Dáil Éireann Debate, Tuesday - 29 May 2018
40. Deputy Alan Kelly asked the Minister for Health if he has full confidence in HSE management and its practices and, in particular, those in charge of the national screening programme both past and present. [23798/18]
Amharc ar fhreagraThere are many people watching these proceedings for the Minister's answer on this question. It relates to the National Cancer Screening Service and the management of it, particularly of CervicalCheck. Has the Minister confidence in the way the HSE has handled this? Has he confidence in the current management? Has he confidence in the management who were over CervicalCheck during the period in which this crisis developed and who are still operating in the HSE? It is very important that the answer the Minister gives today is something the people who are watching, who have been affected by it, can understand and be very clear about. I do not have confidence in those people and it is very important to say that. I ask the Minister to make a very clear statement today on this matter.
I thank Deputy Kelly for the question and for his work on this important issue in recent weeks and months.
I want to say first that in regard to the HSE as a whole, I do not believe the current governance structures are appropriate. I believe the HSE is far too bureaucratic and is not accountable enough. I believe we need to move quickly as an Oireachtas to put in place an independent board to improve governance and accountability and strengthen the oversight and performance of the HSE. We have known we needed to do that but the national screening programme has made that even clearer. What has arisen in regard to CervicalCheck has made that very clear as well.
I have now published a general scheme of the Bill. This will provide for a nine-person non-executive board, including a chairperson and a deputy chairperson. I want this board to include patient advocates as well. The board will have the authority to perform the HSE's function and will be accountable directly to the Minister of the day. The HSE will have a chief executive officer, CEO, rather than a director general, who will be accountable to the board for the performance of his or her functions. I look forward to working with the Deputy and other Members of the Oireachtas to bring this Bill through these Houses urgently. I have taken on board the Deputy's suggestion in regard to looking at appointing the chair of that board to have a role in the recruitment of the new CEO rather than doing it the other way around.
In regard to CervicalCheck in particular, I made my views very clear on a number of occasions that I was not happy and that I had serious concerns about the way this situation had been allowed to unfold. Recent events have shaken the confidence of many people in the programme. That is why I acted quickly and tried to act with colleagues across this House to put an independent inquiry in place.
The inquiry is led by Dr. Gabriel Scally, Professor of Public Health at the University of the West of England and the University of Bristol. I am aware that many of the people whose confidence in the CervicalCheck programme has been shaken are very happy with the way he is going about his work. He is working with an international expert on women’s health and will also be advised, as appropriate, by Dr. Hugh Annett and Professor Julia Verne. The Scally inquiry will examine all aspects of CervicalCheck and involve engagement with the women and families affected. The Deputy is aware that the terms of reference are very comprehensive and reflect the cross-party engagement. A website, scallyreview.ie, has been set up and went live on 23 May. It will enable the inquiry to communicate progress, including with the women and their families who have been impacted on.
Rather than being judge and jury, I want to await the outcome of the inquiry. Dr Scally is due to provide a progress report on his work in the first week of June. The full report is due by the end of June. I will make my adjudication on specific questions on the basis of the full report.
The Deputy is also aware that I have agreed to establish a commission of investigation. Serious lessons need to be learned. We have asked an international expert to come and get to the bottom of it; of who knew what, when and where and if people acted appropriately. I am satisfied to wait for those few weeks to let this international expert do his job, engage with the women and their families and report back to us.
We are five weeks into this process and while I accept the details of what the Minister has said about the report which is due next week, I want a guarantee that Dr. Scally will make quick decisions on how it happened. We are dealing with people who are in line management positions in the service. I do not have confidence in them. The people who are watching do not have confidence in them either. From the revelations in emails from the Minister's Department which were given this week, the Department did ask extra questions to make sure it was not a patient safety issue. It was a patient safety issue. The HSE did not fundamentally understand, comprehend or get the seriousness of the issue and it is getting worse. I am intent because while we consider it to be a live issue, the women affected are unable to get the findings of the reviews. I hold in my hand one example. The 209 women affected are not obtaining the documentation they require. I want a guarantee from the Minister that the HSE will give all documentation and audit review findings to the women in question by the end of this week. They are going to meet their consultants and being told to go through official lines to get the documentation. This is treating women who have been treated very badly with further disdain. That is why I do not have confidence in management.
We are all aware that Dr. Scally is independent in his work, which is right and proper. We also all agreed to the terms of reference, which are very clear on the work Dr. Scally is to set about doing. He has shown himself to be well able to get to the bottom of serious issues. While I can absolutely understand how people who have been so badly let down cannot have confidence in elements of the health service and while I cannot speak for them, it is fair to say they can have confidence in the work of Dr. Scally, who is also engaging with them directly. What the Deputy has referred to is not good enough in any way. It disgusts me to hear it. Immediately after we conclude priority questions in the Chamber I will get my Department to make direct contact with the HSE to ensure all documentation and review findings - information that belongs to the women in question - will be provided for them without any bureaucratic hurdle whatsoever. I give the Deputy my word that I will follow up on that matter now.
I appreciate the Minister's last comment. I am sure the House agrees that all of the women deserve all of their documentation after five weeks. They also deserve all of the audit review findings. There is one solicitor who is representing many of the women. A total of 90% of the women he represents have not yet received their documentation. After five weeks they deserve it. I will lose confidence in the management structure in the HSE if management does not deal with the issues appropriately. It let the quality assurance director of the HSE go on holiday during what was the biggest crisis in decades. There is also a conflict between what the State Claims Agency stated at the Committee of Public Accounts and what CervicalCheck stated about informing women, an issue to the bottom of which we will get this week. On top of that, we are aware that there is further bureaucracy in the provision of documentation to which the women in question are entitled. I understand the terms of reference for the Scally inquiry. I understand that by next week Dr. Scally is to make certain decisions on what he has found. If that does not happen, I will be shocked. Because the issue is live and because of the fact that the women in question are not being provided with documentation to which they are entitled by the HSE, I do not believe that for some decision making we can wait until the end of the process, if Dr. Scally does not do what we expect him to do by next week.
I agree with the Deputy on the documentation and review findings required. I will follow up on the matter directly immediately after priority questions. For those who are watching and to have confidence in the screening programme and that information will be given, it is important to say two things. First, there has been a huge volume of calls in the last few week to the CervicalCheck helpline. I am pleased to note that the overwhelming majority of the callbacks were by women asking for a clinical consultation to talk to a nurse or a doctor about their situation. The overwhelming majority have been concluded, which is welcome. It was a big body of work, but it was important to get through it in the interests of answering the questions of many thousands of women. More than 11,000 required callbacks.
On the issue of supports and the practical measures we have put in place to try to help people, we have put public health nurses in place in each of the CHOs throughout the State to directly meet the women and their families from the group of 209 - if I may refer to it as such. I understand that work is ongoing.
My very clear understanding from the terms of reference is that Dr. Scally will provide a progress report in the first week of June. I look forward to hearing exactly what progress he has made. He will provide the full report by the end of June. I look forward to engaging with colleagues when we receive it.
