We have fantastic people working in our health service and the outcomes for those who access it are generally very positive. The year 2018, however, has been marked by a number of incredibly tragic incidents that are still ongoing.

We had CervicalCheck and the implications of that. Deputy Alan Kelly hosted a very powerful meeting last night around some of the women affected there. We had the issue that I raised with the Tánaiste in November, highlighted by Mr. Justice Peter Kelly about non-qualified doctors in our hospitals.

Yesterday we had the report from the analysis of the scans at University Hospital Kerry. That found that 11 patients, one of whom has passed away, suffered delayed diagnosis. That person waited for 76 weeks, 18 months, for a diagnosis of lung cancer. A total of 44,831 X-rays were audited and found to be correct. That is an important figure to remember. A figure of 1,298 X-rays had significant errors, and 420 patients had to be recalled and, of those, some 59 required further tests. According to the report, these X-rays and the scans were read by a locum consultant who no longer works in the hospital, having resigned from it in October 2017. Can the Tánaiste confirm that that person is not working in the Irish health service at the moment?

On the broader issue, there are currently more than 500 consultant positions filled by non-consultants. They are either locum, fixed-term or specified-purpose contracts. That represents 16% of the total population of consultants. There are further 199 unapproved posts. We have vacancies at therapist level, nurse level and GP level right across the health service. It is straining under the pressure of work, which is being exacerbated by these vacancies. A key recommendation of the report yesterday was that we would define acceptable volumes of work for individual radiologists. That is surely a concept that can be extended right across the health service. How does one define "acceptable volume of work" for anybody in the health service when there are such vacancies and such demand? The Government is continuing to put its head in the sand about the impact of those vacancies on patient care, and on people working in the service and the pressure those vacancies are putting on already pressurised work environments.

Does the Tánaiste accept that the vacancies across our health service are unacceptable? Does he accept that the vacancies are allowing doctors who are not qualified to work in positions that they should not be in? Is he concerned about the impact these vacancies are having on the quality of care available and the impact that these are having on morale among those working within the health service?

I thank the Ceann Comhairle. The Deputy has a lot of questions there.

First, I wish to express my heartfelt sympathies to the patients and families involved in the recent case and the report that was published this week. I acknowledge that this was a time of real uncertainty for many patients and their families. I appeal for confidentiality to be respected for the families concerned.

It is important to note that the aim of this look-back review has always been to ensure patient safety, to identify whether any clinically significant radiological findings had been missed and to ensure that those identified were managed correctly in the interests of patients, with patients being communicated with appropriately and at the right time. Throughout the review process the HSE has had a comprehensive communications process, including provision for open disclosure and dedicated clinical co-ordinators to liaise with patients and GPs. This included a freephone helpline and a dedicated website. I have been advised that all patients have now received follow-up and care, as needed, and have been provided with support from the South/Southwest Hospital Group. The report of this process provides assurances that the issues have been examined appropriately from a clinical perspective. In its report the serious incident management team, SIMT, has made a total of 16 recommendations and the HSE has confirmed that the implementation of the recommendations of the report is already well under way.

Legal proceedings have been issued in three cases and they will be managed by the State Claims Agency.

All imaging related to one individual consultant radiologist between 24 March 2016 and 27 July 2017 were reviewed. The HSE has advised the scope agreed for the review was focused solely on University Hospital Kerry. The consultant radiologist was placed on administrative leave pending a full review and has since resigned their position. The Irish Medical Council was notified of the concerns in relation to poor professional performance by this doctor in October 2017 and its assessment is still under way.

The total number of patients identified during the review with missed or delayed diagnosis is 11. Four of the patients identified with either missed or delayed diagnosis have now passed away. Of the 11 patients, eight had either re-presented to the health service or their diagnosis was made by the normal multi-disciplinary review. These patients had been diagnosed by the time of the look-back review. A further three, however, were found during the look-back review process and diagnosed thereafter as a result. Following repeat imaging during the recall, 59 patients were identified as requiring further clinical follow-up and-or investigation. Ten further patients have been referred to other hospitals for specialist care.

