Confidence in Minister for Health and Children: Motion (Resumed).

The following motion was moved by Deputy Jan O'Sullivan on Tuesday, 28 November 2007:
That Dáil Éireann,
expressing its serious concerns about disclosures of major failures in cancer care services at the Midlands General Hospital, Portlaoise, including the failure to diagnose breast cancer in nine women who had presented for mammograms and the recall of a further 97 women who had undergone ultrasound scans at the hospital;
deploring the way in which the women have been treated subsequent to these disclosures, including the failure to provide adequate counselling for those who have had to undergo surgery and the fact that women who had undergone scans first heard on news bulletins that they might be recalled;
noting that concern had previously been expressed about the adequacy of equipment and facilities at Portlaoise;
condemning the failure of the Department of Health and the HSE to ensure the provision of cancer screening and treatment services in which the public can have full confidence;
urging the public, notwithstanding these alarming failures, to continue to present for screening and assessment;
noting that the HSE was the creation of the Minister for Health and Children, Deputy Mary Harney, and that it has failed to deliver the improvements promised in the health service; and
believing in the principle of political accountability for such shocking failures in our health system,
has no confidence in the Minister for Health and Children, Deputy Mary Harney.
Debate resumed on amendment No. 1:
To delete all the words after "Dáil Éireann" and substitute the following:
"—expresses its sympathy and regret to the women who were patients at the Midland Regional Hospital at Portlaoise and their families, who were affected by errors of misdiagnosis and miscommunication;
deeply regrets, most particularly, that a review of diagnoses became necessary;
expresses its confidence in the efficiency and high quality of the work carried out in the review of mammograms and at the special clinic at Portlaoise by leading clinicians, supported by specialist nurses and other health service staff;
approves the actions of the Minister for Health and Children in ensuring that the special clinic was put in place immediately last weekend;
acknowledges the leadership shown by the Minister for Health and Children in setting a clear direction in the National Strategy for Cancer Control for the development of quality assured cancer control services as the best way of ensuring that the risk of such events is minimised in the future; and
supports the Minister for Health and Children in her commitment to ensuring equitable access to high quality cancer services for patients throughout the country;
in particular, Dáil Éireann acknowledges:
the Minister's approval of National Quality Standards for Symptomatic Breast Disease Services under the Health Act 2007 to ensure that every woman in Ireland who develops breast cancer has an equal opportunity to be managed in a centre which is capable of delivering the best possible outcome;
the significant progress made to date by the HSE in reorganising breast cancer services in order to comply with the National Quality Assurance Standards for Symptomatic Breast Disease, including the recent decision by the HSE to cease breast cancer services at a number of hospitals with very low case volumes;
the plans over the next two years to provide breast cancer services in line with the development of quality assured capacity in the eight designated cancer centres;
that cancer survival is improving in Ireland for all of the major cancers and that relative survival for breast cancer improved from 72.9% (for people diagnosed between 1994 and 1997) to 78.2% (for people diagnosed between 1998 and 2001) in line with improvements that have been seen in other developed countries;
the establishment by the Minister of a National Cancer Screening Service Board and the commencement last month of the BreastCheck screening process in the south and west;
the appointment by the HSE last week of Professor Tom Keane to lead and manage the establishment of the National Cancer Control Programme to implement the National Strategy for Cancer Control;
the additional investment of over €1 billion in cancer control since 1997; and
that the National Development Plan 2007-2013 includes major investment in the implementation of the Cancer Control Strategy, including state of the art diagnostic and treatment facilities."
—(Minister for Health and Children).

I understand there is agreement that the Fine Gael slot should continue for ten minutes. Is that agreed? Agreed.

I support the motion that this House has no confidence in the Minister for Health and Children, Deputy Mary Harney. The principal reason she should resign is her failure to oversee in a competent manner a health system that provides proper care for patients. She has failed to lead our health service, failed to deliver on commitments made by her own Government, and ultimately failed those who use the health service, especially the women of the midlands who, scandalously, have been left waiting for further medical assessment.

However, we are used to words from the Minister, Deputy Harney. Three years ago she promised to solve the accident and emergency department crisis. Today there are 251 people on trolleys, yesterday there were 257, that is, 50 more each day than the same days three years ago.

In January of this year she stated there would be no cutbacks in the health service and that patients would not suffer. In September, she stated that the cutbacks would not hurt patients but they did. Operations were cancelled up and down the country. Home helps were withdrawn. Home care packages for children with a disability were cancelled and suicide prevention training courses were cancelled also.

However, on Thursday last, at the Joint Committee on Health and Children, the killing casualness of the announcement exposed how shallow and hollow the words, promises and rhetoric of the Minister have been. The news that 97 women needed further medical examination but had not been told, exploded once and for all the myth of Deputy Harney being the tough, effective and caring Minister on top of her job. The decision to delay informing these women until the HSE had the "cohort" it required and the reference to women "jamming up the lines" revealed the hard cold truth of the Irish health service under this Minister and revealed how concern for the system outweighs concern for the patient.

The surge of action on Friday when the Minister's political neck was on the line demonstrated where her priorities lay, the protection of her political career. Of course, an excuse was rolled out. Is there not always one? This time it was "a communications failure", but could the Minister have anticipated this?

Last night she referred to reports produced before the HSE was set up. One of those reports, the 2003 Brennan report, could have forewarned her. Commenting on the relationship between the Department of Health and Children and the HSE, Professor Brennan stated "it will be essential that the Department be closely in touch with the on-the-ground reality of policy implementation". In a prophetic piece, Professor Brennan went on to state "if the relationship between the two parties does not work properly, it could substantially compromise the capacity of the health service to deliver its objectives". How right she was.

The Minister, Deputy Harney, had yet another warning about the need to stay on top of her brief in the Travers report of March 2005. Mr. Travers made clear recommendations. In future, he stated, she should "probe, in an insightful and effective way, areas of policy implementation, operations and administrative difficulty". He added that the Minister should "insist on full and periodic briefings on key issues of policy and operational performance". In the Minister's press release about that matter, Deputy Harney stated "'issues of singular importance' ... should be identified and dealt with in clear language and with a clear purpose and remedy".

How did the Minister measure up? Did she deal with Mr. Naughton's letter of 2005 "with a clear purpose and remedy"? She did not because she did not even read the letter. When cancer services in Portlaoise were suspended in August this year, did she deal with this "with a clear purpose and remedy"? She did not. She spoke a great deal about how concerned she was for the women involved, how they were her priority, how they would be cared for and how they would get all the treatment. It sounded like clear purpose and remedy, but the reality was different. The Minister retreated to her Hawkins House ministerial suite bolstered by a €25,000 increase in salary and ignored the issue until just before she was about to appear before the House to answer parliamentary questions.

By her own admission, she and her Department did not know about the ultrasound review, even though it is set out explicitly in the terms of reference. Did she even read these? By her own admission, she could not get information on the ultrasound review on Wednesday, 21 November. This is an appalling admission for any Minister.

By her own admission, she was able to instruct her officials to tell the HSE to hold a special clinic in Portlaoise on Saturday last. When political will was shown, the HSE's plan for clinics in Dublin were also overthrown. By her own admission, that special clinic only took place because concerned cancer specialists volunteered their services. That is a new version of a dig-out for the Department of Health and Children — specialists' goodwill instead of the political will of a Minister. Contrast that with the comment of Professor Keane who stated that the system should be that a cancer suspect would get immediate attention and not be left hanging around with weeks of trauma, pressure and stress, like the Minister allowed happen to those women in Portlaoise and the midlands.

The Minister, Deputy Harney, states repeatedly she will not walk off the pitch. The reality is that she was not on the pitch when she was needed. To continue that analogy, in any credible and functioning Government she would be dropped from the team by now. She did walk off the pitch and she abandoned leadership when she was pursued by former Minister, Michael McDowell SC. She is now, with diminished authority, in a diminished ministry.

She is left carrying the bottles.

The so-called communications failure that the Minister hides behind is only a symptom of a serious failure in the governance of our health service. It is a symptom of a health system where the Minister and her Department have detached themselves from the delivery of the service. It is a symptom of a service where the HSE is now a dysfunctional organisation, with senior executives kept in the dark about critical patient reviews. It is a symptom of a health service which is patently not patient-centred.

This Health Service Executive is the creation of this Government and of this Minister. This is her agency, set up with her legislation, peopled with her senior executives and communicating in a way that she dictates.

She and her colleagues have been in office for ten years of wealth and prosperity. There has been investment, not service. From the Minister, Deputy Cowen, who could not wait to get out of the brief, to the Minister, Deputy Martin, who did not read the brief, to the Minister, Deputy Harney, who gave the brief away to the HSE, they all have failed. It was a wasted decade from a bunch of wasters.

(Interruptions).

I never expected the Minister, Deputy Harney, to quit. This Government does not do resignation. It cannot do resignation because that culture comes from the top, from a Taoiseach who has lost the confidence of the people but clings to power.

