Frances Fitzgerald (Fine Gael)

I move:

That Seanad Éireann, recognising that:

the Health Service Executive, HSE, has frozen recruitment in the health service for the month of September;

during the recent general election both the Taoiseach and the Minister for Health and Children promised the creation of 4,800 new posts in the health sector by the end of the year;

and noting:

the crisis of confidence affecting cancer services and in particular the suspension of breast cancer treatment facilities and misdiagnosis first highlighted by Rebecca O'Malley in Cork earlier this year;

calls on the Government to;

clarify recruitment plans for the HSE; and to

outline the measures it intends to take to restore confidence in cancer services.

I am glad to have the opportunity to move the Fine Gael Private Members' motion on health and I welcome the Minister to the House this evening.

Obviously, this is a critical issue for people. Recent weeks have been shocking for many patients. In particular, cancer patients cannot believe some of what they have heard in the past few weeks, and with good reason. In the brave new world of the Health Service Executive, apparently it has let its services grind to a halt in some areas. This has been outlined in the newspapers and is for a sadly familiar reason, namely, because it has overrun its budget. Such overruns were much heard of in the old days when the health boards were responsible. However, it had been hoped that, following the upgrading of the health board structures into the HSE, the change regarding budgeting would be obvious and such difficulties would not arise.

Instead of several small overruns, we now have a fairly massive overrun, as well as major inefficiencies. This is a game of punish the patient, because when recruitment is frozen without consultation with relevant front-line health personnel, patients suffer. In recent weeks, Members have heard case after case outlined by patients themselves, their consultants, hospital staff and nursing personnel. The people on the front line state clearly that patients are being adversely affected. The Minister has stated on a number of occasions that she has faith that there will be no negative patient outcomes. I hope she is correct, but the evidence from people's direct experience does not seem to support her.

Before the general election the Eamon Keane "Lunchtime" show on Newstalk exposed a plan for the axing of 1,000 health sector jobs, mainly front-line jobs. The Minister rubbished the story and denied cuts would come from the front line. At the time she stated, "Reports about staff levels in health are totally inaccurate. There will be substantial increases, not reductions, in staff levels this year."

The Taoiseach also got involved in the debate about whether there would be health cuts. He stated that Newstalk had "got a bum steer". It is now clear that if one wants the truth about the health service one might be better advised to go to Newstalk than to go to either the Minister or the Taoiseach, judging from what was stated at that time about the health cuts and what we have seen in recent weeks in the freeze on recruitment and on services for September. It would seem the promises and the reassuring words to patients were not worth the candle. The election happened, the Minister was re-appointed and the recruitment freeze began. The Minister's promise that such measures would not reduce services was inaccurate. One need only ask the 30 nurses and four consultants at Sligo General Hospital whose contracts are not being renewed as a result of the freeze or the chairman of Sligo hospital's medical board, Dr. Niall Considine, who described the cull of its temporary staff as "swingeing cuts" that will reduce breast operations by 50%, or read the motion that was passed by the executive council of the Irish Nurses Organisation. The INO, whose members should be in a position to know, states that the cutbacks curtail essential services, from baby vaccination clinics to palliative care. They are on the front line and this is what they are saying. Mr. Liam Doran, the general secretary of the INO, described the cuts as unforgivable. Even the Minister of State at the Department of Health and Children, Deputy Jimmy Devins, admitted on RTE News on Friday last that while the HSE states patients' care will not be affected by the cutbacks, staff have told him otherwise. I must ask how cuts that are doing grievous damage to patient care can be defended. If the Department of Health and Children and the HSE are so concerned about strategic management in our hospitals, how can they push this recruitment freeze? Surely there is a better strategic response to overspending than damaging patient care and what about the 4,800 new posts?

There is much talk of managers getting bonuses. Given that the Minister is imposing a freeze on recruitment and given that there is an enormous budget overrun, how can these bonuses be justified? The Minister could buy many nursing hours for those thousands of euros.

It appears the Health Service Executive is making decisions without the input of hospital staff who know the realities of patient care. There is strong feeling in the health services that front-line staff are not being consulted enough and that their input is not being sought on decision-making at a higher level. Surely it is important to note the views of those who meet the patients every day. It seems to be a clear issue of management.

There is an Alice in Wonderland quality to the exchanges between Professor Drumm and the Minister, or maybe it is a "good cop, bad cop" one. The Minister states no freeze in May and Professor Drumm announces one in September; Professor Drumm states public provision would have delivered radiotherapy services quicker and the Minister states the PPP model will do it faster; and the Minister states co-location is the way to go, yet there are reports of Professor Drumm querying this behind the scenes.

