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Dáil Éireann debate -
Tuesday, 16 Oct 2007

Vol. 639 No. 4

Leaders’ Questions.

Ceisteanna na gceannairí, an Teachta Kenny.

Tá Gaeilge ana mhaith ag an Cheann Comhairle.

This is breast cancer awareness month and it seems the Government hides behind the Health Service Executive as some remote agency which seems suddenly to implement Government policy without reference to the human cost. The health service was defined as being necessary to cure people and help when they needed health-based assistance, not just as an employment measure. I read the letter from Susie Long — God rest her — who was recently laid to rest, in which she described what she went through waiting seven months for a simple colonoscopy. There was another letter in the daily newspapers last Saturday with the description by a mother of how her child had gone through serious difficulties sitting on a hard chair in an accident and emergency unit all night.

It is three years since the Minister for Health and Children announced her famous plan to resolve the crisis in accident and emergency units but this is not much better, save in a few cases. There is no connection between what the Government says about having a world class health service and how it impacts on people and the reality expressed in communications to every Deputy, members of the Taoiseach's party included. Last week Navan hospital announced the closure of an orthopaedic ward for December. The response of the Minister for Health and Children was to say this was no big deal because only six operations were being cancelled. In fact, the number is likely to be 200.

We hear that there are home care packages available for everybody, yet the National Rehabilitation Centre in Dún Laoghaire cannot discharge patients because there are neither home care packages nor care available when needed. We hear the same story over and over from the Minister and her Government colleagues. The HSE is doing the Government's job but there is no connection between the reality of people's lives and what Ministers tell us. This was very different for Susie Long, for those who have been waiting for hip operations, and the children or elderly sitting on hard chairs in accident and emergency units. The response for breast cancer awareness month is to have a frenzy of decisions to close down treatment centres. No one can defend an inferior service but where services are available, they should not be taken away in the absence of a better alternative. How much further must we go before the world class health service of which the Taoiseach speaks is available?

This is breast cancer awareness month. The Department of Health and Children, the Cabinet committee on health and the HSE management work closely together. It is a big service that spreads throughout the country. Deputy Kenny has raised different aspects of it. I will confine my reply to breast cancer services. The development and improvement of diagnostic and treatment services for cancer patients, including breast cancer patients, is a major priority for the development of cancer services nationally. We have allocated a large amount of resources to the development of services for symptomatic breast cancer disease nationally. Practically all of those resources are for staff. I accept the BreastCheck service is not yet available everywhere, but we are committed to ensuring that it is rolled out to remaining regions in the country as quickly as possible.

In January this year the National Cancer Screening Service Board was established. This amalgamated BreastCheck and the Irish Cervical Screening Programme to deliver programmes nationally. BreastCheck will commence its roll-out this month. We have also allocated resources this year to meet the additional costs of that national roll-out, bringing its budget up to more than €20 million. A total of 111 posts have been approved and recruitment is under way. We have allocated capital funding of almost €27 million which has been allocated for two clinical units, seven additional mobile units and the provision of state-of-the-art digital equipment. Construction is under way on both these sites. Both are static sites, one in Galway, one in Cork.

Does the Taoiseach believe all of that?

Allow the Taoiseach to continue without interruption.

BreastCheck is currently available in 15 counties in the eastern, north eastern, midland and parts of the south-eastern and western regions. BreastCheck has reported a very high volume of screening activity in 2006. Approximately 64,000 women were screened last year. That is a significant increase on the previous year. Screening has detected several hundred cancers.

The Minister has recently approved a national quality standard for symptomatic breast disease services under the Health Act 2007. These are, essentially, the standards under the national cancer control strategy. This will ensure compliance with the standards. The Minister has also called on hospitals in the independent sectors to take steps to ensure that BreastCheck complies with these standards. The Department and Barrington's Hospital continue to work closely together on the terms of reference and the progression of the review of symptomatic breast disease services under the auspices of Barrington's Hospital. That review is to be completed at the end of this month and any patients identified as needing further diagnostic or therapeutic interventions in the course of the review will be informed of this and referred promptly to the hospital for such intervention.

I know there are problems. Deputy Kenny mentioned the death of Susie Long last Friday, and how she fought her case and obviously felt let down by the system.

She was entitled to feel so.

I followed what she said about how her diagnosis was handled given that she was a public patient and not a private patient, an issue about which she felt strongly. It is regrettable that the system did not live up to the standards in that case, as has been clearly put forward.

There are thousands more such cases.

I extend my sympathy to the family of Susie Long on her death.

She was kept waiting seven months for a colonoscopy.

Is the Taoiseach aware that there are nearly 600 whole-time staff members in the Department of Health and Children at a cost of €30 million a year? This is breast cancer awareness month. Breast cancer services at Ennis Hospital have been closed. The service in Galway has been reduced to three days a week. The closure of several hospital treatment units has been announced where little activity was taking place. There is no argument about that. The frenzy of closures is now spreading to places such as Drogheda, Sligo, Mayo General, Wexford and Kilkenny.