The Taoiseach and the rest of them will support the Minister, Deputy Harney, because his party needs her. Deputy Harney is the mudguard of the Fianna Fáil Party, and the now spineless Green Party, whose members stated here on the motion of confidence in the Taoiseach that their job is to look after themselves. Of course they will vote for the Minister. If they had any sense, they would not because when they go back to their constituencies they want to be able to state that, as they themselves know, she is the remnants of the Progressive Democrats and leave her there for the time being.

Deputy Kenny himself was keen to make a mudguard of me.

In recent days some commentators have asked what would be achieved by the resignation of the Minister, Deputy Harney.

Deputy Kenny had his chance and he blew it.

I will tell them what would be achieved. First, they would get a change of heart. Second, a new Minister would be appointed. Third, he or she would understand that with a crisis like that in Portlaoise a Minister should be on top of his or her brief. He or she would ensure that women who needed attention would not be waiting for weeks or months for it. He or she would have a mandate to shake up the HSE, to squeeze the bureaucratic bulge and to prioritise the frontline service in the interests of patients.

Where is Deputy Kenny's policy?

A new Minister would also send a clear message that times have changed and that performance and output must be achieved in the interests of the patient.

The Minister, Deputy Harney, has failed to achieve that vision set out in the Government's health strategy for which she is responsible and in which she speaks of "a health system that is there when you need it, that is fair and that you can trust".

She stated last night that she wanted to look every patient in the eye. She wants every woman and every man to know that she is a caring person, that she is delivering a service for them. I ask her to go and talk to the person who wrote this letter. This is a woman who, at the request of her doctor, received notification to attend for her mammogram on Tuesday, 19 May 2009 at 11.33 a.m. That woman is waiting for a mammogram requested by her general practitioner and she has been told to wait that length of time when she may well be a suspect for what the women in the midlands have. That is the Minister's incompetence. That is her failure. She might be in situ but she is not in charge.

I support this motion.

I want to share time with Deputy Grealish, the Minister for the Environment, Heritage and Local Government, Deputy Gormley, the Minister of State at the Department of Health and Children, Deputy Smith, and Deputy Curran.

Is that agreed? Agreed.

The suffering of all of the women who have been caught up in the events arising from breast cancer services in Portlaoise, and indeed in other places, has been immense. It did not take graphic accounts of the anxiety, uncertainty, disbelief and anger expressed by a number of the women concerned for the rest of us to understand the enormity of the distress that has been created.

What is the Government doing about it?

For that, they deserve the fullest apology. The Minister, Deputy Harney, has already expressed her deep regret that this happened and I readily join with her in expressing my profound regret for what they have gone through.

And well she ought to.

I want to focus my remarks this evening on two issues in my limited time, namely, the policy response of the Government to the challenge of developing world class cancer services and the issue of accountability for what has gone wrong. In the first place, I am proud of this Government's record in the development of cancer services. We have created a blueprint for the development of a rational, safe and effective cancer treatment programme. We have backed that strategy through investment in the development of the key centres that will provide the backbone of this service.

Does that include Portlaoise?

We have listened to the experts and, in the person of Professor Tom Keane, we have drafted in a world class expert to help us to realise our strategy. With particular reference to breast cancer, we are extending the nationalscreening programme, BreastCheck, and we are backing the strategy to create centres of excellence that will organise, plan, deliver and support the treatment of women both within these centres and in more local hospitals where necessary and appropriate.

It is small consolation, but the suffering of the women caught up in recent events has been a powerful spur to drive on the implementation of the new strategic approach that has at its heart the determination that women will receive the best possible care when faced with the prospect of breast cancer.

It takes some sacrifice to spur the Government.

I want to turn now to the question of accountability for what happened. "Accountability" is a word that can be misused, sometimes deliberately. Fundamentally, it means being required to give an account or an explanation of something that has happened.

The Taoiseach is joking. Is he being serious?

In that sense, the Minister for Health and Children, Deputy Harney, is accountable and has indeed given an account, both in this House last night and on other occasions and more generally to the public through the media.

That is not much good to the women in question.

She has given a full account of all of the information at her disposal about what happened——

Where is the O'Doherty report?

——but also on the very effective and immediate steps that were taken to respond to the misdiagnosis problem.

The Minister is not the only one accountable. The Health Service Executive, its board and its management are also accountable for their direct management and oversight of the system.

What about the Government? Is it accountable?

Individual clinicians and health managers are also accountable for the actions they took or did not take.

What about the Taoiseach?

In the case of the HSE, they are accountable to the Minister and, thus, to the Government in addition to Dáil Éireann.

Is that a mea culpa? What about the Taoiseach?

Staff of the HSE have their own accountability structures and clinicians are accountable within the framework of regulation of medical practice to their peers, leaving aside any legal liabilities that might arise.

A more relevant question than accountability is perhaps responsibility. That means knowing what went wrong, how it went wrong and why it went wrong.

It also means taking responsibility.

And making sure it does not recur.

That in turn requires a full understanding of what would represent normal or acceptable performance so that the deviations from it can be judged. It requires an understanding of the context and the extent and nature of any shortcomings that may arise. That in turn requires detailed, expert analysis that the Minister and the HSE put in place immediately when concerns were expressed that all was not well.

Two and a half years later.

Of course, the public — especially the women directly concerned and their families — and Members of this House have a right to be informed as soon as information becomes available on a matter of this gravity, but I have not been impressed by the rush to judgment, to attribute blame and to call for heads.

Should we say nothing?

Have a free vote.

Despite knowing full well the extent of the careful analysis being undertaken to establish precisely what happened and why and the impossibility of drawing firm conclusions without such evidence, the pressure has been for immediate judgment and the exacting of the highest possible political price to the advantage of the Opposition. This is little more than playing political games with the tragedy of these women and their families.

The Taoiseach would not know anything about that.

The Taoiseach will start crying.

(Interruptions).

It has seen appalling disregard for basic facts and even a misrepresentation of the standard of accuracy that might be expected in various procedures. Population screening and symptomatic disease investigation have been widely confused. Ignorance of the subject has been no barrier to the political opportunists baying for the Minister's head.

Have an independent inquiry.

The truth is that we do not yet know fully what happened and why. We do not yet know the full consequences in terms of the number of women who were given false negative results when, in all reason, they should not have been, but the relevant experts are compiling their work and we will know the answers to these questions at that point. Then effective accountability can be applied at all of the levels of the health care system, which I mentioned earlier.

We will also know more about how the response to aspects of this crisis were handled by the HSE, including the appropriate briefing of the Minister and her officials in a matter of the utmost public concern. The board of the HSE is rightly organising an independent, external review of aspects of the handling that, I must confess, are difficult to understand. However, when it comes to establishing responsibility for what happened——

The Government will blame others.

——we will have a basis of fact and expert analysis on which to depend. It is then that the appropriate accountability relationships can properly apply and, in applying them, the question of culpability — to whom or what should blame be attached — will be clearer. One person who is not to blame and will not be found to be blameworthy is the Minister for Health and Children, Deputy Harney.

It will be a whitewash.

The Taoiseach has prejudiced himself.

(Interruptions).

I do not need to remind this House of the range of her political achievements over many years of public service.

That is telling us.

I would simply point to her record in health, a ministerial portfolio that, because of its unique characteristics, contains huge potential for political disaster across every western country.

For which reason the Taoiseach's party does not want to take it.

In driving a reform agenda, she has taken on vested interests of all kinds. She has taken expert advice to restructure the way in which health services are managed and operated.

It is early days in what has been one of the most extensive transformation projects ever attempted in this country. Already, the potential for much more effective and efficient health care is evident from the creation of a national framework for the planning and direction of the health service.

The disaster is evident.

Of course, there are many difficulties in bringing this to completion. Others must answer as to whether they, as stakeholders in our health care system, have been sufficiently responsible in engaging with the Minister in this challenging agenda.

The Government will not meet us. The Taoiseach is talking rubbish.

The Taoiseach without interruption.

At the heart of the Minister's concern has been the needs of the patient. This is demonstrated by the dramatic improvements that have come about in waiting times for elective treatment——

A Deputy

Can we believe that?

——and in waiting times and conditions for those awaiting admission from accident and emergency departments.

(Interruptions).

It is also evident from the structural changes that have been included in an independent, expert and arm's length overseer of standards and safety. Now getting into full swing, the Health Information and Quality Authority will have an ongoing, proactive role in ensuring that institutions, services and indeed individuals are up to the clinical and caring tasks they undertake. In time, this will be seen to be a major protection for patients and their families.

However, it is in cancer services, especiallybreast cancer services, that the Minister's qualities and determination are best seen. I can do no better than to quote extracts from today's letter in The Irish Times from the emeritus professor of surgery in University College Dublin, Professor Niall O’Higgins, who chaired the expert group on how the national service for women with breast cancer should be developed.

How much did the Government pay him?

He has changed his mind since.

