Dáil Éireann debate -
Tuesday, 20 May 2008

Vol. 654 No. 4

Adjournment Debate.

Hospital Services.

Deputy Fergus O’Dowd

I regret that the Minister for Health and Children did not remain in the House for a few minutes longer. I cannot think of anything more important than the health and concerns of the people, 4,600 of whom have been asked to wait a maximum period of eight weeks before finding out the exact position regarding their X-rays and CAT scans. It is of fundamental importance to our society that when an error is made or health misdiagnoses take place, there is complete transparency, openness and honesty in respect of what happened.

It is time for the Government and the Health Service Executive to think again. It is time to concentrate on shortening considerably the maximum eight-week waiting period before learning one's correct diagnosis. There are many ways to so do, some of which have been discussed by the HSE and some of which have not. The Minister of State, Deputy Barry Andrews, and his boss, the Minister for Health and Children, Deputy Mary Harney, have a duty of care to all the people affected to ensure this waiting period is as short as possible. They must wait for eight weeks, or 56 days and nights, although the original X-ray may have been taken more than a year ago. If something is wrong, people cannot afford to wait.

The health service in its entirety, including doctors and radiologists, must act in concert with the HSE, the Minister of State and the Minister — who would not wait five minutes for Members — to ascertain whether the waiting period can be abridged and whether something can be done to sort it out. Why can this not happen within one week or immediately? There is no reason people should be obliged to wait for eight weeks - one would not wait eight weeks for a tooth filling. Thankfully, the majority of those concerned have been told there is nothing wrong with them. However, many of those who have been in contact with my colleagues and me have had cancer in the past. Many have put behind them breast or lung cancer and have had X-rays in the interim. Such people are deeply worried about what is happening at present. They suffer anxiety and sleepless nights, and their families also are worried. It was not good enough for the Taoiseach to state today that a precautionary principle is being applied and that eight weeks is okay. It is never okay and never will be acceptable. That it has come to this is a disgrace.

This happened because there was no oversight and no audit. I have to hand Ms Justice Maureen Harding Clark's report into the Dr. Neary affair. Dr. Neary got away with his actions because there was no audit of his work. While I do not suggest the consultant in this instance is in the same realm, the key point in the Harding Clark report stated there must be clinical audit of all consultants in the system. However, no clinical audit of the work of the man concerned took place and this is the reason these people are suffering tonight.

I wish to make two further points. Although what took place was bad enough, the Government also messed up the mail merge. The health service has 100,000 employees, as well as an entire Department of Health and Children. However, faced with the obligation to contact 4,600 people, the mail merge was outsourced and given to a company that could not deliver. It messed up the mail merge and sent the wrong letters to the wrong people, including letters to people who are deceased. Not only did it send a first letter, it also sent a second letter. Today I received a telephone call from the family of a person who was in her 90s when she passed away. They had previously received two letters addressed to her but today they received a telephone call asking that she go to the hospital to have her X-ray examined. This demonstrates how appalling this mess is.

The Government has demonstrated it does not care. The Minister will not even wait to discuss what is the most important issue to have arisen in my region for many years. It is an absolute and total disgrace. The Taoiseach has stated he is a republican and has spoken of the new Republic. I understand he has used words such as "equality", "brotherhood" and "fraternity". In a republic other than a banana republic, equality of treatment above all else would mean emergency action in this case. One would press all the buttons to ensure these people were looked after and would ensure that no head would lie on a bed worrying about his or her diagnosis for a single night longer than was necessary. This is the key. However, the Health Service Executive could not care less and is not accountable and the Minister will not sit and listen to Members for five minutes.

Deputy Caoimhghín Ó Caoláin

In the course of the career in politics of the Minister of State at the Department of Health and Children, Deputy Barry Andrews, he should learn the lesson of the example provided tonight by his senior Minister. Her walking out at the outset of this debate is deplorable——

Deputy Fergus O’Dowd

It was disgraceful, appalling and shameful.

Deputy Caoimhghín Ó Caoláin

——and gives a very bad signal to the people of the north east, on whom she has already turned her back repeatedly in respect of the health issues of concern to them. I have to hand one of the letters sent out by the Health Service Executive to thousands of people in counties Cavan, Monaghan, Louth and Meath. It was received by one of my constituents in Carrickmacross, County Monaghan. The woman in question is willing to share the information that at the best of times she is prone to anxiety and stress. One can only imagine her distress when she read this letter. She now faces two months living in fear and trepidation as she awaits the outcome of the review of her case.

