Cancer Services Reports: Motion (Resumed).

Wednesday, 12 March 2008

Dáil Eireann Debate
Vol. 650 No. 1

First Page Previous Page Page of 155 Next Page Last Page

The following motion was moved by the Ministerfor Health and Children, Deputy Mary Harney, on Wednesday, 12 March 2008:

Debate resumed on amendment No. 2:

[70]

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  With agreement, I wish to share time with Deputy Enright.

An Ceann Comhairle: Information on John O'Donoghue  Zoom on John O'Donoghue  Is that agreed? Agreed.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  The hospital in Portlaoise is my local hospital and I know many of the women whose misdiagnoses were the catalyst for the four reports under discussion. Their lives and the lives of their families are in turmoil. The hospital, which is close to me, is used by my family, is the one in which one of my daughters was born and is the only hospital available to most of my friends, neighbours and constituents.

Peopled in the midlands are in shock and are still coming to terms with the events in question. The four recent reports offer cold comfort to those who use the services in Portlaoise hospital. The timing of last week’s reports was classic spin, all published together on a big news day with a big bang. After the Kearney murder and the Paisley resignation, someone in the Department or the HSE told people to let it rip and to bury it.

I wish to refer to three matters in the short time available, namely, equipment, the outstanding issue of the letters and where we go now. The issue of equipment in Portlaoise hospital was not thoroughly examined. Why was the machinery in the X-ray department not subjected to scrutiny in the Dr. O’Doherty report? It was not her choice not to examine the machine used for the mammography examinations. The machine was decommissioned when cancer services in Portlaoise were suspended last August. Contrast the speed with which the machine was decommissioned when cancer services became the subject of media scrutiny with the obvious reluctance or, perhaps, refusal to provide a more modern, safer machine prior to that date. The irony of the shameless neglect on the part of the State in this scandal is that the machine was purchased by the community through voluntary fund-raising some years ago. Government negligence in the provision of mammography services in Portlaoise is beyond doubt. Removing the machine before Dr. O’Doherty could examine it was highly irregular given the two major questions to be answered in respect of what had occurred, namely, the equipment used and the staff who used it. Moreover, Dr. O’Doherty was not told how old the machine was. She guessed that it was at least 15 years old, making it something of a relic in the current age of rapidly evolving technologies. Such machines should be decommissioned nationally after ten years. Knowing that Portlaoise hospital’s mammography equipment was still in use five years after it should have been decommissioned, I cannot help but wonder [71]about the rest of the equipment in the hospital. The Minister for Health and Children, Deputy Harney, should assure the people of the midlands that all equipment in use at the hospital is both modern and safe.

My colleague, Deputy Reilly, has spoken at length on the issues in respect of the letters from Dr. Peter Naughton, past and present, beginning in 2002. I am concerned that of the seven letters sent by him, which were referred to by the former Minister for Health and Children, Deputy Micheál Martin, only two are in the public domain. This continuing reluctance to embrace transparency and accountability does not bode well for the future. I ask the Minister to publish the remaining five letters to allow the full story to be known. She should assure the House and the people that measures have been put in place to ensure such letters will be acted on promptly in the future. Members are aware that they were ignored shamelessly in the past. Much suffering could have been avoided had the warnings contained in Dr. Naughton’s first letter been dealt with promptly by the then Minister, Deputy Martin, and subsequently by the present Minister, Deputy Harney.

The Fitzgerald report documents mismanagement and poor governance within the HSE in respect of how the aftermath of the cancer misdiagnosis scandal was handled. The Doherty report identified serious gaps in the system and, far from exonerating the Department of Health and Children, is most critical of its handling of the issues. Sadly, the Minister in her opening statement this morning ignored this finding. Will she assure Members that she has made the necessary changes to ensure such issues will be addressed in her Department and that the HSE and her Department will henceforth be patient-focused rather than focused on passing the buck?

The Minister has decreed that cancer services are at an end at Portlaoise and will be transferred to Dublin. I support this move with certain provisos to ensure people from the midlands will be able to obtain a service. There appears to have been no consultation with local people when this decision was being made. Why was St. Vincent’s Hospital chosen over St. James’s Hospital? I have concerns about the capacity of St. Vincent’s Hospital to deal with the additional patients from the midlands. Sadly, one of the nine women affected was refused a bed in the hospital for a crucial procedure before Christmas and nothing was done about the matter. Will the people of the midlands face endless waiting lists, more trolleys on corridors or vital months passing by before they are seen, diagnosed and operated on? If the Minister intends to remove local services, she must be able to guarantee an adequate service to those who will be obliged to travel up to 80 miles to be seen in Dublin by an appropriate specialist. Changing the location of cancer services from County Laois to Dublin without consultation shows that patients’ needs have been overlooked once again. St. Vincent’s Hospital is the most inconvenient hospital for midlands residents, not being close to mainline rail stations or motorway access.

The wording of the motion and the attitude of the Minister show that little has changed in respect of accountability. Such an attitude must change fundamentally if the Minister hopes to restore confidence in the health system that, sadly, has let down the people of the midlands in general and the nine women and their families who were given false information on their cancer diagnoses, in particular. The least the Minister can do is to learn lessons from this tragic chain of events and take the steps necessary to ensure there will never be a recurrence.

Deputy Olwyn Enright: Information on Olwyn Enright  Zoom on Olwyn Enright  Probably the most used political phase throughout the duration of the scandal that has surrounded the cancer treatment of women from my constituency has been “going forward”. I fear that in the Government’s political rush to avoid accountability, it still has not learned from the mistakes of the past. The Minister was correct when she stated she [72]was unable to undo what had been done. No one knows this better than the women directly involved.

There are two aspects to this debacle, namely, the cause of the original misdiagnosis and how the issue was handled on discovery of the problem. On the first issue, I am not satisfied that anything has been learned from the misdiagnoses of the aforementioned nine women. While the Minister talks continually about centres of excellence, I have noticed that she has started describing them as specialist centres. Perhaps she finally has realised that excellence is not designated but must be earned. She continues to side-step the fact that Portlaoise hospital was a designated centre. Although she may not have liked how that came about, she was in government when the designation was made.

Although the Minister has attempted to wash her hands of any decisions in this area, at a Progressive Democrats conference in Emo, County Laois in October 2005 she trumpeted the news that the long-awaited cancer unit at Portlaoise General Hospital would be up and running within 12 months and that interviews would take place to find staff. In reality, staff queries, complaints, reports and comments were not acted upon. Each time a complaint was made regarding equipment, staff were told to file an incident report. Although they did so several times, nothing happened.

Members still have not received a sufficient explanation in respect of what happened to Dr. Naughton’s letter of April 2002. The former Minister, Deputy Micheál Martin, accepted last week that it had been received, adding that he had acted on the issues contained therein. His version of action, however, differs significantly from what was needed. Nothing changed at Portlaoise following his action. The letter, however, went missing. What specific changes will be made in every hospital across the HSE to ensure genuine staff concerns about patient safety will be responded to and acted on?

This designated centre had a viewing area for imaging that was completely inadequate. The radiology department put in writing its concerns about the compression plate and the filming and screen system. What confidence can the Minister give that such issues will be addressed in all designated centres? Probably the most important line in Dr. Ann O’Doherty’s report was that “a mechanism for measuring standards in each centre and comparing practice between centres should be devised rapidly” as women wish to be reassured that the standard of care they receive is optimal. When will such standards be in place for cancer and all other services?

The second issue pertains to the handling of this affair from August last. The malaise does not lie within the HSE alone. The Minister showed a remarkable lack of urgency from August to November, until she was embarrassed into taking action at the Oireachtas Joint Committee on Health and Children. At that point, as political pressure built, she sought reports left, right and centre, which in fairness are hard-hitting within their terms of reference. No inquiry was made into her Pontius Pilate approach to her brief. The HSE should use her to front their “have you washed your hands” campaign.

In the past 11 years a culture and belief have emerged on the benches opposite that because they have enough bums on seats and can scrape through votes, they can sit matters out and they will blow over. It will not blow over for the women affected.

The Minister set up the HSE, which almost every Government Deputy has criticised at some stage. However, they cannot, or refuse to, see this chain of accountability. We hold our soccer and rugby managers to a higher level of accountability than the Government. While I want the HSE to work and seek the best possible health service for the people I represent, I do not believe it can improve, unless the issue of accountability is dealt with. John Fitzgerald described [73]“systemic problems of governance, management and communication”. The Taoiseach reassured Members last November that what had happened in the midlands was not a systems failure. However, the HSE is a failure of the Minister’s creation. She herself noted at the joint committee meeting last week that some of the systems were transferred from the health boards. Whose fault was that? Who set up the system with practically everyone still in the same job, albeit perhaps with a slightly different title? No patient-centred system looks for cohorts or would leave concerned women to gather in a relatively public place for tests because it was waiting for a cohort.

The Minister has learned very little. As for change, while I will reserve judgment, I remain sceptical. The Government motion supports the actions being taken but Members do not know how they will work. Last week’s big idea appears to have been to appoint one person to oversee crises management. What about averting crises in the first place? Is that not what should demand the most attention?

  4 o’clock

The Minister has noted that this issue would never have come to light were it not for the courage of the director of nursing whom I also commend. However, this constitutes a huge admission of the shortcomings of the system. Were it not for one person, staff still would be filling incident reports, writing letters, begging for proper equipment and women would be getting sicker, possibly without being aware of the cancer growing inside them. As it is clear the Minister will not leave office, she should, at least, honestly re-examine the HSE, talk to staff on the ground and accept there is no one in charge and that people do not know their role or to whom they are accountable. Until this changes, patients will never be put first.

I have to hand a letter from one of the women who was recalled for a test and received another e-mail today. The women in question still have not been written to by the HSE to be given the all-clear. While they were given the all-clear on ringing the helpline, four months later some women still have received nothing in writing, which is unacceptable.

Deputy Martin Mansergh: Information on Dr Martin Mansergh  Zoom on Dr Martin Mansergh  I wish to share time with Deputy Finian McGrath.

An Ceann Comhairle: Information on John O'Donoghue  Zoom on John O'Donoghue  Is that agreed? Agreed.

Deputy Martin Mansergh: Information on Dr Martin Mansergh  Zoom on Dr Martin Mansergh  I wish to deal with the substance of the issue first and the politics afterwards. Nowhere is the delay in receiving the correct diagnosis and treatment more critical than in the field of cancer, one of the main killers. Overall, the survival rate over five years, according to the National Cancer Forum in 2006, has been 50% or somewhat less, although female breast cancer patient survivors are nearer to 75%. The subject inevitably is a cause of acute anxiety for those affected and their near relatives. Any suggestion of an unreliable diagnosis only adds to the trauma. All Members feel deeply for the women who were let down by wrong diagnoses at Portlaoise General Hospital.

