Jan O'Sullivan (Limerick East, Labour)

I move:

That Dáil Éireann,

expressing its serious concerns about disclosures of major failures in cancer care services at the Midlands General Hospital, Portlaoise, including the failure to diagnose breast cancer in nine women who had presented for mammograms and the recall of a further 97 women who had undergone ultrasound scans at the hospital;

deploring the way in which the women have been treated subsequent to these disclosures, including the failure to provide adequate counselling for those who have had to undergo surgery and the fact that women who had undergone scans first heard on news bulletins that they might be recalled;

noting that concern had previously been expressed about the adequacy of equipment and facilities at Portlaoise;

condemning the failure of the Department of Health and the HSE to ensure the provision of cancer screening and treatment services in which the public can have full confidence;

urging the public, notwithstanding these alarming failures, to continue to present for screening and assessment;

noting that the HSE was the creation of the Minister for Health and Children, Deputy Mary Harney, and that it has failed to deliver the improvements promised in the health service; and

believing in the principle of political accountability for such shocking failures in our health system,

has no confidence in the Minister for Health and Children, Deputy Mary Harney.

I wish to share time with Deputies Joan Burton, Kathleen Lynch and Caoimhghín Ó Caoláin.

I am amazed that the Government's amendment does not propose confidence in the Minister for Health and Children. It refers to a variety of matters, including sympathy and regret, and expresses confidence in the efficiency and high quality of the work carried out in the review of mammograms, approves the actions of the Minister for Health and Children, acknowledges the leadership she has shown and supports her in her commitment to ensuring equitable access to high quality cancer services, but nowhere does it express confidence in the Minister. That is extraordinary. Why is confidence not expressed by the Government in the Minister for Health and Children?

We have tabled this motion of no confidence because the women and their families who have suffered so appallingly are entitled to have their health and lives taken seriously enough for somebody to take responsibility. If political accountability is to mean anything, the Minister, Deputy Harney, must accept overall responsibility for the way these women were treated. Of course she is not responsible for the misdiagnosis. However, she set up the system that has become so focused on itself rather than the patient that, incredibly, it ended up telling the Oireachtas health committee before it told the women themselves that 97 human beings who had been told they were clear of cancer had to be recalled and may, after all, have had the disease when they were referred for tests.

How could it have happened that these women did not get an individual and immediate response as soon as the doubt was known? How was it that their files were neatly stacked up and batched until the number reached 97 to be dealt with as a package? How could it have appeared more important to protect the system by telling the committee than to protect the women by telling them? How is it that, 24 hours later, when the Minister and the nation knew, those women had still not got a telephone call? How could counselling not have been put in place as promised and how could the help-line not be staffed with sufficient personnel to prevent it being swamped? The Minister can have three highly paid advisers on her staff, but only two cancer care nurses could be found to staff the helpline. Every time we think lessons have been learned, something else happens to show that they have not.

What is the Minister's response? She has asked for a report from the board of the HSE which, we are told, will be ready in a few weeks. What kind of response is that to people who have been so badly let down? I acknowledge, as I was chairing the committee meeting, that the Minister did not know any sooner than I that 97 women were to be recalled for ultrasound review. However, she should have known — she is the Minister. The most basic lines of communication and accountability were not functioning. It is inconceivable that the Minister did not keep in regular contact with the investigative process.

The Minister told the Dáil on 7 November that Dr. Ann O'Doherty "has been asked to look over the mammograms, ultrasounds and anything else that is relevant, including the machinery". Last Wednesday, during Question Time, she said in a reply to me that a further two women were diagnosed with breast cancer, in addition to the seven already diagnosed, and gave me to understand that this was the final number. Dr. O'Doherty's brief included ultrasounds. At what point were they transferred to a parallel investigation? Who is examining the 15 year old equipment? If, as we are told, Dr. O'Doherty's report is completed, is it confined to the mammography reviews or is it more comprehensive? How many reports will there be? Is anybody examining why inadequate systems stayed in place despite the letter sent directly to the Minister in July 2005 by Mr. Peter Naughton, a surgeon in Portlaoise, who described the diagnostic services there as "a shambles"? The Minister must be accountable on these matters of vital public concern.

