I want to return to the central issue of cancer services. They say a week is a long time in politics, but for the eight women in the midlands awaiting the results of a second test, a week can be an eternity. Yesterday, the Taoiseach stated on the record of the House that the matter in Portlaoise was a systems failure. He stated: "I am informed that there was no systems failure involved". If there was no systems failure does the Taoiseach place the blame on human error?

On 19 February 2002, the then Midland Health Board wrote to town commissioner Kathleen O'Brien stating, "You will recall that a board deputation met the Minister for Health and Children on 11 April 2001". That Minister was Deputy Micheál Martin, following on from Deputy Cowen and preceding Deputy Harney. The letter continues that the Minister confirmed "that the centre of excellence for symptomatic breast disease services was to be developed at the Midland Regional Hospital at Portlaoise".

The letter states that a unit was to be developed

at the Midland Regional Hospital at Portlaoise with both surgeons and radiologists located in Portlaoise. All intervention radiology, triple assessment and breast cancer surgery for the board's area would be performed in this unit.

That is the confirmation given by the Minister on 11 April 2001, that in the Midland Health Board area there would be radiologists and surgeons in Portlaoise and all intervention radiology, triple assessment and breast cancer surgery for the area would be carried out in that area.

That was the system approved by the Government. The Taoiseach is receiving a running commentary from the Minister for Health and Children to back him up in presiding over this shambles. That was a system the Government put in place and the Minister confirmed to the women and men of the former Midland Health Board area. Why is it that since April 2001 what the then Minister confirmed on behalf of the Fianna Fáil Government did not take place in Portlaoise hospital? Why has there been no triple assessment? Why do we hear complaints about 15 year old machinery? Why were breast cancer surgery services not carried out as was envisaged? This was the Taoiseach's system, his policy and his failure, and he should tell us why the confirmation given by the Minister for Health and Children was never implemented?

I was not clear what Deputy Kenny stated. Yesterday, he stated there was a systems failure but I stated there was not a systems failure and I explained what the details were. I am not sure what distinction Deputy Kenny is drawing in that.

As I understand it — I received a briefing on this — over the years radiologists were appointed. They had difficulty in the location recruiting consultant radiologists but they did recruit radiologists. There was no triple assessment. That is correct, as I understand it.

The letter refers to confirmation of triple assessment.

Triple assessment was not implemented.

Has it been implemented since?

The question is why.

Why not?

They had difficulties getting——

I do not want to be disruptive, but the letter states, "All intervention radiology, triple assessment and breast cancer surgery for the board's area would be performed in this unit."

As I understand it, while they did appoint consultant radiologists, radiographers and staff, they had difficulties getting staff but they did not bring in triple assessment.

Why? The Government stated it would.

This is Leaders' Questions. The Taoiseach, without interruption.

I want to deal with the other point made by Deputy Kenny. I do not want to get into a blame game in this because a report is being prepared and the consultant will bring in all the facts. I understand that the original images diagnosed by the radiologist involved to determine the cases were used in the re-examination. The report will have to give its verdict on all that. Staff, equipment and quality assurance issues will form part of the report. There were staff and a consultant radiologist in the unit. They were recruited, some of them in recent times. Those staff were carrying out their duties. When this issue was raised by a member of staff the same images that were originally diagnosed by the radiologist involved were used in the examination. We will have to wait for the report by the consultant radiologist at St. Vincent's hospital, Ann O'Doherty.

I am not sure whether the Government, which seems to have removed itself from all reality and expects this to operate by remote control, understands the mentality, mood and anger of people throughout the country. People want a system that will deliver a service they can trust for its integrity so that if a woman has a mass on her breast which requires attention, she will know she will receive the best level of service and attention and will have the best chance of survival.

The letter of confirmation issued by the Minister for Health and Children on 11 April 2001 stated there would be triple assessment in respect of Portlaoise. That did not happen. It is not for me to adjudicate on whether the machinery is inferior or outdated but I know that where two radiologists sign off on every mammogram, the incidence of doubt and anxiety can be addressed. Irrespective of whether a systems failure occurred, the letter confirms that the Government failed to implement its own system.

Hear, hear.

Today, we learned about further misdiagnoses in Cork. I am unsure whether the Taoiseach has read the relevant report but I would like him to indicate if he has information from the Minister for Health and Children setting out whether this is true. Will the Minister will issue an instruction today that as and from this moment every mammogram is to be read by two radiologists?

