Mary Harney (Dublin Mid West, Progressive Democrats)

There was a large number of questions asked. In reply to Senator Feeney, all of the mammograms have been reviewed by Dr. Ann O'Doherty at St. Vincent's Hospital and the final patient will be met tomorrow. Tomorrow afternoon, when the last patient is met, we should be aware of the outcome of all of the readings of the mammograms.

On the extension of the age for BreastCheck, I was asked earlier about it being an annual check. In Britain it is done every three years. In Ireland we meet the best international standard recommended, which is every two years. The National Cancer Forum does not recommend reducing the age criteria below 50. It recommends moving to an older rather than younger age and we must adhere to the advice of the experts. I do not make these decisions.

Senator Feeney also asked how we would inform the public. Communication is important here. I hope Professor Keane will engage in communications because in talking about some of these issues I find — I do not want to sound arrogant — that people are misinformed. Among those with whom we must communicate are clinicians because patients have great faith in their doctors. The reality is that surgery, for example, is moving towards specialist procedures and generalists are not appropriate for matters such as breast cancer, and many patients do not understand that. I hope that between the Health Information and Quality Authority, HIQA, with its emphasis on standards, and Professor Keane and the team he will assemble around him, we will engage in communications on many of these issues.

Senator O'Malley asked about the consultant contract. I stated publicly last week that we have come to the end. The independent chairman made recommendations a couple of weeks ago. I accepted them. The HSE accepted them. The doctor representative body seemed to accept them but, notwithstanding their acceptance, people want to start negotiating all over again and time is running out. We are recruiting virtually no new consultants into the system. We are depending, as people retire, on locums. That is not satisfactory but we cannot continue to recruit on a contract of employment that is unsatisfactory as far as the public health system is concerned. The advertising campaign, which was suspended at the request of the chairman, will now proceed. I have been discussing that with the HSE, with the chairman of the board, with Professor Drumm and with my officials in the Department of Health and Children.

On private hospitals, we have already written to the independent hospital group and to insurers on the new standards because approximately 500 breast surgeries seem to take place in the private system. Clearly, there is no licensing or accreditation regime in Ireland for private provision, and this is a significant deficit. We have established the patient safety commission, chaired by Dr. Deirdre Madden BL, to examine these issues and what kind of licensing or accreditation system we need in place, and she is due to report next summer.

The intention is that the standards will apply. The Minister for Health and Children has an obligation to patients, whether public or private, to ensure they are cared for appropriately.

HIQA's inspectorate will apply to places where children — whether Irish or non-Irish — reside, to the disability sector and to public and private nursing homes. It applies, not to asylum cases where families are living, but to places where children, people with a disability or older people are in care.

As Senator Leyden will be aware, if I recall correctly from my recent meeting, one of those surgeons is shortly to retire. The intention, given the recommendation from the Royal College of Surgeons which is the training body for surgery in Ireland, is that there should be a joint department of surgery between Portiuncula Hospital and Roscommon County Hospital and that their surgical affairs should be arranged on that basis. The HSE recruited the chief surgeon in Scotland who is working with both hospitals and with the clinicians to make that a reality. If memory serves me correctly, a meeting on these issues took place this week in Roscommon. From my point of view, and that of the Government, we want services to be provided as locally as possible to where people live provided they can be quality and patient-safety assured.

On accident and emergency department services, there is a new stroke drug which is suitable for only certain stroke patients. It must be administered within three hours of a person having the stroke. It must be administered by highly specialised staff or otherwise one could kill the patient. If we take people to a place where we do not have the expertise to administer a drug of that kind, for example, and if we have delayed the vital time in getting the person to the centre where that could happen, it could have dire consequences.

After 5 o'clock in the evening, in the main, our accident and emergency departments are staffed by junior doctors. These are doctors in training. That is not satisfactory. We must put patient safety and quality first in everything we do. That must come before constituencies, institutions, doctors and whoever. The Minister for Health and Children has an ethical obligation to stand up for what is right in terms of patient safety.