Cancer Services: Motion.

I welcome the Minister for Health and Children to the House and I congratulate her and wish her well on her re-appointment as Minister for Health and Children.

I move:

That Seanad Éireann, recognising that:

the Health Service Executive, HSE, has frozen recruitment in the health service for the month of September;

during the recent general election both the Taoiseach and the Minister for Health and Children promised the creation of 4,800 new posts in the health sector by the end of the year;

and noting:

the crisis of confidence affecting cancer services and in particular the suspension of breast cancer treatment facilities and misdiagnosis first highlighted by Rebecca O'Malley in Cork earlier this year;

calls on the Government to;

clarify recruitment plans for the HSE; and to

outline the measures it intends to take to restore confidence in cancer services.

I am glad to have the opportunity to move the Fine Gael Private Members' motion on health and I welcome the Minister to the House this evening.

Obviously, this is a critical issue for people. Recent weeks have been shocking for many patients. In particular, cancer patients cannot believe some of what they have heard in the past few weeks, and with good reason. In the brave new world of the Health Service Executive, apparently it has let its services grind to a halt in some areas. This has been outlined in the newspapers and is for a sadly familiar reason, namely, because it has overrun its budget. Such overruns were much heard of in the old days when the health boards were responsible. However, it had been hoped that, following the upgrading of the health board structures into the HSE, the change regarding budgeting would be obvious and such difficulties would not arise.

Instead of several small overruns, we now have a fairly massive overrun, as well as major inefficiencies. This is a game of punish the patient, because when recruitment is frozen without consultation with relevant front-line health personnel, patients suffer. In recent weeks, Members have heard case after case outlined by patients themselves, their consultants, hospital staff and nursing personnel. The people on the front line state clearly that patients are being adversely affected. The Minister has stated on a number of occasions that she has faith that there will be no negative patient outcomes. I hope she is correct, but the evidence from people's direct experience does not seem to support her.

Before the general election the Eamon Keane "Lunchtime" show on Newstalk exposed a plan for the axing of 1,000 health sector jobs, mainly front-line jobs. The Minister rubbished the story and denied cuts would come from the front line. At the time she stated, "Reports about staff levels in health are totally inaccurate. There will be substantial increases, not reductions, in staff levels this year."

The Taoiseach also got involved in the debate about whether there would be health cuts. He stated that Newstalk had "got a bum steer". It is now clear that if one wants the truth about the health service one might be better advised to go to Newstalk than to go to either the Minister or the Taoiseach, judging from what was stated at that time about the health cuts and what we have seen in recent weeks in the freeze on recruitment and on services for September. It would seem the promises and the reassuring words to patients were not worth the candle. The election happened, the Minister was re-appointed and the recruitment freeze began. The Minister's promise that such measures would not reduce services was inaccurate. One need only ask the 30 nurses and four consultants at Sligo General Hospital whose contracts are not being renewed as a result of the freeze or the chairman of Sligo hospital's medical board, Dr. Niall Considine, who described the cull of its temporary staff as "swingeing cuts" that will reduce breast operations by 50%, or read the motion that was passed by the executive council of the Irish Nurses Organisation. The INO, whose members should be in a position to know, states that the cutbacks curtail essential services, from baby vaccination clinics to palliative care. They are on the front line and this is what they are saying. Mr. Liam Doran, the general secretary of the INO, described the cuts as unforgivable. Even the Minister of State at the Department of Health and Children, Deputy Jimmy Devins, admitted on RTE News on Friday last that while the HSE states patients' care will not be affected by the cutbacks, staff have told him otherwise. I must ask how cuts that are doing grievous damage to patient care can be defended. If the Department of Health and Children and the HSE are so concerned about strategic management in our hospitals, how can they push this recruitment freeze? Surely there is a better strategic response to overspending than damaging patient care and what about the 4,800 new posts?

There is much talk of managers getting bonuses. Given that the Minister is imposing a freeze on recruitment and given that there is an enormous budget overrun, how can these bonuses be justified? The Minister could buy many nursing hours for those thousands of euros.

It appears the Health Service Executive is making decisions without the input of hospital staff who know the realities of patient care. There is strong feeling in the health services that front-line staff are not being consulted enough and that their input is not being sought on decision-making at a higher level. Surely it is important to note the views of those who meet the patients every day. It seems to be a clear issue of management.

There is anAlice in Wonderland quality to the exchanges between Professor Drumm and the Minister, or maybe it is a “good cop, bad cop” one. The Minister states no freeze in May and Professor Drumm announces one in September; Professor Drumm states public provision would have delivered radiotherapy services quicker and the Minister states the PPP model will do it faster; and the Minister states co-location is the way to go, yet there are reports of Professor Drumm querying this behind the scenes.

I also note that Professor Drumm is giving a briefing to all Oireachtas Members, chaired by the Ceann Comhairle, in a local hotel. While this also happened last year, there is confusion in executive responsibility if the Ceann Comhairle is chairing a meeting of all Oireachtas Members outside of the Dáil. I am all in favour of getting good quality information from the Health Service Executive, but I certainly query what the Ceann Comhairle is doing chairing this meeting. One could imagine him in the financial services centre next, chairing a meeting of concerned players in the financial sectors. It is strange that he is chairing the meeting and it ought to be questioned whether that is an appropriate role for the Ceann Comhairle.

The second part of our motion deals with breast cancer services. I note and welcome the Minister's announcement today. Of course it raises issues about transport and support for patients who must travel long distances, but we have waited a long time for centres of excellence and what every woman with breast cancer needs is a centre of excellence where she can get the best quality diagnosis, treatment and help, and to increase her chances of survival by at least 20%.

I draw the House's attention to the recent statistics from the National Cancer Register, reported inThe Irish Times, that one in 11 women in Ireland will develop breast cancer, 2,352 new cases of breast cancer were diagnosed in 2005 and approximately 650 people die from the disease every year. According to the Irish Cancer Society, there is no systematic approach to care or adherence to national quality assurance standards, and this is entirely unacceptable. Patients could not have put it better themselves. The lack of national quality assurance standards has created a crisis of confidence about breast cancer services in the State.

I recognise there has been some movement on this recently. It started with the case of Rebecca O'Malley in Cork earlier this year. A series of mis-diagnoses and questionable treatment practices have led to a real fear about the quality of our treatment services. Now we have inquiries into treatment practices at Barrington's Hospital in Limerick and a review of thousands of mammograms and breast ultrasounds at the Midlands Regional Hospital in Portlaoise.

As if all this was not enough cause for concern, it now transpires that the Department of Health and Children was aware of seven separate issues concerning the quality of breast cancer service at Barrington's Hospital some 19 months before it took action to address these concerns. This was reported inThe Irish Times on Saturday, 22 September last. The newspaper had seen correspondence sent to Professor Brendan Drumm by Paul Barron, assistant secretary of the Department of Health and Children. In his letter Mr. Barron asked that specific issues be examined at the hospital, including the fact that mastectomies were performed on a day case basis and that breast surgery was undertaken without prior imaging. This is scandalous. The Irish Times further stated that, “Other concerns outlined in the letter to Prof Drumm include the fact that there was no multi-disciplinary team working in relation to breast services; that the consultant radiologist worked single-handed, meaning there was no guarantee that mammograms were ‘double read’, and no quality assurance framework was in place.” This refers to 2007, when we have known for many years the nature of quality care for breast cancer. Furthermore the letter revealed that patients who “encountered difficulties” at Barrington’s were referred to symptomatic breast services in Dublin rather than the Mid-west Regional Hospital and this led to additional trauma.

However, the HSE decided that as Barrington's Hospital was a private hospital, it did not operate under the aegis of the HSE. This is a damning statement and I want the Minister to address this specifically. For example, VHI has no difficulty in paying private hospitals. Clearly, there is a issue of standards which must be met in that VHI is paying these hospitals, but what will we do about the issue of standards in the case of private hospitals so that the same statement, that a hospital did not operate under the aegis of the HSE, is not made again? Obviously, when it comes to patients' safety and quality of treatment, public or private ownership should not come into consideration and the HSE, or perhaps someone in the Department, should immediately have acted in the interest of public safety. Will the Minister outline her approach to this and the action she proposes to take to ensure all private hospitals are subject to the highest standards and state who is responsible for taking action where such a report is made from her Department to the HSE? Many people are concerned about this.

The Minister, stating that Barrington's Hospital was ordered to cease breast cancer services last month, said that concerns about the hospital were not forthcoming "until the start of August of this year". This sparks the obvious question, did the Minister make misleading comments on this issue or was she simply not aware of the details of it? I want the Minister to inform the House of the timeframe of her knowledge of this and the action that should have been taken.

It is clear the HSE needs to invest in specialist centres for breast cancer treatment. I welcome the Minister's comments and the initiative she announced. Specialist centres must operate a multidisciplinary model of care. They were first proposed first years ago by Professor Niall O'Higgins. One can ask what has happened in terms of these centres for the past seven years. It is a fact that 20% more women would survive if these centres were in place. That means, unfortunately, that many women have died in this country because they did not have access to multidisciplinary specialist centres.

I call on the Minister to clarify the recruitment plans for the HSE, to outline how she intends to meet the promise to create new jobs in the health sector by the end of the year, and to lift the recruitment freeze that is having a devastating effect on front-line services in many hospitals. I also invite her to outline what measures she intends to take to restore confidence in cancer services. I intended to call on the Minister to reveal the timeframe for the establishment of specialist breast cancer services but perhaps she can indicate also what is the timeframe for the announcement she made today. When does the Minister expect all of the services to which she referred to be up and running?

