Dáil debates

Thursday, 14 June 2018

Topical Issue Debate

Cancer Screening Programmes

4:30 pm

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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As the Minister for Health is aware, we have been around the houses on this today, in the Committee of Public Accounts and on Leaders' Questions. The hearing of the Committee of Public Accounts was extraordinary for the lack of information that the acting chief executive of the HSE has on this issue. He has met Dr. Scally only once. Also, the programme manager of CervicalCheck has never met him or spoken to him. While what Dr. Scally has said about the provision of information is accurate, the head of the programme offered him a facility through the HSE for direct electronic access to all the information he required. The head of the HSE did not know that today until I pointed it out to him, even though he was sitting beside him. He complimented him on putting it forward, even though I had to go through the management system.

My issue is that I sat down with the Minister and negotiated in good faith on several occasions. Through its spokespeople, the Dáil decided to go forward with this scoping inquiry, which I now regret because I think we should have voted on it. My concern is that this scoping inquiry has drifted into becoming something different. The Dáil also decided the timeline. The date of completion was the end of June. Now the Government has decided to push that back to the end of August. I want a guarantee from the Minister that this will not drift beyond the end of August, and that he will call back the Dáil so we can set up the commission of investigation. The latter point is not for debate, despite Dr. Scally saying numerous times in interviews that he would decide whether one was needed.

Will the Minister give this House a guarantee that this will happen? I am concerned that this will continue to creep. I do knot know if Dr. Scally will be able to complete the work, as he feels it is constituted, by the end of August. I understood that he was to have quick facts, that he would ascertain the key requirements for the terms of reference, and that then we would set up the commission of investigation. That was his role as I understood it. I commend him as a person. His CV is excellent. However, this has gone way too far.

I do not believe we will get the quick information we require for the families of the women who have died and for all of the women who are in very difficult health situations currently who need answers quickly. If the Government, as opposed to the Dáil, has decided that this will go to August I want it absolutely guaranteed that it will be concluded by August, because the commission of investigation cannot commence until the Dáil is sitting. The Minister will have to bring back the Dáil on 1 September, or a date close to it, for the investigation to commence. This is not what was agreed. I am willing to give its completion the benefit of the doubt, if that is what the Minister advocates, however, that date must be locked down. I want all ten terms of reference fully completed by that date. I also want to see a complete change in attitude from the HSE on information provision and how Dr. Scally gets access to people and information for this. The Minister has a role to play in this. I request specifically that the Minister actually meets the people in CervicalCheck in Limerick. They have asked me to ask him to do so to get a full picture of what is going on.

4:40 pm

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I accept Deputy Kelly's invitation to visit CervicalCheck in Limerick. We are entering a frantic number of weeks with regard to legislation, but at the earliest possible opportunity I will visit there. It would be extremely beneficial. I also want to thank the people who have been working on the front line. I believe they have been working extraordinary hours in recent weeks and months to try to get on top of this. I heard Deputy Kelly acknowledge this earlier at the Committee of Public Accounts meeting.

I thank Deputy Kelly for raising this issue and giving me an opportunity to update the House and answer some of the questions he put to me directly. For the record of the House, on Tuesday I published two interim reports prepared by Dr. Scally outlining the work he has carried out so far as part of his scoping inquiry to date. One report is a progress update and the other is a first report addressing point D of the terms of reference on information for women about screening. This is a very important area of work. There are nine other areas, but I know we agree rebuilding confidence in the screening programme is very important with regard to what women are told when they go to the screening programme about consent and open disclosure.

I welcome Dr. Scally's recommendations, as I know the Irish Cancer Society does. I have heard a number of women and next of kin who have been impacted by the audits welcome it also. I have accepted all six recommendations in full. I also welcome his approach to the work. I welcome the fact Dr. Scally seems absolutely to have the confidence not just of people in this House but of the families with whom he is interacting. I have heard some very positive feedback from them and from some patient advocacy groups in terms of how he is going about his work. I thank Deputy Kelly for acknowledging this.

Deputy Kelly is right that Dr. Scally has requested he be allowed to continue his work until the end of the summer. He said to me quite honestly that he could, in theory, rush his report but he did not believe it would do justice to the issue and that he would like to work his way through the summer months. This reflects the need to engage with more women and families affected and also to go through the sheer volume of documentation that he has received. Importantly, he has not said by any manner or means that he is off until the end of the summer, good night and good luck. He has said he will continue to provide discrete reports as they are completed so we can get on with implementing some of the practical changes. I would like to see something on governance, on which he is working within the terms of reference, and something on the laboratories and the review of contracts. I welcome the fact that today the HSE confirmed he will get access to those contracts very quickly. This is vital.

