Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

The Sinn Féin Deputies support the Labour Party motion of no confidence in the Minister for Health and Children, Deputy Harney. We have also tabled our own motion of no confidence, which states:

That Dáil Éireann, noting:

the scandalous misdiagnosis of women who were screened for cancer in the Midlands region;

the crisis in cancer care including the inadequate provision of radiation oncology with cancer sufferers having to travel inordinate distances for treatment, the long delay in delivery of promised centres of excellence, the diminution of existing cancer services in local hospitals in advance of that delivery, the flawed plan for location of these centres, leaving whole regions inadequately served; and

the apartheid in our health services which sees private patients able to gain speedy access to diagnostic services for cancer while public patients must join long waiting lists;

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

The motion of no confidence we are debating has been made necessary by the extraordinary revelation at the Joint Committee on Health and Children meeting last Thursday that 97 women in the midlands needed to be recalled after their ultrasound scans were reviewed. "Appalling" is the only word to describe the plight of those 97 women who heard the news through the media. They heard it that way because it was revealed for the first time in a public presentation by a HSE official at the committee. Subsequently, we had the most extraordinary situation where both the Minister, Deputy Harney, and the chief executive of the HSE, Professor Brendan Drumm, stated that the public presentation was the first they had heard about the review of the ultrasound scans.

There is no public confidence in the Minister or the policy and management of health services by this Fianna Fáil-Green Party-Progressive Democrats Government. The scandalous situation in the midlands, which has seen women misdiagnosed after cancer screening and then treated deplorably by the HSE, demands that Deputies of all parties hold the Minister and the Cabinet accountable. Each Deputy has the opportunity at the vote tomorrow night to show where he or she stands on the crisis in cancer services and the shambles that is the health system presided over by this Minister, Taoiseach and Cabinet. The Minister and her colleagues in the Cabinet are responsible for the fundamentally flawed policies and gross mismanagement that has led to such situations. Fianna Fáil and the Progressive Democrats have had more than a decade to deliver the world class health service they promised. Instead, they have maintained a two-tier system riddled with inefficiency and inequity.

In countless written replies to Dáil questions, the Minister stated that the funding, management and delivery of health and personal social services are the responsibility of the HSE. It could not be clearer. Between them, the Minister's Department and the HSE have failed miserably in terms of the effective and targeted funding, the proper management and the patient-centred delivery of cancer services. In the case of diagnostic services for women in the midlands, the failure has been catastrophic.

The crisis is not confined to the midlands. Questions have been raised about other hospitals and professionals. Thousands upon thousands of women are being put through emotional turmoil as a result. It is not confined to the 3,000 whose mammograms were reviewed in the midlands. Thankfully, the majority have been given the all clear, but these women were put through an unnecessary ordeal and others may face the same as the dysfunction in diagnostic cancer services is unravelled.

When the Dáil debated the cancer services crisis on 7 November, I highlighted the concerns of the Well Woman organisation over the ongoing outsourcing of smear tests for cervical cancer to the United States for analysis and the absence of any clear information as to what cytology laboratories will be used to underpin the national cervical screening programme from January 2008. I want to flag that issue again because I did not get adequate answers from the Minister when she replied to the debate. I hope that further grief and tragedy are not being stored up for the future with the approach taken to this vital area of women's health.

Speaking in the debate to which I have referred, the Minister stated that patient safety should come first. We are in total agreement. She stated patient safety should come before hospitals, constituencies and the professions. That is also correct. It has been and must be the priority for us all. The difference is that the Minister has been in the responsible position for a long time. She cannot shirk her responsibility or that of her Department or the HSE for this situation. The HSE is charged with maintaining standards and managing the health services. This crisis in diagnostic cancer services should never have arisen in the first place and a shadow has been cast over those services for all women.

Let it not be forgotten that the issue here is not confined to the competence of health professionals or the suitability of our cancer care infrastructure and its location. This is also about access to services and how our grossly inequitable two-tier health system affects access. The late Susie Long, as a public patient, was denied speedy access to a diagnostic procedure that, if received in time, could have detected her cancer and saved her life. That courageous woman took the decision to highlight her plight nationally, not to seek personal redress for herself and her family but to expose the apartheid in our health services. This apartheid saw patients with access to private care being diagnosed in time, while Susie's diagnosis was too late. How many more Susie Longs have there been? How many in the area of cancer care alone? How many in other areas of care where there are two waiting lists and two parallel systems, public and private?

It is deeply ironic that Professor Tom Keane, the new interim director of the national cancer control programme, should have come from British Columbia in Canada. As one eminent commentator on the Irish health services has stated: "Canada has a strongly egalitarian, one-tier system of health care, which delivers results; life expectancy in Canada exceeds the EU average by over a year for women and nearly two years for men." That system is in total contrast to the two-tier system that exists in this State. As the Irish Congress of Trade Unions states in its study, How Ireland Cares: "The existing State subsidies and tax incentives and the existing organisation of the health care system subsidise private care and discriminate against those who depend on the public system."

The Minister is reported to have complained to an RTE executive about the number of times leading oncologist Professor John Crown was appearing on the station. This was in the days before he was dropped from a "Late Late Show" panel. Far more interesting than the row about the television programme was what Professor Crown himself had been saying. In a recent interview in An Phoblacht, he was asked what he considered the greatest single deficiency in the health service. He stated:

The single biggest deficiency is inequity. It is deliberately engineered. We have a two-tier system because the people running it want a two-tier system. The number of people availing of the public system will decline. The number of people going private is getting bigger.

See this speech in context