Private Notice Questions.

Hospital Services.

I will call on the Deputies who tabled questions to the Minister for Health and Children in the order in which they submitted their questions to my office.

Jan O'Sullivan

Ceist:

Deputy Jan O’Sullivan asked the Minister for Health and Children when her attention was drawn to the fact that there were serious problems in Tallaght hospital, Dublin 24 with regard to the failure to have X-rays reviewed by radiologists; when the Health Service Executive was first made aware of this problem; the action that she took as a result; the steps that are being taken to inform patients whose X-rays were not reviewed; the further steps that are being taken to speed up the review of the outstanding X-rays; the inquiry that will be held to establish the cause of the serious failures at Tallaght hospital; and if she will make a statement on the matter.

Arthur Morgan

Ceist:

Deputy Arthur Morgan asked the Minister for Health and Children the way she could preside over a situation in which 58,000 X-rays were not read by a consultant radiologist; the action that has been taken to ensure there will be no repeat of this incident which, in itself, is a repetition of other unread or misread X-rays; and the way she proposes to instil confidence in the public in her health service with this level of incompetence and negligence on her part and on the part of those answerable to her.

Caoimhghín Ó Caoláin

Ceist:

Deputy Caoimhghín Ó Caoláin asked the Minister for Health and Children the implications for patients of the fact that more than 57,000 X-rays taken at Tallaght hospital, Dublin 24, were not reviewed by a consultant radiologist; and if there will be an urgent review of management and supervision of consultants at this hospital and throughout the hospital network arising from this development.

James Reilly

Ceist:

Deputy James Reilly asked the Minister for Health and Children if she will explain the failure to have X-rays read by a consultant radiologist at Tallaght hospital, Dublin 24, from 2005 to 2009; the way she was not informed by the Health Information and Quality Authority; and the reason the authority simply accepted a figure of 41,000 when 58,600 were involved; and if she will make a statement on the matter.

I welcome the opportunity to deal with the issue that has arisen with regard to the reading of X-rays at Tallaght hospital. Patients have a right to expect the best possible standards of diagnosis, treatment and follow-up care in hospital and the Government is committed to ensuring this is achieved consistently, across all hospitals.

In the case of X-rays, best practice is that they should generally be seen by and formally reported on by a consultant radiologist. It is clear this did not happen in the case of 57,921 X-rays in Tallaght hospital. I am advised these X-rays were seen by doctors involved in the patients' care and referred for assessment by a radiologist but that they were not formally reported on by a radiologist. In this context, the X-rays in question constitute about 6% of the total X-rays taken over the period. The remaining 94% were reviewed and reported on by a radiologist. The CEO of Tallaght hospital has acknowledged this practice fell below appropriate clinical standards and was not acceptable.

When an issue of this kind arises, there is a clearly established serious incident protocol for dealing with it. This was established by the HSE with the support of the Department of Health and Children. The protocol puts patients' interests first and foremost in all actions to be taken. It requires that one must correct or cease the practice that has given rise to the concern; consider the need for and if necessary undertake a clinical review of patients who have been through the service to identify any whose care or treatment may have been adversely affected as a result and to immediately provide them with appropriate care; and consider whether an investigation of what happened and why is required in order to address any systemic failures and minimise the risk of a similar occurrence in the future.

The CEO of Tallaght hospital has confirmed that since September 2009 all X-rays are now read and reported on by a suitably qualified consultant radiologist. This is the first step and is designed to avoid risk of harm to further patients. The clinical review is already well under way. As the CEO explained, approximately 60% of the total X-rays involved have been reviewed and the aim is to complete the review by May. The HSE has announced that it is to carry out an investigation into the circumstances that led to the accumulation of unreported X-rays. The investigation will be chaired by a person independent of Tallaght hospital and the HSE. The details of the investigation will be announced in the coming days. The priority now is to ensure that the remaining X-rays are reviewed so that any patients requiring further follow-up are identified and provided with the necessary services. The protocol is very clear that cases should first be reviewed and patients informed where these is a need for follow-up. Only then should the question of publicising the matter arise. The fact that the information relating to this incident became public while the hospital was still in the process of reviewing X-rays has meant that, unfortunately, many patients have been given cause for unnecessary distress and worry.

It is for this reason that the new HSE director of clinical care, Dr. Barry White, and the recently appointed national lead for radiology, Dr. Risteárd Ó Laoide, consultant radiologist at St Vincent's Hospital and Dean of the Faculty of Radiologists, along with other senior HSE executives, are attending Tallaght hospital today to see if the clinical review can be further expedited. I very much regret any distress caused to patients by the manner and timing in which this came into the public domain. It is important to stress that the vast majority of patients have no cause for concern and would have been reassured in that regard once the clinical review had been completed.

