Seanad debates

Tuesday, 23 February 2010

6:00 pm

Photo of Fidelma Healy EamesFidelma Healy Eames (Fine Gael)
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The Minister of State is welcome. I thank her for taking this Adjournment matter.

My question is to ask the Minister for Health and Children, Deputy Mary Harney, if she will present evidence and justification for her comments in the Dáil on 8 December 2009 on public diagnostic laboratory services and if she will support them with respect to clinical laboratory services in the HSE. The Minister stated:

The main issue is quality and cost. The Deputy knows from the report that our turn-around time is bad, our quality is poor and our cost is enormous. Clearly, from any perspective, that is not satisfactory. The intention is to go to tender and there has been discussion with stakeholders. One would hope that the public service would be successful in that tender but clearly it must compete on the basis of quality, turn-around time and cost. That must be the future because if we waste €200 million on this service that could be used in areas where we have deficiencies, be that in the child protection area or the many other areas where there are deficiencies, no one could defend that. Quest Diagnostics is in discussions about a public facility in Ireland with a view to putting facilities in place.

I seek a defence of this statement and evidence to support what the Minister said. This statement has caused much offence. It was made in support of the policy of the Department of Health and Children to pursue privatisation of diagnostic laboratory services. The Minister said, "The Deputy knows from the report that our turn-around time is bad, our quality is poor and our cost is enormous". I draw attention, in particular, to the words, "our quality is poor". That is a sweeping statement and indicates that either she is poorly informed or deliberately misrepresenting the entire public laboratory service to suit her political agenda. The quality assurance systems in publicly owned diagnostic laboratory services in Ireland are variable but as a result of tremendous efforts, some are now fully compliant with the ISO 15189 standard for quality assurance and many others are compliant with the CPA UK standard.

If accreditation was slow, this was because the Government did not invest in timely accreditation of our laboratories and then criticised them unfairly for not having accreditation. It turned to Quest to outsource much of our laboratory testing. Given this, the Minister's statement is offensive to those who have worked so hard to achieve this quality standard. Furthermore, it appears the Minister's statement is likely to be prejudicial to the ability of the HSE to defend claims of medical negligence related to clinical diagnostic services since litigants will be able to point to a public statement on the Dáil record by the responsible Minister that the quality of diagnostic laboratory service is poor in Ireland. That is quite a claim and it is important that the Minister retract it.

She also stated that turnaround is poor and there is no doubt that turnaround varies from place to place and with the type of test. There is little evidence that I am aware of that most doctors or patients are dissatisfied with the turnaround for most laboratory tests; surveys of users performed by some laboratories show overall quite positive perceptions of service by most respondents. If the Minister has evidence that clinically unacceptable turnaround times for commonly requested tests is common, she should produce it.

Costs are certainly too high but there are many ways of reducing cost, of which privatisation is one but not the only one. A significant factor in the high costs are the salary increases awarded without changes in work practices during the tenure of the Minister, Deputy Harney, and her failure throughout this tenure to pursue a policy of consolidation of service in a limited number of regional centres with critical mass. Regardless of the merits of the policy of privatisation the Minister should withdraw her unqualified criticism of the quality and turnaround time of existing laboratory services or else produce evidence to substantiate it. I look forward to the Minister of State's comments.

Photo of Áine BradyÁine Brady (Minister of State with special responsibility for Older People and Health Promotion, Department of Health and Children; Minister of State, Department of Environment, Heritage and Local Government; Minister of State, Department of Social and Family Affairs; Kildare North, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

Approximately 77 million laboratory tests are undertaken annually across 44 public hospitals. At present the annual cost of this service is approximately €470 million. The workload comprises both urgent and non-urgent tests and a significant proportion of the activity originates in the primary care setting. As with all other parts of the health service and the public service generally, it is essential that laboratory services are delivered as safely and as cost-effectively as possible.

The external review of laboratory services which was conducted for the HSE by Teamwork Management Services in 2007 highlighted limitations in the organisation of laboratories. These limitations had an adverse effect on quality, turnaround and cost. The review found at that time that "the whole system quality" of laboratories was not of a sufficiently high standard. The review also found that the overall proportion of individual laboratory medicine disciplines that had achieved accreditation status was low, "end-to-end" information systems were unsatisfactory and logistic services were inadequate. It found as well that the general condition of the laboratory estate typically was of traditional design and outmoded.

In light of the review, the HSE announced plans last year to modernise laboratory services and achieve significant efficiencies in the configuration and operation of these services. The HSE has already had significant engagement with stakeholders in progressing this initiative. Groups such as the faculty of pathology, the Medical Laboratory Scientists Association and the Association of Clinical Biochemists will continue to have a significant input into the process.

As part of this initiative, the HSE has commenced discussions with the National Development Finance Agency about the capital financing of a small number of dedicated "cold" laboratories to process the large volumes of routine patient tests, many of which originate in primary care, currently undertaken in hospital laboratories. This process will include a robust analysis of the cold laboratory business model from a value-for-money perspective.

The Minister is pleased to acknowledge that some improvements in laboratory services have taken place since the completion of the Teamwork review. The number of individual accredited laboratory disciplines has increased significantly. In addition, some reconfiguration of laboratory services has been achieved by transferring work undertaken in a number of small laboratories to larger laboratories. This has allowed for a higher level of throughput. The HSE has indicated that improved processes introduced in the past year have achieved non-pay savings in 2009 of some €5 million.

The Minister is satisfied that the measures being taken by the HSE, with ongoing input from stakeholders, to modernise laboratory services are necessary and appropriate for the reasons which have been outlined. On behalf of the Minister I again acknowledge the important contribution of staff and other stakeholders to the planning and implementation of these changes and to the shared commitment of all to the objective of providing high quality, cost effective laboratory services. The Minister looks forward to continued significant progress on this important agenda for the health service.

Photo of Fidelma Healy EamesFidelma Healy Eames (Fine Gael)
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I thank the Minister of State for her response but I am not satisfied that the statement addressed the issue. Is the Minister concerned that her statements on the record will open the State to litigation?

Photo of Áine BradyÁine Brady (Minister of State with special responsibility for Older People and Health Promotion, Department of Health and Children; Minister of State, Department of Environment, Heritage and Local Government; Minister of State, Department of Social and Family Affairs; Kildare North, Fianna Fail)
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I am not prepared to answer that question but I will pass it on to the Minister.