Thursday, 19 January 2017
Topical Issue Debate
Cancer Screening Programmes
I thank the Ceann Comhairle for allowing this issue to be raised as a matter of urgency today. This concerns the publication today of the HSE report which confirmed 13 misdiagnoses of bowel cancer at Wexford General Hospital. In October 2014, two persons who had previously been cleared of having bowel cancer were subsequently diagnosed with it. This led to a review of more than 600 patients, 400 of whom had to undergo further colonoscopies, and it was confirmed in today's report that 11 additional people were identified as having cancer which, to use the HSE's terminology, was "probably missed" by the original screening process. That gives a total of 13 misdiagnoses and we know that one person died before a review could be carried out.
While there is always a risk of human error in medical assessments, it appears that this was much more and it is clear that this should not have happened. My thoughts at this time are with those who were misdiagnosed and their families. It must be an extremely distressing and fearful situation for them to find themselves in. There was also unnecessary stress for the 600 people who were subjected to a review and the more than 400 people who had to undergo a second colonoscopy. All of these people suffered additional and unwarranted stress. It appears that the hospital, on detection, acted quickly to inform the patients and to carry out a recall. However, why were so many failed screenings carried out before an issue was identified? The large number would point to systemic failures as well as human error.
The appointment of an external expert to carry out a review is welcome but it is important that this expert would be free to carry out a wide ranging review and not one just into the individual decisions of the clinician concerned. It is important that it would review the wider aspects of the issue. It is clear that there has been a serious lapse in proper health care. The families have been caused serious and needless stress, one man has lost his life and others will forever wonder whether the cancer could have been identified sooner.
The safety incident management report released today into the discovery of 13 possible missed cancers at Wexford General Hospital is another huge failure on a long and botched list of failures in the Wexford-Waterford HSE area. I would go so far as to say that probably two of the most dysfunctional strands of a malfunctioning national organisation are to be found in the HSE in the south east, in particular, in Wexford-Waterford. We have the Grace case and other similar incidents, the six year delay to a satellite dialysis service for Wexford, the removal of acute mental health services in the county with the highest suicide rate in the country, the long waiting lists, and the complete failure to provide an adequate amount of respite and residential care places for children and adults with disabilities. Now we have this too.
For the most part, the report gives a comprehensive outline of what occurred at Wexford Regional Hospital and Ely Hospital, but surprisingly, or unsurprisingly if one is familiar with how the HSE operates, there is an appalling lack of accountability on the part of those who run our health service. The HSE has its scapegoat - human error and a consultant endoscopist it has labelled "Clinician Y". That is where the HSE is happy to wrap up and tie a bow around its investigation. The problem with the human error scapegoat defence is that further questions must be answered. At some stage, Clinician Y was recruited by the HSE as a full-time permanent consultant. He was also on the specialist register of the Irish Medical Council. Nowhere in the report does the management team discuss the recruitment process of Clinician Y. Who recruited this consultant? Who provided references? Where did Clinician Y operate before operating in Wexford General Hospital? If Clinician Y carried out screenings in other hospitals before being recruited to Wexford General Hospital, what checks have been carried out in those hospitals? Has Clinician Y been replaced on a full-time basis?
The lack of accountability in how the HSE operates is shocking. It is not new and it did not start under this Government's watch, but is anyone doing anything about it?
I thank both Deputies for raising the issue and, again, pass on the apologies of the Minister for Health, Deputy Simon Harris, for not being here.
First, I acknowledge the anxiety and distress for the patients concerned in this programme and extend my sincere sympathy to the family of the patient who, unfortunately, died before the HSE review commenced.
I welcome today's publication of the report by the HSE which identifies 13 cases of probable missed cancers in patients who had undergone a colonoscopy at Wexford General Hospital under the national bowel screening programme known as BowelScreen. When the first two cases were identified, work was undertaken by the HSE’s serious incident management team and the BowelScreen programme to investigate this fully. Following the HSE audit, 615 patients were recalled for either a repeat colonoscopy or an outpatient appointment. This work led to the identification of an additional 11 probable missed cancers.
The Minister for Health has been aware of the incident and has received regular briefs on the progress of the review. The report outlines the look-back process and the actions taken by the HSE and the HSE has related these events to the practice of a single clinician. The matter has been referred to the Medical Council. I am informed that all patients and families involved have been contacted and all had open disclosure and have since been provided with the appropriate support and treatment. The full report was made available this morning on the HSE website.
Since the Wexford General Hospital incident, BowelScreen has reviewed its quality assurance procedures to ensure that all units and individuals delivering colonoscopy services on behalf of BowelScreen are doing so at the highest possible standard. All BowelScreen services are provided in internationally accredited centres. Wexford General Hospital has introduced a number of new patient safety measures across all hospital services, including the appointment of a clinical risk and quality manager.
We should remember that bowel cancer is the second most common cause of cancer death in Ireland and approximately 2,500 people are diagnosed each year. Screening is the most effective way to detect bowel cancer, including pre-cancerous changes. The BowelScreen programme provides a valuable service and 517 cancers have been detected since its initiation in 2012.
In line with good practice, an external review is due to commence immediately to see what further lessons can be learned. It will consider how the incident was identified, escalated and managed and will include recommendations pertaining to governance, accountability and authority at each level involved. The review is expected to take six months to complete and it will ensure that all lessons from the incident in Wexford General Hospital are embedded in the overall health system as quickly as possible.
It is important that confidence is restored in the cancer screening programme. As the Minister of State stated, this is the second most common cancer in the country but we have a very low uptake on screening. This is critical to people's lives because, if the cancer is caught early, outcomes are good when help is obtained. The HSE report makes comprehensive recommendations, which are welcome, but it is a wonder that those recommendations were not already in place given they seem to be fairly sensible and obvious. I am somewhat concerned that the report does not seem to have an implementation plan or timelines. Will the Minister of State state whether a plan and timeline for the implementation of those recommendations will be published and acted on?
It is striking that the issue with Clinician Y's screenings only came to light after two cancer cases were identified externally. Where is the oversight at Wexford General Hospital? Why has it taken more than two years to release the report? Why did it take more than eight months from the time concerns were first raised for 98% of those who needed to be recalled to undergo a second screening? I read today that the HSE is commissioning an external expert to review the quality assurance measures put in place and the overall management of the incident. Is that the case? If so, why is the HSE commissioning an external expert? How independent will an external expert be given that he or she will be commissioned and paid for by the HSE?
I repeat that the HSE is a dysfunctional organisation and has been for a long time. When will we get a Government that is prepared to sort it out?
With regard to clinician Y, as far back as February 2015, the clinician agreed to stand down from all colonoscopy work and voluntarily undertook not to perform colonoscopies outside Wexford General Hospital. He has remained on leave during the investigation process and has undergone retraining in colonoscopy. The Medical Council was advised of the incidents in April 2015.
I agree with Deputy James Browne that, given that this bowel cancer is the second most common cancer and that 517 cases of bowel cancer have been detected since the initiation of the national bowel screening programme, BowelScreen, in 2012, it is important that people have trust both in the service and Wexford General Hospital. Since the incidents, BowelScreen has reviewed its quality assurance indicators to ensure all units and individuals delivering colonoscopy services on its behalf are doing so at the highest possible standard.
To respond to Deputy Mick Wallace, the Health Service Executive is in the process of commissioning a national review of gastroenterology and endoscopy services, which will assess the current operation and quality and safety of the services. I will provide further information on this matter if the Deputy wishes.