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Seanad Éireann debate -
Wednesday, 23 Jun 2010

Vol. 203 No. 9

Health Services

I welcome the Minister of State, Deputy Áine Brady. My matter is as follows: the need for the Minister for Health and Children, in light of serious questions which arise from the content of documents released to me under the Freedom of Information Act as directed by the Information Commissioner, Ms Emily O'Reilly, to hold an independent review of governance standards in the HSE and the Health Information and Quality Authority; to carry out an evaluation of the relationship and interaction between both organisations; and reform of the Health Act 2004 in order to introduce some level of public accountability to our health service.

As the Minister of State and Members will no doubt be aware, in recent years in the context of fighting to prevent cancer services moving from Sligo to University College Hospital Galway, I sought information, including a number of reports, from the Health Service Executive and HIQA. I do not want to dwell on the cancer issue for Sligo because sadly the horse has bolted on that issue, much to the inconvenience of the people in the entire north west region, an argument I made here on many occasions in the past. The information I have managed to secure — the documents I have finally managed to extract from both organisations — and not least the inordinate and obstructive process to secure them raise potentially very serious questions over the integrity and credibility of both the Health Service Executive and the Health Information and Quality Authority. They also suggest an urgent need for the examination of the objectivity of the work of our so-called independent standards and quality watchdog.

I have the report before me. I know that if documents are to be mentioned in the House, I need to lay them before the Office of the Cathaoirleach, which I have done. It took me 14 months to get this information in order to assess the work of HIQA, our independent quality authority. Its website states: "we will publish the findings of our inspections so that the public can make informed choices when seeking care". That is only in the instance when there is a Senator Marc MacSharry who is prepared to spend €500 and 14 months trying to extract that information. It is only when Senator Marc MacSharry manages successfully to solicit the support of the Office of the Information Commissioner to get that information.

I do not want to get drawn into the cancer issue again because much bigger issues are at play. However, the HIQA report proves — not my words, but its words — that University College Hospital Galway was not ready for the transfer from Sligo.

It did not at that time meet the standards. That is a fact and a matter of public record. I regret that I and many thousands of people in the north west were vilified by health professionals and, in my view, people who acted in concert to subvert the course of a process that should have been objective, but was completely subjective. These are all matters that are borne out in documentation finally extracted under duress from the Health Information and Quality Authority.

One HIQA document that came to me was a minute of a meeting which involved the management of the hospital in Galway; its surgeons; Tony O'Brien, the revered head of the national cancer control programme; and John Billings, the quality director of the Health Information and Quality Authority. The top of the document states: "Draft confidential, not for circulation". It does not surprise me. I must quote from it. When members of the medical team in Galway indicated they were nervous about the review it states:

HIQA will construct something that will allow the reviewers to dip into details on certain aspects, but will not aim to catch the centres out. [That is damning in the extreme.] Surgeon is concerned that HIQA may fail on a technicality.

At this stage JB — John Billings, no doubt, the director of quality in our so-called independent Health Information and Quality Authority — said: "No. That will not be the case. We will not do that." These are all documents that we have now managed to get. It took 14 months. In response to my request for all relevant documentation to do with the preparation of this report and the minutes of any relevant meeting, on 18 June 2009 the Health Service Executive had the gall to write to me stating: "No such meetings have taken place between Galway University Hospital and HIQA".

So what have we got here? It is most concerning. We need to assess the implications of the effective organised concealment of information of systemic importance to what HIQA is supposed to be doing in informing the public when they are making informed choices in seeking health care. However, it was the organised concealment of this information that prevented that. In assessing this matter, the similarity with some of the causes of our financial meltdown is unbelievable. We have seen the catastrophe that has been caused in our economy by the unhealthy proximity and familiarity of service providers, the regulatory authorities and, of course, the overall Central Bank and the financial sector, about which I have spoken on many occasions as finance spokesman for the Government. Without doubt, the documents I have confirm that the health service providers — in this instance UCHG, but perhaps others — the independent quality authority and the HSE are operating in an environment that is over-familiar, highly subjective and — if we are to learn from the early lessons from our economic woes — one that could compromise far more than people's financial well being. Clearly that confirms the need to assess governance standards in the HSE, which are clearly in the gutter, and to evaluate the independence of HIQA and the subjective nature of its work, clearly proven by these documents.

I also seek reform of the Health Act 2004 to give some level of public accountability to our health service. I need not remind the Minister of State that €15 billion of the people's money, representing more than 50% of the tax take, is voted directly from the Minister for Finance to one individual, the chief executive officer of the Health Service Executive. That is a disgrace. The people will not put up with such a lack of accountability. I make an analogy. If a person was to spend €100,000 on renovating a house, would he or she go to the local chippy or labourer and hand him or her the entire sum before doing the work? It would not happen; there must be accountability and a project must be managed.

We need as a matter of urgency reform of the Health Act 2004 to bring the budget back under Government control to ensure some level of accountability. Regardless of what is stated on the HSE and HIQA websites, I can indicate the obstructive nature of these bodies, which can be confirmed by the Information Commissioner, Ms Emily O'Reilly. It took me some 14 months to get the information I needed on behalf of the public to assess the policy and performance of an organisation in which there is no public representative influence or involvement. It acts as it sees fit without recourse to the Government or the people. This must change.

They have savaged medical services in the context of cancer treatment services throughout the north west. I have proved that, and it took me 14 months to do so. I remember being vilified by many Members for being critical. However, as the Leader of the House, Senator Cassidy, often says, there is no wrong time to do the right thing. I appeal in earnest, therefore, to the Minister of State on the issue.

