Cancer Services: Motion.

Deputy James Reilly

I move:

That Dáil Éireann, noting:

the announcement of a national cancer strategy;

the proposal to develop eight centres of excellence at various locations around the country;

the intention to provide every patient with the best medical care and clinical attention;

the absence of a centre of excellence north of a line from Dublin to Galway and conscious specifically of the geographical challenge and population distribution of the west-north-west region; and

the proposed closures at University College Hospital, Galway, where the centre of excellence is to be located, for the month of August this year due to severe budgetary constraints;

calls on the Government to:

proceed immediately with the provision of centres of excellence, based on an adequate and ring-fenced budget;

proceed immediately with the provision of a satellite unit at Letterkenny General Hospital and under the responsibility of the Galway centre of excellence;

retain existing safe, high quality cancer services as at Mayo General Hospital and Sligo General Hospital as satellite units under the responsibility of the Galway centre of excellence;

ensure that all centres of excellence and satellite units are the subject of an annual HIQA audit; and

continue to work closely with the authorities in Northern Ireland on the development of cancer services.

I propose to share time with Deputies O'Mahony and Jan O'Sullivan.

I welcome the support of the Labour Party for this motion. The motion is self-explanatory but the rationale behind it requires further elucidation. At the core of it is the question of trust. What is at issue is whether the people of the north west and west can trust the Government, the Minister for Health and Children and the monolithic Health Service Executive to deliver the services they have promised.

Let us look at the record. In January 2007, the Minister, Deputy Harney, and the then Taoiseach, Deputy Bertie Ahern, gave a commitment in an interview on Newstalk that there would be no cutbacks in health. That proved not to be the case. The Minister then said that the cutbacks would not hurt patients, but they did. We saw the closure of wards, the cancellation of operating lists, increasing numbers of patients lying on trolleys, a 10% increase in waiting times for procedures, the withdrawal of home help packages for children and people with disabilities, the removal of home help for the elderly alongside the more recent suspension of hospital in the home scheme and the failure to implement the vision for change in mental health, with 50% of the funds allotted going elsewhere. Susie Long died after waiting seven months for a colonoscopy, while Beverly Seville Doyle died on her own in the early hours of the morning while attached to a drip in an accident and emergency unit toilet. These are but two of the tragedies we have seen last year.

We must also consider some of the other issues that have arisen. A debacle arose in breast cancer care in Portlaoise because the Minister ignored early warnings from Mr. Peter Naughton in 2005, with the scandalous result that nine women were misdiagnosed with cancer and 97 women were callously left waiting until a cohort — or a boxcar — was filled before action was taken. We had the Barringtons hospital affair in which letters were passed back and forth for 19 months before real action was taken over the breast cancer services offered there. We encountered problems in laboratories in Cork and Galway regarding a locum pathologist.

Most recently, a scandal arose in the north east, where locum radiologists were used for several years despite a health board warning in 2001 that this was a major problem. The problem was highlighted by Judge Maureen Harding Clarke but nothing was done. The HSE knew about the misdiagnosis of lung cancer when four people died in November 2007 but it waited several months to do anything about it, made a hames of its response and then blamed the problem on a private company. Approximately 4,600 people have to wait anxiously for eight weeks to find out whether they have a serious medical problem, despite having previously received the all clear.

The damning Fitzgerald and Doherty reports underscore the dysfunctional nature of the HSE and its inability to deliver safe and effective treatment. When the Minister announced her cancer strategy last year, she closed 13 centres which provided breast cancer care. Patients in Ennis were advised to go to Galway or Limerick. The following week, however, cutbacks were introduced which prompted the medical board of the Galway hospital to state that its five day breast cancer service would be reduced to three days. That is not reassuring.

There is the continuing preoccupation with the privatisation of our health service, the co-location of hospitals and, in particular, the recent bizarre decision to outsource cervical smears to an American company which has been found to be recalcitrant in its behaviour. In 1998, 2001 and 2004, the aforementioned company was fined a total of $40 million for fraudulent claims. The situation now arises whereby a company which has been fined nearly $500 million in America will provide dialysis for patients in Limerick.

Deputy Pádraic McCormack

God help us.

Deputy James Reilly

Is something wrong with the HSE given that it cannot find a partner abroad which does not have a record of fraud?

Quest, the cervical cancer screening company, has a margin of error of 15%, whereas our laboratories have a margin of 5%. A recent comparative study of 14,500 slides conducted by St. Luke's hospital shows that, even accounting for urgent cases, Quest's laboratory has an error rate of 30% in detecting high grade pre-invasive cancers. That equates to 2,000 missed cases per annum. Another study conducted in Cork showed an even higher rate of missed high grade smears. One could argue that a 15% margin of error is acceptable in a country where smears are done annually but it cannot be acceptable here in view of our intention to conduct smear tests every three to five years. Given our record, the interval will be five rather than three years. As we will not have a facility for multi-disciplinary team meetings between the smear reader, the cytologist and the colposcopist to discuss cases prior to treatment, we will not be pursuing best practice. Furthermore, the loss of 100 highly paid jobs will hardly encourage young people to take up science as a career option. We are going to lose this pool of expertise and it will not be available to us again. It will have been decimated when we realise in two year's time that we made the wrong decision. Why is the Minister persisting with this plan to outsource smear tests when medical experts believe that between 1,000 and 2,000 cases of pre-invasive cervical cancer will be missed per annum, thereby putting women's lives at risk? Will we have another Portlaoise on our hands in a few years time? Despite all of these issues and the fact that pathologists will have to go abroad to finish their training, the Government is gung ho to go.

I recently undertook a tour of Castlebar, Sligo and Letterkenny hospitals and University Hospital, Galway. I agree that a centre of excellence should be established, with proper resources and funding, at University Hospital, Galway. Mayo General Hospital, Sligo General Hospital and Letterkenny Hospital should operate as satellite units of the Galway centre of excellence. Mayo General Hospital currently operates as a satellite of University Hospital, Galway, as does Letterkenny Hospital under a locum. We propose that Sligo General Hospital should operate under the same guidelines and that all hospitals should be audited by HIQA annually to ensure the best outcome for women.

Professor Tom Keane, who is an expert in his field, is being used as a shield to protect the Government from its own decisions, much as it used Professor Brendan Drumm in respect of the HSE. Professor Keane has made it quite clear that he is here to implement a programme. Fine Gael subscribes to the concept of centres of excellence in the same way that I would have subscribed to the concept of the HSE as a single entity delivering health care to 4.2 million people. However, the manner in which the HSE was established was a disaster given that it in effect amalgamated 11 companies while promising that nobody would lose a job or move positions. That was an impossible place to begin by any standard. The Government failed in 2002 to bite the bullet on redundancies and today patients are dying and choking on that bullet. Once again, I fear that we have an excellent concept for specialist centres of cancer care but we are going about it the wrong way. Instead of providing the new resource first, the HSE wants to close down two centres that currently give excellent care on a promise of excellence to come in Galway, which is to shut down much of its services for the month of August.

When I visited Galway regional hospital this weekend, I found its medical and surgical wards to be operating at 100% capacity. In April 2007, 188 people were on trolleys overnight waiting for beds the following day. Last month, that figure rose to more than 440.

Deputy Pádraic McCormack

Shameful.

