Mary Harney (Dublin Mid West, Progressive Democrats)

——is not acceptable. Take, for example, breast cancer. In 2003, about 76 surgeons performed operations for this condition in 35 hospitals around the country. Some 39 of the surgeons operated on less than five cases in a whole year. We know from international experience that such a low volume of surgery is dangerous, the survival rate is poor and the outcomes are bad. As we seek to change that, which is what patient safety is all about, we are being loudly condemned by the Opposition, from which we have had not a single voice of support. We know, too, that with 53 acute hospitals serving a population of 4.3 million, we cannot safely provide the range of acute services that is required in every single one of them. Therefore, we have to make decisions, governed only by what is in the interest of safe patient care and how much of it can be provided as conveniently and locally as possible. That is what is determining the health reform agenda.

I frequently hear calls in this House for the old health board regime or something similar to be put back in place. Most of the criticisms heard this evening occurred under the watch of the old health board system, including the experiences at Leas Cross. It is certain that if we do not have a single entity such as the HSE, responsible for the delivery of the health care system for a population of 4.3 million and accountable to the Oireachtas for the money it gets — unlike the former health boards which were accountable to the then Minister for Health for how they spent the money even while they were responsible for delivering the service — there will not be good management, appropriate delivery of services or responsibility.

The reality, if we really want to be governed by patient safety considerations, is that we have to make tough decisions. Those decisions are being made and I look forward to receiving support for them over the coming months, in the light of tonight's motion.

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