I fully appreciate there will be a set-piece reply in which it will be indicated HIQA and the HSE are doing great work on our behalf. I do not want to undermine the individuals who work in both organisations and are doing exceptionally good work. What is wrong — it is fascism in the extreme — is the level of independence of these organisations which act without recourse to the public. This cannot continue, as €15 billion of the people's money is given to them, without a single public representative being able to query them.

This is a minute aspect of the health service, but it took me 14 months to get the proof I needed. I thank the Acting Chairman and the Minister of State for giving of their time and apologise if people believe I am overly passionate on the issue, but do not confuse passion with a lack of determination or conviction. I know I am and have been right on this issue and now I have proof.

I welcome the opportunity to set out the position on the Health Information and Quality Authority, HIQA, and its role with regard to the Health Service Executive, HSE. The HSE was established in January 2005 under the Health Act 2004 as the single body with statutory responsibility for the management and delivery of health and personal social services in Ireland. HIQA was established in May 2007 under the Health Act 2007 and its mission is to drive high quality and safe care for those using health and social services. Key functions which enable it to fulfil its mission include the setting and monitoring of standards. Both the HSE and HIQA act under the democratically set policies of the Government which have also frequently been approved by the Oireachtas and both are fully accountable as public service organisations to the Oireachtas through the Minister for Health and Children.

A number of standards have been developed and published by HIQA to date. Examples include the national quality standards for residential care settings for older people in Ireland published in 2009 which are used as the basis for registration and inspection of public and private nursing homes and the national standards for the prevention and control of health care associated infectionspublished in 2009 which will form the basis for hygiene inspections and audits of facilities provided by and on behalf of the HSE. HIQA operates in an open and transparent fashion and reports on its activities, including inspection and monitoring reports, are routinely published on its website. Where deficits are identified, its approach is generally one of assisting service providers in making the necessary improvements.

In 2007, at the request of the Minister, the Government approved the national quality assurance standards for symptomatic breast disease services. The standards, adopted by HIQA, were prepared by a national group chaired by Professor Niall O'Higgins which comprised experts in the major cancer disciplines, including surgery, pathology, radiology, medical oncology, radiation oncology, nursing and general practice. It also included patient advocates from the Irish Cancer Society and Europa Donna. The purpose of the standards was to improve the quality of care for women with breast disease in Ireland and address the fragmentation of services nationally at the time.

Also in 2006 the Government adopted a new national cancer control strategy, NCCP, setting out a way forward for cancer control in Ireland. On foot of the Government strategy, the NCCP was established by the HSE in 2007 and, accordingly, eight cancer centres were designated. In November that year Professor Tom Keane took up the post of interim director of the cancer programme. During his tenure significant progress was made in the reorganisation of cancer treatment services in the eight centres. Centralising breast cancer diagnosis and surgical services was the first priority. This was absolutely imperative in order to guarantee women in every region of the country the same access to the highest quality diagnosis, care and best outcomes from cancer treatment. This process was completed at the end of 2009 and all breast cancer surgical and diagnosis services are now provided in the eight centres, plus an outreach centre at Letterkenny which is linked with the services in Galway.

Between 2008 and 2009 HIQA undertook an assessment against the national standards of the symptomatic breast services at the eight cancer centres. Interim reports on compliance with the standards were produced for each hospital. These were based on a self-assessment exercise by each centre in early 2008, followed by feedback from and validation visits by HIQA in autumn that year. The interim reports which were provided for the eight hospitals and the HSE national cancer control programme indicated the aspects of the standards that were being met in each centre and where there were gaps that could be addressed. HIQA, the NCCP and each of the eight centres worked together to ensure ongoing progress was made in addressing any gaps identified before a final assessment was carried out in the eight centres in late 2009. HIQA's final report on compliance with the standards was published in February. It found that at final assessment stage all the eight cancer centres, without exception, had met the fundamental requirements to provide quality care for breast cancer patients, although it recognised that in most centres there remained opportunities for improvement.

HIQA operates within a robust and comprehensive code of governance which the Minister approved and commits it to observing the highest standards of probity in the exercise of its functions. The Minister is satisfied that HIQA carries out its role in accordance with the terms of the Health Act 2007 under which it was established. She is also fully satisfied that its assessments of the eight cancer centres have at all times been entirely impartial, appropriate and focused on the fundamental goal of ensuring standards are met in order to achieve best outcomes for patients.

The Government's national cancer control strategy is being implemented entirely properly in their respective roles by the HSE and HIQA, with full accountability. Cancer patients, now and in the future in all regions, are the beneficiaries. There are no grounds for a review of the roles of the HSE and HIQA arising from their implementation of the cancer control strategy.

Minister, I do not accept anything that was said. The Minister is obviously happy with what she has been told, but I have proof that it is flawed and has been organised and engineered in the same way Ministers from my party were told by regulators, central bankers and service providers that the banks were well capitalised weeks before the collapse. There is no ambiguity; there cannot be self-regulation or over-familiarity in the health service such as occurred in the financial sector. We saw the catastrophe to which that led. I thank the Minister of State for her response which I accept and appreciate, but I do not agree with its contents for the reason I have given. The contents of my speech bear out exactly what that is. The revealed documents pose very serious questions over the integrity, credibility and governance standards at a senior level within the HSE and HIQA. As a citizen, I intend to see to it that these questions are answered.

I will take on board what the Senator said.

Before calling on Senator McFadden, I welcome to the Seanad a delegation from the County Cavan job initiative forum which includes Mr. Clifford Kelly, Mr. Michael Mulvey and Mr. Mel Greaney.

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