Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context

Now that the Taoiseach is back from canvassing for another position as an exit strategy——

Johnny Brady (Meath West, Fianna Fail)
Link to this: Individually | In context

Deputy Kenny will not be doing it anyway.

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context

The Deputy is crowing very early. I wish to ask the Taoiseach about a few issues of real importance to the people. In recent times, we have heard of patients having to wait up to 18 months for a colonoscopy, a simple procedure and test for the early diagnosis of cancer that can save lives. Reports indicate delays of four months in Cork, nine months in Kerry, eight months in Wexford, 18 months in Portlaoise and up to 12 months in Tralee and Galway. Consultants have said to me face to face in different hospitals that patients die because they are not seen as quickly as they should be seen. The Minister for Health and Children, who is not present, says these delays are unacceptable, as if she were some sort of innocent bystander rather than the Minister responsible for the health service.

What will the Taoiseach do to ensure that what happened to Susie Long — God rest her — does not happen to any other patient? She could not get a colonoscopy on time. In respect of colonoscopies, what has the Taoiseach to say about his comment that we are running a world-class health service in respect of which he should be congratulated?

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

The Minister for Health and Children will be addressing some of these issues tomorrow during Question Time, but the HSE has advised us that colonoscopy scheduling is based on clinical need and that each patient is assessed individually by his general practitioner and referred accordingly. Cases that are classified as urgent are given the next available time slot and patients are usually seen between two to three days and five weeks, depending on their geographical location. There are big differences depending on geographical location. The non-urgent cases are placed on a waiting list and a patient may wait from three to 18 months, again depending on geographical location. The waiting period is based on the level of urgency attached to the case by the doctor.

The waiting time for routine investigations can and will be reduced by making better use of existing capacity. That is the point the Minister for Health and Children made. The head of the cancer control programme, Professor Tom Keane, has said there are many unnecessary follow-up visits for certain patients after treatment and that resources could be far better used for initial investigations for new patients. The professor plans to eliminate such unnecessary follow-up visits in developing clinical practice norms, which he believes will dramatically improve the service.

It is important that clear criteria be applied to distinguish between urgent and routine cases. Significant work has already been undertaken in the area of breast cancer, supported by the Irish College of General Practitioners in respect of referral criteria and the development of appropriate referral forms to allow for appropriate triage of urgent and non-urgent cases. The lists about which we are talking can be very different depending on whether cases are regarded as urgent.

Professor Keane also plans to develop and implement a referral process for other cancers, including colon cancer. Hospitals are working closely with clinicians and the National Treatment Purchase Fund to reduce waiting times. Any patient waiting for over three months can be referred to the National Treatment Purchase Fund. Patients can self-refer or are referred by the hospital to the fund, and hospitals are currently validating their colonoscopy waiting lists by contacting patients on the list and determining whether the procedure is still required by them so that if the procedure is still required, the patient can be assessed for eligibility by the National Treatment Purchase Fund.

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context

That puts the buck back on the patient. It is difficult for the Taoiseach to appreciate the frustration, anger and anxiety of these patients who are waiting on these lists, especially if he is away canvassing on another job.

Four months in Cork, 12 months in both Tullamore and Galway are 18 months in Portlaoise are the times concerned for people who are on those waiting lists. What they want to hear from the doctor or from the consultant is that they are all right and that there is nothing wrong with them, or that at least they will have their test carried out and the truth of the findings of that test will be made known to them. That is what patients want to hear and patients want to find out that they will have that facility.

Ms Suzie Long, before she died, wrote:

I then came home, flicked on the tv and got into bed. The first ad on the tv was from the government telling people that bowel cancer can kill, but not if caught in time. If Bertie Ahern or Mary Harney or Michael McDowell were within reach I would have killed them. Literally. I'm not joking.

That young girl is dead because she did not get a colonoscopy in time. I am telling the Taoiseach that these are not phantom lists. These lists are real evidence of people, some of whom consultants have stated will die because they will not be seen on time.

If the Taoiseach was interested, or if the Minister for Health and Children, Deputy Harney, was sufficiently interested, instead of being a bystander she would see to it that the HSE receive instructions and directions from Government to implement Government policy. First, will the Taoiseach and the Minister direct the HSE that there be clear guidelines set out for who should be seen and who should not be seen? Second, will the Taoiseach direct the HSE to set a target time of six weeks for every person who needs a colonoscopy to be seen? Third, will he direct the HSE to use this very expensive equipment lying idle every weekend in every hospital to maximum capacity to reduce these waiting lists?

Jim O'Keeffe (Cork South West, Fine Gael)
Link to this: Individually | In context

It is a fair point.

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context

Fourth, will the Taoiseach confirm when the long-promised reports about failures in the cancer services will be published?

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

I repeat that of course this is urgent, and hugely so for the people concerned — there is no issue about that.