Lives depend on competence in this area and this competence has been in short supply. We have been big on promises and small on delivery. When it comes to patient care, significant improvements are needed so the issues I outlined, which received major attention in recent weeks, are rectified.

I congratulate the Minister, Deputy Harney, on her reappointment as Minister for Health and Children. It is three years since the Minister was first appointed to this office. One can ask what success has been achieved within the health service. There is no doubt money has been spent but the successes are few. Part of the problem is a combination of incompetence and complacency about what is happening in the health care service. I do not believe the Minister is personally responsible for all the problems. It may be the case that the Minister's partners in Government have no interest in the health service. It may also be the case the Department of Health and Children is not fullyau fait with what is Government policy. It is also possible the HSE is completely at sea in terms of looking after the health care of the population.

In 1996 the then Minister for Health, Deputy Michael Noonan, drew up a cancer strategy. It was ten years before the Government, of which the Minister was a part, drew up its own strategy in 2006. As yet, there has not been any implementation policy for cancer treatment within the health service. Appointing a tsar from England to make changes will not make any difference unless the Minister is certain about the type of change that is proposed. Reference was made to eight hospitals but the Minister did make any clear statement of her intentions. It is a bit like BreastCheck; it gets rolled out bit by bit. The same situation applies to cervical cancer screening. Screening has not been extended beyond Limerick city in over seven years.

As Fine Gael spokesperson on health, I drew up a policy on cancer screening as far back as 2005 with the assistance of one researcher. How is it the case that the Minister, with 500 people at her disposal in the Department, cannot draw up a policy on cancer screening across the country rather than make an announcement about the possible screening for bowel cancer next week? I am not sure what staff in the Department are doing especially when the HSE appears to run parallel to the Department.

Let us look at what is happening on the ground. In Wexford the steriliser for cleaning the colonoscopy which is used in the diagnosis of bowel cancer has been broken for the past two months. Accordingly, the diagnosis of bowel cancer for patients is being postponed for a further two months. Is it on the basis of the money saved in not treating bowel cancer the HSE officials received their bonuses two months ago? This is not just happening in County Wexford, it is happening right across the country where similar stories can be heard in every single constituency of ineptitude, complacency and downright waste of money by people who are supposed to be running the health service on behalf of the people of Ireland. That is what the Minister is overseeing, as part of the Government. She is not getting to grips with what is happening.

When I was health spokesperson for Fine Gael in the Dáil I always backed up the Minister in making difficult decisions I thought would help people. I said I would back her on a public-only contract for consultants. What has gone wrong in that regard? Before one can make cancer treatment services work, one must have the consultants in place in hospitals. They must be working in teams in a way that will deliver a service. Why is it the case that the talks on contracts which began as far back as 2003 are still in limbo in 2007? Four years later the talks are going nowhere. When I backed the Minister early in 2006, I stated there was a good chance this would happen, yet the Minister allows this train to chug along. That is what is happening with the health service.

What about the reforms the Minister mooted as far back as 2001? What changes to work practices in the health service has the Minister overseen in the past three years? The sector has been benchmarked and increases have been paid. A total of €900 million of the health service budget is based on changes in productivity and in how people work. What are those changes? We do not see them and there has not been an improvement in access to health services for patients.

The Minister stated outcomes have changed but she was referring to a base that was disastrous. If change had not occurred the Minister would have been imprisoned for negligence. We expected improvements would take place. When one benchmarks cancer outcomes in this country against other countries in Europe, we are not doing so well. In fact, we are doing pretty badly. The Minister should not be benchmarking herself against the lower base that prevailed in this country in different economic circumstances.

The Minister must also examine what she wants to do. For the time being I am keeping the discussion global. I do not believe the Government has a coherent policy on what it wants from the health service. Let us look at what happened in the case of Leas Cross. Patients were dying of neglect in this private nursing home. When reports were made to the HSE it took it a year and a half to respond. When the Leas Cross report was published, more energy and effort was expended by senior management in the HSE in making excuses for their behaviour than in trying to make changes. The Minister introduced legislation on HIQA, the Health Information and Quality Authority. At the time she stated this body would protect patients. In the course of the Dáil debate on the matter I contended and still believe that we need a statutory patient safety authority that is not answerable to any Minister as such but to the people, or at least to the Oireachtas. The Minister disagreed with me and set up HIQA.

When a crisis occurred in a private hospital, it emerged the remit of this organisation that came into legal effect at the beginning of 2007 does not cover private institutions. What passes for Government policy currently is to move health care into the private sector as evidenced by the co-location of private hospitals on the grounds of public hospitals. I accept this is a difficult issue for some of the Minister's party colleagues but this is what is happening. Beds are being provided in the private sector where the standards cannot be checked by the organisation that was set up by the Minister to monitor this area. That is a perfect example of why things are going wrong in the health care service. In order to get it right the Government must organise a cancer care strategy in a way that works for patients.

I move amendment No. 1:

To delete all words after "recognising that:" and substitute the following:

the number of people employed in the public health service since 1997 has increased by 63%, from just under 68,000 to over 111,500 whole time equivalent staff; and in particular, by the end of 2006, there were

2,736 more medical and dental staff, a 55% increase;

8,975 more health and social care professionals, a 151% increase; and

11,000 additional nurses, a 43% increase.

frontline service posts are increasing again this year, with the HSE having already authorised an additional 2,500 new posts in the context of approved new service developments;

reaffirms the statutory requirement that the Executive should manage its budget within the Vote approved by Dail Eireann and acknowledges that the Executive has taken steps to ensure that it meets this objective in 2007, by means of its Breakeven Plan 2007;

and notes, in particular, that the pause in recruitment will be reviewed by the Executive on 1 October 2007, in the light of the financial situation then obtaining;

acknowledges the significant new investment made in cancer control, and supports the Minister for Health and Children in her commitment to ensuring equitable access to high quality cancer services for patients throughout the country.

and acknowledges in particular:

that cancer survival is improving in Ireland for all of the major cancers;

the establishment by the Minister of a National Cancer Screening Service Board which will roll-out BreastCheck commencing in October of this year and the Irish Cervical Screening Programme commencing in January 2008 and also advise on a colorectal cancer screening programme;

the Minister's approval of National Quality Standards for Symptomatic Breast Disease Services under the Health Act 2007 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;

the additional revenue investment of €20.5 million in cancer control in 2007 and the establishment by the Health Service Executive of a National Cancer Control Programme to implement the National Strategy for Cancer Control;

that the National Development Plan 2007-2013 includes major investment in the implementation of the Cancer Control Strategy, including state of the art diagnostic and treatment facilities; and

the commitment of the Government and the Health Service Executive to achieving a progressive expansion of radiotherapy capacity over a timeframe which meets patients needs."

I welcome the Minister. I am delighted to see her back. The HSE was set up in January 2005. Countless debates took place in this House prior to its setting up. The tenor of these debates ranged from positive to negative and somewhere in between. Some people took a certain approach and expressed their feelings about the abolition of the old health boards. The HSE is now in place and it is responsible for the running of the health service with an annual budget of €14.3 billion.

It is important to note the generous increase to the health budget by the Fianna Fáil-led Governments in the past ten years. The Government has said, and will continue to say, it will invest and give more resources to the HSE. We must be prepared to let the Health Service Executive do its job. It is not yet three years in operation and already people are writing it off. Like any other organisation or, indeed, household, we must remain within our budgetary allocations. The HSE has a chief executive officer and a board in place to run this massive organisation in a professional manner. Let us have faith in them and give them the confidence to do a very difficult job. It is an enormous and complex organisation when one considers all the components that go to make it up and who they must look after — doctors, nurses, associated health professionals together with administration and domestic staff — and an annual budget of €14.3 billion of taxpayers' money each year.

I listened with interest to what Senator Fitzgerald had to say when she raised the issue of Sligo General Hospital, which is my own general hospital. I am aware Sligo General Hospital has been asked to make savings of up to €5 million out of an annual budget of €108 million, 75% of which goes to pay staff, but it has only been asked to make savings on services for which it does not already have funding and where it had taken on consultants to work in those areas. Senator Fitzgerald quoted Mr. Niall Considine's very good letter inThe Irish Times last Saturday. I know Niall Considine very well. My colleague, Senator MacSharry, and I, along with our two Deputies, work very closely with Mr. Considine for the betterment of Sligo General Hospital. We sat around a table on many occasions and hammered out deals with the Department and the HSE for the betterment of Sligo General Hospital.

On a point of clarification, is the Senator agreeing with the cutbacks?

Is Senator Twomey talking to me?

Senator Feeney, without interruption.

I listened patiently to the speakers on the other side of the House. I did not interrupt when they were speaking and I would ask Senator Twomey to show some respect. I know he is new to the House but he should show a little respect.

The Senator has the floor.

I am aware of how he behaves because I sat on the health committee with him for two and a half years. He never stops barking. He should sit and listen and have a little respect.

The Senator should speak to the motion.

I would like a straight answer from the Senator. That is all I want.

We recognise in Sligo that there are savings to be made. I spoke to the manager of the hospital this morning and they are prepared to make them. They have to make them. It is the world we live in. We all know about budgets and we have to work within our allocation.

