James Reilly (Dublin North, Fine Gael)

Cancer is the single biggest killer in Ireland. According to the National Cancer Registry, there are approximately 22,000 new cancer cases reported each year, with over 7,000 people dying from this life-threatening disease. The incidence of cancer is likely to double to 44,000 cases by 2020. One in three Irish people will develop invasive cancer and one in four will die from the disease. That is why the word "cancer" strikes such fear into the hearts of those who are diagnosed with the disease and their families. Thankfully, the outlook for many who receive such a diagnosis can be very positive but only if their illness is detected early and if they receive appropriate treatment in a prompt fashion. The evidence supporting early diagnosis and treatment across virtually all cancers is irrefutable.

Despite the fact that risk of developing cancer continues to increase and that the population has increased by at least 500,000, facilities to treat this frightening illness have not improved and remain stagnant. Given that 60% of people diagnosed with cancer will be obliged to avail of radiotherapy during the course of their treatment and that international best practice for ensuring best outcomes states that patients should not have to wait any longer than six weeks for such treatment, it is not just shameful that people must wait up to six months for therapy but, in a country as wealthy as ours, it is morally reprehensible.

Although Fianna Fáil has been in power for ten years and has had access to unprecedented resources, the repeatedly announced breast screening programmes first mooted in the national health strategy published in 2001 have still not been put in place. Cervical screening in the mid-west has remained at pilot level since 1999. This is all the more inexplicable in light of the fact that cervical cancer can be prevented because screening detects changes in the cells that are pre-cancerous and these cells can then be destroyed by means of a simple out-patient procedure. In 2005, 253 women were diagnosed with cervical cancer and approximately 70 women die from this eminently preventable disease each year. There has been nothing but stagnation in respect of the radiotherapy plan announced only two years ago. We are now informed that it will not be delivered until 2015 and not 2011 as promised.

There is nothing but chaos in the health service. Promises have been broken, patients are in distress, families have become disillusioned and staff morale has reached an all-time low. Frontline staff cuts will further exacerbate our already unacceptable waiting lists. The Minister guaranteed that the latter would not happen. The people of Ireland and the members of Fine Gael cannot possibly accept her assertion that the loss of 30 nurses and four consultants at Sligo General Hospital will not affect the delivery and standard of care available to patients in the north west. Given that there are only two breast surgeons there, this represents a 50% reduction in this critical area of cancer care.

Recent media reports exposed a frightening reality in respect of cancer services. Inequitable access to cancer treatment and incidents of cancer misdiagnosis are costing people their lives. These are real people — our friends and families. Thousands of women in the midlands are obliged to undergo the deeply distressing experience of being re-examined as a result of a fragmented, unreliable cancer service. Is it any wonder that a crisis of confidence has swept across the health service?

The emergence of disturbing information on breast cancer care at Barringtons Hospital supports the need to establish a patient safety authority that would register and accredit all health care facilities, including private hospitals. This is Fine Gael policy. At Waterford hospital, there is no waiting room and the treatment room relating to oncology services, which was designed to deal with ten patients, is regularly used to treat 50 patients.

I tabled this motion in the hope of obtaining answers as to why the public has been misled with regard to the delivery of urgently needed radiotherapy services. The Minister for Health and Children's national plan for radiation oncology, announced with much fanfare in 2005, has been exposed as nothing more than an empty promise. Last January, a leaked Health Service Executive report seen by Newstalk 106 showed that the Government's €500 million cancer treatment plan had encountered serious problems. The assessment by the HSE exposed years of delay, cost uncertainties and concluded that the plan's timeline was not achievable. The document also revealed that the Minister for Health and Children, Deputy Harney, did not involve the HSE before announcing the plan in 2005. At the time, her response was to cover up the facts and accuse whistleblowers of political scaremongering. Delay being that deadliest form of denial, the Minister opted to sit on the issue. Now, after a nine month wait, she has received a report confirming what we already knew, namely, that the timetable is looking less achievable than it did in January.

As a result of the Minister's failure to consult the HSE before announcing the plan, cancer patients will be obliged to wait until 2015 for urgently needed services. Last week, the head of the HSE, Professor Brendan Drumm, conceded that the plan could not be delivered on time and blamed the delay on the fact that it was to be delivered by way of a complex public private partnership arrangement. According to Professor Drumm, there is no doubt that a public private partnership represents a more difficult way to deliver anything. Rather than accept these findings, the Minister, Deputy Harney, seems to have slipped into a state of denial. She simply refuses to accept that the plan cannot be delivered, just as she refuses to accept that health cutbacks and recruitment bans will affect patient care.

Not only is the Minister refusing to accept the opinion of HSE management, she is also ignoring that of the Department of Health and Children's hospital planning office and the National Development Finance Agency, which accept that the target date of 2011 cannot now be met. This begs the question as to why the Minister is so set on providing this service via the public private partnership route. Will she confirm that it is her intention to insist on using a single private company to build all of these facilities throughout the country? If the answer is yes, that is hardly the stuff of competition or quality assurance. Why place all our eggs in one basket?

