Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

There was a time in this House when everybody had respect for everybody else, inside and outside the House. Sadly, we are moving away from that. I would never come to a judgmental decision and say that the Minister, or anybody else in this House, whether in government or in opposition, was unfit to do his or her job, and nor should I. People come into this House in good faith and to serve their country, their constituency and the community. They do it very well, and have done since the foundation of the State. It is very easy to take away from somebody's character by saying that they are not fit to do his or her job. Likewise, it has become commonplace to mention people outside the House. I thought we had perhaps learned our lesson on that in recent times. It is not a good thing to do and there may be a price to be paid for it. The privilege we have in this House will be taken away from us unless we recognise that we have to honour Dáil privilege in spirit and letter. Your point is well made, a Leas-Cheann Comhairle, and I concur entirely.

To go back to the issue in question, we have seen a long and tragic series of events for an awful lot of women in this country. However, we have to measure that, and I will deal with that in a second.

The procedure was put in place several years ago to try to identify the presence of cancer in women at the earliest possible stage in order to give the services a chance to combat it. In fairness, the screening tests saved the lives of thousands of women, as is readily admitted. I emphasise that the screening test was never a diagnosis, although I am sure that we have all come across cases were a diagnosis was subsequently proved wrong as well.

I know all about the court case, the judgment and the call for absolute certainty. It is very difficult to diagnose cancer with absolute certainty, whether on the positive or the negative side. There have been countless instances over the years. We all know from our own families of instances of a person being diagnosed and told that he or she has no chance, or words to that effect, only for the whole situation to subsequently change. That is obviously to the joy of those concerned, but we have had similar situations where people were given the all-clear and problems subsequently arose. We have all also come across people with various forms of cancer for the second, third, fourth and fifth time. We need to respect that there is an element of the unknown in this. Therefore, we need to look at the circumstances in which this test was provided in the first place.

As I said, the test saved the lives of thousands of women. The flaw was due to the number of women who were awaiting treatment, outsourcing and a reliance on home-based tests. The sad part is that this test has an 80% accuracy rating. That is a fair distance from absolute certainty, which cannot exist in such circumstances. This accuracy means that there is 20% that no one is too sure about at all. Uncertainty can transpire on the positive and negative sides, because there is a sizeable unknown element.

However, one way or another, the situation arose when patients should have been told but they were not. Nobody asked for the look-back, but it was agreed within the system because somebody spotted something. A determination was made as to whether their particular circumstances should have been identified at the first test. For all kinds of reasons that I will not go into now, tests in other countries are more frequent than they are here; that is part of the tragedy. It was discovered that there appeared to be a number of cases in which the screening test did not show up cancer-giving properties and the patient was subsequently diagnosed with cancer. The look-back took place and we know what happened in the meantime.

The problem was that there were so many cases in the pipeline and the fear and worry for the women concerned was so great, that the Taoiseach, the Minister and every Member of the House expressed the wish that we should do something to alleviate the burden and stress caused to women in whatever way we could, and to try to produce a system more amenable to the women who were directly affected.

None of us is happy that women in those circumstances must go through the courts. However, both combatants in every tribunal, no matter where, have the right of access to the courts. Both the defence side and the other side have the right to go to court in the final analysis. I do not accept criticism of the courts, even if a court's decision is made in camera. Many courts make decisions in cameraand that practice has been well established since the foundation of the State. It is untrue and unfair to state that a court meeting in camera, or in secret, to examine the circumstances surrounding a particular case is somehow wrong. This merely means that the next stage, the Court of Appeal, examines the circumstances surrounding the case. A woman may feel that she was not fairly treated and the tribunal did not do all the things that she expected it to do. In such circumstances, every woman has a right of appeal and to go to the courts. That is a fact and we should not make too much of it.

Over the years, women have been subjected to some strange treatments and have not always been told about it. Symphysiotomy is a particular procedure that was frequently visited upon women. They were not told about it in most cases. It was deemed to be good for them, although I do not know why. I have been in this House as long as the Leas-Cheann Comhairle and nobody ever explained to us why that particular procedure should be good for women and yet they were medically advised to have that treatment. Hysterectomies are another example. Of course, there were situations where a hysterectomy was desirable and necessary but what about all the women who were told to have hysterectomies anyway and that it would be good for them when there was no necessity for it at all? That happened in several hospitals.

When we pretend that this is the first time that these kinds of things have ever happened, we should remember that it is not. There were worrying cases in the past that affected women and their health to quite a considerable extent. We need to keep that in mind as we proceed, although that is not at all, in any way, to make excuses for the scenario that unfolded in this case and affected the women whose tests were inaccurately recorded.

