Enda Kenny (Mayo, Fine Gael)
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I want to return to the central issue of cancer services. They say a week is a long time in politics, but for the eight women in the midlands awaiting the results of a second test, a week can be an eternity. Yesterday, the Taoiseach stated on the record of the House that the matter in Portlaoise was a systems failure. He stated: "I am informed that there was no systems failure involved". If there was no systems failure does the Taoiseach place the blame on human error?

On 19 February 2002, the then Midland Health Board wrote to town commissioner Kathleen O'Brien stating, "You will recall that a board deputation met the Minister for Health and Children on 11 April 2001". That Minister was Deputy Micheál Martin, following on from Deputy Cowen and preceding Deputy Harney. The letter continues that the Minister confirmed "that the centre of excellence for symptomatic breast disease services was to be developed at the Midland Regional Hospital at Portlaoise".

The letter states that a unit was to be developed

at the Midland Regional Hospital at Portlaoise with both surgeons and radiologists located in Portlaoise. All intervention radiology, triple assessment and breast cancer surgery for the board's area would be performed in this unit.

That is the confirmation given by the Minister on 11 April 2001, that in the Midland Health Board area there would be radiologists and surgeons in Portlaoise and all intervention radiology, triple assessment and breast cancer surgery for the area would be carried out in that area.

That was the system approved by the Government. The Taoiseach is receiving a running commentary from the Minister for Health and Children to back him up in presiding over this shambles. That was a system the Government put in place and the Minister confirmed to the women and men of the former Midland Health Board area. Why is it that since April 2001 what the then Minister confirmed on behalf of the Fianna Fáil Government did not take place in Portlaoise hospital? Why has there been no triple assessment? Why do we hear complaints about 15 year old machinery? Why were breast cancer surgery services not carried out as was envisaged? This was the Taoiseach's system, his policy and his failure, and he should tell us why the confirmation given by the Minister for Health and Children was never implemented?

Bertie Ahern (Dublin Central, Fianna Fail)
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I was not clear what Deputy Kenny stated. Yesterday, he stated there was a systems failure but I stated there was not a systems failure and I explained what the details were. I am not sure what distinction Deputy Kenny is drawing in that.

As I understand it — I received a briefing on this — over the years radiologists were appointed. They had difficulty in the location recruiting consultant radiologists but they did recruit radiologists. There was no triple assessment. That is correct, as I understand it.

Enda Kenny (Mayo, Fine Gael)
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The letter refers to confirmation of triple assessment.

Bertie Ahern (Dublin Central, Fianna Fail)
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Triple assessment was not implemented.

Enda Kenny (Mayo, Fine Gael)
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Has it been implemented since?

Olivia Mitchell (Dublin South, Fine Gael)
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The question is why.

Bernard Durkan (Kildare North, Fine Gael)
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Why not?

Bertie Ahern (Dublin Central, Fianna Fail)
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They had difficulties getting——

Enda Kenny (Mayo, Fine Gael)
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I do not want to be disruptive, but the letter states, "All intervention radiology, triple assessment and breast cancer surgery for the board's area would be performed in this unit."

Bertie Ahern (Dublin Central, Fianna Fail)
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As I understand it, while they did appoint consultant radiologists, radiographers and staff, they had difficulties getting staff but they did not bring in triple assessment.

Olivia Mitchell (Dublin South, Fine Gael)
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Why? The Government stated it would.

John O'Donoghue (Kerry South, Ceann Comhairle)
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This is Leaders' Questions. The Taoiseach, without interruption.

Bertie Ahern (Dublin Central, Fianna Fail)
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I want to deal with the other point made by Deputy Kenny. I do not want to get into a blame game in this because a report is being prepared and the consultant will bring in all the facts. I understand that the original images diagnosed by the radiologist involved to determine the cases were used in the re-examination. The report will have to give its verdict on all that. Staff, equipment and quality assurance issues will form part of the report. There were staff and a consultant radiologist in the unit. They were recruited, some of them in recent times. Those staff were carrying out their duties. When this issue was raised by a member of staff the same images that were originally diagnosed by the radiologist involved were used in the examination. We will have to wait for the report by the consultant radiologist at St. Vincent's hospital, Ann O'Doherty.

Enda Kenny (Mayo, Fine Gael)
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I am not sure whether the Government, which seems to have removed itself from all reality and expects this to operate by remote control, understands the mentality, mood and anger of people throughout the country. People want a system that will deliver a service they can trust for its integrity so that if a woman has a mass on her breast which requires attention, she will know she will receive the best level of service and attention and will have the best chance of survival.