One of the first things that must be done by the Minister for Health and Children is to provide the resources to expedite the reviews and to shorten the agonising waiting time for patients. Some letters from the HSE have arrived months after the person in question has died as a result of cancer, greatly adding to the grief of their loved ones. While the HSE originally stated that four people who were misdiagnosed had died, I understand this figure could prove to be as high as ten.

This issue first came to public notice with a report in The Sunday Tribune on 30 March that the HSE in the north east was considering a review of radiology services, possibly involving the rechecking of thousands of scans for cancer. Given the experience of women in the midlands, this was of major concern to those in the north east who had undergone such scans. Concerns were expressed directly to me at that time. On 31 March, the HSE issued a statement indicating that a limited review was under way. The HSE did not state the exact nature of the tests involved and it was unclear whether the HSE had contacted patients who might have been affected. There was no clarity for patients, even though the HSE stated that the requirement to inform patients and their families must take precedence over all other considerations. I stated at the time that there should be no repeat of the mismanagement and lack of information that surrounded the midlands cancer screening scandal. I also stated that inadequate resources and facilities for oncology in the north east had been highlighted repeatedly by frontline staff and that cancer services in this region required significant enhancement. I regret that from what has been learned subsequently, this appears to be a repeat of the midlands scandal.

A locum radiologist was employed by the HSE from August 2006 to August 2007. My Sinn Féin colleague on Louth County Council, Councillor Tomás Sharkey, has highlighted how a man in his constituency was X-rayed in May 2007 and was sent home after being given the all-clear. On 14 November 2007, however, he was re-admitted to hospital and X-rayed. On this occasion, the radiologist on duty immediately recognised cancer on the X-ray. The second radiologist checked the May 2007 X-ray result and realised it was clearly shown on that one too. The patient in question was told he had cancer only when he went to another hospital for further treatment. X-rays of this man were taken hours before his death and the family have never been given a proper explanation as to how this tragic case was handled.

The locum radiologist who worked from August 2006 to August 2007 lives in Scotland. In the Irish edition of the Mail on Sunday of 18 May, he alleged he was being scapegoated. He stated he knew nothing about X-rays being recalled, as no one had informed him of the review. He also stated, “Why I am being singled out for all of these supposed mistakes when there were others in those hospitals who also saw the X-rays bewilders me.”

What was most significant in this report was the alleged comment from a person described as a senior source close to the review who said other members of staff had also viewed the X-rays of some of the patients who later died and had also missed the cancer lesions. The source is quoted as saying there were other weak links in the chain. Another source who attended the meeting held after the diagnosis of one patient said the oncologist's age was a major factor in his being singled out by the review team. This raises very serious questions.

We hear a lot about clinical governance and the better management of our health services. Are we looking at a cover-up of the systems failure for which the current Minister and successive Ministers are ultimately responsible? The Minister for Health and Children, Deputy Mary Harney, must ensure complete and comprehensive information is provided, including by way of a public inquiry if necessary, on the systems failures that have led to the terrible situation facing thousands of people in counties Cavan, Monaghan, Louth and Meath.

We need an explanation for the delay in acting on this matter after it first came to the notice of the HSE. Coming in the wake of previous cancer diagnosis reviews, all of this highlights the failure of successive Ministers, the Departments and the HSE to ensure the delivery of the best care for all patients at all locations where cancer services are provided.

Minister of State at the Department of Health and Children (Deputy Barry Andrews)

I will be taking this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The HSE has instigated a look-back review of all chest X-rays and CT scans reported on by one locum consultant radiologist, who worked in Our Lady of Lourdes Hospital in Drogheda and Our Lady's Hospital, Navan between August 2006 and August 2007. This decision was made following expert clinical advice from Ireland and the UK and an examination of the cases raised. This review is being done as a precaution and as a reassurance for patients.

The look-back review was prompted by concerns that four patients in two Louth and Meath hospitals during 2006 and 2007 had their diagnoses delayed due to an abnormality on their chest X-rays not being noted on initial examination. These patients were subsequently diagnosed with lung cancer by follow-up X-rays and have all passed away.

The Minister was informed in March of this year that the HSE, following further examination of the issue, was considering a separate look-back review regarding the work of that radiologist. The HSE issued a press release on 31 March following media reports concerning radiology services in the north east. That press release was based on the information available at the time. In its subsequent assessment of the situation, and taking into account the advice of external experts, the HSE agreed that the look-back review would include 70 CT scans.