Four families have lost their loved ones because of this and we do not know how many more of the other seven may be affected. I join in the expressions of sympathy but it is not good enough. We do this every time we have an incident, and that sympathy is heartfelt but we do not learn from it. We need to learn that this must not happen again in another hospital. We need to have some sort of patient focus at the heart of Government that actually says we will not continue to come into this Chamber every few months offering sympathy. We need action. I have identified the recommendations from the report on what are determined to be acceptable workloads. Is that something the Government will take on board and implement across the health service at all grades? Will it give health professionals workloads that they can manage, the support they need to do their job and take a proactive role in filling the vacancies at every level? The Government cannot keep putting its head in the sand about our consultant, GP and nurse vacancies. We need proactivity to fill those vacancies to take the pressure off our health professionals and to avoid a situation where we come back to another expression of sympathy.

Finally, I repeat my question - is the person involved in this case still working in the health service?

I do not disagree with anything the Deputy has said. We need action and action is taking place. The whole point of this look-back review was patient-centred. It was to expose failings if they were there and how they happened to ensure that they would not happen in the future. There are 16 recommendations and they are already being implemented in some cases, and they all will be implemented. Yes, there are vacancies across our health system and the HSE and the Department of Health are working to ensure that those vacancies are addressed.

There has been a significant increase in the number of nurses in the healthcare system in the past 12 months. There have also been increases in the numbers of consultant doctors. Therefore, all of the actions for which the Deputy is calling are under way. I agree with him that it is simply not good enough, but all the same, it needs to be said that what families expect and want when their loved ones go into hospital is that they receive the highest quality of care and that if mistakes are made, they will be exposed quickly through the systems that pick them up and that we learn lessons from them in order that they are less likely to be repeated in the future. That is what is happening in this case.

I also want to refer to the review published yesterday by the HSE of the 46,000 radiology scans carried out at University Hospital Kerry in Tralee. The report has found that 11 patients had their diagnosis of cancer delayed and that four of them have since passed away. Some of the 11 patients received the report by taxi, which is not an appropriate or patient-centred way to deliver a report to any victim. Our thoughts are with the families, in particular, at this very difficult time and all those affected by the scandal. While I welcome the publication of the report, there are a number of outstanding issues on which we require clarification which I hope the Tánaiste will be in a position to provide.

First, less than two pages of the report deal with recommendations to prevent a similar situation from arising in the future. When asked yesterday by my colleague, Councillor Toiréasa Ferris, what was the timescale for implementation of the recommendations, hospital management could not give her an answer. Unless management accepts its failings and responsibilities and puts measures in place to address what happened, it can and could happen again. The concerns about misdiagnoses and hospital scans were being raised by hospital staff and GPs and it seems that the appropriate action was not taken until a later stage. Therefore, I want to know what are the HSE and the Minister going to do about it? Will a timeline for implementation of the recommendations be produced and will it be published?

The matter of most concern is that, over a year after the issue first came to light, not only are guidelines on the volume of work radiologists should be undertaking not in place but the process to develop them does not seem to have even started. What specifically is being done about this and will the guidelines be produced without delay? That is absolutely crucial because the workload of the consultant in question was a key contributory factor in patients receiving a misdiagnosis or there being a delayed diagnosis. That issue needs to be addressed urgently.

The report acknowledges that four people died as a result of receiving a misdiagnosis or there being a delayed diagnosis, but there is a fifth person whose family believe she passed away as a result of the same factor. She had been told that her case was part of the review in February, but she heard nothing after that point. Unfortunately, she has since passed away. Will the Tánaiste give an assurance that the hospital will engage with her family in order that they can receive the answers they are so desperately seeking?

