Dáil Éireann debate -
Thursday, 8 Feb 2001

Vol. 530 No. 2

Adjournment Debate. - Cancer Treatment Services.

Mr. McGinley:

There is serious concern in County Donegal about the rumoured downgrading of the breast cancer clinic in Letterkenny General Hospital. This concern results from the report by Professor Niall O'Higgins which recommends the creation of a number of specialised breast cancer treatment centres throughout the country.

People are afraid that Sligo or another location further away may become the treatment centre for all Donegal patients. While the development of breast cancer centres is highly desirable it should not be done to the detriment of services already located in Letterkenny General Hospital. Hundreds of women are screened every year for breast cancer in Letterkenny General Hospital and up to 50 patients undergo treatment there with positive results. If these patients had to travel longer distances to Galway, Sligo, Dublin from places such as Buncrana, Fanad, Gweedore, Glencolmcille or the islands, the inconvenience would be so prohibitive that some women may delay seeking advice and diagnosis and leave it too late for effective treatment.

While I do not object to developing the breast cancer facilities in Sligo the long journey to Sligo would further add to the distress of these women. There is no direct public transport for most of County Donegal to Sligo and in many cases this would necessitate an overnight stay en route. The islanders, especially those living on Tory, Aranmore, Inisbofin and Inisfree, have the extra worry of their journey to the mainland being weather dependent for at least six months of the year.

A total of 1,670 women are newly diagnosed with breast cancer annually. Approximately 650 die from the disease each year. Some 43% of women who develop breast cancer die compared to an overall mortality rate of 37% of the European Union and as low as 30% in some countries.

Any decision that would result in women postponing treatment could have disastrous consequences. The prospects of travelling long distances for treatment is a source of considerable distress for many women. When one's life is under threat from this dreadful disease, not only is the best medical care available needed but also the support of family and friends and not the trauma of isolation from home, family and community. Donegal women want and are entitled to the option of staying close to their families and friends and have the greatest confidence in the treatment facilities and medical personnel in Letterkenny General Hospital.

The O'Higgins report envisaged a degree of co-operation between Letterkenny General Hospital and Altnagelvin Hospital in Derry. There is already co-operation between these two hospitals in other areas of medical treatment. While I am in favour of such co-operation it cannot and should not be achieved by downgrading facilities in Letterkenny.

What the people of Donegal demand is extra investment to provide the necessary medical equipment in Letterkenny and also the additional personnel such as radiologists, pathologists and oncologists to provide the highest standard of treatment for Donegal patients in their own county.

I appeal to the Minister for Health and Children, Deputy Martin, to allocate the necessary resources so that the already excellent resources in Letterkenny General Hospital can be further improved to benefit health care and, particularly, the prevention of breast cancer and the treatment of breast cancer in Donegal. Go raibh maith agat.

Ms Hanafin:

Ba mhaith liom buíochas a ghabháil leis an Teachta McGinley as ucht an t-ábhar tábhachtach seo a ardú. Athnaímíd cé chomh uafásach is atá an galar sin agus an tslí a chuireann sé isteach, ní h-amháin ar mná, ach ar a gclann agus gach duine a bhaineann leo. Táimid go léir ar chomh intinn gur chóir dúinn an méid is féidir linn a dhéanamh ar son na mban chun an fhadhb seo a réiteach agus chun cabhair a thabhairt dos na mná.

On behalf of my colleague, the Minister for Health and Children, Deputy Martin, I am glad of the opportunity to set out the situation in relation to the development of breast cancer services in the North Western Health Board area, including those at Letterkenny General Hospital.

Deputy McGinley is aware that there have been substantial developments in the care and treatment of patients with cancer throughout the country over the past number of years. Major developments in the treatment and care of patients with cancer have taken place since the launch in November 1996 of the national cancer strategy. The principal objectives of the strategy are to take all measures possible to reduce rates of illness and death from cancer and to ensure that those who develop the disease receive the most effective treatment and care.

Underlying these objectives is the need for a high quality, patient focused service. To achieve the objectives set out in the cancer strategy, some £60 million of targeted development funding has been allocated between 1997 and 2001 to develop a range of cancer services throughout the country.

Some of the more significant features of the developments to date are the provision and development of consultant appointments in the areas of medical oncology, haematology, palliative care, histopathology and the introduction of the national breast and cervical screening programmes.

It is intended to continue to build on these significant developments. In this regard, at the request of the previous Minister for Health and Children, the National Cancer Forum, which was established and appointed by his predecessor, Deputy Noonan, to advise on the 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 overriding objective underlying this review was to develop our breast cancer treatment services to an optimal level that ensures the highest possible quality of care and the best opportunity for long-term survival for breast cancer patients. A sub-group of the National Cancer Forum undertook a detailed review of the symptomatic breast cancer services and its recommendations are contained in a report entitled Development of Services for Symptomatic Breast Disease. The broad thrust of the report has been accepted by the Minister.

In relation to the specific recommendations concerning services in the North Western Health Board area, the report recommends that there should be one specialist breast unit in the area. There is acknowledgement in the report that a service is currently being provided in both Sligo and Letterkenny. In Letterkenny, a committed group of people is currently providing symptomatic breast disease services. However, there is not a sufficient volume of patients to develop and maintain the expertise of the staff concerned. The board is currently considering how best to utilise the expertise present in this unit and is exploring the possibility of linking with a unit in Northern Ireland with a view to coming to an arrangement to increase caseload, experience, expertise and formal cross-cover.

The North Western Health Board is actively engaged in discussions with many interested parties in endeavouring to put proposals together on this. The board has cognisance of the fact that whatever services are put in place must be of the highest standards possible and that outcomes for patients would be favourably comparable with international standards. To this end, the board is in consultation with Northern Ireland bodies such as the Altnagelvin Hospital Trust and the Northern Ireland Health Services while at the same time having discussions with its own hospital consultants and management.

The Minister for Health and Children is confident that these deliberations and consultations on the future provision of services for symptomatic breast disease will result in an enhancement of the services currently being provided.