Mary Harney (Dublin Mid West, Progressive Democrats)

I move:

To delete all the words after "Dáil Éireann" and substitute the following:

"—acknowledges the increased investment in cancer control, and supports the Minister for Health and Children in her commitment to ensuring equitable access to high quality cancer services for patients throughout the country; and in particular welcomes:

—the appointment by the Health Service Executive of an Interim National Cancer Control Director to lead and manage the establishment of the National Cancer Control Programme;

—the designation by the Executive of four Managed Cancer Control Networks and eight Cancer Centres in order to deliver the highest quality cancer services and best outcomes for patients;

—the progress that has been achieved to date on the implementation of the National Plan for Radiation Oncology as an integral part of the National Cancer Control Programme;

—the commitment of all necessary capital funding for the plan through public private partnership and Exchequer sources; and

—the commitment of the Government and the Health Service Executive to achieve a progressive expansion of radiotherapy capacity over a timeframe which meets patients' needs."

I begin by saying how pleased I am to be able to participate in this debate. I congratulate Deputies Reilly and O'Sullivan on being selected as spokespersons on health for their respective parties. I have no doubt they will be very busy over the next number of years and that we shall have a good deal of engagement with each other.

I said in the Seanad earlier that one of the features of the last Dáil was the frequency of the meetings of the Joint Committee on Health and Children. Many of those meetings went on for more than six hours, so it was an enormous time commitment for Deputies. In the event, many of the members of that committee lost their seats. In fact it was quite extraordinary, so I am not sure there is a great political bonus in participation in the health committee and attendance at its meetings, although perhaps it was coincidence. However, I look forward, genuinely, to working with the Deputies opposite. I know they are both motivated by the same things I am, namely, to create a better health service for patients and a world class health system, which I believe we can aspire to.

Having said that, a number of matters must be put in context. What passes for health debates in Ireland often ignore some basic facts. At present we spend 8.9% of GNP on health. Based on OECD figures that is equivalent to the average of the 30 wealthiest countries in the world, even though 11% of our population is over 65, as against 17% on average for the OECD. On a purchase parity or similar basis we spend per capita $2,596 on health. That figure is for 2004 and there has been a substantial increase since then and the OECD average is slightly under that, at $2,500. I mention these statistics because there is an assumption that more money and staff would solve all the problems. If that were the case, there would not be a single health problem in Ireland today because we have almost multiplied public expenditure on health fivefold in the last decade. As a matter of interest, since I became Minister the proportion of public to private funding on health has increased. It was 78:22 and it is now 80:20, which means 80% of funding on health comes from the public purse and 20% from private investment. In the OECD, on average, it is about 73:27, a higher proportion across Europe and other countries being private investment. It is worth noting this, given many of the comments being made.

I come to this debate on cancer with only one interest, namely, patients. I am not trying to be smart when I say this. Many of the contributions Deputies have made have been about particular interests in particular constituencies. For too many years, local, institutional, political and professional vested interests have prevented appropriate developments in cancer care.

Reference was made to Barringtons Hospital. What happens there is happening in many public hospitals today. Breast cancer operations are being carried out by surgeons in circumstances that are not good for patients. We all know, not just from our expertise but also from well-documented international evidence, that if a woman has breast surgery in a centre of excellence that deals with at least 150 new cases per year, and if her individual case is assessed by a pathologist, radiologist and surgeon, her outcome will be more positive. Her likelihood of survival will be much greater than it would be in a place where a surgeon is carrying out various other surgical procedures. This is why we announced today that 13 hospitals will have to cease breast surgery with immediate effect.

Deputy Naughten mentioned Roscommon hospital and should note that breast surgery was stopped there 18 months ago. The hospitals ordered to cease breast surgery are dealing with less than 20 cases per year and only two deal with double-digit figures. Portiuncula Hospital had 17 cases and Louth County Hospital had 15. The rest of the hospitals deal with approximately one to four cases, bearing in mind that one in this group dealt with seven cases.

The decision regarding centres of excellence was made in the interest of patients. It is known that volume and multidisciplinary care must be taken into account when treating cancer. The survival rate improves by 20% when one is treated in a centre of excellence with multidisciplinary care. In other words, it ensures the survival of one in five patients who would not normally survive.

This leads me to the issue raised by Deputy Creighton, namely, St. Luke's Hospital. It is recognised, both by Irish experts, including the doctors who work at St. Luke's, and international experts, that stand-alone radiation facilities are not in the best interest of patients. Patients should be treated in a multidisciplinary environment where medical oncology, surgery and radiation therapy are all provided. This approach is the approach of the future and the eight centres announced today will adopt it. The only exception to the high-volume stipulation will be in Letterkenny where, for reasons of geography and distance, there is to be an outreach centre. This centre will be linked to the one in Galway and will be quality assured. The staff will be members of staff in Galway and will carry out the work in Letterkenny on an outreach basis.

