Bertie Ahern (Dublin Central, Fianna Fail)

The motion for tomorrow's debate reads "to ensure that patients' interests come first in the future management of all such reviews and serious adverse incidents", so patients' interests are included in the motion.

I have discussed the reports with my colleagues. We discussed them in the health committee when they were published last Wednesday and have since discussed them further and we have had meetings with the relevant Ministers on them. I will not rehearse all the details but Deputy Gilmore will be aware these reports concerned events which took place in 2003, prior to the establishment of the HSE. Rather than bundling that into it as if the issues did not arise in the former system, they did because the report went back to two years before the HSE was set up.

When one looks at the issues — I have not read every line but I have read large chunks of the four reports — Ann Doherty noted there were no multidisciplinary team meetings other than in oncology, consultant medical staff were not represented at the meeting which decided to suspend breast radiology services, confusion arose regarding roles and responsibilities in the hospital and gaps existed in decision making processes. John Fitzgerald noted a fundamental weakness in the management and governance of the review process because an authoritative co-ordination role was not established for the process as a whole, decision making was fragmented, communication was inconsistent and confusion in the status of the overall review process arose because too many individuals were involved. None of these issues makes good reading but they are probably happening in other areas.

This was not happening in the centralised management offices of the board of the HSE, as some comments implied. It was happening on the ground in the regions where decentralised services had been operating for many years despite the advice of a number of reports, including one several years ago by Professor Niall O'Higgins, that we should pull these together and create critical mass units. Let us be frank; nowhere has it been argued more than in this House over the years that we should keep a bit of the service everywhere and reject the many reports which advise that large units with a critical mass resulting from dealing with a sufficient number of cases are best. That is politically difficult, so we always try to keep a bit for everybody in the audience. We are beginning to learn that is the wrong thing to do.

It is fair to ask what we are doing about it. The implementation of the national cancer control programme is the Minister's major priority. We were lucky to get a person with the expertise of Tom Keane to take up the position. The recent decisions by the HSE in regard to the four managed cancer control networks and the eight cancer centres will be implemented on a managed and phased basis, hopefully by the end of this year, even though Professor Keane is committed to having it done by the end of 2009. There is the north-east one, centred on Beaumont and the Mater hospitals, the mid-Leinster one, centred on St. James's and St. Vincent's hospitals, the southern one, centred on the Cork University Hospital and Waterford Regional Hospital, and the western one, centred on University College Hospital Galway and Limerick Regional Hospital. The aim is to pull together the service that led to many of these issues and try to turn it into a world class service. That is what we are doing and what I support.

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