Alan Shatter (Dublin South, Fine Gael)

Today we discuss the findings of the Rebecca O'Malley report, the Barringtons Hospital report and the Fitzgerald, Doherty and O'Doherty reports into the Portlaoise cancer crisis. All these reports are a damning indictment of 11 years of Fianna Fáil-Progressive Democrats policy, now supported by the Green Party. In the past three years, we have had a health policy run by a Minister who engages in a semi-detached oversight, fails to accept responsibility and does not recognise the concept of accountability for the appalling failures in our health service.

Continued revelations of appalling mistakes in diagnosis and treatment of individual patients, discussed by the media on a daily basis, have totally undermined patient confidence in our health services. Excellent work done by so many nurses and doctors who save lives and improve the quality of lives gets lost in people's consciousness by the increasing doubt created about the competency of our overall diagnostic and treatment services. It has reached a stage whereby many people genuinely in need of hospital care are frightened to enter hospital for inpatient treatment. Those reliant on diagnostic and inpatient services lack confidence in results furnished to them and feel compelled to seek second and third opinions to ensure they are not the victim of yet another error.

The legacy of 13 years of Fianna Fáil-Progressive Democrats Government is not only that we have a health service that falls scandalously below the standard expected in an EU-advanced economy but that a majority of people totally lack confidence in the capacity of the service to provide them with appropriate, timely, reliable and competent diagnostic and medical services.

As I have been allocated a short time, I can only draw on the more prominent aspects of the reports. I hope that as a result of recent events detailed in these reports real lessons have been learned and real reforms are implemented. However, considering the promises made by the Government in that regard, the Fine Gael Party has little confidence in the Minister or the current management and structure of the HSE.

The Fitzgerald report catalogued the systemic failures in the HSE's response to the Portlaoise cancer crisis. Fitzgerald found "a fundamental weakness in the management and governance of the process from the outset because there was no authoritative co-ordination and management role established for the review process as a whole." Communication throughout the period was inconsistent and sometimes contradictory, too many people were involved from different levels and areas in the HSE who were unclear of their roles and responsibilities and they had differing understandings of what was going on. His report also found that the entire management process surrounding the Portlaoise cancer crisis has been a bungling mess from start to finish.

Fitzgerald found a lack of urgency from the HSE prior to the Oireachtas health committee meeting on 22 November 2007 when it was announced that 97 women reviewed under the ultrasound process needed to be recalled. These women were not contacted immediately but were treated like job lots and left until a sufficient cohort was accumulated before they were contacted.

The Minister for Health and Children was unaware of the ultrasound review until the day before the committee sat. In the intervening period, between the time she learned and the time the committee sat, she was unable to get detailed information from the HSE, a body which she created and which should directly report to her on health issues of national importance.

One would assume that when the issue broke last autumn this was the first time the HSE and the Department of Health and Children knew of the problems in Portlaoise General Hospital. We subsequently learnt that a consultant surgeon in Portlaoise General Hospital, Dr. Peter Naughton, had written a series of letters to the Minister, Deputy Harney, and her predecessor, the Minister, Deputy Martin, dated as far back as 2002, expressing his substantial concerns about the cancer services in that hospital.

In July 2005 he stated that radiological services were being provided by people who had no expertise in the area and that women were having unnecessary surgery because of a lack of decision-making. He described the services as a shambles. It is scandalous that nothing changed, no one took responsibility and no decisions were made. The correspondence was apparently ignored.

The frightening findings of the Fitzgerald report were echoed in the report published by the Health Information and Quality Authority, HIQA, into events surrounding the misdiagnosis of Rebecca O'Malley. The report catalogues a series of systemic failures in the organisation and the handling of the situation. Roles and responsibilities within hospitals and HSE management were not sufficiently understood, no one took lead responsibility for the situation, pathways of accountability and reporting at senior management level were not clear, there was insufficient understanding of risk management at all levels, communication between management and staff was not effective and there was a lack of confidence in the integrity of the communications process.

Of all the failings identified, it is particularly worrying that responsibility was left to Rebecca O'Malley to pursue her case. She made the hospital aware of her concerns in an incident form completed in November 2006, but it did not trigger an effectively managed action plan. There was no integrated system-wide approach, a lead individual to manage the overall response or a system to respond to her letters in a timely manner. It was left to her, through sheer frustration and determination, to pursue the issue, to raise questions regarding errors in her care and to bring this terrible error to the nation's attention.

According to the report, there was a collective lack of accountability, cohesion and focus on the needs of the patient. This is the so-called patient-focused health system to which the Minister refers frequently. It is unacceptable that a person who suspects a misdiagnosis or has concerns about his or her health should be treated in such a manner. It is unacceptable that these concerns, which could reflect on the health of others, could be ignored. It seems almost unbelievable that, in the construction and framing of the new HSE system for which the Minister is directly accountable and responsible, such policies and procedures were not considered and effective systems put in place.

The report found that major financial pressures demanded management time and energy, creating the potential for other priorities to be given less attention. Perhaps patient care and safety are a priority to which the HSE has, in the years since its establishment, failed to give adequate attention. They seem to be less important than the HSE's bureaucratic and administrative priorities, which are occasionally more concerned with covering up or ignoring difficulties than with investigating them. Most damning was the HIQA findings on the HSE's governance and management of the situation. According to the report, disillusionment with the role of the HSE was a consistent feature in most of the interviews. It found that the HSE network management system does not have the confidence of its staff and that the new system delayed decision making processes instead of facilitating them. This matter must be addressed. I am not reassured by the Minister's statement, which we have heard previously.