Somebody made a comment at the announcement of the new programme to the effect that a parent with a child who is very sick with cancer will go almost anywhere to ensure he or she is treated appropriately. The same applies to ourselves. In the past week, I lost a friend to brain cancer. A couple of weeks before she died she examined the possibility of going to the United States for a clinical trial. She knew she had a slim chance but that is what she wanted to do. As it happened, she was not able to travel. These are the kinds of options patients and their families consider with a view to getting better. They will do almost anything. Thankfully, we do not need people to do almost anything because we can provide eight cancer centres for the population of this country.

I was asked about the time it will take to roll out the breast cancer treatment centres. Some 60% will be completed in the first year, that is, during 2008, and 90% will be completed by 2009. The 22 existing centres will be reduced to eight. Some 50% of the cancer centres will be completed during 2008 and 80% to 90% will be completed by 2009. This is the target the HSE has set.

Today we announced the appointment of Professor Tom Keane, an Irishman and graduate of University College Dublin. He completed his initial oncology training at St. Vincent's Hospital and has been working in Canada for 35 years as a medical oncologist, both as a clinician and manager. He set up the cancer services in Ontario and subsequently in British Columbia, where I met him when I visited two years ago. I was very impressed and asked him whether he intended to come home. He had no plans to do so at the time but has decided to take the position offered for approximately two years in order to set up our programme. We are very fortunate to have somebody of his standing, experience and expertise.

British Columbia, at the time of my visit, had 4.1 million people, which is roughly the same as the population of Ireland. The province has ten inpatient beds dedicated to radiation oncology while there are 179 in St. Luke's alone. Professor Keane makes the point that the Irish approach is not only expensive but also inappropriate. The most expensive beds in any country are acute hospital beds. Clearly, treating patients on an ambulatory basis, as is possible for most patients receiving radiation therapy, or having them stay in hostel-type or hotel-type accommodation represents the model of the future. This is the kind of innovation we must support and which is working extraordinarily successfully in Canada.

In Ireland our machinery works for six and a half to seven hours per day, which does not represent very good use of linear accelerators. In Canada the machines work for ten hours per day. When I am asked how many linear accelerators we need, I reply that it depends very much on the length of time for which they can be worked. If our machines can be worked for ten hours per day, which would involve industrial relations issues, we can achieve a lot more for patients.

In British Columbia the period of 28 days from the time a decision is made that one requires radiation oncology has been reduced to 14 days. This is an incredibly short period, as Deputy Reilly would acknowledge. We are a long way off that in Ireland.

When Deputy Reilly was concluding his contribution, he asked why the private sector can provide radiation oncology facilities in 18 months. This is a very valid question. I asked the HSE why it takes the public sector over ten years given that the private sector can build a new state-of-the-art facility in Waterford in approximately 18 to 20 months and commission it a couple of months later. I accept that public procurement procedures must be followed and that we must put the work to tender. This causes delays in putting public facilities in place but I do not accept the provision of the facilities in question can take as long as has been said.

I met officials from the HSE and my Department this morning regarding the roll-out of radiotherapy facilities. I am assured by the HSE that we will have the capacity we require in the public system by 2010. As has been acknowledged, the number of cancers will increase greatly and we must therefore continue with our programme of investment over the coming years so the required radiotherapy facilities will be in place.

When the Government made the decision to roll out the national strategy two years ago, I said that two new linear accelerators would be installed in St. Luke's and that they would be commissioned from the start of next January. I also stated a facility would be provided according to traditional procurement practices at Beaumont and St. James's hospitals, and this is going ahead. Those facilities, together with the services currently being procured by the HSE on behalf of patients from private providers, will provide the capacity we require by 2010. We are ensuring capacity at present at Whitfield and the facility in Limerick, which is being provided by the Mater Hospital and built using the Limerick trust fund. The majority of patients being treated at Whitfield are public patients.

If facilities are safe it should not really matter whether they are funded privately, publicly or by both means. The main consideration is to ensure the standards we expect apply to both the public and private sectors. Although the newly-established Health Information and Quality Authority was given responsibility in the first instance for public services and services procured by the public system from private providers, it was not possible, according to my legal advice, to extend its remit to private health providers until such time as we have a system of authorisation, accreditation and licensing for them. This is why I established the Commission on Patient Safety and Quality Assurance, which is chaired by Dr. Madden and due to report in nine months, to consider issues pertaining to licensing and authorisation. It would not be acceptable to have one standard for public providers — not just providers of cancer services — and a different one for private providers. Patients are entitled to expect that the Government, including the Minister for Health and Children, will quality assure services being provided in the State. That is not the case because, until now, we have never really examined the issues of licensing and accreditation. Our performance in that regard has represented a deficit in this country's provision of health facilities. We have not studied the standards in the public system either. I acknowledged this earlier when I spoke about what was happening in Barringtons Hospital. That brings me to the issue of who knew what and when. I was not aware of the issues in that hospital until the August bank holiday weekend of this year. I did not know that issues had been raised — that is a fact.

See this speech in context