Enda Kenny (Mayo, Fine Gael)
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Last year, we witnessed the scandal of misdiagnoses of cancer in women in Portlaoise. Following the unearthing of that scandal we had the usual reports from the Minister for chaos in health that this matter would be rectified and that lessons had been learned. We were told management and governance would be improved and that communications failures would be ended. We were promised that new protocols and rapid responses would be put in place and that there would be no more miscommunications of information. Let us consider what happened recently in the north east.

The HSE became aware of misdiagnoses in the north east last November, at the height of the scandal in Portlaoise. In March 2008, when this matter was brought to the notice of the public by Deputy O'Dowd and others, the HSE played it down and said that CT scans were not part of the review. Last week, six months after the misdiagnoses were first uncovered, a bombshell was dropped on the people of the north east. We were told that 6,000 X-rays and 70 CT scans were being reviewed. Not only that, but the communications were completely and utterly botched. Despite the fact that there are more than 100,000 people working in the HSE, this matter was outsourced to a company. Some patients received part of their correspondence, while some received their own correspondence and correspondence for other people. Letters were sent to persons who were deceased, which is absolutely scandalous and upsetting for their families.

For example, there is the case of Anne Kealy. In March 2007 she went for a CT scan and was told she had pneumonia. She went to hospital and contracted MRSA. When she was still unwell five weeks later, her family demanded a new scan. That scan showed that Anne Kealy had cancer in her kidney, lungs and brain. Anne Kealy got two letters last week. The letter she received on 14 May stated:

The x-rays and scans [. . .] will be carefully re-examined by an expert team of radiologists who are carrying out this look back review. . . . [B]ased upon expert medical advice it is our expectation that in the vast majority of cases there will be no cause for concern.

It went on to say:

[I]f you are reading this letter and are not the addressee, we very much regret any distress this letter may cause you and your family.

Anne Kealy died in August 2007. She received two letters this week.

Does this not amount to a cluster bomb of offences? It is a cluster bomb of incidents of mismanagement and further mismanagement over which the Minister for Health and Children, who was re-appointed last week by the Taoiseach, presides. Is the Taoiseach, as a long-standing Deputy and Minister, not ashamed of this situation? We were told last year that lessons had been learned, that new protocols would be put in place and that such a situation would never recur. Why has it taken six months to act in this matter? Why was the family of Ms Anne Kealy subjected to this type of treatment? How many more Anne Kealys have passed away in the meantime due to misdiagnoses and misinformation presided over by the Government and the re-appointed Minister for Health and Children?

Deputies:

Hear, hear.

Brian Cowen (Laois-Offaly, Fianna Fail)
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First, I apologise to the family for any distress caused in this matter. Obviously, there would have been some distress.

Shane McEntee (Meath East, Fine Gael)
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Serious distress.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Regarding the question of 4,500 cases, it can unfortunately be the case that, through human error, an issue such as this can arise. It is to be regretted and responsibility for it must be taken by the company concerned. The review of 4,500 cases and more than 6,000 X-rays is a precautionary measure in line with best practice based on the advice received by the HSE from people in this area. The total review of the locum's work was necessary.

It is important to ensure that people's anxieties are dealt with as quickly and professionally as possible. It will take approximately eight weeks before the last of the X-rays and CAT scans are reviewed and confirmed as being in order based on the previous understanding of the situation. It is important that, where errors occurred under the locum, matters such as the one that arose in 2006 and 2007 be dealt with and that the precautionary principle be applied. That 6,000 X-rays are being examined is not to suggest that the same level of danger applies in each case. Rather, a precautionary principle is being applied in 4,500 cases. It is important we recognise this and allow the HSE to conduct its work as quickly and professionally as possible in a way that seeks to minimise people's anxieties.

Enda Kenny (Mayo, Fine Gael)
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It is unfortunate the new Taoiseach must be required to continue where his predecessor finished in apologising continually for a litany of mismanagement affecting people's lives and the sensitivities of their families. The Government accepted the Harding Clark findings to the effect that a new system should be put in place to deal with this issue. While the Taoiseach states it is a question of human error, the company selected by the hospital sent second letters claiming the problem was due to an internal process.

The late Anne Kealy's case highlights what has gone wrong. We were told one thing by the absent Minister for chaos and health — that new systems would be put in place and that such miscommunications would never recur — but Ms Kealy, who went to hospital, had a scan and was told she had pneumonia, was told after another scan five weeks later that she had lung, kidney and brain cancer. She received two letters before dying. In 2008, €15 billion is being spent on a system that carries on in this way and experiences a litany of incidents every day of the week.