The reading of X-rays is not a precise or exact science. However, the available evidence is that the risk in this cohort of patients is extremely low. Of the 34,752 X-rays reviewed to date, it appears that just two patients had a delayed diagnosis. One of these patients died last summer and the other is receiving treatment in the hospital. The hospital is continuing with its clinical review and in the event any patient requires treatment, this will be made available immediately by the hospital.

I want to deal with the question of when my colleague, the Minister for Health and Children, became aware of this situation. The matter was first mentioned to her by the newly appointed CEO of Tallaght hospital on 15 December 2009 after a meeting with him, the Master of the Coombe and officials of the Department on another matter. It was one of a number of initial priorities the CEO, who had just taken up his position, intended to address. However, it was only yesterday that the Minister became aware of the nature and scale of the situation. It was not raised as a significant patient safety issue. The hospital had not brought the matter to the attention of the Department.

That being said, the critical issue, as far as the Minister is concerned, is whether the matter has been and is being managed appropriately by the hospital. On the basis of the information provided to her so far, the Minister is satisfied the new CEO has, since his appointment, accorded this the priority it warrants. Dr. Barry White has also confirmed the hospital has taken the necessary action to address the risks to patients arising from this situation.

The most important thing is to complete the clinical review, identify whether any patients need further treatment and if so provide the necessary services and reassure any other patients who may have concerns about their X-rays. As soon as that has been done, we can focus on the investigation that has already been announced by the HSE. The serious incident management protocol is key to putting patients' interests first and it must guide us in all of the actions to be taken.

I regret very much that the Minister saw fit to go away for St Patrick's day one week in advance and that she is not here to answer questions. One part of my question concerns what action the Minister took and it appears she took no action whatsoever. I have number of questions for the Minister of State, Deputy Andrews, and his colleagues arising from his response. Knowing that there are more than 20,000 outstanding X-rays that have not yet been examined by radiologists, how can he say that this is of low concern, if that is the phrase he used? How can this be so? We do not know what is in the 20,000 outstanding X-rays. We know that one patient has died already and another has had a delayed diagnosis. The Taoiseach gave a similar reply this morning and I was astonished at the suggestion that with 20,000 outstanding X-rays, we can blandly say it is acceptable to take time over this because there is probably no issue for other patients. We do not know that. I ask the Minister of State to address this so that the rest of the X-rays are examined as quickly as possible.

Regarding the Minister's knowledge of the issue, on "Morning Ireland" Professor Conlon said:

I explained to the Minister and I explained to the HSE the issue we had with radiology. I also explained to her that we were going to deal with it and I explained to her that we were going to deal with it by bringing extra consultants in and that we were going to clear this backlog as fast as is humanly possible.

Does that not indicate there was a considerable amount of information given to the Minister at that time in December? Does the Minister of State know if the Minister for Health and Children was told of the numbers involved? We know that Professor Conlon knew the numbers at that stage. Did the Minister for Health and Children ask to be kept informed of progress on the issue? The statement by HIQA suggests it was told the backlog would be removed by the end of March. Does the Minister know why this did not happen? The HIQA statement suggests this would happen by March.

Of the X-rays not reviewed, how many involved private patients and how many involved public patients? Was each X-ray assigned a number? The Minister indicated they may have been assigned a radiologist but the radiologist never examined the X-rays. Can the Minister of State clarify this point?

The main point I am concerned about is that the Minister was given substantial information in December. The CEO had the full information on the number, over 57,000 outstanding. Can the Minister of State provide any reassurance to the public why the Minister for Health and Children did not act on this information or take responsibility? It is very hard to have confidence in the Minister for Health and Children in the context of all the information she had regarding previous incidents of misdiagnosis and the recommendations in the public domain. When she was given this information about a large publicly funded hospital she appears to have totally ignored it and is not in the Chamber to answer questions. These issues are extremely serious for patient confidence in the health services. There remain many outstanding questions and I hope the Minister of State can answer them.

Deputy O'Sullivan rightly began her contribution by concentrating on the reassurance we can give to patients listening to this debate or hearing reports of it. The information I have to hand is that when HIQA began to involve itself in this issue, it was satisfied that the risk stratification process had been contemplated in a manner in which the reviews of these X-rays would take place after December so that in the initial stages the more serious cases would be examined. Given an issue has arisen in only two of the X-rays already reviewed — there is nothing about which we can be complacent — remaining patients who have not yet been contacted can be reassured to a certain extent. There obviously remains a great deal of work to do. However, the most important message that we should put out today is that this work will be expedited and people will be informed without any further delay.

