Leaders' Questions.

Yesterday we heard of the tragic case of a woman given the all-clear and then diagnosed as having breast cancer. I have listened to the Taoiseach for long enough and on many occasions he stated that the people of Ireland should thank him for the health service. The Taoiseach and the Minister for Health and Children have repeatedly referred to the sum of €14 billion spent on the health service.

When was the Minister for Health and Children first notified of difficulties with the breast cancer service in Portlaoise hospital? How can the Taoiseach, after ten and a half years in office, stand over a systems failure in Portlaoise whereby only one radiologist signed off on each mammogram? By any standards, those of a centre of excellence or elsewhere, mammograms are signed off by more than one radiologist. This is a systems failure over which the Taoiseach presides, yet he says people should thank him for the state of the health service.

Eight women, as far as we know, in the midlands were misdiagnosed because of that systems failure. Despite the repeated assertions of Minister after Minister, that is where the blame lies. Government policy is outlined by the Government, namely, Fianna Fáil, the Progressive Democrats, the Green Party and the Independents. The Taoiseach has allowed a situation to arise whereby people are leaderless in terms of integrity in the health service. What people who are not trained in the medical area want is integrity of system and trust in that system so that if they are obliged to seek treatment, it will give them the very best chance of survival.

I will ask my two questions again. When was the Minister for Health and Children first notified of difficulties in respect of the system at Portlaoise hospital? How can the Taoiseach stand over a systems failure as blatant as that which arose at Portlaoise and under which only one radiologist signed off on each mammogram?

The HSE has apologised to all of the women involved for the delay in diagnosis. Everyone is concerned about these eight women and it is important that the requisite treatment and counselling services have been put in place in respect of them.

The Minister for Health and Children was informed on 29 August last that following concerns raised by the relevant staff, the HSE had established a review of all breast radiology diagnoses at the Midland Regional Hospital in Portlaoise made in the period from November 2003 to August 2007. That review is being led by Dr. Ann O'Doherty, consultant radiologist at St. Vincent's University Hospital who also works with BreastCheck. The HSE advised the Department that 3,026 mammograms — representing the total number involved — had been reviewed, that this led to 234 women having their diagnosis status and clinical notes reviewed and that, as a result, 54 individuals were called to clinics at St. Vincent's University Hospital. Of the 54 recalled, to date seven have been identified — another person was also identified but not under this review — as having a diagnosis of cancer. All seven women have been offered the appropriate treatment and counselling.

At the beginning of this week, the cases of 19 women were still to be reviewed. Of these, six have been referred to the special clinic at St. Vincent's. Four of them attended the clinic yesterday and two are scheduled to attend on Thursday. The review will be completed this week and a full report will be published by the end of November.

I understand that a consultant radiologist whose practice gave rise to this review remains on administrative leave. I also understand that a helpline has been put in place.

As Deputy Kenny is aware, until recently there were 35 different hospitals throughout the country at which treatment was available. The HSE has for some time — in line with the practice in other jurisdictions, including Northern Ireland — been reducing that number and establishing centres of excellence at which different standards apply. The latter information is separate from the matter under discussion but it outlines what the HSE has been endeavouring to do in providing a service. The eminent person charged with driving the reform programme will be commencing work in a few weeks and will be bringing the cancer service into line with the review carried out by the HSE. We look forward to that happening during 2008 and 2009.

The Taoiseach did not answer the question I asked. How can he stand over a systems failure under which only one radiologist signed off on these women's mammograms? At Mayo General Hospital, double signing has been in place since 1990. I understand there is a letter, written on 13 December 2006, on RTE's website, which indicates that in order to avoid the possibility of serious litigation, it would be necessary to replace the equipment in Portlaoise hospital as a matter of extreme urgency. As the Taoiseach is aware, this was identified by Professor O'Higgins in his report relating to 12 centres. However, neither funding nor resources were ever provided in respect of Portlaoise.

The Taoiseach stated that the Minister for Health and Children was first informed about this matter on 29 August last. However, it is clear that there is another letter, dated December 2006, on the file which indicates the necessity for major investment to be made in respect of equipment.

As the leader of the Government for the past ten and a half years, how can the Taoiseach justify presiding — along with successive Ministers for Health and Children — over a situation where, in respect of the system designed to deliver the best service to the women of the midlands regarding symptomatic breast disease, only one radiologist signed off on mammograms?

On RTE this morning, Mr. O'Brien, CEO of the national cancer screening service, stated that in order to deliver the type of service to which he was referring, one must first set out clearly one's intent and then engage in a clear process of planning how one should proceed. Will the Taoiseach outline this clear process? When will we be informed that this will form part of the critical infrastructure Bill? Where is the money that has been allocated? What buildings, facilities and personnel will be used to deliver the service to which the Taoiseach refers?

I am of the view that the HSE is but a tool of the Government.

It is a mudguard for the Taoiseach.

