Mary Harney (Dublin Mid West, Progressive Democrats)

I move:

That Dáil Éireann:

welcomes the publication of reports into events relating to breast cancer services at the Midlands Regional Hospital, Portlaoise;

supports the action being taken by the Minister for Health and Children, and the board and management of the HSE, to ensure that patients' interests come first in the future management of all such reviews and serious adverse incidents;

reiterates its support for the National Cancer Control Programme to ensure equitable access to high quality cancer services for patients throughout the country;

expresses its appreciation for the leadership and work of clinicians, nurses and staff in delivering improved levels of care for cancer patients under the Cancer Control Programme;

welcomes the improvements in survival rates and supports the Cancer Control Programme which will deliver further improvements; and

commends the early progress made by Professor Keane since his appointment in late 2007 on the improvement in symptomatic breast cancer services.

I am pleased to have the opportunity in this House to discuss the four reports into the events that happened in Portlaoise hospitals between 2003 and 2007. Last Thursday, we had an opportunity at the Joint Committee on Health and Children to have a discussion with Deputies, the day after those reports were published. A week later, a debate can be better informed because Deputies will have had an opportunity to study those reports and to reflect on them.

At the outset I want to reiterate the apology I expressed in this House when these matters first came into the public domain last autumn. I extend that apology to all of the women who were caused upset and anxiety as a result of the necessary review of mammograms in the period from 2003 to 2007. In all, there were over 3,000 women involved. Subsequently more than 600 ultrasounds were also reviewed. Thankfully, in regard to the ultrasounds, no new cancers were diagnosed. Clearly the biggest apology has to go to the nine women whose diagnosis was delayed as a result of an initial misdiagnosis. Eight of those were in Portlaoise hospital and one was in St. Vincent's Hospital in Dublin.

If there is anything we have learned from what happened in Portlaoise, it must commit us all to ensuring we put in place in Ireland the best possible cancer service that this country can provide for cancer patients, whether from Portlaoise, Donegal or Cork. In regard to the findings of the report, the clinical report is clear that nine cancers were misdiagnosed. As a result those women had their treatments delayed. Some of that misdiagnosis happened when the health boards were in place and some of it happened following the establishment of the HSE. All of those clinical errors were errors of doctors and not errors of management. We must remember that.

If we are to minimise the capacity for doctors to make errors, particularly in regard to breast cancer, where there are 250 different publications worldwide, we must have specialist doctors working in teams in major centres where there are large volumes of patients. That is the finding not just in Ireland, as a result of the expertise we put together, but it is also the advice from countries around the world. Until relatively recently we had in Ireland more than 30 different hospitals performing breast surgery. Only four out of every 100 surgeons were doing more than 50 procedures per year. Three out of every ten women had their surgery performed by surgeons who did really low volumes of activity. Perhaps I will get an opportunity to speak about that in a while.

In summer 2005, a few months after I became Minister for Health and Children, I put together a group, chaired by Professor Niall O'Higgins, who is recognised as one of the leading experts, not only in Ireland but internationally, on breast cancer. He chaired a group at my request to advise me on what guidelines and standards need to be put in place to deal with symptomatic breast cancer. He reported and I took that report to the Government, which endorsed it. The findings of the report were that no hospital should perform breast surgery unless it was dealing with a volume of 150 cases per year. Notwithstanding that this was during the run-in to the election, when many felt it was not a wise time to publish and endorse these standards because of the consequences for so many hospitals, we endorsed them and published them in the spring of last year in the presence of the HSE and HIQA.

From that point on, it became a question of how quickly we could implement the standards. Since then, 16 hospitals have ceased breast surgery and a further seven will cease breast surgery this year. Although the cancer control plan in respect of breast cancer was to be implemented over a two-year period, Professor Keane told me that he expects it to be at least 90% implemented by the end of this year. Such is the speed at which patients are demanding that they be treated in specialist centres. As a result of the publicity and awareness surrounding Portlaoise, many patients are better informed. There is strong advice coming from patients groups such as the Irish Cancer Society, Europa Donna and others in respect of safety and quality. Volume equals quality, and this is not to do with the skills of individual doctors. It is only with high volumes that one can get specialist doctors to work in centres.

There is much debate about letters. I reiterate that politicians, Ministers, clinicians and officials have a responsibility to redouble our efforts to make sure the appropriate cancer care is established in Ireland. In the past, that did not happen because of medical opposition not political opposition, which was the beginning of something not happening. Professor Keane has acknowledged, and I have seen, that there is major clinical buy-in to the new cancer control plan and terrific clinical leadership, as evidenced by the announcement from Mayo General Hospital, Castlebar yesterday. Dr. Barry, a highly skilled breast surgeon, has agreed to move to Galway to carry out breast surgery. He is in discussions with Professor Keane in respect of those arrangements. That is a major positive, putting the patients first.

When the decision was made to designate Portlaoise as the breast cancer centre for the midlands, cancer care was to be spread across three sites — Portlaoise, Mullingar and Tullamore. If there is a small population and one spreads the cancer resources of clinical expertise across three sites, one will never get the outcomes one expects even in 2002.

Mr. Naughten has issued a copy of a letter he says he sent to my predecessor at the end of April 2002. To be fair to officials in the Department of Health and Children, all letters sent to the Minister are electronically recorded in the Minister's office and in the Department. There is no record of the letter there, nor at the health board office, which would be normal practice. I am not suggesting that the letter was not sent but there is no record of it. Mr. Naughten gave a copy of the letter to Ann Doherty when she was carrying out the report. Subsequent to the letter, some €500,000 was allocated by my predecessor in that year, 2002. That letter was sent during the election campaign leading up to the election on 17 May 2002. Following his reappointment as Minister for Health and Children, Deputy Martin allocated €500,000 to cancer services in the midlands and sanctioned the appointment of three clinicians, a surgeon, a radiologist and a pathologist, who were to have specialist interest in breast cancer and who were to work in a multidisciplinary team with triple assessment. That was the condition on which the appointments were sanctioned. Much emphasis has been placed on letters. It is not the case that no action took place or that there were no resources.

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