Deputy O'Sullivan also asked about the state of knowledge of the Minister for Health and Children. As I mentioned in my opening comments, the Minister was informed of the matter in December following a meeting on another subject. It was not an agenda item for that meeting and was not brought to her attention as a patient safety issue. The matter was brought to her attention in the context of it being an issue about which they wished to inform her but in respect of which they did not wish her to take any action. There is no doubt in any——

That is a little like the situation in respect of nursing homes and the Minister for Foreign Affairs, Deputy Micheál Martin, when Minister for Health and Children.

Deputy Rabbitte, please allow the Minister of State to continue.

The Deputy's knowledge of the history of this House is greater than mine. However, I can assure him that nobody is in any doubt in terms of the competence of the newly appointed CEO at Tallaght hospital to deal with this issue. Equally, the Minister for Health and Children had absolute confidence that Professor Conlon would discharge his responsibilities, namely, that the practice had ceased and that the review would commence. Deputy O'Sullivan quoted what Professor Conlon had to say on radio this morning, namely, that he told the Minister that extra consultants were being appointed and that this would be done as quickly as humanly possible. I believe the Minister was entitled to rely on the information as represented to her at the time. For this reason, the Minister, as stated, left it to the hospital to deal with the situation, which was right and proper.

Was the Minister aware of the number of X-rays involved?

I cannot say that that information was represented to her at that time. I cannot inform the House of the exact nature of the conversation that took place. Deputy O'Sullivan also asked the number of public and private patients involved. I do not have that information either.

I must, without being overly political on a serious issue about which people are concerned, take the Deputy to task and reiterate that the Minister has displayed a considerable commitment to patient safety through the establishment of the commission on patient safety, the Medical Council and Health Information and Quality Authority, HIQA. It is quite possible that without HIQA we would not know all of this information and that the matter might not have been resolved as quickly.

HIQA was told there were only 4,000 X-rays involved.

The Minister has also introduced extraordinary reforms in respect of cancer care, which I do not believe anybody disputes and on which HIQA reported very positively. Deputy O'Sullivan is entitled to her political opinion but I dispute it strongly. The Minister has been a reforming Minister——

It is not a political opinion, it is an opinion on behalf of patients.

The reforms she has introduced are beginning to bear fruit for the health service.

I call Deputy Arthur Morgan.

Perhaps the Minister of State will say when this whole sorry mess was discovered. We know that the new CEO learned of the situation on his appointment in December. When prior to that was the situation in this regard known about and by whom? I understand the Minister was informed of the position around that time and that she is claiming she was not made aware of the number of X-rays involved. We are told this situation was discovered some time in December. However, it was the CEO who discovered it then. When, prior to that, was this situation known?

We are now in the middle of March and the HSE clinical director and a number of other big shots are only today going to visit the hospital to discuss the matter despite that this situation has been known about since at least end of December. Why were those big shots not called to the hospital long before now to sort of out what could or should be done? Why did they wait until now to do this? Is it because the matter is in the public domain and is being reported on by the media and discussed in this House? Are they trying to dampen it down? Why were they not called in long before now? Will the Minister of State give us a categorical assurance that the remainder of the X-rays will be read and will he provide us with a specific timeframe or aspirational date in this regard so that people who are concerned about their health, some possibly with cancer, their families and the many thousands of people well beyond the 58,000 mentioned here, can be put at ease?

The Minister of State in his opening remarks stated that the 58,000 X-rays represented 6% of all X-rays carried out at Tallaght hospital and that 94% of X-rays had been read. It sounded to me as though the Minister of State — perhaps he will clarify this — regards a 6% error rate as being not too bad at all. I believe a 1% error rate is a scandal. Perhaps the Minister of State will clarify his position in this regard. It is extremely important that he do so. Does the Minister of State accept that this Government is wrecking the health service and that the Fianna Fáil element of this Government has been wrecking our health service for more than 20 years now and will not settle until such time as it has privatised the whole shooting gallery, which clearly is its political agenda? For the purpose of clarity, I do not seek to hang this matter around the neck of the current Minister of State, Deputy Andrews, and his colleagues but, broadly, that has been the political agenda of Fianna Fáil Governments for more than 20 years now.

The exact details of who knew what and when will be explored by the investigation announced by the HSE. I do not wish to anticipate the outcome of that inquiry. I can say that HIQA was first informed of the matter on 24 April 2009. On the manner of the issue coming into the public domain, it is good that these matters do come into the public domain. However, the sequence within which they do so is unfortunate. Clearly we would wish to first complete the review and to inform all patients and families likely to be affected before putting the issue into the public domain. Members present in the House today know there was no intention not to put it in the public domain. HIQA would have done so anyway. It would not be behind the door in ensuring that happened. The correct sequence would be as outlined earlier.