Hear, hear.

Consultants and surgeons tell me various stories from around the country. In cases where mammograms are taken, will the Minister issue an instruction to the overabundant, over-managed and in many cases overpaid HSE officials who claim they are dealing with the matter? She is the Minister for Health and Children and she should lay down an instruction now. Can I get confirmation from the Taoiseach that such will be the case so that women can have some hope and faith in a system that has been allowed to fail and has been doomed to fail under what the Government has established?

Deputy Kenny raised several points I will try to answer. On the first point, Ann O'Doherty, the consultant radiologist in St. Vincent's University Hospital, is producing an overall report. People's careers are involved so I do not want to say anything——

People's lives.

People's health too.

——that concerns the individual staff concerned.

Is it the Taoiseach's career we are discussing?

Deputy Kenny's question referred to cases in which women's lives might be at risk. That is precisely the point I explained yesterday in respect of why 13 units were closed down. Only two weeks ago, I was on the floor defending that position in response to questions put by the Deputy and others regarding why the units were closed. These units are considered to be less safe than they could be if multidisciplinary teams were in place.

I asked about triple assessment in Portlaoise.

I will answer the Deputy's questions and I will come to that issue because he does not understand it, unfortunately.

It was the Government's failure.

We want to provide safe units for all women. Some 15,000 mammograms are done each year. Two consultants read mammograms in the medical world of this country, Northern Ireland, Britain and, I understand, elsewhere only where numbers are below 500. It is not the practice in the medical world that mammograms are read by two people except where there are very low numbers. That is the position where a cancer is identified. Triple assessment only applies where cancer is identified and, because cancer was not identified in these cases that issue does not arise.

Triple assessments were promised.

They were only read by one radiologist. That is why they were misdiagnosed.

The Taoiseach must be allowed to reply without interruption.

If the value of Leaders' Questions lies in dealing with current issues and misinformation that is what I am trying to do. In this case, the difficulty was that the cancer was not seen when the mammograms were read. Triple assessment only applies where it is read and then referred on. I hope that point is clear.

Why did the Government promise triple assessment?

Triple assessment takes place when there is a lump, whether benign or malevolent.

The Taoiseach must be allowed to complete his answer.

Triple assessment may be relevant to other issues and I have already stated it was not in place but in the case under discussion——

Why was it not in place?

For the women involved, the problem was that the mammograms did not show cancers, so triple assessment would not have taken place. I hope the position is clear.

Why did they not show?

On the issue of low volumes, the difficulty is that in our hospitals — I made this point yesterday and have to return to it today — 15,000 mammograms are conducted outside the auspices of BreastCheck. We are endeavouring, with the recent decisions made by the HSE, to designate four managed control networks and eight cancer centres which will be implemented on a managed and phased basis. Professor Keane is due to take up his post in the week commencing 19 November and is expected to quickly designate national clinical leaders of radiation, surgery and medical oncology. Arrangements are in hand to enable him to take control of all the new cancer developments from the start of the new year and all existing cancer services and related staff on a progressive basis. He intends to designate the locations for a range of cancer specialists among the eight centres by early January and will therefore engage in detailed planning to facilitate these designations as soon as he arrives. The breast consultants have already been recruited by this Government in recent years. I am told we probably have more than we require but we need multidisciplinary teams.

The last question raised by Deputy Kenny pertained to Cork. On 14 June, the Health Information Quality Authority published the terms of reference for its independent investigation into the care provided to Rebecca O'Malley. This is a case from four months ago. In addition to investigating the circumstances surrounding the care of Rebecca in regard to her symptomatic breast disease, the investigation will examine the provision of the pathology services provided by the Health Service Executive at Cork University Hospital and the symptomatic breast disease services provided by the Mid-Western Regional Hospital. I stated that in the House several months ago. I am aware Ms O'Malley's consultant surgeon at the Mid-Western Regional Hospital wrote to the pathologist at CUH requesting that the case be reviewed internally by the CUH and externally by the Mater hospital. I am told that at this juncture no additional cases of undetected malignancy have been identified. The HIQA investigation is ongoing and a report is expected later this month. For absolute clarity, HIQA was asked in May to undertake an investigation into the O'Malley case. That investigation is due for completion before the end of this month and includes an examination of the pathology services at CUH and symptomatic breast disease services at the Mid-Western Regional Hospital, where Ms O'Malley first presented for treatment, and the 24 cases form part of that investigation.