I am very used to hearing Fine Gael Members say they met a man who said this, a woman who said that or a child who did something. I did not hear either of the speakers talk about the wonderful contribution of Mr. John McCormack, chief executive officer of the Irish Cancer Society, on "Morning Ireland" today. It was a wonderful contribution. He talked about cancer services having turned a corner and how it is an exciting time for cancer care in Ireland. He knew it was long overdue but the time has come. It has turned a corner. He said that in welcoming the announcement of the eight new designated cancer services centres that are to be set up,there is no doubt these centres will improve the outlook for patients suffering from cancer. He said outcomes in the centres will be much better and that there will be a 20% better chance of beating cancer in these centres because they will have multidisciplinary teams. I would have expected Senator Twomey to know at first hand what multidisciplinary teams would mean for people.

The Senator should check the record of the Dáil. I backed the Minister on that issue two years ago.

I am not in the habit of checking the record of the Dáil. I am a Member of the Seanad. I check the record of the Seanad.

The Senator is asking me——

Ciúnas. Senator Feeney, without interruption.

I will judge Senator Twomey on his contribution here in the Seanad.

If the Senator asks me the question, I will answer it.

Not only will these units be for treatment, they will also be centres for learning, research, education and access to clinical trials, which is so important for patients suffering from cancer. They can now be put on therapies that might be much more beneficial to their outcome. Research has shown that outcomes are better as a result of treatment in centres that have multidisciplinary teams and those are the centres we are setting up.

It is a well known fact that people will live longer as a result of centres of excellence and being cared for in centres with multidisciplinary teams. There will be reactions in the communities that are losing out but it is important to note that while smaller communities or hospitals may lose out, the country as a whole will benefit from the announcement made today. We are putting in place a solid framework for cancer treatment which will lead to mortality figures decreasing. Systems currently are not working. They are too fragmented. We all know the outcomes where a multidisciplinary team is not in place. Mr. McCormack said today that if one can pass a hospital treating ten cancer cases a year and go on to the one treating 100 cancer cases a year, one's chances of survival and outcome result will be much better.

I am delighted that the HSE has appointed Professor Tom Keane to oversee the implementation of this framework. I am not picking on Senator Twomey but I thought he would have known that Professor Tom Keane is an Irishman returning from Canada. I do not know where he heard that he was from the United Kingdom. He is not English. I cannot find any article that stated he is English.

Did he work in the UK?

British Columbia, but that is in Canada.

Thank you, Minister.

My geography was never very good.

He will be heading it up and he brings wonderful expertise and experience to the post and we wish him well.

If the Minister gets around to talking about the areas for the west, I would like to ask her about the links in terms of Galway and Letterkenny and perhaps Sligo. We have a wonderful surgeon in Sligo. We value our cancer services in Sligo but we recognise we must do what is best for the country and, first and foremost, for patient care.

The BreastCheck service is very successful and is working very well. I am delighted to hear that December 2007 to January 2008 will see the roll-out in the south and the west. A friend of mine who I was with today, who is 50 years of age, rang St. Vincent's Hospital to inquire about getting a breast check. She is new to Dublin. They are sending out a form to her to register. They will ring her in a few weeks' time and make an appointment. That is the effectiveness of the service. I wish the Minister well.

I call Senator Prendergast who has eight minutes.

I will not use the eight minutes. I welcome the Minister to the Chamber. I have worked at the front line of the delivery of health services, as a midwife, for more than 20 years. Many aspects of the health services are excellent and I welcome any changes that will give a better patient service.

Had I not had the great honour to be elected to this House, I would not have a job because of the public service recruitment embargo. What is happening locally, and my colleagues have assured me of this, is that they are being asked to work overtime for which they will not be paid and when matters are resolved, they will be given back the time. That is not satisfactory. Parental leave is being cancelled for many involved in the delivery of the health care services.

There are issues in the health services that are a cause of concern. The developmental check for children at nine months is often not being done until the age of two. The reason it is done at nine months is because any deficiencies in the developmental check can be rectified, and the optimum time for diagnosis is nine months. That is a matter of concern to me.

While the further roll-out of BreastCheck is welcome, there should never be an availability of services on the basis of where one lives. Geography should not disadvantage people——

——requiring BreastCheck or prostate cancer treatment services. Services should be provided where they are needed. We would not be let take our cars on the road without passing the NCT but we are not as good when it comes to health services.

As somebody who has worked at the front line in the delivery of services, I am concerned about a number of issues. For instance, if someone has the use of crutches for one week, they can no longer be used by anybody else because health and safety regulations will not allow it. We need to evaluate where money is going in the health service because it is not always going to frontline support, as it should. I would like to know when all areas will have BreastCheck and screening services. I await the Minister's reply.

I compliment the Senator on her maiden speech and wish her well.

I take pleasure in seconding the amendment. I welcome the Minister for Health and Children to the House. I am a great admirer of her and the determination and conviction with which she pursues the reform of the health service. I would not have been in favour of the break-up of the health board system but, as Senator Feeney stated, we are where we are. The HSE is in place and is substantially resourced. We can see that Professor Drumm intends to pursue reform with the same determination and conviction as the Minister.

At a personal level, my family and I have in the past year experienced the health service at first hand, from paediatrics to oncology. While we often choose to kick political footballs around both Houses of the Oireachtas, the frontline services of which I have first-hand experience are fantastic. However, that is not to claim all is rosy in the garden because it is not. Much work needs to be done. As I said, I admire the conviction of Professor Drumm and the Minister, Deputy Mary Harney, in seeking to do that work.

Despite the political bashing by which Senator Twomey seeks to score points in the House, the fact remains that no Administration in the history of the State other than the last two Fianna Fáil-Progressive Democrats Administrations has done more in terms of investing and reforming the health service. This Administration, with the help of our colleagues in the Green Party, will be no different.

With regard to cancer services roll-out, I welcome the appointment of Professor Keane and the announcement of the eight centres of excellence. Such centres, which offer the full range of services and research so that people have the benefit of the newest possible treatments, must be the way forward. We would all like to have these centres in our back yards — I would like such a centre in Sligo — but this cannot happen. However, as there is a linkage between NUI Galway and Letterkenny, I ask that we would also maintain existing services at Sligo General Hospital and in addition have a satellite radiotherapy service with linear accelerators. This is possible and it would accord with Government policy under the national spatial strategy with regard to providing services for the people of the area. If there can be a link with Letterkenny, why not have a satellite link with Sligo also?

While I am not a health professional like Senators Prendergast and Twomey, it appears to me the general management of the health service needs to be addressed. The Minister and the senior executive of the HSE are seeking to achieve this. For example, among the types of expenditure postponed at present is the booking of hotels. Senator Fitzgerald alluded to the fact Professor Drumm will brief us in the Davenport Hotel in due course. I agree it is a disgrace that hotel rooms are being booked when facilities exist in the Leinster House for those coming to address us. This kind of expenditure is where we should begin to cut back. If circumstances have changed, people must change their minds. If cutbacks must be made, we must make them. However, frontline staff should be the last to be affected.

As Senator Feeney stated, Sligo General Hospital will play its part in what must be done. It it is a matter of great regret, however — I know I speak for Senator Feeney, the Minister of State, Deputy Jimmy Devins, and Deputy Eamon Scanlon — that it is frontline professionals who must be cut back in this instance. However, we will take our bit of pain in the interest of the long-term service to the people of Sligo and the north-west regional community.

It is the administrative side that must be addressed, for example, the booking of hotels and foreign travel that is not important to patients or the delivery of service in the front line. One can barely walk into a hotel in Ireland without seeing on the notice-board that whatever band is playing that night, the HSE has a number of rooms booked for interviews and so on. At the same time, state-of-the-art infrastructure is sitting idle — at Manorhamilton, for example — while we waste taxpayers' money on the rental of rooms and training courses. It is in this area rather than in the front line that we should seek to make savings.

Naturally, it is painful for those on the Government side to be forced to accept that the posts of some 30 nursing staff and five locum consultants are being cut back. I would prefer if this was not happening. Will the Minister clarify in what way the Department will be able to connect directly to the HSE in this regard or are we just policy-making while the HSE does as it will in terms of staffing?

To sum up, I welcome the appointment of Professor Keane and the announcement of the eight centres of excellence. I appeal in earnest to the Minister to do all she can to ensure satellite services, such as those being created in Letterkenny, will also be created in Sligo, while the existing oncology service and various other cancer services are maintained.

Much needs to be done but much has been done, as I have experienced at first hand in the past year. We should be responsible while criticising the health service and acknowledge that much has been achieved. We are in the process of the biggest reform the State has ever undertaken in this regard. I was initially a sceptic with regard to moving away from the health boards but I am prepared to give the process time. It has been ongoing for three years and, as Senator Feeney said, we should continue as we have and, hopefully, services will continue to improve in the way all in this House wish to see.

I wish to share my time with Senator Paschal Donohoe.

Is that agreed? Agreed.

I wish to address the crisis of confidence affecting breast cancer services and the way in which the HSE has handled this. I represent the west. The current realities for women with breast cancer living in the west are as follows: we have the worst health outcomes from breast cancer in the country; we are years behind the rest of the country; and a woman in the west has much less chance of survival from breast cancer than in any other part of the country. This is not right.

