Jan O'Sullivan (Limerick East, Labour)
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Question 79: To ask the Minister for Health and Children when she expects the publication of each of the outstanding reports on cancer diagnosis and treatment, including the three reports on the Midland Regional Hospital, the report on the case of a person (details supplied), and those concerned with Cork University Hospital, Galway Regional Hospital and Barringtons Hospital, Limerick; and if she will make a statement on the matter. [9455/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I published two reports this morning on the Midland Regional Hospital, Portlaoise. The Health Service Executive is publishing reports on the clinical reviews this afternoon.

The investigation by the Health Information and Quality Authority, HIQA, into the care provided by the HSE for the named individual commenced in June 2007. I am advised that the draft report is going through the necessary legal verification process which includes consulting those referred to in the report. The pathology review in Cork University Hospital is completed and a report is being finalised by the HSE.

The investigation by HIQA into pathology services at University College Hospital, Galway, commenced in September 2007. While it is difficult to predict precisely when the work will be completed, it is hoped the investigation will be concluded in April and the report published as soon as possible thereafter.

In regard to the review of breast services in Barrington's Hospital and medical centre, the review team expects to finalise the draft report this month. Following the completion of the necessary legal requirements, the report will be submitted to me and the hospital management.

The incidents that gave rise to all these reviews highlight the need for swift implementation of the national quality assurance standards for symptomatic breast disease. Implementation of the standards will ensure every woman who develops breast cancer will have an equal opportunity to be managed in a centre capable of delivering the best possible results.

Jan O'Sullivan (Limerick East, Labour)
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I do not know whether it is a coincidence that two of these reports have been published on the day this question is tabled, with a third to be published later this afternoon. We did not have much time to read the two reports published earlier today. Will the Minister take a hands-on approach to this issue? We tabled a motion of no confidence in her last autumn and I have not read or heard anything today to suggest we were wrong in that regard. The reports we received today expose a total shambles in terms of HSE management in the midlands. I have no reason to believe it is not the same elsewhere. There is an array of managers who perform different roles and do not report to each other. Even clinical directors report to different people than those to whom nurse managers report. Has the Minister undertaken any investigation of how management is operating in the HSE? Why has she approved the appointment of six senior managers above grade eight this year?

At the meeting on 28 August in Portlaoise why were there five managers but no doctor? Is the Minister not concerned about this? The initial response of the HSE which was posted on the Department's website seemed to indicate its intention to do something about the management of serious incidents. Clearly, there is no intention to do anything about how management operates in various hospitals.

Will the Minister take responsibility for the HSE, which she established? Clearly, it is a shambles. Does she accept that patients' lives are being put at risk because there is no clear understanding of what is going on? In the case of Portlaoise, why was there no triple assessment and no radiologist with expertise in mammography? Why were women's lives put at risk by the misdiagnoses arising from this?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I will deal with the Deputy's last question first. Ms Ann Doherty, the acting head of the National Hospitals Office, highlights at the start of her report the fragmented nature of the service which is spread across three hospitals. The report should not be confused with that of Dr. Ann O'Doherty who did the clinical review which is also being published today. The Doherty report mentions that although there was supposed to be a policy of providing services in one location in the midlands, the Midland Health Board decided to provide services at three locations. The manner in which services were spread across three sites, contrary to medical advice, made it impossible to obtain the expertise needed. Until recently, over 30 hospitals were dealing with breast cancer. Such services were recently withdrawn from 15 hospitals because it was not safe to have such a large number of hospitals dealing with 2,500 new cases each year. It is not possible to recruit specialist clinical staff, or to put multidisciplinary teams in place, at so many hospitals. It is important that we implement the national control plan which recommends that we concentrate on eight designated cancer care centres. I have huge confidence in Professor Tom Keane who is overseeing the plan.