The public health service must be capable, as one of its highest priorities, of providing within a short period a prompt accurate diagnosis and treatment without regard to the health care status of the patient.

From what I have heard, public policy is intent on achieving that and the roll-out of BreastCheck and other cancer services is evolving. A related issue is the uniform availability and accessibility of the best diagnostic and treatment facilities so that survival rates do not depend on the part of the country in which one lives. The rationale of centres of excellence is to provide a uniform level of service. Account has to be taken of the need to spare sick people unnecessarily long weekly journeys for treatment where it can be provided closer to home. This [74]issue arose in respect of the provision of radiography for the south-east region in Waterford but has since been largely resolved.

I have some sympathy for those who live in the north west. I was present in Sligo when a bereaved former Minister for Finance spoke at his wife’s funeral to urge that excellent facilities in Sligo Regional Hospital be retained and I have read similar pleas in the newspapers. All the regions which are well removed from Dublin need to look after each other. The principle of centralisation should be balanced by the principle of subsidiarity, which means that a service or treatment should be provided locally when it can be done so equally well.

Cancer services, which are literally a matter of life and death, cannot be allowed to operate on a de facto two-tier basis, whereby survival depends on whether one is a private or public patient. The establishment of an acceptable standard which gives public patients an equal chance is the litmus test of the viability of our current dualistic health service model.

Many people admire the Minister for Health and Children, Deputy Harney, for taking on an enormous task, one of the most challenging in Government at present. The HSE has more than its share of teething problems and the jury is still out as to whether it can successfully bring about the necessary transformation in our health services. Problems in communication and a top heavy bureaucracy should not obscure the fact that much excellent work is being done in our hospitals. There are horror stories but there are also a large number of people who are very happy with the care that they or their loved ones have received. Many of us in our personal sphere encounter more good experiences than bad, although as politicians we get to hear of both.

There has been considerable discussion in the Dáil and the media about responsibility and accountability, which often translates crudely into a demand for resignations when anything at a systemic level goes seriously wrong or, as newspapers tend so charmingly to put it, that heads should roll at political, bureaucratic or medical levels. Significantly, the metaphor of “heads rolling” is taken from the reign of terror in the French Revolution, which may have provided an all-time peak of excitement for contemporary newspapers like L’Ami du Peuple but does not provide a model of good governance. Perpetual political instability characterised by summary populist judgments which abruptly terminate the careers of even the most worthy seems to be the type of responsibility and accountability that some would wish to see established here, but that trend must be resisted. Public servants are right not to tolerate scapegoating for political failures. Like cream, credit for success rises to the top but it is amazing how far down responsibility can reach when something goes wrong.

The Labour Party leader, Deputy Gilmore, is fond of quoting President Truman’s phrase, “the buck stops here”. How many US Presidents have resigned since George Washington’s inauguration in Federal Hall, New York, in 1789? I believe there was only one, President Nixon, for a grave abuse of office rather than any policy failure. Responsibility and what “the buck stops here” mean are standing one’s ground, acknowledging and addressing failures, coping with unexpected crises and devising better systems and plans. That is what the Minister, Deputy Harney, and the Government have been doing. They have not thrown in the towel at the constant howls for resignation. The Government is not a private company or a football team. It is a democratic institution governed by rules clearly set down in our Constitution. Article 28.4.1° of the Constitution states: “the Government shall be responsible to Dáil Éireann” and Article 28.4.2° states: “The Government shall... act as a collective authority, and shall be collectively responsible for the Departments of State administered by the members of the Government”. It refers to collective rather than individual responsibility. Strictly speaking, motions of no confidence in individual members of the Government, of which two are on the [75]Order Paper, are not constitutionally correct. The Government as a whole is responsible for the administration of health and every other policy area.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Is the Deputy suggesting the entire Government should resign?

Deputy Martin Mansergh: Information on Dr Martin Mansergh  Zoom on Dr Martin Mansergh  Governments submit themselves to the people every five years, when they can be dismissed, but this Government has been returned for a third time in a new and enlarged configuration and while it retains the confidence of a majority in Dáil Éireann it will remain in office. It will not allow individual Government members to be targeted and taken out by an aggressive Opposition or elements of the media.

The reform and improvement of our health service is as difficult a task as it is elsewhere, and setbacks are likely to be encountered along the way. The Minister has the support of this side of the House in her perseverance, particularly as there is seldom any critical acknowledgement of long-term progress or the many daily unsung achievements.

Deputy Finian McGrath: Information on Finian McGrath  Zoom on Finian McGrath  I am grateful for the opportunity to speak on this debate on cancer services. Everyone, whether speech therapist, social worker, HSE manager, porter, nurse, doctor or politician, has a role to play and a civic responsibility to work to the best international standards. I do not go along with people who refuse to accept responsibility. We need to accept that major mistakes were made if we are to end this problem.

I welcome the publication of the reports on events pertaining to breast cancer services at the Midlands Regional Hospital in Portlaoise. I strongly support the goal of the national cancer control programme of ensuring equitable access to high quality services for patients throughout the country. Every Member of this House should support Professor Keane in his efforts to radically reform our health service in the interest of patients. We have a duty to put patients first, so there should be no fudging on this important issue. I commend Professor Keane for showing courage, leadership and vision on cancer services.

Deputy Kathleen Lynch: Information on Kathleen Lynch  Zoom on Kathleen Lynch  It is a bit early for that.

Deputy Finian McGrath: Information on Finian McGrath  Zoom on Finian McGrath  We should take the tough decisions on the so-called issue of special centres and reflect once again on best practice for all our patients. In regard to the issue of funding for cancer services, I commend the Minister on her efforts during the budget negotiations to secure €35 million for cancer services, despite the downturn in the economy. Beaumont Hospital has been selected as one of these specialist centres, which I welcome. The team at that hospital is looking forward to developing services on the north side of Dublin for people throughout the country. It is a step in the right direction.

The population of the Republic of Ireland has increased by nearly 325,000 in the four year period 2002-06. Having only recently passed the 4 million mark, the population is set to increase to 5 million within the next 15 years and 5.8 million by 2036. With an average age of 35.6 years, Ireland has a relatively youthful age structure. However, this is set to change. Those aged 65 and over will account for 20% of the population, or 1.14 million people, by 2036. The number of people aged 80 or over will treble from the 2001 level of 98,000 to 320,000 by the same year. These changes will have significant implications for public spending and health care expenditure in particular because the elderly typically require two to five times the resources of those aged under 65. The life expectancy of those over the age of 65 has improved significantly in recent years, although it remains low in comparison with our western European neighbours. Diseases which continue to be the principal causes of death include cancer.

[76]I welcome this debate but it is up to every Deputy to progress reform of the health service. I warmly welcome the 64 rehabilitation beds being developed at the Incorporated Orthopaedic Hospital of Ireland, Clontarf, which will open in mid 2009.

Deputy Kathleen Lynch: Information on Kathleen Lynch  Zoom on Kathleen Lynch  I wish to share time with Deputy Ó Caoláin.

Acting Chairman (Deputy Seamus Kirk): Information on Seamus Kirk  Zoom on Seamus Kirk  Is that agreed? Agreed.

Deputy Kathleen Lynch: Information on Kathleen Lynch  Zoom on Kathleen Lynch  That last announcement by Deputy Finian McGrath was in paragraph five of his agreement with the Taoiseach.

Deputy Finian McGrath: Information on Finian McGrath  Zoom on Finian McGrath  That is correct.

Deputy Kathleen Lynch: Information on Kathleen Lynch  Zoom on Kathleen Lynch  While I do not speak for everyone, virtually every Member of the House understands that centres of excellence are the way to go — it is a “no-brainer”. That is where people will have the best outcome and the best prognosis and where multidisciplinary teams will be found. This is the message we have heard from the Minister for Health and Children for the past year. Everyone agreed with this before they got around to examining the nitty gritty with regard to the centres of excellence. I am not just supporting this policy because there is a centre of excellence in Cork but because I believe it is the way to go. There were also references to the centres at Limerick and St. Vincent’s Hospital. However, for a centre to be excellent, it must be resourced to the maximum extent. This is not happening, which is very worrying.

I put down several questions with regard to two obstetric theatres that are still not open in the new Cork University Maternity Hospital. It has a magnificent building and it is incredible to read of the services it is intended to provide there. However, it cannot provide the services because it does not have the facilities or staff to give the level of care we expect for our citizens.

I listened to Deputy Mansergh earlier — I have listened to him often in the past 12 months. All I can say is that it is clear the benefits of a classical education are very good for writing speeches but not very good for finding solutions. He comes here and quotes from every revolution he can think of from centuries ago. He does not talk about what is happening today or the solutions needed but instead tells us about the great classical battles. Thank God for him. He is a bit of entertainment, if nothing else.

There is familiarity about the debate on cancer services in Ireland. That familiarity relates to a Minister, who, when asked about an issue, replied: “I never heard of it. I never got to know about it.” When the Minister, Deputy Martin, vacated the chair now taken by the current Minister for Health and Children, we thought this was gone by the board. There was the nursing home scandal where the then Minister, Deputy Martin, never read the file. There is the issue of Professor Peter Naughton’s letter which was sent in November 2002 and which Deputy Martin now admits he saw although he does not know where it is and cannot remember if he read it. It is mind-blowing. This is typical of an institution where everybody has a particular job to do but nobody knows to whom they are supposed to report or what is their specific area of expertise, and, therefore, no-one is responsible.

At the end of the day, someone must be responsible. We cannot continue to have meetings of the Oireachtas Committee on Health and Children where the Minister tells us “That never happened. We do not have that letter”, only for it to be suddenly produced. We cannot have a Minister for Health and Children who tells the committee meetings that no other women are being called back because of misdiagnosis only for us to find there are 97 such women. This cannot continue and it is our duty to ensure it does not happen again. To continue to operate [77]a health service at this level is not good enough. We need to begin to build up confidence in the health service among the population.

Deputy Finian McGrath referred to congratulating Professor Keane. He sounds fantastic and if he does what he intends to do, it will be great. However, it is a bit early to know whether he will get the resources necessary to give us the type of cancer care he managed to deliver in Canada. Will he get those resources? That is the big question.

In five years, will we talk about a machine that should have been replaced ten years ago? Will we once again blame the equipment? Whose job was it to decide the machine did not work properly and should be replaced? It was not the job of the radiologist. I am a great believer in delegating responsibility and having a clear chain of command. In five years, will we say a piece of machinery is obsolete and should have been replaced?

