Jan O'Sullivan (Limerick East, Labour)

I am trying to address the Chair but the Minister is not listening to me. She is listening to other people in the House.

When Portlaoise was designated as a centre for cancer, an expert with mammography experience and interest, triple assessment and multiple disciplinary teams were supposed to be in place. None of these was put in place and nobody has taken responsibility for this debacle. Somebody must have had the responsibility of ensuring these factors were in place in the aftermath of Peter Naughton's letter in which he raised the issue with various people. Deputy Flanagan stated that the post was not even advertised at the time but, even if it could not be filled through one advertisement, the HSE should have continued to work on the issue until it was resolved. It is not acceptable to say the HSE advertised but could not find the appropriate person.

When Professor Keane goes home, will these centres have what they require? There is no evidence in the responses of the Government and the HSE to the crisis in Portlaoise to suggest we will have a different system. When the Minister established the HSE in November 2004, she stated that she would retain clear accountability for our health services. It is clear, however, that she handed accountability to the HSE. She also claimed that the HSE would be an integrated and accountable organisation which would offer value for money and a simpler governance structure but it has none of these qualities. That is how the Minister established the organisation. She guillotined debate in the Dáil in 2004 in order to establish it in January 2005 and, in effect, she stuck Professor Drumm and his team on top of the existing structure of the health boards. Nobody knows who is responsible and the entire structure is centralised. Any decision-making capacity that existed at local level was returned to the centre. The reports, and Ann Doherty's in particular, clearly identify this. Dr. Doherty's report describes the various kinds of managers employed by the HSE, such as the network manager, the general manager, the manager for strategic planning, the hospital manager and the risk manager, all of whom were reporting in different directions. Some did not even know to whom they were supposed to report. I do not see evidence of actions being taken to prevent those circumstances recurring in various places. The Minister might address that issue in her reply given the reports in this week's newspapers that the Government was considering a return to some kind of regional structure for the HSE. Apparently, however, it decided not to make that change. The Minister has to do something about the structures. Speaking to the Joint Committee on Health and Children last week, she stated that the issue concerned patients. If she does not reform the system and structures, patients will suffer but she does not appear to accept that point.

She claims that Professor Keane is ahead of his schedule and will have 90% of his work completed by the end of this year. Where are the resources to achieve that aim? I do not see evidence of resources being invested. Deputy Reilly referred to Waterford hospital, which is extremely concerned about having the resources it needs to be a centre of excellence. I concur with these concerns because no commitment seems to have been made on giving them the necessary resources. Limerick is also a designated centre. One of my constituents wrote that, as a VHI member, she is not eligible for breast screening before July or August 2008. If she was a public patient, her wait would be much longer. She was told that because Ennis and Barrington's hospitals have stopped screening, the regional hospital is dealing with the work of three hospitals with one machine and the same number of staff. She was originally told in October 2007 that she would be screened in January 2008 but the waiting time has been extended by at least eight months and possibly much longer. I received a telephone call from somebody else who told me she was waiting in Limerick with approximately 30 other people. The environment in Limerick is stressed and the clinical director has indicated that he needs more resources in order to respond appropriately. I do not see evidence that Waterford and Limerick will be given the resources they require to provide the service they have to give to patients.

Issues do not arise solely in respect of breast cancer. Figures on waiting times for colonoscopies were published recently. The longest wait for public patients was 18 months, and nine months in my own area. The waiting times vary across the country. Colonoscopies are tests which determine whether somebody has bowel cancer. We were supposed to learn from the Susie Long case in respect of which apologies were given and apparently genuine concern expressed about the fact that she did not get a diagnosis or early treatment because she was a public patient. She died after waiting ten months but others are clearly waiting 18 months for colonoscopies their GPs have recommended. We have to get real in terms of resources and ensuring people get the assessments they need in an appropriate timeframe if we are to reduce the fatality statistics in Ireland.

This week I received a letter from Europa Donna which stated that since 2000 Ireland's mortality rate for women with breast cancer has been 15% higher than the European average and referred to the national quality assurance standards for symptomatic breast diseases. It refers to concerns, including the concerns of Professor Niall O'Higgins, who advises it, as to what is required in the designated centres with regard to prioritising the timetable. Europa Donna also expresses serious concern that there is a litany of best practice deficits that need to be resolved through the provision of resources for the specialist centres.

The Minister talks as if everything will be perfect by the end of 2009, which it will not be. I do not care whether the Minister calls them centres of excellence or otherwise, but we will not have appropriate centres unless they are given appropriate resources and unless the structures are such that when a gap in the resources is noticed, as a gap was noticed by Professor Peter Naughton, there is a way in which the clinical experts can have their voices heard. I did not hear anything in what the Minister said to suggest this will happen.

On the outstanding reports we have not received, including the report on the Rebecca O'Malley case and the reports in regard to diagnostic services at Galway and Cork, until we get all of those reports into the open and we find exactly what the adequacies of the system are, we cannot fully put it right. I urge the Minister to ensure that the rest of those reports are published as soon as possible so we can address the issues raised in them.

We are dealing with the health of the nation. We have put a great deal of our money into this — I acknowledge that spending has increased in recent years. However, there is a sense that nobody is in charge of the service, that it is dysfunctional and that a huge amount of money and goodwill is wasted in a system that is frustrating those who want to deliver care. The Minister needs to address this. She needs to take the HSE by the neck and take responsibility for it. She needs to do what she should have done before she set it up in the first place. She should set up very clear chains of command so that people know exactly what they are responsible for, and have the authority to make decisions where they are needed.

I take phone calls and receive e-mails every day from people who work in the health system, as I am sure other Members do. These people have a wonderful work ethic and want to do their best for their patients, whether they be doctors, nurses, other medical staff or others working in the health service. Since the establishment of the HSE, however, their level of frustration has grown enormously. I know the Government backbenchers agree with me because they are in touch with what is happening on the ground.

The Minister must admit something is wrong before she can put it right. It is not enough to focus narrowly on what she hopes Professor Keane will achieve because that is only a small part of the picture. That will not bring about the root and branch systematic changes needed in this country if we are to avoid a repeat of what happened at Portlaoise. I urge the Minister to do the big job that is required, not take the small steps. She should open her mind to what is wrong with the system and not hide behind the derisory Government motion before the House, which is closed to everything we should have learned from the Portlaoise situation and everything we will learn from the other reports due.

This debate must achieve a radical change in the HSE and in particular in the thinking of the Minister in her stewardship. There is an urgent need, for the country's sake, for the Minister for Health and Children to take charge of her brief.

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