Mary Wallace (Meath East, Fianna Fail)

Yesterday the Health Service Executive published the review of chest X-rays and CT scans reported by a locum consultant radiologist at Louth-Meath hospitals group from August 2006 to August 2007. The review commenced in May 2008 and examined 6,000 X-rays and CT scans from 5,000 patients.

The review found that nine patients in Drogheda and Navan hospitals had their diagnoses of lung cancer delayed as a result of missed radiological diagnoses. Eight of these patients are now deceased and one is receiving ongoing treatment. The review acknowledges that the delayed diagnosis had varying impacts on these patients' care and treatment options. Along with my colleague, the Minister for Health and Children, Deputy Harney, I extend my deepest sympathies to the families of the patients who suffered delays in their diagnoses of lung cancer. These nine patients had been identified and diagnosed prior to March 2008. The review therefore did not find any previously undiagnosed lung cancer. The HSE and the radiologist whose work gave rise to this review have apologised to the families of the patients who were affected by these delayed diagnoses. The review will be forwarded to the Medical Council of Ireland and the General Medical Council in the UK.

While I understand that concerns were raised in 2001 in regard to radiology services in the north east, services have been enhanced in the intervening period. The HSE has confirmed that all radiology services in the Louth-Meath group are entirely consultant delivered. In 2001, five consultant radiologists were employed in the group. It is acknowledged that complexity and workload have increased in recent years and ten consultant radiologists currently work in the radiology departments of the hospitals in Drogheda, Navan and Dundalk. All the consultant radiologists have joint appointments to two of the three hospitals.

The importance of audit in a modern health care system is fully recognised and the HSE has informed the Department that peer reviews are conducted in the hospitals concerned. The radiologists hold separate weekly clinical radiology meetings in all three hospitals in medicine, surgery and breast radiology and regularly participate in grand rounds in Drogheda and Navan. Electronic conferencing is fully operational in Navan and is being developed in Drogheda.

In response to the matters described in the review, HSE north east hospital network is adding to its existing patient safety measures by beginning an additional process to enhance clinical governance in the radiology services of the hospitals. A good system of clinical governance in health care involves quality assurance systems aimed at reducing the likelihood of errors occurring and increasing the early detection of those errors which do occur. This will cover the five hospitals in the north east and will produce an agreed programme to improve clinical governance and, therefore, patient safety and quality of care. This process is underway and will result in an initial action plan in December to enhance the system and ethos of effective clinical governance in radiology services in the north east.

In regard to locum appointments, Louth-Meath hospital group's radiology department has in recent years employed no more than one or two locum consultant radiologists at any one time, out of a complement of ten consultant radiologists. This is due in part to the high degree of cross-cover provided among consultant colleagues in the hospital group.

The group's human resources department has in place a procedure for the recruitment of permanent staff and this is also used for the recruitment of temporary and locum consultant staff. In the case of the locum consultant radiologist involved in this review, all normal recruitment procedures were followed. Following an interview, registration with the Medical Council was confirmed and a reference was received from previous employers. Therefore, it is not considered that any specific issue arose in respect of this consultant's recruitment or appointment. However, given the overall requirement to provide assurance on the level and recruitment of locums in medical practice, the HSE issued national guidance in May 2008 which requires hospitals and facilities to accept locum medical staff only from medical recruitment agencies that meet a series of stringent requirements relating to the doctors they refer to the employers. These include ensuring that the doctor has full references and full CV, is a member of the relevant Medical Council register and has been given full occupational health clearance and police screening. Standards in recruitment and in levels of use of locum clinicians will continue to be reviewed and monitored by the HSE.

The HSE is committed to learning from this review and to driving change. In partnership with its clinical staff, it will do all it can to enhance patient safety at all levels.

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