This complacency and inflexibility is completely unacceptable to Fine Gael and to the patients who are awaiting much needed cancer treatment services. In recent months a series of misdiagnoses and unreliable treatment practices have exposed a frightening reality as regards our health services. Inquiries into practices at Barringtons Hospital in Limerick, along with a review of thousands of mammograms and breast ultrasounds at the Midlands Regional Hospital, Portlaoise, have justifiably led to a crisis of confidence in our cancer services. The latter is further compounded by the fact that, 19 months ago, the Department of Health and Children and the HSE were aware of seven separate issues concerning the quality of breast cancer services at Barringtons Hospital. However, no action was taken and these questionable practices were allowed to continue unabated while private patients were referred and had their bills paid by the VHI. It is absolutely appalling and utterly reckless that the Minister for Health and Children, who has responsibility for the welfare of all patients, could allow this to happen. Will she inform the House whether public patients were being treated at Barringtons during the period in question under the National Treatment Purchase Fund?

The Minister's assertion that she did not know, the HSE's claim that it had no remit over private hospitals and the Department of Health and Children's inaction have further strengthened the belief that no one is in charge of the health service. Had she been prepared to take action, the Minister could, as sole shareholder in the VHI, have withdrawn cover from Barringtons Hospital and, if appropriate, instructed the NTPF to discontinue referring patients until the matter was resolved. Instead, the repeated concerns highlighted by the director of cancer services in the mid-west, Dr. Raj Gupta, regarding the quality of such services delivered at Barringtons were ignored. The Minister indicated that she did not become aware of concerns in respect of the hospital until the start of August of this year. This issue was passed from Billy to Jack — or Brendan to Mary — with nobody accepting responsibility and patients' lives continually being put at risk.

In terms of a cancer diagnosis, 19 months is a long time. This is completely unacceptable, particularly as best international practice dictates that treatment should begin within six weeks. Given the existence of spare capacity in our private hospitals, many of which have two linear accelerators and thus meet best practice standards, surely the Minister should instruct the HSE to avail of these life-saving machines and thereby shorten waiting lists and lengthen the life expectancy of patients. I understand there are eight such machines and their use would greatly enhance the current level of service provision and thus reduce much suffering and stress on the part of patients and their families. With the Minister's well known preference for the private sector, we should surely avail of this golden opportunity to fill a gap in the service.

I take this opportunity to point out to the Minister that a national annual age appropriate check up would not only ensure early detection of many cancers, which is so critical to a positive outcome, it would also detect many other diseases such as high blood pressure, diabetes, etc., and allow for early treatment, thus avoiding needless pain and suffering for patients and the incurring of unnecessary expense by the State. It is a well-established fact that for every euro spent on prevention, one saves €20 on treatment. We could refer to this as the NBT — the national body test — given that we have an NCT. I am sure the Minister would agree with me that people are more important than cars. As the Minister is aware, this has been Fine Gael policy since 2005 under Senator Liam Twomey.

Today, Fine Gael calls on the Government to urgently deliver treatment services for cancer patients as quickly and efficiently as possible so that we will no longer have to suffer a situation where one is less likely to have access to treatment services such as radiotherapy, chemotherapy and hormonal therapy if one lives in the west because of the variation in access to services regionally; where one is more likely to survive breast, bowel and prostate cancers if one lives in the east but significantly less likely to do so if one lives in the midlands, south, south east or west of this country; where breast cancer incidence is 26% lower in Ireland than in the US but where the mortality rate is 33% higher; where Ireland spends less on research in comparison to other European countries — Ireland spends €3.99 per head of population in comparison to Great Britain, which spends €13.18 per person; where Ireland consistently falls below the European average when it comes to survival of major cancers, such as colorectal, lung, breast, ovarian, testicular, prostate cancers and Hodgkins disease; where we have a 20-week wait for radiotherapy services for prostate cancer sufferers; and, where we still have no interim service in Beaumont Hospital or St. James's Hospital, despite being promised this two years ago as an integral part of the plan then announced with such fanfare. I think the Minister will agree that while one might take some time to build these facilities, it takes time to build up expertise among personnel. That is why these interim facilities are of such importance. We should get to the stage where we will no longer have to tolerate a situation where a 30-year-old woman from the north west with three small children under the age of five feels she has to choose between lengthy journeys to Dublin for radiotherapy and precious time with her young family.

In this regard, a strategy for the treatment of seriously ill patients in the north west that depends on the goodwill and variable availability of services in Belfast is not acceptable. Clearly, the people of Sligo, Donegal and Leitrim cannot be blamed for expecting that their illness will be treated on the basis of severity and not on whether they live north or south of the Border, as the current plan clearly stipulates. If such North-South arrangements are to be put in place, it must be on the basis of a defined guaranteed service that patients can rely on.

My job is to hold the Minister and the Government to account when her policies are ill-judged or misguided and do not result in improved patient care in a timely fashion. It is also my remit to support her when her policies deliver for the patient in an efficient fashion. With this in mind, I ask her to divorce herself from this ideological wedding to public private partnerships in this instance as all the professional advice from those working in the service, both medical and administrative, including the CEO of the HSE, indicates that it is obstructing and delaying the roll-out of these life-saving services. I leave the Minister with one final question. How is it possible for a private facility in Waterford to be built in 18 months and in a position to deliver cancer care in a further two months, a timeframe of 20 months, when the Minister's putative plan will now take until 2015? The Minister should forget about ideology. Patient care comes first.

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