Mary Harney (Dublin Mid West, Progressive Democrats)

Within the health system I meet well motivated individuals from different specialties and each one tells me we need so many beds for each specialty. If I added them all up, we would need to double the number of beds we have in the system. We cannot adopt a piecemeal approach. We must work on the basis that everybody works together to deliver the service and that the system responds to patients when needed. This is particularly the case at weekends, for example, with regard to care of the elderly.

The focus now is on trying to strengthen primary, community and continuing care, which gets 65% of the health budget, despite the fact that hospitals tend to form the biggest part of public debate. Primary, community and continuing care must remain the emphasis as we move forward. I am pleased that the new out-of-hours service on the northside of Dublin, which serves 500,000 people, has been successful. There has been a positive response to the service and it is incredible we did not have it until recently and that three doctors were expected to cover the on-call service for that population base. It is for that reason significant pressures were placed on hospitals on the northside of Dublin.

I accept there are gaps in the out-of-hours service — Deputy Enright mentioned Tullamore — but over 80% of the population is covered by an out-of-hours service. Generally, where the service operates, it works well and is responsive to the needs of patients. The service has experienced doctors, general practitioners, dealing with patients that require services after 5 p.m. and over the weekend.

I want to deal with the issue of the cancer report and radiotherapy strategy. On behalf of the Government I issued a policy directive to the HSE to provide this facility in a number of centres around the country and two satellite centres in Waterford and Limerick, and to do so on the basis of a public private partnership by 2011. The management of the HSE felt this was not deliverable, but the board of the HSE did not accept that and neither do I. When we see the facilities that sprang up over a two-year period in Whitfield in Waterford, I cannot accept that we cannot roll out radiotherapy facilities over the next four years. Last week, the board of the HSE confirmed the facilities will be provided in that kind of timeframe. We must all, myself included, think outside the box to find speedier responses to issues confronting patients in our health care system.

Patient safety must govern where services happen at hospital level. Up to recently, 35 hospitals in the country performed breast surgery. This number has been reduced and must be reduced further. International evidence, which has been backed up by what I have been told here, shows that where surgery is performed by a unit that does not carry out at least 100 similar surgical procedures a year the outcome is not good. Our outcomes across a number of cancers do not compare favourably with other European countries.

The one area where we perform extraordinarily well is that of children's cancer. When we moved children's cancer haematology from Tallaght Hospital to Crumlin Hospital and centralised it, the outcomes improved by 70%, which proves when we bring the expertise together and centralise the planning of the service for delivery on a more localised basis, we get better outcomes. We must have the courage to do the same in other areas throughout the country where international evidence and best practice dictate this should be the case.

See this speech in context