Dr. Michael McCarthy:

While I am not directly involved in the campaign it is a common problem across the country. In the north-west region we also have satellite units, in Castlebar and Portiuncula. One of the big challenges we do not have good solutions for yet is that medical oncology and radiation oncology and surgery are increasingly becoming more sub-specialised, because the pace of change in what the standard of care should be for different types of cancers is changing quickly. One of the concerns is how we make sure the patients from County Kerry or Dingle get access to that same level of expertise in terms of decision making as people who are living in Wilton in Cork. That is a real challenge. We have strong multidisciplinary teams set up around different cancer types and linking in peripheral sites with one of the designated cancer centres is critical. We cannot have a designated cancer centre in every county and the national clinical programmes, NCP, model of care so far has been to build up the expertise in the designated cancer centres and then those consultants travel to other sites. It often comes up as a question when a hospital becomes busy enough, when is the tipping point reached that permanent on-site expertise is more appropriate. It is a commonly-asked and good question.