Serious issues are raised in the reports which I asked for and which have been published today. As I appoint the board of the HSE, it is accountable to me. I have huge confidence in the board which is responsible for the management of the HSE. The Fitzgerald report which I asked the board to produce after the ultrasound issue arose on 21 and 22 November 2007 states "problems arose from systemic weaknesses of governance, management, and communication". I said in my response to the board of the HSE, which I made public this morning, that I wanted it in the first instance to put a protocol in place to deal with these issues and ensure patients came first. The first thing that should happen when incidents of this nature occur is that there should be personal and direct communication with patients. It should not happen through the media or the political system. I want to ensure one person is in charge of ensuring the protocol is implemented. While I do not suggest the person should undertake the reviews in such circumstances, he or she should be responsible for ensuring the protocol is implemented.

I also want the board to be centrally involved in risk assessment. I have asked the chairman to ascertain whether the issues which arose in Portlaoise have wider application across the HSE. In particular, I want permanent personnel to be appointed to management positions which are currently vacant with acting personnel in place.

Pádraic McCormack (Galway West, Fine Gael)
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When will all that happen?

Jan O'Sullivan (Limerick East, Labour)
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The Minister has not said she will take responsibility for changing the whole HSE system. She spoke about appointing more managers. At the meeting on 28 August last there were five managers with different responsibilities. Does the Minister not accept that the HSE is over-managed and under-staffed with clinicians?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am not appointing more managers — I am simply asking the HSE to put in place a permanent management structure. The primary, community and continuing care unit and the National Hospitals Office, for example, have acting heads.

Pádraic McCormack (Galway West, Fine Gael)
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They are all actors.

Mary Harney (Dublin Mid West, Progressive Democrats)
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There is an acting head in charge of information technology and an acting head in charge of human resources. In fairness, the HSE has gone to the market a couple of times and I understand an appointment is imminent in one case. It has not been easy to fill some of these positions. Some of those originally appointed to fill certain positions have moved on. The first thing I want to see is a clear management team permanently in position. The second thing I want to see is a clear line of accountability and responsibility. We have learned that nobody was in charge.

Pádraic McCormack (Galway West, Fine Gael)
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There is no one in charge.

Mary Harney (Dublin Mid West, Progressive Democrats)
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A number of people were going to meetings.

Jan O'Sullivan (Limerick East, Labour)
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There are too many managers.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The new cancer control plan would never have happened under the former health boards.

James Reilly (Dublin North, Fine Gael)
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It might not happen yet.

Mary Harney (Dublin Mid West, Progressive Democrats)
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It would never have happened.

Jan O'Sullivan (Limerick East, Labour)
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The Minister will not take responsibility for anything.

Mary Harney (Dublin Mid West, Progressive Democrats)
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There is no designated centre in the midlands. I could not imagine one of the old health boards deciding not to designate a centre in its functional area.

James Reilly (Dublin North, Fine Gael)
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That was a designated centre.

Olwyn Enright (Laois-Offaly, Fine Gael)
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Portlaoise was designated.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Cancer was being treated at three locations in the midlands, which was highly unsafe.

Pádraic McCormack (Galway West, Fine Gael)
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The Minister will keep defending the HSE.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Quality care could not be assured. That was one of the problems.

Jan O'Sullivan (Limerick East, Labour)
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The HSE has been in existence for three years. Is the Minister taking any responsibility?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I certainly am. If somebody is trying to——

Jan O'Sullivan (Limerick East, Labour)
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The Minister set up the HSE.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Twenty years ago Fine Gael called for the establishment of a semi-State body to deal with the unified health service.

Pádraic McCormack (Galway West, Fine Gael)
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The Minister might as well go back to the foundation of the State.

Mary Harney (Dublin Mid West, Progressive Democrats)
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No organisation is perfect.

Olwyn Enright (Laois-Offaly, Fine Gael)
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The HSE is certainly not perfect.

James Reilly (Dublin North, Fine Gael)
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It is dysfunctional.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Nothing short of a unified system of delivery——

James Reilly (Dublin North, Fine Gael)
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The health boards would have done a better job.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not accept that.