The review to which the Taoiseach referred states that eight weeks will pass before the final scans will be determined. The process will be completed eight months after the first patient was known to have been misdiagnosed. The House is aware that, after the bombshell in Portlaoise, the Minister for Health and Children appeared in the Chamber because her head was on the line and arranged for clinics that weekend. We saw them on television. What happens to the people in the north east? They are expected to wait eight weeks for the assessment of scans and X-rays.

Michael Creed (Cork North West, Fine Gael)
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Shameful.

Enda Kenny (Mayo, Fine Gael)
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Consultant after consultant tells us that patients die on waiting lists because they are not seen or assessed. Early intervention and action saves lives. While the people in the north east must wait eight weeks, the people in the midlands had clinics that weekend because the Minister's political head was on the line. Those in the north east are not waiting eight weeks. Rather, they are attending their general practitioners and presenting at accident and emergency units to have scans and X-rays done. I agree with this.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy is over time.

Michael Creed (Cork North West, Fine Gael)
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The Government is over time.

Enda Kenny (Mayo, Fine Gael)
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Neither the Taoiseach nor any other Deputy would await a scan's analysis for eight weeks. Will the Taoiseach call in the absent Minister for chaos and health and tell her to make the same arrangement for the people of the north east as applied in the midlands——

Deputies:

Hear, hear.

Enda Kenny (Mayo, Fine Gael)
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——to have those scans assessed in the next week and to have the matter finalised, which he is authorised to do and as occurred in respect of Portlaoise? If he does it now, he will take some credit from another shambles in health. People are becoming desensitised to the Government's litany of failures. Despite presiding over an expenditure of €15 billion in 2008, the situation has regressed instead of progressed. Will the Taoiseach instruct the Minister for Health and Children to complete the process in the next week?

Deputies:

Hear, hear.

Brian Cowen (Laois-Offaly, Fianna Fail)
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It is unfortunate the Leader of the Opposition insists on characterising the Minister in that way.

Michael Creed (Cork North West, Fine Gael)
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There is nothing else.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Obviously, it is done for political headlines. The serious issue, apart from——

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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The Government's mismanagement.

Brian Cowen (Laois-Offaly, Fianna Fail)
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——the tactics in which the Opposition is engaged, concerns best practice in the review of these matters. Best practice has been outlined by the expert clinical advice available.

The Portlaoise situation involved established misdiagnoses and making arrangements to have a number of patients re-examined in the Cuisle Centre. The principle in this case is precautionary. More than 200,000 X-rays are carried out in the hospital in Drogheda each year. A locum's work in four cases came under the scrutiny of a consultant at the hospital.

Shane McEntee (Meath East, Fine Gael)
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Navan hospital.

Brian Cowen (Laois-Offaly, Fianna Fail)
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In both Navan and Drogheda. We all have a responsibility in terms of pointing out that some 6,000 X-rays are to be reviewed on the basis of a precautionary principle, not on the suggestion of a misdiagnosis in each case.

Fergus O'Dowd (Louth, Fine Gael)
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That is the concern.

Enda Kenny (Mayo, Fine Gael)
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Anne Kealy is deceased.

Brian Cowen (Laois-Offaly, Fianna Fail)
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There is a sufficient level of public anxiety without inflaming the issue or misrepresenting it to gain political effect.

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

Brian Cowen (Laois-Offaly, Fianna Fail)
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The position is clear.

Michael Creed (Cork North West, Fine Gael)
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The Taoiseach should withdraw his remark.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I will not withdraw it.

Shane McEntee (Meath East, Fine Gael)
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It is not true.

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

Brian Cowen (Laois-Offaly, Fianna Fail)
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I listened in silence.

Shane McEntee (Meath East, Fine Gael)
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The Taoiseach is totally out of line and he should withdraw his remark. It is not fair on the family in question.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am simply explaining——

Shane McEntee (Meath East, Fine Gael)
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The Taoiseach should spend a week with the families.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The suggestion——

Shane McEntee (Meath East, Fine Gael)
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It was outrageous and I have no respect for him for making that comment.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The Deputy should allow me to explain.

Shane McEntee (Meath East, Fine Gael)
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The Taoiseach should bring the families to the Oireachtas to apologise.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy McEntee should not speak during Leaders' Questions.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I ask the Ceann Comhairle to allow me to reply to Deputy McEntee. Deputy Kenny spoke in highly charged language.

Shane McEntee (Meath East, Fine Gael)
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He spoke the truth.

Brian Cowen (Laois-Offaly, Fianna Fail)
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It was designed to heighten rather than dampen people's anxieties.

Enda Kenny (Mayo, Fine Gael)
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The woman is deceased.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I acknowledge people's legitimate anxieties, but there is a difference in this instance in that we are applying a precautionary principle to a large number of files. It is wrong to suggest that an inherent danger of a possible misdiagnosis attaches to them all.