Planning for this review commenced at the end of March 2008. A steering group was formed by the HSE on 9 April 2008 to oversee the radiology review. From April to 14 May, the steering group undertook preparatory work which included defining the methodology for the look-back exercise, sourcing radiologists to undertake the look-back, arranging indemnity for the reviewers, developing the process and resources for the look-back exercise across two X-ray departments in Navan and Drogheda and establishing the communication needs around the review and putting plans in place to meet them.

Chest radiographs are performed for many reasons — most are done for respiratory tract infections, bronchitis, asthma, pneumonia, accidents, injuries, chest pain and heart failure. A small number are done for possible lung tumours, but the majority of patients who are being checked are extremely low-risk and are included as a measure of prudence.

Numerous challenges arose throughout this planning phase, particularly with regard to securing radiologists in Ireland who would undertake the look-back in association with the Louth and Meath radiologists. Following a review of options available, including external companies in the UK to undertake the look-back, a decision was made to proceed with an internal-external mixed panel of radiologists from Louth, Meath and Northern Ireland. The look-back review commenced on 15 May 2008 and it is expected that it will be completed within eight weeks. As each X-ray and CT scan is reviewed, the HSE will write to the patient to let him or her know the result of the recheck.

The HSE announced today in a media statement that, in the context of this review and during the last three weeks, two people already receiving treatment for lung cancer were identified to the review team. These people were found to be part of the original group of 4,500 patients to be reviewed. The HSE has advised the Department that, since these two people were identified, the focus has been on checking on their current status and care and assessing their significance in the context of this review. Before contact was made with the families of these patients and information provided to their families, it would have been inappropriate ethically and medically to make any public statement with regard to these cases. The HSE has been making contact with the families concerned since Friday, 16 May 2008 and continues to do so.

The HSE has also advised the Department that information confirmed by a HSE official to public representatives yesterday pertaining to these two cases was not in line with the HSE policy of not releasing any detail of the review or the people concerned until the review process is complete.

Deputy Fergus O’Dowd

Will he or she be sacked?

Deputy Barry Andrews

An information line has been put in place and people affected by the review can make contact with the HSE directly. The number is 1850 241850. In patients' interests and in keeping with the lessons learned from previous reviews, neither the HSE nor the Department will report any further on specific details of the reviews until they have concluded.

I agree with Deputies that it is vitally important we ensure the delivery of best cancer care for all cancer patients. This is the reason this Government is totally committed to implementing the HSE national cancer control programme. The programme will offer equal access to all patients to the expertise of cancer specialists working together in major centres serving large numbers of patients. The designation of cancer centres aims to ensure that patients receive the highest quality care while at the same time allowing local access to services, where appropriate.

It is also important people are fully aware that where diagnosis and treatment planning are directed and managed by multi-disciplinary teams based at the cancer centres, much of the treatment, other than surgery, can be delivered in local hospitals. Chemotherapy and other aspects of follow up care will be carried out at local hospitals. This will involve significant realignment of cancer services to move from the present fragmented system of care to one that is consistent with international best practice in cancer control.

It is time to recognise that we cannot achieve high standards for cancer services by trying to provide a full range of services in centres that do not provide multi-disciplinary care and have very low volumes of patients. With the implementation of the national cancer control programme we are moving towards a more equitable system that can produce better outcomes than the existing system.

Urban Regeneration.

Deputy Aengus Ó Snodaigh

The issue in question is the urgent need for the Government to address a crisis that has arisen due to the pulling out by McNamara Construction from contracts for five regeneration projects. This is not only about building homes; this is about regenerating five communities in this city and the knock-on effect for other communities who wait in hope for regeneration projects.

I believe the decision by McNamara Construction is a vote of no confidence in the public private partnership route Dublin City Council took, encouraged by the Government. In a previous life this Government, with Deputy Martin Cullen as Minister, rejected a community plan developed for St. Michael's estate, despite the plan originally having the support of Dublin City Council.

The Government must now renew the confidence of these communities in regeneration — it must fill the gap and take charge of all five projects. The Government must underwrite this scheme to the extent that it not only builds social housing, but affordable housing and private homes also. It must also provide the facilities promised to St. Michael's estate, O'Devaney Gardens, Seán McDermott Street, Dominick Street and Infirmary Road.

I reiterate a call made by Councillors Críona Ní Dhálaigh and Christy Burke today. I call on Deputy Michael Finneran, Minister of State at the Department of the Environment, Heritage and Local Government, with responsibility for housing, the Minister for the Environment, Heritage and Local Government, Deputy John Gormley, the Minister for Finance, Deputy Brian Lenihan and even the Taoiseach to visit these areas and talk to the residents. They have put up with a great deal since these regeneration projects started. They have put up with devastation and disadvantage in the hope that their dreams would come true. Those dreams have now been shattered. I wish Ministers would come to these areas and live there for a week to see the effect this decision has had. The Government has not taken this matter seriously. There is a crisis and it needs to be addressed with greater urgency than it has shown so far.

