatment the following week. Seven days later she started radiation in a private hospital.

Dr. Crown is right. We have an apartheid system in our health service. It is there because the Government refuses to address it and it is getting worse because the Minister for Health and Children promotes inequality with the expansion of private care at the cost of public care. She has overseen the closure of public facilities, cutbacks and a staff freeze in the public sector that is now causing serious delays in many hospitals. Meanwhile, she is featherbedding the private hospital sector with generous tax breaks and offers of public lands. To be fair to the Minister, she certainly took the hit on her policies at the last general election, while the Taoiseach continues to deflect any responsibility on to doctors, health workers, patients, administrators, public representatives, community activists and in any direction except towards himself. This is a political matter and it is the responsibility of a government to ensure standards in and access to health care. This is why this morning's response by the Taoiseach when he was asked questions on the issue was despicable. I like others want to acknowledge that the Minister for Health and Children has chosen the correct route in offering an apology to those who have suffered so much.

The Minister for Health and Children was informed on 29 August about the problems at Portlaoise hospital. In her speech she made an interesting point that the person taking the lead role in alerting the authorities about the problems was a director of nursing. There is a parallel. In the case of the Dr. Neary scandal where patients were in effect mutilated and nobody shouted "Stop", it was a young midwife who eventually blew the whistle and bravely stood outside the herd in order to ensure the matter came to an end. In this incident it is a director of nursing, which surely tells us something. Why do we need to depend on the courageous director of nursing or the courageous nurse to alert us to what is going on in our hospitals?

That information came to the Minister on 29 August and it is now 7 November and we still do not know what has happened. We know there is a crisis of confidence not just in cancer services in Portlaoise, but also generally. It requires a political response and leadership, but we have got neither. It also raises again the importance of establishing a patient safety authority with statutory powers to oversee and investigate hospital services in order that standards are met and patients are protected. If we had that authority now, expertise would be building up to ensure a swift response when something went wrong — inevitably things go wrong no matter how perfect the system. We need an authority with power to ensure that information is garnered speedily and action taken. Such an authority should have an ongoing oversight role. HIQA is simply not capable of providing that role.

We need to know what standards prevail at any centre carrying out tests. We need an overall look back at mammograms. We have a curious anomaly in that there is double assessment in the cases of mammograms carried out by BreastCheck. While the vast majority of people who turn up at BreastCheck are perfectly healthy, systems are in place to ensure double-checking of any testing it carries out. However, in incidents such as in these ones in Portlaoise where people had indications and symptoms in some cases, no such safeguard was in place. It only came to light because of concerns being expressed at a high level of false positives — not false negatives. In effect, the problem was discovered by accident.

We need to ensure services are of good quality in existing centres. We all want to move to the model of centres of excellence. Let us get rid of that canard — that is what we want as is generally understood. However, it seems that only people on this side of the House appreciate the length of time it will take to reach that new model. In the meantime there is a need to treat patients properly in the system we have. It is not a question of just closing down units, which would just overload the system. A 26-week delay in accessing radiation therapy in St. Luke's Hospital represents a red light telling us we cannot simply close down small units and rely on existing infrastructure to take the additional demand.

I wish Professor Keane well — he has a hard job ahead of him. However, the appointment of one individual is not enough in itself. Resources, planning, staffing and strategic thinking are all required. We also need a debate about the matter. We need to consult and bring people with us in order that there is general understanding about what is required and what is being done. While time is of the essence, it will still take considerable time to construct the new model. In the meantime, public trust in our cancer care services needs to be rebuilt. Resources need to be dedicated to the establishment of centres of excellence. Funding needs to be ring-fenced and real commitment needs to be shown by the Government that has done so little in the past seven years while patients have been put at risk. I agree with the Deputies from the north west that we need to know what will happen in that region, which is in a very isolated position under the new plans. While it is difficult enough at the moment, provision must be made for them under the new plan.

Returning to the bigger picture, ending apartheid in our health service is essentially a political challenge. The Government and its predecessor have been intent on deepening the divide rather than bridging it. Susie Long, while she was alive, was proof of the inequity of our two-tier health service. We know that other women are waiting in line today because they happen to be public patients and not private patients. Unfortunately, we will get more evidence unless the issue is addressed. We need a response fitting to the problems encountered. It is more in hope than in anticipation that I ask for this action. Ultimately, we need to remember the anguish of women who were impacted by what happened in Portlaoise hospital. We must ensure that nobody goes through a similar ordeal.

See this speech in context