James Reilly (Dublin North, Fine Gael)

No further action was taken and the patient has not been put at the centre of the health service. Furthermore, the Minister misled me at last week's meeting of the Joint Committee on Health and Children. She stated: "Professor Keane has also agreed with the Irish College of General Practitioners on a new method of referring patients for breast diagnosis". However, this is not so, as no such agreement is in place. Why does the Minister seek to mislead the House again? Waterford, which is supposed to have a centre of excellence, awaits funding despite promises from the Minister and the Taoiseach. I am deeply concerned by Professor Drumm's assertion that transport costs are to be cut. How will this affect transport to our centres of excellence?

The Minister's reform of the health service through the establishment of the HSE was supposed to put patients first. How often have we heard this? It was supposed to increase efficiency, transparency and accountability, and make a real difference to the quality of health services delivered to the people. These were the Minister's words, not mine and these are her failures.

The Fitzgerald report catalogues the systemic failures in the HSE's response to the Portlaoise cancer crisis. I reiterate that although a former Ombudsman has stated one cannot blame Ministers for every tittle-tattle, one certainly can do so when there is system failure and they should be held accountable. Members must remember that this body, with its systemic failings, oversees the spending of more than €12 billion of taxpayers' money.

The Fitzgerald report found a "fundamental weakness in the management and governance of this process from the outset, because there was no authoritative co-ordination and management role established for the review process as a whole". It reported that communication throughout the period was inconsistent and sometimes contradictory, that too many were involved from different levels and areas within the HSE who were unclear about their roles and responsibilities and that they had differing understandings of what was going on.

Overall, the report found a lack of urgency on the part of the HSE prior to the meeting of the Oireachtas Joint Committee on Health and Children on 22 November, when it announced that 97 women reviewed under the ultrasound process needed to be recalled. It commented that had the same urgency been shown before November as was shown subsequently, much of those patients' pain and suffering would have been avoided. Unfortunately, the Minister was unaware of the ultrasound review, which demonstrates clearly communication difficulties. Unfortunately, this is what one has come to expect, namely, a detached and disinterested Minister for Health and Children who is unaware of what is going on.

It was not until the aftermath of the joint committee meeting and the subsequent media furore that emergency clinics were set up to examine the women in question. Had this issue not been flagged at the Joint Committee on Health and Children, it is questionable whether these clinics would have been set up in the first place. As I have noted, the Fitzgerald report concluded that had the same level of urgency that was shown subsequently, when the Minister's neck was on the line, been shown beforehand, a different situation would obtain today.

The Minister cannot continue to avoid responsibility. The reports published last week demonstrate the falsity of her claim that she presides over a health system that puts patients first. Instead of attributing responsibility to any individuals, the reports refer to systemic failures. However, one must ask who put the system in place? Who designed and built the HSE? Who decided on its staffing structure? The Minister presided over it all. She must accept responsibility for her creation and ignoring the warnings about a bureaucratic bulge in the HSE, in which there is no shortage of managers but a serious shortage of anyone who takes responsibility. The Minister must take responsibility for the lack of urgency shown from August to November.

A health service is needed that is not about bloating bureaucracy and ineffective management structures but is about patient values and how people are cherished. A health service is needed that prioritises patient safety, as one has learned time and again that the current structure does not protect patients. A health service is needed that is accessible, provides high quality care when needed and does not waste the resources available to it. Accountability and transparency are required in order that one always can answer the questions: who made the decision? Why did they make it? How much did it cost and, most importantly, what impact did it have on patient care?

A full independent inquiry must be carried out by the Health Information and Quality Authority, the terms of reference of which would allow for examination of all matters from 2000 to 2008, including the roles of successive Ministers for Health and Children, the Department of Health and Children, the HSE and the health boards. Above all, a Minister who will listen is needed. I refer to a Minister who recognises the failings of her creation, in whom the people can trust and who recognises that tomorrow's plans are not today's achievements.

The Minister has lost trust. The HSE is a low trust organisation. There is a disconnection between those on the front line who are struggling to deliver efficient and reliable services and those who are part of a centralised and controlling bureaucracy. The HSE has prioritised its bloating bureaucracy over patient care and failed test after test.

Yesterday, Tuesday, 11 March 2008, 390 patients lay on trolleys in accident and emergency departments. Despite a promise in 2002 to extend eligibility to a full medical card to an additional 200,000 people, only 29% of the population have a medical card today, compared to ten years ago in 1998, when 32% of the population were entitled to a full medical card. Moreover, one hears of the catastrophic effects on children suspected of having autism being obliged to wait for up to two years for initial assessment. This constitutes two years out of the three-year window that can make all the difference to such a child's future. Although this is brain awareness week, people with brain injuries are obliged to wait up to two years to see a specialist, even though the first two to four weeks after diagnosis are crucial.

I refer to the disgraceful situation in St. Ita's Hospital, in which 23 women lie in an open ward with 3 ft between beds. The 23 women share a shower with the ceiling coming down, a bathroom and three toilets. Although this is 2008, they have no privacy when getting dressed. What does the Minister do in response to their request? Having planned for a new psychiatric unit at Beaumont Hospital in 2004 and having put it out to tender in 2005, she now has plonked her private co-located hospital on the site. How is that for putting patients first? Moreover, cystic fibrosis sufferers must wait for their isolation rooms and the waiting list issue goes on and on. Some of my patients are obliged to wait. One lady, thankfully, is having her operation today. However, although it should have been performed two weeks ago, it was cancelled repeatedly. She has a large tumour and I wish her well.

This is the Minister's health service and her responsibility. Her greatest achievement is a centralised bureaucracy that does not work or deliver patient care. I have noted that this debate takes place for the women of Portlaoise and their families who have suffered appallingly because of the failures of the Minister and the HSE. However, it constitutes poor recompense to the nine women wrongly diagnosed as not having breast cancer, as well as the dozens of women whose potentially life-saving treatment was delayed because of the failures of the Minister's system. The women of Portlaoise are the victims of this atrocity. They paid a high price for the decisions made and not made by the Government and carry a heavy burden for the failings of the system. These failures arise directly from decisions made by the Minister and her predecessor, Deputy Micheál Martin.

When will the Minister listen and accept that some reform of the HSE is required to restore credibility and trust in the system? When will she accept that tomorrow's plans are not today's achievements and that promises of excellence tomorrow are no substitute for service today? The remedies are clear. The HSE must put patient care at the centre of all its activities, all its employees must have total clarity about their roles and responsibilities, HSE decision-making on services must be devolved to regional and local level to the greatest extent possible, bureaucracy at HSE headquarters must be reduced and the HSE's accountability to the Oireachtas must be dramatically improved. These constitute five simple steps to restore some credibility to the HSE which is a failed and deeply flawed entity.

On behalf of the people, I demand that the Minister cease making empty promises and take real action as suggested to give the people the health service they deserve and for which they have paid so dearly. I commend the amendment to the House.

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