Shane McEntee (Meath East, Fine Gael)
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The ones in which people died should be dealt with.

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

Brian Cowen (Laois-Offaly, Fianna Fail)
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It does not assist the situation to portray what I acknowledge is a serious matter in the way it is being portrayed. There is a suggestion that the precautionary principle is not being applied. However, if it was not being done in that way, there is a suggestion that a greater number of files should be looked at. As I said, the purpose is to use the precautionary principle across the board in respect of all files with which that individual may have had contact.

Fergus O'Dowd (Louth, Fine Gael)
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The HSE has said that the CT scans were not part of the review.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The point I have made is fair and accurate. The expert clinical advice is that it is necessary to go through these files over this period. The whole idea is to provide reassurance. The way to do so is to follow the advice provided by clinicians who have greater expertise than me or anybody else in this House as to how we should go about it and do it properly. As I said in my initial reply, before Deputy Kenny put forward his robust supplementary question, we are trying to reassure people in a proportionate way, based on the precautionary principle. That is an important point. Deputy Kenny is suggesting that there is an imminent danger in respect of all these files. That is not the situation.

Fergus O'Dowd (Louth, Fine Gael)
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People are worried. They have to wait eight weeks for the results.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am aware of that.

Fergus O'Dowd (Louth, Fine Gael)
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Why is action not being taken to shorten that timeframe?

Brian Cowen (Laois-Offaly, Fianna Fail)
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Our responsibility is to explain to those who have any concerns and worries that the expert clinical advice available to us is that this is the best way to go about dealing with that anxiety and concern. If somebody else puts forward the idea that there is another way of doing it which is not in compliance with the expert advice, let them take responsibility for that suggestion.

Fergus O'Dowd (Louth, Fine Gael)
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The key point is that patients have to wait eight weeks before the X-ray results are available.

Deputies:

Would the Taoiseach wait eight weeks?

Brian Cowen (Laois-Offaly, Fianna Fail)
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It is only fair to make the points I have made in response to the way Deputy Kenny is seeking to portray the situation.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I do not have to remind Deputy Kenny, who is an experienced Deputy, that the title of the Minister for Health and Children must be utilised and cannot be distorted.

Enda Kenny (Mayo, Fine Gael)
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I have no wish to be derogatory towards the Minister for Health and Children.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I am obliged to make that point.

Enda Kenny (Mayo, Fine Gael)
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However, it is the case that she is presiding over failure, chaos and mismanagement.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I have no difficulty with political charges being made. However, Deputies must not distort the name or title of the Minister.

Enda Kenny (Mayo, Fine Gael)
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I will take the Ceann Comhairle's advice on this occasion.

Eamon Gilmore (Dún Laoghaire, Labour)
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Yesterday, a major developer, the McNamara-Castlethorn consortium, withdrew from five public private partnerships with Dublin City Council for the regeneration of several areas of the city, including St. Michael's estate in Inchicore, O'Devaney Gardens, Dominick Street, Infirmary Road and Seán McDermott Street. These projects involved the provision of more than 1,000 social and affordable housing units, along with community and neighbourhood facilities, in an effort to regenerate and revitalise areas which are among the most disadvantaged not only in Dublin city, but in the State. Much work was done over a seven-year period in bringing forward these regeneration schemes. This involved consulting with the communities themselves and with the wider neighbourhoods to agree the schemes that were eventually devised. In anticipation of the work, a considerable amount of detenanting has taken place within those areas. In O'Devaney Gardens, for example, four of the 14 blocks have been detenanted. Similar levels of detenanting have taken place in the other estates.

The people living in these estates are absolutely devastated that their hopes for the regeneration of their homes and neighbourhoods are now dashed. Several questions arise. What can the Taoiseach say to the people living on these estates and whose hopes have been so badly damaged by yesterday's announcement? What hope can he offer them that the regeneration will proceed as planned? What alternative arrangements will be put in place to ensure this is so? Why was the same developer awarded the contract for all these schemes?

What penalty clauses, if any, were attached to the contract which allow the developer to withdraw at this late stage? As we said last week during an exchange of opinions on this area, public private partnership should not only exist when times are good. The concept includes the idea that the partnership should also be there when times are tightening. It should not be the case that the Exchequer takes all the risk and the developer pulls out when the situation gets trickier. Are we likely to see the plug being pulled in coming weeks or months on any other public private partnerships in which either this or other developers are engaged?