Deputy James Reilly

That is hardly a hospital with sufficient capacity to take on a regional centre. The €5 million which is to be spent on the eight centres divides into €625,000 per unit, which is not the sort of money needed to deliver the excellence Galway hopes to provide. These issues arise before I even begin to discuss the parking difficulties experienced around University Hospital, Galway. Many patients have to park on Headford Road and walk or take a bus to the hospital. University Hospital, Galway, is already €4.5 million over budget and last year it experienced 30 new cases of MRSA. This is evidence of overcrowding and a hospital at the limit of its capacity.

I received a letter which emanated from doctors working in Galway regional hospital. It is addressed to the management of that hospital and states:

We enclose the figures for the number of patients waiting on trolleys for an inpatient bed in the [emergency department] at UHG for the month of April 2008. You will see that this month we have had a total of 444 patients on trolleys at 9 am. This compares to a total of 188 for the same period in 2007. This is an increase of 136% at a time when the HSE is meant to be moving towards a zero tolerance for trolley waits in Emergency Departments, as recommended by the Task Force Report.

There is no doubt that this continued overcrowding in the Emergency Department is adversely affecting patient care. Recent independent research from Australia suggests that this persistent overcrowding is resulting in anywhere between 10 to 20 unnecessary deaths per year for a population the size of Galway [assuming a population of 230,000]. The implication that there are one or more unnecessary deaths per month in Galway University Hospital as a result of the persistent overcrowding is a very worrying one.

I will not read the remainder of the letter into the record because it is not particularly relevant. However, the staff at the hospital are highlighting a problem that is being ignored.

As stated earlier, I do not believe in the ability of the Government to deliver on its promises or even in its political will to do so. All we need do is consider the position at Mallow General Hospital, where a third surgeon was let go and where patients were told to go to Cork University Hospital. However, the surgeon at the latter has said he has no additional resources to deal with these people and that they should not come to him. Therefore, the excellent 24-7 service in place at Mallow General Hospital will be reduced to a nine to five, Monday to Friday service.

There is also the situation at Monaghan and Cavan hospitals. When the accident and emergency department at Monaghan Hospital was closed for 18 months, 17 people died on the road between Monaghan and Cavan while bypassing their own hospital. Monaghan is to close, Cavan is to take the load. There are 3,000 admissions to Monaghan annually and 5,000 to Cavan. The latter does not have additional capacity; it has a new ward but no staff. Cavan Hospital's budget is €9 million down on last year. Its emergency department is considerably smaller than that in place at Monaghan. The coronary care unit at Monaghan has been audited by Professor Michael Walsh of St. James's Hospital, who found it to have excellent outcomes. I mention these facts as further evidence of the Minister's modus operandi, which is to strip away the service people enjoy today on the promise of something wonderful to come tomorrow. However, tomorrow never comes.

As has been pointed out by surgeons, the same patients will be seen by the same surgeon, oncologist, radiologist and pathologist in Galway as are now being seen in Mayo and Letterkenny. How will that improve outcomes? We know what it will do — inconvenience and hurt patients and force them to travel long distances. How does the Green Party feel about this much increased carbon footprint? At present, all the aforementioned specialists are linked by technology to the centre. Furthermore, the plans for the Letterkenny satellite centre, which we wish to proceed, are based exactly on the Mayo General Hospital model. As the manager in Letterkenny informed me, the only difference will be that there will not be the same proximity of access as exists in Mayo. We want to see the same links established between Sligo General Hospital and Galway University Hospital as those which exist in respect of the other two hospitals to which I refer.

I return to the issue of trust and the Minister's statement that operations were carried out in respect of only 37 cases of breast cancer at Mayo General Hospital in 2007. An extensive trawl has been carried out — this was reviewed by both the manager of the hospital and the surgeon — and the fact is that 90 cases were dealt with last year. Of these, 92 were new and three involved recurrences. Some 73 of these patients were diagnosed and treated at Mayo General Hospital in 2007, six were diagnosed at the hospital and had reconstructive surgery — involving the surgeon from Mayo — at University College Hospital Galway and a further six were diagnosed and had appropriate non-operative care at Mayo General Hospital. In addition, nine patients who were diagnosed in 2007 were treated in 2008. One further patient who was diagnosed at Mayo General Hospital was treated in Dublin.

The plan with which we have been presented seems to be based on misinformation at best and disinformation at worst. One would want to be particularly guileless, gullible and naive to accept the Minister's plan as currently outlined. I reiterate that the concept of excellence is one we fully support. However, it is the Minister's manner of pursuing it that we reject.

Figures have been produced which show that outcomes for breast surgery in the west were 25% worse than was the case on the east coast. However, these figures relate to the period 1994 to 2001. It is interesting to note that the breast service at Sligo General Hospital and Mayo only commenced in 2000. I have in my possession the outcome figures for Mayo General Hospital for 2002 — they are the latest available — which show a five-year survival rate among patients of 88%. This compares very favourably with the European average for breast cancer of 70%, as published in The Lancet Oncology.

It is suggested that Mayo would lose only two breast cancer operations a week, which would lead one to believe approximately 100 patients a year are being diagnosed. This is what surgeon and manager of Mayo General Hospital have stated. However, there are 1,200 new cases seen each year at Mayo General Hospital. These people will all be obliged to travel to University College Hospital Galway. This does not include the thousands of reviews dealt with annually at Mayo and Sligo.

There really is no possibility of what is proposed being achieved at University College Hospital Galway without massive investment being made. To be honest, I do not think it makes sense to oblige the numbers of people to whom I refer to travel to see the same staff. The case for satellite centres has already been accepted by the Government in respect of Letterkenny. Why dismantle the very model on which it was based, namely, that at Mayo, where safe, effective care is being delivered and excellent outcomes achieved? The motion specifically seeks an audit of all centres and their satellites, thus ensuring best outcomes for women so that a centre which is not performing can be closed. This is the feeling of the doctors themselves — that is how confident they are of the service they provide. The confidence to which I refer is shared by the people.

I wish to deal with the issue of satellite centres in general and the fact there is more than one way to deliver excellence. The Sloan-Kettering Hospital in New York, one of the largest cancer hospitals in the world, deals with 2,000 cases a year. The total number of cases dealt with in Ireland each year is 2,500. The Sloan-Kettering Hospital has a centre in Manhattan, three satellites and five community-based cancer treatment centres. So successful is this system that the authorities at the hospital are considering the addition of a further satellite in upstate New York over 100 miles from the main centre.

The basis of the plan to provide breast cancer care at Galway is that staff will turn patients around in two to five days. However, the average stay at the Sloan-Kettering unit, which is one of the best in the world, is six days. Doctors at Mayo and Sligo hospitals can turn patients around in two to three days. However, they will always encounter difficult cases such as, for example, a lady who lives on the side of a hill and who has no infrastructural support and no family. Such a woman could not go home in such circumstances, particularly because she would have no one to help change her dressings. There is no provision in the plan for additional accommodation where patients can be monitored and have arrangements put in place to support their early discharge into the community. The patients to whom I refer would still have surgical drains attached to them, their wounds would not be healed and so on.

It has been stated — it was also mentioned at the ICGP by Professor Tom Keane — that GPs can be trained in Canada to do this work. What was not stated is that GPs must be taken off site for two months and replaced by locums. I informed the Minister previously that there is a manpower crisis in the area of general practice but she refused to make provision for even 30 additional places on the training schemes. We currently train 120 GPs each year. However, 50% of GPs will retire in the next 12 years and it has been stated that we will need 300 new GPs each year for the next five years just to stand still, not to mention discussing their taking on extra work. On a personal basis, I would like to see them take on such work. It will be a long time before we can afford to release GPs for the length of time envisaged in order to allow them to be trained on the schemes to which I refer.