I want to again mention the difficulty in attempting to come to a conclusion about a diagnosis, particularly in a screening case, with absolute certainty. I do not think we can do that. It is a danger for that responsibility to fall on somebody because nobody will take a decision in such circumstances. People in authority will walk away if they are expected to take upon themselves responsibility for arriving at a diagnosis they cannot stand over because it is impossible to do so. The whole system is then affected and defective. We should not try and do that. We should, within reason, try to ensure that we apply the highest possible standards, that every possible effort is made to ensure that the procedures we put in place are followed to the letter and that a procedure is in place to do a fairly ready check to pick up any situation that might arise where mistakes might be made. There have been quite a number of mistakes in medical procedures of one kind or another in recent years, although that is not to suggest that those in the medical profession are to blame. I am not stating that they were right or wrong but this points to something we should all recognise. In that kind of profession, it is not always possible to be absolutely certain about what should be done in particular circumstances. There are other circumstances where it should be possible and, very often, procedures that should be followed are not, although that argument is not for tonight's debate.

When we look back, there was a serious flaw in the system. It had an 80% accuracy rate, or a 20% inaccuracy rate. That is a flaw in the system. The HPV test will eventually replace the old system. It is coming, and hopefully soon, but it is not fair to state that the Minister has deliberately dragged his feet or that someone else has failed to do his or her job. These procedures have to be put in place and that takes time. If one mistake was made in recent years, there is no use following it with another. What we put in place must be reliable and accurate, insofar as we can make it so, and we must be able to rely on the conclusions with some kind of certainty because otherwise we are going to find ourselves in this kind of situation in a few years' time trying to unravel something else.

In the past, there was a theory that a medical practitioner should not tell a patient everything. Does the Leas-Cheann Comhairle remember that? Medical practitioners did not tell patients everything because certain patients would not want to know. If diagnoses were not good, medical practitioners thought it better not tell patients. The diagnosis was wrong in some of those cases and the patient recovered. It does not follow that it is beneficial to a patient to keep information from him or her, or that he or she will benefit from that in years to come. The reverse is the case.

That leads me to my final point. Full disclosure is something that the health service is committed to in the future, and the sooner the better. Without prejudice, there is a need for a patient and community to know what happened. If there is a liability, we can spend all the money we want going through the courts and trying to prove it but it would help if, for example, the relevant medical institution was able to state that a procedure went wrong or that a mistake that should not have been made was made. Accidents will always happen. Medical institutions should say that not to boast about it, or pretend it was an achievement or something, but to at least put something in place that acknowledges there are two ways to go about this. The institution can tell the patient or his or her family that it is sorry the procedure did not go right and try to make amends in some way. That would cost an awful lot less than going through the courts to prove something one way or the other, or going to tribunals.

When full and open disclosure takes place and becomes commonplace, it must be observed in both the letter and the spirit. There is not much sense in having that procedure available to people unless it is honoured. Some will state that it will cost money. The simple answer to that is that it will be worthwhile if it helps the patient and does not cost more money than the alternative. It could not cost more because it is merely an admission that something went wrong. If something goes wrong in particular circumstances, it naturally follows that the patient or his or her family will follow it up with legal proceedings because they feel they have to and they feel like they have been put through the ringer in terms of stress and trauma. Why should they walk away without making a claim?

I stated many years ago that we should not be so ready to contract out tests of this nature. We should have the relevant facilities in this country. It is quite possible to provide all the necessary technology here that exists in any laboratory worldwide. There are good laboratories in my constituency and in many other places.

There is no reason we cannot invest in that technology. Some in this House will say it has become the practice in here that every time anybody looks to spend, people will say we cannot have that. If we cannot have it, we do not deserve to have a proper service of any kind. The children's hospital is very expensive but it is what we must pay if we want that quality and standard of service. We can play with the words as long as we like or we can just contract the job to people who provide the services. We need to invest in infrastructure in our own hospitals. We must put money into them and justify it rather than running away from the issue and making excuses. We should not be saying that people will be in trouble if they spend money. If we spend the money initially, we would do a great service for the people of this country to ensure they have available to them the best quality service on the globe.

I hope we have learned a salutary lesson and we will no longer have to tell patients, men or women, that we are sorry but we did not get something right when we thought we did. Things were said when the women involved with these cases were not being properly informed by their consultants, or in some cases where the consultant told the GP that the flow of information should be paused. It was a case of hitting the pause button and not telling the women until the clinicians saw what happened. No purpose was served by that action.

In the heel of the hunt, I hope we have learned that lesson and when this is over, we can put in place a system recognising the need to serve patients, with patients' interests coming first. I also hope we can raise the level and quality of our services, both at consultant and GP level, wherever they may be, to such an extent that we will not have to visit this scene or anything like it again. If we need arbitration in circumstances of this nature, it should be at the beginning. The matter should be referred to a tribunal, with people having the right to go to court if they are not satisfied with the outcome of that tribunal. That is always the way it has been and it is the way it should remain. We hope our small contribution to this debate is of some benefit to those who have suffered and the families of those who have passed away so tragically. We also hope this salutary lesson will stand us in good stead in future.

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