Warren Buffett, reputed to be the wealthiest man in the world, applies his philosophy to all businesses across the board. When commenting on the woes of financial institutions, he once said: “You only learn who has been swimming naked when the tide goes out”. The tide has gone out on this issue.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  Ba mhaith liom mo bhuíochas a ghabháil don Teachta Uí Loingsigh. Ar son Teachtaí Shinn Féin, ba mhaith liom tacú leis na leasuithe ó Pháirtí an Lucht Oibre agus ó Fhine Gael agus cur i gcoinne rún an Rialtais. The Minister, Deputy Harney, in her initial response to the Fitzgerald report stated that she had asked the board of the HSE whether lessons arising from these systemic failures have wider implications across the HSE. It is patently obvious that they do and that this scandal, as well as the ongoing critical situation throughout our health service, raises fundamental questions about Government health policy and HSE management.

The Fitzgerald report highlights the weakness of management and governance in the process of review following the exposure of the misdiagnosis of women in the midlands. It states that “the needs of the patients potentially affected receded” and refers to the “systemic weaknesses of governance, management, and communication for dealing with critical situations”. This is a very damning admission. The Minister’s commitment that this will not happen again, as I said to her directly in the Joint Committee on Health and Children just the other day, cannot be taken seriously in the light of her failure to address the scandalous waiting times of up to 18 months for vital cancer tests such as colonoscopy, as exposed last week. In the case of the late Susie Long, such a delay proved fatal. All too sadly, we do not know how many more Susie Longs there have been or will be.

People throughout the country were appalled at the plight of the women who were given the all-clear after breast cancer screening in the Midland Regional Hospital in Portlaoise but who were later diagnosed with cancer. These reports show that the HSE cannot shirk the responsibility for this situation. The HSE is directly responsible for public hospital services and it has a duty to ensure that proper standards are maintained.

It was disgraceful for HSE chief executive, Professor Brendan Drumm, to try to shift the blame for this situation on to the people of Portlaoise and the midlands because, like people in other regions, they opposed any threatened downgrading and loss of services at their hospital. He did not apologise for that. We now have a situation where the Minister and the HSE are using public fear in the wake of the midlands scandal to drive forward their policy to centralise all cancer services in eight centres. We in Sinn Féin argued that eight centres is too few and that large swathes of our population will be ill-served by such a configuration. We are far from alone in this but there is now a climate of fear and people are reluctant to make this argument. For our part, we will continue to do so.

[78]The loss of mammography services in local hospitals, such as Cavan General Hospital in my constituency, has been worrying for many women and their families in those counties. It represents yet another loss of a hospital service in the north east region. There is real and justifiable concern now that local services are being taken away without the full cancer treatment services being available and accessible at these promised centres of excellence. No such centres are planned north of a line from Dublin to Galway so the north east region falls into a black hole once again, with people from as far away as west Cavan and north Monaghan having to travel to Dublin for treatment.

Sinn Féin supports the development of centres of excellence for cancer care. Let people make no mistake about it. A revised plan for such cancer care centres must ensure all regions are covered, that cancer patients do not have to travel long distances for vital treatment and that existing cancer services in local hospitals are fully resourced and of a high standard. The removal of such services on the promise of as yet undelivered centres of excellence is not acceptable.

The HSE under the Minister, Deputy Harney, and the CEO, Professor Drumm, has become, frankly, a quango from hell. There is no other way to describe it. It is a totally unaccountable bureaucracy and an inefficient management established by this discredited Government to implement its grossly inequitable health policy. Major changes are required.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  I wish to share time with Deputy Byrne.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Is that agreed? Agreed. Can we expect it to be an equal share?

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  It may be a little unequal.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  In favour of——

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  Me.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  ——Deputy Moloney.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  Possibly. I appreciate being allowed to contribute to this debate. Coming from County Laois I am close to the issue we have been debating for the past few hours. I extend my good wishes to the nine women involved, their families and also the numerous women who were called back to the hospital for a re-check and their families. I add a word of encouragement to the staff in Portlaoise hospital who clearly have been equally traumatised by the exposure of the hospital and its facilities.

I acknowledge the Minister’s immediate acceptance of responsibility, for which I thank her. I have every confidence in her, regardless of what has been said in the House in this and previous debates. I also acknowledge Professor Drumm’s apology which I hope will go a little further. I also hope that in the short term the recommendations of the John Fitzgerald report will be acted upon as quickly as possible by the HSE; otherwise, it will be virtually impossible to restore confidence in the service and, in particular, the HSE. The quicker the HSE comes to grips with the recommendations the better for all health services throughout the region.

The most important finding in the report concerns the need to have central locations. Some are opposed to the term “centres of excellence” but whatever we call them, that is the way forward. I support the notion of centres with triple assessment, the most modern and high-tech equipment and, more importantly, committed, skilled medical experts who meet numerous patients and upskill. This is in contrast to what we have seen where we had something like 30 [79]centres dealing with fewer than 20 new cases per annum. That is a positive move which has come from all of this.

Since the debate began on hospital services in the midlands I have not been to the forefront on the issue in public as, having supported the selection of Tullamore over my own county hospital in Portlaoise in the 1990s, people took offence to my utterings on any issue because they considered that, first, I had let down my own county and, second, I was not with the people of County Laois. Nothing could be further from the truth but it took a long time for people to sit back and think about the implications.

It is a tragedy that Opposition Deputies should try to target the Minister on the issue of Portlaoise General Hospital. I was delighted and surprised to hear Deputy Shatter say what I was going to say, namely, that if in 1999 the Deputies and health board members in County Laois had taken the advice of the National Cancer Forum, independently advised by Professor James Fennelly, this debacle would not be happening in Portlaoise today and, in fact, we would not even be debating this issue.

When the hospital in Tullamore was selected as the lead centre, a row erupted in County Laois and I remember leading a delegation to the Department of Health and Children. We asked for Professor Fennelly to attend that meeting, with the then Minister, Deputy Cowen, to explain why the hospital in Tullamore had been selected. We were told that, first, it was located in the centre of the region; second, that we could have all of the services located there required for cancer treatment and, third, that finance had been committed. I changed my mind at that meeting and said on my return to County Laois that I was opting for the hospital in Tullamore rather than the one in Portlaoise. We lost valuable time through people attacking the position of members of the Laois group in the health board who at the time saw the sense in having one centre in the region long before Professor Tom Keane saw it. If we had followed that strategy, no blame would attach to anybody because we would have done the right thing.

During the course of the debate reference was made to the fact that the Minister was not responsible for the machine and that a letter had been lost. That is no more than a convenient argument. We can go back and discuss the real issue. Deputy Flanagan was to the fore at the time in challenging the decision in the High Court. I have listened to all of this for years. I heard it said that because Deputy Cowen was a friend of mine he told me the centre must be located in Tullamore. The reality is that for the three years of debate I supported and still support the position of the then Minister, Deputy Noonan, who was the one who selected the hospital in Tullamore. If it had been selected and Government policy had been adhered to, we would not be having this debate today. I do not see why the Minister should be the target.

It is worth noting what the judge said in his summing up. I would have welcomed it if people accepted the judge’s recommendations and advice but instead we were made out to be the ones who had let the county down. We should remember that the argument was that it was a political decision to locate the services in Tullamore because Deputy Cowen lived there. On 10 May 1990 Mr. Justice Kearns indicated that the September decision of the board to locate the chemotherapy services in Tullamore was not a capricious volte-face carried out for no apparent reason or motive, of which we were accused, nor was it made for purely political reasons, of which we were also accused, but instead was soundly founded on a number of expert reports to which I continued to refer throughout 1999 and 2000. Even then——

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  Two years later the Minister, Deputy Martin, said the opposite.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  He was not in the frame at that stage.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  He said the opposite.

[80]Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  I will deal with that in one minute.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  We are eroding the time available to Deputy Byrne.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  I will not be much longer. The present Minister would not be a target today if we had followed Government policy, as outlined by the then Minister, Deputy Noonan.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  But it was designated by Deputy Martin when Minister.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  I have only four minutes.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  We are in this position because of the decision made by him.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Deputies, please, there is limited time available.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  Notwithstanding the finding of the court, we had to wait two further years. Were it not for the political motivation of Opposition members of the health board this sad debacle would not have occurred. I have one piece of advice to impart. I hope Professor Tom Keane does not meet the same level of opposition as he tries to set up the centres in question. I call on medical experts to try to support him and urge politicians to give the necessary lead to prevent a recurrence of what happened in Portlaoise.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  I am pleased to hear Deputy Moloney’s words.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  That is the first time the Opposition has exercised more power than the Government.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  The Deputy’s party was in government for the——

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Deputy Flanagan, please.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  Its Minister made the decision.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  The Opposition in counties Louth and Meath is trying to make the same mistakes again. I pray that we do not repeat the mistakes made in Portlaoise.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  That is spin. I know where it is coming from, too.

Deputy John Moloney: Information on John Moloney  Zoom on John Moloney  No, it is not.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  That happened in 1999, two years before the matter was decided.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Deputy Flanagan, please.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  Too many people in County Meath and County Louth are dying of cancer. I fully support the national strategy. There has been much talk about the Dóchas centre in Our Lady of Lourdes Hospital, Drogheda which has provided a great service for people in counties Meath and Louth since it was founded. Many patients publicly and privately attest to the hard work and dedication of the staff concerned and the centre will continue to operate services. It will not close, as has been reported. However, what is regarded as a better service for patients for diagnosis and surgery will be available at Beaumont Hospital. Our Lady of Lourdes Hospital, Drogheda will continue to provide chemotherapy and palliative care for patients.

I would dearly love to see a centre of excellence located in Drogheda or Navan but if an insufficient number of operations are being carried out and an insufficient number of patients [81]are being seen, who are we as politicians to tell the experts and the cancer societies that they are wrong? That is what the Labour Party and Fine Gael are doing locally. We cannot put votes ahead of lives.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  That is absolute rubbish.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  We are not.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  Lives are too precious. I, for one, will not campaign for what might seem——

Deputy Olivia Mitchell: Information on Olivia Mitchell  Zoom on Olivia Mitchell  That is nonsense.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Balderdash.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  I have been accused of selling out the town of Drogheda.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  I will not get five minutes to refer to the shameful and disgraceful running down of cancer services in Our Lady of Lourdes Hospital.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Deputy, please.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  I will not have it on my conscience that my constituents are not getting the best possible cancer care.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  A total of €600,000 that was meant for cancer services was provided to balance——

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Please, Deputy O’Dowd.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  No way. They want the best and are entitled to it.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  We now know that the Opposition has more power than the Government.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  Many of them who are worried sick about a cancer diagnosis are already going to Beaumont Hospital.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  We should have more time to talk on this issue.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  Labour Party representatives will be on local radio tomorrow accusing me of selling out the town of Drogheda. County Meath has one of the highest death rates, from lung cancer, lymphoma, melanoma, oesophageal cancer, prostate cancer and stomach cancer. How can anyone seriously campaign to retain the status quo?

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  Deputy Thomas Byrne is campaigning to retain the status quo.