I have two simple questions. First, will the Taoiseach or the Minister for Health and Children give an assurance on the floor of this House that no service will be withdrawn from the five centres I mentioned until the centres of excellence are built, staffed and financed, and are in operation and in a position to supply a better service and quality of care for patients than we have now, and until it is proved that what the Government is now doing in closing down centres wholesale in a frenzy will not result in women in particular having to wait long periods for assessment, treatment and aftercare?

Second, the HSE is the Government's creature and implements Government policy. Can I take it that the policy of the Government is to treat all cancers in the same manner and that there will be no distinction between those receiving potentially curative care and those receiving palliative care? Yesterday, I listened to a senior executive of the HSE imply that there will be a distinction and that persons who are to receive potentially curative care will be treated in one place while those receiving palliative care will be treated elsewhere. Will the Taoiseach confirm that the Government's policy is to make no such distinction? Thousands of ward sisters all over the country who do a wonderful job with either category give of their best. I do not want to hear the HSE executives, the creatures of this Government, applying a determination that will split types of services for people afflicted with cancer.

In reply to the Deputy's first question, I have given the facts in regard to the resources that have been allocated and the policies of the Department of Health and Children. Far from cutting back on breast cancer services, we have approved 111 additional posts, recruitment for which is under way. On the capital side, two new clinical units, seven additional mobile units and state-of-the-art digital equipment have been provided.

What about the embargo?

The construction of the two static sites in Cork and Galway, approval for which was given a year ago, is under way and they will be completed this autumn. On the overall question, clinical decisions on cancers are made by consultants. I cannot say what clinical decisions will be made in any particular hospital.

They are made by the HSE.

The HSE administration cannot do that either. The clinical and medical directors make such decisions. The HSE recently announced the appointment of Professor Tom Keane as the interim director of the national cancer control programme. His function is to lead and manage the establishment of a national cancer control programme. The delivery of cancer services on a programmatic basis will serve to ensure that we get equity of access to services and equality of patient outcomes. I accept that is important irrespective of geography. Investment in cancer control will be based on the reform programme now being implemented by the HSE. I know Deputy Kenny supports that reform programme, as I do. The implementation of the national cancer control strategy is a priority of Government. It is the policy of the Government. The reorganisation of cancer services is at the heart of the delivery of the strategy. It is imperative that the decisions of the HSE in regard to the designation of the four managed cancer control networks and the eight centres are implemented without delay. That is our policy.

I have noticed that every little effect on the service around the country under the HSE budget of €14 billion, which caters for 120,000 people, is being faxed to me, as it is to the Deputy and to every Member. This concerns a 1% control on the HSE's annual budget, based on its national strategy, and represents a small amount of the overall resources.

It hurts the poor.

It affects 25% of patients.

I have read four or five such notes today.

There were no cutbacks before the election.

It is not a cutback when a body goes over its budget of €14 billion. The HSE has a service delivery budget.

Is the HSE working?

I am not involved in individual cases but, at times, people look around to find the emotive angle rather than any other. We are talking about the HSE being 1% over budget. With the small amount of resources involved, for a short period in the year, everybody should do their best to ensure sensitive services, of which cancer is just one, are not affected.

What about the removal of home help for the elderly?

Susie Long was a very brave woman who has done this country a great service. Her e-mail to Joe Duffy last January, which is reprinted in full in today's The Irish Times, is probably the most compelling narrative we have seen about what is wrong with our health service. She describes how she had to wait for seven months for a test which could have been carried out in three days and describes the disgusting conditions she had to endure at the Mater Hospital while she was a patient there. The Taoiseach is wrong. Susie Long did not blame the system — Susie Long blamed the Government. I will read from her e-mail, which she wrote when she was, admittedly, angry:

I've finally reached the angry stage, I guess. Who am I angry at? I'll tell you, Joe. The health service has been in the hands of Fianna Fáil and the PDs for years and all they can think to do is put resources into privatisation. They don't have the ability to change structures in the public sector that would put more resources toward patient care.

Why did Susie Long have to wait seven months for a test that could have been carried out in three days? Why, if medical science, hospitals, consultants and doctors are in a position to carry out a test or procedure for a patient who is insured or who can pay directly, do public patients have to wait for months for the same service? After more than ten years heading this Government, what is the Taoiseach doing to put that right?

It is deeply regretted that any patient referred to a hospital with possible symptoms of cancer was subjected to a delay in diagnosis.

It is normal practice.

As we know, the earlier the diagnosis of a cancer is made and treatment commences, the better for the prognosis. The Minister has been assured by the Health Service Executive that any patient referred to St. Luke's for an endoscopy which was considered urgent by a doctor is given an urgent appointment and is seen within a week or two. That is the stated policy of the organisation. Urgent cases are forwarded daily, directly to the medical consultants, for prioritisation and general practitioners are encouraged to make contact directly with the medical consultant. That is how the system is meant to operate and how it normally operates but it did not do so in this case, which I acknowledged earlier this year. The system should have allowed Susie Long to be given a diagnosis and that should have been the case whether she was a public or a private patient.

