Brian O'Shea (Waterford, Labour)

The net total Estimate for the Health Service Executive in 2007 is €11.183 billion. My confidence in the executive and in its relationship with the Minister for Health and Children has been shaken in recent times. On 26 October 2006 I raised the issue on the Adjournment of the urgent need for the State to provide for the treatment of public cancer patients at the Whitfield Clinic, Waterford.

The final sentence in the reply of the Minister for Health and Children was, "I share Deputy O'Shea's view that we will be able to procure services at the Whitfield centre for patients from the Waterford region in advance of our investment opening there in 2011." The assistant national director of the HSE's hospitals office stated last Monday that public patients from the south east should be able to access radiotherapy in Waterford early in the new year. I cannot reconcile these two statements.

On 25 July 2005 the Minister for Health and Children announced the Government's approval for a national network of radiation oncology services to be put in place by 2011. Part of the network was an integrated satellite centre in Waterford. The capital cost of the national network for radiation oncology will be in excess of €400 million approximately, most of which, according to the Minister, will be funded through public private partnerships.

The Minister also stated at the time that one third of the population will suffer some form of cancer at some stage in their lives. Over half of all cancer patients should receive radiation oncology as an integral part of their treatment. The national network will achieve that objective by 2011. The Minister further stated in reply to the matter I raised in the Dáil on 26 October 2006 that the HSE has her full support in procuring quality services for patients from private not-for-profit independent providers or from the public sector. What all that boils down to is that treatment for public patients can be provided in Waterford once there is a service agreement with the HSE.

In reply to a letter which I sent to the Minister on my own behalf and that of the Labour Party councillors in the Waterford constituency regarding the provision of radiotherapy services for public patients at the University of Pittsburgh Medical Center at the Whitfield Clinic in Waterford, I was informed that the Health Act 2004 provided for the Health Service Executive and, under the Act, the executive was required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. The reply further stated that responsibility for the provision of funding rested with the executive and that a copy of my correspondence had been referred to the chief executive officer of the HSE who would arrange for the matters raised to be investigated and a reply would be sent to me directly.

On Monday morning the assistant national director of the HSE's hospitals office announced on national radio that he needed to clarify that up until the middle of September the National Hospitals Office had received no contact from the Whitfield Clinic and that the HSE did initiate the contact themselves. In response to this, the University of Pittsburgh Whitfield Cancer Center issued a press statement qualifying the situation in regard to access to radiotherapy for public patients. Mr. Michael Costelloe, managing director of UPMC Cancer Centres International, operators of the cancer centre developed in partnership with the Irish health care firm Euro Care International said on Monday that there had been a clear commitment from the outset that the facility in Waterford would be open on an equal basis to all patients from the south-east region who needed it, irrespective of whether their treatment was funded by private health insurers or the HSE, and that contrary to what had been stated by the assistant director of the National Hospitals Office there had been repeated contacts between the project team at UPMC Whitfield Cancer Center and various HSE personnel from 2004 onwards. While Mr. Costello was not involved at that stage there may well have been initial contacts in 2003 when details of the project were first outlined by the original proposers. The then CEO of the South Eastern Health Board, Mr. Pat McLoughlin, visited the UPMC headquarters in Pittsburgh in October 2004 on a fact finding mission. Senior personnel from UPMC met the Minister for Health and Children, Deputy Harney, in Dublin in February 2005 to discuss the issue of how public patients could access treatments that were not available in Waterford and the south east.

In April 2005 a medical and technical group from the HSE south-east region visited Pittsburgh to view the UPMC facilities. In May 2005 at the sod turning at the Whitfield clinic it was emphasised again that the facility would be open to all. This was confirmed to the Taoiseach and the then Tánaiste at meetings in September 2005. Mr. Costello wrote to Professor Brendan Drumm, chief executive, Health Service Executive, on 14 February 2006, officially advising Professor Drumm that the centre would open later this year and stating the eagerness of UPMC to treat public patients. Even though Professor Drumm's office responded shortly afterwards stating the matter had been referred to the director of the HSE national hospitals office, there was no contact from the national hospitals office with UPMC. On 15 March 2006 Mr. Costello met with the HSE south-east network manager in Waterford and presented him with a copy of his proposal which had already been delivered. This was followed up by a letter a fortnight later.

What I find absolutely incredible is the apparent massive lack of communication within the HSE on major health issues. That this could occur within a very large organisation charged with delivering health and personal social services to the citizens that is to receive €13 billion gross in 2007 is a major indictment of the Minister for Health and Children and of the HSE.

How is it possible to have confidence in either the stewardship of the Minister or of the HSE in regard to the provision of vital services for up to 1,000 patients per annum in the south-east region, many of them extremely ill? I demand to know what the Minister intends to do urgently about acquiring radiotherapy in Waterford for public patients in the south east. Excuses are raised about national guidelines for radiotherapy services but it is the lack of response by the HSE to UPMC and the non-provision of funding that is really to blame. I trust there is sufficient funding in the 2007 HSE south-east region budget.

I shall refer to some of the areas surrounding my brief, particularly community affairs. Under the heading of improved co-ordination of local and community development services there is a cut of 49% in this year's Estimate from €4.2 million last year to €2.2 million this year. The improved co-ordination of local and community development services was a much heralded aspect of this new department. I see no evidence that objective has been achieved. Is the Government giving up on this issue by reducing the budget and moving away from it?

On the drugs initiative, the young peoples facilities and services fund has not been increased this year, which an allocation of €43 million this year and €43 million next year. Given the funding is at a standstill and not keeping pace with inflation, one would think the drugs problem had reached a point where the solution is at hand. Members on all sides know that is far from the position. A television programme last night indicated there is a need for a great deal more spending on prevention, medical services and so on. The country is awash with heroin. There is a culture out there that believes that cannabis, which is widely used, is not a harmful drug. There are similar views in regard to the use of cocaine. A worrying trend is the use of cocaine for leisure purposes by the middle class.

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