I congratulate the Minister, Deputy Martin, on his re-appointment and welcome back Deputy Pat "The Cope" Gallagher and congratulate him on becoming a Minister of State.
In line with the recommendations of the report of the subgroup of the National Cancer Forum, the Southern Health Board is to develop two individual symptomatic breast disease centres of excellence at the South Infirmary and Cork University Hospital. There is widespread concern in Kerry about this decision, especially among women and GPs throughout the county. Women want a service as close to their homes as possible. At the moment, if a lump is detected by a GP on a Friday, the individual involved will be seen in the clinic in Tralee on the Monday morning. There is a very quick reaction time and women feel confident that if a lump is detected, it will be seen to immediately. However, if the service is not provided in Tralee General Hospital, it will mean women having to make appointments in Cork, which can sometimes take weeks. In view of this and given experiences of other areas of surgery, there is genuine concern.
There are five weekly clinics for breast care at Tralee General Hospital, including on Monday mornings, which is very important. Recently, more than 300 people picketed the main meeting of the Southern Health Board at the county council offices in Tralee. They expressed their concern about any diminution by the board of the breast cancer services at Tralee hospital. During their protest and at a subsequent meeting, those involved made it clear that they want the services upgraded and improved and not reduced.
At present, Tralee General Hospital provides all the mammography, biopsy, chemotherapy and consultant services. The breast clinic at the hospital is on a par with the type of centre of excellence proposed for the two hospitals in Cork. In addition, patients can get same day results, immediate diagnosis, and they can be assured that they have nothing to worry about. That can also be very consoling for their families.
From 1 January to 31 December 2001, 1,187 women attended the breast clinic for investigation at Tralee General Hospital, which illustrates its success. It also demonstrates the confidence women in Kerry have in the clinic and the clinic's personnel, including the nurses and consultants, who operate it. Eighty of these women were diagnosed early with cancer and are receiving treatment. Last year, I understand the surgeon carried out 40 operations in the hospital and since 27 January, 574 repeat visits were made to the clinic. Some 232 new patients have been seen since then, of which 21 were diagnosed with cancer. Consultants and GPs maintain that had this service not been available, the women in question would not have been seen as soon and, as is the experience of any Kerry patient seeking treatment in Cork, they would have had to join a waiting list at which point diagnosis may be have been too late.
I am pleased the Minister is present for this debate. I call on him to direct the Southern Health Board to designate Tralee General Hospital as a centre of excellence for symptomatic breast disease care. The Minister's colleague, Councillor Paul O'Donoghue, asked for a review of the designation of the two centres of excellence in Cork. At the last Southern Health Board meeting, he said that north Cork and parts of east of Cork could be seen as part of the Tralee General Hospital catchment area, with a centre in Cork and Kerry. He also raised this matter at a recent county council meeting and it is worth consideration.
The service in Tralee needs an immediate injection of funding to ensure that an extension of services at the oncology unit can commence, including the provision of counselling services, which is very important. Kerry patients do not want to go through the trauma of travelling to Cork, resulting in psychological stress and major inconvenience to their families.
Mr. Martin: I thank the Deputy for raising this issue. The planning, organisation and management of services at Tralee General Hospital is, in the first instance, a matter for the Southern Health Board. The Deputy is aware of the history of this issue. The report of the sub-group of the National Cancer Forum, Development of Services for Symptomatic Breast Disease, was published in March 2000. It set the 13 centres of excellence that should be established across the country. Rather than politicians making the decisions, it was clinicians and people with expertise in the area of oncology and breast cancer who made these recommendations, and they did so on the basis of survival rates. We should always remember as we debate this issue that the bottom line is what we can do to organise our cancer services to get the best survival rates for women. I know that is the concern of all and, as conveyed to me by the National Cancer Forum and the sub-committee, that was the fundamental issue that concerned them.
The report referred to the establishment of a network of specialist breast units across the country – 13 in all – and the appropriate infrastructure, personnel and equipment that was needed for them. It also made recommendations on the siting of the units. I accepted the recommendations and as breast cancer remains a major public health issue, I am committed to ensuring that quality services are developed for symptomatic breast disease.
The report recommends that women with breast disease are best served by a team of specialists working together and that women experience better outcomes if their cancer is managed in centres along the lines of the recommendations of the sub-group. The report advised that, based on the population in the board's functional area, it is appropriate that two centres of excellence be located in the south. The Southern Health Board's own proposals for the development of symptomatic breast disease services are informed by the report's recommendations. Accordingly, and in line with the recommendations of the report, the board agreed to develop two individual centres of excellence, located at South Infirmary-Victoria Hospital and Cork University Hospital. The centres will function as one unit with regard to audit, data, collection, protocols, teaching and quality assurance. On a day to day level, two individual teams of clinicians and specialist nurse working independently in the two hospitals will carry out the clinical management of patients with symptomatic disease.
With regard to oncology services in Tralee General Hospital, the current services are being maintained. When this report was published we gave a commitment to people in Tralee and to local public representatives that we would not downgrade or run down the existing services there. That commitment still stands. It was requested at the time by public representative and members of the Southern Health Board from the Kerry area.
A dedicated oncology unit in Tralee General Hospital was established in 1999 operating five days a week and staffed by an oncology nurse specialist and three staff nurses. This unit functions as an integral part of the cancer services in the Southern Health Board. The specialist nurses in this unit co-ordinate the treatment of patients, manage side effects from cancer and chemotherapy and provide information and psychological support for patients and their families. It also co-ordinates care of patients attending other centres of chemotherapy and provides local support for patients and their families.
The medical supervision of the oncology services provided at Tralee General Hospital is the responsibility of the consultant medical oncologist at Cork University Hospital, who attends Tralee General Hospital twice a month. In addition, there are plans for a medical registrar to attend at the unit twice a month from July onwards. A palliative care consultant is due to take up a post on 25 November 2002 and a dedicated social worker is also being recruited. It is anticipated that this post will be filled by September 2002. Those appointments will lead to an enhancement of services at the hospital.
I appreciate the concerns of the women of Kerry and the Deputy. The only motivation is to get our cancer services in the region up to international standards in terms of outcome and survival rates. That is the bottom line. The medical personnel across the region of Cork and Kerry are working together and are co-operating to try to ease the situation for patients in terms of convenience, which is important, and the trauma that can often result from having to travel and so on. They are also trying to arrange protocols to facilitate that.
We in this House and elsewhere have an obligation to ensure that we keep focused on the big picture, which is to try to improve survival rates and to get the best cancer service we can in place gradually. We have made some progress over the last five years with the allocation of approximately €100 million in funding and the appointment of 62 cancer consultants, but we have a long road to travel in terms of proper, expanded oncology and radiotherapy services, etc.
I thank the Deputy for his compliments on my re-appointment as Minister. I will focus strongly on outcomes and survival rates. I give him a commitment that there will be no running down of the services at Tralee General Hospital – rather, they will be enhanced. That will be the philosophy underpinning my work over the coming years.