The letter of confirmation issued by the Minister for Health and Children on 11 April 2001 stated there would be triple assessment in respect of Portlaoise. That did not happen. It is not for me to adjudicate on whether the machinery is inferior or outdated but I know that where two radiologists sign off on every mammogram, the incidence of doubt and anxiety can be addressed. Irrespective of whether a systems failure occurred, the letter confirms that the Government failed to implement its own system.

Deputies:

Hear, hear.

Enda Kenny (Mayo, Fine Gael)
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Today, we learned about further misdiagnoses in Cork. I am unsure whether the Taoiseach has read the relevant report but I would like him to indicate if he has information from the Minister for Health and Children setting out whether this is true. Will the Minister will issue an instruction today that as and from this moment every mammogram is to be read by two radiologists?

Deputies:

Hear, hear.

Enda Kenny (Mayo, Fine Gael)
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Consultants and surgeons tell me various stories from around the country. In cases where mammograms are taken, will the Minister issue an instruction to the overabundant, over-managed and in many cases overpaid HSE officials who claim they are dealing with the matter? She is the Minister for Health and Children and she should lay down an instruction now. Can I get confirmation from the Taoiseach that such will be the case so that women can have some hope and faith in a system that has been allowed to fail and has been doomed to fail under what the Government has established?

Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Kenny raised several points I will try to answer. On the first point, Ann O'Doherty, the consultant radiologist in St. Vincent's University Hospital, is producing an overall report. People's careers are involved so I do not want to say anything——

Enda Kenny (Mayo, Fine Gael)
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People's lives.

Fergus O'Dowd (Louth, Fine Gael)
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People's health too.

Bertie Ahern (Dublin Central, Fianna Fail)
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——that concerns the individual staff concerned.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Is it the Taoiseach's career we are discussing?

Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Kenny's question referred to cases in which women's lives might be at risk. That is precisely the point I explained yesterday in respect of why 13 units were closed down. Only two weeks ago, I was on the floor defending that position in response to questions put by the Deputy and others regarding why the units were closed. These units are considered to be less safe than they could be if multidisciplinary teams were in place.

Enda Kenny (Mayo, Fine Gael)
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I asked about triple assessment in Portlaoise.

Bertie Ahern (Dublin Central, Fianna Fail)
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I will answer the Deputy's questions and I will come to that issue because he does not understand it, unfortunately.

Bernard Allen (Cork North Central, Fine Gael)
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It was the Government's failure.

Bertie Ahern (Dublin Central, Fianna Fail)
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We want to provide safe units for all women. Some 15,000 mammograms are done each year. Two consultants read mammograms in the medical world of this country, Northern Ireland, Britain and, I understand, elsewhere only where numbers are below 500. It is not the practice in the medical world that mammograms are read by two people except where there are very low numbers. That is the position where a cancer is identified. Triple assessment only applies where cancer is identified and, because cancer was not identified in these cases that issue does not arise.

Olivia Mitchell (Dublin South, Fine Gael)
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Triple assessments were promised.

Enda Kenny (Mayo, Fine Gael)
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They were only read by one radiologist. That is why they were misdiagnosed.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Taoiseach must be allowed to reply without interruption.

Bertie Ahern (Dublin Central, Fianna Fail)
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If the value of Leaders' Questions lies in dealing with current issues and misinformation that is what I am trying to do. In this case, the difficulty was that the cancer was not seen when the mammograms were read. Triple assessment only applies where it is read and then referred on. I hope that point is clear.

Brian Hayes (Dublin South West, Fine Gael)
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Why did the Government promise triple assessment?

James Reilly (Dublin North, Fine Gael)
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Triple assessment takes place when there is a lump, whether benign or malevolent.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Taoiseach must be allowed to complete his answer.

Bertie Ahern (Dublin Central, Fianna Fail)
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Triple assessment may be relevant to other issues and I have already stated it was not in place but in the case under discussion——

Liz McManus (Wicklow, Labour)
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Why was it not in place?

Bertie Ahern (Dublin Central, Fianna Fail)
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For the women involved, the problem was that the mammograms did not show cancers, so triple assessment would not have taken place. I hope the position is clear.

Bernard Durkan (Kildare North, Fine Gael)
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Why did they not show?

