Jan O'Sullivan (Limerick East, Labour)

Although the Minister speaks eloquently, unfortunately eloquence and fine words do not deliver an excellent health service. It seems likely the Minister, Deputy Harney, will remain as Minister for Health and Children after the incoming Taoiseach takes office in two weeks. It is almost unbelievable that the reason she will remain as Minister for Health and Children is that no one else wants the job. No one else, in the very large Fianna Fáil Party or in the Green Party wants the job. They are leaving it to the Minister, Deputy Harney, whose party has the support of 1% of the electorate. This is an appalling indictment of the Government. The Minister is being left there because the others do not want the post rather than because they consider her to be doing a good job as Minister for Health and Children. Certainly, the Minister talks a good talk, but if she is as detached from the real reforming work as she appears to be in respect of the HSE or if she is as detached in respect of the delivery of the cancer strategy, the new Taoiseach will have failed unless he replaces her as Minister for Health and Children. This is the responsibility of the Government rather than of the Minister.

I will begin where Deputy Shatter left off in respect of the HSE. It is important to establish what the Minister said in November 2004 when the HSE was established. Again, fine words were used, but what has been delivered? If it has not been delivered with regard to the HSE, will it be delivered in respect of the cancer strategy? Members have a responsibility to ensure that what is stated and promised in this House is delivered and I take this duty seriously as a spokesperson for the Opposition and for the Labour Party.

Members need a Minister who does what the Minister, Deputy Harney, promised in the Dáil in November 2004 when the legislation setting up the HSE was being rushed through. She stated she would retain clear accountability for our health services. However, on a daily basis, one sees the Minister and her partners in government shirking their responsibility for the health services, as well as blaming and criticising the HSE. I refer to the words used in 2004, not the action. The Minister promised that the HSE would bring efficiency, value for money and a scaling down of bureaucracy. One of the guiding principles was to be a move away from care in hospitals and institutions to care in the community.

However, a nationwide litany of evidence has emerged this week that the opposite is happening and that those vital supports that make the difference between a family being able to care for a loved one at home as opposed to in a hospital or an institution are being reduced. This week alone there have been accounts of the closure of respite and rehabilitation beds in Leopardstown Park, Dublin, which is located in Deputy Shatter's constituency. I visited the north east last week and was informed that St. Oliver's, Dundalk, must close its respite and rehabilitation beds. One hears of reduced home help throughout the country and yesterday I learned of the ending of the hospital in the home scheme, which had been operating in the Dublin area. There is a failure to fill vacancies in occupational therapy, physiotherapy, speech and language therapy posts and a wide variety of other support services within the community, while waiting lists of two years and longer exist for some of the aforementioned therapies.

Last night I discussed a family in County Kildare with one of my colleagues. The father is blind and has a series of health complaints and there are three intellectually disabled young adults in the family. Incredibly, the family has had its home care support service withdrawn. The events I have just recounted demonstrate that matters are going in the opposite direction to what was promised by the Minister in this Chamber in November 2004 before the establishment of the HSE. It is becoming increasingly difficult for families to keep their sick relatives out of hospital and this piles on pressure in an acute system that is bursting at the seams.

If eloquence and promises could deliver a good health service, Ireland would have one, but unfortunately they cannot. I make this point in the context of this debate on cancer services because Members again have heard an eloquently presented and convincing verbal picture of a vision of what should be put in place. The most important question is how to get from the present position to such a point. The Minister provided that fine line about the ultimate aim of delivering safer care and treatment for all who use our health services. She also referred to Professor Tom Keane and what he will do during his two-year term. Moreover, she referred to the establishment of the cancer strategy and noted that the HSE has designated eight centres. She stated: "The HSE National Hospitals Office will shortly transfer full responsibility for symptomatic breast services to the national cancer control programme".

This constitutes further long-distance management from the Minister. As Minister, she is responsible. She set up the HSE and appears to have washed her hands of how it operates. The HSE now intends to set up the national cancer control programme and, presumably, it will be given a budget. However, in two years' time, Professor Tom Keane will have returned to Canada. How will Members then ensure the recommendations contained in the reports before the House today are implemented? Will Members then be informed that, regrettably, it was not possible to implement all the recommendations of the Rebecca O'Malley report because the national cancer control programme did not use its budget wisely? Will they be informed, for example, that triple assessment in Waterford, appropriate equipment in Limerick or the provision of a service for the people of the north west cannot be ensured? Members require an absolute assurance from the Minister that in contrast to her actions regarding the HSE, she will take responsibility for this programme. Otherwise, a new Minister is required. The most important issue pertains to delivery of this programme rather than to the painting of a fine picture with fine words.

