Dáil debates

Tuesday, 22 May 2018

Ceisteanna - Questions

Taoiseach's Meetings and Engagements

3:45 pm

Photo of Michael MoynihanMichael Moynihan (Cork North West, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

1. To ask the Taoiseach if he has spoken with or met a person (details supplied). [19994/18]

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

My office contacted Vicky Phelan to offer a meeting with her. Ms Phelan has agreed to meet me at a date that is convenient for her. She is in regular contact, however, with the Minister, Deputy Harris.

Our priority and focus remains on getting to the truth of what happened through the Scally inquiry, ensuring that women who have been affected are contacted and engaged, rebuilding confidence in the life-saving CervicalCheck screening programme and carrying out individual case reviews of all 209 women who formed part of the audit to assess their smear tests and determine the impact that the alternative reading had on their diagnosis and treatment.

The Government has agreed a comprehensive package of health and social care measures to assist the 209 women, and their families, who have been diagnosed with cervical cancer and whose audit result differed from their original smear test.

The Government has also announced that the State Claims Agency is advancing a new initiative aimed at expediting resolution of the outstanding legal cases in a sensitive manner utilising mediation wherever possible and wherever agreed.

The impact on these women and their families of the failure of disclosure, transparency and sharing of information has been devastating, and has added to the distress and huge difficulty they are already experiencing as a result of their cancer diagnosis. The package of supports cannot undo the hurt caused, but will at least ensure that their health and social care needs will be met. Women and families will be offered support through counselling and practical assistance with costs such as childcare and travel and also access to clinical trials and experimental medicines.

The National Cancer Screening Service is writing to the 209 women, or their next of kin, apologising for failures in relation to disclosure and setting out the actions being taken to deal with the issues identified.

The Minister, Deputy Harris, has also asked the HSE to introduce human papilloma virus, HPV, testing as the primary screening method for prevention of cervical cancer as soon as possible. Like all screening tests it is a screening test, it will not be individually diagnostic and it will produce false negatives and false positives. It is, however, more accurate than the current test and we will be one of the first countries in the world to introduce it.

The Government has also agreed to the proposal of the Minister, Deputy Harris, to establish an independent board for the HSE to strengthen the management, governance and accountability of the organisation. The general scheme of the Bill has been published. The board, with strong competencies across key areas, will be accountable to the Minister for the performance of its functions.

Photo of Micheál MartinMicheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

First, I wish to say again that if it was not for Vicky Phelan we would know nothing about any of this. Given all the documentation that has emerged through the various committees of this House, both the Committee of Public Accounts and the Joint Committee on Health, and that has come into the public domain, it is quite an extraordinary fact that if it was not for Vicky Phelan's decision to reject any suggestion of non-disclosure of her settlement, we would not be here discussing this matter. That needs to be reflected on regarding the health of our public services in terms of disclosure and revealing issues of public interest, in particular ensuring disclosure to patients generally in our health service and, in this context, to women who were the victims of non-disclosure of false negatives and wrong results in terms of cervical cancer.

What I find quite striking is the very significant degree of correspondence between doctors, people in CervicalCheck and chief executive officers, CEOs, such as the CEO of the mid-western health group, the numbers of people involved in the Department of Health, HSE leadership and CervicalCheck itself yet it did not get to any policy level in terms of someone shouting "stop" and saying that we have a clear policy of open disclosure here and should disclose to the women concerned. During Leaders' Questions last week, the Taoiseach told me he had regular discussions with the director of health and well-being, Dr. Stephanie O'Keeffe. Was the CervicalCheck programme in general raised with him? Were any issues relating to difficulties, challenges or needs involving CervicalCheck raised with him in terms of its ongoing progress? The Taoiseach might indicate to the House whether any such issues were raised with him at any time.

It is extraordinary that after the former Minister, Senator James Reilly, abolished the board of the HSE, it has taken so long to restore it to ensure some degree of governance and accountability on the part of the director to a board nominated externally and not just officials being accountable to officials, which is the current position. I do not know what the former Minister, Senator Reilly, was at.

3:55 pm

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

Most people are still reeling from the sudden revelations that emanated from the aftermath of the very important stance taken by Vicky Phelan and all that has come into the public domain. There will be tiers of questions to be answered but one of the two things that are most urgent and fundamental are that this State would give complete support to those women who are most affected, namely, the 209 women instanced by the Taoiseach. In terms of the package of measures he has talked about that was announced last week, are these measures currently available to these women? If not, when will they be available to them?

