Dáil Éireann debate -
Wednesday, 22 Mar 2000

Vol. 516 No. 4

Adjournment Debate - Cancer Treatment Services.

Mr. Kenny

Thank you, a Cheann Comhairle, for allowing me to raise this important matter. I am glad the Minister is here to respond. The issue here is the continuation of service being provided at the breast cancer unit in Mayo General Hospital which is now in doubt arising from a recommendation in a report prepared by Professor Niall O'Higgins. This report is in the context of the Department of Health and Children preparing a national strategy for dealing with cancer, including breast cancer. The report in question has not yet been published. The matter is also about the integrity of Mayo General Hospital and the consequences for the future. It also calls into question the equality of access for women from the county to breast cancer treatment facilities.

I do not have time to deal with all the issues involved but I want to make a number of fundamental points. There are three consultants in Mayo General Hospital qualified and working in the area of breast cancer. Eighteen breast cancer operations have been carried since 18 January 2000 to today's date. Two clinics per month are held with 25 patients seen at each clinic. Urgent requests are seen immediately with no waiting list and a lessening, therefore, of the serious trauma caused to any woman who has to undergo such examination. A triple assessment is carried out in each case and, if necessary, these include clinical assessments, mammography, with or without ultrasound, fine needle biopsy and aspiration of cyst on the same day when suspicious of cancer, followed by surgery, if required, on the next immediate list with frozen section result, adjuvent therapy by visiting an oncologist/radiotherapist, counselling, availability of prosthesis fitting and long-term follow up clinic.

The consultants and staff involved, who include Paul Eustace, Kevin Barry, Ronan Waldron, Mr. Ravis from the Sudan who is working as a locum, together with the staff under the leadership of Assumpta Walshe and her colleagues, in this vital area in Mayo General Hospital would welcome any audit of the quality of the service provided in the hospital in this area and I recommend that.

The O'Higgins report is based on a model system employed in England and is not relevant in this region, the third largest county in the country. The report recommends that in the west three specialist units should be set up in Letterkenny, Sligo and Galway. There is neither a history nor an infrastructure of this work in Sligo Regional Hospital.

The women of Mayo are entitled to equality of access to this medical care. I want this service to continue to grow in partnership with University College Hospital, Galway, which currently shares facilities and services. That is where the future lies in this regard.

If the Minister does not overrule the O'Higgins report and, having listened to the views of the chief executive officers of the health boards and the National Cancer Forum, make a decision that this breast cancer unit should continue in Mayo General Hospital, the women of Mayo will lose out as a consequence. That would mean that no breast examinations of any kind would take place there with consequent increased trauma, longer travelling distances and increased waiting lists in Galway or another location. It would amount to a dismantling of hospital facilities in Mayo, which were fought for so hard over 25 years. Phase one and phase two of Mayo General Hospital, which includes the full orthopaedic unit, were delivered during my time as a Minister from Castlebar in a Fine Gael led Government.

I welcome the Minister to Mayo General Hospital to open phase two, but I will not allow this service to be removed. I will not stand for it. I warn the Minister of the absolute unity that exists in total resistance to this proposal. I want a guarantee at the earliest opportunity that the removal of this service will not be allowed. The continued operation of this unit is a challenge to the Minister, the Minister of State, Deputy Moffatt, and Deputy Cooper-Flynn who is chairperson of the Western Health Board. The Minister should overrule the Niall O'Higgins report.

Mr. Ring

I thank Deputy Kenny for sharing his time with me. I pay tribute to the work of the staff, the doctors and all those who provide this service. There is outrage in the county since word of this leaked report has surfaced. The people of Mayo are worried that this service will be removed from the county hospital. If it is removed, a woman from Aughleam in Bellmullet, which is 75 miles from Castlebar, which is 40 miles again from Galway, will have to travel 115 miles to avail of a service. Niall O'Higgins's report is only a report, but the Minister is in charge and I wish him well in his appointment. The Minister of State, Deputy Moffatt, is from County Mayo and Deputy Cooper-Flynn is chairperson of the Western Health Board. If this service is removed from Mayo General Hospital, I will call for their resignations. This issue is that serious.

As a person whose family was affected by breast cancer – a sister of mine died from breast cancer last year – I will fight the removal of this service politically and in every other way. The women of County Mayo and the husbands, sisters and mothers and of the women of county Mayo will fight to ensure this service is not removed. It is a limited but valuable service, which we are thankful to have and one Deputy Kenny and I, and all the political and community leaders in County Mayo will fight to maintain. I ask the Minister to overrule this report. If he allows this service to be removed, I will call on the Minister of State, Deputy Moffatt, to resign and Deputy Cooper-Flynn to resign as chairperson of the Western Health Board.

