Dáil debates

Tuesday, 20 May 2008

8:00 pm

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I regret that the Minister for Health and Children did not remain in the House for a few minutes longer. I cannot think of anything more important than the health and concerns of the people, 4,600 of whom have been asked to wait a maximum period of eight weeks before finding out the exact position regarding their X-rays and CAT scans. It is of fundamental importance to our society that when an error is made or health misdiagnoses take place, there is complete transparency, openness and honesty in respect of what happened.

It is time for the Government and the Health Service Executive to think again. It is time to concentrate on shortening considerably the maximum eight-week waiting period before learning one's correct diagnosis. There are many ways to so do, some of which have been discussed by the HSE and some of which have not. The Minister of State, Deputy Barry Andrews, and his boss, the Minister for Health and Children, Deputy Mary Harney, have a duty of care to all the people affected to ensure this waiting period is as short as possible. They must wait for eight weeks, or 56 days and nights, although the original X-ray may have been taken more than a year ago. If something is wrong, people cannot afford to wait.

The health service in its entirety, including doctors and radiologists, must act in concert with the HSE, the Minister of State and the Minister — who would not wait five minutes for Members — to ascertain whether the waiting period can be abridged and whether something can be done to sort it out. Why can this not happen within one week or immediately? There is no reason people should be obliged to wait for eight weeks - one would not wait eight weeks for a tooth filling. Thankfully, the majority of those concerned have been told there is nothing wrong with them. However, many of those who have been in contact with my colleagues and me have had cancer in the past. Many have put behind them breast or lung cancer and have had X-rays in the interim. Such people are deeply worried about what is happening at present. They suffer anxiety and sleepless nights, and their families also are worried. It was not good enough for the Taoiseach to state today that a precautionary principle is being applied and that eight weeks is okay. It is never okay and never will be acceptable. That it has come to this is a disgrace.

This happened because there was no oversight and no audit. I have to hand Ms Justice Maureen Harding Clark's report into the Dr. Neary affair. Dr. Neary got away with his actions because there was no audit of his work. While I do not suggest the consultant in this instance is in the same realm, the key point in the Harding Clark report stated there must be clinical audit of all consultants in the system. However, no clinical audit of the work of the man concerned took place and this is the reason these people are suffering tonight.

I wish to make two further points. Although what took place was bad enough, the Government also messed up the mail merge. The health service has 100,000 employees, as well as an entire Department of Health and Children. However, faced with the obligation to contact 4,600 people, the mail merge was outsourced and given to a company that could not deliver. It messed up the mail merge and sent the wrong letters to the wrong people, including letters to people who are deceased. Not only did it send a first letter, it also sent a second letter. Today I received a telephone call from the family of a person who was in her 90s when she passed away. They had previously received two letters addressed to her but today they received a telephone call asking that she go to the hospital to have her X-ray examined. This demonstrates how appalling this mess is.

The Government has demonstrated it does not care. The Minister will not even wait to discuss what is the most important issue to have arisen in my region for many years. It is an absolute and total disgrace. The Taoiseach has stated he is a republican and has spoken of the new Republic. I understand he has used words such as "equality", "brotherhood" and "fraternity". In a republic other than a banana republic, equality of treatment above all else would mean emergency action in this case. One would press all the buttons to ensure these people were looked after and would ensure that no head would lie on a bed worrying about his or her diagnosis for a single night longer than was necessary. This is the key. However, the Health Service Executive could not care less and is not accountable and the Minister will not sit and listen to Members for five minutes.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In the course of the career in politics of the Minister of State at the Department of Health and Children, Deputy Barry Andrews, he should learn the lesson of the example provided tonight by his senior Minister. Her walking out at the outset of this debate is deplorable——

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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It was disgraceful, appalling and shameful.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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——and gives a very bad signal to the people of the north east, on whom she has already turned her back repeatedly in respect of the health issues of concern to them. I have to hand one of the letters sent out by the Health Service Executive to thousands of people in counties Cavan, Monaghan, Louth and Meath. It was received by one of my constituents in Carrickmacross, County Monaghan. The woman in question is willing to share the information that at the best of times she is prone to anxiety and stress. One can only imagine her distress when she read this letter. She now faces two months living in fear and trepidation as she awaits the outcome of the review of her case.