Can we give absolute assurance to women who are going for smear tests today, tomorrow and the next day? The Taoiseach again instanced the fact that we will introduce a new screening process, namely, the HPV screening process. Again, can he be specific about when that new test will be introduced? I raised a matter previously that I want to clarify in my own mind so that I understand this. The Taoiseach indicated that the current testing programme has a reliability rate of between 65% and 70%. That came as a surprise to many people. The Taoiseach explained why this is the case and that the new HPV test has 100% accuracy because it tests for the HPV virus but that the virus is the cause of only 70% of cervical cancers. Will the missed rate improve substantially or, as I have read in some publications, will the existing screening continue in parallel with HPV screening to significantly increase the probability of accurate testing of cervical cancer?

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Along with others, I acknowledge the bravery of Vicky Phelan, her family and all those who have come forward to tell their stories. It is extraordinary that the chief medical officer was privy to information relating to the audit, the availability of information and the deliberate withholding of information from women and their families but did not share this information with the Taoiseach, who was then Minister for Health, at the very time when both of them were clearly in discussions around the issue of open disclosure and a policy of candour. Can the Taoiseach shed more light on those matters?

Can he also comment on the fact that, as reported in today's newspapers, the author of fairly shocking memos - a senior HSE executive - who actually made a call to withhold information from women and their families has been promoted? The Taoiseach will know that for Vicky Phelan and so many others, accountability is at the root of addressing this scandal. They have been very clear about this.

A story that gave rise to many concerns that appeared on the front of a Sunday newspaper set out a scenario whereby Emma Mhic Mhathúna would be embroiled in a scenario best described as damage limitation. I raise this issue with the Taoiseach not to make any negative assertions against him but because his state of knowledge on those matters or lack thereof needs to be clarified in the Dáil. More specifically, the concerns now involve the Taoiseach as the then Minister for Health, what he did or did not know and the nature of his exchanges with the chief medical officer. If he withheld information from the Taoiseach, has the Taoiseach addressed that issue with him?

Photo of Joan BurtonJoan Burton (Dublin West, Labour)
Link to this: Individually | In context | Oireachtas source

Like others, I would like to say how brave people like Vicky Phelan have been in dealing with this and related matters. The Taoiseach spoke about the systems the Government is putting in place, some of which sound fine. However, it is very difficult to understand others unless the Taoiseach is more forthcoming with the details of what the Government is proposing. Does the Taoiseach have clarity at this point about the lines of communications between CervicalCheck and the HSE? In his answer, he alluded to the fact that he now intends to reinstate both the HSE board and regional boards. From some of what the Taoiseach and the Minister for Health have said, my understanding is that these boards will have executive chairpersons. In particular, the HSE will have a high-level executive chairperson. That is a major change. I struggle to understand how the incoming CEO of the HSE, who will obviously be a full-time executive, will deal with that. If there are also to be regional boards, and there is a lot to be said for the regionalisation and localisation of significant elements of the HSE, is the Taoiseach really proposing a whole set of executive chairpersons along with a chief executive and about 30 very senior subordinate executives to the HSE in his plan? Could he share the plan with us? Better still, could he get somebody to draw us a graph of what this proposed structure will look like? From my experience of structures, it seems that the Taoiseach is almost overreacting with a top-heavy structure that will be almost impossible to operate. The leadership issue relating to motivating the staff in the HSE seems to be entirely absent.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

If we do not give the Taoiseach time, he will not be able to draw any graphs for us and he certainly will not be able to tell us what he is proposing to do.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

What Deputy Micheál Martin said is quite correct. Were it not for Vicky Phelan's strength and bravery in refusing to agree to a confidentiality clause, we would not know what we now know. Once again, I wish to put on the record that the State Claims Agency and the State did not request that. In fact, they counselled against that being done.

I would have met Dr. Stephanie O'Keeffe approximately every two months when I met the directorate. Certainly, any conversations we had on CervicalCheck were not about the audit or the issue of non-disclosure. They would have been about the functioning of BreastCheck, CervicalCheck and BowelScreen, which was relatively new at the time. The two issues that would largely have arisen would have been whether the targets for participation in BreastCheck, CervicalCheck and BowelScreen were being met because we were always very keen to ensure that people were participating in those screening programmes. The big job of work that was being done was extending BreastCheck to an older cohort of women. That was one of the main projects about which I would have spoken to her frequently. There were other issues of public health relating to anti-smoking campaigns and so on. Those would have been the main areas on which we interacted.

