Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

It just seems much longer. I feel weary thinking back on every day of the intervening period. She bears direct responsibility for a situation whereby public patients with symptoms which might indicate cancer have to wait as long as 18 months for vital tests. There is no excuse for this. The Minister says it is unacceptable, and she is correct. However, if it was unacceptable when she became Tánaiste in 1997, she has had a decade to address it. She has failed and, while her Fianna Fáil colleagues in Government like to hide behind her skirts, they share her responsibility. That is the context in which we discuss the latest reports on failures in cancer care delivery.

The reports on the cases of Rebecca O'Malley and Barrington's Hospital can only be described as an indictment of the Health Service Executive and its management of cancer services. Basic principles of patient care were violated by the HSE. The right of patients to information about their cases and to prompt and meaningful responses to their concerns were denied. In the report of its inquiry into the Rebecca O'Malley case the Health Information and Quality Authority stated: "The impression gained was of a system that delayed or avoided difficult decisions". The report reveals that when Rebecca O'Malley raised her concerns about her misdiagnosis no real effort was made to assist her and inform her of the facts of her case and how it had been handled. It was up to the patient to pursue the case through the system, which she did with great difficulty. Publication after publication has documented the arduous and difficult steps that she had to take all along the way to try to establish the factual position and the "why" behind her particular experience. No one within the hospital system or the HSE took the lead in responding to the patient.

The HIQA report found "a collective lack of accountability, cohesion and focus on the needs of the patient". When the report was issued, Rebecca O'Malley stated, and it deserves to be recorded again on the record of this House:

I asserted myself and demanded answers to my reasonable questions. The system responded to my efforts by erecting, through ignorance or inertia, a wall of deafening silence that is so typical of the walls that patients regularly have to climb in an arduous effort to make the health system accountable to the very people it exists to serve.

The HIQA report demonstrates that the system failures with regard to patient care and properly informing patients who were exposed in the Portlaoise breast cancer scandal are replicated across the hospital system for which the HSE is responsible. The Barringtons Hospital report illustrates the lack of proper regulation and accountability of the private hospital system. One media commentator put it very well when he said that "by over-centralising decision-making the HSE has emasculated regional managers to the point where front-line services are compromised".

There is a point we must acknowledge. Human error will occur in the delivery of health care — that is a fact and is inevitable. No one should try to fool the people into thinking otherwise. No system is perfect and better management cannot eliminate all instances of human error. However, the system must be open and transparent. It must be prepared to admit its mistakes and, above all, it must give patients full and frank information. Clearly, we are looking at a substantive body of evidence that shows this is not the case with the current system.

The question to be posed is whether lessons will be learned. With respect to the Minister, the signs are they will not. As far as the HSE and the Government are concerned, ruthless centralisation is the name of the game in both the management of our health services and the delivery of care, particularly hospital care. The Minister, Deputy Harney, and the HSE are about to put in place a plan which will concentrate cancer care in just eight so-called centres of excellence, four of them in Dublin, leaving large swathes of the country without proper access. Even in advance of this, services at local hospitals are being cut. As was said earlier by Deputy Shatter, none of the proposed eight centres is located north of a line from Dublin to Galway.

The term "centres of excellence" is and has been bandied about and something needs to be said about it. We should start from the premise that every centre where cancer care of whatever type is delivered — I emphasise "of whatever type" — ought to be a centre of excellence. They should all be centres of excellence. By placing the emphasis on eight centres only, the Government and the HSE promote the belief that care delivery at other sites must be inferior, which is a dangerous fallacy. It would also be a travesty if the reports under consideration today were to be used to promote the policy of over-centralisation, to which the Minister is clearly heavily committed.

I want to make the following point in regard to cancer care as I have made it in regard to a raft of acute hospital services, time after time in this Chamber and in other fora. No one is arguing for radiation oncology facilities in every hospital in the country. However, eight centres with such facilities are too few, and they are, as I and others have repeatedly pointed out, totally unbalanced in terms of regional spread, leaving much of the population very badly served or not served at all in real terms in my part of the island. What is needed is a truly all-Ireland and regionally based cancer treatment service — I commend this approach to the Minister once again.

Radiation oncology should be delivered within the regions. I have a very close and dear friend in St. Luke's from Monday of this week until Friday. She will return home for the weekend and will return to the hospital for five days of each week for the following four weeks. She is a very special and lovely person. I know first-hand the terrible trauma she has suffered in terms of the preparation for this long absence and disconnect from her family and friends. As in her case, other cancer sufferers are being subjected to long and painful journeys for treatment. Many patients feel too ill to travel and choose not to avail of radiotherapy as a result, which is a terrible situation. The resources are there, even in current straitened times, to deliver radiotherapy on a regional basis. The Government needs to go back to the drawing board with its plans.

Cancer patients have been denied life-saving treatment because successive Governments have failed to provide the radiation oncology facilities required. The Government has had ample time and a booming economy over many years to plan and budget for the provision of radiotherapy centres. The State could and should have taken the lead and provided these centres directly as public facilities open to all and available and accessible on the basis of need alone. Instead, the Government has committed itself to public private partnerships to deliver them, although it was then found these would take too long and a review was ordered. The Minister, Deputy Harney, told us the planned centres may have to be provided entirely by the private sector. Professor Drumm, on the other hand, has told us the public sector can do it. I agree with him, at least on that.

The disconnect and the lack of clear management and timely and effective decision making that has been exposed in the reports we are considering comes as no surprise. It is replicated at the very top with the Minister and her Government colleagues, and at the highest level in the HSE. There is clearly no agreed cohesive, cogent approach to all of this. There are serious differences in the utterances of the Minister, Professor Drumm and others.

It was a cancer patient, the late Susie Long, to whom Deputy Jan O'Sullivan referred, who most recently and starkly highlighted the injustices of our two-tier health care system. It is a system that does not provide adequate care for cancer patients. It is a system where one can get a faster life-saving diagnosis if one is a paying customer. Public patients like Susie Long have to wait. In her case, that wait in the second-class queue proved fatal.

This Fianna Fáil-Progressive Democrats-Green Party Government is attempting to shirk its responsibility for the chaotic state of our cancer care services. The mammography issue at Barringtons Hospital in Limerick has exposed the failure of the Government to ensure that private hospitals are properly accountable. The Health Information and Quality Authority was established in legislation in these Houses in 2006 but was empowered only to monitor services provided by the Health Service Executive. It does not have powers to hold private hospitals fully accountable. That is something I and other voices in this House pointed out at the time of the HIQA Bill but the Government ploughed on regardless.

Through the infamous co-location scheme the Government is encouraging the development of more private for-profit hospitals without proper accountability. When we last addressed cancer care here I recall asking the Green Party Members in Government if they remembered their opposition to co-location. I am still awaiting their answer.

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