HIQA found a disconnect between hospital management and the HSE's National Hospitals Office in that the HSE expects hospitals to accept without question significantly increased workloads that are unmatched by resources or staff. This is a consistent theme across the health system. The sad reality is that patient-centred care is a low priority in the day-to-day workings of the health service and in the approach taken by the HSE. The report concludes that the HSE is designed in such a way as to delay and avoid difficult decision making and to prioritise emergency issues that have the media's attention rather than to meet the local needs of patients and frontline staff.

Combined, the reports demonstrate that the Minister's claim concerning her presiding over a health system that puts patients first is false. Instead of attributing responsibility to an individual, the reports refer to systemic failures. The Minister stated her desire for a reporting culture in which no blame is attached. The Minister, HSE management and those employed in the health service cannot be free of blame. They must be accountable for the service they deliver to the public and recognise their responsibility. If something goes wrong, there must be accountability. If there is none, there will be further scandals and tragedies as a consequence of the HSE's failures.

For months, we have listened to the Minister's plans for eight cancer centres of excellence. No one can disagree with the concept of excellence in cancer care or the proposals, but I cannot understand how the Minister can justifiably withdraw excellent cancer services from hospitals around the country when alternative and replacement infrastructure has not been put in place at the new centres. If the Government has a serious intent to establish centres of excellence, it must fully address issues concerning those hospitals where cancer services are to be terminated.

Back bench Deputies and, more importantly, Ministers should stop playing cynical local political games, namely, pretending to fight to keep cancer services in hospitals in their local constituencies while coming to Dublin and voting for closures. The conduct of the Minister of State, Deputy Devins, in this regard is particularly reprehensible. As a Minister for State at the Department of Health and Children, he can directly contribute to the decisions being made on cancer policy and services. His cynical and self-promoting presence at protests to maintain services at Sligo General Hospital when he is in a position as a Minister of State to ensure those services are maintained — if doing so is consistent with providing the expert medical care to which cancer patients are entitled — is nothing short of farcical. By his conduct, he is undermining any credibility vested in his position.

We do not know when the cancer centres of excellence will be fully operational. The Minister, Deputy Harney, has given some indication of the general progress proposed by the HSE, but we do not know the details. For example, we do not know how much additional funding will be dedicated to these centres, how many extra beds will be needed, whether beds will be relocated or whether new beds will be created. How many staff are expected to move under the proposed plan and how many new staff will be recruited? What arrangements will be made for hospitals north of the Galway-Dublin line? What arrangements will be made to facilitate patients who cannot afford the cost of travelling to the centres of excellence? When will the national radiation oncology plan be delivered and by what method of financing? How can patient safety be prioritised when services, be they cancer or other health services such as those in the north east, are withdrawn without alternative services being put in place?

The reports published in recent months prove that patients are not put first, HSE management is anything but effective and, three years since its establishment, people are still unclear of their roles and responsibilities. The reports establish that there is not an appropriate, up-to-date and effective communication system between the HSE and its many segments and the Minister and her Department. At times, the Minister seems to discover difficulties or disasters more speedily via media reports than via direct communication between her Department and the HSE.

Discussing the establishment of the HSE in November 2004, the Minister stated:

It is a once-in-a-generation event. It is our generation's chance to put patients first in the design of the management of health services.

She stated: "To achieve them we badly need clarity of roles and accountability — political responsibility for the Minister and management responsibility for the management" and "That will make a real difference to the quality of health services provided for our people". In the years since the HSE's establishment, the Minister has not only failed to deliver in this respect, but the situation has gone wrong. Members on all sides of the House lack confidence of any nature in the capacity of the HSE to deliver a competent health service. Our confidence is further diminished by the HSE's tendency under financial pressure to cut frontline services while preserving an overwhelming, unnecessary and overlapping bureaucracy. We need a health service that is not about bloated bureaucracy and ineffective management structures, but patient values and how we cherish our people.

None of the reports reflects the worries and anxieties experienced by each of the women involved or the dreadful impact events have had on them. Some reactionary action was taken by the Minister in response to the situation, but the HSE has failed to create real public trust in its capability. The investigation team behind the O'Malley report stated that an urgent review should be conducted by corporate HSE of communications within its hospitals to ensure effective communications policies and procedures are in place to provide an efficient and co-ordinated response to the patient when a serious incident occurs.

The Minister should take heed of this and initiate such a review to ensure the appropriate and necessary changes are introduced as a priority. In addition, the Minister should finally recognise that the HSE, as created by her, is a failed organisation whose structure does not lend itself to the delivery of an appropriate and efficient quality health service. The present need for root and branch reform of the HSE and the manner in which it conducts its business must be recognised. Moreover, there is a requirement to ensure that the vast resources which are going into the health service are being used to provide frontline patient care and not to continue building an unnecessarily large administration and bureaucracy, which operates in a world in which it seems on occasion that not only does the right hand not know what the left hand is doing but has not yet been introduced to it.

See this speech in context