The timeframe for completion of the existing reviews was May. As I mentioned earlier Professor Conlon represented to the Minister in December that he would do everything he could to ensure the matter was addressed as quickly as possible. However, now that the matter is in the public domain and there may be some disquiet and some reassurance required, the clinical director of the HSE, Dr. Barry White, is meeting the consultant radiologist at Tallaght hospital today to ensure further resources are drawn in. Naturally, the question as to why this was not done from day one will be asked. Obviously, this will require us to draw on other resources and as everybody in this House knows, when they put their politics to one side——

Surely it would have drawn resources anyway.

——there are limited resources in every aspect of the public service. One hopes that expedition of this matter will not adversely affect other services. It is a matter of huge national concern and it must be addressed in the quickest timeframe possible. As I stated earlier, the matter is being addressed this afternoon by Dr. Barry White.

That does not answer my question.

I am afraid it will have to do because that is what is happening right now.

Is "it will have to do" the best the Minister of State can offer?

Deputy Morgan, please.

They are the facts, Deputy Morgan. The Deputy is afraid of them.

"It will have to do." That is what is wrong with this Government.

Deputy Morgan, please allow the Minister of State to continue without interruption.

The Minister of State's answer of "it will have to do" is pathetic.

The answer I have given is the correct factual response.

We are in a national Parliament and I can do no more than give the correct factual information. If the Deputy does not find that adequate, that is a matter for him.

I do not find it adequate.

Deputy Morgan, please.

The truth is that the timeframe for completion——

The Minister of State is hiding behind——

Deputy Morgan, please restrain yourself.

It is important that we clarify that the process was to be completed at the end of May. Given the matter is now in the public domain and there is now a heightened fear and naturally so, steps are being taken to shorten that period. We are now in the middle of March. This process will now be completed in the next few weeks. We would like to do it tomorrow. To date 3,000 reviews a week have taken place, which by any standards is a quick turnaround. We are trying to ensure the look back is carried out as quickly as possible. The intention is to complete this process quicker given the concerns now raised. I have already outlined that the Minister, Deputy Harney, is a reforming Minister. It is now common folklore that once one gets into the health service, it is one of the best in the world.

It always was.

Everybody agrees with that, which is a fact nobody can dispute.

Concerns were raised by Deputies——

Deputy Morgan, please do not interrupt. I call on Deputy Ó Caoláin.

Does the Minister of State accept that we are looking at another scandal in our health services? Would the Taoiseach like to revisit his own position on the issue this morning? In my view, he showed scant regard for the cases already addressed, which have led to the loss of one life and the diagnosis of cancer in another case. There are also 14,000 patients who are obviously in great distress in the absence of certainty about their health situation. There was no understanding in the Taoiseach's responses this morning and he made a big effort to minimise what was involved here. There was no apology to the people concerned, their families and their loved ones. That is surely where we should have started.

How can it be claimed that this is not every bit as serious as the previous cases of misdiagnosis? In this situation we are looking at no diagnosis or delayed diagnosis, which is every bit as serious. People need to know that what is happening in Tallaght is not also the situation applying at other hospital sites the length and breadth of this State. There are 14,000 patients for whom around 23,000 X-rays have not been read. Every available resource should be employed to expedite this process because it could happen to anyone. As this situation might apply to other hospitals, the concerns could be expressed by anybody across the country, including our family, friends, neighbours and extended communities. People want to know how this could have happened in the first place. How is it possible for neglect to take place on this scale?

Our former Dáil colleague and now Councillor Seán Crowe raised this issue regarding Tallaght hospital two years ago, following a row-back on the services and a shortage of staff. I pulled up the various statements we issued at the time he highlighted the shortage of radiologists at Tallaght. That was two years ago when he gave expression to what the service providers at the hospital were saying, as well as those who had a direct interest in ensuring it was a hospital of high repute. Has a shortage of radiologists and other staff directly contributed to the failure of consultant radiologists to read these X-rays over the 2005 to 2009 period? I fear the answer is "Yes". The Minister of State should provide more information on this because his opening statement is simply not good enough.

Where was the management of the consultants? How do these people function if they can get away with completely ignoring one of their core responsibilities in our hospital network? Who manages, oversees or ensures that these consultants are doing their work? Does all this go into an office where nobody has any oversight responsibility and where nobody asks a question until the crisis erupts and appears on the floor of this Chamber? Where are the checks and balances in the hospital system to make sure that people are doing the job which they are employed to do?

Reading the HIQA statement causes even more alarm. A local GP told officials from HIQA in April 2009 about unopened orthopaedic referral letters from general practitioners and a backlog of radiology reporting in Tallaght.

That is scandalous.