Bertie Ahern (Dublin Central, Fianna Fail)
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On the issue of low volumes, the difficulty is that in our hospitals — I made this point yesterday and have to return to it today — 15,000 mammograms are conducted outside the auspices of BreastCheck. We are endeavouring, with the recent decisions made by the HSE, to designate four managed control networks and eight cancer centres which will be implemented on a managed and phased basis. Professor Keane is due to take up his post in the week commencing 19 November and is expected to quickly designate national clinical leaders of radiation, surgery and medical oncology. Arrangements are in hand to enable him to take control of all the new cancer developments from the start of the new year and all existing cancer services and related staff on a progressive basis. He intends to designate the locations for a range of cancer specialists among the eight centres by early January and will therefore engage in detailed planning to facilitate these designations as soon as he arrives. The breast consultants have already been recruited by this Government in recent years. I am told we probably have more than we require but we need multidisciplinary teams.

The last question raised by Deputy Kenny pertained to Cork. On 14 June, the Health Information Quality Authority published the terms of reference for its independent investigation into the care provided to Rebecca O'Malley. This is a case from four months ago. In addition to investigating the circumstances surrounding the care of Rebecca in regard to her symptomatic breast disease, the investigation will examine the provision of the pathology services provided by the Health Service Executive at Cork University Hospital and the symptomatic breast disease services provided by the Mid-Western Regional Hospital. I stated that in the House several months ago. I am aware Ms O'Malley's consultant surgeon at the Mid-Western Regional Hospital wrote to the pathologist at CUH requesting that the case be reviewed internally by the CUH and externally by the Mater hospital. I am told that at this juncture no additional cases of undetected malignancy have been identified. The HIQA investigation is ongoing and a report is expected later this month. For absolute clarity, HIQA was asked in May to undertake an investigation into the O'Malley case. That investigation is due for completion before the end of this month and includes an examination of the pathology services at CUH and symptomatic breast disease services at the Mid-Western Regional Hospital, where Ms O'Malley first presented for treatment, and the 24 cases form part of that investigation.

Eamon Gilmore (Dún Laoghaire, Labour)
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Today, we learned that the equipment in Portlaoise hospital is 15 years old. A leading radiologist said on radio this morning that the radiology equipment in half of this country's hospitals is also 15 years old. How many Ministers are driving around in 15 year-old cars and how many Departments rely on 15 year-old computer equipment? If that is not good enough for the Government, why is it good enough to scan women for breast cancer?

While we were discussing the issue in this House yesterday, Professor John Crown was speaking on the radio, where he described the Government's approach to health services as insane.

He said the Government is presiding over an apartheid system and that its policy appears to be to make public health care as unattractive as possible. He added that the Government has an attitude to public health care which is like its attitude to the dole — it despises it — and that the Government is being hypocritical in closing public facilities on the grounds that they are too small while opening private facilities that are even smaller.

Professor Maurice Nelligan yesterday at a conference said it is immoral and wrong to run down small hospitals without having in place the promised centres of excellence.

Deputies:

Hear, hear.

Eamon Gilmore (Dún Laoghaire, Labour)
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He went on to say that the plan to build private hospitals has more to do with suiting the construction industry than suiting the needs of the patient. He said the Minister and the HSE are in cloud cuckoo land if they believe that patients are not suffering as a result of the Government's health policies. He also said the Minister for Health and Children would have resigned or been sacked from her position if she was in any other country.

In this morning's Irish Examiner, Professor Ray Kinsella argues that responsibility rests squarely with the Government and that the policies now being pursued, whatever about the Ministers who are pursuing them, were rejected by the electorate in June. Professor Niall Higgins, who drew up the cancer strategy, has described what happened in the hospital in Portlaoise as "a systems failure", something the Taoiseach said yesterday it was not and which he repeated again here this morning.

These people are respected experts in the field of medicine and health economics. They are not Opposition politicians nor leaders of political parties. They do not have a political axe to grind.

Eamon Gilmore (Dún Laoghaire, Labour)
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Hold on one second, these are people who cure people. These are people who do their job responsibly and if this Government was doing as good a job in managing and running the health service as these people are in curing their patients, we would not have the problems in the health service that we have today.

Deputies:

Hear, hear.

Conor Lenihan (Dublin South West, Fianna Fail)
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The Deputy is very deferential to the professions.

Eamon Gilmore (Dún Laoghaire, Labour)
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They say that what is happening in the health service is the Taoiseach's responsibility and the Government's responsibility. I have one question for the Taoiseach and ask him not to answer me but to answer them. Does he accept responsibility for what is happening in the health service?

Bertie Ahern (Dublin Central, Fianna Fail)
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The Deputy has asked more than one question.

Bernard Allen (Cork North Central, Fine Gael)
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Answer the last one.

Olivia Mitchell (Dublin South, Fine Gael)
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Answer at least one.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Gilmore was afforded the courtesy of silence and the Taoiseach should be afforded the same courtesy.