Deputy Catherine Byrne

I thank the Minister of State for being here. I have lived and worked in St. Michael's in Inchicore all my life. For the past 18 years I have been hearing about the plan for the regeneration of St. Michael's estate. I have been a member of the board of St. Michael's for the past eight years. On numerous occasions plans have been brought to the table and rejected. The plan recently abandoned, a public private partnership in conjunction with McNamara Construction, had brought great hope to people. People thought they were finally going to get homes they could live in, that they would be part of a community, and that they would have facilities that were badly needed. It would bring a new beginning and, above all, a new social agenda. People living in the community need to be re-educated, to participate in programmes for working in the community, and to have homework clubs. It was to be the start of a new life.

Yesterday a shock wave went through our community. The hopes and dreams not only of those living in St. Michael's estate but also those in the wider community of Inchicore were shattered. Through the years, Inchicore has put up with many problems, including at one stage the closure of many shops due to the huge drug problem in the area. Things have since improved and at this stage people are seeing light at the end of the tunnel. However, yesterday the project was again put on the back burner. I am not here this evening to blame the board, Dublin City Council, the developer or even the Government. I am here to request sincerely that the Government consider this issue. It is now time to make a decision for those people who have remained in St. Michael's estate for the last number of years, some of them in quite difficult conditions. If it were not for the fact that Dublin City Council has improved living conditions in St. Michael's to a certain extent I dread to think what it would be like.

I believe the project, which was started two years ago, is not lost and that there is a chance it can be completed. I want this to happen, as do the people living in Inchicore and the residents of St. Michael's estate. I want the Government to honour the commitment that has been given to the residents of St. Michael's estate to improve their lifestyle, to go forward together and to give them a new vision of what regeneration is about — a new life and a new beginning. The Government needs to step in and support the regeneration project. It should support the board and those in the community who have played a major part in the project. I am not here to roar and shout but to request on behalf of those living in St. Michael's estate and Inchicore that this project, which is so badly needed, be revitalised and that the Government step in and take the issue seriously. I am fed up coming into this Chamber with requests under Standing Order 32 that are rejected. This is a matter of national importance and I seek the Minister of State's reassurance that something will be done for all of us who have put in so much work in the area.

Deputy Joe Costello

With my two colleagues, I wish to raise this important issue and seek intervention by the Minister of State and the Minister for the Environment, Heritage and Local Government.

It has come as a huge shock to the people of the north inner city that McNamara Construction and Castlethorn Construction have suddenly decided to withdraw from their public private partnership agreements with Dublin City Council. The hundreds of tenants of O'Devaney Gardens, Infirmary Road, Seán MacDermott Street and Dominick Street, not to mention St. Michael's estate on the south side where the project has been promised for a even longer period, are shell-shocked on hearing that their long-promised homes and facilities are now less likely to materialise. The Minister for the Environment, Heritage and Local Government must outline his plans to assist these devastated local communities which are dependent on the successful delivery of the PPP model. He must outline the implications for Dublin and for other cities and towns in which the same PPP model is being promoted. He must also state the level of binding legal commitment in the agreements reached between the city council and the private developer and whether the city council or the State has any legal recourse. The Minister must state whether this devastating news has implications for the successful delivery of other projects within his brief which depend on the PPP model. We have heard that a number of these projects are also in jeopardy.

The retiring Comptroller and Auditor General, Mr. Purcell, speaking last Sunday night on "The Week in Politics", urged the Government to be cautious in its use of the PPP model. The fact that so many projects in Dublin should have been agreed at the same time with McNamara Construction and should collapse at the same time needs to be explained. My main concern is for the hundreds of tenants of the four project areas in my constituency who feel absolutely betrayed. They and their representatives have patiently worked to plan the regeneration projects hand-in-hand with the developers and the local authority over recent years. The local authority must organise meetings with them to reassure them that the social, affordable and community housing aspects of the projects will be retained and that these homes will be constructed. There is an immediate need for the Minister for the Environment, Heritage and Local Government to make that commitment.

I welcome the new Minister of State with responsibility for housing, Deputy Michael Finneran, and congratulate him on his appointment. I want to be the first to invite the Minister of State to come to Dublin Central, attend our meetings, visit the estates and meet the residents. I would like the Minister of State to come with the ability to make a financial commitment that the social, affordable and community development aspects of the projects, which have been in the pipeline for so many years, will be delivered in the not too distant future. It has long been promised that at last this public private model would be successful. I ask the Minister to make such a commitment.