This is the Government's policy and it has failed eight women, that we know of, in the midlands. The Taoiseach presides over that policy. Despite all the fine words and the undoubted investment that has been thrown at the health service, eight women were misdiagnosed as a result of a blatant systems failure over which the Government has presided.

I do not wish to discuss why somebody is on administrative leave. I will, however, outline to the Deputy the advice I received. I am informed that there was no systems failure involved. When the recruitment process took place, one person applied for the post. That individual was taken on to fill the position but is now on administrative leave.

Those who run the 35 hospitals to which I referred earlier would argue that we should have state-of-the-art equipment. That is precisely why we are moving away from that position. We are following best international practice by having fewer centres. Northern Ireland used to have 19 centres but it now only has five.

That has nothing to do——

(Interruptions).

The Deputies should please not interrupt me. Nobody interrupted Deputy Kenny.

The Taoiseach, without interruption.

Last week, people in the House stated that we should have all of these centres.

(Interruptions).

People should cop on. If individuals want to politicise this matter, we can do so.

The Taoiseach should be ashamed.

We have taken on 70 additional consultants in this area. We need to maximise investment in state-of-the-art facilities, with full multidisciplinary teams. Professor Keane is due to take up his post on 19 November. He is expected to quickly designate national clinical leaders in the areas of radiation, surgical and medical oncology. Arrangements are in hand to enable him to take control of all the new developments relating to cancer services from 1 January and, progressively, to assume responsibility for all existing cancer services and related funding and staffing. He intends to designate the locations for a range of cancer specialties from among the eight centres in early January. I hope he will be allowed to do so, particularly because everyone will be seeking these specialties for their facility. He will, therefore, be changing, as soon as he arrives, into detailed planning to facilitate these designations. On the orderly phased transfer of services between locations, the HSE plans to have completed 50% of the transition of services next year and to complete up to 90% of it by the end of 2009.

As Deputy Kenny is aware, the Minister for Health and Children approved a national quality standard in respect of systematic breast disease services under last year's Health Act. That standard requires significant reorganisation of breast cancer services to ensure that each centre providing such services serves a population of approximately 300,000 to 350,000; manages a minimum of 150 new cases each year; allows for a minimum number of new cases, 50 per year, to be managed by specialists — breast surgeons; ensures that such care is provided by a team made up of a surgeon, a radiologist and a pathologist; and has a minimum of two nominated consultants in each of these specialties. All of the other initiatives in this area were set out last year.

Where will women go while we are waiting for this to happen?

Those guidelines were set out——

The Taoiseach has gone over time.

How can it be achieved without ring-fenced funding?

I do not have time to set it out in one minute. It was all published last year and Deputies can look at it.

What we should do in this House is try to make the necessary reforms to ensure these issues do not happen. The best way to do so is to make sure we have state-of-the-art, well-organised and well-focused multidisciplinary teams in a limited number of locations where we can give people the best service possible. This is what is set out clearly for us, what is being implemented and it is the right thing to do.

It is seven years too late.

The Taoiseach speaks about this like a man heading the Government for the past ten weeks and not the past ten years. What happened in Portlaoise is the worst in a recent series of misdiagnoses including a woman in Galway who was misdiagnosed twice, the case of Rebecca O'Malley in Cork and the cases in Barringtons Hospital about which we were supposed to have had an inquiry but which has not yet got underway fully.

What happened in Portlaoise? I do not want to hear about system failures or the Taoiseach to tell me he cannot talk about somebody being on administrative leave. Why not? A serious misdiagnosis occurred in Portlaoise and I want to know what happened. The Taoiseach should tell the House in plain language. What went wrong? Why were the checks not carried out? The women concerned at least deserve the courtesy of having it explained. When was it discovered in the hospital in Portlaoise and what was done about it at that time? We were told it was made public at the end of August and we are now told the Minister for Health and Children was informed on 20 August.

The Minister for Health and Children is reported to have stated she is considering a review of mammograms throughout the country. Is such a review being contemplated? I expect many women who have had mammograms during recent years must now be concerned about whether the results they received were accurate. Is a review being carried out elsewhere? Is there any reason to believe the type of problem which arose in Portlaoise might present in other hospitals?

I will try to answer most of those questions. I understand it was around 29 August, or perhaps a week before.

That it was discovered.

How was the Minister informed on 20 August?

On 29 August.

She was told on 29 August.

The reason was that one of the senior consultants had concerns about the diagnoses and as I understand it — I want to be fair to people and due process — the mammograms being read by one consultant showed different results to another consultant's reading of them. As I stated, a consultant is on administrative leave because of this. Consultant Ann O'Doherty of St. Vincent's Hospital and BreastCheck is preparing a report which will be published this month. She will cover all aspects of the case.

On Deputy Gilmore's more general question, I understand from what I have read and from previous briefings on setting up national centres that we have more consultants than we need. We have 70 consultants. People ask what have we done during recent years. We have taken on more than 70 senior breast cancer consultants. For our size, population and geographical and regional base it is more than we require. The fact is that we do not follow best international practice because we use 35 locations. This is not the way to do things. The best thing is to get multidisciplinary teams working together on oncology in centralised locations. Of course they can outsource and use modern technology.