If nobody is considered responsible, no lessons will be learned. An unidentified woman at the ICA public meeting a few days ago expressed what most women in Ireland are now thinking: "If I find a lump or another symptom that worries me and I go for tests, can I be sure that the result I am given is correct?" That is a fundamental question which no woman should have to ask. The latest news that 15 patients at Cork University Hospital, and perhaps others at UCHG, were wrongly diagnosed is adding to the uncertainty. It is essential that trust is restored, but this can only be done by making real and transparent change.

We have been accused of stirring up fears and playing political games. I wish to confront those accusations and refute them. The fear and mistrust are caused by the facts of what has happened. Women's lives have been unnecessarily put at risk. The monstrous bureaucracy, the HSE, set up by the political decision of the Government and the Minister, failed miserably to handle the consequences appropriately and ensure that the focus was on patient care.

It is our job to hold the Minister and the HSE to account. We would be letting down brave women, such Rebecca O'Malley and Susie Long, the Midlands woman who spoke with her back to the camera to protect her family, the mother of four from Kildare who was one of the nine whose mammography was misdiagnosed and who has had surgery, if we did not speak out as strongly as we can. The woman from Kildare, quoted in The Irish Times this morning, said she had no faith in the Minister, Deputy Harney. "I don't think she has a clue how to run the system. I know she didn't do the mammograms but after the way she has handled this whole situation I really do think she should step down," she said. These women were brave enough to stand up and be counted, as we should be. They did so because they wanted to bring about changes.

We are not questioning Deputy Mary Harney's integrity or her commitment. She is an eloquent and persuasive speaker and believes in what she is doing. She is committed to doing what she believes is right for the health services. However, that is part of the problem. She has the ability to persuade others that she is right and, despite the fact that her party got only 2% of the votes of the people, nobody in Fianna Fáil or the Green Party is willing to take on the job. They stand by while the ideologically driven philosophy of the Progressive Democrats hones and shapes the future of the health services. The fact that she cannot be answerable for every detail of the operation of the HSE is a red herring. The present catastrophe in Portlaoise and other crises cannot be passed off as errors by one or more clinicians. They are primarily failures of management in a system established by the political decision of the present Minister and most of the people in the current Government.

Speaking in the Dáil in November 2004 when she introduced the legislation to set up the HSE, the Minister said:

It is a once in a generation event. It is our generation's chance to put patients first in the design of the management of health services. It is our chance to put in place modern, effective management to make the best use of these tremendous resources we are applying to health and to get clear value and clear results for that money.

Later in her speech she said there were two ways Government policy would be judged:

. . . better outcomes for patients and better value for taxpayers' money. To achieve them, we badly need clarity of roles and accountability — political responsibility for the Minister and management responsibility for the management. The lines of responsibility and accountability are clear in this legislation, the clearest they will ever have been in health administration in this country. That will make a real difference to the quality of health services provided for our people.

Three years on, the only thing that is clear is that none of this has been delivered. There is no clarity of accountability, no value for money, no taking of responsibility and, above all, no sense that patients are being put first. The health service has become a huge centralised bureaucracy with hundreds more senior and middle-management personnel than ever existed in the old health board system. When one talks to people — I have talked to many — who work at the coalface taking care of patients, they say that it is much harder now to have decisions made. Morale is low and there is a huge level of frustration with the system.

The HSE should never have been set up in its cumbersome, centralised, top-heavy form. There must be root-and-branch reform, with layers of management taken out and lines of accountability clearly defined, including that of the Minister. Deputy John Gormley, now the Minister for the Environment, Heritage and Local Government, was right when he stated in the Dáil in December 2004 during the debate on legislation establishing the HSE:

This is retrograde legislation. It is a sad day for democracy and this House. In years to come people will ask what the Government was thinking about when it rushed this Bill through. It is clear the Tánaiste wishes to rush it through and to guillotine it because she does not believe in the same democratic values in which we on this side believe.

The Minister, Deputy Gormley, is on the other side now. Will he stand up and be counted on his democratic values? We cannot stand by and see the health service shaped into an entity that provides speedy treatment according to ability to pay, sees patients as numbers, and is run by an organisation whose structure even Government Ministers such as Deputy Ó Cuív cannot fathom. The Government as a whole must take responsibility for the health service rather than allowing it to be run according to the ideology of a tiny party. Backbenchers who are in touch with the concerns of their constituents and those who call themselves Independents should have the courage of their convictions and vote accordingly.