How could that happen? Is there a parallel inquiry or investigation into the number of unopened orthopaedic referral letters and other referral letters from GPs to that hospital or any other hospital? How many consultant radiologists were in Tallaght between 2005 and 2009? How does the Minister of State account for the fact that the former CEO of the hospital told officials from HIQA last June that there were only 4,000 unreported X-rays and that it was only with the advent of a new chief executive that we discovered the number is 57,000? The figures did not jump from 4,000 to 57,000 in the last six months of 2009 because they cover a four year period from 2005. Will this discrepancy be investigated?

Some of us would like to ask questions if Deputy Ó Caoláin would only finish his Second Stage speech.

If my voice does not give up on me, Deputy Rabbitte will have to be patient and allow me to finish.

The Minister has admitted that she only learned of this scandal on 15 December, and only as a secondary matter in a meeting with the chief executive at Tallaght hospital on another issue. Is the Minister negligent for not inquiring about the number of cases involved when this matter was first raised in December? Has she made inquiries about the matter since? We are now in the second week of March. I find the situation absolutely incredible. She needs to explain her role as Minister. Does she believe that acting in the interest of patients by the Minister for Health and Children equates to meddling, as she claimed on "Morning Ireland"? I find that absolutely outrageous. She has a responsibility to ensure that we receive best care and best practice in all our acute hospitals.

I agree that, on the face of it, these practices were absolutely unacceptable. It is unfortunate that it had to come to light through a doctor like Professor O'Dowd, who informed HIQA of the matter. If I were able to answer all the questions the Deputy has put there would be no need for an investigation. If I were able to put on the record of the House the reason it happened, the management failures that caused it to happen and whether it was based on a lack of resources, there would be no need for an investigation but there is a need for an investigation. The Health Service Executive has announced it. It has not announced who the chair will be or the terms of reference but I am sure today's debate will allow the HSE to inform the terms of reference to ensure they not only reveal exactly what went wrong but also restore public confidence in the process that happens in all our hospitals.

Deputy Ó Caoláin asked whether this could have happened in other hospitals. It is possible that it could have happened in other hospitals and that is the reason, as part of the reforms introduced by the Minister, Deputy Harney, the clinical director of the HSE has appointed a clinical lead specifically for radiology to ensure that problems such as these are tackled directly by the HSE, in conjunction with the Commission on Patient Safety and Quality Assurance and HIQA, to achieve the best standards in this country.

I understand there are 12 radiologists in Tallaght hospital at present. As the Deputy said, the new chief executive officer tackled this issue with great speed. As I have already said, the Minister was informed at a meeting that was set up for a different purpose. It was not presented to her as a patient safety issue. Professor Conlon represented to the Minister that it was a matter that was in hand, that the adverse incident protocol was being followed properly and that the correct time to put it in the public domain was when each patient and his or her family was properly informed of the circumstances surrounding the failure to properly report on all of these X-rays.

I call Deputy Reilly and request that he be concise——

I shall endeavour to do my best. I will acknowledge that Deputy Rabbitte is Rabbitte by name but not rabbit by nature.

I would point out to the Minister of State that patients come first.

Is that a clinical diagnosis?

Free of charge, to boot.

This is a very serious matter. We have had scandal after scandal in this country. Patients have suffered. Patients have died. Families have suffered. The position is that the X-rays of 20,000 people have not been read three months after that became obvious. A major question arises about that too. In its statement this morning HIQA stated that staff from the authority met with the former chief executive on 24 June who reported that there were approximately 4,000 unreported X-rays. On a radio programme this morning, however, Professor Tom O'Dowd intimated that there were 20,000 when he asked HIQA in April to get involved. I find it extraordinary that HIQA took the word of a third party in this matter.

Furthermore, what happened between June and December of 2009 when the hospital knew this problem existed? When did remedial action start? When did action start in regard to reading these X-rays which had not been checked by a consultant radiologist? We must be clear about this. The minimum standard that anybody is entitled to when they have an X-ray taken is that it is reviewed by a consultant radiologist in a timely fashion. There are scores of stories of people who have had X-rays read at night by doctors who were not radiologists and serious fractures were missed. We heard of one on the radio this morning involving a lady who was X-rayed, sent home and eight weeks later told her spine was fractured. That person is lucky that she is not paralysed. That is a failure of our State.

The report from HIQA states that the medical director, Professor Kevin Conlon, who is now the chief executive officer, met HIQA in August. It is clear, therefore, that he knew about this in August. I put it to the Minister, however, that as a medical director he must have known about this problem before August and if he did not we have to wonder why. I find it astonishing that HIQA would not have informed the Minister for Health and Children of this serious problem.

It is now clear, having read the HIQA statement, that it is not acceptable for it to rely on third party information when a figure of 4,000 is given that six months later transpires to be 57,000. I said earlier that families have suffered. People have suffered and died in Portlaoise hospital, in the north east, Drogheda, Cork, Ennis, Limerick, Galway and now Tallaght. I must put it to the Minister, and to all the Ministers present, that this is one scandal and one death too many.