Did the Taoiseach read the other doctor's letter?

He stated: "It was not until Mary Harney became Minister for Health and Children——

Is the Minister for Enterprise, Trade and Employment listening to this?

He has been there.

——that efforts were made to implement recommendations in a systematic fashion for women with breast complaints."

(Interruptions).

Allow the Taoiseach to proceed without interruption.

What of the previous Ministers, Deputies Martin and Cowen?

That is some vote of confidence in the two previous incumbents.

Professor O'Higgins stated:

She established an expert group to specify quality measures so that the performance of centres could be assessed, compared and judged against the highest prevailing standards. When launching the report of the expert group in May this year, she expressed her determination to develop and designate the centres, a decision that followed shortly afterwards. She has supported strongly the extension of BreastCheck, the national breast screening programme, soon to become a nationwide service. She enlisted the talented and experienced cancer specialist, Professor Tom Keane, from Canada, to guide the development of the national cancer strategy, in which services for breast cancer are a large component.

He also stated: "The Minister has taken major decisions to improve breast cancer care. Her decisions are not only courageous but they are necessary and should be supported."

Seven years and we are still not there.

The Taoiseach should ask the people of the midlands.

That is why the Minister for Health and Children has my support and the support of the entire Government.

What of John Crown's letter?

That is why it is right to await the outcome of the inquiries the Minister has put in train to establish exactly what happened, what and who are responsible and what degree of culpability they must carry.

Where is Deputy Ned O'Keeffe?

To do otherwise trivialises the suffering of the women whose anger needs to be respected by proper analysis and proper accountability, not political posturing for the sake of headlines by an appalling Opposition.

There was no mention of the word "confidence" in the Taoiseach's speech.

I thank the Taoiseach for sharing time.

The speech from the dock before Deputy Grealish jumps ship.

Deputy Grealish does not know which party he is heading for.

Deputy Grealish will be joining continuity Fianna Fáil next.

Why is Deputy Grealish leaving the Progressive Democrats?

In my view, and in the view of many people, Deputy Harney is all that a politician and Minister should be. She is dedicated, hardworking, full of common sense and in touch with people.

That is why Deputy Grealish is leaving the party.

She is tough, fair, loyal, principled and honest.

(Interruptions).

She is loyal but Deputy Grealish is not.

Most of all, she is highly effective in the job in the Department of Health and Children as she was in her previous portfolios in the Department of Enterprise, Trade and Employment and the Environment.

The Taoiseach has an affiliation for the Deputy in the folds in his pockets.

At least Deputy Grealish is useful.

In three years in the health portfolio, she has put patients first by delivering new services, benefits and regulations. She made accident and emergency services a top priority and achieved a 50% reduction in the number of patients waiting for admission. She put in new beds at accident and emergency wards in numerous hospitals. She also made services for older people a top priority from the start.

She abolished the home help scheme.

She has delivered the largest ever expansion in services for older people funded by an extra €400 million. This is providing thousands of older people with home care supports for the first time, more home help hours, higher subvention for nursing homes and more palliative care.

Would the Deputy speak to the motion?

Does the Deputy live in the same country?

Quiet. This is the Deputy's maiden speech.

She made it much easier to get medical cards and introduced GP visit cards. In two years, 125,000 more people have medical cards, and 75,000 have GP visit cards. Up to 200,000 more people can visit the doctor free of charge now than when she came to office. Normal waiting times for hospital operations are down from years in many cases to two to four months.

Were the 200,000 cards part of her job?

Cancer services are expanding throughout the country, in particular, with major new investment at University College Hospital, Galway, which already has excellent cancer care and will be a specialist cancer centre for the west.

As long as Galway is taken care of, that is all that matters.

She arranged the first ever independent audits of hospital hygiene, and full publication of results, the real way to raise standards.

She brought in new legislation with a focus on patient safety and lay majorities on boards for the first time in the Medical Practitioners, the Pharmacy and the Health and Social Care Professionals Acts. She also put patients' representatives on a variety of State boards.

She put Progressive Democrats members on State boards.

She put patients first with a redress scheme for victims of Dr. Neary's malpractice in Drogheda. She brought in a special life assurance scheme for people infected with contaminated blood products.

I heard much Opposition rubbish and clichés last night about talking the talk and walking the walk, from one who is taking his baby steps in political life.

We have been hearing much rubbish from that side of the House.

We have had to listen to much rubbish these two nights.

Deputy Harney is not just a great speaker. She walks the walk in health——

When is Deputy Grealish walking from the Progressive Democrats?

Deputies

Go on, when is Deputy Grealish walking?

Deputy Grealish should walk the plank.

——even the most politically difficult walk, particularly sticking by an expert decision on the location of the new children's Hospital. That was when a political, dirty and underhand campaign was set up against her in her constituency in the general election. How many Members had to put up with that?

The Deputy will not have to do so for much longer if he jumps ship.

How many of the Opposition speakers last night have been tested by fire, as Deputy Harney has been?

The job in health is never easy.

A Deputy

She asked for it.

To be fair, it was not easy for former Ministers, Deputies Howlin, Noonan, Cowen or Martin. There are many interests which oppose change and put self-interest first.

A Deputy

We buried Deputy Micheál Martin on that one.

The Minister, Deputy Harney, said three years ago there was no magic wand, just hard work, persistence and a willingness to make the right decisions and stick to them.

The most eloquent testimony of Deputy Harney comes from outside politics. Professor Niall O'Higgins——

Where was he rolled out from?

Did the Deputy read all the article?

——author of the original work on standards for breast cancer care in Ireland, wrote today in The Irish Times, which the Taoiseach quoted. That is a testimony to Deputy Harney. I am delighted to support my colleague——

She is the only colleague the Deputy has.

For the time being.

——who is making a large difference in politics as Minister for Health and Children.

Deputies

When is Deputy Grealish jumping ship?

I call on Deputy Curran.

Is Deputy Grealish going to join Fianna Fáil soon? When is he jumping ship? Is he not sitting side by side with them now?

Deputies, please allow Deputy Curran to begin.

I welcome the opportunity to contribute to this debate. I oppose the motion of no confidence in my constituency colleague, the Minister for Health and Children, Deputy Harney. This motion has no political integrity.

(Interruptions).

I say that because following the meeting of the Joint Committee on Health and Children, Deputy Jan O'Sullivan said she did not believe the issues that arose were a resigning matter for the Minister for Health and Children. Yet some hours later, it was Deputy Jan O'Sullivan and her party which brought forward the motion of no confidence. The reason she did so was not because of ideology but because she was specifically caught on the hop when Deputy Reilly said he was going to his party leader. She did not want to lose the opportunity.

Deputies

Hear, hear.

Absolutely not. I believe the women affected should come first. It is about people not taking responsibility.

Let us be blunt, the motion has been tabled.

The Deputy should deal with the issue.

Her first comments were what she believed but she changed because she did not want to be caught on the hop. She was caught and I make no apologies for saying so.

I wish to be associated with comments made by the Minister for Health and Children in the House last night when she apologised to the patients of the former midland health board and those in Portlaoise hospital.

She also apologised to those who suffered anguish and distress. She apologised to the nine women whose treatment was delayed by misdiagnoses.

That is all she has done.

She further apologised to those women who last Thursday first heard on the airwaves there was an issue with ultrasound scans. I wish to associated with those comments.

Last night Members on the other side of the House spoke of specific difficulties and findings within the health service. All said the Minister was not personally responsible for these misdiagnoses.

The buck stops with the Minister.

Members on the other side spoke of specific problems in the health services but made the point that the Minister was not personally responsible.

She is because of repeated broken promises.

I am referring to comments made on that side of the House. We, on this side of the House——

No one is responsible.

I did not say that.

Who is responsible?

Deputy Kathleen Lynch contributed to the debate last night. All Members on the Opposition side made the point that the specific issues raised——

The Deputy is losing it.

Who is responsible?

Did the Deputy not read the notes?

I am not immune to the problems in the health service.

Every Member on this side of the House is aware there are issues.

They will be aware after this.

The problem is we disagree with your philosophy on the changes needed.

Deputy Kathleen Lynch, you stood up last night——

Deputy Curran, you must address your remarks through the Chair and stop the argy bargy.

Deputies

Hear, hear.

I am sorry a Cheann Comhairle. I have two critical points I wish to make.

Deputy Curran is not reading all his notes.

Last night Deputy Kathleen Lynch claimed the move from 11 health boards to the HSE was a disaster. She spoke about accountability and so forth. Going back to that model is going nowhere.

At least one could get an answer to a question then.

We cannot make head nor tail of it.

Nothing has been done with the HSE.

A Deputy

The Deputy should ask the Minister for Community, Rural and Gaeltacht Affairs, Deputy Éamon Ó Cuív, about it.

Reform of the health service is the only way we can go. Our Minister is leading us in that direction and she is not alone. Members on this side of the House are fully behind her.

(Interruptions).

