Catherine Murphy (Kildare North, Independent)

I begin by acknowledging that many public patients receive first-class care. Many are eager to tell me of the professionalism and kindness they encounter. We must concentrate on those who are not lucky enough to be able to say that. What is required is a plan to provide equality of access.

A member of my immediate family had reason to test the quality of the public hospital system within the past 18 months when he was diagnosed with cancer and underwent surgery at Connolly Hospital and chemotherapy at Beaumont Hospital. While he now enjoys an optimistic outcome and was very satisfied with the care he received, it was impossible to ignore the difficult environment in which the staff who tended him, in Beaumont Hospital in particular, must operate while attempting to deliver a quality health care service.

Given that our population is growing and aging and that the incidence of cancer is set to increase significantly, it is difficult to reconcile the available services against what is needed in the future. It is even more difficult to reconcile the transfer, for example, of 20,000 cancer patients annually to St. James's Hospital from St. Luke's Hospital, which is due to occur by 2010 under the cancer care strategy. There is an existing problem inSt. James's Hospital that cannot simply be ignored.

While there are many strategies, plans and theories, the issue at point is what happens in practice. There is no point having a good strategy if the delivery does not match the intention. There may be good arguments for providing a total package of care, including surgery andfollow-on treatments, in one location. However, the holistic approach in treating patients in St. Luke's, including the subsidiary services paid for out of public donations, will be absent when that transfer occurs. There is genuine upset among patients at this prospect.

We all acknowledge the need to secure the best possible outcome for patients. The problem is that the difference between plans regarding services at St. James's Hospital and the stories shared courageously by people through such fora as "Liveline" is the difference between hype and reality. There is serious evidence of a significant difficulty with the service at this stage, let alone in the future when we will lose some capacity in the system.

It used to be the case that one used private health insurance to pay for a private room in a public hospital. That is no longer the case. The availability of health insurance did not result in improving the life chances of those lower socioeconomic groups who rely on the public health system. The survival rate is still better where patients can pay for their care.

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