Barry Andrews (Dún Laoghaire, Fianna Fail)

I welcome the opportunity to deal with the issue that has arisen with regard to the reading of X-rays at Tallaght hospital. Patients have a right to expect the best possible standards of diagnosis, treatment and follow-up care in hospital and the Government is committed to ensuring this is achieved consistently, across all hospitals.

In the case of X-rays, best practice is that they should generally be seen by and formally reported on by a consultant radiologist. It is clear this did not happen in the case of 57,921 X-rays in Tallaght hospital. I am advised these X-rays were seen by doctors involved in the patients' care and referred for assessment by a radiologist but that they were not formally reported on by a radiologist. In this context, the X-rays in question constitute about 6% of the total X-rays taken over the period. The remaining 94% were reviewed and reported on by a radiologist. The CEO of Tallaght hospital has acknowledged this practice fell below appropriate clinical standards and was not acceptable.

When an issue of this kind arises, there is a clearly established serious incident protocol for dealing with it. This was established by the HSE with the support of the Department of Health and Children. The protocol puts patients' interests first and foremost in all actions to be taken. It requires that one must correct or cease the practice that has given rise to the concern; consider the need for and if necessary undertake a clinical review of patients who have been through the service to identify any whose care or treatment may have been adversely affected as a result and to immediately provide them with appropriate care; and consider whether an investigation of what happened and why is required in order to address any systemic failures and minimise the risk of a similar occurrence in the future.

The CEO of Tallaght hospital has confirmed that since September 2009 all X-rays are now read and reported on by a suitably qualified consultant radiologist. This is the first step and is designed to avoid risk of harm to further patients. The clinical review is already well under way. As the CEO explained, approximately 60% of the total X-rays involved have been reviewed and the aim is to complete the review by May. The HSE has announced that it is to carry out an investigation into the circumstances that led to the accumulation of unreported X-rays. The investigation will be chaired by a person independent of Tallaght hospital and the HSE. The details of the investigation will be announced in the coming days. The priority now is to ensure that the remaining X-rays are reviewed so that any patients requiring further follow-up are identified and provided with the necessary services. The protocol is very clear that cases should first be reviewed and patients informed where these is a need for follow-up. Only then should the question of publicising the matter arise. The fact that the information relating to this incident became public while the hospital was still in the process of reviewing X-rays has meant that, unfortunately, many patients have been given cause for unnecessary distress and worry.

It is for this reason that the new HSE director of clinical care, Dr. Barry White, and the recently appointed national lead for radiology, Dr. Risteárd Ó Laoide, consultant radiologist at St Vincent's Hospital and Dean of the Faculty of Radiologists, along with other senior HSE executives, are attending Tallaght hospital today to see if the clinical review can be further expedited. I very much regret any distress caused to patients by the manner and timing in which this came into the public domain. It is important to stress that the vast majority of patients have no cause for concern and would have been reassured in that regard once the clinical review had been completed.

The reading of X-rays is not a precise or exact science. However, the available evidence is that the risk in this cohort of patients is extremely low. Of the 34,752 X-rays reviewed to date, it appears that just two patients had a delayed diagnosis. One of these patients died last summer and the other is receiving treatment in the hospital. The hospital is continuing with its clinical review and in the event any patient requires treatment, this will be made available immediately by the hospital.

I want to deal with the question of when my colleague, the Minister for Health and Children, became aware of this situation. The matter was first mentioned to her by the newly appointed CEO of Tallaght hospital on 15 December 2009 after a meeting with him, the Master of the Coombe and officials of the Department on another matter. It was one of a number of initial priorities the CEO, who had just taken up his position, intended to address. However, it was only yesterday that the Minister became aware of the nature and scale of the situation. It was not raised as a significant patient safety issue. The hospital had not brought the matter to the attention of the Department.

That being said, the critical issue, as far as the Minister is concerned, is whether the matter has been and is being managed appropriately by the hospital. On the basis of the information provided to her so far, the Minister is satisfied the new CEO has, since his appointment, accorded this the priority it warrants. Dr. Barry White has also confirmed the hospital has taken the necessary action to address the risks to patients arising from this situation.

The most important thing is to complete the clinical review, identify whether any patients need further treatment and if so provide the necessary services and reassure any other patients who may have concerns about their X-rays. As soon as that has been done, we can focus on the investigation that has already been announced by the HSE. The serious incident management protocol is key to putting patients' interests first and it must guide us in all of the actions to be taken.

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