There is a real possibility that people may have to go through the courts to get justice in what clearly are cases of medical negligence. We already know that one application has been lodged. Will the Tánaiste give us an assurance that that will not happen and that the hospital and the HSE will engage with victims and families to ensure they do not have to go through the rigmarole of the convoluted legal process to get justice? In some cases people are terminally ill. The issue is time sensitive and we need to ensure action will be taken immediately, something which has not happened heretofore.

The report was only published in the past 48 hours. It contains 16 recommendations and my understanding is they are being implemented. Tragically, four people have passed away since the review began. I do not know the circumstances of each individual case. Therefore, in the circumstances we should be careful about what we say in apportioning blame. Families who still have questions to ask and need answers need to receive the full co-operation of the hospital and the HSE. The review was triggered by complaints which led to concerns about the quality of care patients were receiving in the hospital. As a result, all of the scans and workload linked with one consultant doctor were re-examined, from which we have learned lessons which raise serious questions which need responses.

I do not have the guidelines on the workload of radiologists in front of me, but I expect that there would not be a problem with making them available. It is the job of the HSE and hospital management to make sure they have teams available that can work in a way that is consistent with medical guidelines. If there is a family or an individual to whom the Deputy is referring with particular concerns, I do not have their details, but if the Deputy makes them available, I will certainly ensure the Minister's office is made aware of them. We are trying to ensure the response will be patient-centred, that lessons will be learned, that systems will be put in place on the back of the mistakes made to make sure they will not happen again and that if families continue to have concerns or questions to which they need answers, the hospital and the HSE will provide them. People should not have to go to court to have basic questions answered about patient care and patient safety in the hospital.

The problem is that it has not been patient-centred and that people are going to court because there is no other avenue available to them to get justice. I mentioned one of the 11 patients who was identified in the report as having received a misdiagnosis or in respect of whom there was a delayed diagnosis which had resulted in severe negative outcomes for his health. Between March and October 2016, the now 71 year old who is a husband, a father and a grandfather had three chest X-rays, in which his cancer was not picked up. The radiologist whose work was reviewed is not the only one who was involved in the case; there was another doctor who reported on at least one of the scans. The symptoms persisted and, at the insistence and because of the persistence of his wife, the GP referred the man in question for another X-ray in early 2017 when his lung cancer was finally diagnosed. The error had not been detected and despite the delayed diagnosis, he was scheduled for a CT scan in June that year, months after the misdiagnosis had been identified. His wife persisted and ensured that the scan was brought forward to April. It was discovered that the cancer had spread at such a rate that it was wrapped around the main artery to his heart. He went through what his wife described as "horrific treatment", but it was too late. I am informed that he only has a short time left and that the family firmly believe that if the cancer had been detected in any of the three earlier X-rays, it would not have been terminal. They have asked me to make the point that they have to fight for appointments in the health service to receive the care and treatment needed. They have to fight for grant aid in order to provide such basic things as a downstairs toilet in order that the man in question who was failed by the health service can live out his final days in comfort. He is on oxygen 24 hours a day and his family are devastated. They are appealing to me to ask the Tánaiste, the Taoiseach and the Government not to force an individual who has been so let down and failed to go through a complicated legal process. We need to ensure we wrap him and his family in the supports available, provide grant aid without them having to fight for it and appointments without them having to demand that his treatment be fast-tracked. It is not patient-centred and the family should not have to go to court. I want assurances from the Tánaiste that everything that can be done will be done to provide the best treatment available for the individuals affected in whatever days they have left and that a process will be put in place to avoid their having to take the legal route.

The family to which Deputy Pearse Doherty refers is clearly going through a very traumatic time. I assure him that the State, through the HSE, Kerry University Hospital and the Department of Health, will do everything it can to ensure the individual concerned gets the maximum care possible to manage what sounds like a case of terminal illness.

My understanding is that three legal proceedings have been issued in relation to cases that were dealt with in the report. The State Claims Agency will be managing those cases. It is always the objective of the State to try to deal with such cases in a patient-centred compassionate manner to prevent families having to go to court. That is not always possible but that is what the State Claims Agency will try to do.