I am taken by the Minister's statement that the first thing to do is correct or cease the practice which has given rise to the concern. When was that done? Was it in mid-December when it should have been done in April or August? He further stated that the second thing to consider is the necessity to undertake a clinical review of patients. When did that begin? Was it April, August or December 2009? The Minister stated that the third thing to do was to consider an investigation. We are hearing today that we will get an investigation but that is only because it is in the public arena because a whistleblower, Fergal Bowers, had the courage to tell somebody about what was going on.

I put it to the Minister that not everything that should have been done has been done. The State failed these patients yet again. When this was discovered in December, if that is when it was discovered, and the Minister was informed, if she was a dutiful Minister she would have kept a watching brief on this issue every week. She would have ensured that resources were made available to the chief executive officer to bring in other radiologists from around the greater Dublin area, and beyond if necessary, to get through this work within a month. A person has died because that was not done. They may have died anyway but I say to the Minister of State that not enough effort was made. I put it to the Minister also that one person has died and another has been diagnosed with cancer. There are still 20,000 X-rays to be read and there is every chance, statistically, that another cancer will be found.

Not enough effort was made. This matter should have been resolved within a month, all the resources made available and the public announcement made but this Government appears to have a problem with releasing information and reports, and the Minister in particular seems to have that problem. The Minister stated that he very much regrets any distress caused to patients by the manner and timing in which this came into the public domain——

Deputy, it is not appropriate to read quotations into the record.

Excuse me, I want to remind the Minister of State of what he said. I did not hear an apology to the family of the patient who died, the persons whose delayed diagnosis may have impaired their recovery or the parents, families and friends of the patients concerned for the distress caused by the problem, not by the manner in which it was leaked. That is the issue. I do apologise, on behalf of my own party and, I am sure, every Member of this Dáil, for the State's failure yet again under this so-called reforming Minister, who is too busy in New Zealand to be in this House to address this issue, and we know she knew about it before she travelled.

I want to ask some salient questions. On what date was the serious incident protocol the Minister alluded to established? What is the position in other hospitals such as Beaumont, my own hospital, Blanchardstown hospital, Cavan hospital, St. Vincent's Hospital and Cork University Hospital? Are these practices going on in those hospitals? Are X-rays that have not been read by consultant radiologists piled up in a corner in those hospitals? We need to know the answers to these questions.

HIQA has not covered itself in glory on this issue. We asked it a question and it stated it must get assurance from the hospitals that this is not the case. It must go into those hospitals and check, on behalf of the Irish people, that the hospitals are safe and that there are not X-rays waiting to be reviewed. It should not take somebody's word on that and walk away.

I would point out, in regard to Tallaght hospital, information which came to me from my colleague, Deputy Brian Hayes, who is in the Chamber. There are only 12 radiologists in Tallaght hospital, which the Minister has confirmed, yet it sees nearly twice as many people per annum in its outpatients department, and nearly twice as many people in its accident and emergency department, as St. Vincent's, which has 16 radiologists.

This is chronic under-resourcing and a failure by the Minister to face up to her responsibilities. I refer to the continued approach whereby the Minister says she was told about a matter but left it to others to review. I refer also to the disingenuousness of saying, "I do not meddle."

The Minister had better wake up and realise there is a huge difference between managing and meddling. What she has done is mismanage. I, for one, found she has been grossly ineffective, has dithered and should resign. No doubt we will receive more evidence of her wonderful approach to reform. The Minister of State should note that the Minister's main plank of reform regarding bed capacity comprised the now much-discredited co-located hospitals. With regard to the cancer strategy, recommendations on only one of all the cancers, breast cancer, have been delivered upon.

The Deputy is going off the point. I call the Minister of State.

I would like the Minister of State to answer my questions, particularly those on hospitals.

The Deputy should allow the Minister of State to respond.

Can he assure the House that the aforesaid practices are not ongoing?

Deputy Reilly began by referring to numbers. As he rightly pointed out, reference was made to the number being 4,000 initially. Professor O'Dowd said on the radio he believed the number was 20,000 at one point. As we now know, the figure is almost 58,000. I can only repeat that what has happened is clearly some kind of system failure. It is totally unacceptable but it has been remedied. We are in the process of ensuring those patients who are entitled to have their radiology reported on by a consultant will have this done in the next few weeks. That is the main point on which one must be assured in this discussion.

From my experience as a Minister of State with responsibility for children, the role of HIQA, as an inspectorate and body that provides support and advice, has been exceptional. It has constituted a significant instrument of reform in our health service and the delivery of crucial social services, particularly in the area of child protection. In the House, we tend to look at issues with the benefit of hindsight. What appears in hindsight to be obvious is far less clear-cut at the time it occurs. We tend to judge these matters not with foresight but with hindsight. In those circumstances, it is possible to be outraged and scandalised as easily as Deputy Reilly is in the House.

