Áine Brady (Kildare North, Fianna Fail)

I welcome the opportunity to set out the position on the Health Information and Quality Authority, HIQA, and its role with regard to the Health Service Executive, HSE. The HSE was established in January 2005 under the Health Act 2004 as the single body with statutory responsibility for the management and delivery of health and personal social services in Ireland. HIQA was established in May 2007 under the Health Act 2007 and its mission is to drive high quality and safe care for those using health and social services. Key functions which enable it to fulfil its mission include the setting and monitoring of standards. Both the HSE and HIQA act under the democratically set policies of the Government which have also frequently been approved by the Oireachtas and both are fully accountable as public service organisations to the Oireachtas through the Minister for Health and Children.

A number of standards have been developed and published by HIQA to date. Examples include the national quality standards for residential care settings for older people in Ireland published in 2009 which are used as the basis for registration and inspection of public and private nursing homes and the national standards for the prevention and control of health care associated infectionspublished in 2009 which will form the basis for hygiene inspections and audits of facilities provided by and on behalf of the HSE. HIQA operates in an open and transparent fashion and reports on its activities, including inspection and monitoring reports, are routinely published on its website. Where deficits are identified, its approach is generally one of assisting service providers in making the necessary improvements.

In 2007, at the request of the Minister, the Government approved the national quality assurance standards for symptomatic breast disease services. The standards, adopted by HIQA, were prepared by a national group chaired by Professor Niall O'Higgins which comprised experts in the major cancer disciplines, including surgery, pathology, radiology, medical oncology, radiation oncology, nursing and general practice. It also included patient advocates from the Irish Cancer Society and Europa Donna. The purpose of the standards was to improve the quality of care for women with breast disease in Ireland and address the fragmentation of services nationally at the time.

Also in 2006 the Government adopted a new national cancer control strategy, NCCP, setting out a way forward for cancer control in Ireland. On foot of the Government strategy, the NCCP was established by the HSE in 2007 and, accordingly, eight cancer centres were designated. In November that year Professor Tom Keane took up the post of interim director of the cancer programme. During his tenure significant progress was made in the reorganisation of cancer treatment services in the eight centres. Centralising breast cancer diagnosis and surgical services was the first priority. This was absolutely imperative in order to guarantee women in every region of the country the same access to the highest quality diagnosis, care and best outcomes from cancer treatment. This process was completed at the end of 2009 and all breast cancer surgical and diagnosis services are now provided in the eight centres, plus an outreach centre at Letterkenny which is linked with the services in Galway.

Between 2008 and 2009 HIQA undertook an assessment against the national standards of the symptomatic breast services at the eight cancer centres. Interim reports on compliance with the standards were produced for each hospital. These were based on a self-assessment exercise by each centre in early 2008, followed by feedback from and validation visits by HIQA in autumn that year. The interim reports which were provided for the eight hospitals and the HSE national cancer control programme indicated the aspects of the standards that were being met in each centre and where there were gaps that could be addressed. HIQA, the NCCP and each of the eight centres worked together to ensure ongoing progress was made in addressing any gaps identified before a final assessment was carried out in the eight centres in late 2009. HIQA's final report on compliance with the standards was published in February. It found that at final assessment stage all the eight cancer centres, without exception, had met the fundamental requirements to provide quality care for breast cancer patients, although it recognised that in most centres there remained opportunities for improvement.

HIQA operates within a robust and comprehensive code of governance which the Minister approved and commits it to observing the highest standards of probity in the exercise of its functions. The Minister is satisfied that HIQA carries out its role in accordance with the terms of the Health Act 2007 under which it was established. She is also fully satisfied that its assessments of the eight cancer centres have at all times been entirely impartial, appropriate and focused on the fundamental goal of ensuring standards are met in order to achieve best outcomes for patients.

The Government's national cancer control strategy is being implemented entirely properly in their respective roles by the HSE and HIQA, with full accountability. Cancer patients, now and in the future in all regions, are the beneficiaries. There are no grounds for a review of the roles of the HSE and HIQA arising from their implementation of the cancer control strategy.