How does one move from the reality of what was described in the three reports on Portlaoise to the failure to diagnose cancer in nine women and informing 97 others over the airwaves and through the Oireachtas Joint Committee on Health and Children, instead of personally, that they could have cancer? How does one deal with the reality of the systematic shortcomings and inadequate resources that led to the misdiagnosis of Rebecca O'Malley and Ms. X in Limerick and Cork, respectively, or the reality of misdiagnosis in Barringtons Hospital and UCHG? How does one move from such issues to a reliable, safe service that is trusted by the people of Ireland?

The Minister referred to hue and cry and a search for blame. This is not a hue and cry or a search for blame, it is a search for responsibility and accountability and an ongoing process to monitor and ensure that what is planned will be put in place. I welcome the comments of the Health Information and Quality Authority, HIQA, representatives of which appeared before the Joint Committee on Health and Children last Tuesday, that it intends to visit all the aforementioned centres and set out standards in respect of what should be available. Ultimately, however, HIQA does not have the teeth to ensure the resources are put in place to make this happen. The Minister should give a commitment that she, or whoever succeeds her, will come into this Chamber on a regular basis to outline progress on these reports. She should ensure ongoing monitoring and that the requisite resources are available. It cannot operate like the HSE, where everything is blamed on the executive but no responsibility is taken in this House.

I ask the Minister for precise answers on how she will be accountable for implementing the recommendations in the various reports on her desk. The public must be informed of the timeframe, staffing, governance systems and resources and who will have responsibility and authority to ensure that what is needed at all levels is in place. Rebecca O'Malley stated at the press conference to launch the HIQA report on her misdiagnosis that the system to protect the patient did not fail because there was no system. We will have failed Rebecca and many others if the fine words which were uttered in this Parliament are not translated into action. We need to hear precisely how each of the 15 recommendations of the HIQA report will be implemented and the timeframe for doing so. The system for monitoring progress on each element of the recommendations needs to be explained and the person with responsibility for ensuring each step is taken must be identified.

The Opposition has agreed to support the cancer strategy but our support is not uncritical. We do not agree, for example, with the plan to leave the entire part of the country north of a line from Galway to Dublin without a specialist centre. We insist that the money is delivered to fulfil the promise made by the Taoiseach to the people of the south east in advance of the general election that Waterford Regional Hospital would be developed and resourced sufficiently to provide everything required of a proper centre of excellence.

I will misquote the Ceann Comhairle by saying this debate is not the end of the focus on the reports on cancer misdiagnosis, it is the end of the beginning of an ongoing process of providing a safe and comprehensive cancer screening, diagnosis and treatment service. That is why I want an undertaking from the Minister that she will take a hands-on and focused approach rather than operate at a distance of three steps from the HSE, the cancer control programme and the various centres. Otherwise, nobody will take responsibility for implementing these reports.

The BreastCheck programme has not yet been rolled out in my county and we do not expect it this year because we are being serviced by a mobile unit. Several other counties in the south and west also lack BreastCheck screening. I want an assurance from the Minister that the programme will be rolled out as quickly as possible because we are at risk currently. There is no mammography service in my own region except where patients are referred to the symptomatic breast centre by their GPs but even in that case patients face a long waiting list unless their symptoms are urgent.

I also want an assurance that the cervical screening programme will be rolled out within the indicative timeframe. I have concerns about the plan that appears to be on the cards for sending cytology abroad. At least two centres in Ireland are undergoing the process of accreditation and I urge the Minister to give them the resources they need to meet the requisite standards so that we do not lose their expertise.

The cancer control programme is meant to be full and comprehensive but a full hospice palliative care service is not yet in place throughout the country. I want a commitment that the resources will be made available so that the care can be provided. People should not be disadvantaged merely because they live in a certain part of the country.

The OECD recently highlighted statistics that suggest Ireland is at the lower end of the scale on a range of cancers, including breast, prostate, cervical and colorectal cancers. It is important that all aspects of cancer are included, not just the areas highlighted in our deliberations.

In regard to the late Susie Long and the importance of a system that is fair to everybody, irrespective of whether one is a public or private patient, I want an assurance from the Minister that public patients will not have to wait so long that their health and lives are put at risk. There should be no discrepancy between public and private patients and, for that reason, the Labour Party has put forward a proposal for universal health insurance so that everybody will be on the same waiting list.

Ultimately, responsibility must be taken for implementation as opposed to the vision of the cancer strategy. Due tribute would be paid to the women whose lives were put at risk from misdiagnoses by implementing in full the recommendations of the reports before us. The current Minister for Health and Children and her successors should take responsibility for implementing the reports and we will hold them accountable for doing so.

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