Deputy Reilly asked when remedial action——

Unnecessary debts are something to be scandalised about. The Minister of State should make no mistake about it.

Deputy Reilly is a doctor.

I thank the Minister of State for noticing.

He is able to conclude safely that this debt was as a result of the diagnostic failure——

I never mentioned "this debt" in particular but said debts are a matter of scandal.

We are discussing this issue today and one must be careful with the language one uses and not be unnecessarily emotive——

As careful as the Minister of State is.

——about an issue of such serious and national concern.

If the Minister of State were more careful about patient care and the care of children, we would have made much more progress.

I ask the Deputy to couch his comments in a manner proportionate and appropriate to what we know today. What we know today is that the practice that is subject to this discussion stopped in September. The look-back began in December at the time of the appointment of the CEO, Professor Conlon. It was done with all due haste and expedited as quickly as possible, and the Minister was informed accordingly. We are anxious to get through this work as quickly as possible. I made the comment in my response that it is unfortunate the information came out in the manner it did. The main misfortune concerns the reassurance that is necessary for patients today. The hospital is to have the work done by the end of May and provide assurances in what I hope will be the vast majority of cases.

As I stated, HIQA and the hospital are satisfied that a risk stratification process was engaged in so the more serious cases would be examined in the earlier part of the review. The reforms are real and are bearing fruit. HIQA is an example of the kind of body needed to improve and restore public confidence in our health services, which are all too often criticised in this House and the media when great work is being done, particularly in the areas of breast cancer and cancer care reform generally.

Three Members are offering to speak, Deputies Brian Hayes, Rabbitte and O'Connor. We will group their three contributions, after which the Minister of State will reply.

Will the Minister of State tell us about the hospitals I mentioned? Is he not supposed to answer the questions I put?

I call Deputy Brian Hayes.

For the purpose of clarity, will the Minister of State confirm——

We are setting the objective of concluding at 4.45 p.m.

For the purpose of clarity, will the Minister of State confirm to the House that HIQA did not inform the HSE and the Department of Health and Children when it first learned of this matter? Is that the position of the Minister as outlined to the House?

I understand officials from the Department of Health and Children were present at the famous meeting in December. Was a note of that meeting taken? Did it not set off alarm bells given the circumstances in many other hospitals in recent years? Why did the Minister not appoint additional consultant radiologists to Tallaght hospital at the time in question? Will the Minister of State confirm whether three additional appointments have been made, bringing the number from 12 to 15, given the fact that this was first raised in the Department in December?

Will the Minister of State confirm as a fact that the number of radiologists is to increase to 15? As Deputy Reilly has just informed the Dáil, the number of radiologists in the hospital is the lowest per volume of patients of any hospital in the State. The legacy dates from when the hospital was first established. It was straddled with a debt of over £8 million. The then Minister for Health and Children, now the Taoiseach, Deputy Cowen, allowed that situation to obtain. His doing so led to the resignation of the then chief executive officer, who went back to Canada because of the straddling of debt in the hospital. Will the Minister of State confirm whether three additional appointments will be made? Will he inform the House with certainty that HIQA informed no one in his Department, the HSE or elsewhere about this matter when it first arose?

I wanted to ask some questions asked by Deputy Reilly but to which he did not get answers. Is one of the difficulties we have that the Minister of State, Deputy Barry Andrews, and Fianna Fáil are semi-detached from responsibility for health? The Minister for Health and Children, Deputy Harney, is regarded as not being one of them. They believe she is in reality but it suits them to say she is not because it allows them to claim, as a consequence, that they cannot get answers. Consider what occurred at the meeting in December. Is the Minister of State seriously repeating to the House that, having become aware of the scale of this problem, all Professor Conlon did was mention it on the edges of a meeting to the Minister for Health and Children? I find that virtually impossible to believe.

Bearing in mind the point raised by Deputy Brian Hayes, I find it impossible that HIQA would not bother reporting this to the Department of Health and Children or the HSE. Is the dereliction of accountability in the health service now so advanced that something of this scale is not even worthy of being reported any more? Why was the backlog not cleared by March 2010, as committed to? When will it be cleared? Have private patients been affected in the same way as public patients? Did the matter arise because consultants were tied up dealing with their private patients?

With regard to the relative caseload at St. Vincent's and Tallaght hospitals, why is the latter so disadvantaged in terms of posts? Will this be rectified?

