Bertie Ahern (Dublin Central, Fianna Fail)

I thank Deputy Gilmore. Maybe in a minute I will say a few words and wrap up on my own issue.

On the Rebecca O'Malley case, to recall in June 2007 the Health Information and Quality Authority commenced an independent investigation into the care provided to Rebecca O'Malley by the HSE. As part of the investigation into the circumstances around the care of Rebecca O'Malley regarding her systematic breast disease, that investigation examined the pathology services provided by the HSE at Cork University Hospital and of course the systematic breast disease services provided by the HSE in the Mid-Western Regional Hospital. That report by HIQA was published today.

The main finding of the report, to record for the House, is that the interpretive error made by a consultant pathologist that led to the initial misdiagnosis was a single mistake of human error. However, the report notes the absence of triple assessment review in the case and the missed opportunities to correct the error. The report was also critical of the HSE in governance, management and communication of the way in which Rebecca O'Malley was informed of matters relevant to her care. Not to go into them all, the report makes 15 recommendations for the HSE, including matters relating to clinical practice and management. Obviously it is for it to make sure they are implemented. The board of the HSE has recently adopted a new interim policy and procedures on serious incident management which include learning from recent reports on the Portlaoise events and will, coupled with the implementation of the new policy on the development of centres of excellence for breast disease services, provide solutions to many of the recommendations in this report. If I can come back in a minute, I will also say a few words on the Barrington's issue which the Deputy asked me about. I will let him in first.

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