Minister for Health and Children (Mr. Martin)

I thank the Deputies for raising this matter on the Adjournment and for giving me this opportunity to set out the current position on the development of breast cancer services. The Minster of State, Deputy Moffatt, and Deputy Cooper-Flynn conveyed to me the views of the people of Mayo on breast cancer services generally and the good work that has been done through the provision of the existing services.

I was taken aback by the rather overt party political tone of the debate. The report, which I have not yet received, was not prepared by the Minister of State, Deputy Moffatt, or Deputy Cooper-Flynn. It is being prepared by the National Cancer Forum. The Deputies should reflect on that and not jump the gun by endeavouring to politicise the issue on a party basis.

There have been substantial developments in the care and treatment of patients with cancer throughout the country over the past number of years. Major structured improvements have taken place since the launch in November 1996 of the national cancer strategy and the announcement in March 1997 of the action plan to implement it.

The national cancer strategy's two principal objectives are to take all measures possible to reduce rates of illness and death from cancer in line with the targets established in the health strategy, Shaping a Healthier Future, and to ensure that those who develop cancer receive the most effective care and treatment and that their quality of life is enhanced to the greatest extent possible.

Underlying these objectives is the need for a high quality, patient focused service. In order to achieve the objectives set out in the cancer strategy, £41 million of targeted development funding has been allocated between 1997 and 2000 to develop a range of cancer services throughout the country.

Some of the more significant features of the developments to date are additional consultant appointments in the areas of medical oncology, haematology, palliative care and histopathology; the introduction of screening programmes including the national breast screening programme, which has commenced, and the forthcoming national cervical screening programme; the publication by the National Cancer Registry of national reports on the incidence of and mortality from cancer in Ireland – funding of more than £100,000 has been provided to enable the registry to develop a data analysis and research programme; a review of counselling services throughout the country, which is a very important element in the treatment of patients with cancer, this has been funded and carried out through the Eastern Health Board, and the appointment of 24 cancer liaison nurses in the eastern region to improve and enhance the integration and co-ordination of the treatment of cancer patients.

The Western Health Board, including Mayo General Hospital, has benefited from additional consultant approvals in each of the four specialties I outlined. The total funding made available to the board under the strategy to date has amounted to £3.876 million. The development of radiotherapy services as part of the phase two development at University College Hospital Galway will mark further major progress in this programme of transformation of the quality and availability of services to cancer patients in the region.

I intend to continue to build on these overall developments to date. I am aware that many of the improvements being undertaken nationally have given rise to further demands on existing services available in areas such as radiotherapy services, symptomatic breast cancer services, specialist oncology nurse training and education, palliative care and counselling services. For this reason, reviews have been initiated in each of these areas with a view to achieving a further enhancement, as opposed to a dilution or downgrading of the overall quality and volume of service available to cancer patients.

In this regard, at the request of my predecessor, the Minister, Deputy Cowen, the National Cancer Forum, which was established and appointed by his predecessor, Deputy Noonan, to advise on appropriate developments and structures in the area of cancer, set up a specialist expert group to examine the symptomatic breast cancer services throughout the country.

The forum's advice on how best to achieve that objective will be a central factor in taking decisions as we move forward. It is important to emphasise that I have not yet received the forum's recommendations in this regard. I point out to Deputy Kenny that it is not one individ ual's report, rather it is the National Cancer Forum's recommendations. When he asks me to overrule a person's report, he is asking me to overrule the recommendations of the National Cancer Forum, whatever they may be.

I am not in a position to speculate upon or comment on any particular aspect of what will emerge, including the question of appropriate structures to be recommended for the delivery of the service in the Western Health Board region. I am aware that the forum has arranged to meet next week with the health board chief executive officers, who ultimately have responsibility for implementing service developments within their regions. This will provide an opportunity for the chief executive officers to discuss with those responsible for making the recommendations, particular implementation issues relevant to their regions.

I must reassure the Deputies that any suggestion that Mayo General Hospital is to be downgraded in some way by the Government is completely ill founded. An overall revenue development package of £1.9 million has been made available to the hospital in 2000 to meet the costs of a new CT scanning service, to provide an accident and emergency consultant and to meet the operational costs of the new accident and emergency department, a central sterile supplies department and a geriatric assessment unit which are due to open this year. Overall construction work on the major £22 million phase 2 development of the hospital is continuing. This will greatly enhance the overall capacity of the hospital and enable an in-patient orthopaedic service to be developed there on completion.

In short, the hospital is experiencing an exciting and unprecedented transformation of the shape and scale of the services it is providing, backed by the unparallelled commitment that this Government has displayed to the development of services for the people of Mayo.