Women from all areas of the country are in the Chamber but Senator Feeney and I are the only two living in the west. Should our chances be any less than any of my female colleagues in this Chamber? I think not. This is how unjust and unequal the delivery of cancer care facilities is and has been. Why is this the case? It is due to the lack of access to cancer care services in our region. To date BreastCheck is not operational in the west yet the first unit opened in the east in 1999.

We are way behind national policy in implementation terms. This is clearly political and a result of the lack of political decision-making in favour of the west, so much so that the women of the west are at risk of being 16% behind the national average with regard to survival from breast cancer. This is not right and is a clear indictment of the Government and the Minister for Health and Children, who have neglected women in the west and their families since 2000.

While I welcome the announcement that a much needed dedicated cancer care centre will be established in Galway, I seek specific details on when it will be established, whether funding is available and, if so, if this funding will feature in this year's budget. We have heard promises before.

A high volume cancer centre with a range of expertise — multidisciplinary teams — available to best assess in the patient's favour is the best way forward. A small, private institution with low volume and low throughput, Barrington's Hospital, for instance, could never be reliable in terms of patients' results. It is madness that private hospitals remain unregulated in that they are not accountable to the Health Service Executive or the Department of Health and Children. According to a letter from the HSE national director in the office of the chief executive officer, the reason is that they are not under the aegis of the HSE. This means, once again, that patient health is further put at risk owing to a lack of timely intervention by the HSE, despite formal requests to do so by a surgeon in Limerick, Dr. Gupta. As Senator Fitzgerald pointed out, the Department was aware of complaints for 19 months but it took one woman's persistence and bravery to highlight the problem. It was then that other stories began to emerge. It is little wonder that women are nervous and members of the public have lost faith in the entire system.

Funding for cancer care has been delivered in an unco-ordinated manner. University College Hospital Galway does not have a dedicated space for breast cancer services, which are located in various parts of the building. The problem facing a surgeon is that he or she is not guaranteed access to beds or outpatient facilities. Patients in Galway have reported being frequently more concerned about securing a bed than receiving their cancer diagnosis. In the event of a car accident or other emergency, the beds are required elsewhere.

For these reasons, I strongly support the establishment of a cancer care centre with dedicated space, functioning beds and a range of in-house expertise. Research supporting this approach has been available for a long time. The NationalBreast Cancer Research Institute in Galway has been preaching this message for years.

What is the Minister for Health and Children doing with resources? She is sending a mixed message by trying to offload care into private hospitals and resourcing private health care through tax breaks, the National Treatment Purchase Fund and the co-location policy, which members of the public clearly oppose. Earlier this year, I carried out a study in Galway city which confirmed that 80% of residents do not want a private hospital built on public lands in University College Hospital Galway. On the contrary, they want available resources to be invested in the public hospital.

The Health Service Executive, on the other hand, refers to centres of excellence. To date, the results in this regard have been piecemeal and unco-ordinated, which ties into the current debate on the seriousness of HSE cutbacks. While I agree that efficiencies are needed, Professor Drumm, in his attempt to remain within budget, is in one fell swoop taking a machete rather than a scalpel to the health system. Management in Sligo General Hospital have certainly interpreted it in this way by cutting 40 staff, most of whom work on the front line.

Professor Drumm has been in post for more than two years. After many studies and audits, he should know clearly where the problems are in the health service. The financial management he oversees across the health system must be questioned three quarters of the way through the financial year. What happened to quarterly and half-yearly reviews? I can only guess it was too politically sensitive to give us the bad news when a general election was in the offing. This type of management is not acceptable. The buck stops with Professor Drumm and the Minister, both of whom must come clean on their intentions. Does the Minister have faith in the public health system or has she given up on it? Will she implement a policy which proves she is committed to the system? Can Professor Drumm communicate his intentions across the system to his line managers or is the system too unwieldy? Can he communicate in a way that ensures we have safety in the health system and patients are not put at risk?

In the past week, I have spoken to many health care workers who doubt the budgetary overrun will be corrected by 1 October. Some speculate the current measures will last until 1 January. It is time to be clear. People need to know not only that critical services will not be hit but that services such as speech therapy in the community, occupational therapy and public health will remain unaffected by these measures. I want to know in what direction the health system is moving.

As I make this speech, it brings home to me the importance of this Chamber, which is new to me. The Minister has come to the House to address points of major importance to the communities Senators represent and to the country at large. I will confine my remarks to the amendment to the motion, a copy of which I received as I entered the Chamber. In many ways, the amendment sums up very well the difficulties we have in the health service and the country. The first sentence refers to the major increase in the number of people working in the health service since 1997. If we have had such a substantial increase in the number of staff working in the HSE, the Department of Health and Children and our hospitals, why are we encountering so many difficulties and continually discussing problems related to the quality of patient care and securing access to the services patients require when they enter our hospitals and health care institutions?

The fact that every household spends an additional €5,000 per annum in tax on health care is welcome. As we have grown wealthier, we should pay more. Why, in light of the substantial increase in staff and expenditure, is the House debating health cutbacks? Why do we continually discuss public dissatisfaction with health care and the problems patients encounter in the health service?

With regard to comments made by Senators from the other side, the contribution I heard by Mr. John McCormack on a radio programme today may have been different from that to which Senator Feeney referred. While Mr. McCormack acknowledged the value of the new strategy on cancer services, he also asked why it had taken so long to reach this point and referred to the difficulties faced by patients and members of his organisation.

I am struck by the number of speakers who take credit for those things that are going well but shift responsibility for problems in the health service to the Health Service Executive. Responsibility for these matters rests with the Government. Do my fellow Senators support the cutbacks which have been made? If they want to claim credit for the money that has been spent, they must also claim credit for the money not being spent and the cutbacks under discussion.

I welcome the Minister to the House and thank her for attending this important debate. The motion addresses the important issues of the delivery of cancer services throughout the country and the recently announced freeze on recruitment in the health service. The recruitment freeze raises a central question. What should be the optimal size of the health service and, in particular, what should be the appropriate ratio between direct care staff and administrative-managerial staff? There was a legitimate expectation that the abolition of the health boards, a decision with which many Senators may not have agreed, would result in the establishment of new structures with much leaner administrative and managerial sides and much greater emphasis on direct care staff. Unfortunately, this does not appear to have happened. It is clear that in some areas of the health service, staff levels are excessive while in others, staff numbers appear to be inadequate.

The announcement of a freeze on recruitment has caused many medical professionals to express strong concerns that it will impact negatively on patient care. The Minister has stated publicly that this need not be the case. Will she expand on her statement and indicate whether various hospitals will get guidelines or assistance from the HSE regarding how it might trim its budgets without negative impacts on patient care?

The way in which the announcement was made was abrupt and done without sufficient consultation with the relevant stakeholders. The health unions have complained to the Health Implementation Board about how they believe some of the agreements reached under the social partnership process have been breached. Be that as it may, industrial relations problems may emerge and compound existing difficulties in the health service.

The decision in question was made approximately three quarters of the way into the accounting year, which is far from ideal in terms of general practice. I hope other decisions will be made with a degree more consultation with the relevant stakeholders. While the Green Party is in Government, I hope we will be able to use our influence to try to ensure that occurs.

Cancer is a chronic disease. While there have been welcome increases in recovery rates, a high level of mortality is associated with it. This necessitates the centralised specialised services we have been discussing. They are extremely expensive and add significantly to the financial burden on our health services. The Green Party would argue that they are end-of-pipe services and that more emphasis should be placed on prevention. The role of environmental conditions should be examined closely.

The cumulative impact of lifestyles, eating habits and pollution from transport and industrial discharges go some way towards explaining why clusters of specific cancertypes are noted in particular parts of the country but not elsewhere. The cancer register highlights where cancers occur, but it does not provide a reasonable or acceptable explanation as to why.

More must be spent on cancer research. Ireland spends approximately €4 per person on cancer research while the United Kingdom spends approximately €15. To a greater extent, we could examine the possibility of carrying out more cancer research and addressing the environmental component of the disease.

The main issue being discussed is the availability of cancer services. It is an important matter because much depends on location, such as early identification and appropriate treatment. That situation is not acceptable. In broad terms, the Green Party supports the announcement of the eight specialised cancer units. Such treatment is essential in cancer care, but it leads to a difficulty in that the more centralised the service, the further people must travel. While my constituency of Wicklow is in the greater Dublin area, it is primarily a rural county. Difficulties are posed to constituents who must travel from the south of the county to Loughlinstown Hospital or Naas Hospital for medical treatment. If centralised centres are to be put in place, family-oriented accommodation centres for the relatives of people with long-term illnesses must be provided to make their stays comfortable. This would address some problems.

On the question of centralising health services, we should also be going in another direction. While we need to centralise specialised services, we should localise our health services to a greater extent and provide more local primary health care services that emphasise accessibility, have a multidisciplinary approach and can deal with the minor and ordinary conditions with which people present. Due to high mortality levels, we should provide a network of hospices and home care services to support the new structures to be put in place. We have concerns about the age-specific focus of BreastCheck and believe it should be changed. The dates provided to Cork and Galway for the roll-out of BreastCheck services have passed, so the roll-out should be expedited.

Regarding pathology labs, we have discussed the delays and problems surrounding the results of cervical tests. The issue was raised with me by a number of constituents, but there is no legal requirement for hospital or pathology labs to be accredited to international or European Union standards. This leads to concerns about errors and delays in the tests. On 5 June, the National Hospitals Office announced that cervical smear tests would only take one month to be analysed from the end of June onwards. Unfortunately, this has not come about, as the return of cervical smear test results takes between two and six months.