Brian Cowen (Laois-Offaly, Fianna Fail)
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I have asked the Minister for the Environment, Heritage and Local Government to provide me with a report on this matter arising from yesterday's developments. I will answer Deputy Gilmore's questions to the best of my ability. I acknowledge that this is a setback for those communities who have been working hard in conjunction with the city council to devise regeneration plans for their areas. These are areas where we would like to see improvements and regeneration take place.

Following the withdrawal of the developer from the public private partnership projects in question, I understand members of the regeneration board had a meeting with city council officials yesterday. Despite this setback, there is a continuing commitment on the part of the council to prioritise the prospect of regeneration for these communities. This may involve approaching other developers who have indicated an interest in participating in public private partnership. The public private partnership contracts with the developer are not available to me and I am not in a position to answer questions about the details of those contracts. However, I will seek to find some information on this for the Deputy.

The Deputy referred to the detenanting that has taken place in these areas. The need to provide housing for these people as quickly as possible, whether through a reactivation of the public private partnership process in conjunction with a different developer or via a phased development based on a more traditional procurement method, is a priority for the city council. That is a matter for consideration by Dublin City Council officials as they seek to assess where they go from here and decide the next steps in dealing with this setback.

Eamon Gilmore (Dún Laoghaire, Labour)
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The difficulty is that the physical conditions in the estates in question are probably worse as a consequence of the detenanting that has taken place. We do not want a situation where people must continue living in poor physical conditions and in circumstances where the hopes they had for the regeneration of their homes and neighbourhoods are entirely dashed. I hope arrangements will be put in place quickly to ensure these schemes proceed without delay.

Are we likely to hear other news about public partnership projects in conjunction with the same or other developers? For example, will the Finglas village project, in which I understand the same developer is involved, proceed as planned or will the plug be pulled on that also? I notice a proposal has been withdrawn from the Dáil Order Paper in respect of the building of the prison at Thornton Hall. I understand the same developer is the proposed builder of Thornton Hall prison. That proposal was to have been brought before the Dáil today and tomorrow for approval but I note it has been withdrawn. Is the developer proceeding with the Thornton Hall prison or has there been a change in that regard? Does yesterday's announcement regarding projects in Dublin city have implications for the developer's involvement with that project? More generally, what are the implications for the public private partnership method of providing social and public infrastructure? Yesterday's events will certainly dent the confidence of public authorities engaging with developers on projects of this kind if the plug is so easily pulled at the last minute.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Since this arose yesterday, no further suggestion has been made beyond those which are in the public domain. At this stage, I await a report from the Minister for the Environment, Heritage and Local Government on his assessment of the full situation as best he can gauge it. It is only fair to say that PPP models differ. These projects involved Dublin City Council leveraging the grounds it owned by means of a PPP so that residential social and affordable housing could be built in addition to other mixed developments which would be sold on by the developer to help finance the construction of social and affordable housing to meet the requirements of existing tenants and occupiers. The intention is to bring about regeneration and a greater community spirit not only in terms of residential housing but also by developing other much needed facilities for the area. That model was applied in Fatima Mansions and other successful projects which have been seen to bring a lot of added value and helped to restore and support the communities in these areas.

The Thornton Hall project involves a different PPP model based on the construction of the prison and staged annualised payments thereafter. I have received no indication from the Minister for Justice, Equality and Law Reform that the project has stalled. We are at an advanced stage of the process, although I understand it has not yet been finalised. An additional purpose of that proposal is to facilitate the development of prison complexes in the inner city which will greatly enhance the quality of life for people living there.

To answer the Deputy's question as best I can, as of today, I am not aware that any further issues have arisen but that will become clearer when the Minister for the Environment, Heritage and Local Government has an opportunity to assess the situation. The Thornton Hall project involves a different model and is not complete at this stage in respect of the PPP issue. Specific issues arise in respect of the residential aspect, market conditions etc., which are impinging upon the viability of this project as it stands. The issue now for tenants and Dublin City Council is to take the next step by working with the local regeneration boards on determining whether other developers can become interested in completing the project as envisaged and the extent to which traditional procurement of housing by local authorities in those areas can be part of the solution.

In regard to those who may wish to be de-tenanted to live in better conditions pending the development of their areas, I am sure that process can continue. As Deputy Gilmore noted, not all the areas have been de-tenanted and that varies from estate to estate. These are issues which Dublin City Council will consider. I note the council continues to contend this is a priority for it. We are spending just less than €1.5 billion annually on social housing, over €200 million of which has been allocated to Dublin City Council. The council's housing programme contains a multi-annual commitment to housing which is very considerable, and rightly so. We will have to determine what this setback means for the projects and whether they can be reconfigured or if traditional procurement will have to play some part in the rehousing process.

Emmet Stagg (Kildare North, Labour)
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Do not offend McNamara whatever you do.