In answer to the question on waiting times, those who are classified as urgent get the next available time slot and that works out usually at between two to three days and five weeks, depending on the geographical location. Therefore, they would all be within the period to which Deputy Kenny referred.

An issue is what is urgent and non-urgent. If one is a patient and one is worried, everything is urgent. I understand that but that is the classification that is made.

Professor Keane has stated that in his view of these follow-ups for certain patients for treatment, resources would be far better used for investigations on new patients and that would help these waiting lists dramatically, and he plans to eliminate these follow-ups in developing clinical practice norms. As I stated about the procedures, significant work has already been undertaken in the area of breast cancer, supported by general practitioners, to get a criteria for the development of appropriate referral norms — that work is being done. I will not go back over what I said about the national treatment fund.

Recruitment of the additional consultants under the new consultant contract will be of significant benefit to the HSE's national cancer control programme because it is designed to give a far better service to public patients in particular. It is based on four to one — four public patients to one private patient. Under that contract outpatient and diagnostic services will be provided in public hospitals on a one-for-all basis so patients can be seen in order of medical need at this key entry point to acute hospital services.

The Minister has asked the board of the National Cancer Screening Service to advise her on the introduction of the national cancer screening programme, and that advice will be available mid-year and be informed by screening programmes in place or planned in other countries, including the UK. The service has also requested the Health Information and Quality Authority, HIQA, to conduct an assessment of the colon-rectal cancer screening programme as well.

On the reports, I understand two of the reports are cleared to be published and the Minister hopes to do that. The third report is awaiting a legal clearance, which she hopes will be cleared shortly, but about which she cannot be certain.

Eamon Gilmore (Dún Laoghaire, Labour)
Link to this: Individually | In context

The Taoiseach does not understand this problem at all. The distinction he is making between urgent and non-urgent is missing the point. I listened to Dr. Martin Daly speaking on radio the other morning where he made the distinction between urgent and non-urgent. Urgent is where a general practitioner concludes that somebody is already sick and must be seen immediately. Non-urgent is where a general practitioner is concerned that there are some symptoms that need to be checked out.

Suzie Long's case was non-urgent. That is why she waited seven months. She is now dead. Last October I raised her case here with the Taoiseach at the request of her family. They were concerned that no other patient would have to suffer as she and her family suffered, and that a test, which in any decent health service would be available within a matter of days or certainly weeks, took seven months for her.

We have reports that people are waiting up to 18 months for a colonoscopy because, the Taoiseach states, they are non-urgent. He makes it sound like it is some kind of cosmetic procedure they are looking for. These are people who doctors have concluded need to be checked out and they must wait 18 months.

As the Taoiseach wandered around Europe last week, and in all of his visits to various European capitals, has he found any other country where people must wait 18 months for a cancer test? Our health service is a disgrace. His Minister for Health and Children, Deputy Harney, describes it as not acceptable that people should have to wait that length of time for a cancer test. Neither is it acceptable to have a Minister for Health and Children presiding over that kind of system, and it is not acceptable that a Government that has been in office for almost 11 years has allowed this to happen. Even when somebody gets a cancer test, he or she has no guarantee that the test will turn out to be accurate. We are now waiting for seven reports on the various inaccuracies there have been in cancer tests that we know about in Portlaoise, Cork, Galway and other centres.

This week we find an attempt at covering it up. The Irish Examiner, in an article this week, quotes from emails between the current Government press secretary and the former Government press secretary:

In consultation with the Department of Health and Children, it was decided not to go into detail in relation to the numbers of patients involved . . . Doing so would only serve to cause widespread alarm in the public and unnecessary confusion in the media.

They were referring to how many patients had been seen by the Finnish consultant who was employed in Cork and whose contract has been terminated.

John O'Donoghue (Kerry South, Ceann Comhairle)
Link to this: Individually | In context

The Deputy is well over time.

Eamon Gilmore (Dún Laoghaire, Labour)
Link to this: Individually | In context

Can the Taoiseach answer the question? Has he found anywhere where one will wait 18 months or more for a cancer test?

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

I repeat it is not an assessment of urgent and non-urgent that I am making. It is one that the relevant consultants are making. Cases are classified as urgent by the general practitioner who refers the person to the consultant. They are making the call as to whether it is urgent, not an administrative person. The urgent cases are given the next available time slot and patients are usually seen within two to three days. In some areas, where clearly there is not a good system in place, it is within five weeks. That is based on the geographical location. The non-urgent cases are placed on waiting lists and the waiting time varies significantly from three to 18 months.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

They could have cancer. That is the problem.

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

The waiting time for routine investigations will be reduced by making better use of existing capacity, which is what Professor Keane said. He believes there are several ways this can be done and the HSE is working with general practitioners to achieve that. Any patient waiting over three months can be referred, or self refer, to the National Treatment Purchase Fund, as a high proportion are already.