Over last weekend they were not.

Allow Deputy Curran to finish.

Yesterday, Deputy Gilmore asked if Members on this side would walk and join him. He referred to Deputy Ned O'Keeffe.

Deputies

Where is Ned?

Do those Members on the other side want to listen?

Deputy Curran, you will have to conclude.

Tell that to the women of my constituency who are listening to this too.

Deputy Gilmore referred to comments made by Deputy Ned O'Keeffe, claiming the Deputy and his other colleagues should join him. The comments attributed to Deputy Ned O'Keeffe——

Blame the media.

I did not say they were misquoted.

(Interruptions).

Listen for once before you misquote me. I am saying that comments attributed to Deputy Ned O'Keeffe——

Your time has expired Deputy Curran.

Time is up Deputy Curran. Time is up.

I am doing my best a Cheann Comhairle. The comments attributed to Deputy Ned O'Keeffe are his personal comments.

Your time has expired, Deputy Curran.

They absolutely do not reflect the views of my colleagues, the backbench members of Fianna Fáil. My backbench colleagues have fought for time to contribute to this debate. We do not concur with the Deputy. We fully and wholeheartedly support the Minister for Health and Children.

That is a good script.

Did the Deputy not get the note?

I am pleased to have the opportunity to contribute to this debate and affirm my full confidence in my colleague, the Minister for Health and Children, Deputy Harney. For the past six months I have had the privilege of working beside the Minister in the Department of Health and Children. Working on a highly complex brief, I have been struck by her courage and determination and absolute commitment to deliver to the Irish people a health service of the highest quality. As she stated with some conviction last night, everything she has done as Minister for Health and Children has been aimed at putting patients first, and that is what she will continue to do successfully for many years to come.

When she reaches the right cohort.

The Opposition has chosen the current concerns about breast cancer diagnosis in Portlaoise hospital as a platform for this debate. The one thing that unites us in this House is a profound sympathy for the women who have experienced serious worries and concerns about the way the breast cancer services in Portlaoise dealt with their cases.

That is no excuse for inaction.

What about Cavan hospital?

This regrettable incident is the chief target at which the Opposition has aimed its baseless criticisms of the Minister. This Labour Party motion is typical of those speaking out of both sides of their mouths.

What about the Minister of State at the Department of Health and Children, Deputy Devins? Did he look in the mirror?

They accept that the Minister cannot be held accountable for mistakes in the reading of individual mammograms and ultrasounds while at the same time laying the blame for every clinical shortcoming at her door. As the Minister said last night, it is utterly unacceptable that the women first heard that there might be a problem with their ultrasound tests on the airwaves.

There might and there might not be.

This inexcusable breakdown in communication cannot be repeated.

It is too late now.

The Minister took personal and immediate control of the matter once its extent had been established and instructed her officials to work from last Friday morning over the weekend with the HSE to ensure that clinical reviews and other additional services were fast-tracked.

Did the Minister talk to them?

The Minister knew her job was on the line.

This decisive action which is ongoing has been necessary and beneficial.

Professor Tom Keane has this week taken up his position as interim director of the National Cancer Control Programme. He is working to ensure the transition to the new centres of excellence and is expected to quickly designate clinical national leaders.

Where was the Minister of State for the past ten years?

The people of this country need, deserve and are entitled to the services that will be delivered in a multi-disciplinary setting. That will not be achieved without implementation of the transformation programme. The Minister is presiding over the largest and most fundamental reform of the health service, one that has long been identified as necessary. Implementation of these reforms will give the people the quality of health service to which they are entitled. It must be our ambition and resolve to give quality of care to every patient. Without implementation of such reforms that objective will not be achieved.

The Minister is safe.

Deputy Jan O'Sullivan referred on the airwaves this afternoon to the delay in publishing Dr. O'Doherty's report. This report was commissioned by the HSE. It has not been published yet because natural justice requires that the people who may be identified and in respect of whom there may be adverse comment or inferences are entitled to see it first and have their views heard.

There have been hundreds of reports and nothing has been done.

What did the Taoiseach say?

Tell that to the women.

The Minister of State at the Department of Health and Children, Deputy Devins, was looking for time.

This is normal practice, as Members know. The Government wishes to see this report published as soon as possible.

I am calling on the Minister for the Environment, Heritage and Local Government, Deputy Gormley, next. If Members interrupt they must expect to be interrupted and that is no credit to the House. I am in the hands of the House.

I welcome the opportunity to speak on this sensitive and difficult issue. The women in question have been traumatised by incompetence in Portlaoise hospital.

We do not know that because the report has not been published yet.

I welcome the fact that the Minister for Health and Children took the opportunity yesterday to apologise directly to the women in question. It is outrageous that the women heard about their fate on the radio.

Was that the fault of Portlaoise hospital?

Who does the Minister blame for that?

That is completely and utterly unacceptable.

Will the Minister not vote for the Government amendment?

I was sceptical about the HSE in opposition and some of those concerns were justified.

The Minister has changed a lot.

He was sceptical about the Minister too.

Let me say this, and I will talk about the Opposition lot in a few minutes.

The Minister really has joined them now. He is on the Fianna Fáil Front Bench.

The Minister of State, Deputy Devins, is behind the Minister and will hang him at a minute's notice.

We can engage in all the banter we like but it is not appropriate.

The Minister should address his remarks to the Chair and forget about the argy-bargy.

The lives of these women have been turned upside down but the HSE needs to be turned upside down. It needs root and branch reform.

Who will do that?

This Minister will set about doing that.

Who set it up?

We owe a great debt of gratitude to the nurse who blew the whistle in this case.

The Minister wants to gag the consultants. She will not let them speak on RTE.

It is unacceptable that we have to rely on whistleblowers. Will sacking the Minister improve the situation of these women or the health service?

It cannot make it any worse.

The motion is there for debating on Fridays.

The truthful answer is no. The Opposition would have a political scalp but that will not improve the situation for these women.

They are weasel words.

A Deputy

That is what the Minister has to accept officially.

Will the Minister, Deputy Gormley, take the job himself?

The best way forward is through consensus.

It is sickening.

It is possible to get consensus on many issues and it should be possible to get it on the health issue because there does not appear to be a great difference between the parties on the question of health.

There is no consensus on that side of the House.

The Minister is prepared to listen to us but not to answer questions.

I saw the manifestos.

The Government is caught between American medicine and a public health service.

That was the first sell-out.

That was a big sell-out.

I saw the Labour Party's political manifesto.

This is a democratic forum. The Minister is entitled to make his views known.

I do not know how the Opposition can have the social insurance model it has advocated without advocating tax increases. I have looked at every single model.

The Green Party was going to loot it.

It is just like the incinerator.

The Minister went for American medicine instead.

The Minister is looking through green tinted glasses.

The honourable exception is the Sinn Féin Party which said that we need tax increases. If the Opposition thinks that we can have a world-class health service on the cheap, it is wrong.

The crisis happened anyway.

What does the Minister think?

He wants authority without responsibility.

The Opposition advocated tax cuts. That is the problem. It should be possible, given that there is not much difference between all the political parties on the question of health, to get a consensus on this, as the Minister for Health and Children said yesterday.

No matter how much money goes into the system we will not get value for it.

I recall the Minister opposing co-location.

That was a different time in a different country.

It was a different ballot. The Minister would not like to vote on it now.

Experts such as Maev-Ann Wren say we face a double difficulty because our population is ageing and we have better medicine and technology.

The Government is facing it.

We have a disastrous health service.

Unfortunately, they will not die.

People are staying alive longer and the statistics are quite startling.

Is it a bad thing that people are living longer? Does the Minister want them incinerated?

Cancer occurs predominantly in older people, with approximately 60% of cases diagnosed in people aged 65 and over.

It occurs in poorer people too.

Mainly for demographic reasons the number of patients will double over the next 15 years.

We are well aware of that.

The Minister wants them to go into the private hospitals that the Government is building.

More than 96,000 patients were discharged from hospital following a diagnosis of cancer in 2006. That is an increase of 75% over 1997.

What is the Minister's point?

That is the reality we face in the health service.

We have no health service.

That is why we need consensus. More than 60,000 people were treated as day cases in 2006, an increase of 140% over 1997. Those are the difficulties.

The Minister should speak on the motion.

I could speak on other issues in respect of cancer prevention if I could get a word in edgeways.

What about the motion?

The Minister should speak on the motion.

Consensus is the way forward, not these sorts of partisan motions.

I wish to share time with Deputies Wall, Sherlock, Ciarán Lynch, Penrose and Costello.

(Interruptions).

Deputy McManus only has five minutes so will the Deputies please allow her to speak without interruption.

One thing we now know is that the Green Party will accept any spin Fianna Fáil gives it to be in power.

It will swallow it however it is peddled.

It is interesting that the Government is trying to suggest the reason Deputy Harney must remain Minister for Health and Children is nobody else can take up the job. The obvious answer to this is that many of us on this side of the House would be willing to take up the challenge but the excuse that no one feels he or she could do better than the incumbent also shows the bankruptcy on the Government benches.

