Fergus O'Dowd (Louth, Fine Gael)
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It is becoming increasingly difficult for the public to understand why, despite so many external reviews of clinical services in north-east hospitals, so many problems continue to occur. External independent reviews have been conducted in the past few years on services in Cavan, Monaghan and Navan, and on maternity and midwife services in Drogheda and Cavan. All of these reports have been critical of clinicians and of lay management. They have highlighted deficits in staffing levels and in management oversights.

Now we hear of another external independent review of radiology services conducted at a time when it seemed there were significant problems with staffing levels in the radiology units in Drogheda, Dundalk and Navan hospitals. I raised the serious concern outlined in 2001 by a consultant radiologist in the region about the dependence of the hospitals on locum consultants and the intolerable work pressure on the permanent staff. Is it true that a shortage of consultants led to concerns about the ability of all three hospitals to provide a full range of radiology services? Is it true that the significant work pressures, and the resultant work practices, contributed to a climate where the work of a locum consultant was not monitored or audited within the Louth-Meath radiology department? What confidence can this House and the public have in the ability of the HSE to provide safe acute hospital services in the north east?

This review took place. It was initiated in early March 2006. It was commissioned by the HSE by an outside consultant. The problem is that, just after that review commenced, there was a consultant radiologist who took up to 6,000 X-rays of 4,500 persons, many of whom must have had two or more X-rays. As a result of mis-diagnosis, at least six persons died subsequently of lung cancer. These incidents occurred over two years ago and some people, even today, do not know what the full outcome of their radiology was after this review took place. Everybody knew about this, but nothing happened.

The key point relates to the recommendations in this report which were issued in December 2006. To date, some of these recommendations have been implemented, some are currently being worked on, while others have not been progressed for a number of reasons, including the financial and recruitment implications. However, the facts are that people have died prematurely because of errors that were made.

I want to know what this review found out. What was it saying? What were the recommendations? I put it to the Minister that inadequate action was taken. Subsequent to this review we had the appalling vista of 6,000 X-rays being revisited and upwards of 150 persons at least have been called back for a review of their X-rays, some of them two years after they were taken.

John Moloney (Laois-Offaly, Fianna Fail)
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I hope in the response I can cover the points raised by Deputy O'Dowd. I will be taking the matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney, who cannot be available this evening.

It is important to distinguish clearly between the review referred to by the Deputy which was carried out in 2006 and the review currently under way. The 2006 review was essentially concerned with organisational arrangements to ensure optimum efficiency. The current review is concerned with patient safety.

In 2006, the Health Service Executive commissioned an external human resources and industrial relations specialist to carry out a review of the organisational arrangements in the department of radiology at the Louth-Meath hospital group. The joint department of radiology provides services at Our Lady of Lourdes Hospital, Drogheda, Our Lady's Hospital, Navan and Louth County Hospital, Dundalk. The HSE advises that the review was commissioned as an internal advice document for the hospital group with recommendations on the optimum organisation arrangements for the department. The hospital group wished to ensure that it would make best use of the personnel and expertise in the radiology department and across the three hospitals, to meet the service requirements of the population in Louth and Meath. The review was finalised in 2006. A number of recommendations came out of the report dealing with staffing levels; consultant involvement in management; other governance issues; information and communication technology support; safety, health and welfare at work; communications; and service developments.

The Department has since been advised by the HSE that the hospital group has taken the recommendations on board and has worked with the staff of the radiology department in the Louth/Meath hospital group to progress the implementation of the recommendations as far as possible. Some of the recommendations have fed into the process of the overall reconfiguration and development of hospital services in the north east, and are currently being addressed by the radiology network, which was established following the teamwork report on health services in the north east.

The HSE has stressed that the 2006 review was commissioned as an organisational design and administrative aid. The current look-back review of X-rays and CT scans in Louth/Meath hospital group was prompted by concerns that four patients had their diagnosis delayed due to an abnormality on their chest X-ray not being noted on initial examination by a locum consultant radiologist. These patients were subsequently diagnosed with lung cancer and, unfortunately, have since passed away. The HSE arranged for these cases to be reviewed by an external expert. The HSE also decided that a look-back exercise was required to review the approximately 6,000 X-rays and 70 CT scans reported on by the locum consultant radiologist between August 2006 and August 2007. The look-back review is being carried out by a panel of radiologists from Louth/Meath and Northern Ireland.

The HSE has stressed to patients that the look-back review is a precautionary measure. 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 would have been done for possible lung tumours, but the majority of patients who are being checked are extremely low risk and included as a measure of prudence.

In the interests of patients and their families, the HSE is not making any public comment while the look-back review is ongoing. When all the X-rays and CT scans have been reviewed, a report will be produced which will detail the background to the look-back review, the methodology, the outcome and the learning from this review. It is expected that the final report will issue within four weeks of the completion of the review.