Mary Harney (Dublin Mid West, Progressive Democrats)

Many questions have been raised by the Deputy. First, the terms of reference will mandate that the inquiry be concluded within three months because speed is important. It is important for confidence in Ennis General Hospital, for the patients who attend there and for everyone else who is involved. Second, the mammogram in St. James's Hospital was analogue and not digital. However, I understand it is now digital. The mammogram was taken in the private hospital, which at the time was not part of the PACS system and was of the other breast. Unlike Deputy Reilly, I am not a clinician but the report of the mammogram states it was clear. Doctors have told me it is highly likely that the cancer does not spread to the other breast but to other parts of the body. I understand this was metastatic cancer. However, in the dialogue HIQA has had with Mr. Henry, the issue of the missing mammogram in St. James's Hospital has been part of their consideration.

As for the issue of expertise, the expertise in respect of whether we have clinical look-backs rests more with people such as Professor Hill and Professor Keane than with anyone in this House. I reject the suggestion, which places a question over their professionalism, that people on their level with reputations such as theirs would be rolled out or used by anyone. Certainly there is no question of me asking anyone, not least someone at that level, to perform a function they do not wish to do. If they are invited by the media to participate in programmes and agree to so do, they give their honest views on matters as they perceive them.

As a general practitioner, the Deputy will acknowledge that the speed of the transformation in breast cancer services in recent months has been incredible. It has happened with incredible speed, which is impressing clinicians. Only last night I spoke to a clinician from Galway who, as a doctor, was really inspired by the speed at which the reforms have been put in place. I welcome this and that is the reason the target date for the completion of the transition of breast services from the smaller hospitals to the eight centres has been brought forward. It is precisely because women themselves wished to attend such centres and did not wish to attend hospitals that were not designated centres.

Professor Keane sought and received resources for the transition last year. He has sought resources for next year for prostate and lung cancer in particular and will receive those resources, notwithstanding the changed economic circumstances. He has made the point that we spend considerable resources in the area of cancer. Successive Ministers for Health and Children, including Deputy Noonan, who is present, invested considerable resources in cancer. However, when such investment is fragmented, the same benefit does not accrue from those resources as would be the case were the resources and expertise brought together. This is what is taking place and much of the additional resources involves transferring the resource from the local hospital to the centre. For example, Mr. Barry in Mayo will move to Galway from Castlebar hospital for two days a week to perform breast surgery. The same also will apply to other breast surgeons. I understand one already has moved from Kilkenny to Waterford and so on.

As for the two individual cases and what other facts must emerge, we know a lot about what went wrong in both cases. Although Ann Moriarty should have been referred back to St. James's Hospital, where she had been treated for breast cancer, that did not happen. As for Edel Kelly, while the Deputy knows more about this than do I, the HIQA report in respect of Rebecca O'Malley made recommendations about fine needle biopsies. As I understand it, one does not simply go in with a needle, take a sample and send it for a biopsy. Instead, I understand one also uses ultrasound to guide one as to which tissue to remove. I understand that did not happen. Therefore, I presume the tissue that was subject to the pathology examination in Limerick Regional Hospital probably was fine. I understand the issue is whether the appropriate tissue was examined.

HIQA is a patient safety authority. Its job is to set and enforce standards in the health care system. Such standards are set and enforced with a view to improving services for patients. We have had the report of the patient safety commission and, among others things, we must introduce a licensing or accreditation system. The reality is that we do not have particular standards of care and criteria for the opening and functioning of hospitals. That, in particular, is very unsatisfactory from a patient safety perspective. I will bring the recommendations of the commission to Cabinet very shortly with a recommendation for their implementation.

With regard to the comments about me not acting speedily, I met Mr. Henry last week. I became aware of the Edel Kelly case late last week. I am always interested in meeting patients and I meet a number every week. Many cases never get into the public domain and many patients are satisfied with how their complaint has been resolved at a local level. The Deputy would know that. Many people feel they are listened to and supported while others feel their complaint was not taken seriously or dealt with as sensitively or speedily as they would have wished.

I met Mr. Henry and the late Ann Moriarty's sister. I will meet the Kelly family next week. I emphasise that every time we have a misdiagnosis or error — we have them every day and even when we have the eight centres of excellence I am advised by experts there will be an approximate 1% error rate — we cannot continue to have inquiries which tie up the best experts we have in the country. As there has been a second case in addition to that of Edel Kelly, it is important for the hospital that people can have confidence in the services. The cancer services have closed but other services continue to be provided. I understand many telephone calls have been made to the hospital and others in the region, with people worried not just about cancer, but about other services in the hospital.

We owe it to the hospital, patients and staff to ensure we clinically review what is happening there with a view to ensuring that anything which needs to be put right is done as quickly as possible.

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