One of the first things that must be done by the Minister for Health and Children is to provide the resources to expedite the reviews and to shorten the agonising waiting time for patients. Some letters from the HSE have arrived months after the person in question has died as a result of cancer, greatly adding to the grief of their loved ones. While the HSE originally stated that four people who were misdiagnosed had died, I understand this figure could prove to be as high as ten.

This issue first came to public notice with a report in The Sunday Tribune on 30 March that the HSE in the north east was considering a review of radiology services, possibly involving the rechecking of thousands of scans for cancer. Given the experience of women in the midlands, this was of major concern to those in the north east who had undergone such scans. Concerns were expressed directly to me at that time. On 31 March, the HSE issued a statement indicating that a limited review was under way. The HSE did not state the exact nature of the tests involved and it was unclear whether the HSE had contacted patients who might have been affected. There was no clarity for patients, even though the HSE stated that the requirement to inform patients and their families must take precedence over all other considerations. I stated at the time that there should be no repeat of the mismanagement and lack of information that surrounded the midlands cancer screening scandal. I also stated that inadequate resources and facilities for oncology in the north east had been highlighted repeatedly by frontline staff and that cancer services in this region required significant enhancement. I regret that from what has been learned subsequently, this appears to be a repeat of the midlands scandal.

A locum radiologist was employed by the HSE from August 2006 to August 2007. My Sinn Féin colleague on Louth County Council, Councillor Tomás Sharkey, has highlighted how a man in his constituency was X-rayed in May 2007 and was sent home after being given the all-clear. On 14 November 2007, however, he was re-admitted to hospital and X-rayed. On this occasion, the radiologist on duty immediately recognised cancer on the X-ray. The second radiologist checked the May 2007 X-ray result and realised it was clearly shown on that one too. The patient in question was told he had cancer only when he went to another hospital for further treatment. X-rays of this man were taken hours before his death and the family have never been given a proper explanation as to how this tragic case was handled.

The locum radiologist who worked from August 2006 to August 2007 lives in Scotland. In the Irish edition of the Mail on Sunday of 18 May, he alleged he was being scapegoated. He stated he knew nothing about X-rays being recalled, as no one had informed him of the review. He also stated, "Why I am being singled out for all of these supposed mistakes when there were others in those hospitals who also saw the X-rays bewilders me."

What was most significant in this report was the alleged comment from a person described as a senior source close to the review who said other members of staff had also viewed the X-rays of some of the patients who later died and had also missed the cancer lesions. The source is quoted as saying there were other weak links in the chain. Another source who attended the meeting held after the diagnosis of one patient said the oncologist's age was a major factor in his being singled out by the review team. This raises very serious questions.

We hear a lot about clinical governance and the better management of our health services. Are we looking at a cover-up of the systems failure for which the current Minister and successive Ministers are ultimately responsible? The Minister for Health and Children, Deputy Mary Harney, must ensure complete and comprehensive information is provided, including by way of a public inquiry if necessary, on the systems failures that have led to the terrible situation facing thousands of people in counties Cavan, Monaghan, Louth and Meath.

We need an explanation for the delay in acting on this matter after it first came to the notice of the HSE. Coming in the wake of previous cancer diagnosis reviews, all of this highlights the failure of successive Ministers, the Departments and the HSE to ensure the delivery of the best care for all patients at all locations where cancer services are provided.

Photo of Barry AndrewsBarry Andrews (Dún Laoghaire, Fianna Fail)
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I will be taking this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The HSE has instigated a look-back review of all chest X-rays and CT scans reported on by one locum consultant radiologist, who worked in Our Lady of Lourdes Hospital in Drogheda and Our Lady's Hospital, Navan between August 2006 and August 2007. This decision was made following expert clinical advice from Ireland and the UK and an examination of the cases raised. This review is being done as a precaution and as a reassurance for patients.