Bertie Ahern (Dublin Central, Fianna Fail)
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First, I remind Deputy Gilmore that the hospitals in Portlaoise and Cork are both public hospitals, so the issues we are talking about are consultants appointed by the process that exists to do their professional job in public hospitals. These issues did not arise in private hospitals. The Deputy knows my view——

James Reilly (Dublin North, Fine Gael)
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What about Barringtons Hospital?

Bertie Ahern (Dublin Central, Fianna Fail)
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I said Cork and Portlaoise. I did not mention any others.

James Reilly (Dublin North, Fine Gael)
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Barringtons had the exact same problems.

Bertie Ahern (Dublin Central, Fianna Fail)
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With regard to equipment, almost every hospital will argue all the time that it should have the most modern equipment. The argument in this case——

Emmet Stagg (Kildare North, Labour)
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And so they should.

Bertie Ahern (Dublin Central, Fianna Fail)
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I am not disputing that. In fact, we are more advanced in this country than they are across the water and in other countries in moving towards digital equipment.

Joan Burton (Dublin West, Labour)
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More people die here.

Liz McManus (Wicklow, Labour)
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We have not even got BreastCheck right.

Bertie Ahern (Dublin Central, Fianna Fail)
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We are more advanced in this country, I am told by the medics, in moving towards digital equipment.

Dan Neville (Limerick West, Fine Gael)
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The Taoiseach should answer the questions asked.

Bertie Ahern (Dublin Central, Fianna Fail)
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The machine in question was 15 years old. The normal period for a mammography machine would be in excess of 11 years and this machine had been tested on an annual basis. I am not saying that better equipment is not needed, but that is not the point. As I said earlier, it was the same mammograms that were examined by two different teams. It was the same mammograms and had nothing to do with the equipment. The fact is that one person reading a mammogram decided one issue and another person decided another issue, so that is not about the equipment. In any case, the consultant will deal with it.

On the political point — it is a political point — as to whether I accept responsibility for the 120,000 people who work every day in the health service, I expect that when this House votes €15 billion to those staff, when we resource our health service probably as strongly as anywhere in the modern world, when we provide the facilities as best we can — we have improved facilities enormously with the increase from €3 billion to €15 billion in a short period of time — and when we increase staff by 30,000, I expect the staff to be doing their best, as everyone else is in society.

Bernard Allen (Cork North Central, Fine Gael)
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Give them the money and wash one's hands.

Bertie Ahern (Dublin Central, Fianna Fail)
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I am not here to decide whether Maurice Nelligan, when he had that job before he retired many years ago, did his cardiac surgery operations perfectly. Whether he made a mistake or not and somebody died, I am not here to form judgment on that or on any other consultant. I am not here to answer ——

Brian Hayes (Dublin South West, Fine Gael)
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We know that is not what the Taoiseach is here to do.

Bernard Allen (Cork North Central, Fine Gael)
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The Taoiseach is not here to take responsibility either.

Bertie Ahern (Dublin Central, Fianna Fail)
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I am not here ——

John O'Donoghue (Kerry South, Ceann Comhairle)
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We must have silence for the Taoiseach.

Bertie Ahern (Dublin Central, Fianna Fail)
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I am not here to answer for the consultants in this country when they are in their operating theatres, doing a perfect job. It does not do this House much good that I am reading out some of the clinical and surgical diagnoses of individual patients. That is not what I should be doing. We provide modern facilities to very well paid people in this country.

Dan Neville (Limerick West, Fine Gael)
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What about the 15 year-old machinery?

Bertie Ahern (Dublin Central, Fianna Fail)
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The vast majority earn far in excess of what I do in terms of salary.

Brian Hayes (Dublin South West, Fine Gael)
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The Taoiseach must be joking.

Bertie Ahern (Dublin Central, Fianna Fail)
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One of the individuals the Deputy mentioned, to the best of my knowledge, has a huge private practice along with his public practice and the best of luck to him.

Bernard Allen (Cork North Central, Fine Gael)
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The Taoiseach is not taking responsibility. He continues to pass the buck.

Bertie Ahern (Dublin Central, Fianna Fail)
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If Deputy Gilmore expects me to come in here every single morning and say that the 120,000 people working in the health service — every one of them, whether in an operating theatre or out in the community — have performed to the highest standards, I cannot do that.

Liz McManus (Wicklow, Labour)
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What about the Taoiseach himself?