Minister of State at the Department of the Environment, Heritage and Local Government (Deputy Michael Finneran)

I thank the Deputies for raising this matter. The fact that three Deputies are combining to speak on this issue reflects its importance and the very real concerns about the regeneration process in the areas affected. The regeneration of estates is a key element of the Government's housing policy statement, Delivering Homes, Sustaining Communities, and more than €120 million has been provided from the Exchequer in 2008 to aid this process. This is in addition to funding from the private sector and from local authorities' own resources.

I remind the house that Dublin City is a very active and successful authority in terms of regeneration. The Deputies will be aware of Dublin City Council's track record in the successful regeneration of inner city flats complexes as well as its role in overseeing the substantial regeneration programme under way in Ballymun. The Ballymun regeneration project itself, which was the subject of a recent report by the Comptroller and Auditor General, is one of the largest developments in the State and has been brought about through a combination of public and private money, construction expertise and management skills.

We should not forget the contribution to regeneration arising from the work of the Dublin Docklands Development Authority, which has so visibly transformed the inner city of Dublin. The Fatima Mansions regeneration project is nearing conclusion and is a clear demonstration of Dublin City Council's successful implementation of the public private partnership model. The project involved the demolition of 364 largely vacant flats and will deliver 150 new local authority homes, 70 affordable homes and 395 homes for sale on the private market. The redevelopment also includes enterprise space, a community centre, commercial space, a leisure centre and general infrastructural and landscaping works.

Public private partnerships are part of a range of options used by Dublin City Council to renew and regenerate its social housing estates and provide new social and affordable housing in the city. PPPs are a way of promoting sustainable development by encouraging social, income and tenure mix in an economically efficient way. The partnership model is based upon Dublin City Council optimising the use of its existing land holdings to leverage private finance. The developer in turn provides the local authority with an agreed number of social and-or affordable housing units and funds the overall development in whole or in part from the sale of the housing units to the general public.

It is important to note that public private partnerships are by no means the only mechanism being employed by Dublin City Council to advance its ambitious social and affordable housing programme. Significant Exchequer resources are also being provided and the council was recently allocated more than €250 million from the 2008 social housing investment programme, including €65 million for the regeneration of Ballymun. In the past five years, Dublin City Council has completed more than 3,000 social housing units outside of the regeneration programme and Ballymun.

On Monday, 19 May 2008, Dublin City Council announced that its PPP regeneration projects with Castlethorn-McNamara in St. Michael's estate and O'Devaney Gardens and with McNamara on Dominick Street, Convent Lands in Seán McDermott Street and Infirmary Road would not go ahead as planned. The current economic climate and the substantial changes that have recently occurred in the residential housing sector have, according to the developers, rendered these projects non-viable. The council is working with its tenants to explore options for regenerating the five areas affected by the announcement. It will meet the three regeneration boards involved in St. Michael's estate, O'Devaney Gardens and Dominick Street to explore all options and to consider alternative plans to deliver the social housing needed in those areas. The original apartment blocks in St. Michael's estate containing 346 flats are substantially vacated, with 23 families remaining. The immediate priority will be to ensure that this process will continue and new homes will be found for the remaining families, pending the area's regeneration. Further physical work is scheduled in O'Devaney Gardens where four vacant blocks are due for demolition.

The next step is for Dublin City Council to examine all of the social, economic and legal implications of the recent announcements and to table alternative proposals so that the regeneration process can proceed. It is important to remember that procurement processes are under way in respect of other PPP projects in other areas of the city, which will help in informing the way forward. My Department will actively engage with the council in terms of alternative proposals for the projects. It will also consider the wider implications, if any, for the approach to PPPs generally. At this point, it is too early to try to detail the factors that have led to this situation, beyond noting the obvious fact that market conditions have changed significantly in the past six months. However, this matter must be examined in depth to allow my Department to consider the wider implications for the PPP regeneration programme as a whole. What is clear is that we will still need private enterprise, in whatever form it takes, to help build sustainable mixed communities. There is no going back to the era of large mono-tenure social housing estates, with all of the consequential concentration of economic and social deprivation.

All the options for progressing the projects raised by Deputies are being examined by Dublin City Council. I assure the Deputies that my Department will continue to engage with the council actively with a view to moving these projects forward as quickly as possible. As someone who worked for many years with the Dublin health authority, I know the areas well. It is my intention to visit the different locations during the coming days and weeks.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 21 May 2008.