It is not the case.

Very regrettably, it was not. Susie Long concluded, from her conversation of that day, that it was because she was a public patient. I can understand that, but that is not the practice or the policy.

I do not want to repeat the data to Deputy Gilmore but enormous resources are being put into the health services. In the period I have been Taoiseach, they have increased from approximately €3 billion to €15 billion.

The country has changed.

Most of that figure goes towards staff, with almost 120,000 staff employed to provide services in what is a relatively small country.

The Government is getting rid of them now.

I have acknowledged some of the services which we do not have but resources are being prioritised and given to certain services such as those related to cancer. BreastCheck alone has received €60 million in additional funds in the past decade. As part of the capital programme, €27 million was spent on services last year.

Why are they not working?

Resources are improving services but is it perfect? Are there services in every part of the country? At this stage there are not but I have outlined why the reform programme is necessary. One of the aspects of the reform is based on the continuous advice that we are better having centres of excellence in fewer locations, where all ancillary services and all the medical and surgical facilities are available in single campuses. It is hard for people to accept that because they believe it is better the services be as close as possible to their own homes——

That is not the point.

They are afraid they will not get into the hospitals.

People are fed up waiting.

——but that is not the advice of any international group which has looked at the matter. The Health Service Executive is doing its utmost, as are we by committing resources to assist in that regard.

Is that why we have a staffing crisis?

The HSE has approved over €5 million to build a new 24-hour day-procedure purpose-built colonoscopy unit at St. Luke's in Kilkenny. It is putting in the resources for the facilities to provide the services to which Deputies refer.

The Taoiseach's answer is a total red herring. First, how does one know a case is urgent until one carries out the test? This woman was looking for a test to be carried out to establish her condition. To suggest there can be an urgent and non-urgent list, as if GPs, to whom patients present in the first place, can, without the benefit of the diagnostic tests, make such judgments in advance, is absolutely absurd. If it is suspected that somebody has cancer, to the extent that they need a test for the disease, that is pretty urgent and they should not have to wait seven months for that test.

There is a problem in the way the Taoiseach looks at the health service. He looks at it from a completely different perspective from the people who experience it. He looks at the health service from the perspective of reports, advice, the HSE and budgets, etc, but the people who have to use the health service see it from the other end. They see it from a plastic chair in a waiting room. From that point of view they are seeing a service which they expect to receive and are not getting. I accept that the Government is spending more than €14 billion per year on the health service and that 120,000 people are employed in it. However, with a population of slightly more than 4 million, it must be possible to organise the service so as to avoid the continuing problems we experience day in and day out.

The tragic case of Ms Susie Long is not a lone one. People tell us every day of their experiences waiting for procedures and tests. The issue, which after ten years in office the Taoiseach has not addressed, is the provision of a health service to which everyone has access, regardless of ability to pay, possession of insurance or appearance on one list or another. Anyone who needs a service should be able to access it reasonably quickly. No one should have to face the awful circumstances endured by Ms Susie Long and eventually expire.

The Minister for Health and Children has been assured by the Health Service Executive that any patient referred to St. Luke's Hospital for an endoscopy and considered urgent by her doctor will be given an immediate appointment and seen within one or two weeks.

I do not look at the health service from a strange or different perspective from Deputy Gilmore. I hear what patients are saying and I also hear complaints. Improvements are required. Annual capital investment to improve services and facilities amounts to €500 million. In some cases reforms are necessary. These are well documented. The HSE and the Department of Health and Children have spelled out where reforms would systematically help the health service in areas where there are difficulties. For example, they believe centres of excellence and the grouping of consultants and facilities would lead to a better service, which brings its own controversies.

Availability of staff is also an issue. The health service must be available 365 days a year. It is not a 35 or 39 hours a week service. Extra staff are needed at key times. Reforms are required and we are trying to implement them at all staffing levels.

I acknowledge that many complaints are genuine and that upsets or even fatalities are suffered by patients. Nevertheless, when patients, as distinct from commentators, were asked about the health service, 76% of inpatients said they were admitted to hospital immediately upon being told they needed admission.

If they got that far.

In response, 11% said they were admitted within one month and 4% within three months; 76% of non-GMS patients were admitted to hospital immediately they were told they needed admission; 83% of hospital inpatients felt they had been treated with dignity and respect; and 64% of inpatients and 54% of outpatients rated their experience as excellent.

The Taoiseach is a joke.

What about MRSA?

There are difficulties but one should not try to paint a picture which puts fear into people who are going into the hospital service when those in hospital rate the service as very good. One should not turn the health service into a fear issue.


I acknowledge difficulties where they occur but these are the facts as given by 3,500 people who were beneficiaries of the health service. They did not all say they were satisfied but a high number, by international standards, commended the service. We will continue to deal with areas where there are difficulties.

Did they survey the ones who died?