Everything I have stated is clear evidence that the plan to move to Galway is unsustainable as currently envisaged. The people of Mayo and Sligo have a safe service and they wish to retain it.

Voluntary transport services do not offer a realistic option in today's Ireland, particularly when one considers that citizens are time poor and are obliged to commute long distances and spend many hours in congested traffic while travelling to and from work. How will people find time to offer voluntary travel services to cancer patients? At €750,000, the budget for travel looks very slim when compared to what I understand to be the €10 million spent annually on transport for kidney dialysis patients.

The people of Mayo and Sligo have access to a service that is delivering safe and effective care and excellent outcomes. The authorities at Letterkenny Hospital are evolving their model, which is based on that which obtains in Mayo. Why does the Minister want to endanger women's lives by closing the service before proving that what is to replace it will work? All her talk relates to patient safety but all her actions scream "Save money, not lives".

I commend the motion to the House.

Deputy Jan O’Sullivan

I welcome the opportunity to join the Fine Gael Party in proposing this motion on cancer services in the north west. I welcome those in the Gallery who have travelled long distances to be here to listen to the debate.

Deputy James Reilly

Hear, hear.

Deputy Jan O’Sullivan

I want to begin by assuring the Minister and Professor Tom Keane that we have no intention of reopening consideration of the cancer strategy or setting it back in any way. I note that in the media Professor Keane suggested that is what we might be trying to do. We want to make one change only, a change that we signalled from the start. We in the Labour Party fully support the proposal to establish so-called centres of excellence, where diagnostic and surgical cancer services and after-therapy will be delivered in designated specialist units, backed up by triple assessment and provided through multidisciplinary teams. We welcome and embrace the proposals in the strategy designed to improve outcomes for patients.

We support the work of Professor Tom Keane. However, Professor Keane will not always be with us — I gather he will return to Canada in approximately a year and a half — and we will not give uncritical support to the Minister unless we are satisfied, on behalf of patients, that the necessary resources are developed in each centre to deliver the excellent care to which patients are entitled. There should also be extra capacity for the increased number of patients who will travel to be treated in these centres.

I am very concerned because there is no assurance with regard to resources. There is a famous quote from the Minister, Deputy Dermot Ahern, that there was not "one red cent" to develop a hospital in the north east. Unfortunately, we have no information that the resources required will be provided in Galway or the other designated centres. Will we have the staff, beds, theatres and other supportive arrangements required if we are to have centres of excellence in those locations?

Professor Keane is quoted in one of the newspapers today as saying the number of centres is "immaterial". He implies there could have been any number of centres, as he came to implement what had been decided.

Those who recommended those eight centres are not infallible and their report is not gospel. It is a matter of fact that a previous expert report suggested 11 centres was the right number. Who are we to believe? Who did these people consult and who suggested the eight centres? What information did they use and who exactly made the decision for eight centres? Why did they know more than Professor O'Higgins and his team, which suggested a larger number of centres a couple of years before that?

Looking at the map of Ireland, one would have to question why four of the proposed centres are in Dublin while there is none north of the line between Dublin to Galway. One must question why that decision was made. That is a very large part of the country with no centre of excellence.

That aspect of the recommendations is wrong. I believed that and said so when it was announced and I still believe it. It is true, as the Minister stated, that people will travel long distances if they know they will get the best service by doing so, but they should not have to travel such disproportionately long distances in the north west in comparison to everybody else in the rest of the country. It does not make sense that four centres will be in Dublin and none in the north west.

I question who made these decisions and if they were totally objective in reaching the proposals. I will refer to an issue in my region. Only a few years ago, on the publication of the Hollywood report on radiotherapy, we in the mid-west were told in no uncertain terms that we would not have radiotherapy services. They were to be delivered in four super centres, with two in Dublin, one in Cork and one in Galway. The report concluded that the Irish population did not justify having any more centres. Nobody from the mid-west was on that body, which was large. However, people in the mid-west and the south east were well aware of the suffering of very ill people who had to travel long distances for approximately six minutes at a time of radiotherapy. We did not accept the judgment of those who made such decisions safe in the knowledge that they were within a short distance of treatment.

In Limerick, we fundraised and set up a radiotherapy service which initially paid for both public and private patients out of a fund raised by the Mid-West Hospitals Trust. When it was up and running and had proved its worth, with a unit in Waterford, it was brought into the approved cohort of service and under the public purse for public patients. Nobody is saying those units should not be there but they would not exist if we had taken no for an answer and accepted the so-called expert report.

I will repeat my question. Why are there four centres in Dublin and none in the north west? Let us not pretend that these decisions are entirely objective. Let us not pretend either that a satellite centre in Letterkenny will fulfil the safety criteria but one in Sligo will not. If the multidisciplinary teams and triple assessment safeguards that are the accepted standards of care can be provided in an outreach centre in Letterkenny, whether linked to Galway, Belfast or anywhere else, they can also be provided in Sligo or Mayo. Deputy Reilly indicated the safety outcomes with figures he has with Mayo.

The Labour Party would favour one full, ninth designated centre in the north west. That has been rejected by Government. Instead the outreach centre model has been favoured. If that is to be the model, and the advice to Government is that it is a safe model, it should also be comprehensive in addressing the population of the north west.

The cancer campaigns in the north west are led primarily by patients and medical practitioners. It is an insult to them to suggest, as has been said before, that any of us is somehow playing politics with this issue. Those who can be accused of that are the people who say one thing in their constituencies and do something else in Dáil Éireann. I was present when we had a debate on cancer services approximately two months ago. People behind the Minister suggested we needed a service in the north west and stood up for their own region. However, when the Minister replied to the debate she did not refer to those contributions but accused us on this side of the House of playing politics with the issue.

Deputy Michael Ring

That is right.

Deputy Jan O’Sullivan

I should be clear. Whatever we say here we will repeat in the regions. What I stated on Ocean FM radio a few months ago I am repeating clearly in the Dáil and I stand over it.

Deputy Enda Kenny

Correct.

Deputy Jan O’Sullivan

I stress that we are not in favour of maintaining unsafe services. That is why we only advocate this one exception and why we have included in our motion yearly audits of all designated centres, both full centres of excellence and outreach centres. The disregard for the lives of women and men who have been misdiagnosed because of bungling, bad organisation and governance, poor resources or ill-chosen locum staff must never happen again. The lessons of Portlaoise must be learned and the recommendations of the series of reports on misdiagnosis must be rigorously implemented.

It is an important part of the motion that there be yearly audits of all centres. There have been a litany of appalling incidents in various parts of the country where cancer has been misdiagnosed. We had three reports on Portlaoise, the Rebecca O'Malley report and the Barringtons Hospital report and we await a report on Cork and Galway. There have been a litany of reports and serious and important recommendations, and they must be implemented.

All those recommendations have resource implications. I hope the Minister will answer the question of where are the resources required to build up the centres. Where are the resources for Galway and the other centres? How can patients in the north west with cancer symptoms or those who are worried about the disease be confident that the excellent services they now have confidence in will be replaced by a similar level of service in Galway if their local centres are closed? We have raised the issue many times in this House but we were never given clear answers on the provision of resources. We know Professor Keane will return to Canada at the end of next year but we have not been given any assurances that what he sets up will continue in a way that provides the necessary resources.