Ireland is a relatively small country, with a population roughly equivalent to that of Greater Manchester. There are successful models for us to follow and we have the money to invest. I acknowledge that a considerable amount of money has been invested in the health services — a greater increase than any other comparable OECD country. However, we cannot continue to lurch from crisis to crisis and watch the loss of confidence of patients and staff. It is possible to re-organise and restructure the delivery of health services to the standard of excellence to which we all aspire. The Labour Party has made positive proposals on how this can be done, particularly by advancing the concept of universal health insurance.

We support specialist cancer centres, but they must be properly resourced. There have been suggestions that we have not been supportive of the proposals with regard to cancer. We are completely supportive of the establishment of specialist cancer centres, but we must be told how they are to be resourced before they become, once again, distanced from the Minister through the HSE and towards Professor Tom Keane. We must know that the resources will be provided and for that reason I am pleased that the Minister for Finance is here listening to me. We have campaigned vigorously for the roll-out of BreastCheck across the country and sponsored whistleblower legislation. We have also called for the establishment of patient safety alert processes, the accreditation and development of laboratory provision in Ireland, clinical audit and the expansion of HIQA's role to cover private as well as public institutions. We want open accountability and equity across the system. These are practical measures that would improve patient safety outcomes, increase confidence in the system, allow people who have concerns to raise them, and ensure constant auditing and reviews of clinical practice in our health service. These are all matters for political implementation and political judgement.

What people want above all is to be able to trust the health services. They want to feel that someone is in charge and that those who give care are enabled and supported in doing so. Responsibility has not been taken in the appalling circumstances of the Portlaoise debacle and I see no evidence of it in the Government's amendment to our motion. Each day new and more shocking disclosures have emerged. Those relating to Cork University Hospital are the latest, and who can say with any confidence that they will be the last?

We still do not have the answers we were promised. In the first week of November, when asked about the O'Doherty review, the Taoiseach told the House: "The review will be completed this week and a full report will be published by the end of November." Today he told the House that the review has not been completed and he did not give any indication as to when the report would be published. Is the report being withheld and, if so, why? It was also reported today that Dr. O'Doherty had never spoken to the consultant radiologist at Portlaoise who was sent on administrative leave when the controversy first broke. As the Taoiseach failed to respond when asked about this today, I now ask the Minister for Health and Children to respond to five specific questions when she speaks in this debate. Has the O'Doherty review been completed? Has the report been submitted to the HSE and the Department? When will the report be published? Did Dr. O'Doherty speak to the consultant radiologist during the course of her inquiry? Finally — this is a question about which I have some concerns, as there is a lot of confusion — was Dr. O'Doherty initially assigned to cover ultrasounds and equipment as well as mammographies? That is what the Minister said initially. The impression given now is that she was not covering anything except mammography. We need clarity on this.

After listening to the Taoiseach today I am more confused than ever. When Deputy Gilmore asked whether Dr. O'Doherty was aware of the fact that Mr. Naughton was doing these reports, the Taoiseach replied that from listening to colleagues, he assumed Mr. Naughton was trying to be sure to be sure. Is that the way to restore confidence? Why exactly was Mr. Naughton looking at the ultrasounds? Was it to do with the O'Doherty report or was it something he took on himself? This is the type of thing that causes confusion and concern among the public.

Does the Minister accept that although money could never compensate the women who turned up for screening, were misdiagnosed and subsequently had to undergo surgery, women who find themselves in this situation are likely to be entitled to financial compensation — probably significant compensation — from the State? Has she sought confirmation of this from the Attorney General?

This has been one of the blackest chapters in the recent history of our public health service, made all the worse by the failure of those in political office to accept their responsibility for the pain, suffering and trauma caused to patients. The reality, as Deputy Gilmore said in the Chamber earlier today, is that the Minister has lost the confidence of the public. She has lost the confidence of those who work in the health service and she has most certainly lost the confidence of those women who put their trust in our health service and who have been so badly let down.

The Taoiseach seemed on the verge of taking a courageous step today by agreeing to have a free vote on this motion tomorrow, before rapidly backing off. He knows as well as I do that if he allowed a free vote the Minister would be clearing out her desk in Hawkins House on Thursday morning. We will not have a free vote, but I still hope there will be some in the ranks of the Independents or on the Fianna Fáil back benches, who have been happy to engage in whispered criticisms of the Minister, Deputy Harney, in the corridors of Leinster House, who will have the courage of their convictions and do the right and honourable thing by supporting the Labour Party motion of no confidence in the Minister for Health and Children.

See this speech in context