Let us examine the record on hospital beds, medical cards, the consultant contract, community nursing beds, hygiene standards and accountability. All of these things were promised but none were delivered and this Minister has actually made matters worse. The feather-bedding of private hospitals, the ending of local democracy and the promotion of inequality are all part of her record.

In November 2004, the Minister, Deputy Harney, bulldozed the Bill that set up the Health Service Executive through this House. She promised high quality patient care and modern, effective management. I argued at the time that this hijacking of democracy was the latest in a comedy of errors that had every likelihood of becoming a catalogue of disasters. I wish I had been wrong but we now have that catalogue of disasters with patients suffering needlessly and dying prematurely. One such patient was Susie Long, a brave mother who died almost three years after the HSE was set up. If the person with ministerial power and authority does not accept responsibility for the botched state of our cancer services, which led to the death of Susie Long, then who will?

The Minister claimed she would deliver improved, integrated, high-quality care and she must take the blame for not doing so. She said last night that she does not accept failure but such hubris only sends out the message that whatever one does, whoever one is, one can duck the flack and keep one's job. Deputy Martin, when he was Minister for Health and Children, cost the State millions when he did not read a brief but he ducked responsibility and got another job. The Minister, Deputy Harney, is presiding over a catalogue of disasters and cannot get information from the Frankenstein she created called the HSE. If she does not accept responsibility for these failures why should anyone working inside or outside the health service do so? Why do Ministers exist if not to take responsibility for what they do and fail to do?

They take their wages.

Instead of asking the Opposition to embark on a kind of Tallaght strategy it is important that we nail this issue. We should not misrepresent the situation because Alan Dukes believed in the policy behind the Tallaght strategy. The Labour Party and the wider Opposition, which used to include the Green Party, which we can now forget about, oppose this Minister on her policy, her privatisation agenda, and her desire to deepen the divide and cause greater inefficiency in the health service through privatisation. We disagree with all of that and will continue to oppose it because it will make things worse, rather than better.

A Deputy

What does the Deputy propose to do?

Regarding support for the cancer strategy, the Minister for Health and Children has less reason to complain about the Opposition and its support for good cancer care and strategic thinking than about her own side of the House.

Where is the Minister of State at the Department of Health and Children, Deputy Jimmy Devins, today?

We must nail this lie because we have stood by good health care in this country when Fianna Fáil used it, from time to time, to win votes.

Everyone has a different attitude to life and I always give people the benefit of the doubt. In this debate Deputy Grealish and the Minister of State at the Department of Health and Children, Deputy Smith, suggested the Minister's policy was to put patients first. I would like to believe that but 30 minutes before the Minister commenced her speech in the House yesterday, I received a phone call from the husband of one of the seven people diagnosed with cancer in Portlaoise. He was very angry because he phoned the Minister's office on three or four occasions and left word with her private secretary that he would like her to call him back. He phoned the head office of the Progressive Democrats and asked them to pass on a message to the Minister that he would like her to call him. He phoned Hawkins House and left a message stating that he would like the Minister to call him. Sadly he is still waiting to hear from the Minister.

This individual's wife is receiving chemotherapy and in two weeks she will go to Dublin for six weeks of continuous treatment. Not one person from the Minister's office thought it worthwhile to make a phone call that could alleviate some of the trauma a family experiences when a loved one is diagnosed with cancer. The Minister claimed in her contribution to this debate that she sympathises with all involved in this matter but the facts say otherwise. The Minister knows who I am talking about and I ask her or a member of her staff, even at this late stage, to call the family in question. This would alleviate some of their suffering.

On a point of order, I read——

The Minister need not read newspapers on this subject because I am talking about facts gleaned in a phone call from the husband of the woman in question.

I believe what the Deputy is saying but I read in a newspaper today that a certain person had phoned my office and left a message. Staff in the private office in the Department of Health and Children checked all of the messages left.

This is not a point of order.

The Department is not passing on messages.

I must be fair to people who are not here but if the Deputy gives me the number of the person in question I will be happy to call him.

As soon as I finish speaking I will give the Minister the number and I ask her to call the man in question. I believe in honesty and I believe the person who phoned me was traumatised by what happened.

The argument seems to be that the HSE is afloat in the ocean with no one in control but we must remember who built the boat. The Minister for Health and Children, Deputy Harney, built the boat.

She launched it too.

How could we spend an hour and a half debating this matter last night and tonight without pointing out that the Minister created the HSE? It is now out of control and it is hard to believe the Minister, the Secretary General of her Department, the head of the HSE and the head of the hospitals sector could not get information from the very body she created.

The Minister cannot walk away from responsibility for this matter. I am not here to check Deputy Harney's credibility because that has been done nine or ten times in her constituency of Dublin Mid-West. I am here to seek accountability from her regarding something she created and no longer wants to recognise. She has the audacity to call for a bipartisan approach at this stage. Given the structure she created, the purpose of which was to shove responsibility as far as possible from the Department so that her own responsibility would be reduced, it is unthinkable that she now seeks to put her arms around the Opposition. There is no doubt in my mind that the Minister is responsible for what has happened, through the creation of the HSE. She should resign on that point alone.

Deputies

Hear, hear.

We have now reached a point where people have lost confidence in the system of delivering cancer care. That people's confidence in the system has been shaken to its foundations is putting it mildly. That thousands of women who are at risk of breast cancer face a cloud of uncertainty is a sad indictment of the Government. That a committee of this House was informed by the HSE that 97 women would have to be recalled for tests before the women themselves were informed speaks volumes. That these women had not been contacted personally within 24 hours is nothing short of a scandal.

When Dr. Peter Naughton told the Minister in 2005 that breast cancer services at Portlaoise were a shambles, did she listen to his concerns? Yes, she did. Did she act in a manner that was reflective of her position as Minister for Health and Children? The answer is "No".

If the answer was "Yes", the Minister would not only have referred the matter to the HSE, she would have followed this issue to its proper conclusion and taken total responsibility. That conclusion should have been the restoration of confidencein a system upon which thousands of women rely.

What is the culture that now pervades the politics of health? It is one where responsibility is passed from the Executive to the bureaucracy and where political accountability is non-existent. The Minister was wrong to adopt a hands-off approach. That is plainly and simply wrong. A Minister for Health and Children cannot adopt a hands-off approach. Otherwise, Angola will surely follow.

If this motion achieves nothing else, it will have put down a clear marker to the Government that the issue of political accountability must be placed at centre stage in terms of health care facilities and delivery. That the Minister for Health and Children has been forced to give an account of her actions is a victory for political accountability and for those women who tonight live in fear for their futures and those of their families. No longer will the people of this country endure a system that leaves no person or organisation accountable for the lack of delivery of cancer care and other services.

Our role as public representatives of the people must be respected. If we seek answers, we must get answers, not carefully worded attempts to dodge the issue. The Minister should not take us for fools. Nor should she take the women we represent for fools. If we deem it necessary to seek answers on behalf of the countless victims of the current health care regime, the Minister must respect that and must respond in kind. We can no longer accept a lack of political accountability. The question tonight is whether the Minister acted with due diligence. She did not.

Deputies

Hear, hear.

This motion focuses on the principle of political accountability whereby someone must account for the significant failures that seem to be systemic within the health service. Nobody can accuse the Minister for Health and Children of being personally responsible for misdiagnoses or for the oversight of each mammo-gram and the reading and assessment of same. We in the Labour Party support the concept of centres of excellence. However, my colleague, Deputy Jan O'Sullivan, raised significant concerns last night. We are all aware of the significant trauma and angst caused to those women who had to be recalled for further tests and assessment and to the nine women who suffered a failure of diagnosis in the first place.

The Minister cannot deny that it was she and her Cabinet colleagues who put in place the HSE, which has turned out to be a labyrinth of bureaucracy and non-accountability. For example, I wrote to the Minister on 15 November about the closure of cancer services at Midland Regional Hospital, Mullingar, which were successfully overseen by Peter Magill, consultant surgeon, Hugh Logan, consultant radiologist, and Kevin Cunnane, consultant pathologist. I stated in this letter that it was my understanding that patients normally catered for in Mullingar would now be transferred to the Mater Hospital. I asked the Minister:

Is there adequate capacity available at the Mater Hospital to cater for the number of patients who availed of this important service for women at Mullingar over the years?

I went on to ask:

Will the HSE provide transport for people who do not have same, in order to enable them get to their appointments at the Mater Hospital? For example, patients who have to travel from Moyne or Aughnacliffe in north Longford, Lanesboro in south Longford or other rural areas may well have to travel in excess of 100 miles and, in many instances, there is no element of public transport available. I am requesting that appropriate transport facilities be provided for any patients who finds themselves in such a position.

