Dáil Éireann díospóireacht -
Thursday, 30 Nov 2000

Vol. 527 No. 2

Adjournment Debate. - Hospital Services.

Mr. Deenihan

I am happy to acknowledge the presence of the Minister for Health and Children to answer this matter.

There is serious concern in County Kerry about the rumoured downgrading of the breast cancer clinic at Tralee General Hospital. This concern results from a report by Professor Niall O'Higgins which recommends the creation of a number of specialised breast cancer treatment centres throughout the country. It is feared that Cork University Hospital will become the treatment centre for Kerry patients. The development of breast cancer centres is highly desirable but not to the detriment of services at Tralee General Hospital.

Since the breast cancer clinic was established in Tralee in the early 90s it has provided excellent treatment for 50 patients, on average, every year. The numbers, unfortunately, are growing. These people have, in general, done better than patients at other centres. The back-up services including mammogram X-rays, breast care nursing and physiotherapy are of the highest standard. In addition there is an oncology ward where patients may complete their chemotherapy.

More than 500 women are screened ever year for breast cancer in Tralee General Hospital and up to 50 patients undergo treatment, with very positive results. The inconvenience which would be involved for many patients travelling long distances from places such as Ballydavid, Valentia or Tarbert to attend clinics in Cork or Dublin is so prohibitive that some women may delay seeking advice and diagnosis and leave it too late for effective treatment.

The Department of Health and Children should develop a nationwide protocol for the treatment of breast cancer combined with video conferencing and computer link-ups, which would enable each centre to provide the optimum treatment for each patient. I understand the specialist group which was set up to develop breast cancer services met with the Southern Health Board but did not meet any of the women who were successfully treated in Tralee General Hospital. This is a source of regret to many of the women who could have outlined the case for Tralee General Hospital. Any of these women could have made a constructive contribution to the expert group.

The prospect of travelling to Cork for treatment is a source of considerable distress for many women. When your life is under threat from this dreadful disease you need not only the best medical care available but also the support of family and friends, and not the extra trauma of isolation far from home. Kerry women want the option of staying close to their families and friends and they have absolute confidence in the treatment facilities and the medical personnel at Tralee General Hospital.

I quote an extract from correspondence sent to the Minister and which I received recently. This letter from a woman who experienced breast cancer reinforces my argument that the services in Tralee should not only be retained but expanded. She writes:

In my place of work, from a workforce of 100, I and two of my colleagues have suffered from breast cancer over an 11 month period. So, unfortunately, I have intimate experience of the physical and psychological trauma endured by sufferers. The breast clinic at Tralee General Hospital has been constantly there for me and I credit it and the wonderful people who work there as my saviours.

I speak for all Kerry people when I call on the Minister to provide extra funding to enable the services to be expanded at the breast cancer clinic at Tralee General Hospital and not to downgrade it. I make this appeal on behalf of the victims of this deadly disease which, unfortunately, appears to be on the increase.

Minister for Health and Children (Mr. Martin)

I thank the Deputy for raising this issue and I am glad of the opportunity it affords me to inform the House of the current position in relation to breast cancer services at Tralee General Hospital. The overall objective of the cancer strategy and of the breast cancer sub-group is to improve outcomes for women all over the country and in Kerry. The provision of medical services in Tralee General Hospital is a matter for the Southern Health Board.

At my request the national cancer forum established a sub-group to examine the provision of services for women with symptomatic breast disease. The sub-group was asked to assess the impact on the existing diagnostic services for benign and malignant breast disease in the light of the national breast cancer screening programme, the increase in the target population, the increased awareness of the importance of breast screening and the current and evolving technologies in the area of breast screening. The sub-group was also asked to make recommendations to me on the diagnostic services for symptomatic breast disease necessary to meet projected increased needs; the need to develop associated services in radiotherapy, medical oncology, counselling and other support services and the resources required to develop these services and the principles that should underlie the organisation and delivery of services for breast disease.

As part of the work of the sub-group, the regional directors of cancer services were asked for information concerning their current service and their views were sought regarding how the service should be developed in their regions. In addition, three members of the sub-group visited each region. The consensus view regarding best practice in the management of breast disease was presented to regional representatives and their views on how this could be achieved in their regions were sought.

The sub-group found that although services should be delivered as close to the patient's home as is feasible, the overriding priority should be to provide the best, safest and most effective treatment for women and in so doing, provide the best opportunity for long-term survivial to those who are found to have breast cancer.

I have received a report of the sub-group on the development of services for symptomatic breast disease. No final decisions regarding implementation arrangements at health board level have been taken. I established an advisory group under the chairmanship of Professor Niall O'Higgins to assist the health boards in formulating their plans for the development of services for symptomatic breast disease.

The Southern Health Board has advised me that the general hospitals committee meeting of the board scheduled for 7 December 2000 will hear a presentation on the report of the sub-group of the cancer forum. The presentation will be given by Professor Paul Redmond of Cork University Hospital who is the new chairman of the national cancer forum and is the regional director of cancer services in the Southern Health Board region. I understand Professor Redmond will outline the important role Tralee General Hospital has played and will continue to play in the future as it is intended that Tralee General Hospital will be integrated into the overall breast cancer services.

The committee members will have an opportunity to consider in detail the proposals for this new service in the Southern Health Board region. There are no proposals either to cease or reduce in any way the existing services provided at Tralee General Hospital.

I understand the Southern Health Board proposals to develop a quality and integrated service for the women of Cork and Kerry are being drafted and, following consideration by board members, will be forwarded to my Department.

I will keep a close eye on this matter and will work with the board to make sure we have a consensus resolution of these issues. The board's objective is to enhance services for women in the Southern Health Board area. I ask people to concentrate on this aspect of the proposals. Nothing will be taken from an existing service in any general hospital.