I wish to return to the issue of Letterkenny. It is clearly Government policy that an outreach centre will provide a good and safe service in Letterkenny, which I welcome. How will the triple assessment and the multidisciplinary teams be delivered in Letterkenny and what is the level of expertise that will be available on-site? How will the clinicians who will be working in Letterkenny and Galway operate? I assume the Minister can answer all these questions. I assume she can stand over the safety of the proposal for an outreach centre in Letterkenny. If she can answer such questions, I do not understand why these services cannot be delivered in Sligo, in Mayo or in both places. If the Minister believes services can safely be provided in Letterkenny, surely she can give us answers in relation to the other centres. That is what this motion is about — the provision of safe and reliable services in all the centres.

I would like to reflect on the Government's habit of accepting proposals lock, stock and barrel without examining the detail of what is proposed or ensuring that such proposals can be fully implemented. A report produced by Comhairle na nOspidéal several years ago suggested that accident and emergency care be provided in secondary hospitals 24 hours a day, seven days a week. The proposals in the more recent Hanly and Teamwork reports were completely different, however. We are expected to swallow the various reports whole, without any question. When it was suggested there should be eight designated centres under the cancer strategy, that plan was accepted and minds were closed. Those who felt strongly that the plan was jeoparding their safety and care had no opportunity to make the case for their strong belief that some services should be retained in the north west under the cancer strategy. When we tried to open up a debate to try to have the matter considered, we felt we were beating our heads against a brick wall.

It is worrying that reports are simply accepted as gospel and that is it. As I said earlier, the same thing happened when the Hollywood report on radiotherapy was published. We were told it would be neither sensible, practical nor a good use of resources to offer such services anywhere other than Dublin, Cork and Galway. We have now shown that an alternative model can work. It was reported today that Professor Tom Keane has said that far too many patients are being given radiotherapy on an inpatient basis. If cancer care centres were provided in more locations, radiotherapy could be provided more frequently on an outpatient basis.

I question the Government's philosophy of accepting reports without question. Such reports tend to be implemented in a hands-off manner. I want to refute the suggestion that anyone who questions that approach is somehow mischievous, politically motivated or not working in the best interests of patients. All of us are primarily concerned with the best interests of patients. I submit that people in Belmullet and other extreme parts of the north west who have cancer and have to travel for services think that Galway is a long way away. Therefore, the Minister should open her mind to the development of another main centre, or of a series of outreach centres.

I would like to comment on another couple of aspects of cancer care before I conclude. The BreastCheck service has not been delivered to all parts of the country. While some of the mobile units have been rolled out, not all of them have been. People in the north west, like people in my own region, have not yet been able to avail of the services of BreastCheck. It is clear that they are suffering as a result of unequal treatment. The sooner BreastCheck is rolled out in all parts of the country, the sooner all the women of Ireland will have a fair service. Last week, the Joint Committee on Health and Children discussed palliative care services, which are unevenly distributed throughout the country. While the region I represent is one of the better regions in that regard, many other regions are not properly served. It is a question of fairness, geography and treating patients in the north west with the same level of respect as their counterparts in the rest of the country.

It is important that the motion proposes that we "ensure that all centres of excellence and satellite units are the subject of an annual HIQA audit" to ensure they are safe. We all wish to ensure that the services which are delivered are absolutely safe and fulfil the criteria which have been set out in the cancer strategy. I urge the members of the Government to open their minds and to give the people of the north west an opportunity to avail of safe cancer services near their homes.

Deputy John O’Mahony

I am delighted to have an opportunity to express my views on cancer services in the west and the north west. I commend my party's health spokesman, Deputy Reilly, and my party leader, Deputy Kenny, for highlighting this matter in the Chamber. It is one of the most emotive issues to have arisen among the people of Mayo and the west for many years. The motion does not prevent or impede the establishment of centres of excellence throughout the country. It does not advocate the operation of cancer services that fail to meet the highest standards of audit. We are not looking for millions of euro to be invested to provide additional services we do not already have. We are demanding the retention of the cancer services that have been built up passionately and expertly over the years by the consultants, doctors, nurses and staff of Mayo General Hospital and Sligo General Hospital. These satellite services have operated successfully with a full mandate from the Department of Health and Children and full clinical support from University College Hospital, Galway. The multidisciplinary approach of the teams at Mayo and Sligo hospitals has ensured that the clinical outcome of every patient treated there stands up to the highest scrutiny. Professor Brendan Drumm recently acknowledged publicly the high quality of surgical care provided at Mayo General Hospital. We deserve and will accept nothing less in the future.

I fully support the provision of a satellite unit at Letterkenny General Hospital, under the responsibility of University College Hospital, Galway, which was rightly recommended in the national cancer strategy on the basis of the particular and unique geographical circumstances of County Donegal. Why have the geographical circumstances of counties Mayo and Sligo not been taken into account in the provision of cancer services for the region? Do the decision-makers have any idea of the isolation felt by women in Ballina, Blacksod, Belmullet, Ballycastle, Achill and the islands off the coast of County Mayo? Are they familiar with the standard of roads and transport services in such areas? People in such locations can only dream of motorways, dual carriageways, Luas services, rail links and bus services that would get them to Galway efficiently and on time.

Hundreds of Mayo women who have been successfully operated on, treated and cured at Mayo General Hospital are in the Gallery, along with their families. Why are their views not being taken into account? Why is no consideration being given to the views of consultants who have provided services to a high standard in Mayo and Sligo? Why were Professor Kevin Barry and his consultant colleagues recently forced to publicly support the retention of the existing services at Mayo General Hospital? Was it as a result of the misrepresentation of their views in this House by the Minister, Deputy Harney?

Why have the views of the thousands of people who marched in Castlebar last October in support of the retention of cancer services in County Mayo been ignored by the Minister, Deputy Harney? They have also been ignored by our local Government representatives, Deputies Flynn and Calleary. The people of County Mayo have been told in recent days that the two Deputies intend to vote against this motion. The Deputies have suggested that they would prefer to work from within to retain services and get additional ones. I would be the first to shake their hand if there was evidence of any progress. I will not be holding my breath, however, if their efforts in this regard over recent months are anything to go by. They pledged their support to 10,000 protestors in Castlebar last October. They will have a chance tomorrow night to walk the walk and uphold this pledge.

A number of other questions need to be clarified by the Minister during this debate. On a recent visit to Mayo General Hospital to launch the mobile breast cancer unit, the Minister, Deputy Harney, clearly stated the number of breast surgeries performed in Castlebar last year was 37, although the actual number verified by Professor Barry and his colleagues is in the 90s. Can the Minister stand by her claim even though the certified evidence on the ground contradicts it? This is not just a difference of six but 60 cases. Surely the Minister can acknowledge the gravity of this misinterpretation. How can we be expected to have confidence in a decision based on a misrepresentation of figures of operations performed?

It is also important to state that the Fine Gael motion supports the HSE and Government policy outlined as recently as December 2006 when it was envisaged that the newly established clinical network between Letterkenny General Hospital and University College Hospital, Galway, would work alongside the Mayo and Sligo hospitals. What changed between December 2006 and June 2007? Would it have anything to do with the general election in between?

Acting Chairman (Deputy Kathleen Lynch)

The Deputy should conclude.

Deputy John O’Mahony

Furthermore how can the Minister tell us that the cancer services currently available in Mayo will be moved by the end of the year when there is no evidence on the ground that the hospital in Galway, already under pressure to deal with the existing demand, will be ready to cope with an increased demand in the short term. This transition cannot be achieved within this timeframe without women's lives being put at risk.