On behalf of the Green Party, I support broadly the introduction of centralised cancer services. I was delighted to hear John McCormack supporting it on radio this morning, but if we continue to centralise all health care facilities, support services are needed and we must examine the localisation of primary health care in rural constituencies where people must travel long distances.

May I share time with Senator Coffey?

This debate is timely and I pay tribute to the staff of the HSE, who do a wonderful job on our behalf. Responsibility and accountability in the delivery of services are needed in the health service.

I welcome the Minister for Health and Children, Deputy Mary Harney, to the House. I admire her conviction as a politician, but I do not agree with her philosophy regarding the HSE or with its creation, as it is a failed entity. There is no accountability or meaningful strategy. If the HSE is as good and everything is as rosy in the garden as Members opposite have stated, why does Paul O'Brien write in today'sIrish Examiner about how the “Health Service Executive exceeded its sanctioned budget and spent almost €11 million more on information and communications technology last year than the Government had permitted”? This does not inspire confidence.

In the southern region, there are cutbacks and a recruitment freeze. I say this as someone who is a former member of the Regional Health Forum, has worked in the health service and is involved with disability groups. Last Friday, I attended the opening of the new maternity unit of University College Hospital, Cork with the Minister. Professor Drumm was right when he stated we should celebrate what is good in the health service. I salute the staff of the maternity unit as they played a pivotal role in its opening, but we should acknowledge that morale is low among frontline staff, ask why that is the case and read the transcripts of last weekend's special conference of the INO in Tralee.

I have read a memo from a member of staff in the HSE, southern region. I will paint a little picture. Imagine a night sister or night nurse in UCHC. He or she goes to work and is met by his or her nurse manager, who says the room temperature is one degree too high according to memo specifications. This is what is happening.

Is it correct that day wards are being closed a week early for Christmas? Is it the case that agency staff cannot be employed to replace existing staff? If our health service has become so cash-rich, why has the HSE frozen recruitment at this point in the financial year? The cutbacks and recruitment freeze are affecting the vulnerable and weak. These patients and their families, along with the front-line staff, are the victims. The result will be longer waits for patients in accident and emergency departments, longer waiting times for outpatient appointments and elective treatments, and cancellations of elective surgery.

I accept Professor Drumm's argument that the HSE's budget must be balanced. Why is it, however, that efforts are being made in this regard on one level while bonuses are simultaneously being awarded to HSE managers? I ask the Minister to sanction an audit of how the HSE operates. Staff numbers have more than doubled since the establishment of the HSE, as indicated in the Government amendment. However, the purpose of the new executive structure was to facilitate an improvement in patient care. This has not been achieved.

I ask the Minister to examine whether the HSE's management structure can be altered to include fewer levels of management and to ensure a greater emphasis on delivering front-line services. Somebody must accept that mistakes have been made in the years since the HSE was established. We cannot expect patients to pay the price. The staff of the HSE, at all levels, do a great job. They require our support and leadership.

I thank the Minister for Health and Children for attending this debate. This is my first contribution in the House and I look forward to engaging with the Minister on this issue.

There has been much discussion of cancer services in the regions. In the south east, which includes my own County of Waterford, there is a well documented deficit in public radiotherapy facilities and cancer services. Commitments were made by the Minister and others in Government that a satellite centre for such facilities would be provided at Waterford Regional Hospital by 2011. It has since emerged that this date has been pushed back. I did not hear Professor Keane's comments this morning but I plan to ask him whether there is a particular implementation date for the national cancer strategy. That is what is of concern to citizens.

I agree with Senator Prendergast's comments on breast cancer screening services in the south east. Commitments were given that BreastCheck would be in operation in the region by this October and that the recruitment of radiographers and other staff was under way. Has the recruitment freeze affected those commitments? Is consideration being given to the provision of screening for testicular and prostate cancers? Men are in need of such services just as women require a comprehensive breast cancer screening service.

I am particularly concerned about the provision of neurology services in the regions, including the south east. The Comhairle na n-Ospidéal report of 1991 and its subsequent report on neurology services in 2003 included specific recommendations that there should be one consultant neurologist per 150,000 head of population. In the south-east region, which has a population of almost 470,000, 55,000 people are estimated to be affected by neurological conditions. Some 4,000 of those are being treated in centres in either Dublin or Cork. Round trips of more than 220 miles are often involved, with patients travelling for more than eight hours in one day. These are patients with debilitating illnesses such as motor neuron disease and Parkinson's. The Minister must agree this is unacceptable. It is an unbearable situation for affected families.

Four consultants have been recommended for the south-east region but, to date, only one consultant, Dr. Paul Crowley, has been appointed in a temporary capacity. He will require support staff such as a clinical nurse specialist, occupational therapists and administrative support. Will those limited services be affected by the recruitment freeze? They are not sufficient to meet the capacity requirements and the problems in this regard will continue.

Fine Gael agrees that the health service must be reformed and become more efficient. However, we must also have a more accountable public service and be more responsible in our approach. We do not agree with reducing front-line staff numbers while the service is bloated with managers and administrative staff. There is a better way of doing business. We expect responsibility, accountability and delivery by the Minister and the staff of the HSE on behalf of the citizens of this State.

I propose to share time with Senator O'Malley.

Is that agreed? Agreed.

I welcome the Minister to the House. She is a person for whom I have great regard and respect. She has probably the most difficult job in the State. It is extremely difficult when the issues with which one must deal are so personal and affect people's lives and futures in such a significant way. I acknowledge the work that has been done in the health service, particularly in the area of cancer care. My contribution will reflect the issues pertaining to cancer care services in County Donegal.

Before that, however, I will draw Members' attentions to some facts. Since this Fianna Fáil-led Government entered power in 1997, more than €1 billion has been invested in cancer services. There are more than 100 additional consultants specialising in the areas of medical oncology, radiology, palliative care, histopathology and haemoatology. More than 340 additional clinical nurse specialists have been appointed to cancer care services. Members on both sides of the House must acknowledge and welcome these improvements.

There has been much discussion of cancer care services in County Donegal. As the Minister is aware, two lobby groups were established in the county, Donegal Action for Cancer Care and Co-operation for Cancer Care North West. Both these groups are working in an effective manner to pursue the need for additional cancer services in Donegal. I acknowledge the work they undertake on a daily and weekly basis, working with public representatives in raising the pertinent issues pertaining to cancer care for patients in the county.

I welcome the Minister's announcement today of the details of the implementation of the national cancer control programme. I also welcome the appointment of Professor Tom Keane as interim director of the programme. I do not know him personally but understand he is a man of integrity and ability. I have no doubt of his ability to implement his brief in an effective manner. A consideration of his past achievements means we can all be confident in this regard.

According to the criteria outlined in today's announcement, the centres will be based around populations of 500,000 people. I assume this follows from the recommendations of the O'Higgins report. I note with interest the proposal that North-South co-operation between Letterkenny and Belfast should continue and that provision will be made for radiotherapy care services from Belfast. Does this provision mean patients will have to travel to Belfast or will these services be available in Letterkenny?

In view of the restoration of the power-sharing institutions in the North, will the Minister outline what opportunities now exist in regard to cross-Border care, particularly in respect of the western Northern Ireland counties of Derry and Fermanagh? In particular, could there be an opportunity to co-operate on a more stable basis with Altnagelvin Area Hospital in Derry? I am aware that discussions were underway with the hospital in that regard but I am unsure whether they have concluded or broken down. I would like to hear the Minister's opinion on the matter. It is almost the same for a patient from west County Donegal to travel to Belfast as to Dublin and while there may be more of an affinity with the latter, I would like those factors to be taken into consideration when the new policy is implemented.

On Monday evening I attended the launch of a booklet,You Are Not Alone, which was compiled by a sub-committee of Donegal Action for Cancer Care. This lovely and helpful booklet gives a flavour of what community groups can achieve when they work with statutory organisations. It is aimed at helping patients by providing information on travel, subsistence and the services and assistance available to link County Donegal with Dublin.

We should acknowledge the work being done because it is a challenge to roll out cancer care over a relatively small island and it will be difficult to make services available in every parish. It becomes even more of a challenge when the existence of the Border and the Six Counties are taken into account but we should use that to our advantage. Cavan hospital is mentioned in the press release and welcome the care which it will provide.

We are anxious in County Donegal to see a link being developed with Altnagelvin hospital for radiotherapy services. We would also like to see a permanent appointment made for a breast surgeon, although I am aware an announcement has been made in that regard, and the establishment of a satellite radiotherapy unit in co-operation with the North and Sligo, so that it will be easier for patients in the north west to receive treatment locally.

Cancer is an issue without boundaries and it touches every family. We are all trying to work together to the same outcome, so now is not the time to be acting in a politically motivated manner.

Give us the services and we will not attack the Government.

We should work together on an equal basis to bring about the services we all want because cancer has nopolitical boundaries.

Give us the services and we will not complain.

We know too well.

I welcome the Minister to the House. Earlier, Senator Twomey asked what she has achieved over the past three years. I am sure she would have liked to have done more, particularly with regard to issues such as the consultants' contracts. I was amused by the Senator's contribution, which implied it is the Minister's exclusive fault that the contract issue has not yet been resolved. Nobody was more determined than the Minister to find a resolution by a certain date but unfortunately that has not come to pass. However, now that the consultants realise she will remain in her job, I am sure they will agree to find a solution for the sake of the country so that we can have the health service we deserve.