In a lovely letter I received in response from the Minister earlier this week, she stated:

Responsibility for the provision of hospital services rests with the executive. A copy of your correspondence has been referred to the chief executive officer of the HSE, who will arrange for the matters raised to be investigated and a reply issued directly to you.

I had already written to Professor Drumm to alert him to my concerns. He responded by thanking me for my letter and reassuring me that the parliamentary affairs division would investigate the matter and that a reply would be sent to me in due course.

What type of whirligig is this? The health board system at least provided some accountability and transparency because membership of the boards included political representatives and professionals. There is nobody at the end of the telephone in the HSE. The Minister expects us to join some type of Tallaght strategy where she advocates the United States model of health care, where it is all about profit and 40 million people have no medical cover. When Alan Dukes agreed the Tallaght strategy with Ray MacSharry, there was a unanimity of approach to economic policy. We could not be further apart on health policy. I would resign from the Labour Party if there was any suggestion that we go along the route advocated by the Minister of private, for-profit medicine. A universal right to access and equality of treatment are the basis of the Labour Party's philosophy in regard to the provision of health care.

Nothing less becomes the HSE than its cold, clinical way of dealing with patients, as typified by the peremptory and unforgivable manner in which it announced the decision to close thebreast cancer service at Mullingar. There were no complaints about the service and the women attending there under Peter Magill, Hugh Logan and Kevin Cunnane regarded it as first class. In a letter published in today's Westmeath Examiner, these doctors state their belief that the breast clinic service at Midland Regional Hospital, Mullingar was of a high quality. They go on to state:

We reject the notion that the breast service in Mullingar deserved to be withdrawn because of unsafe standards and believe that the manner of the HSE's precipitous move to do same (given that plans to close the service were already well advanced) did a grave disservice to those clinicians who have worked hard over the years to provide a quality service only to hear that the "plug was being pulled" on turning on "Six-one" on RTE 1.

What way is this to run a health service?

So much for negotiation.

I am in favour of the proposed centres of excellence.

There were only 19 cases of breast cancer in the region.

Some 630 women availed of the service in Mullingar. Where is the centre of excellence for the midlands?

The Government ran it into the ground.

Professor Niall O'Higgins said that a population of some 300,000 is entitled to a centre of excellence. He advocated the provision of 12 such centres, but that number has been reduced to eight. Why is there no centre in place for the midlands? Asking people to travel 140 miles at a time of great trauma, angst and emotional suffering is unacceptable. I urge the Minister to establish a centre of excellence in the midlands, whatever the precise location. Moreover, everybody suffering from cancer should be given a medical card to ensure they receive the service to which they are entitled.

Deputies

Hear, hear.

"I beheld the wretch — the miserable monster whom I had created." That is a quote from Mary Shelley's Frankenstein which goes to the centre of this debate and asks who is the villain of the piece, the entity created or the creator of the entity? The HSE is the creation of the Minister and like Shelley’s Frankenstein it has grown completely and utterly beyond her control.

The Minister told us her reason for creating the HSE was to allow a health service that would be free of political interference. Instead, she gave us a health service free of political accountability and a health system hamstrung by ideological interference, which sees the improvement of public health care through the development of private hospitals in order to profit from sick people.

If one were to have reservation or concern about tonight's motion, it could relate to who will be the Minister's replacement. Would it be Deputy Martin Cullen of electronic voting fame, provisionally licensed Deputy Noel Dempsey or Deputy Harney's predecessor and serial announcer, Deputy Micheál Martin? However, any concern about the Minister for Health and Children's replacement can only be seen in the context of the idea that making mistakes, no matter how great or regular, will not be a deterrent to being a Minister in this Government.

Accountability and delivery are at the centre of this debate, and I make this point with reference to the Minister's reply to this motion last night. When the Minister speaks on health matters, she does so with conviction and a sincerity that may well be genuine. Underpinning that sincerity is a clear ideological position which sees a solution to our public health care service in privatisation. It is that contradiction which "has us now where we are", as the Minister herself stated.

We can all acknowledge that there are many good parts to the health service. Thousands of people are successfully treated for serious and complex issues every day. Those successes are not attributable to the Minister but she is accountable for them. The Minister sets the direction for the health service, disburses money, approves health care systems and appoints, implements and manages them.

She may not be directly responsible for these systems but she is ultimately accountable for them. She is not responsible for the day-to-day operation of the HSE but she is accountable for it. It is simply unacceptable for the Minister to state, as she did last Friday, that there are communications issues to account for her lack of knowledge.

It is unacceptable that she could go into a meeting ignorant of the fact that 97 women were to be given the most appalling news on that evening's news bulletins. It is unacceptable that the Minister for Health and Children feels entitled to be one remove from health care issues.

For example, when a Deputy tables a parliamentary question to the Minister, it is invariably kicked over to the HSE, which will reply not in a matter of days but perhaps weeks or months. That reply is not entered into the public record of this House and may never come to the attention of the Minister or her officials.

It is seven years since the Government set out a plan to establish eight specialised centres of excellence to treat cancer. In that time of unprecedented prosperity, the Government has failed to provide the funding or leadership necessary to put these in place.

I will give an example by quoting a letter which straddles that seven-year period. It states:

Dear Patient. As a major research programme, the National Breast Cancer Research Institute is conducting a large genetic study of the west of Ireland population.

This letter was sent on 31 October 2007 to somebody who died in March 2000.

This cumulative failure to put the strategy in place is shambolic and reflective of the events in recent weeks. It is because of these events and the failure of the Minister to take responsibility for them, and despite her apology, that she finds herself facing a vote of no confidence. The Minister created the monster which has gone on to frustrate and impede the development of decent health care services. She has used it to distance herself from accountability to this House and the public.

Confusion, frustration and outrage are the legacy of this Minister and her Government. In Shelley's famous book, the creator of the monster ultimately saw the madness of his ways, took responsibility for the mayhem which ensued and fell upon his sword. It is time for the Minister to do the same.

Misdiagnosis, misinformation and miscommunication have categorised the cancer screening and treatment services at the Midland General Hospital in Portlaoise. This extraordinary level of dysfunctionalism occurred long after and despite Mr. Naughton, a surgeon in Portlaoise, writing to the Minister, Deputy Harney, in 2005. He described the diagnostic services there as "a shambles". No meaningful action was taken by the Minister to remedy this problem.

Yesterday we learned of the appalling case of a woman diagnosed with a breast tumour in March 2005 but who was not informed until nine months later, when she returned to the same hospital in pain for further diagnosis. Only then did she discover the chilling news of the diagnosis which had been known nine months earlier. Through gross negligence and unprofessional conduct, this was never communicated to her. The tumour was left untreated, the woman's life was put at risk and she died six months later.

The structures in Portlaoise are clearly not functioning and have not done so for a considerable period of time. The Minister knew all about it. We learn today about major new concerns in Cork and Galway university hospitals. This is enough reason for any responsible Minister to act honourably and resign.

The Minister, Deputy Harney, entered the Department of Health and Children with a flourish over three years ago. She was going to do the devil and all. She announced plans and promised great strides of progress within six months, then 12 months, then two years. At that stage she indicated Rome could not be built in a day. In the run up to the general election she argued that she needed a second term to make real progress, which she passionately told us last night she would see through.

What will the Minister see through and at what cost to the patient? Is it the withdrawal, due to the current staffing embargo, of essential physiotherapy services to a former postman on Sheriff Street who is suffering from Parkinson's disease, hypertension, back pain, ulcerated legs, depression, vertigo, an inoperable hernia in his chest, and who is on 20 tablets a day? His essential and necessary physiotherapy has now been withdrawn completely and indefinitely because there is no staff to deal with him in the Mater Hospital. That has been put in writing from the services section to me.

Are we to have more of the misleading HSE daily statistics, which do not include busy weekends and omit the time patients spend in the accident and emergency department prior to diagnosis? These statistics state that patients have left the accident and emergency department when they are simply transferred to an annex, a sort of limbo euphemistically described as an admissions lounge.

Accident and emergency department statistics are now deftly massaged for public consumption but patients are no closer to a bed in a hospital ward. Is it to continue to be the Minister's assertion that the 3,000 beds taken out of the hospital system are not needed, although our population is growing and ageing? At the same time the Minister is brazenly replacing those beds with beds in co-located private hospitals on public hospital grounds.

Is it to be the so-called fair deal proposals due to be implemented in January that will cost residents of nursing homes 80% of their disposable income during their life and up to 15% of the value of their estate after their death? Is it to be the refusal of a centre of excellence for the entire population of the north west?

If these are the plans, policies and practices that the Minister, Deputy Harney, wants more time to implement, it is definitely time for her to go.

The five short minutes I have in this debate are inadequate for the number of issues which have arisen. We require more debate in this House on issues like this, not just arising from crises coming up from day to day or week to week.

We need a far more general debate.

We need debate, not statements.