Acting Chairman

The Deputy is way over his time.

Deputy John O’Mahony

The people of Mayo are asking us to put people before politics. Tomorrow at 8.30 p.m. there is an easy decision to be made and I ask the Government Deputies from our part of the country to make the right decision.

Minister for Health and Children (Deputy Mary Harney)

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"—strongly supports the National Cancer Control Programme which aims to ensure that all patients have the best possible outcome from their diagnosis and treatment, regardless of where they live;

notes that the programme was developed on the basis of extensive international evidence which shows that cancer survival rates are greatly increased when patients are treated by teams of experts in dedicated centres that deal with a high volume of cases;

endorses the approach taken in the programme that cancer survival must be the priority in treating patients;

notes that under the programme patients will usually only require a single visit to the specialist centre for their initial diagnosis and a second visit for their surgery, and will continue, as at present, to receive follow-up chemotherapy treatment at their local hospital;

welcomes the appointment of Professor Tom Keane and his team of clinical leaders to implement the programme;

welcomes the support of leading cancer specialists and non-governmental organisations, including the Irish Cancer Society, in the development and implementation of the programme;

notes the improvement in 5-year survival of many cancers in Ireland and reaffirms its confidence in the National Cancer Control Programme as the best way to achieve further progress for cancer patients; and

urges all concerned with achieving better outcomes for cancer patients to work together to achieve the goals of the National Cancer Control Programme."

I will be sharing time with the Minister of State, Deputy Barry Andrews.

This debate is about cancer services. The diagnosis of cancer is a terrible experience for individuals, their families and for their friends. In Ireland 22,000 people are diagnosed each year with cancer and 7,500 people die. One in three of us will get an invasive cancer during our lifetime. What are we saying to those cancer patients? We are saying that we want to offer them in the first instance the best possible diagnosis when they get cancer and the best possible care the country can offer. We are also saying to them that in offering them the best diagnosis and care, we will use the best evidence available to us to deliver that.

I was asked earlier who devised the plan, A Strategy for Cancer Control in Ireland, which was adopted by Government. There were 23 people involved in devising this plan, 17 of whom were doctors. There were patient representatives from the Irish Cancer Society and other groups that support patients who have cancer. They drew on the best expertise in Ireland and the best international expertise. They brought to Ireland the man known as the cancer tsar from the UK, Dr. Mike Gibbons, and many other specialists from around the world. Using the best evidence available to them they advised the Government to have eight centres, one per 500,000 people. The Government adopted the plan in advance of the general election even though many people claimed it would not be popular. To be fair to the Opposition, both Fine Gael and Labour supported it and welcomed it. The only question they had about it was whether it would be adequately resourced.

That is the plan we are now implementing. The evidence is not my evidence or the evidence of the Government. Tonight we are talking about breast cancer. There are 250 different medical publications from all over the world by the world's leading doctors who have treated patients that prove that if a woman is treated in a centre that deals with at least 150 new breast cancer cases a year and if a surgeon is dealing with at least 50 individual cases a year, that woman's chances of recovery are improved by 20%. That means the difference between four women surviving and only three women surviving. That is compelling evidence.

Deputy Reilly referred to the Memorial Sloan-Kettering Cancer Center, which I have visited. He stated it has approximately 2,500 cases a year, which is true and is the same number of breast cancer cases we have in Ireland. He went on to say that it is going to have three or four different centres for 2,500. We will have eight centres for 2,500 and we are being criticised for that.

Deputy Pádraic McCormack

The Government is closing centres.

Deputy Mary Harney

The second evidence is domestic evidence in Ireland. The National Cancer Registry of Ireland, a new organisation established in the early 1990s, has produced two reports on breast cancer, one for the period 1994 -97 and one for the period 1998-2001. Those two reports show that women treated in specialist centres in Dublin have a survival rate that is 25% better than women treated elsewhere in the country. Unfortunately the women in the west have the poorest survival rates. What does that mean? It means that where four women in a Dublin centre will survive only three women will survive having been treated elsewhere.

Deputy James Reilly

That information is out of date.

Deputy Mary Harney

There is more analysis coming from the National Cancer Registry of Ireland in the autumn. I understand it is currently collating its report. The advice available to me is that the pattern will continue. Either we can ignore that or we can do something about it. I believe this debate is about the truth. If we are sick and go to our doctor we want the right diagnosis and a good prognosis — we want to be told the truth. We have a moral obligation to tell people the truth. Already there is significant evidence that people are moving to specialist centres even when local facilities are available. Yesterday I visited South Tipperary Hospital. I went to the oncology ward where some men but mainly women who suffer from breast cancer were receiving chemotherapy. Many of them had their surgery in Waterford because the service has been withdrawn from South Tipperary Hospital and the surgeon has gone to Waterford as a full-time breast surgeon. When I asked for their opinions, each and every one of them was hugely satisfied with the service and very happy they were having their chemotherapy in South Tipperary Hospital. Of course, chemotherapy services will continue to be provided in Sligo and Mayo. Some 55% of breast cancer patients will require chemotherapy and those services will be provided locally in Sligo and Mayo.

What are we suggesting in the designation of eight specialist centres? In this instance we are talking about breast cancer because those are the services provided in these two hospitals. For a patient's initial diagnosis and surgery, she will be treated in the specialist centre and thereafter her care, having been planned in the specialist centre, by way of chemotherapy will be delivered locally. That can provide for cancer patients a quality-assured service. Ireland is 18th out of 23 in our performance on cancer in Europe. Our survival rates are improving and as we saw from the recent OECD report in breast cancer they have improved by just under 7%.

However, in treatment of children's cancer we are ahead of the United States and Europe because we have one specialist centre at Our Lady's Hospital for Sick Children in Crumlin which has been there for 50 years. All the diagnosis happens there. The initial surgery happens there. The follow-up treatment, although planned there in accordance with a protocol can be delivered in 16 other hospitals around the country. We have proved with children's cancer when we keep the expertise and specialist doctors together dealing with high volumes of patients, we get better outcomes and results. That is what this debate is about.

Deputy Pádraic McCormack

People cannot get into hospitals.

Deputy Mary Harney

I wish to deal with the question of Galway coping with the numbers. Galway currently has six beds for breast surgery and it will probably have to increase that to eight to provide services for the rest of the region. That is what we are talking about.

Deputy O'Sullivan constantly asks me about resources. When Professor Keane was asked to take over the implementation of a plan similar to ours in Canada, he was told by the Prime Minister there that, unfortunately, due to difficult times no new money could be provided. This year we have allocated €5.8 million to Professor Keane, which is what he asked for. Currently, he is recruiting at least 22 cancer specialists for the health care system. One can ask why it is important that we get those specialists. We are over-dependent on units with one individual, which is not good because if the individual is on leave we have to get a locum. Our system is far too dependent on locums and other issues arise in that regard. The first priority is to recruit the manpower by way of consultant specialists into the cancer control programme and that recruitment is under way. Thankfully, the new consultant contract, which was voted on overwhelmingly last week by the Irish Hospital Consultants Association, will allow us to have consultants work in a way that better meets the needs of the public health care system working in teams with clinical directors. That programme is under way.

Second, there are issues around how patients are referred. Professor Keane is working with the Irish College of General Practitioners, which has responsibility for training and education among general practitioners. As Deputies are aware, last weekend Professor Keane addressed the annual conference of the ICGP. He is working with it on referral protocols so that any urgent case can be seen within two weeks. That is a good international standard and one we want to see implemented here. If we separate what can broadly be called routine cases from urgent cases we will be able to achieve that.