Senator Healy Eames asked whether we have faith in the public health service. I would like to relate my recent experience of the health service, in which I have utmost faith. I attended St. Vincent's public hospital because I do not believe that a public representative should buy privilege. I accept that others can choose for themselves but that is the decision I have made. My experience in the hospital was a very happy one. I was met within five minutes of my appointment and the procedures I underwent were administered efficiently.

The Senator is an exception.

It is important when we have good experiences that we recognise it is not all gloom and doom.

On becoming a Senator, one is absolved from dealing with a geographic constituency. Our responsibility is to the entire nation and all the people who live in this country. We can and should be discussing what is good for all people in the country regardless of where they live, so I accept the points made in regard to the lack of availability of BreastCheck throughout the country.

Today's announcement on the eight centres of excellence addresses the so-called crisis of confidence. However, outcomes are most important when it comes to the location of all medical services.

We must stop the practice of pandering to our local hospitals because it suits us. We have a national responsibility in this House——

We are discussing an entire region in the west.

Allow Senator O'Malley to continue without interruption.

——to provide national services. We must remember that outcomes are the measurement for services.

No one disputes that.

I wish to briefly address the issue of remaining within budget. Senator Buttimer asked how we can have a plan if it then has to be abandoned. It is precisely because one must remain within a budget that one can have a plan because what is the point in having a health service that does not keep to a budget? How can sustainability be maintained if the fundamental of a budget is not honoured? If we constantly reward waste, we will not be able to provide a budget. We need to recognise that the amount of money available is limited.

This morning it was €11.3 million. There is no accountability.

Spending has increased in the region of 10% annually. We certainly rank highly in the international context of spending on health care.

We are not getting the services.

We are not getting the outcomes.

Ghandi said we must be part of the change we want ourselves. That includes all of us, public representatives as well as those working within the services. We must all be part of the change if we are to deliver better services. Let us not forget our responsibilities in that regard.

I wish to share three minutes of my time with Senator John Paul Phelan.

Is that agreed? Agreed.

I welcome the Minister to the House. Today's announcement that ten acute beds will be lost to Monaghan hospital in my constituency forms a sad backdrop to tonight's debate. Peadar McMahon from the Monaghan Hospital Alliance, who is well known to the Minister, is outside the gates protesting on that issue.

Current health strategy in this country is predicated on developing a GP-led primary health care service on a nationwide basis. I am in favour of such an approach. Primary care at local level is the key to the delivery of health services. It can contribute to a freeing up of hospital places and the delivery of a better, more patient friendly service. I am proud that one of the leading national examples of primary health care is situated in Virginia, County Cavan, which is in my constituency.

The provision of primary health care centres is wonderful in theory, if only it could be put into practice. However, we cannot deliver proper primary health care in this country without 500 additional doctors and 2,000 additional nurses over the next ten years. At present we have one of the lowest ratios of general practitioner to population in the OECD, at 2.8 per 1,000. It is nonsense to talk about the delivery of a primary health care service when we have a dearth of GPs. I ask the Minister to address that issue. Rather than freezing recruitment we should be engaging in a proactive campaign to entice the requisite numbers of GPs into the system. We must provide the necessary college places, training and attractive terms and conditions. We simply do not have enough GPs or nurses to deliver proper primary care.

In the psychiatric area, which is a critical one, we need 20 staff members for every 50,000 people. Such staff are not in place currently. In order to deliver front-line, community based psychiatric services we need an increase in medical personnel and a greater investment in the area. If we must make cuts, as Senator Coffey said earlier, we should look to bureaucracy, administration and other areas of waste, but not to front-line staff.

The dental services are suffering as a result of the cutbacks. Last year, in the area that I represent, including Bailieboro and east Cavan, the primary school children did not undergo the dental screening process that is normally done in first and sixth class. The embargo on recruitment will prevent the appointment of the dentists required to alleviate that situation. There is an inadequate complement of dentists to deliver the services that are required in the north east region.

There is clearly a crisis in the area of maternity services. The services have not been adapted in terms of medical personnel or space to deal with the rise in the number of births. This was recently referred to by no less objective a source than Dr. Michael Geary, Master of the Rotunda Hospital.

In the worst of times in Ireland, in the bad old days when we were less prosperous, we at least had a quick response to cancer patients. We talked about cancer with awe and fear. Now it is possible that a patient could have to wait six months for radiotherapy treatment. It is unthinkable.

During the last general election campaign Fine Gael pointed out that 1,000 health service jobs would be cut by the Government, which was denied by Fianna Fáil and the Progressive Democrats. In fact, they countered by saying that 4,800 new jobs would be created in the health service. What do we have now? We have a freeze on recruitment across the entire service. It was a travesty of truth to deny the proposition put forward by Fine Gael that 1,000 jobs were at risk.

We are making cuts in the wrong places and are under-investing. We need people at the coal face in order to deliver a proper medical service. At a time of great prosperity, when we have reached a level of sophistication and wealth never seen previously, it is a great indictment of our society that we are having this debate tonight. I urge the Minister to lift the embargo on the recruitment of coal face staff, whose numbers must be increased.

I welcome the Minister and this opportunity to discuss the health services. During my time in the Seanad we have had several discussions on the difficulties that have arisen in the service across the country. I am glad that Senator O'Malley had a successful visit to St. Vincent's Hospital recently but my record of visits to various hospitals around the country is not as good. As I mentioned in a similar debate before the summer, I had to accompany my father, who is an elderly man, to the Regional Hospital in Waterford. We spent nine hours there. It transpired that he had gallstones but it took nine hours before he got a pain killer. My father is 82 years old. That is my personal experience of what my father went through. I could relate similar stories I have heard from constituents in recent years and that is unacceptable. I wish we all had a service that was available as efficiently as the one apparently available in St. Vincent's Hospital but Senator O'Malley's experience is not reflected in the rest of the country.

I do not agree with Senator O'Malley's argument about people pandering to their local hospitals. Often when one is dealing with matters of health, one is trying to get a person seen as soon as possible. If one lives in a rural area, the local hospital is very important and the confidence that a service will be available should one need it is vitally important. I ask the Minister to outline in her response to the House the current position of the Hanly report.

I have recently been presented with a number of cases in my local area that highlight difficulties with the ambulance service. Difficulties have arisen in both private nursing homes and public services for the elderly in terms of transporting people to hospital for surgery. There appears to be a very significant problem in the south-eastern region, with operations being cancelled because the ambulances and staff are not available. That is nothing short of neglect of the elderly. It is very easy to neglect elderly people because very often they are not in a position to raise their voices. I wish to see significant improvements in that area.

I have also become aware that in the south-eastern region, the surgeon who was dealing with all issues relating to breast surgery retired more than six months ago. He spoke on local radio yesterday and outlined how his former position has not yet been adequately filled. A person has been appointed but is not an expert on mastectomies, lumpectomies and certain other procedures. It is highly regrettable that the former occupant of that position had to go on the public airwaves to express his concerns in this regard. That situation must be remedied as soon as possible.

I echo the sentiments of Senator O'Reilly concerning the provision of dental treatment. There is a significant problem with the provision of services, particularly to young people with serious problems. I was made aware of a case of a child who had two teeth growing down through her palate, who was told by the HSE that she would have to wait for over a year to be seen by the public dentist. That is a disgrace. God knows what long term damage would have been done to that child, had her parents not been able to afford private dental care. I ask the Government, the HSE and the Minister to rectify these problems, and others referred to tonight, as soon as possible.

I support the amendment to the motion laid before the House. This area has commanded a great deal of time in both Chambers of the House, rightly so. I note that the motion tabled by the Opposition places heavy emphasis on recruitment. Does this miss the point somewhat? I think the issues facing the health service relate to productivity and value for money and there are many reasons for this.

In the past ten years, the number of people working in the health service has increased from 68,000 to 111,500, and this may be mentioned in the motion. Expenditure has gone from €3.5 billion to €14 billion this year. There have been improvements in the health service due to increased investment, but it should be acknowledged that these improvements are not commensurate with the level of investment, which has been quadrupled.

The Minister for Health and Children, Deputy Mary Harney, has taken initiatives that will benefit the health service. In the previous Seanad, she ensured the person at the helm of the Health Service Executive, HSE, would be someone in whom she would have confidence. Aer Lingus saw a very positive transformation in its fortunes when it appointed one of its former pilots to the position of chief executive officer, CEO. Similarly, it was enlightened to place a consultant in charge of tackling shortcomings in the health service.

I understand the reasoning behind the abolition of the health boards and the introduction of the HSE, but the system could have been enhanced had tiers of accountability been built in. I made it known to the Minister and her predecessor that I felt we should have continued a system that saw boards appointed at regional level that would report to the national board, rather than from executive to executive. The latter system has corporate governance flaws because people in executive positions will tend to cover for each other and this has occurred quite a bit in the health service. I refer not just to the misdiagnosis, which we instanced earlier.

In many ways, the manner in which we dealt with the blood transfusion issue left a lot to be desired. Nobody was held responsible for what amounted to criminal negligence that saw many people suffer and die. Well paid positions in the health service involve a responsibility to do a job well and there must, therefore, be accountability. The Minister should examine this matter.