There is no problem about that. We have allowed the narrative about health to be dictated in the political culture of this country on the basis of the presumption that we have a perfect system, and if a problem arises, the person with ministerial responsibility should resign on every occasion. We need to bring into our debate that reform is the buzzword of every political progressive and yet when people are involved in trying to implement reforms, too much of the adversarial system in this House enables oppositions of all types, depending on when they are in those benches to take up the views of the vested interests. That often happens because there are many resisters to change and no more so than in the health service. I have heard discussions in the background today about ideological positions, with talk about privatisation and all the rest, which is not relevant to this debate.

It does a disservice. At the moment we have a public and private health care system. I do not want this argument to take up all the three or four short minutes I have in defending the Minister.

The Tánaiste abandoned Angola.

The idea of co-location is really about making sure we have the cheapest way of getting more beds into the system on a co-located basis.

The beds are there in Monaghan if the health service used them.

That is not the chief thrust of my argument, which is as follows. We also heard in this House because of the absence of analysis and thinking about this area the idea that we should revert back to the health board system because in some way that was a better system.

It is about accountability.

We want accountability.

Nowhere is that true, even considering what happened in Portlaoise, about which I know because I was Minister for Health and Children at the time. The problem has always been the argument not just at political level but also at medical political level, which has been far more partisan in many respects when it comes to debates about health and the need for change. The real issue is that in many cases it is arguments about where the service might be rather than what is the quality of service to be provided on a universal basis to all our citizens.

Regarding the social partnership model we have, I congratulate and thank the Irish Congress of Trade Unions which has proposed setting up a health forum.

What about the motion?

I say to those people who want to make this work and ensure we improve our system, there have been real improvements in our health service. The idea that there has been none is a falsehood. There have been real improvements in our health service.

Does the Tánaiste believe that?

I can prove it because in can be seen in health care, health status, productivity in our hospitals, the number of people going through our hospitals and the number of additional people employed in our hospitals. We know this much even if we will not articulate it and be honest enough in this House. If it was simply a question of resources we would have this problem solved by now.

The Tánaiste should speak to the motion.

It is about working in a collaborative way to ensure the practices and service delivery mechanisms in the interest of protecting public services are developed. In psychiatric care in recent years we have moved from an institutional system to people with psychiatric illnesses being able to take their place as citizens in the community.

The Tánaiste should stick with Portlaoise in his constituency where triple assessment was not introduced.

Allow the Tánaiste to speak without interruption.

Yet we have this continuing effort to portray the health system as simply an acute hospital system. It is about developing more primary care teams, as we are doing. It is about introducing more GP out-of-hours services, as we are doing and as has helped greatly in Dublin.

The Tánaiste was the Minister who named the Department of Health and Children "Angola".

I assure Deputy Quinn that I know some of the people involved, many of whom are from my constituency. I do not come in here to say anything untoward about it only to this effect. Of course what happened should not have happened. However, we must take into account that real progress is being made in the development of cancer care services. I was aware and people like the rest of us from the midlands who know about it have been able to show that the development of acute hospital services was possible.

The Tánaiste is the man who named it "Angola". He could not get out of the Department of Health and Children quickly enough.

I can talk about that if the Deputy wants to shout me down about it. It was about the fact that it is a Department where it is possible to get up the next day and something comes out of the left field about which nobody informed the Minister. That can happen and that is what I meant by it.

The Minister could at least respond to letters.

That has also been portrayed wrongly because some people want to portray it in a different way. The bottom line is that we have a Minister for Health and Children who is involved in the process of change and wants to bring reform.

She wants to talk about but does not want to deliver reform.

Whatever our political differences, the primary responsibility of this House is to represent citizens, not resisters of change or vested interests in the health service who want to hold it back.

I wish to share time with Deputy Gilmore.

I have listened with great care to all that has been said on all sides of the House in the debate tonight and last night. I agree with the Tánaiste that we need considerably more focus and debate on the health services in this House, which I would welcome. I am one of the few Members of this House — the Tánaiste is another — who can truly empathise with the Minister, Deputy Harney. I know the job. The Minister is not accountable or responsible for the actions or failures of each and every employee of the health service, nor do we ask her to be, but she is politically accountable to this House and through us to the people for her political decisions, promises and commitments. The Minister's big project, her big idea, was and is the HSE, and that is not working. Worse than that, it is making patient care worse, not better. That is my honest assessment.

Over 20 years I have dealt with constituency queries on health issues. Even in the poorest of times I never felt less able to address the frustrations of my electorate in dealing with health issues than I do now. Health workers, general practitioners and nurses are contacting my office to express their frustration and exasperation at what is going on. I will give two brief examples from the dozens I could have picked from my clinics in the past few weeks. A three year old child in my constituency has been suffering from severe tonsillitis since November 2006, 12 months ago. He is so bad that antibiotics are no longer effective. The child is constantly distressed, cannot take solids and has been living for months on infant formula at three years of age. He is awaiting an appointment with an ENT consultant.

I contacted the PAD, parliamentary affairs division, of the HSE and the reply I received stated:

I wish to advise you that two referral letters from [the child's] GP, in addition to a referral letter from [a] Consultant Paediatrician was received on behalf of [this child]...

All of the above has been clinically assessed by the Consultant ENT Surgeon who has placed [the child] on the routine list, for an appointment.

I asked further whether that meant the child was on a waiting list for a tonsillectomy or whether having waited for a year he might qualify for the treatment purchase scheme and I received a reply last week staring that the child is on a waiting list to be seen by a consultant. He is on the waiting list to get on the waiting list. He does not qualify for the treatment purchase scheme because he needs to be on the waiting list for three months before qualifying for that scheme.

I will give another example — I said I could pick dozens. A man was in full-time employment until he suffered a painful back injury in September 2006. He attended his GP, but when medication failed to relieve his symptoms his doctor recommended he see an orthopaedic surgeon. He attended an accident and emergency unit in severe pain and was referred to an orthopaedic surgeon. However, he never received an appointment. On being informed that he would wait two years, he decided to see a consultant privately. Not having health insurance he ended up paying €6,700, money he needed to borrow. He has now been told that because he went privately he is not entitled to be treated for pain management in the public service even though the man has a medical card.

So much more could be said. The bottom line is as follows. Every Member of the House has similar tales to tell. Some will argue that Deputies should not be involved in such matters. However, when the doctors are sending their patients directly to our offices, what else do we do?

Deputies

Hear, hear.

The Minister promised health delivery. She got the legislation she wanted through the Houses. She has the resources that any of her predecessors would have given their right arm to have and it has failed. Her plan has failed and she must take political accountability and political responsibility for that failure.

I thank every Member of the House who has contributed to this debate. It has been a long time since we had a Private Members' debate that attracted such a full house——

And a full Gallery.

——and in which every party leader participated. The Minister, Deputy Harney, made a very eloquent speech last night. She set out what she wanted to do and called on us all to rally in support. It would have been a credible speech if she had made it as she started her term as Minister for Health and Children. The Minister and her colleagues have been in government — responsible for the management of the health service — for 3,782 days. While I accept that the Minister, Deputy Harney, was not Minister for Health and Children for all that time, she was the Tánaiste when she had other responsibilities. The Government has been in power for so long that young doctors who are beginning to work in hospitals throughout the country had only started secondary school when it took office. The amount of time it has been in office should be long enough for any Government to sort out the problems in the health service.

In her speech, the Minister, Deputy Harney, called for a bipartisan approach to the issue of cancer care. The Minister, Deputy Gormley, called for consensus. The Minister, Deputy Cowen, called for more debate. I do not disagree with any of that. When the legislation that established the Health Service Executive was being debated in this House in 2004, Deputies on this side of the House tried to argue that the HSE would not work, that it would be an over-bureaucratic monstrosity and that patients would ultimately suffer.

The Government, which is now calling for a bipartisan approach, guillotined the debate on the Health Bill 2004 to force it through the House.

There was no bipartisanship when the Minister reneged on her promise to give 200,000 additional medical cards to people in this country.

It was over 200,000.

There has been no bipartisanship on the issue of co-location.

If anything, a majority of the Members of this House opposed the co-location policy over the course of the last general election.

And privatisation.

It is not merely the case that the Minister has failed to secure a bipartisan approach for the policy she is pursuing — she does not even have a mandate for it. One can only have genuine bipartisanship when one has an agreement on policy. It is quite rich of the Minister to ask the Opposition to support her policy when the Minister of State who was sitting beside her when she made that call yesterday, Deputy Devins, was outside the gates of this House last week protesting against the very policy on which the Minister wants a bipartisan approach.

Deputies

Hear, hear.

I was not protesting against it. Deputy Gilmore should know better than that.