I also note that Professor Drumm is giving a briefing to all Oireachtas Members, chaired by the Ceann Comhairle, in a local hotel. While this also happened last year, there is confusion in executive responsibility if the Ceann Comhairle is chairing a meeting of all Oireachtas Members outside of the Dáil. I am all in favour of getting good quality information from the Health Service Executive, but I certainly query what the Ceann Comhairle is doing chairing this meeting. One could imagine him in the financial services centre next, chairing a meeting of concerned players in the financial sectors. It is strange that he is chairing the meeting and it ought to be questioned whether that is an appropriate role for the Ceann Comhairle.

The second part of our motion deals with breast cancer services. I note and welcome the Minister's announcement today. Of course it raises issues about transport and support for patients who must travel long distances, but we have waited a long time for centres of excellence and what every woman with breast cancer needs is a centre of excellence where she can get the best quality diagnosis, treatment and help, and to increase her chances of survival by at least 20%.

I draw the House's attention to the recent statistics from the National Cancer Register, reported in The Irish Times, that one in 11 women in Ireland will develop breast cancer, 2,352 new cases of breast cancer were diagnosed in 2005 and approximately 650 people die from the disease every year. According to the Irish Cancer Society, there is no systematic approach to care or adherence to national quality assurance standards, and this is entirely unacceptable. Patients could not have put it better themselves. The lack of national quality assurance standards has created a crisis of confidence about breast cancer services in the State.

I recognise there has been some movement on this recently. It started with the case of Rebecca O'Malley in Cork earlier this year. A series of mis-diagnoses and questionable treatment practices have led to a real fear about the quality of our treatment services. Now we have inquiries into treatment practices at Barrington's Hospital in Limerick and a review of thousands of mammograms and breast ultrasounds at the Midlands Regional Hospital in Portlaoise.

As if all this was not enough cause for concern, it now transpires that the Department of Health and Children was aware of seven separate issues concerning the quality of breast cancer service at Barrington's Hospital some 19 months before it took action to address these concerns. This was reported in The Irish Times on Saturday, 22 September last. The newspaper had seen correspondence sent to Professor Brendan Drumm by Paul Barron, assistant secretary of the Department of Health and Children. In his letter Mr. Barron asked that specific issues be examined at the hospital, including the fact that mastectomies were performed on a day case basis and that breast surgery was undertaken without prior imaging. This is scandalous. The Irish Times further stated that, "Other concerns outlined in the letter to Prof Drumm include the fact that there was no multi-disciplinary team working in relation to breast services; that the consultant radiologist worked single-handed, meaning there was no guarantee that mammograms were 'double read', and no quality assurance framework was in place." This refers to 2007, when we have known for many years the nature of quality care for breast cancer. Furthermore the letter revealed that patients who "encountered difficulties" at Barrington's were referred to symptomatic breast services in Dublin rather than the Mid-west Regional Hospital and this led to additional trauma.

However, the HSE decided that as Barrington's Hospital was a private hospital, it did not operate under the aegis of the HSE. This is a damning statement and I want the Minister to address this specifically. For example, VHI has no difficulty in paying private hospitals. Clearly, there is a issue of standards which must be met in that VHI is paying these hospitals, but what will we do about the issue of standards in the case of private hospitals so that the same statement, that a hospital did not operate under the aegis of the HSE, is not made again? Obviously, when it comes to patients' safety and quality of treatment, public or private ownership should not come into consideration and the HSE, or perhaps someone in the Department, should immediately have acted in the interest of public safety. Will the Minister outline her approach to this and the action she proposes to take to ensure all private hospitals are subject to the highest standards and state who is responsible for taking action where such a report is made from her Department to the HSE? Many people are concerned about this.

The Minister, stating that Barrington's Hospital was ordered to cease breast cancer services last month, said that concerns about the hospital were not forthcoming "until the start of August of this year". This sparks the obvious question, did the Minister make misleading comments on this issue or was she simply not aware of the details of it? I want the Minister to inform the House of the timeframe of her knowledge of this and the action that should have been taken.

It is clear the HSE needs to invest in specialist centres for breast cancer treatment. I welcome the Minister's comments and the initiative she announced. Specialist centres must operate a multidisciplinary model of care. They were first proposed first years ago by Professor Niall O'Higgins. One can ask what has happened in terms of these centres for the past seven years. It is a fact that 20% more women would survive if these centres were in place. That means, unfortunately, that many women have died in this country because they did not have access to multidisciplinary specialist centres.

I call on the Minister to clarify the recruitment plans for the HSE, to outline how she intends to meet the promise to create new jobs in the health sector by the end of the year, and to lift the recruitment freeze that is having a devastating effect on front-line services in many hospitals. I also invite her to outline what measures she intends to take to restore confidence in cancer services. I intended to call on the Minister to reveal the timeframe for the establishment of specialist breast cancer services but perhaps she can indicate also what is the timeframe for the announcement she made today. When does the Minister expect all of the services to which she referred to be up and running?

Lives depend on competence in this area and this competence has been in short supply. We have been big on promises and small on delivery. When it comes to patient care, significant improvements are needed so the issues I outlined, which received major attention in recent weeks, are rectified.