Deputy Howlin asked me about the package of supports being offered to the 209 women and their families. Public health nurses are visiting each of the women or their next of kin individually, trying to prepare an individualised package. I am sure the Deputy has spoken to some of the people affected and all of those involved have different needs in light of their circumstances. Individual meetings are happening with public health nurses - in people's homes, sometimes in a hotel and sometimes in an office or a hospital. That is ongoing. I am not sure if everyone involved has had such a meeting but many did so last week and many will this week as well. Those packages are being put in place.

Up to now, the plan was to introduce the new test in October. Given the change of personnel and the disruption to CervicalCheck, it is still anticipated that the October target will be met. However, it will be more difficult now given that there is no clinical director and so on. However, it is still intended that it be introduced in October. It will require tendering for labs and for virology for example.

4:05 pm

Photo of Micheál MartinMicheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Does that mean it will be delayed?

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

October remains the target date.

Deputy Howlin asked some very valid questions about the science of the new test. I am reluctant to answer those questions. It can be dangerous to know something about something, because one may answer-----.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

I raised it the last day and the Taoiseach did not get a chance to answer it.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am reluctant to answer for those reasons. However, I know that, since 2015, HPV testing has already been introduced in circumstances where a low-grade or high-grade abnormality is identified. The plan now is to move to primary screening whereby the test is done for HPV first and cytology later. At least that is my understanding, but I would be afraid to answer that question in too much detail without knowing what is involved.

The patient-safety package was published in October or November 2015 at the patient safety conference, which, if I recall correctly, was held in Dublin Castle. Any discussions I had with the CMO about the form of open disclosure we would select happened in 2015 before the publication of that package and many months before the first memo on the CervicalCheck audit arrived in the Department of Health, which was in March 2016. I believe the first memo arrived on 29 March 2016. I ceased to be Minister for Health in the first week of May 2016. Hence, there was a period of about five weeks during which I could have been informed and there was an opportunity to do it. There was a significant issues paper and a MinMAC meeting in that five-week period. As the former Minister of State, Kathleen Lynch, who was present and received those papers, can attest, it was not in the significant issues paper or raised at that MinMAC meeting. During that period, however, the audit was still under way. Perhaps this explains why that was the case.

It is proposed that the HSE board will have between nine and 12 members. There will be a CEO - the director general post will evolve into the role of CEO - and there will be a chair. I can understand some of the confusion on that. I know that in past cases, for example, that relating to CIÉ, there was an executive chair who was effectively the chair and the CEO. That is not intended in this case. There will be a CEO. The chair will not be a member of the executive, but will have an enhanced role. Rather than being a chair who attends monthly meetings, the person appointed will have a greater involvement and will be asked to devote one day or two days a week to the job. Given the size of the organisation - 110,000 employees and a €16 billion budget - it would be more appropriate to have a chair who puts in a day or two a week and that is what is intended.

Deputy Burton asked about the regional boards. To a certain extent, they exist already. The hospital groups all have boards and these have been populated. However, they do not exist on a statutory footing. The plan, in line with what is proposed in the Sláintecare report, is to bring the hospital groups and the community health organisations together into a single combined hospital group.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

To re-rationalise them.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

I thank the Taoiseach. We need to move on.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Each of those will have its own board.

Photo of Joan BurtonJoan Burton (Dublin West, Labour)
Link to this: Individually | In context | Oireachtas source

We need that graph.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

That will all be graphed and mapped out in the Sláintecare implementation plan, which, I anticipate, will be published certainly before the summer recess.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The Taoiseach did not answer my questions.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

Which one?

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I would need another seven or eight minutes to answer all the questions.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I raised the matter of the HSE executive - the promotion.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I have not read that story.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

The Taoiseach is not aware.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I also raised the Sunday newspaper story about Emma Mhic Mhathúna.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I answered that in Monday's newspapers.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

This is the Dáil.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

This is the Dáil and this is where the Taoiseach is supposed to-----

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

Question No. 2 is in the name of Deputy Burton. For this question, we will only have about ten minutes if that is okay.