I would like to be clear on cancer policy . Despite what some people are saying, this is not about politics. Deputy O'Sullivan has stated publicly, as Deputy McManus did when she was our health spokesperson, that the Labour Party supports the cancer strategy and the centres of excellence. The provision of an additional centre in the north west should be debated and discussed. The problem we have with the cancer strategy is that it is not being implemented. There is no budget or timetable for it. The approach being adopted involves the closure of local facilities before centres of excellence are put in place. In the script circulated by Deputy Ned O'Keeffe, which I understand he was not allowed to deliver here tonight——

——he makes the fair point that while promises of world-class centres of excellence, best practice and the messiah from Vancouver sound great, they cannot disguise the lack of capacity in existing hospitals, which is the single biggest contributor to the current crisis.

Deputies

Hear, hear.

That sums it up.

Ned will not save the Government's bacon.

The most pathetic part of the speech made last night by the Minister for Health and Children was when she described the lonely position she found herself in last Wednesday, when she struggled to get her own officials and officials from the Health Service Executive to explain why the 97 women in Portlaoise had not been notified and why an additional crisis had developed. The Minister, Deputy Harney, who is experienced and able, said when she established the HSE that it would help to solve the crisis in the health system, but she was unable to get answers from that body when she needed them. Nothing makes the case more eloquently that the Minister is no longer in control of the health service, or even in charge of her Department. The Minister has responsibility for these officials. She is able, in her own words, to direct the Health Service Executive. She can order it to provide the information she seeks. She can appoint and sack the members of the HSE.

She sacked the Secretary General of the Department.

She has all these powers under the Health Act 2004. She is the ultimate authority for the health service under the Ministers and Secretaries Acts. The people with whom she was struggling are well-paid officers of the State for whom she approved bonuses in addition to the salaries they are already paid, presumably on the basis that they were doing a good job. However, she was unable to get basic answers from them when they were needed. The clinic which 97 women were told to attend last Saturday was arranged at short notice, after the Labour Party had tabled this motion for debate in the Dáil. It was organised in such a hurry that the women could not be guaranteed the privacy they deserved as they turned up. Although three months have passed since the Portlaoise crisis arose, we have not yet seen a report into what happened there. We have not yet received an explanation. The Minister, Deputy Gormley, has admitted that there was incompetence in Portlaoise.

It was not confined to Portlaoise.

Where is the report? Where is the explanation? What action has been taken? We know there is a report in draft form somewhere, but the Minister has said she is not allowed to see it. It is buried somewhere beneath a pile of lawyers and is likely to stay there for a long time.

It will be incinerated.

All of this was not entirely new. The Minister's attention was drawn to the problems in Portlaoise in this regard when Dr. Peter Naughton wrote a letter to the Department two years ago. The Minister passed the letter on for answer by the HSE as if it were a routine parliamentary question. We are not talking about accountability for administrative issues. In the past, we have debated missing files in the Office of the Attorney General. Officials have resigned in Britain because CDs containing personal information have gone missing. We are talking about a life-threatening disease that kills hundreds of women, including young women who leave behind young children, every year. This disease thrives on delay, but all we are getting in response to this issue is delay. Two years after the Minister first heard there was a problem in Portlaoise, and three months after the misdiagnosis came to public attention, we still have no explanation for what has happened.

I agree with Deputy Howlin that we should not expect the Minister, Deputy Harney, to take the blame for every wrong clinical decision that is made by individual doctors. When things go wrong, however, I expect the Minister to produce an explanation of what happened. After ten years in office, the Government should have put in place a health system in which things like this do not happen and in which there is a proper flow of information and communication. This motion is not about giving the Minister clinical blame — it is about how she has discharged her duties, for which she has legal responsibility under the Health Act 2004 and the Ministers and Secretaries Acts. Some idea of the Minister for Health and Children's ministerial style can be gleaned from a reply she gave to a parliamentary question some time ago:

I do not attend management meetings, nor did I do so in the previous Department. I believe that is the role of the management in the Department, although we have policy meetings with officials and so on.

If the Minister takes this kind of a hands-off approach to the running of her Department, if she acts like some kind of semi-detached non-executive director, then she can only expect to have got what she got last Wednesday; a Department under her control which is out of control; an agency which she set up which does not appear to be under anybody's control and patients who are not getting the quality of health service which they deserve and for which the taxpayers are paying.

I move that this House vote no confidence in the Minister for Health and Children.

I am obliged to put the question to the House as it is now 8.30 p.m. Prior to putting the question, while Standing Order 71 provides that a list vote through the lobbies is the appropriate way of taking a vote when it is a vote of no confidence in the Government, I consider that a vote of no confidence in a Minister is of such import that I should exercise my discretion to have a full list vote on this item also.

Amendment put.
The Dáil divided: Tá, 84; Níl, 73.

  • Ahern, Bertie.
  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Andrews, Chris.
  • Ardagh, Seán.
  • Aylward, Bobby.
  • Behan, Joe.
  • Blaney, Niall.
  • Brady, Áine.
  • Brady, Cyprian.
  • Brady, Johnny.
  • Brennan, Séamus.
  • Browne, John.
  • Byrne, Thomas.
  • Calleary, Dara.
  • Carey, Pat.
  • Collins, Niall.
  • Conlon, Margaret.
  • Connick, Seán.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cregan, John.
  • Cuffe, Ciarán.
  • Cullen, Martin.
  • Curran, John.
  • Dempsey, Noel.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gogarty, Paul.
  • Gormley, John.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Hoctor, Máire.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Killeen, Tony.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • Lowry, Michael.
  • Mansergh, Martin.
  • Martin, Micheál.
  • McDaid, James.
  • McEllistrim, Thomas.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M. J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Brien, Darragh.
  • O’Connor, Charlie.
  • O’Dea, Willie.
  • O’Flynn, Noel.
  • O’Hanlon, Rory.
  • O’Keeffe, Batt.
  • O’Keeffe, Edward.
  • O’Rourke, Mary.
  • O’Sullivan, Christy.
  • Power, Peter.
  • Power, Seán.
  • Sargent, Trevor.
  • Scanlon, Eamon.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • White, Mary Alexandra.
  • Woods, Michael.

Níl

  • Allen, Bernard.
  • Bannon, James.
  • Barrett, Seán.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burke, Ulick.
  • Burton, Joan.
  • Byrne, Catherine.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Coveney, Simon.
  • Crawford, Seymour.
  • Creed, Michael.
  • D’Arcy, Michael.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Feighan, Frank.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Gregory, Tony.
  • Hayes, Brian.
  • Hayes, Tom.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Kenny, Enda.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Morgan, Arthur.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Donnell, Kieran.
  • O’Dowd, Fergus.
  • O’Mahony, John.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ring, Michael.
  • Shatter, Alan.
  • Sheahan, Tom.
  • Sheehan, P. J.
  • Sherlock, Seán.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Upton, Mary.
  • Varadkar, Leo.
  • Wall, Jack.
Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Paul Kehoe and Emmet Stagg.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 83; Níl, 73.

  • Ahern, Bertie.
  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Andrews, Chris.
  • Ardagh, Seán.
  • Aylward, Bobby.
  • Behan, Joe.
  • Blaney, Niall.
  • Brady, Áine.
  • Brady, Cyprian.
  • Brady, Johnny.
  • Brennan, Séamus.
  • Browne, John.
  • Byrne, Thomas.
  • Calleary, Dara.
  • Carey, Pat.
  • Collins, Niall.
  • Conlon, Margaret.
  • Connick, Seán.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cregan, John.
  • Cuffe, Ciarán.
  • Cullen, Martin.
  • Curran, John.
  • Dempsey, Noel.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gogarty, Paul.
  • Gormley, John.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Hoctor, Máire.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Killeen, Tony.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • Lowry, Michael.
  • McDaid, James.
  • McEllistrim, Thomas.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • Mansergh, Martin.
  • Martin, Micheál.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M. J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Brien, Darragh.
  • O’Connor, Charlie.
  • O’Dea, Willie.
  • O’Flynn, Noel.
  • O’Hanlon, Rory.
  • O’Keeffe, Batt.
  • O’Rourke, Mary.
  • O’Sullivan, Christy.
  • Power, Peter.
  • Power, Seán.
  • Sargent, Trevor.
  • Scanlon, Eamon.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • White, Mary Alexandra.
  • Woods, Michael.

Níl

  • Allen, Bernard.
  • Bannon, James.
  • Barrett, Seán.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burke, Ulick.
  • Burton, Joan.
  • Byrne, Catherine.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Coveney, Simon.
  • Crawford, Seymour.
  • Creed, Michael.
  • D’Arcy, Michael.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Feighan, Frank.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Gregory, Tony.
  • Hayes, Brian.
  • Hayes, Tom.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Kenny, Enda.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Morgan, Arthur.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Donnell, Kieran.
  • O’Dowd, Fergus.
  • O’Mahony, John.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ring, Michael.
  • Shatter, Alan.
  • Sheahan, Tom.
  • Sheehan, P. J.
  • Sherlock, Seán.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Upton, Mary.
  • Varadkar, Leo.
  • Wall, Jack.
Tellers: Tá, Deputies John Curran and Tom Kitt; Níl, Deputies Emmet Stagg and Paul Kehoe.
Question declared carried.