One assumes St. Patrick's Day will fall, as it traditionally does, on 17 March. What preparations is it necessary for the Minister to make for the St. Patrick's Day festivities in New Zealand that she cannot be here today to deal with an issue that one suspects she knew very well was in the pipeline. There must be extensive preparations to be made in Auckland if she has to be there already. Is this not reminiscent of the famous failure by the then Minister for Health and Children, Deputy Martin, to read his brief on nursing home charges, which ended up costing the State an additional €120 million?

The Deputy is drifting. I remind him that we are working under a serious time limitation.

When will a Minister of the Fianna Fáil hue in this Government ever take responsibility for any lapse in public administration that occurs?

Never in a month of Sundays.

How many more lapses will we have where the Minister says it is not her task to meddle and that she did not know about it? She has said she attended a meeting about something else at which somebody whispered in her ear, in passing, that there might be a problem in regard to X-rays. However, she claims she did not know the scale of the problem until yesterday. Any Minister who seriously asks this House to accept that he or she did not know about the scale of an issue such as this until yesterday is a Minister who should stay in New Zealand.

I welcome the opportunity to ask a brief question on this issue. I would be deeply upset and concerned were we discussing any hospital in the State; that we are discussing my local hospital, near where I live and in which I have been a patient, shocks me greatly. It is good to have an opportunity to raise these issues and to express our upset. My first priority is to stress that patients and their families who are affected by this issue must be looked after. This hospital caters not only for the area represented by Deputies Rabbitte, Brian Hayes and me; its catchment extends to counties Kildare and Wicklow, as far south as Carnew. Many people in those areas are deeply upset today. Deputy Reilly and I were members of the health board for some years and so understand the issues that are particularly relevant to that catchment area, as does Deputy Ó Fearghaíl, my colleague from Kildare, who is Chairman of the Joint Committee on Health and Children. I am pleased to see Deputy Ó Fearghaíl in the House today.

I would like to respond to the points that have been made but do not have sufficient time to do so other than to make one or two brief points. Reference was made to our local GP, Dr. Tom O'Dowd, who has done a great service to the community in regard to this matter. As I understand it, he said on national radio this morning that he first brought the issue to the attention of the board of Tallaght hospital by mail last April. He has confirmed personally to me that he received no reply to this correspondence. The chairman and other board members must answer for the governance issues that have arisen and must outline how they propose to address this matter.

There is an important issue in terms of the communication that must take place with the patients and families affected so that they can be informed of what will happen next. I hope the Minister of State can offer assurances in this regard. I would like to say more but have run out of time. I thank the Ceann Comhairle for his courtesy in accommodating me.

On Deputy Brian Hayes's first question, the answer is simply that HIQA never informed the HSE or the Department of Children.

That is unbelievable.

A protocol was put in place in early 2008 that was to be followed in cases like this in order to allow them to be managed between HIQA and the hospital considered. This case was being managed accordingly. I am not going to put words in the mouth of HIQA but, broadly speaking, it was satisfied that the process was conforming to that protocol and was following the procedures as indicated. It is too early to say whether resources were a causative factor in this process; I cannot say whether that is the case, whether it was a question of management systems or a combination of both. It is difficult to say. I do not know about any additional consultants being appointed to Tallaght hospital, but I am sure we can elicit that information at a later time.

Deputy Rabbitte asked why this matter was raised only in passing with the Minister, Deputy Harney. Professor Conlon had only just been appointed chief executive officer at the time of the meeting in question and this issue was not on the agenda. He raised it separately with the Minister, among several issues he wished to bring to her attention which he considered would require his serious attention in the coming weeks. The Deputy asked why the backlog was not cleared by March 2010 as had been initially represented to HIQA. I do not have that information to hand, but I reiterate that the clinical director of the HSE has undertaken today to liaise with the hospital in order to finalise these reviews without delay.

I was already asked about the public-private mix of patients, and I have no information in that regard. I will treat the references to St. Patrick's Day as questions of a rhetorical nature.

On the public-private matter——

I agree with Deputy O'Connor that Dr. O'Dowd's contribution to this issue has been of the first order——

The public-private issue deserves——

——and I add my voice in recognition of his achievement.

Do I have to make a point of order in order to stop the Minister of State rambling?

The Deputy should allow the Minister of State to speak without interruption.

The matter was first raised in April 2009, as I mentioned before——

Will we get a reply on the public-private issue?

It is worth noting in answer to Deputy O'Connor's question that a helpline has been established so that anybody who is concerned about this issue can contact the HSE.

Does the Minister have a reply on the question of the mix of public and private patients?

That is a matter for the investigation.

I have given more than an hour to this discussion and we are now way beyond time.

To what extent did the private patients' workload of the consultants concerned contribute to the backlog? If the Minister of State does not have that information, I ask that he find it out and make it available to us.

I do not have that type of information at my fingertips.

We have given this matter a fair airing.

Written Answers follow Adjournment Debate.