Deputy Thomas Byrne: Information on Thomas Byrne  Zoom on Thomas Byrne  This strategy must be implemented and resourced, as the Labour Party said, as soon as possible. We might do slightly better in County Meath with breast cancer, probably BreastCheck, and the Dóchas centre has been doing much work. Still too many people are dying. Let us get this up and running, resource it and let Professor Keane get on with his job and stop people dying.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  Let us have the truth.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  The Deputy without interruption please.

[82]Deputy Olivia Mitchell: Information on Olivia Mitchell  Zoom on Olivia Mitchell  He is telling lies.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  I would also like to speak. As an elected Member of this House I would like to respond to that. May I ask a question?

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  That concludes the contributions. We are moving to the session which will allow Members to put questions to the Minister for Health and Children. I call Deputy Ó Caoláin.

Deputy Olivia Mitchell: Information on Olivia Mitchell  Zoom on Olivia Mitchell  Hold on.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  On a point of order, this man has already spoken. I want to get back to this issue.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  He is to ask a question. We will allow him.

Deputy Olivia Mitchell: Information on Olivia Mitchell  Zoom on Olivia Mitchell  We have lost an entire slot because ten minutes extra were allowed to Fianna Fáil.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  I have no control over the order. The order was made that we begin questions at 4.30 p.m. and I am implementing that.

Deputy Olivia Mitchell: Information on Olivia Mitchell  Zoom on Olivia Mitchell  Fianna Fáil was not entitled to those ten minutes and it has enough platforms to make its points.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  We will allow the Deputy. Ar aghaidh leis.

Deputy Olivia Mitchell: Information on Olivia Mitchell  Zoom on Olivia Mitchell  It is out of order to go back to somebody who has already asked——

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  From previous experience we have a difficulty where Members turn it into Second Stage contributions. Could Members make their questions as short and succinct as possible and we will try to get as many people as possible in?

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Tá triúir anseo nach raibh seans acu labhairt agus tá beirt tar éis labhairt cheana féin. Ba cheart go mbeadh na daoine seo in ann labhairt.

Deputy Olivia Mitchell: Information on Olivia Mitchell  Zoom on Olivia Mitchell  Deputy Ó Caoláin is incapable of a short question.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  Question time is open to us all and I do not want to preclude anybody from speaking. I will make my question short. I indicated and was called. There is no other agenda. The other Members could have all indicated before me for all I knew.

Deputy Olivia Mitchell: Information on Olivia Mitchell  Zoom on Olivia Mitchell  We did.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  As I said, the Fitzgerald report talks about systemic weaknesses of Government management etc. It was reported yesterday that in light of this scandal the Minister and the Department have been considering the role and remit of the HSE. Is that correct and how does the Minister respond to that report? Does the Minister agree with the senior official of her Department who is quoted as saying the HSE is a ship “perilously close to the rocks”? Has she confirmed that this statement was made from within her Department and what is her response to it? Does she agree with the view, which I do, that the HSE is perilously close to the rocks? The HSE is this Minister’s and Government’s creation and she has stated time and again that she has asked the board of the HSE whether lessons arising from these systemic failures have wider implications. If there is to be an audit of the HSE, [83]what form will it take and when will it report the result to the Minister and the Houses of the Oireachtas?

As a Deputy from the north east, while the Minister drives forward with her eight centres, what does she suggest the people in south and west Ulster, the north-east and north-west regions do? These people who live in the vast swathes of the country north of a line from Dublin to Galway will not be served by these fledgling centres of excellence for cancer.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Could we group a number of questions?

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  I have no issue with that as long as the Minister replies.

Deputy Deirdre Clune: Information on Deirdre Clune  Zoom on Deirdre Clune  When the HSE was established three years ago in 2004 the Minister said we would have clear accountability for our health services. Following last week’s publication of the Fitzgerald report, clearly we do not. Two issues surround Portlaoise. One is the misdiagnosis. I listened to today’s debate. I do not accept the fact that we looked for qualified staff to operate the services in Portlaoise and nobody replied to the advertisement. I find that statement difficult to take and it will sit very uncomfortably with the misdiagnosed women. The other issue is what happened once it was recognised that misdiagnosis had taken place. In August 2007 a review was put in place and last week Mr. Fitzgerald said there appeared to be no urgency about that review until the meeting with the Oireachtas health committee. I do not want to erase what has happened. What protocols will be put in place should such a situation arise again? We hear talk about centres of excellence and I can accept them. What protocols will we put in place should such a situation arise again? That critical issue must be addressed. We do not want people scattering off in all directions with no clear idea of their roles and to whom they should report. It is Portlaoise today; I hope it will not happen somewhere else tomorrow. Given the dysfunctional HSE described by Mr. Fitzgerald we can have little confidence that such a situation will not arise again.

Deputy Olivia Mitchell: Information on Olivia Mitchell  Zoom on Olivia Mitchell  The Minister and members of the Government, including the Taoiseach, maintain the Fitzgerald report makes the case for centres of excellence. Nobody in this House ever suggested there is not a compelling case for centres of excellence. Would the Minister accept this case is not made by Mr. Fitzgerald, who is not given to hyperbole? He makes the case for reform throughout the system. He says the opposite, that he does not want to blame the inaction of individuals in Portlaoise but the systemic problems of Government’s management of communication. He was reporting on his examination not just of what went on in the hospital but at regional, national and departmental level, right into the Minister’s office. The problem is systemic. If we respond with a protocol to deal only with critical incidents we deal merely with one aspect of the problem, whereas the problem is endemic throughout the system. What happened in Portlaoise is merely a microcosm of what is happening every day through the HSE and Department. If the Minister accepts that, what will she do about it? Does she accept she is the only person who can do something about it? The health system is vital to every person and she must do something about it. How many reports do we need to show there is something fundamentally flawed about the HSE?

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  To answer Deputy Ó Caoláin’s question, there is no plan or discussion about changing the structure of the HSE. I do not go around my Department and ask every official whether they spoke to a journalist. I have the height of regard for the journalist in question, Dr. Muiris Houston. There is no plan at management or political level to return to the old health board system with 273 people in charge of a health delivery system for 4.3 million people. In advance of establishing the HSE we had many reports and examined what happened [84]in many countries. Other countries are following us in having a unified system. Only through a unified system can one have consistency of standards, drive quality and have specialist centres.

Of course there are management issues. Contrary to what was said, the O’Doherty report was requested long before the issue arose at the Oireachtas committee in mid-November. On my behalf, my Secretary General asked the CEO to report to us on why the service was suspended in Portlaoise on 28 August and the circumstances that led to that. That was the O’Doherty report, which covered the configuration of services and many matters. Subsequent to the events of 21 November I asked the chairman of the board to examine the HSE’s handling of the issue from a management perspective.

There was clinical misdiagnosis. The only way we will minimise error is by having teams of specialists working in big centres with large volumes of patients. We know that not just from Ireland but around the world, particularly in breast cancer. Some 250 different medical publications back up that fact. Last spring for the first time we introduced symptomatic breast health service standards. The first requirement of this is that there should be 150 in a centre, and that has all the consequences we know for smaller places.

There is no cancer centre in the north east. Half of all surgical patients and 30% of medical patients from the north east come to Dublin hospitals, as I have told Deputy Ó Caoláin before. I strongly believe patients will go where they will get quality service. Patients who are very ill, particularly with cancer, are prepared to go to the specialist centre for diagnosis and surgery. We clearly need to make financial and transport facilities available to many. They will go there. That is what patient advocacy organisations say to me.

I have written to the board of the HSE as a result of the Fitzgerald report. The first thing to do with accountability is to find out what happened. The second thing we need to do is to learn lessons and having done that, we need to make the changes. I have discussed these issues with the chairman of the board, which will meet tomorrow. It is a high priority for the board to learn the lessons from the Fitzgerald report, not just in how they apply to Portlaoise, but in how they apply to governance, communications and management.

The guarantee I give to patients is that if there is another serious incident, communication and management will be appropriate and it will be acted upon quickly. Many people know Ms Margaret Murphy, including Deputy Clune. She was one of the first patient representatives I met when I became Minister for Health and Children. I met her at a conference in the UK. She told me that her son died as a result of medical error in a hospital in Cork and that she had to litigate to get the facts. She did not want money and when she got the award, she donated it to charity. She had to go through the trauma of litigation to find out what happened. That era is over and people will no longer have to litigate. We now have HIQA, which is about setting and monitoring standards and carrying out investigations. The Rebecca O’Malley report is imminent, as is the report on the pathologist in Galway and Cork and the report on Barrington’s Hospital. I have no doubt these reports will not make pleasant reading, but it is much better to find out warts and all what is happening and to do something about it, than to sweep it under the carpet and oblige other families to litigate.

I agree with Deputy Mitchell that Mr. John Fitzgerald does not deal with the clinical issues. He deals with management communication issues and I knew him when he was manager of South Dublin County Council. He has great credibility as far as management is concerned, especially management of public sector organisations. He identified serious failings and we must learn the lessons from his report quickly. I accept that many of the criticisms of the HSE are valid, because it is a new organisation and is the largest in the country with 130,000 people. There will be teething problems and many of the jobs at the top are not yet filled. I want to [85]see that done as quickly as possible so that we have a clear line of management and clear lines of accountability. I still think everybody here admires the vision, the determination and the courage of Professor Drumm. Many of his clinical critics did not apply for the job, as not that many doctors were queuing up to be CEO of the HSE.

Deputy Clune asked about doctors filling positions. A radiologist was appointed in the summer of 2004 to Portlaoise and another was appointed in the autumn of 2005. A recruitment campaign began for a third radiologist and a successful candidate was identified, but that candidate withdrew after a couple of months. The HSE advertised again but no successful candidate could be identified. These are the facts and that is what happened to radiology in Portlaoise.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Will the Minister do anything to reform the HSE to ensure there are clear lines of command and that people know who is responsible? That is the basic problem in the HSE. Will she slim down the senior management structures?

Does the Minister have a system of dealing with letters that come from professionals who indicate concerns? She mentioned that it was a nurse who indicated the problems that existed in Our Lady of Lourdes Hospital in Drogheda. A nurse manager brought attention to the problems in Portlaoise. Dr. Naughton’s letter to the Minister and her predecessor did not get any response at all. If people see a serious problem in their place of work in the HSE, will there be an appropriate and specific response? Did Dr. Naughton get a reply to his letter from either the Minister or the then Minister, Deputy Martin?

A number of us referred to the questions raised by Europa Donna. Has the Minister put in place a system of assessing the gaps in the services in those designated centres? In many parts of the country, especially in Waterford, Cork and Limerick, the services are not up to the standard required. Is there a specific plan and timetable to provide the necessary resources so that we can have an even service throughout the country?

The Doherty report to which the Minister referred shows a level of incompetence in the management of services in the midlands. Did these managers get bonuses over the period of time highlighted in these reports? Has anyone been called to account for their various responsibilities? Is nobody responsible?

