Mary Harney (Dublin Mid West, Progressive Democrats)

To answer Deputy Ó Caoláin's question, there is no plan or discussion about changing the structure of the HSE. I do not go around my Department and ask every official whether they spoke to a journalist. I have the height of regard for the journalist in question, Dr. Muiris Houston. There is no plan at management or political level to return to the old health board system with 273 people in charge of a health delivery system for 4.3 million people. In advance of establishing the HSE we had many reports and examined what happened in many countries. Other countries are following us in having a unified system. Only through a unified system can one have consistency of standards, drive quality and have specialist centres.

Of course there are management issues. Contrary to what was said, the O'Doherty report was requested long before the issue arose at the Oireachtas committee in mid-November. On my behalf, my Secretary General asked the CEO to report to us on why the service was suspended in Portlaoise on 28 August and the circumstances that led to that. That was the O'Doherty report, which covered the configuration of services and many matters. Subsequent to the events of 21 November I asked the chairman of the board to examine the HSE's handling of the issue from a management perspective.

There was clinical misdiagnosis. The only way we will minimise error is by having teams of specialists working in big centres with large volumes of patients. We know that not just from Ireland but around the world, particularly in breast cancer. Some 250 different medical publications back up that fact. Last spring for the first time we introduced symptomatic breast health service standards. The first requirement of this is that there should be 150 in a centre, and that has all the consequences we know for smaller places.

There is no cancer centre in the north east. Half of all surgical patients and 30% of medical patients from the north east come to Dublin hospitals, as I have told Deputy Ó Caoláin before. I strongly believe patients will go where they will get quality service. Patients who are very ill, particularly with cancer, are prepared to go to the specialist centre for diagnosis and surgery. We clearly need to make financial and transport facilities available to many. They will go there. That is what patient advocacy organisations say to me.

I have written to the board of the HSE as a result of the Fitzgerald report. The first thing to do with accountability is to find out what happened. The second thing we need to do is to learn lessons and having done that, we need to make the changes. I have discussed these issues with the chairman of the board, which will meet tomorrow. It is a high priority for the board to learn the lessons from the Fitzgerald report, not just in how they apply to Portlaoise, but in how they apply to governance, communications and management.

The guarantee I give to patients is that if there is another serious incident, communication and management will be appropriate and it will be acted upon quickly. Many people know Ms Margaret Murphy, including Deputy Clune. She was one of the first patient representatives I met when I became Minister for Health and Children. I met her at a conference in the UK. She told me that her son died as a result of medical error in a hospital in Cork and that she had to litigate to get the facts. She did not want money and when she got the award, she donated it to charity. She had to go through the trauma of litigation to find out what happened. That era is over and people will no longer have to litigate. We now have HIQA, which is about setting and monitoring standards and carrying out investigations. The Rebecca O'Malley report is imminent, as is the report on the pathologist in Galway and Cork and the report on Barrington's Hospital. I have no doubt these reports will not make pleasant reading, but it is much better to find out warts and all what is happening and to do something about it, than to sweep it under the carpet and oblige other families to litigate.

I agree with Deputy Mitchell that Mr. John Fitzgerald does not deal with the clinical issues. He deals with management communication issues and I knew him when he was manager of South Dublin County Council. He has great credibility as far as management is concerned, especially management of public sector organisations. He identified serious failings and we must learn the lessons from his report quickly. I accept that many of the criticisms of the HSE are valid, because it is a new organisation and is the largest in the country with 130,000 people. There will be teething problems and many of the jobs at the top are not yet filled. I want to see that done as quickly as possible so that we have a clear line of management and clear lines of accountability. I still think everybody here admires the vision, the determination and the courage of Professor Drumm. Many of his clinical critics did not apply for the job, as not that many doctors were queuing up to be CEO of the HSE.

Deputy Clune asked about doctors filling positions. A radiologist was appointed in the summer of 2004 to Portlaoise and another was appointed in the autumn of 2005. A recruitment campaign began for a third radiologist and a successful candidate was identified, but that candidate withdrew after a couple of months. The HSE advertised again but no successful candidate could be identified. These are the facts and that is what happened to radiology in Portlaoise.

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