I want to be crystal clear on the record of the House that there is no ambiguity about this. There will be a commission of inquiry. There will be a statutory inquiry. I am committed to establishing one. I brought a memo to the Government to establish one. Let us be honest, I have to acknowledge that when I first came into the House it was my original intention to set up a HIQA inquiry. Deputy Kelly pointed out the limitations of this and advocated very strongly. We worked on a cross-party basis. There will be a commission of inquiry. I believe, as do most people in the House, that there is value in Dr. Scally answering as many of those terms of references as he possibly can over the summer period so we do not have to put a huge body of work into a commission that could go on for far too long.

I want to stress that Dr. Scally is very committed to the work. It is important we give him the time he has requested to complete his inquiry in a comprehensive manner. He has asked that that be until the end of the summer. It should be acknowledged that Dr. Scally was only requested to provide an update on progress at this stage but he went further than that in providing one other report. One of the recommendations made was on an ex gratiapayment, which obviously we accepted in full. I want to say on the record, in case of any confusion, this is not instead of compensation, redress or support packages. It is an additional support and its sole purpose is to ensure there are no financial obstacles to any woman or her family participating fully in the inquiry.

Deputy Kelly knows that the recalling of the Dáil and when the Dáil sits is not a matter for me, but if Deputy Kelly is asking me whether I want to see the commission of inquiry established in September and whether I want to work with Members of the House to make it happen the answer is that I do. I will work and engage, as I believe I have shown to date I would like to do, with the Opposition on what exactly we should put into the commission of investigation.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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I respect Dr. Scally. I respect the manner in which the Minister has engaged with me on this issue. I thank him for the changes he has taken on board from my suggestions throughout this. However, my issue here is very clear. I am afraid of creep, and to date this has crept enormously. Dr. Scally's comments in the media really worried me, when he thought there may not be need for a commission of investigation. His scoping is very tight. There are ten terms of reference but they are only to find the basic facts.

One of the things I believe he has to do is get the cytology results of the 209 women by laboratory, by date, by grade, by cytologist and graph them and show where the issues are and, basically, put it out there so we can see where the problems are. We do not have time to document all of these poor women's stories. They do not have the time. Remember, these are the same laboratories with the same shiny accreditation using the same staff and quality assurance and under the same tenders that are carrying out the smears now as in the 209 cases, which number, we heard today, will increase.

My real issue is that as long as this creep and this drift towards a longer period continues we will not get to the bottom of how these women ended up in the situation in the first place. We need to get there quickly and then we need an investigation as to what happened. We need to make decisions based on Dr. Scally's scoping exercise. The Minister has to ensure it is completed by August because I will come back in here, and the Minister knows I will, if this is not concluded by August. If I find out at the end of August this has not concluded I will know we are not doing the best for these women.

Will the Minister please go to Limerick and ask Dr. Scally to engage with the people in Limerick and meet the programme manager, who has never spoken to him, which is extraordinary? Will the Minister please get to the bottom of the issue that Dr. Scally has identified with regard to information provision? By all accounts, at the very beginning the programme manager offered him full direct electronic access, so who in the HSE blocked it and why? We must remember the chief executive is on record as saying he did not have a clue this happened.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I will indeed go to Limerick and talk to the CervicalCheck team, and I will thank them for the work they are doing. I just read in the news headlines as I came down the good news that Vicky Phelan received today, which I welcome and I am sure Deputy Kelly does also.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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Absolutely, 100%. It is great news. It is fabulous news.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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It is appropriate that Deputy Kelly and I acknowledge this, along with everyone in the House, because we would not be here if it were not for the work she did.

Deputy Kelly's concerned about time creep is genuine, and it is a good way of putting the idea that this could slip on and on. We need to get the answer. The idea of the scoping inquiry is to get the answer. I am very satisfied that Dr. Gabriel Scally will get a lot of good answers. This is a man who, as Deputy Kelly rightly acknowledged, has a very impressive CV and track record. He calls it as he sees it and we saw that this week. He does not take any messing around from anyone.

With regard to the issue of documents and information, I could not have been clearer with him and, in fairness, he said this publicly. I took the opportunity to phone him again yesterday to tell him if he encountered any blockage from anyone in getting any information or any records to tell me directly. He said he appreciated that and he would be back to me if it arose. I have legal powers to request documentation from the HSE and make it available to others. I do not believe I will need to use them because everyone has said they will co-operate, but I will stop at nothing to make sure he gets the information that he requires.

I also want to pick up the point Deputy Kelly made, quite rightly, and it was raised at the meeting of the Committee of Public Accounts today, on the number of cases being likely to increase. It is important that as audits are carried out and completed they are disclosed to women. Had that happened in the first place we would not have the awful mess in which women have found themselves, where information about their own health care was concealed.

Auditing is good but not disclosing audit results is the problem. I expect, as the audits are completed, that the women will be first to be notified. It will not be this House or the media but rather the women who will be informed about their medical records. Dr. Scally will be kept informed in this regard.

I am absolutely committed to setting up a commission of inquiry in September and working with the Opposition to ensure that is as effective as possible. I thank Dr. Scally for his superb work and I look forward to more of his recommendations.