I am the first to accept that the current transport arrangements between, for example, Sligo and Galway are not satisfactory. Professor Keane has allocated €0.75 million this year to the Irish Cancer Society because in other countries it is patient organisations such as the Irish Cancer Society that are seen to be the most suited to put into effect appropriate transport for patients. That is in addition to the transport arrangements we already have in place. The idea is to provide more modern and convenient transport facilities.

Professor Keane made the point himself about accommodation at St. Luke's Hospital, that we have four times more inpatient beds for radiation oncology than what is available for a similar population in Canada. Many of the patients need not be in an acute hospital environment. They could be in a hotel-hostel environment, which would be much more satisfactory from the point of view of the patients and from the point of view of being cost effective, which is important in terms of getting resources to invest in the appropriate area.

The Government's cancer programme is not universally popular. I know that, as I have had discussions with people in Sligo and Mayo. I was happy to meet an excellent group of women — all of whom had breast cancer — when I visited Mayo recently. I know how strongly people feel about the issue. We all feel strongly about it. No Minister for Health and Children worth his or her salt or who is worthy of the job, could fail to stand over the implementation of a plan based on best international evidence.

I say to Deputy O'Sullivan that when Professor O'Higgins produced his proposals seven years ago the international evidence was that a centre should deal with 100 new cases a year. That evidence has now changed to 150 new cases a year. As we know in regard to breast cancer, the developments taking place globally have been described by oncologists as revolutionary. The information, medicine, pharmaceutical products etc., are changing rapidly, which is why much better outcomes can now be achieved. We have to respond to those changes if we want to deliver the best possible quality-assured services for patients. That is what the Government is doing. That is all the Government is doing. The Government is not withdrawing anything to put in something inferior. It is looking at the best evidence, putting in place in 2008 the best possible cancer services this country can afford, and making sure in particular that as many services as can be quality assured are provided in local hospitals, such as chemotherapy. Chemotherapy services will continue to be provided in Sligo, Mayo and in many of the other hospitals where surgery is moving to the specialist centres.

We are talking about specialist centres, not centres of excellence. We are talking about centres where all the specialists in cancer care, pathology, radiology, surgery, medical oncology and so on work as a team around the highest possible number of patients to ensure they can see every possible scenario from a patient perspective. We want every health care setting to be a centre of excellence but we want surgery and diagnosis, which are the two most important aspects, to be done in the specialist centre.

Of the 100 women who will attend a breast clinic, only five will have to have a biopsy or follow-up treatment. Ninety five people will never have to come back again. That is the evidence and it is very good. We are saying that out of every 100 women from Mayo or Sligo, five of them may have to come back for a biopsy and, of that number, perhaps two or three will have to have further treatment. If in doing it that way we are able to guarantee those women that instead of only three people surviving four people will survive, I believe that is a risk worth taking and it would be irresponsible of any of us to stand in the way of its implementation.

Minister of State at the Department of Health and Children (Deputy Barry Andrews)

Deputy Barry Andrews

I would be impressed if Deputy McCormack could find anybody on his side of the House who has not read a script. He might find a few of them.

On the perspective of women, it is understandable that they have concerns about changes to the traditional arrangements for their care. Women in Mayo and Sligo currently enjoy rapid access to their local hospital service when they require it. They are familiar with their local hospital. They often know the nursing and medical staff and have a high regard for them. They know other women who have had breast cancer and who have had it successfully treated in their local hospital. They fear having to rely on a service that is further away and less personal. Understandably, they worry when doctors or public representatives tell them they will get a poorer service.

From the perspective of general practitioners, in Mayo and Sligo they have a long-established relationship with their local hospitals, as is the case with hospitals in towns throughout the country. They know the consultants personally and regularly meet them at clinical meetings and in other settings. That close personal relationship provides local GPs with the security of having access to a good quality and trustworthy clinical opinion when they need it. It also provides them with the means of being able to have patients seen speedily when they are worried about them. They value that access and do not wish to see it compromised.

The Minister wishes to reassure all women that the service they receive in the west will be of the highest quality and that it will be there when they need it. Under the cancer control programme the services will be organised to meet everyone's needs and the proof of a better service will be seen from the beginning of the new arrangements.

It is important to explain what the new arrangements will mean. For women who have breast cancer, travel will be required only for the initial assessment in the clinic, as the Minister said, and again for the surgery. In the case of women who require chemotherapy, this can be delivered at both Mayo and Sligo hospitals in accordance with protocols set out by the multidisciplinary team based in Galway. Far from countless visits involving long journeys, it will be possible for women to have the great majority of their care locally. All of us must reflect on whether we feed into a spiral of fear among patients who are already suffering a trauma in their lives for narrow political aims.

The multidisciplinary teams in the designated centres will carry out high case volumes. In surgery for breast cancer, for example, each centre should carry out a minimum number of 150 such surgeries. There should be no form of the disease that the surgical team has not seen. The team should predict complications and should be familiar with all relevant investigations and treatment for the disease. People attending the centres will know they are in the hands of highly skilled consultants and nurses who have access to all the resources necessary to achieve the best results possible in terms of survival rates.

In all the local debate, we must not lose sight of what we want to achieve, the best possible outcome for patients. The reorganisation of cancer services is at the heart of the delivery of the national strategy for cancer control, which was approved by the Government in 2006. Patients enjoy an improvement of up to 20% in survival if they are treated in specialist centres which provide multidisciplinary care. The new configuration of services will allow for the delivery of quality assured patient focused care, which will be in keeping with international best practice and the highest standards.

The major focus of the Health Service Executive's implementation plan to date has been on breast cancer services. Since 2000, more than €60 million has been made available for the development of symptomatic breast disease services nationally.

In June last year the Minister approved national quality assurance standards for symptomatic breast disease services under the Health Act 2007. The implementation of the standards is an essential element of the quality agenda set out in the national cancer control strategy. The aim of the standards is to ensure that every woman in Ireland who develops breast cancer has an equal opportunity to be managed in a centre which is capable of delivering the best possible outcome.

Funding of €5.8 million has been allocated from the programme in 2008 across the eight centres to support additional staff, including consultant, radiography, nursing and clerical posts. Funding has also been allocated for some necessary additional equipment.

Changes of the kind being implemented are difficult. They lead to concerns about local services and an understandable fear that the new will not be as good as the old, but we are not alone in dealing with these changes. Canada, like Ireland, has very sizeable areas that are sparsely populated and patients there often must travel hundreds of miles to attend for treatment.

The decisions on the location of the eight designated centres have been made, taking account of travel times, proximity to large urban centres and the ability of the centres to recruit and retain top clinicians. The availability of multidisciplinary teams and up-to-date technology is also very important.

One Irish person in three will develop invasive cancer, while one in four will die from it. Currently there are approximately 22,000 new cases and 7,500 die of the disease. We are aware that the number of cancer cases is expected to increase, largely as a result of population changes, from less than 14,000 in 2000 to over 28,000 in 2020. We must, therefore, ensure that the health system has the capacity to deal in a timely, quality assured fashion with the increasing numbers of patients presenting for diagnosis and treatment.

The House is well aware of the reviews into failures in cancer service provision, where due to lack of appropriate standards of care such as the absence of a multidisciplinary team to diagnose and determine treatment options, cancers were missed. We must change the system. We must provide quality assured cancer services and optimise survival rates, and that can only be done by realigning the current fragmented services and concentrating resources for diagnosis and initial treatment in the eight designated centres.

