I want to raise a HSE report into colonoscopy screening services at Wexford General Hospital. The report concerns the recall of patients who were treated by a consultant referred to as "clinician Y". The recall was instigated on foot of two cases of cancer being detected in October 2014 in patients who had recently undergone a colonoscopy but had not been diagnosed. The report found a higher than acceptable rate of interval cancers in the cohort of patients screened by clinician Y. What this presents in non-HSE management speak is a shocking scenario. The report found that a recall of 615 patients found 13 possible missed cancers. Six of the cases concerned patients in Wexford and seven involved patients in Carlow and Kilkenny. Of the 13 cases identified, it has been discovered that one man died before the recall took place. We can only send our sympathies to his family and loved ones this afternoon and indeed to all those affected by this turn of events.

Cancer screening programmes like this one are valuable. They can and do save lives and it is essential that they enjoy public confidence. There is always the possibility of human error in anything, including medical diagnosis. That is possible but this scenario goes way beyond that. Missed diagnosis on this scale reveals potential systemic and institutionalised problems concerning bowel screening in a hospital serving much of the south east. What we need are assurances that this will not and cannot happen again. We all want and need citizens to have confidence in the screening programmes, which are crucial for early diagnosis of life-threatening diseases that can be treated or indeed cured if detected. Events like this one in Wexford General Hospital do not help that cause. They reveal a catastrophic series of errors. What citizens deserve are answers. I listened to Dr. Orla Healy on "Morning Ireland" on my way in this morning. She spoke about key performance indicators, audits and local governance structures. This is all very fine but none of it provides citizens with the answers they want. How did this happen? They want to know why it took so long to rectify and recognise the issues involved and, above all, they want to know who is responsible. Reports report, and God knows we have had lots of reports about the health service, but what we need to know is who is accountable in this instance and where the buck stops.

I acknowledge the huge anxiety and distress for the patients concerned. Like the Deputy, I extend my sympathy to the family of the patient who died before the HSE review commenced. The report outlined the look back process and the actions taken by the HSE following identification of the probable missed cancers. The Deputy talks about this being systemic. It is important to note that the HSE related these events to the practice of a single clinician. The full report has been made available on the HSE website. Following the HSE audit, 615 patients were recalled for either a repeat colonoscopy or an outpatient appointment. I am informed that all patients involved have been contacted.

It is important to note that all had open disclosure and have since been provided with support and treatment. Since the Wexford General Hospital incident, BowelScreen has reviewed its quality assurance procedures to ensure all units and individuals delivering colonoscopy services on behalf of BowelScreen are doing so to the highest possible standard.

In line with good practice as well as the open disclosure, an external review is commencing to see what further lessons can be learnt. It will look at how the incident was identified and managed, and will include recommendations on the point the Deputy has made about governance, accountability and authority at each level involved. It is expected that review will take six months to complete. The Minister of Health has been made aware of the incident and has received regular updates on the progress of the review.

I wish to make the general point that bowel cancer is the second-most common newly diagnosed cancer in Ireland. It is also the second-most common cause of cancer death in Ireland. The BowelScreen programme provides a valuable service and screening is the most effective approach. The uptake of the bowel screening programme offered to individuals is not what it should be. This is an opportunity to encourage people to respond when they receive the letter on screening in the post.

I entirely echo the Tánaiste's sentiments in respect of the screening process. I return to my initial point. This is why public confidence is so essential. For the uptake to increase and therefore for danger to citizens' health to decrease, people must have confidence in the system.

These events date back to October 2014. This has been a long running saga. A number of people placed their trust and confidence in that screening programme and were misdiagnosed or not diagnosed. In any event they left in full confidence that they were hale and hearty only to discover after the fact that was not the case.

The Tánaiste made the point that the misdiagnoses can be traced back to a single clinician. It should be said that the medic in question contests the findings of the report. It is important to put that on the record of the Dáil. People who have heard the news from Wexford General Hospital ask if they can have confidence in the programme, and also who takes responsibility for this. At the end of the day when the reports are written and the audits are done, where does responsibility lie? Is it with an individual? Is it the stresses and strains of an under-resourced system? Citizens need answers to these questions.

Neither the Deputy nor I want to undermine confidence in the screening processes we have in place for various illnesses and health issues. Having said that, in October 2014 when the national bowel screening programme was informed of the two cases, it took action. In November 2014 Wexford General Hospital, BowelScreen and the particular clinician, let us say clinician Y, said no further BowelScreen colonoscopies would be carried out by that clinician until the review of the two cases was completed.

In January 2015, a HSE serious incident management team was established. People were contacted immediately. It is important to note that there has been both action at a local level within Wexford General Hospital and by the HSE and we will also have an external review in line with good practice and that there has been open disclosure. Open disclosure certainly in the way this has been done is new and to be welcomed. The external review will, of course, address the various issues the Deputy has raised today.