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Does the Minister accept Mr. Fitzgerald’s report? A simple “yes” or “no” will do.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I will answer when I have the opportunity.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  A simple nod would do. If she accepts his report, does she accept that his contention that if the urgency shown after 22 November was shown before that date, then much of the hardship inflicted on patients would have been avoided? Surely this criticism about a lack of urgency also applies to the Minister. Does she believe she did everything she could after August and before 22 November, and therefore has no culpability in the matter?

The Minister has a great knowledge of the private sector. Does she find it reasonable that a report showing such deficits in communication and management can find nobody responsible? If this was a private company, what would her shareholders say? A leading businessman gave us an answer during the week. Is the Minister still impressed with the HSE, as she told the health committee?

Deputy Ó Caoláin referred to an article in yesterday’s edition of The Irish Times, which obviously the Minister thinks is incorrect. It stated that the Department of Health and Children held high level discussions about the future of the HSE prior to the publication of these reports on the Portlaoise breast cancer debacle. It went on to state that consideration was given to a [86]radical restructuring of the struggling national health authority that would have involved at least a partial return to the regionalisation of health services in the State. That does not mean a return to the health boards.

Where are all the other reports to which the Minister alluded? When will we get them? Will we get a truly independent investigation into Mr. Peter Naughton’s letter and how it is not on the Department’s files? The Minister alluded this morning to electronic receipts and so on, but that does not answer the question as to how the letter sent is not on the file. The computer shows that it did not appear on the file, but it does not tell us how that happened. We need to know that as our democracy demands it. Will there be a proper independent investigation into all matters relating to the Portlaoise debacle and the manner in which women were affected? It should cover the period from 2000 to 2008 and examine the role of Ministers, the Department of Health and Children, the HSE and the health boards, rather than this little investigation into the period from August to November 2007. The problems stem from a long time before that.

Has the Minister any more to say to the House about her misleading statement to the health committee meeting last week, when she stated that Professor Keane had agreed a new method of referring patients for breast diagnosis with the IGCP? That clearly is not the case and I have checked the facts on this and put them on record. How will the appointment of a protocol manager improve the treatment of patients? People want improvement in treatment. This main plank of the Minister’s response seems to focus on how to limit damage to the system, rather than protect and care for the patient. Worryingly, nothing seems to have changed.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  Is the Minister aware that in the Our Lady of Lourdes Hospital, Drogheda, on 26 June 2007, a clinical nurse manager wrote the following?

Is the Minister aware that on 9 May 2007, during the general election campaign, Professor Des Carney had to write a letter stating that the medical oncology unit had “no option but to limit the amount of chemotherapy” administered to patients on the grounds that it did not have adequate or proper nursing staff and proposing to reduce the administration of chemotherapy to four days per week?

Is she aware that the key to the problem is her failure to provide adequate funding, which has resulted in budgetary cutbacks, inadequate staff cover, appalling pressure on the health services and the circumstances I have described in Our Lady of Lourdes Hospital?

The Minister and her colleague, Deputy Byrne, who has left the Chamber, referred to the north east. Professor Carney, the chief oncologist in the north-eastern region, submitted a letter of resignation in October 2007, effective from this month, citing lack of support from the Health Service Executive, its refusal to appoint a further oncologist for the region and its decision to proceed with a new arrangement with a different hospital without consulting him.

Is the Minister aware of the appalling, disgraceful situation she has created for cancer patients in the north east? While we all support the concept of clinical centres of excellence, the Minister refused to provide proper and adequate funding to existing centres of excellence in which men and women work so hard. The HSE, a disgraceful, shameful mess, refused to communicate [87]with the lead consultants in Our Lady of Lourdes Hospital. One of these consultants wrote to the Minister pointing out that the hospital was unsafe due to underfunding.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Deputy O’Sullivan asked a number of questions. I understand the system for dealing with letters in my office has been in place for a considerable number of years and long preceded my arrival and that of my three or four immediate predecessors. Letters addressed personally to the Minister go to the Minister’s office. As I indicated to the joint committee last week, the Department receives approximately 1,000 letters per week. This is a considerable level of correspondence and, I suspect, in excess of that received in any other Department. Many of these letters are from clinicians, patients, patient representatives, Deputies and public representatives. When letters addressed to the Minister arrive in the Minister’s private office they are recorded electronically and copied. A copy is then sent to the principal officer in the division responsible for the issue raised in the correspondence, for example, hospitals or community services.

There is no record of the Naughton letter of late April 2002, which was during the general election campaign of that year, having been received at any level in the Department, Minister’s office or health board. I am not saying Mr. Naughton did not send the letter but that there is no record of it having been received. As I informed Deputy Reilly, there was a response to the issues raised by Mr. Naughton. In June — two months later — the Midland Health Board applied to the Department for three consultant posts to be assigned to the midlands. In November of that year, the then Minister for Health and Children, Deputy Martin, approved the appointment of three consultants. On the subject matter of Mr. Naughton’s letter, of which I and Deputy Reilly saw a copy last week, the issues raised were responded to by the Minister——

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Inadequately, unfortunately.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  ——on foot of a request from the Midland Health Board in November 2002, subject to conditions such as triple assessment.

On the new procedure in place, letters fall into different categories and, as is the case with referral letters from doctors to hospitals, serious safety issues will arise. As Minister for Health and Children, safety must be a priority for me. This is the reason for many of the measures we have taken, for example, establishing HIQA. Traditionally, the chief medical officer has five deputy medical officers working with him in the Department’s medical team. I asked the Secretary General to ensure the medical team is involved in giving a first view of letters in which doctors, patients or others raise safety issues because they are the best people to advise me of the priority that should be given to particular letters. This system has been established and is a new departure for the medical team which until now has not been involved in these types of issues. This initiative is the least we can do on foot of events in Portlaoise.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Is a system in place to ensure appropriate follow-up occurs in serious cases?

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Yes.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  In other words, cases are not passed on to others and the Department ensures action is taken.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Yes. I am not aware of having received a letter which did not result in appropriate follow-up. If, however, somebody produces such a letter, I will put up my hands. A computer reminder is issued in the first instance. I also have such an electronic means of [88]issuing reminders in my constituency office. While it is possible issues arise concerning the speed at which we respond from time to time, the issuing of a response is a requirement as far as the Department is concerned.

On the size of Health Service Executive management, the HSE is a large organisation which amalgamated several organisations besides the health boards and Eastern Regional Health Authority. I shared the view expressed by many others at the time that a redundancy programme should have been introduced. However, this approach was not supported politically or by the trade unions.

  5 o’clock

I repeat what I have said publicly and to Professor Drumm. If people in areas of administration or management are superfluous to requirements and there are shortages elsewhere, we should take a bold and innovative approach and consider introducing a redundancy programme. This is not generally done in the State sector, notwithstanding one or two examples which may not have been successful. Sometimes one loses the people one does not want to lose, which is not the intention. Having made that remark, I or my Department will receive a call or letter from the employee representative organisations.

Clearly, the HSE must be organised appropriately in terms of deployment. This is particularly important in the labour intensive area of health where more staff are always needed in front-line services. Nevertheless, our acute hospitals have one of the highest ratios of staff to beds in the world. The OECD has been studying this issue recently and I will be surprised if it, as an independent body, does not confirm that.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  How long will it take the Government to do something about it?

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Professor Keane is assessing capacity in the eight centres. This is the area in which he has been allocated a sum of €5.8 million, two thirds of which will go to hospitals outside Dublin. None of the eight centres has the capacity and all of them need more specialists.

The issue is not only one of providing additional money. This year an additional €35 million has been provided. It is also one of redeployment, particularly of clinical expertise at consultant level. For example, I understand Mr. Barry, the breast surgeon in Castlebar, will perform breast surgery in Galway on one day each week.

When Professor Keane was asked to reform the system in British Columbia, he was told by the Prime Minister of that state that he would not receive additional funds. One can imagine the challenge that presented. We are not in that position.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  The systems in place in Ireland and British Columbia are very different.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Additional resources are available and we need to recruit more consultants. One of the reasons it has taken so long to reach agreement on the consultants’ contract is the requirement to have a one-for-all approach to diagnosis and appropriate access for all patients.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Will the Minister take these steps in a specified timeframe?

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I am not capable or competent to decide whether the appropriate resources are in place in Limerick, Cork, Waterford or elsewhere. Professor Keane has been to all eight places and is carrying out an assessment and making the investment, which has amounted to €5.8 million to date.

[89]On the point raised by Deputy Reilly, I have spoken to Professor Keane. He has had discussions with Dr. Michael Boland on behalf of the college. Dr. Boland is the director of resource development and the person responsible for this. Deputy Reilly should not shake his head. I do not tell lies. I spoke to Professor Keane during the break. He has had——

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  A preliminary meeting with one member of the Irish college does not constitute a negotiation or an agreement on referrals. I am sorry but the Minister has misled——

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I am sorry, Deputy. It is not a question of negotiation. I know the Deputy is a former president of the Irish Medical Organisation but this is about best practice clinically.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Yes, I agree.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  We have 2,500 general practitioners and 2,500 breast cancer cases a year. On average, therefore, they deal with one each. There are protocols internationally, well documented in Canada and elsewhere, of how general practitioners refer to surgeons and clinicians.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  There is no agreement, Minister.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  The Minister, without interruption.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  She told us that.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Is the Deputy telling me the Irish College of General Practitioners will not agree to a new protocol?

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I am telling the Minister there is no agreement but the Minister told us there was one.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I am sorry, Deputy.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I am sorry too. The Minister cannot tell it straight.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Deputy Reilly, please——

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  The Deputy should withdraw that. He probably wants people to be paid to do the new protocol.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  No.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I spoke with the president of the Irish college last Thursday evening. They are hugely enthusiastic for this and will be hugely helpful to general practitioners.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  They have not agreed, Minister.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Deputy Reilly, five more people are offering to put questions.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  It is not a question of agreeing. I have no doubt that the Irish College of General Practitioners, as the professional development body for general practitioners, will not disagree with the implementation of best practice.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  There is no agreed protocol.

[90]Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Professor Keane will attend their annual meeting to meet more of them. The surgical teams in the eight centres are involved in this as well, including Professor Hill and others, and it has been implemented very successfully in other countries.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I hope agreement will be reached but it is not agreed and the Minister should not tell the House it was agreed.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Deputy Reilly, please. The Minister, without interruption.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Two issues arise concerning protocols. There are clinical issues, which are a matter for clinicians. We have strengthened the Medical Council with a lay majority. We are introducing competence assurance. We have a more appropriate fitness to practice regime. All of these measures, about which there was much criticism, will greatly help because among the issues that arise is when other clinicians have questions about doctors it has been very difficult under the old legislation to protect them when they report. The new legislation provides that protection if they report in good faith. That is long overdue and important.

