Martin Mansergh (Tipperary South, Fianna Fail)

I wish to deal with the substance of the issue first and the politics afterwards. Nowhere is the delay in receiving the correct diagnosis and treatment more critical than in the field of cancer, one of the main killers. Overall, the survival rate over five years, according to the National Cancer Forum in 2006, has been 50% or somewhat less, although female breast cancer patient survivors are nearer to 75%. The subject inevitably is a cause of acute anxiety for those affected and their near relatives. Any suggestion of an unreliable diagnosis only adds to the trauma. All Members feel deeply for the women who were let down by wrong diagnoses at Portlaoise General Hospital.

The public health service must be capable, as one of its highest priorities, of providing within a short period a prompt accurate diagnosis and treatment without regard to the health care status of the patient.

From what I have heard, public policy is intent on achieving that and the roll-out of BreastCheck and other cancer services is evolving. A related issue is the uniform availability and accessibility of the best diagnostic and treatment facilities so that survival rates do not depend on the part of the country in which one lives. The rationale of centres of excellence is to provide a uniform level of service. Account has to be taken of the need to spare sick people unnecessarily long weekly journeys for treatment where it can be provided closer to home. This issue arose in respect of the provision of radiography for the south-east region in Waterford but has since been largely resolved.

I have some sympathy for those who live in the north west. I was present in Sligo when a bereaved former Minister for Finance spoke at his wife's funeral to urge that excellent facilities in Sligo Regional Hospital be retained and I have read similar pleas in the newspapers. All the regions which are well removed from Dublin need to look after each other. The principle of centralisation should be balanced by the principle of subsidiarity, which means that a service or treatment should be provided locally when it can be done so equally well.

Cancer services, which are literally a matter of life and death, cannot be allowed to operate on a de facto two-tier basis, whereby survival depends on whether one is a private or public patient. The establishment of an acceptable standard which gives public patients an equal chance is the litmus test of the viability of our current dualistic health service model.

Many people admire the Minister for Health and Children, Deputy Harney, for taking on an enormous task, one of the most challenging in Government at present. The HSE has more than its share of teething problems and the jury is still out as to whether it can successfully bring about the necessary transformation in our health services. Problems in communication and a top heavy bureaucracy should not obscure the fact that much excellent work is being done in our hospitals. There are horror stories but there are also a large number of people who are very happy with the care that they or their loved ones have received. Many of us in our personal sphere encounter more good experiences than bad, although as politicians we get to hear of both.

There has been considerable discussion in the Dáil and the media about responsibility and accountability, which often translates crudely into a demand for resignations when anything at a systemic level goes seriously wrong or, as newspapers tend so charmingly to put it, that heads should roll at political, bureaucratic or medical levels. Significantly, the metaphor of "heads rolling" is taken from the reign of terror in the French Revolution, which may have provided an all-time peak of excitement for contemporary newspapers like L'Ami du Peuple but does not provide a model of good governance. Perpetual political instability characterised by summary populist judgments which abruptly terminate the careers of even the most worthy seems to be the type of responsibility and accountability that some would wish to see established here, but that trend must be resisted. Public servants are right not to tolerate scapegoating for political failures. Like cream, credit for success rises to the top but it is amazing how far down responsibility can reach when something goes wrong.

The Labour Party leader, Deputy Gilmore, is fond of quoting President Truman's phrase, "the buck stops here". How many US Presidents have resigned since George Washington's inauguration in Federal Hall, New York, in 1789? I believe there was only one, President Nixon, for a grave abuse of office rather than any policy failure. Responsibility and what "the buck stops here" mean are standing one's ground, acknowledging and addressing failures, coping with unexpected crises and devising better systems and plans. That is what the Minister, Deputy Harney, and the Government have been doing. They have not thrown in the towel at the constant howls for resignation. The Government is not a private company or a football team. It is a democratic institution governed by rules clearly set down in our Constitution. Article 28.4.1° of the Constitution states: "the Government shall be responsible to Dáil Éireann" and Article 28.4.2° states: "The Government shall... act as a collective authority, and shall be collectively responsible for the Departments of State administered by the members of the Government". It refers to collective rather than individual responsibility. Strictly speaking, motions of no confidence in individual members of the Government, of which two are on the Order Paper, are not constitutionally correct. The Government as a whole is responsible for the administration of health and every other policy area.

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