Bertie Ahern (Dublin Central, Fianna Fail)
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I must say, though, that they are well facilitated by this State and I hope they provide that service——

Bernard Allen (Cork North Central, Fine Gael)
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The equipment was 15 years old.

Bertie Ahern (Dublin Central, Fianna Fail)
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——and we will continue to do our best, as a Government, to improve that service.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I call on Deputy Gilmore to ask a brief supplementary question. I remind Members that this is Leaders' Questions and it is not open to other Members to interrupt.

Eamon Gilmore (Dún Laoghaire, Labour)
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That is a scandalous, cowardly reply which does not answer the question. The Taoiseach spent a week, as did the people representing him, including the HSE, casting blame around everywhere else, including the people marching on the streets. Now it is the 120,000 people working in the health service and by side-of-the-mouth implication, it is certain consultants or medical professionals who somehow are not coming up to the mark that are causing the problem. That was not the question I asked. The question I asked was a political question. The buck stops somewhere. Where does it stop? In my view, it stops with the Government. In the view of the respected medical professionals who have spoken over the course of the past 24 hours about what is happening in our health service, the buck ultimately stops with the Taoiseach, his Government and the Minister for Health and Children because they have political responsibility.

The Taoiseach is a great man to come in here and cast aspersions on people who are working in the health service. The one thing that he did not do was own up and stand up for the responsibility that he and his Government has. How much longer does the Taoiseach want to make our health service right? He has now served a probationary period of over ten years and it is in a mess. Over 50% of the people in a survey last week said it is worse now than when the Taoiseach started. It is worse now than when Deputy Harney took office.

Martin Cullen (Waterford, Fianna Fail)
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It is not worse.

Eamon Gilmore (Dún Laoghaire, Labour)
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Those people are entitled to a little better from the Taoiseach, for his management, not the individual staff and consultants who are working in the health service, his responsibility and accountability for the way he spends taxpayers' money on the health service because we are not getting value for the money that is being spent on it. It is a mess and it is time that something was done by the Government, other than casting blame, to put it right.

Deputies:

Hear, hear.

Bertie Ahern (Dublin Central, Fianna Fail)
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As I said yesterday and numerous times in the last week, our work must be to try to help the people who are affected by this and not to get lost in all of the other details. Obviously, for those seven people and some other cases mentioned here over the last few years, the services did not work, for one reason or another. I am not the expert to write the reports. There is a person appointed to do that, who has all the qualifications to write an independent report and I will accept that report, whatever it says. I have been very careful not to cast aspersions on the people involved. I have not even used the briefing notes I have had.

Brian Hayes (Dublin South West, Fine Gael)
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The Taoiseach has briefing notes on everything.

Bertie Ahern (Dublin Central, Fianna Fail)
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People are entitled to due process in this investigation.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Taoiseach must be afforded the courtesy of silence.

Bertie Ahern (Dublin Central, Fianna Fail)
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We will do all we can.

I would say to Deputy Gilmore that before I took this position, there was not even BreastCheck in this country.

Kathleen Lynch (Cork North Central, Labour)
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There still is not.

Bertie Ahern (Dublin Central, Fianna Fail)
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Before I took this position, the 2,000 people annually who had breast cancer were not being treated in the excellent way they are being treated today where 75% of them get top quality breast surgery in this country. We have a huge success rate in breast surgery.

Damien English (Meath West, Fine Gael)
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What about the other 25%?

Bertie Ahern (Dublin Central, Fianna Fail)
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We are doing a top class job for those women which did not happen in the past. I am very proud of the fact we are doing that and of the resources we are putting into our hospitals to do that. Some €0.5 billion per year is being allocated to the capital programme to improve the hospitals.

Kathleen Lynch (Cork North Central, Labour)
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The Taoiseach should come down to Cork.

Bertie Ahern (Dublin Central, Fianna Fail)
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Time and again we have provided additional resources for more staff. I totally reject Deputy Gilmore's view that the health service in this country is inferior to what it was a decade ago because that implies the 30,000 additional staff, along with the 90,000 already there, are, in some way, not doing their job. They do their job well but I am not in this House to say every member of the HSE working in every part of the Twenty-six Counties is doing an excellent job. How could I, or any politician, do that? If I wrote a letter to any consultant and said anything which affected their medical independence, Deputy Gilmore would be the first person into the House ranting and raving that I was interfering. I am not interfering with how they do their job. I make sure they are paid adequately and, if we could finalise the negotiations, would make sure they would be given a good contract.

While I feel sorry for people and I will work might and main to try to improve the position, I reject the position whereby Deputy Gilmore can come into the House and castigate a health service which we put in place and which is a good one.