Payments made to people in senior positions in the health service have been criticised in the media and in this House today. I have been impressed with the initiatives Professor Drumm has taken since he was appointed chief executive of the HSE, but the jury is out on his performance and will remain so for some years until we see the improvements in the health service that we seek. To concentrate on bonuses he has received, however, is to miss the point. I do not believe the chief executive of any company quoted on the European stock market would work for the salary or bonuses he receives. Any person in charge of a service with a €14 billion turnover deserves to be paid accordingly because he carries a great deal of responsibility. He should be judged by his performance, not by what he earns.

I was recently appalled by the story of Susan Long and I am sure the Minister and everyone in the House shares my sentiments. Accessibility is required in the health service and I admire the manner in which the Minister is approaching negotiations with consultants. For too long public services in this country have been controlled by people who benefit significantly financially despite shortcomings in the service given to patients, although many others do excellent work. Whatever happens in the negotiations with consultants, there should be no compromises that result in the patient being anything but the primary focus. People working in such areas of the health service must understand that it is not a nine to five office job. They must accept that if cover is not provided for essential public services around the clock, we will not meet the demands of patients.

I have heard the views expressed from the Opposition benches and the Government benches and this is a difficult debate to listen to. I come from the north west of the country where the Minister for Health and Children, Deputy Mary Harney, and the HSE have behaved very irresponsibly regarding the health care needs of the community I represent. I say this because this is a life and death issue.

A Senator on the Opposition benches mentioned a friend who moved to Dublin and was sent a BreastCheck application in the post. Such a facility is unimaginable to women in Donegal and those who travelled to areas where BreastCheck was available were refused the service. In the meantime, people are dying and that is why I used the language I used in this House, although it is regrettable that it is necessary. People are dying because cancers are going undetected.

In 2005, the Minister announced the radiation plan and, as part of it, she mentioned North-South co-operation on a satellite radiotherapy centre for the north west. Two years have passed and there has been no progress. Since the establishment of the Northern Assembly, I do not believe that the Minister has met the Northern Health Minister, Mr. Michael McGimpsey, to discuss the issue, yet time and again, Deputies and Ministers assure us it is in the pipeline. Senator Ó Domhnaill mentioned the people of Donegal and 15,000 took to the streets, and they demand action on cancer care facilities for the north west. These facilities include a satellite radiotherapy centre, the immediate roll-out of BreastCheck services and assistance for patients who must travel to centres of excellence.

I would like to hear the Minister address this issue and can assure her I will pursue it until there is a satisfactory resolution.

It is a great pleasure to be before this new Seanad. I am not yet familiar with the names of the many new Senators and may mix up some names and faces, but I welcome them all. I began my political career here when I was appointed in August 1977 and the Seanad met in October. I thought the first meeting day would never arrive, such was the sense of excitement, and I hope new Members felt a similar excitement. I see some former Members have returned. I will not say old Members because Senator O'Reilly would not like to be described as an old Member.

I am also pleased that there appear to be more women in the Seanad, although I have not checked the statistics. There are still too few, of course, but it appears to me that there are more women than in the previous Seanad, and that is a good thing. In any body that makes decisions a reasonable balance of women and men is necessary because women and men sometimes come to issues from a different perspective.

Health care is a major issue in every country, especially well developed ones like this. There is no country where it is not foremost in the minds of citizens and their representatives. Many of those who sat on the Oireachtas Joint Committee on Health and Children during the term of the previous Dáil and Seanad lost their seats. This included Senator Twomey, for whom I have a high regard and who made a significant effort in that committee, Paudge Connolly, James Breen, Senator O'Malley and many others. This may convey the message that the public does not appreciate its representatives spending a long time dealing with health issues. We had many meetings, some of which lasted between six and eight hours.

I particularly welcome Senator Fitzgerald, leader of the Opposition and of the Fine Gael group in the Seanad. I have known her for a long time and we worked together during the recent general election.

What passes for a health debate here concerns deficiencies in the service and negative points when people often say that if we only had more people and more money, somehow everything would be right. We have learnt, however, in the past decade that investing more money and significantly increasing the number of people in the service without reform will not deliver the kind of benefits people expect. Last year, the health service budget was increased by €1.2 billion, yet people talk about cutbacks.

To put the events of a few weeks ago in context, the Health Service Executive, HSE, is expected, like any other organisation, to live within the budget voted to it by the Oireachtas. Its chief executive officer, Professor Drumm, is accountable to the Oireachtas, which is unusual in State organisations. The legislation I brought through the Oireachtas provides that the chief executive officer should be the Accounting Officer because those who spend the money should be responsible and accountable to those who provide it. In time, this will be seen as a wise decision.

The decision on staffing will affect between 200 and 300 people out of a total of 120,000, but every day when I read the newspapers and listen to the radio I hear about all the patients who will be affected. To give one example, in Sligo, 30 nurses employed while permanent nurses took their holidays, as happens every year, will not be kept on when their temporary contract ends. There are 640 nurses in Sligo General Hospital. In respect of the four consultants let go, one locum was appointed to allow Dr. Healy, an orthopaedic surgeon, do his work on the Medical Council. He has since retired and a permanent orthopaedic surgeon was appointed in his place, so we are not going to keep the locum. Two locums were appointed to clear a long waiting list for ear nose and throat procedures, which they have done, so we will not continue to employ them. The last was an obstetrician-gynaecologist who retired. He was asked to stay on as a locum for a couple of months pending his replacement's start date, which he did. That is the truth about Sligo. I could repeat that example for other places throughout the country.

Those who think that this is all about money and staff need to think outside the box. Hospital managers need to manage their budgets. Senator Twomey mentioned a piece of equipment in Wexford County Hospital that is broken. I am not familiar with the details of the equipment or how much it would cost to replace it, but I wonder have people in Wexford been going to conferences, or travelling overseas to international gatherings. This is a question of priorities. Patients must come first.

We have the highest proportion of nurses to patients of any country in the world. For example, in France there are seven nurses per 1,000 patients. We have 12.2 nurses per 1,000. The EU average for the former group of 15 countries was nine per 1,000. Between now and June 2008 we are expected to take 2.9 million nursing hours out of the public health care system to meet the commitments we entered into some months ago during the nurses' dispute. The working week will be reduced from 39 to 37.5 hours on a cost neutral basis without any diminution in services to the patients. That is a challenge. If people say that the events of recent weeks will cause serious difficulties for patients, will we have the capacity, on a cost-neutral basis without any diminution in services, to reduce the number of nursing hours by 2.9 million?

We spend 8.9% of gross national product on health care. The OECD average is the same, yet only 11% of our population is over 65 whereas the OECD average is 17%. In Germany it is 27% and in the UK 17%. We spend moreper capita on health care than France or Britain. Based on purchasing power parity among OECD countries, we spend $2,596 per capita as against $2,500 across the OECD which comprises the world’s 30 richest countries. On capital spending we are top of the class with Norway, spending 0.6% of our national income annually.

Often we do not put matters in context. I was asked what I have been doing over the past two and a half years. I have been trying to turn this massive ship around. Unfortunately, one cannot flick it around. The public health service is a large organisation and we have sought to do the right thing. Today, for example, we took four steps to improve cancer treatment. We will ensure that one will get care in the right place, at the right time from the right person, no matter where one lives. That is not the case at the moment, with the exception of paediatric cancer, in which we are top of the class in Europe.

We do badly on other cancers because of the fragmented nature of our service delivery. There are doctors performing breast surgery who are not trained breast surgeons. They are general surgeons and the outcome is poor. People often say we must maintain the service here. We cannot provide triple assessment by a pathologist, a surgeon and a radiologist in every hospital in the country. No country has the resources to do that. Today we announced that 13 hospitals must cease breast surgery immediately because it is not safe. A parent with a sick child will travel almost anywhere to have the child cured, especially of cancer. The same applies to adults. Given a choice between the local hospital or a centre of excellence where one has a better chance of being cured, hardly anyone would fail to opt for the centre of excellence.

Many of these developments did not happen in the past because local institutional, professional and vested interests stopped them happening. Patients were not put first. Senator Healy Eames mentioned the west. A health board had responsibility for that region until two years ago. Many of the shortcomings she criticised were not addressed when local autonomy was vested in a health board comprised mainly of people from the locality, those who worked in the system and those appointed to the health board. The staff-patient ratios in the west are the highest in the country. That is the sad reality. The reform agenda involves doing the right thing, working differently and not just putting more money into working the way we always did because that will not deliver results.

We would have had a consultants' contract two years ago if I had said yes but the test for this contract is that one has equal access to our publicly funded health system whether one is a privately insured patient, has one's own resources or has neither. There should not be a situation, such as arose in Kilkenny, when a woman was told that if she had private health insurance, she could have access to diagnostics immediately, but because she had not, she would have to wait six months. These facilities are funded by the taxpayers and nobody should have preferential access to them. That has been the main difficulty in agreeing a contract of employment.

Those who criticise co-location should re-examine what happens in public hospitals, many of which are hives of private activity in which if one has private health insurance, one group of employees, namely, consultants receive fees, while neither nurses nor anyone else does so. One group of citizens, that decides who is to be admitted to hospital, receives a fee. It is a no-brainer for someone to tell me it is preferable to continue doing this, to have the National Treatment Purchase Fund deal with public patients while letting the public hospitals deal with private patients only.