There are three reports in question with regard to breast radiology services at the Midland Regional Hospital. The clinical review of breast radiology diagnosis from November 2003 to August 2007, when the issue was highlighted, was led by Dr. Ann O'Doherty, consultant radiologist in St. Vincent's. That review has been completed and the HSE expects to publish it in the next few days, perhaps even tomorrow, but I cannot be more definite about that.

The Minister for Health and Children has asked the chief executive officer of the HSE for a report on the circumstances that led to the decisions of the HSE to suspend breast radiology services at the hospital, to place a consultant radiologist on administrative leave and to initiate a clinical review of the breast radiology service. This report, by the review group led by Ms Ann Doherty of the National Hospitals Office, has been submitted to the Minister and I believe is ready for publication.

The Minister has also asked for a report from the board of the HSE on the management of all events, starting from and subsequent to those decisions. Mr. John Fitzgerald has also submitted that report to the Minister. She intends to publish both of those reports, with her considered views and response, tomorrow.

Eamon Gilmore (Dún Laoghaire, Labour)
Link to this: Individually | In context

The Taoiseach makes it sound as though the consultants are out there organising queues, one line for urgent cases and another line for non-urgent cases. The reason cases are designated as urgent is because there is an 18-month queue and consultants must do something with people they have concluded are ill. If the Taoiseach or I went to the doctor and he recommended we get a colonoscopy, we would not wait 18 months to get it done. I do not see why the Taoiseach and his Government should expect people who do not have the money to pay for the service to wait for it either. Just because somebody is not sufficiently well-off to be able to go to a private facility and pay for a test or to have the level of insurance that will provide that test quickly does not mean they should be put at greater risk of dying, which is what is happening.

The Taoiseach has not been able to tell me of any country in Europe with a longer waiting list than Ireland for these tests. He is, and has been, the first out of the traps to claim credit for everything good that has happened here for the past ten or eleven years, but he refuses to take responsibility for what is going wrong. He specifically refuses to take responsibility for what is happening in the health service. Every time he is asked a question about it, he finds a consultant, doctor or administrator somewhere whom he asks to carry the can.

Susie Long was very clear about who was responsible when she told Joe Duffy that she blamed the Government. Frankly, so do I. I ask the Taoiseach again to explain the e-mails that have been passing between his Government press secretary and his predecessor about covering up what happened in Cork. That is what this is about.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

Suppression of information.

Eamon Gilmore (Dún Laoghaire, Labour)
Link to this: Individually | In context

It is about not telling the public how many patients were involved regarding the consultant in Cork. How many patients were involved? What were they trying to cover up when they said they did not want to go into detail with regard to the number of patients involved? Will the Taoiseach tell us the number of patients involved?

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

I do not want to be repetitious. The HSE has stated that the colonoscopy schedule is based on clinical need. That is a medical position. Thankfully, politicians in Ireland do not act as clinicians.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

They only act as politicians.

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

Some 100,000 people work in our medical and health service and they conduct the clinical assessment on each patient and refer accordingly. The Deputy wants to keep talking about the 18-month wait. Let me tell him for the third time that cases classified as urgent get the next available slot, which is between two and three days for the majority of these, and, at the bad end, the wait goes to five weeks. That is the information available.

The waiting time for non-urgent cases — I already explained what Professor Tom Keane said about this issue — ranges from three to 18 months. I agree that seems to be a wide span, but it is a decision medical clinicians make. The important thing is——

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Some urgent cases are waiting six months.

Charles Flanagan (Laois-Offaly, Fine Gael)
Link to this: Individually | In context

Some in Laois are waiting 18 months.

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

That is not the case in Laois. I checked specifically and saw that urgent cases in Laois get their appointment within three days.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

Eventually everyone will become an urgent case so they get seen.

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

Let us not be silly. Everyone's health issue is not equally serious. Clinicians make the decisions and urgent cases are being dealt with quickly.

In response to Deputy Gilmore, Professor Tom Keane said there are many unnecessary follow-up visits which lengthen the waiting list and are not an efficient use of time or resources. He said this time could better be used for initial investigations for new patients——

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Not in colonoscopy.

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

Yes, in colonoscopy.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Nobody has a repeat colonoscopy unnecessarily.

Mary Coughlan (Donegal South West, Fianna Fail)
Link to this: Individually | In context

Not everybody has repeat colon cancer either.

Bertie Ahern (Dublin Central, Fianna Fail)
Link to this: Individually | In context

Unfortunately, that is what he says. I will not argue with the Deputies on that point. He plans to eliminate such unnecessary follow-ups in developing clinical practice norms. He has already set clinical criteria to distinguish between urgent and routine cases, which was the question asked in the first place. Significant work has been done in that regard.

It is important to mention the additional consultants. We need medical professionals to deal with the patients and reduce waiting lists. The new common contract will help in this regard.