The look-back review was prompted by concerns that four patients in two Louth and Meath hospitals during 2006 and 2007 had their diagnoses delayed due to an abnormality on their chest X-rays not being noted on initial examination. These patients were subsequently diagnosed with lung cancer by follow-up X-rays and have all passed away.

The Minister was informed in March of this year that the HSE, following further examination of the issue, was considering a separate look-back review regarding the work of that radiologist. The HSE issued a press release on 31 March following media reports concerning radiology services in the north east. That press release was based on the information available at the time. In its subsequent assessment of the situation, and taking into account the advice of external experts, the HSE agreed that the look-back review would include 70 CT scans.

Planning for this review commenced at the end of March 2008. A steering group was formed by the HSE on 9 April 2008 to oversee the radiology review. From April to 14 May, the steering group undertook preparatory work which included defining the methodology for the look-back exercise, sourcing radiologists to undertake the look-back, arranging indemnity for the reviewers, developing the process and resources for the look-back exercise across two X-ray departments in Navan and Drogheda and establishing the communication needs around the review and putting plans in place to meet them.

Chest radiographs are performed for many reasons — most are done for respiratory tract infections, bronchitis, asthma, pneumonia, accidents, injuries, chest pain and heart failure. A small number are done for possible lung tumours, but the majority of patients who are being checked are extremely low-risk and are included as a measure of prudence.

Numerous challenges arose throughout this planning phase, particularly with regard to securing radiologists in Ireland who would undertake the look-back in association with the Louth and Meath radiologists. Following a review of options available, including external companies in the UK to undertake the look-back, a decision was made to proceed with an internal-external mixed panel of radiologists from Louth, Meath and Northern Ireland. The look-back review commenced on 15 May 2008 and it is expected that it will be completed within eight weeks. As each X-ray and CT scan is reviewed, the HSE will write to the patient to let him or her know the result of the recheck.

The HSE announced today in a media statement that, in the context of this review and during the last three weeks, two people already receiving treatment for lung cancer were identified to the review team. These people were found to be part of the original group of 4,500 patients to be reviewed. The HSE has advised the Department that, since these two people were identified, the focus has been on checking on their current status and care and assessing their significance in the context of this review. Before contact was made with the families of these patients and information provided to their families, it would have been inappropriate ethically and medically to make any public statement with regard to these cases. The HSE has been making contact with the families concerned since Friday, 16 May 2008 and continues to do so.

The HSE has also advised the Department that information confirmed by a HSE official to public representatives yesterday pertaining to these two cases was not in line with the HSE policy of not releasing any detail of the review or the people concerned until the review process is complete.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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Will he or she be sacked?

Photo of Barry AndrewsBarry Andrews (Dún Laoghaire, Fianna Fail)
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An information line has been put in place and people affected by the review can make contact with the HSE directly. The number is 1850 241850. In patients' interests and in keeping with the lessons learned from previous reviews, neither the HSE nor the Department will report any further on specific details of the reviews until they have concluded.

I agree with Deputies that it is vitally important we ensure the delivery of best cancer care for all cancer patients. This is the reason this Government is totally committed to implementing the HSE national cancer control programme. The programme will offer equal access to all patients to the expertise of cancer specialists working together in major centres serving large numbers of patients. The designation of cancer centres aims to ensure that patients receive the highest quality care while at the same time allowing local access to services, where appropriate.

It is also important people are fully aware that where diagnosis and treatment planning are directed and managed by multi-disciplinary teams based at the cancer centres, much of the treatment, other than surgery, can be delivered in local hospitals. Chemotherapy and other aspects of follow up care will be carried out at local hospitals. This will involve significant realignment of cancer services to move from the present fragmented system of care to one that is consistent with international best practice in cancer control.

It is time to recognise that we cannot achieve high standards for cancer services by trying to provide a full range of services in centres that do not provide multi-disciplinary care and have very low volumes of patients. With the implementation of the national cancer control programme we are moving towards a more equitable system that can produce better outcomes than the existing system.