Local hospitals are a cornerstone of health care provision. They have huge, untapped potential in many cases, especially for day surgery and follow-up treatments. In cancer care, however, initial diagnosis by a multidisciplinary team, which has access to state-of-the-art diagnostic techniques and pathology, is the key to improving survival rates.

I strongly believe that the best way to improve cancer survival rates is to implement the national cancer control programme. I join the Minister in calling on this House to endorse the programme fully. We must concentrate on developing the designated specialist centres and stop arguing over local issues, be they political or medical.

Deputy Pádraic McCormack

They are all medical.

Deputy Barry Andrews

We cannot have half-way measures or ill-judged compromises which try to keep everyone happy but end up leaving patients with poorer services.

Deputy Michael Ring

As they will when they go to Galway, which cannot cope with what it has currently.

Deputy Willie Penrose

I am not a doctor and I am not here to argue for a centre for the midlands, even though Professor O'Higgins said clearly that we had the critical mass to have such a centre. I acknowledge that the Minister of State, Deputy John Maloney, has faced up to considerable pressure and adapted to a situation that was to his political disadvantage. Nonetheless, he faced up to it in a fair manner and I acknowledge that here tonight.

The Census of Population 2006 shows clearly that the choice of cancer centres of excellence bears little relation either to geography or the population structure of Ireland. That is the problem I have — I am not arguing about the midlands but addressing the motion about the north west, Sligo and that area.

There is no centre north of a line from Galway to Dublin, leaving ten northern counties and about 18% of the population a considerable distance from such a centre. That is a considerable proportion of the population and I wonder why there has to be four centres in Dublin. It is grand for me because I can avail of the good road from Mullingar. However, for someone in a remote rural area who must first navigate boreens before getting to a tertiary road, then hopefully hitting a secondary road before gaining access to a primary route, it is extremely difficult. Those are the people I am concerned about. It is all right for many of us who can get from A to B. It might solve many of the problems if a proper air ambulance service was introduced. It is no use having one, just piddling around here and there. We need such a service across the country for all health services.

I want to know how such a strange result could have come about because it does not arise from the basic philosophy for health care in Ireland set out with admirable clarity in the national health strategy in 2001:

Access to health care should be fair. The system must respond to people's needs rather than have access dependent on geographical location or ability to pay.

Would the ten northern counties believe they have fair access to the specialised services in terms of geographical location? In terms of the genesis of the problem, two major reports provided the groundwork for the decision on cancer centres, the Hanly and Hollywood reports. The Hanly report was officially about medical staffing and how to ensure compliance with an EU directive for junior doctors. However, it spread out like an amoeba and went into other areas such as medical education and training, organisation and location of acute hospital services, ambulance services, etc. Many of these issues were only covered in a superficial manner, especially the decision that there should be only one major hospital in each region. Accident and emergency, as well as other services, should be centralised in this hospital while other hospitals would become 9 a.m. to 5 p.m. five-day a week care centres. The Hanly report states on page 68 that, ultimately, there should not be a requirement for an on-site medical presence overnight or at weekends.

The most amazing thing about this influential report is that it did not take demographics or geography into account. I am not a medic and I am not here to politicise the issue — I would say this if the Labour Party was in Government — but it does not make sense to plan for a medical reorganisation of hospital services without knowing where people live in Ireland. I was criticised widely for proposing to reduce the number of accident and emergency departments and so on. However, a TCD research group found that the percentage of those in the country able to reach an accident and emergency department within an hour would fall from 82% to 72% and increase from 44% to 47% in the west and north west of the country.

It is surprising that Hanly ignored the 2002 report by Comhairle na nOspidéal, the statutory body advising the Minister on the organisation and operation of hospital services, which showed in detailed analysis that Ireland needed all its 38 accident and emergency units to provide adequate and timely care for the victims of major accidents, heart attacks and so on. Its main argument was about the "golden hour", which all the doctors here know about — seriously ill patients have a much better chance of survival if initial treatment and stabilisation is given within the first hour of an emergency. The most recent international research on accident and emergency services, published in 2007, confirms very strongly the principle of the "golden hour".

The Hollywood report on radiology services was much more research based, but still has serious flaws in its analysis and conclusions. It put great emphasis on the decision to centralise radiology services in Dublin and Cork, with another centre already agreed for Galway. That obviously affected the recent choice of multidisciplinary cancer centres of excellence — that is its origin. The objective was to ultimately balance the potential conflicting aspirations of bringing the service to the patient or the patient to the service. The authors set out two models of care, the hub and spoke, where diagnosis and major care is given in the large centralised hospital, with more routine care given under supervision in a small hospital close to the patient's home. It recommends the centralisation of all radiology services, with just three centres for the whole country. It gives three major arguments for deciding on centralisation for Ireland and all of them are deeply flawed.

The hub and spoke model is used successfully in Scandinavian countries where there is a low density of population. However, it was argued in this report that Ireland's population density is much like that in the UK or the Netherlands, which use centralisation and, therefore, centralisation would be more appropriate for Ireland. That is so stupid that I cannot believe it was included. Norway had 14 residents per kilometre in 2005 and a population of 4.6 million, while Sweden had 20 residents per kilometre and a population of 9 million and Denmark had 126 per kilometre for its population of 5.4 million. Iceland has 3 residents per kilometre, with a population of 296,000, while Ireland has 59 residents per kilometre for a population of 4.2 million. The UK has 245 residents per kilometre and a population of 60 million, while the Netherlands the 389 residents per kilometre and a population of 16.3 million. In terms of residents per sq. km and total population, Ireland is much more like the Scandinavian countries than the UK or the Netherlands. That is fact. With respect to the Minister of State, Deputy Barry Andrews, it has been a great mistake for Ireland to slavishly follow UK medical trends over the years, especially in terms of hospital structures, catchment areas, etc., when in so many ways Ireland is so unlike Britain.

I will not even talk about the fact that the Hollywood report relied on a postal survey of the attitudes of cancer patients. Do not draw me out on that one. Some 2,500 patients were treated in St. Luke's Hospital and more than 700 were treated in Cork. When one has a postal survey, what does one get? A majority of the survey's findings should have come from Dublin, because that is where 3.5 times the cancer population was treated. I will not even comment.

However, the authors of the report expressed concern that if there were satellite centres to give treatment closer to where people actually lived, the medical personnel in these centres would feel very isolated. If they feel lonesome, they can avail of mobile phones.

The hub and spoke system requires very close networking between the major centre and its satellites, with much direct contact among all staff to maintain standards and discuss patients. It would be much more reasonable to ask a few fit and healthy medical personnel to travel occasionally to the central unit or the satellite units in order to prevent feelings of isolation instead of forcing thousands of seriously ill patients to travel long distances every day for weeks on end, as in the centralisation model.

In my view, those major reports which provided the groundwork for the decision on the new cancer centres both suffer from many significant shortcomings — I have only pointed out some of them. Chief of these is the total lack of interest in, or perhaps lack of knowledge of, Ireland's unique demographic structure.