Regarding protocols, we know internationally, and Deputy Reilly knows as a doctor, that adverse events happen in approximately 10% of cases in those countries where this has been researched. Thankfully, very few of them have fatal consequences but adverse events happen in about 10% of cases in New Zealand, Canada, the United States and the United Kingdom and many countries that have researched this area. Unfortunately, we will have adverse events but what we must do is minimise the capacity for error making by changing the way we organise services.

The protocol will concern the way the Health Service Executive deals with these incidents — when it contacts patients and how it does so. In this case what happened was that on 28 August the HSE made a public announcement in Portlaoise that it had withdrawn the service and that 3,000 mammograms would be reviewed. That was the first time those patients heard about that and from now on we must ensure that the patients hear directly. That may not always be possible. There may be leaks from time to time but where possible there should be a protocol for how this is handled that is consistent across the service and a single person should be responsible to ensure the protocol is implemented.

On the issues concerning Drogheda, I am not briefed——

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  With respect, I asked the Minister if she accepted the Fitzgerald report and she has not answered.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Of course I do. I told the Deputy earlier I was implementing the findings. I asked for the report because I wanted to find out what was happening. It is my job to make sure it is put right.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  What about the second question I asked the Minister about his contention that had the same urgency been shown before November——

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Yes. I accept his report. The Deputy attended the press conference. I accept he may not have been present for all of it or perhaps he was not listening. I said then I accepted it.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I am asking the Minister for the benefit of the record of the House, not for press conferences.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Deputy Reilly, we cannot——

[91]Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I am entitled to answers, Chairman.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Yes, but other people wish to get answers as well.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I said it in the committee last week also.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  If the Minister answers the questions concisely and quickly there will not be a problem.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  Allow the Minister continue without interruption.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I told the Deputy in the committee last week that I had asked the HSE——

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Does the Minister believe she did everything she could have done between August and November? That is all I want to know.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Regarding the Fitzgerald report, I said in the committee last week and repeat now, as I repeated earlier, that I asked the chairman of the HSE in a letter I sent him and in discussions I have had with him to make sure we act on foot of the findings, not just in regard to the specifics around Portlaoise but to determine its implications for the wider management governance and communications issues. I accept that the patients should have been dealt with directly but my job is to implement policy. The job of my Department is to support the Minister and the Government in the implementation of policy, bring in legislation, appoint the board and hold the board accountable. When problems are identified it is my job to make sure that the board of the HSE implements the changes necessary to minimise errors of this kind in the future, in terms of the way services are organised, and to ensure that when errors or incidents occur, patients are handled in accordance with protocols patients have been involved in drafting. I want to see patient organisations involved, and they are enthusiastically involved.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Does the Minister believe she did everything she should have done between August and November? That is all I want, a “yes” or “no” answer.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I do. Can the Deputy tell me something I should have done? I am here to learn. I went to British Columbia to learn about their cancer service because I had been told by clinical experts here that it was one of the best in the world. I went there and learned a great deal. I met Professor Keane and asked him if he would come and work with us. To be honest, I did not believe at the time he would, given the hugely important job he had in Canada. That is the reason we take these actions. It is to learn and to make matters better, and I do not believe there is any difference among all of us in that regard.

Regarding Deputy O’Dowd’s questions, I do not have details on the specifics in respect of staffing issues in Drogheda. As the Deputy is aware, a microscope has been focused on Drogheda hospital as a result of the Neary case and Maureen Harding-Clarke’s inquiry. She identified the need for additional resource allocation.

The HSE has chosen the north east as its first area for introducing the transformation programme. I have spoken to the HSE on a number of occasions and notwithstanding what may be called budgetary challenges, I want to see the services in the north east reorganised appropriately as quickly as possible because as we all know there are major deficiencies in the way all the services are organised. Resources are being allocated to that. We have a clinician in charge of it at the clinical level and a management team in charge of implementing that change. The future is the new hospital but between now and then——

[92]Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  On that——

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  ——we must greatly improve the services available. I agreed recently to meet Mr. Vaughan, who is the chairman of the medical board, at the hospital in approximately two weeks’ time. He wrote to me — I do not know if that is the letter the Deputy is referring to — and I agreed to meet him.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  No. This is a letter stating that the situation in Lourdes hospital was unsafe because it was under-resourced. The Minister has not answered the point that she under-resourced cancer services in Lourdes hospital to such an extent——

Deputy Seymour Crawford: Information on Seymour Crawford  Zoom on Seymour Crawford  And the north east generally.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  You completely under-resourced them.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  The Deputy should address his remarks through the Chair.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  I will answer that. Until relatively recently 36 hospitals out of the 52 were dealing with breast cancer. Nobody here needs to be a clinical expert to know we could not possibly resource 36 places at the level that is now required in terms of clinical support — nurses, doctors, equipment. That is a fact.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  On a point of order, I will not labour this point but the clinical nurse manager the Minister spoke so highly of in Lourdes hospital, writing during the general election campaign, said they could not continue with the way the situation was being funded in the Lourdes hospital, which is a regional service. The Government is responsible for that. It is a disgrace and a shame and we will not let the Minister off the hook on this issue. She will not get away with it.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  This year the HSE budget is more than €15 billion.

Deputy Fergus O’Dowd: Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  I have the figures.

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  The Minister, without interruption.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  It is €1.1 billion more than last year. To put it in perspective, since the organisation was established on 1 January 2005, its increased budget is more than €4 billion. That is more than we spent on the entire service in 1996. It is a huge resource. There are many challenges in that resource. Health is very labour intensive. There is a major debate about therapies and the recruitment of therapists. We have 112,000 people, full-time and whole-time equivalents, working in the system. It is a considerable resource. Last year we recruited almost 4,000 more people and this year more people will be recruited. Safety must be a priority and from now on, with the Health Information and Quality Authority setting standards and monitoring them, safety will drive the delivery of services. Practices that might have been justified in the past will not be the order in the future because it will not be safe to have them.

The allocation of these resources between hospitals must be a matter for the National Hospitals Office and Professor Drumm and his team. I have huge confidence in Professor Drumm’s capacity to transform the health service. As he cannot be expected to do it on his own, he needs a good management team around him. We must ensure there are appropriate lines of accountability in the system. That is the job of the HSE board on foot of the findings of the Fitzgerald report.

[93]Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  The Minister did not answer the question on whether performance related bonuses——

Acting Chairman: Information on Seamus Kirk  Zoom on Seamus Kirk  I am sorry, Deputy, but there are five other Members indicating.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Why were representatives of HIQA not sent to Portlaoise General Hospital? I asked that question earlier but did not receive a reply.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  The Minister just wants to keep on talking in order that there will be no more questions.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Will the Minister give a simple yes or no answer to my question on bonuses?

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  The answer is yes; it is part of the contract of employment introduced many years ago for the officials in question.

Deputy Eamon Gilmore: Information on Eamon Gilmore  Zoom on Eamon Gilmore  What about the bonuses?

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  It is supposed to be based on performance.

Deputy John Perry: Information on John Perry  Zoom on John Perry  The Minister is filibustering.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  That was way in advance of the establishment of the HSE. Does the Labour Party want to change people’s terms of employment?

Deputy Eamon Gilmore: Information on Eamon Gilmore  Zoom on Eamon Gilmore  No.

Deputy Jan O’Sullivan: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  No, but targets should be set and achieved.

Deputy John Perry: Information on John Perry  Zoom on John Perry  They are all filibustering.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  The Minister is just washing her hands.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  It is the job of management. In the case of the chief executive officer, it is the responsibility of the board and a sub-committee to examine the matter. Deputy Stagg can wash his hands all he likes.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  The Minister has been doing that for the past ten years. She is acting like Pontius Pilate.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  For too long politics dictated how health services were determined. From now on it will be about qualities, standards and safety.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  The Minister is just passing the buck.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  There is no passing of the buck.

Deputy John Perry: Information on John Perry  Zoom on John Perry  Professor Niall O’Higgins’s report accepted the scientific foundation for eight centres of excellence for cancer care. There should be only two centres in Dublin. The British Columbia cancer care model would reaffirm this. How can the Minister justify not having a centre north of Galway? The population of the north west is 400,000, with up to 4,000 mammograms being conducted at a world class service in Sligo General Hospital. Has the Minister examined the Sloan-Kettering model in America which operates an effective outreach service?

[94]Concerning the cross-Border dimension to cancer services, the Minister stated she would come back to us on the development of a centre with County Fermanagh and the unique opportunity to keep a cancer care service in the region. Will she indicate when BreastCheck will be rolled out in the north west?

Deputy Joe McHugh: Information on Joe McHugh  Zoom on Joe McHugh  Given the ongoing negotiations between the Minister and her Northern counterpart, Mr. Michael McGimpsey, her Department seems willing to put taxpayers’ money into a new radiotherapy centre in the north west. Why does she continue to state there will be eight centres of excellence? Will this affect a potential ninth centre in the north west? Does the Minister have more confidence in the Northern Ireland administration to roll out cancer services than the administration here?

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  Which politicians opposed the redundancy package? Was it Fianna Fáil or the Progressive Democrats because they were obviously in government?

Concerning the Minister’s speed in denigrating the staff and services at Portlaoise Genereal Hospital, did she know when she took up office that the hospital was a designated centre of excellence? If so, why did she not accept it? Is she aware that in 2001 the then Minister for Health and Children said there would not be two centres of excellence in the Midland Health Board area but one developed at Portlaoise Genereal Hospital?

Why was no oncology job advertised between 11 April 2001 and 2004? These were the crucial three years in which the Department sat on the vacancy. Will the Minister accept that it was the consistent and deliberate starving of cash in a conspiracy between the Midland Health Board and the Department that resulted in the debacle at Portlaoise? Will she arrange for publication of the seven letters written by Dr. Peter Naughton to the Department and managers of the health board? Until such time as they are published, the full and true story will not be known.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Between 2001 and 2004 the Midland Health Board received €5 million for cancer services.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  On what was it spent?

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Portlaoise General Hospital received €500,000 in 2001 for its symptomatic service.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  Yet no jobs were advertised. The Department sat on the appointment.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  When the HSE was established, nearly every health board, as well as the staff representative organisations, were opposed to the redundancy packages.

I did know Portlaoise General Hospital was a centre of excellence. A centre, however, that deals with 46 cases is not safe.

Deputy Charles Flanagan: Information on Charles Flanagan  Zoom on Charles Flanagan  That figure of 46 is from a while back. It is different now. If the Minister knew that, why did she not close it down earlier?

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Up to 250 worldwide medical publications have stated a woman’s survival chances are improved by 20%. That means one in five women who would otherwise die is saved if they are treated in a centre that deals with 150 cases a year.

Deputy Seymour Crawford: Information on Seymour Crawford  Zoom on Seymour Crawford  If they can make it to the centre.