Those facilities to be funded by the private sector will provide private facilities on site. This is much better than the present practice of converting publicly-funded beds to private beds. A total of 20% of all beds in our hospitals are designated as private beds for insured patients only or for those who can pay for themselves, and I do not consider this to be fair. It is reasonable to convert such beds to public beds to which all have access and to tell private providers to provide the private facility. For example, such a private facility must make services available to the public hospital at a greatly reduced rate, must share diagnostics with the public hospital if it makes sense and must pay for the diagnostics. This makes eminent sense.

While Fine Gael has always supported private investment in health, it seems to take the view it is acceptable to locate a private hospital five miles away but not five yards away. A total of 700 doctors have category two contracts, 650 of whom are in Dublin. They can work in any number of hospitals and some of them work in three or four hospitals. I want to keep them on site and working in the public hospital for the benefit of all the patients. In addition to converting private beds for public use, this is the main reason the Government supports co-location.

As for beds and their use, I refer to Professor Keane's appointment. He comes from British Columbia, Canada, having been educated in Ireland, and has a highly distinguished track record. He has informed me that British Columbia, which has a population of 4.1 million people, has ten radiotherapy beds. Ireland, which has a population of 4.4 million people, has 179 radiotherapy beds. The most expensive bed in any country is a hospital bed and one could obtain a suite in any hotel in this city for less than the price of any acute hospital bed. Clearly, people should only occupy acute hospital beds if they need them and not otherwise. Therefore, many patients will be treated on an ambulatory basis or in hostel-type accommodation. This is more cost-effective and efficient. Members must recognise that Ireland must learn from best practice, whether it is from Canada, the United Kingdom, including Northern Ireland, or wherever. We should not close our minds to the idea of combining hostel or hotel-type accommodation with hospital treatment as some of the best cancer centres in the world do so.

The issue of regional or local hospitals was mentioned in respect of what will happen in different places. Essentially, the Hanly report pertained to ensuring the provision of consultant-delivered services nationwide. At present, if one turns up at most hospitals at this hour of the evening, one will be seen by a junior doctor. This is not good as to be seen by someone with the title of doctor does not mean one is being seen by the right person. The Government wishes to ensure when one turns up at an accident and emergency department, especially if one is a serious case, one is met on one's arrival and dealt with by a qualified person. As all Members are aware, the sooner one is seen by the right person, the better the result, particularly when one is a trauma case.

Recently, a consultant in Dublin informed me of a new blockbuster drug for strokes. Apparently, it must be administered within three hours of suffering a stroke and not all patients are suitable for it. The drug can induce a brain haemorrhage if given to the wrong patient and only a highly qualified person can administer it. If one went to the wrong hospital and spent an hour or two there, it might be too late by the time one got to the right place. I provide this as an example.

We must begin to introduce such practices in a safe way. Safety and quality must be our guiding principles when it comes to choosing where services are provided. More things will take place in smaller hospitals and more local people will be treated in many such hospitals because, at present, sometimes they go into the major centre unnecessarily. Equally, however, some cases will go to the major centre rather than the smaller hospital because the former is the more appropriate place. I ask Members to be flexible, open-minded and innovative in respect of matters such as putting patient safety first. The correct decision will be made if this is done.

As for bonuses awarded in the HSE, the principle of performance related pay has long been a hallmark of public sector pay and to the best of my knowledge, it has received great support from all parties. It was introduced many years ago and both the review group on higher pay and the benchmarking body support it strongly. Staff in the HSE have been employed on the basis of a particular contract on foot of which they receive X salary and Y bonus. I do not believe the suggestion made by some people that such practices should now be stopped suddenly constitutes good industrial relations practice. Rather, I consider it to be a cheap shot. Undoubtedly, Professor Drumm would earn a great deal more were he to work as a paediatrician in this city. He is not especially interested in money. When Dr. Halligan declined the post of chief executive officer of the HSE, I spoke to a number of people to ascertain whether they would be interested in the post. I was amazed by the numbers who replied they earned in the region of €800,000 or €1 million. I refer to those who I believed genuinely would be in the ball park. It is not unreasonable to pay the kind of salary and bonus received by Professor Drumm if one is to be in charge of a budget that is as large as €15 billion and of staff numbering 120,000 people.

The rolling out of population screening cannot be done overnight. One cannot press a green button and state that one has provided population screening for all the groups that are to be screened. It must be done on a phased basis and I know of no country that has done it. While I welcome this debate, we must back the reform agenda. There is no other way to achieve the health service to which all Members aspire and that I believe can be achieved other than if we continue to have the courage to introduce the changes under way at present.

I thank the Minister for her reply and her presence. She will not find this side of the House lacking when it comes to supporting her reforms. Our problems are not with her announcement today regarding the centres of excellence but with the delay in their announcement and the fact that Professor Higgins's report stating such centres were necessary was on the then Minister for Health and Children's desk seven years ago. As a number of Government Members have acknowledged, issues arise in respect of transport, families who are obliged to travel long distances and the timeframe regarding such specialist centres.

I am pleased the first Private Members' motion in this House pertains to health because it is the key area in which Members must examine and, as the Minister stated, push reform. The Minister will agree there is no room for complacency. She could not be complacent as Minister for Health and Children while listening to the contributions made by Members from Fine Gael, the Labour Party, Sinn Féin and all parties regarding the geographical inequities throughout the State. This constitutes one of the most striking and sad features of our health service and was strikingly illustrated by Senator Healy Eames when she talked about Galway. BreastCheck is simply not available to women in Galway unless they opt for private treatment. Other colleagues spoke of the inequities in the services located in counties Donegal, Waterford and Cavan. I do not simply refer to breast cancer treatment but to treatment in general, such as, for example, radiotherapy in Waterford. The geographical inequities highlighted pose a serious challenge to the implementation of the Minister for Health and Children's reform agenda, notwithstanding Fine Gael's acceptance of the need for specialist services, about which no Member on this side of the House would disagree.

Having listened to the debate, the Minister will agree there is no room for complacency regarding the reality of the shortage of frontline personnel. There are waiting lists for neurology which are completely unacceptable and life-threatening. I saw a letter the other day which stated that a child and adolescent psychiatry service was closing for two years. Parents can not get children assessed. All around the country the personnel are not in place. Some of my colleagues spoke about the lack of general practitioners in certain areas. Others spoke of the lack of dentistry service. I could continue, as the Minister knows.

There are serious issues. Senator Donohoe raised the question, why, with such an increase in budget and staff, are we encountering the type of problems that one would not expect from a health service in an economy such as ours? While we will not answer all of the questions that were raised here tonight, they deserve further debate in this House as the reform agenda in the health area progresses.

We tabled this motion because of our broad concerns about the health services, but also because of the recruitment freeze. Concerns were expressed by some here tonight that this freeze may continue until January. The Minister did not address it in her spoken comments, but in her written comments she stated that there would be a review of the freeze on 1 October. We hope that it will be lifted and we look forward to hearing whether it can be. It is important that it is lifted.

The Minister was not complacent about it tonight but, while she addressed the issue in Sligo, she did not address the wide range of concerns which were expressed by patients, medical staff and nurses about the effect of the current cutbacks. If people are to get the kind of services of which we spoke tonight and which people in Ireland deserve in this century, it is essential that the freeze is lifted on 1 October. With the kind of resources available in the country, we should not see a freeze three quarters of the way through the year. A number of my colleagues have questioned the introduction of the freeze so late in the year. It raises questions about management and it seems fair to raise those tonight. Those are our reasons for making the health motion our priority tonight. I commend the motion to the House.

Amendment put.
The Seanad divided: Tá, 26; Níl, 19.

  • Boyle, Dan.
  • Butler, Larry.
  • Callanan, Peter.
  • Cannon, Ciaran.
  • Carty, John.
  • Cassidy, Donie.
  • Corrigan, Maria.
  • Daly, Mark.
  • de Búrca, Déirdre.
  • Ellis, John.
  • Feeney, Geraldine.
  • Hanafin, John.
  • Harris, Eoghan.
  • Kett, Tony.
  • Leyden, Terry.
  • MacSharry, Marc.
  • McDonald, Lisa.
  • Ó Domhnaill, Brian.
  • O’Brien, Francis.
  • O’Donovan, Denis.
  • O’Malley, Fiona.
  • O’Sullivan, Ned.
  • Phelan, Kieran.
  • Walsh, Jim.
  • White, Mary M.
  • Wilson, Diarmuid.


  • Bacik, Ivana.
  • Bradford, Paul.
  • Burke, Paddy.
  • Buttimer, Jerry.
  • Coffey, Paudie.
  • Coghlan, Paul.
  • Cummins, Maurice.
  • Fitzgerald, Frances.
  • Hannigan, Dominic.
  • Healy Eames, Fidelma.
  • Kelly, Alan.
  • McCarthy, Michael.
  • O’Reilly, Joe.
  • Phelan, John Paul.
  • Prendergast, Phil.
  • Regan, Eugene.
  • Ryan, Brendan.
  • Twomey, Liam.
  • White, Alex.
Tellers: Tá, Senators Déirdre de Búrca and Diarmuid Wilson; Níl, Senators Maurice Cummins and Phil Prendergast.
Amendment declared carried.
Motion, as amended, put and declared carried.

When is it proposed to sit again?

At 10.30 a.m. tomorrow.