When one has 35 hospitals, and as the letter mentioned by Deputy Kenny, they will always look for more equipment. I am not denying that. In this case they were looking for digital technology.

It was a warning about litigation. The Taoiseach is not in the picture.

The Taoiseach without interruption.

Every unit of the health service in the country looks for additional modern technology every day of the week. I am not denying that. We cannot provide it everywhere.

The Taoiseach promised them but delivery is a different thing.

We need to provide them in centres of excellence where we have multidisciplinary teams. Let us be frank about it, when one is ill one wants the best service and the best teams and it is not about where one has it. That is what we should be moving to in this country.

They did not even know they were ill.

This is a designated centre that was not resourced.

As I understand it, the hospital in Portlaoise was not to be the centre.

According to the report in 2000——

We are dealing with Leaders' Questions.

I am doing my best to answer questions.

I have been given quite a lot of facts on this but I think it is best that those facts are put into a detailed report by the consultant, Ann O'Doherty, who is an eminent person and that is fair to everybody. She is actively engaged in putting that report together.

During recent days and during the course of exchanges here today we have been asked to accept that this will improve when centres of excellence are established and that they are the answer to all of this. The problem I have with this and the Government's problem of credibility is that centres of excellence were recommended seven years ago in the O'Higgins report and it still has not happened. According to the Minister for Health and Children it will happen by 2009. According to Mr. O'Brien, who is in charge of the strategy, it will not happen for a further three years after that and it will be well into 2012 or 2013 before they are established.

In the meantime, the Government proposes to close local centres and 13 of them are targeted for closure. What will happen to cancer services after local services are closed and before the Government gets around to establishing the centres of excellence? According to Professor Crown in his radio interview with Pat Kenny today, the Taoiseach and the Minister for Health and Children have been going around the country cutting the ribbons on private cancer facilities which are smaller than the facilities being closed to make way for the centres of excellence.

Cancer treatment and services have been dogged by delay over recent years and the Taoiseach has presided over it. BreastCheck was to have rolled out completely by 2003. It is still not completed. The centres of excellence are seven years coming. We have nothing but continuing delay on the services being provided. The Taoiseach, the Minister for Health and Children and the Government speak as though they are starting from day one and not as people who have been in charge of the dilapidation of the service for the past ten years.

With regard to the Portlaoise issue, what exactly is "administrative leave"? Is it suspension with pay? Who authorised it and who made the decision to put the consultant on administrative leave?

On the final question, it was a decision of the section of the HSE which appoints consultants. I presume it is pending Ann O'Doherty's inquiry.

The 70 consultants taken on in recent years are all in place as are their departments. The problem is that they are too scattered. The Deputy is correct that the provision of centres of excellence has not worked and we are all aware of why that is so.

The national BreastCheck screening programme last year alone screened 64,000 people. Every year there have been substantial increases in the number. It is fully rolled out and is commencing a process——

It is not rolled out.

It is not fully rolled out.

The Taoiseach must be allowed to complete his reply.

At present, it is being rolled out in counties Cork, Galway and Roscommon. We have provided additional funding this year, as we did over the past number of years, so the national cancer screening service can meet its additional costs. The full complement of 111 staff for the roll-out has been approved and the Minister has made almost €30 million available this year for capital funding. We have provided for the construction of two new clinical units, seven mobile units and state-of-the-art digital equipment. Screening in individual counties is dictated by BreastCheck management operation considerations. We have gone from the position of seven years ago, when there was little or nothing. I was present at the launch of BreastCheck, when we had practically nothing. We are progressively rolling it out, resourcing it and putting the staff in place. The published national cancer control programme shows the absolute necessity of implementing the national control programme without delay. The HSE has designated the four managed cancer control networks and the eight cancer centres, and Professor Keane is in place.

Deputy Gilmore asked a fair question in respect of the 13 centres, the operations of which were stopped following the report published last year or the year before. The 13 centres dealt with less than 55 cases between them. I am neither a radiographer nor a radiologist and I do not know anything about mammography but every report, including references to other countries, states that centres which deal with small numbers of cases are not safe and not what we should be doing. It is not that we have any bright ideas; it is international best practice. That is why we brought Professor Keane here, as someone who has done this successfully in Canada. He is Irish but has worked for the Canadian system. He can do this over a two-year period and we have put significant resources into the area. I am not saying that if we had all the digital equipment, the Professor Keanes, the 70 consultants and everything else we need we would prevent somebody from misreading a mammogram or another person reading it in a different way. However, we are progressively putting in place the necessary resources and people for BreastCheck and the national screening programme, as we have done for at least seven or eight years.

The most important aspect of this matter is that seven or eight people have been badly let down by the service and it is our obligation to do everything we can for them.