I will conclude with two major points about the multicentre cancer centres of excellence — it is inappropriate to term them centres of excellence because it implies that all other hospitals and institutions lack excellence. Excellent services can be found in many hospitals, large and small, throughout the country. It is unfair to suggest that excellence in cancer care is only available in a handful of hospitals in the southern part of Ireland. The correct term, as referred to by the Minister, is multidisciplinary centres. The objective, which everyone should support, is that the primary diagnosis and treatment planning for all cancers should take place in a centre where there are experts in radiology who are familiar with the many diagnostic tools necessary for investigating cancer. Experienced cancer surgeons should work together to provide all the necessary preliminary investigations to define both the problem and the best treatment.

As the Minister said, no one should complain about travelling a distance on a number of occasions to have the benefit of a multidisciplinary team working on his or her cancer problems. However, it is important to ensure that the poorer members of society, the elderly, disabled and those who are isolated, have adequate State support to enable them visit the multidisciplinary centre without inordinate difficulty or financial loss.

The big issue in respect of the fact that the cancer centres are not new is that existing hospitals have been asked to take on the additional burden of new and expanded cancer services although these centres, in common with those of the entire acute hospital sector, have fewer beds per 1,000 citizens than in most other developed countries. There are 2.8 per 1,000 while the OECD average is 3.9 per 1,000.

The provision of public health care, of which I am very proud, boils down to a choice. For 26 years, our capital investment in health care was only 63% of the EU average; need we say more?

Deputy Denis Naughten

I wish to share time with Deputy Feighan.

Acting Chairman

Is that agreed? Agreed.

Deputy Denis Naughten

I thank Deputy Reilly for tabling this motion. The Minister for Health and Children asked for truth in this debate and I will therefore state a few home truths.

Over recent years, 13 cancer centres have been closed on the basis that cancer patients would receive better treatment and have higher survival rates by transferring services to regional services. The cancer services provided at Portiuncula Hospital in Ballinasloe and Roscommon County Hospital form part of the service in our regional centre based in University College Hospital, Galway, UCHG. Local public representatives, including me, accepted the regionalisation plan in good faith on the basis that the Government would not dare mess with people's lives by under-resourcing cancer services. We soon found that the transport service that had been provided to cancer patients was withdrawn. Consequently, they had to try to make their own way to Galway, which, for some of my constituents, involves a journey of three and a half hours. The lack of public transport means patients must get their spouses to take days off work and arrange for relatives or neighbours to pick up their children from school just so they can have the pleasure of queuing for up to an hour to get into the hospital carpark. This is after surviving the traffic congestion in and around Galway city.

As a result of the reduction in the number of surgical cases in Portiuncula Hospital and Roscommon County Hospital, the HSE is now planning to transfer the department of surgery in the latter to the former as an interim measure before centralising all inpatient surgery procedures in an already congested UCHG.

We were told there would be more local outpatient clinics, with the consultants doing the travelling and examining patients in Roscommon and Portiuncula hospitals rather than having the patients trek to Galway. This commitment was abandoned. One affected clinic is the urology clinic in Roscommon County Hospital. Since the health authorities would not sanction the €50,000 needed to purchase three sets of cystoscopy equipment to carry out the physical examination, patients must still travel to Galway to be examined.

We were promised that local post-treatment services would be enhanced but the opposite occurred. I refer to the withdrawal of home help services and home care packages. To top it all off, we found out last week that the HSE cancelled the plan to develop an eight-bed hospice service at Roscommon County Hospital in addition to the day care and outpatient services, at a total cost of €8 million, half of which was to be provided by the Mayo-Roscommon Hospice Foundation. The HSE claims it has reprioritised the investment. Last year, Roscommon County Hospital catered for 90 palliative care patients, and many other patients from County Roscommon were treated in other hospitals. The HSE's decision means patients with terminal cancer must now wait for one of the 14 beds in Galway or one of the 14 planned beds in Castlebar to become available.

We now find that, although there is a great backlog of patients for cancer diagnosis in UCHG, that hospital will close down for the full month of August because it is facing a financial deficit of €4.5 million. So much for our centres of excellence and the commitment that was made to deliver excellent services to the communities in which services have been closed down. The current plan will double the number of patients attending UCHG by closing down the services in Mayo and Sligo. UCHG cannot even cope with the demand being placed on it by patients in Roscommon and Galway, never mind those in the north west who will now be thrust upon it.

In her contribution, the Minister stated two additional beds will be provided at UCHG. This will cater for the two operations per week that are taking place in Mayo but will not cater for the patients of the north west who are currently being treated in Sligo. No additional capacity has been provided to cater for this.

The Minister of State, Deputy Barry Andrews, stated further investment is needed in the so-called centres of excellence in Galway and that the funding will be made available over the years ahead. It is clear that the excellent services in Mayo and Sligo will be cut. These services resulted in survival rates above the averages in any other hospital in Europe. We are told we will have an adequately resourced service some time in the future but we have the facts regarding what is happening in my county and know the same will happen in Mayo and Sligo. I commend the motion to the House.

Deputy Frank Feighan

I commend Deputies Kenny and Reilly on raising this very important issue in the House.

In outlining my position, I will depict the more human side instead of facts and figures, although bearing in mind that the facts and figures the Minister cited pertain to the period 1994 to 2001. In this day and age, we should have more up-to-date figures on this very serious issue.

Eight years ago my father suffered kidney failure and had to be brought to Sligo three days per week. We come from a very mobile and well-off family and it was great that he could go to Sligo, just 25 miles down the road, and then come back. Each day, when I saw him coming back tired and jaded after being on dialysis, I shuddered to think of what would have happened had he had to go to Galway. Unfortunately, victims of cancer must travel to Galway, and they spend two or two and a half hours doing so. One would not get through Claregalway or Tuam without difficulty. Last Sunday it took me two hours to get into Galway. Having to travel so far is a great hindrance and problem for patients.

This debate is not about point scoring and politicians are elected by the people. Patients, medical practitioners, families and friends come to us as politicians stating they attended so many public meetings and protest marches in Sligo and Castlebar, and marches to Leinster House. People have taken the time to come to Dublin to listen to this debate tonight because we are approaching the endgame of a charade that has gone on too long.

I have sometimes nearly been embarrassed by members of the Government shouting they are with the people outside the House while adopting a stance against them in the House. It is very difficult to be in government in such circumstances. I genuinely feel for the Senators and Deputies from the constituencies involved because it is very difficult to implement national policy. For once, we must have a little honesty in the House. What has happened has undermined the public perception of politics. There are Deputies present tonight with a heavy heart. I ask the Taoiseach to allow an open vote on this very important issue in the Dáil, and likewise in the Seanad when it discusses the matter. Thus, Deputies and Senators can show where they stand on this very difficult matter.

On coping with cancer, one of the Mayo Clinic's top ten tips states, "Try to maintain your normal lifestyle." How can one maintain a normal lifestyle when oneself and one's family must drive the whole way to Galway and come back the next day? The clinic advises, "Take each day at a time. When the future is uncertain, organizing and planning may suddenly seem overwhelming".

There is a line between Dublin and Galway, above which there are centres of excellence in Castlebar, Letterkenny and Sligo. We now want to ensure there is one in the north west. The people of the north west deserve much better than what is being recommended.

With regard to the protest marches that have taken place, it is up to the Government to listen to the people and to govern. I ask it once more to please respect the wishes of the families and patients in the north west and ensure they have a centre of excellence. I ask the Taoiseach once again to allow an open vote on this very serious matter. I will applaud the Deputies and Senators of the Oireachtas when they participate in that open vote.

Debate adjourned.

Dáil Éireann debate - Tuesday, 20 May 2008

Cancer Services: Motion.

Dáil Éireann debate -
Tuesday, 20 May 2008