Marc MacSharry (Fianna Fail) | Oireachtas source

I welcome the opportunity to speak on this matter. Will legislation be required to transpose the directive and, if so, what will be the implications thereof? I apologise in advance if I will not be present for the Minister's reply but I will check the Official Report.

Given the co-operation that exists on so many other levels, it stands to reason that we should co-operate on health care. I recently dealt with a Bundoran-based patient who went to a hospital in Fermanagh after being injured and was issued with a substantial bill for the treatment. We have been liaising with the authorities there to deal with the issue. I presume the directive will allow issues of this nature to be resolved.

However, while we are all for co-operation and maximising the potential for better outcomes throughout the European Union, the politics of medicine is akin to the level of chicanery associated with these House in terms of horse-trading and competition among institutions to be the best performing or handle the most procedures. I am also conscious that successive Governments have avoided investing in certain parts of Ireland due to resource issues, particularly over the past ten years. I refer in particular to cancer and cardiac care. Governments have taken refuge in our proximity to our Northern cousins and the Queen's generosity. In my area, Altnagelvin hospital in Derry and the new hospital in Enniskillen are expected to somehow solve our resource needs through cross-Border co-operation. The North-South Ministerial Council is supposedly getting along very well and everything is said to be moving in the right direction. The reality on the ground is that if somebody in Glencolmcille needs radiotherapy, he or she will go to Galway or Dublin. Even if such a patient went to Altnagelvin, he or she would be required to travel a considerable distance. As there is no cardiac catheterisation facility in the entire region and there is no plan to provide one, the new approach to cardiac care does not apply to my part of the country. The only treatment available is thrombolysis, which does not have the same potential to save lives as 24-7 cardiac catheterisation facilities and cardiologists. I do not think anybody denies this. It is not feasible for the north west of the country to have the Mayo Clinic or even St. James's Hospital in Letterkenny, Sligo, Ballyshannon or Tory Island but it is reasonable to expect a scaled-down version of those facilities, including cardiac catheterisation and laboratories, within a commutable distance of three hours. There should at least be potential for achieving the goals of the national cancer control programme, which is centrally developed and locally delivered. Patients could get diagnosis and treatment in the centres of expertise in St. James's, Beaumont and, to a lesser extent, Galway and Cork but we could provide radiotherapy satellite facilities along the lines of the system that the former cancer tsar Professor Tom Keane helped to develop in northern Canada. The town of St. George in Canada has a similar catchment to that of Sligo. If one is being treated in the Beacon Clinic in Dublin for a particularly complex head cancer, its specialists will consult colleagues from sister hospitals in the United States for assistance in deciding what level of radiotherapy to apply. They can look at the scans and suggest doing X or Y. We need to aspire to the roll-out of radiotherapy and cardiology treatment plans which take cognisance of all people in Ireland, not only those who happen to back up the statistical success of a particular clinical programme. The parts of the country that Senator Harte and I represent have unique concerns, but the clinical programmes have only paid lip service to Sligo and Letterkenny.

Altnagelvin is committed to developing a centre for radiotherapy but its cardiac catheterisation facilities remain unused because it does not have sufficient cardiologists. We need to provide a cardiology service to my region that offers people living there the same potential to survive as those in other parts of the country. We are not looking for the five cardiologists necessary for centres of excellence. A similar nine-to-five service to that provided in Limerick might suffice. Equally, we need to develop a plan to provide the operators and back-up resources needed for linear accelerators for the application of radiotherapy. The treatments could be determined based on levels of prescription in the centres of expertise and delivered in a central part of my region. We do not need to revisit pre-election promises, but we must acknowledge that citizens live in this part of Ireland and will continue to do so. They will require a level of service and some Government will have to provide it. Why not this one? I will continue when Minister is finished laughing with his representative.

I am probably being repetitive but we cannot overstate this issue. The Minister was a junior doctor in Sligo General Hospital. While I appreciate that some of the points I am making may be humorous, my aspiration is genuine and achievable. Under the guidance of expertise in cardiology and other disciplines, treatments such as radiotherapy and stent insertion could be provided in this part of the country. The reality is that the business case for doing so will never stack up.

According to the guidance of so-called experts in cardiology and other disciplines some treatments, such as radiotherapy or stem provision, could be provided in those parts of the country, but the business case for it will never stack up. If it were up to the likes of the National Centre for Pharmacoeconomics, or if it must specifically stack up economically, there is no doubt, and I am sure Senator Harte would agree, the west of Ireland would be shut down. Electricity and water would probably be cut off around Mullingar.

I would like to see this transposed in a way which would mean good co-operation in areas such as cardiology and radiotherapy where there are no up and running systems in Fermanagh or Derry. We in the South should not seek to take refuge in spurious plans to put such services in place and instead put in place a plan for ourselves in this jurisdiction, and perhaps be prepared to share it, which may enhance the business case. It still would not be economical but the lives of the people of Donegal, Sligo, Leitrim, Cavan and the rest of the area are no less important or valuable than those in Dublin 2 or Dublin 4.