[95]Deputy Olwyn Enright: Information on Olwyn Enright  Zoom on Olwyn Enright  They have to travel to it.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  The entire midlands region did not have that volume of cases. The Northern Ireland health services are way ahead of ours. They were rationalised many years ago and reduced the number of surgeons.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  The Minister has been there for ten years going on about rationalisation.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  Belfast has a centre of excellence.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  She is just whingeing and crying about it all. One would swear she was just a spectator in all of this.

Deputy Mary Harney: Information on Mary Harney  Zoom on Mary Harney  For many reasons, it makes sense for the north west to be served by a cross-Border unit, for which we have indicated our support.

The centres were not chosen by me. The hospital in my constituency is not a centre of excellence. The centres were chosen by the best medical and clinical experts we could assemble both at home and abroad.

Deputy John Perry: Information on John Perry  Zoom on John Perry  What about Sligo?

Deputy Joe McHugh: Information on Joe McHugh  Zoom on Joe McHugh  How can there be nine centres of excellence when the Minister says there will only be eight? What about the north west?

Question put: “That the words proposed to be deleted stand.”

The Dáil divided: Tá, 63; Níl, 56.

Information on Noel Ahern  Zoom on Noel Ahern  Ahern, Noel. Information on Barry Andrews  Zoom on Barry Andrews  Andrews, Barry.
Information on Chris Andrews  Zoom on Chris Andrews  Andrews, Chris. Information on Seán Ardagh  Zoom on Seán Ardagh  Ardagh, Seán.
Information on Bobby Aylward  Zoom on Bobby Aylward  Aylward, Bobby. Information on Joe Behan  Zoom on Joe Behan  Behan, Joe.
Information on Niall Blaney  Zoom on Niall Blaney  Blaney, Niall. Information on Aine Brady  Zoom on Aine Brady  Brady, Áine.
Information on Cyprian Brady  Zoom on Cyprian Brady  Brady, Cyprian. Information on Johnny Brady  Zoom on Johnny Brady  Brady, Johnny.
Information on Thomas Byrne  Zoom on Thomas Byrne  Byrne, Thomas. Information on Dara Calleary  Zoom on Dara Calleary  Calleary, Dara.
Information on Niall Collins  Zoom on Niall Collins  Collins, Niall. Information on Margaret Conlon  Zoom on Margaret Conlon  Conlon, Margaret.
Information on Sean Connick  Zoom on Sean Connick  Connick, Seán. Information on John Cregan  Zoom on John Cregan  Cregan, John.
Information on Ciaran Cuffe  Zoom on Ciaran Cuffe  Cuffe, Ciarán. Information on John Curran  Zoom on John Curran  Curran, John.
Information on Tim Dooley  Zoom on Tim Dooley  Dooley, Timmy. Information on Frank Fahey  Zoom on Frank Fahey  Fahey, Frank.
Information on Michael Finneran  Zoom on Michael Finneran  Finneran, Michael. Information on Michael Fitzpatrick  Zoom on Michael Fitzpatrick  Fitzpatrick, Michael.
Information on Seán Fleming  Zoom on Seán Fleming  Fleming, Seán. Information on Beverley Cooper-Flynn  Zoom on Beverley Cooper-Flynn  Flynn, Beverley.
Information on Paul Nicholas Gogarty  Zoom on Paul Nicholas Gogarty  Gogarty, Paul. Information on John Gormley  Zoom on John Gormley  Gormley, John.
Information on Noel Grealish  Zoom on Noel Grealish  Grealish, Noel. Information on Mary Harney  Zoom on Mary Harney  Harney, Mary.
Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán. Information on Jackie Healy-Rae  Zoom on Jackie Healy-Rae  Healy-Rae, Jackie.
Information on Peter Kelly  Zoom on Peter Kelly  Kelly, Peter. Information on Brendan Kenneally  Zoom on Brendan Kenneally  Kenneally, Brendan.
Information on Michael Kennedy  Zoom on Michael Kennedy  Kennedy, Michael. Information on Seamus Kirk  Zoom on Seamus Kirk  Kirk, Seamus.
Information on Michael Kitt  Zoom on Michael Kitt  Kitt, Michael P. Information on Tom Kitt  Zoom on Tom Kitt  Kitt, Tom.
Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Lenihan, Brian. Information on Conor Lenihan  Zoom on Conor Lenihan  Lenihan, Conor.
Information on Dr Martin Mansergh  Zoom on Dr Martin Mansergh  Mansergh, Martin. Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas.
Information on Finian McGrath  Zoom on Finian McGrath  McGrath, Finian. Information on Mattie McGrath  Zoom on Mattie McGrath  McGrath, Mattie.
Information on Michael McGrath  Zoom on Michael McGrath  McGrath, Michael. Information on John McGuinness  Zoom on John McGuinness  McGuinness, John.
Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael. Information on M. J. Nolan  Zoom on M. J. Nolan  Nolan, M. J.
Information on Éamon Ó Cuív  Zoom on Éamon Ó Cuív  Ó Cuív, Éamon. Information on Seán Ó Fearghaíl  Zoom on Seán Ó Fearghaíl  Ó Fearghaíl, Seán.
Information on Darragh O'Brien  Zoom on Darragh O'Brien  O’Brien, Darragh. Information on Charlie O'Connor  Zoom on Charlie O'Connor  O’Connor, Charlie.
Information on Willie O'Dea  Zoom on Willie O'Dea  O’Dea, Willie. Information on Noel O'Flynn  Zoom on Noel O'Flynn  O’Flynn, Noel.
Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  O’Hanlon, Rory. Information on Mary O'Rourke  Zoom on Mary O'Rourke  O’Rourke, Mary.
Information on Christy O'Sullivan  Zoom on Christy O'Sullivan  O’Sullivan, Christy. Information on Peter Power  Zoom on Peter Power  Power, Peter.
Information on Eamon Ryan  Zoom on Eamon Ryan  Ryan, Eamon. Information on Trevor Sargent  Zoom on Trevor Sargent  Sargent, Trevor.
Information on Brendan Smith  Zoom on Brendan Smith  Smith, Brendan. Information on Noel Treacy  Zoom on Noel Treacy  Treacy, Noel.
Information on Mary Wallace  Zoom on Mary Wallace  Wallace, Mary. Information on Mary Alexandra White  Zoom on Mary Alexandra White  White, Mary Alexandra.
Information on Michael J. Woods  Zoom on Michael J. Woods  Woods, Michael.  


[96]Níl
Information on Bernard Allen  Zoom on Bernard Allen  Allen, Bernard. Information on Thomas P. Broughan  Zoom on Thomas P. Broughan  Broughan, Thomas P.
Information on Richard Bruton  Zoom on Richard Bruton  Bruton, Richard. Information on Ulick Burke  Zoom on Ulick Burke  Burke, Ulick.
Information on Joan Burton  Zoom on Joan Burton  Burton, Joan. Information on Deirdre Clune  Zoom on Deirdre Clune  Clune, Deirdre.
Information on Paul Connaughton  Zoom on Paul Connaughton  Connaughton, Paul. Information on Noel Coonan  Zoom on Noel Coonan  Coonan, Noel J.
Information on Joe Costello  Zoom on Joe Costello  Costello, Joe. Information on Simon Coveney  Zoom on Simon Coveney  Coveney, Simon.
Information on Seymour Crawford  Zoom on Seymour Crawford  Crawford, Seymour. Information on Michael Creed  Zoom on Michael Creed  Creed, Michael.
Information on Michael D'Arcy  Zoom on Michael D'Arcy  D’Arcy, Michael. Information on John Deasy  Zoom on John Deasy  Deasy, John.
Information on Jimmy Deenihan  Zoom on Jimmy Deenihan  Deenihan, Jimmy. Information on Damien English  Zoom on Damien English  English, Damien.
Information on Olwyn Enright  Zoom on Olwyn Enright  Enright, Olwyn. Information on Frank Feighan  Zoom on Frank Feighan  Feighan, Frank.
Information on Charles Flanagan  Zoom on Charles Flanagan  Flanagan, Charles. Information on Terence Flanagan  Zoom on Terence Flanagan  Flanagan, Terence.
Information on Eamon Gilmore  Zoom on Eamon Gilmore  Gilmore, Eamon. Information on Brian Hayes  Zoom on Brian Hayes  Hayes, Brian.
Information on Tom Hayes  Zoom on Tom Hayes  Hayes, Tom. Information on Michael D. Higgins  Zoom on Michael D. Higgins  Higgins, Michael D.
Information on Philip Hogan  Zoom on Philip Hogan  Hogan, Phil. Information on Paul Kehoe  Zoom on Paul Kehoe  Kehoe, Paul.
Information on Ciaran Lynch  Zoom on Ciaran Lynch  Lynch, Ciarán. Information on Kathleen Lynch  Zoom on Kathleen Lynch  Lynch, Kathleen.
Information on Pádraic McCormack  Zoom on Pádraic McCormack  McCormack, Pádraic. Information on Dinny McGinley  Zoom on Dinny McGinley  McGinley, Dinny.
Information on Joe McHugh  Zoom on Joe McHugh  McHugh, Joe. Information on Liz McManus  Zoom on Liz McManus  McManus, Liz.
Information on Olivia Mitchell  Zoom on Olivia Mitchell  Mitchell, Olivia. Information on Dan Neville  Zoom on Dan Neville  Neville, Dan.
Information on Michael Noonan  Zoom on Michael Noonan  Noonan, Michael. Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  Ó Caoláin, Caoimhghín.
Information on Aengus O Snodaigh  Zoom on Aengus O Snodaigh  Ó Snodaigh, Aengus. Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  O’Dowd, Fergus.
Information on Jim O'Keeffe  Zoom on Jim O'Keeffe  O’Keeffe, Jim. Information on John O'Mahony  Zoom on John O'Mahony  O’Mahony, John.
Information on Brian O'Shea  Zoom on Brian O'Shea  O’Shea, Brian. Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  O’Sullivan, Jan.
Information on Willie Penrose  Zoom on Willie Penrose  Penrose, Willie. Information on John Perry  Zoom on John Perry  Perry, John.
Information on Pat Rabbitte  Zoom on Pat Rabbitte  Rabbitte, Pat. Information on Dr James Reilly  Zoom on Dr James Reilly  Reilly, James.
Information on Michael Ring  Zoom on Michael Ring  Ring, Michael. Information on Alan Shatter  Zoom on Alan Shatter  Shatter, Alan.
Information on Tom Sheahan  Zoom on Tom Sheahan  Sheahan, Tom. Information on P. J. Sheehan  Zoom on P. J. Sheehan  Sheehan, P. J.
Information on Sean Sherlock  Zoom on Sean Sherlock  Sherlock, Seán. Information on Emmet Stagg  Zoom on Emmet Stagg  Stagg, Emmet.
Information on Billy Timmins  Zoom on Billy Timmins  Timmins, Billy. Information on Joanna Tuffy  Zoom on Joanna Tuffy  Tuffy, Joanna.
Information on Mary Upton  Zoom on Mary Upton  Upton, Mary. Information on Jack Wall  Zoom on Jack Wall  Wall, Jack.

Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Paul Kehoe and Emmet Stagg.

Question declared carried.

Amendment declared lost.

Amendment No. 1 not moved.

Question put: “That the motion be agreed to.”

The Dáil divided: Tá, 63; Níl, 59.

Information on Noel Ahern  Zoom on Noel Ahern  Ahern, Noel. Information on Barry Andrews  Zoom on Barry Andrews  Andrews, Barry.
Information on Chris Andrews  Zoom on Chris Andrews  Andrews, Chris. Information on Seán Ardagh  Zoom on Seán Ardagh  Ardagh, Seán.
Information on Bobby Aylward  Zoom on Bobby Aylward  Aylward, Bobby. Information on Joe Behan  Zoom on Joe Behan  Behan, Joe.
Information on Niall Blaney  Zoom on Niall Blaney  Blaney, Niall. Information on Aine Brady  Zoom on Aine Brady  Brady, Áine.
Information on Cyprian Brady  Zoom on Cyprian Brady  Brady, Cyprian. Information on Johnny Brady  Zoom on Johnny Brady  Brady, Johnny.
Information on Thomas Byrne  Zoom on Thomas Byrne  Byrne, Thomas. Information on Dara Calleary  Zoom on Dara Calleary  Calleary, Dara.
Information on Niall Collins  Zoom on Niall Collins  Collins, Niall. Information on Margaret Conlon  Zoom on Margaret Conlon  Conlon, Margaret.
Information on Sean Connick  Zoom on Sean Connick  Connick, Seán. Information on John Cregan  Zoom on John Cregan  Cregan, John.
Information on Ciaran Cuffe  Zoom on Ciaran Cuffe  Cuffe, Ciarán. Information on John Curran  Zoom on John Curran  Curran, John.
Information on Tim Dooley  Zoom on Tim Dooley  Dooley, Timmy. Information on Frank Fahey  Zoom on Frank Fahey  Fahey, Frank.
Information on Michael Finneran  Zoom on Michael Finneran  Finneran, Michael. Information on Michael Fitzpatrick  Zoom on Michael Fitzpatrick  Fitzpatrick, Michael.
Information on Seán Fleming  Zoom on Seán Fleming  Fleming, Seán. Information on Beverley Cooper-Flynn  Zoom on Beverley Cooper-Flynn  Flynn, Beverley.
Information on Paul Nicholas Gogarty  Zoom on Paul Nicholas Gogarty  Gogarty, Paul. Information on John Gormley  Zoom on John Gormley  Gormley, John.
Information on Noel Grealish  Zoom on Noel Grealish  Grealish, Noel. Information on Mary Harney  Zoom on Mary Harney  Harney, Mary.
Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán. Information on Jackie Healy-Rae  Zoom on Jackie Healy-Rae  Healy-Rae, Jackie.
Information on Peter Kelly  Zoom on Peter Kelly  Kelly, Peter. Information on Brendan Kenneally  Zoom on Brendan Kenneally  Kenneally, Brendan.
Information on Michael Kennedy  Zoom on Michael Kennedy  Kennedy, Michael. Information on Seamus Kirk  Zoom on Seamus Kirk  Kirk, Seamus.
Information on Michael Kitt  Zoom on Michael Kitt  Kitt, Michael P. Information on Tom Kitt  Zoom on Tom Kitt  Kitt, Tom.
Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Lenihan, Brian. Information on Conor Lenihan  Zoom on Conor Lenihan  Lenihan, Conor.
Information on Dr Martin Mansergh  Zoom on Dr Martin Mansergh  Mansergh, Martin. Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas.
Information on Finian McGrath  Zoom on Finian McGrath  McGrath, Finian. Information on Mattie McGrath  Zoom on Mattie McGrath  McGrath, Mattie.
Information on Michael McGrath  Zoom on Michael McGrath  McGrath, Michael. Information on John McGuinness  Zoom on John McGuinness  McGuinness, John.
Information on John Moloney  Zoom on John Moloney  Moloney, John. Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael.
Information on M. J. Nolan  Zoom on M. J. Nolan  Nolan, M. J. Information on Éamon Ó Cuív  Zoom on Éamon Ó Cuív  Ó Cuív, Éamon.
Information on Seán Ó Fearghaíl  Zoom on Seán Ó Fearghaíl  Ó Fearghaíl, Seán. Information on Darragh O'Brien  Zoom on Darragh O'Brien  O’Brien, Darragh.
Information on Charlie O'Connor  Zoom on Charlie O'Connor  O’Connor, Charlie. Information on Noel O'Flynn  Zoom on Noel O'Flynn  O’Flynn, Noel.
Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  O’Hanlon, Rory. Information on Mary O'Rourke  Zoom on Mary O'Rourke  O’Rourke, Mary.
Information on Christy O'Sullivan  Zoom on Christy O'Sullivan  O’Sullivan, Christy. Information on Peter Power  Zoom on Peter Power  Power, Peter.
Information on Eamon Ryan  Zoom on Eamon Ryan  Ryan, Eamon. Information on Trevor Sargent  Zoom on Trevor Sargent  Sargent, Trevor.
Information on Brendan Smith  Zoom on Brendan Smith  Smith, Brendan. Information on Noel Treacy  Zoom on Noel Treacy  Treacy, Noel.
Information on Mary Wallace  Zoom on Mary Wallace  Wallace, Mary. Information on Mary Alexandra White  Zoom on Mary Alexandra White  White, Mary Alexandra.
Information on Michael J. Woods  Zoom on Michael J. Woods  Woods, Michael.  


Níl
Information on Bernard Allen  Zoom on Bernard Allen  Allen, Bernard. Information on Thomas P. Broughan  Zoom on Thomas P. Broughan  Broughan, Thomas P.
Information on Richard Bruton  Zoom on Richard Bruton  Bruton, Richard. Information on Ulick Burke  Zoom on Ulick Burke  Burke, Ulick.
Information on Joan Burton  Zoom on Joan Burton  Burton, Joan. Information on Catherine Byrne  Zoom on Catherine Byrne  Byrne, Catherine.
Information on Joe Carey  Zoom on Joe Carey  Carey, Joe. Information on Deirdre Clune  Zoom on Deirdre Clune  Clune, Deirdre.
Information on Paul Connaughton  Zoom on Paul Connaughton  Connaughton, Paul. Information on Noel Coonan  Zoom on Noel Coonan  Coonan, Noel J.
Information on Joe Costello  Zoom on Joe Costello  Costello, Joe. Information on Simon Coveney  Zoom on Simon Coveney  Coveney, Simon.
Information on Seymour Crawford  Zoom on Seymour Crawford  Crawford, Seymour. Information on Michael Creed  Zoom on Michael Creed  Creed, Michael.
Information on Michael D'Arcy  Zoom on Michael D'Arcy  D’Arcy, Michael. Information on John Deasy  Zoom on John Deasy  Deasy, John.
Information on Jimmy Deenihan  Zoom on Jimmy Deenihan  Deenihan, Jimmy. Information on Damien English  Zoom on Damien English  English, Damien.
Information on Olwyn Enright  Zoom on Olwyn Enright  Enright, Olwyn. Information on Frank Feighan  Zoom on Frank Feighan  Feighan, Frank.
Information on Charles Flanagan  Zoom on Charles Flanagan  Flanagan, Charles. Information on Terence Flanagan  Zoom on Terence Flanagan  Flanagan, Terence.
Information on Eamon Gilmore  Zoom on Eamon Gilmore  Gilmore, Eamon. Information on Brian Hayes  Zoom on Brian Hayes  Hayes, Brian.
Information on Tom Hayes  Zoom on Tom Hayes  Hayes, Tom. Information on Michael D. Higgins  Zoom on Michael D. Higgins  Higgins, Michael D.
Information on Philip Hogan  Zoom on Philip Hogan  Hogan, Phil. Information on Paul Kehoe  Zoom on Paul Kehoe  Kehoe, Paul.
Information on Ciaran Lynch  Zoom on Ciaran Lynch  Lynch, Ciarán. Information on Kathleen Lynch  Zoom on Kathleen Lynch  Lynch, Kathleen.
Information on Pádraic McCormack  Zoom on Pádraic McCormack  McCormack, Pádraic. Information on Dinny McGinley  Zoom on Dinny McGinley  McGinley, Dinny.
Information on Joe McHugh  Zoom on Joe McHugh  McHugh, Joe. Information on Liz McManus  Zoom on Liz McManus  McManus, Liz.
Information on Olivia Mitchell  Zoom on Olivia Mitchell  Mitchell, Olivia. Information on Dan Neville  Zoom on Dan Neville  Neville, Dan.
Information on Michael Noonan  Zoom on Michael Noonan  Noonan, Michael. Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  Ó Caoláin, Caoimhghín.
Information on Aengus O Snodaigh  Zoom on Aengus O Snodaigh  Ó Snodaigh, Aengus. Information on Kieran O'Donnell  Zoom on Kieran O'Donnell  O’Donnell, Kieran.
Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  O’Dowd, Fergus. Information on Jim O'Keeffe  Zoom on Jim O'Keeffe  O’Keeffe, Jim.
Information on John O'Mahony  Zoom on John O'Mahony  O’Mahony, John. Information on Brian O'Shea  Zoom on Brian O'Shea  O’Shea, Brian.
Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  O’Sullivan, Jan. Information on Willie Penrose  Zoom on Willie Penrose  Penrose, Willie.
Information on John Perry  Zoom on John Perry  Perry, John. Information on Pat Rabbitte  Zoom on Pat Rabbitte  Rabbitte, Pat.
Information on Dr James Reilly  Zoom on Dr James Reilly  Reilly, James. Information on Michael Ring  Zoom on Michael Ring  Ring, Michael.
Information on Alan Shatter  Zoom on Alan Shatter  Shatter, Alan. Information on Tom Sheahan  Zoom on Tom Sheahan  Sheahan, Tom.
Information on P. J. Sheehan  Zoom on P. J. Sheehan  Sheehan, P. J. Information on Sean Sherlock  Zoom on Sean Sherlock  Sherlock, Seán.
Information on Emmet Stagg  Zoom on Emmet Stagg  Stagg, Emmet. Information on Billy Timmins  Zoom on Billy Timmins  Timmins, Billy.
Information on Joanna Tuffy  Zoom on Joanna Tuffy  Tuffy, Joanna. Information on Mary Upton  Zoom on Mary Upton  Upton, Mary.
Information on Jack Wall  Zoom on Jack Wall  Wall, Jack.  

Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Paul Kehoe and Emmet Stagg.

Question declared carried.


Last Updated: 08/10/2010 07:19:10 First Page Previous Page Page of 155 Next Page Last Page