Pat Gallagher (Donegal South West, Fianna Fail)

I welcome the opportunity to address the issues raised by the Deputies from County Clare and to set out the current position regarding mammography services at Ennis General Hospital and breast cancer services nationally. The specific issue raised by the Deputies concerns the organisation and management of the health services and, as such, is a matter for the Health Service Executive under the Health Act 2004.

The HSE has informed the Department that following consultation with experts in the field of cancer care, it has decided to concentrate all mammography services for the mid-west at the regional specialist breast unit in the Mid-Western Regional Hospital in Limerick for reasons of patient safety. The HSE in the mid-west has informed the Department that the decision to discontinue mammography in Ennis is driven by the need to provide the best possible clinical practice. Centres where fewer than 1,000 mammograms are done in a year do not provide the volume of work necessary for the maintenance of the required level of professional skills. County Clare patients requiring mammograms between now and September will continue to be referred to Galway, after which date they will be referred to the specialist breast unit at the Mid-Western Regional Hospital. A total of 402 County Clare patients have had mammograms in Galway since October 2006.

The benefits of this change are the people of County Clare can be assured the services provided to the women of the county are in line with international best practice and subject to all the checks and balances that ensure units fulfil their remit. The HSE appreciates the move will cause inconvenience to some County Clare women but has stressed this must be set against the improvements that will ensue, including greater peace of mind for women undergoing mammograms. I understand clinicians practising in Ennis Hospital have been fully involved in the review and have accepted the need for change.

The new dedicated regional specialist breast unit will be sited adjacent to the outpatient department at the Mid-Western Regional Hospital, Limerick, and will provide dedicated facilities for the symptomatic, reconstruction, review and breast prosthesis and fitting clinics, as well as for nurse counselling sessions. Support services such as X-rays, pathology and physiotherapy will be accommodated in the main departments of the hospital. Work on the detailed design and planning application is well advanced and the project is expected to go to tender before the end of 2007 and be fully commissioned in 2008. The capital cost estimate is €2.6 million, including design fees, equipping and construction.

A national breast screening programme is the most efficient population approach to preventing and controlling breast cancer. BreastCheck, the national breast screening programme, is available free of charge to eligible women in 15 counties in the eastern, north-eastern, midlands and parts of the south-eastern and western regions. This Government is committed to ensuring the BreastCheck service is rolled out to the remaining regions in the country as quickly as possible, and screening commenced in the west last May. Additional revenue funding of €8 million has been allocated for this year to meet the additional costs involved for roll-out, and the full complement of 111 staff has been approved. BreastCheck appointed the clinical directors for the south and west last November and has recently appointed three consultant radiologists, two consultant surgeons and two consultant histopathologists, all with a special interest in breast disease. The recruitment of radiographers and other staff is under way.

The Minister has also made available an additional €26.7 million in capital funding for the construction of two new clinical units and the provision of five additional mobile units and state-of-the-art digital equipment. The static unit at University College Hospital, Galway, is on track for late autumn.

The majority of women with breast cancer are diagnosed and treated outside the BreastCheck programme. It is therefore necessary that we support the symptomatic breast disease services as well as the screening services to ensure comprehensive breast cancer services are available for all women.

Breast cancer is the individual site specific cancer which has received the most investment in recent years and more than €60 million has been made available for development of the symptomatic services since 2000. The Minister for Health and Children recently formally approved quality standards for symptomatic breast disease services, which were prepared by a multidisciplinary expert group and submitted to the Minister by the Health Information and Quality Authority. The implementation of the standards is an essential element of the quality agenda set out in the national cancer control strategy. The response to the standards must be to ensure that every woman in Ireland who develops breast cancer has an equal opportunity to be managed in a centre which is capable of delivering the best possible results. The Department has requested the HSE to prepare a plan to implement the standards for submission to the HIQA. The HSE has agreed that the plan will involve the evaluation of current provision of services and provision for the performance management of specialist centres. A two to three-year timeframe for implementation of the standards is envisaged by the HIQA.

Planned developments for Ennis General Hospital will cost in the region of €40 million and include the upgrading of wards, accident and emergency, radiology and outpatients departments, the intensive care unit and general infrastructural upgrades. I understand an application has been made for planning permission and these developments will be especially beneficial to people in County Clare and the surrounding areas.

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