Mary O'Rourke (Longford-Westmeath, Fianna Fail)

I am very glad to have the opportunity to speak in this debate here today and, like others, to congratulate Dr. Deputy James Reilly, if that is not a mouthful, and Deputy Jan O'Sullivan. In particular, I congratulate the Minister who is some mighty woman, as the Ceann Comhairle and I both know. I am sure Deputy O'Sullivan will be, or is, a mighty woman too. Not to leave out Deputy Reilly, I suppose he will be a mighty man in his day.

However, I have very serious questions which require answers. First, I do not think the public-private partnership, PPP, mechanism is a suitable one for delivering cancer care. It is unwieldy and inflexible and will not be best suited to the provision of services, which is what is required in this field. It is fine for buildings, although we saw how the Comptroller and Auditor General had doubts about the five post-primary schools and the cost-effectiveness of PPPs in respect thereof. It is not a proper mechanism for delivering cancer care.

I strongly approve of the centres of excellence. As Deputy Chris Andrews noted, if somebody was very ill, not necessarily with cancer, one would wish him or her to go to a centre of excellence, irrespective of how near, trusted and valued one's nearby hospital would be. Why go there if it did not have the necessary technology, expertise and range of specialities? I strongly agree with the proposal for centres of excellence.

Although the Minister does not need my advice in this regard, often the mandarins in the Department of Finance regard rationalisation as an occasion to wield the axe and tell the giver of services that it can cut so much off them. That is not so because the setting up of the centres of excellence will require massive finance in staffing, technology, the interdisciplinary teams and other necessary services.

The second serious question relates to the Health Information and Quality Authority, HIQA. It appears that this standards body will now deal only with public hospitals and not with private ones. It is a bit odd that if one is in a private establishment, one does not come under a standard of excellence regime, but that if one is in a public hospital, one does. I am glad the public hospitals have it, but I cannot see how one is a different patient with a different ailment because one is in a private hospital. It is a great pity that amendments to HIQA will be needed so soon after its establishment. Surely this should have been seen for what it was, namely, a grave lack.

It again brings into question the issue of co-location. I was a reluctant convert to it and remain extremely reluctant now because if one is in the private end of a co-location campus, one is not subject to verifying standards, but if one is in the public hospital, one is. Does one run from one hospital with one's hat on saying "We're HIQA" and go to the other hospital on the adjoining or same campus to be told that one does not come under HIQA? That is a grave lacuna which must be attended to.

I agree with Deputy Calleary on the need for transport services for those receiving cancer care to be separated from transport services for other patients. A patient attending radiotherapy or chemotherapy treatment may be in a run-down state. Transport to a centre of excellence which the patient may be attending should be tailored to his or her needs. It should not be given as a form of patronage but as an inherent right within one's care programme. Professor Tom Keane has been described as a tsar, a term which has bad connotations in historical terms. However, if he is all-powerful and can get matters resolved, we can go along with whatever title is given to him.

When will private hospitals be subject to HIQA's strictures? I do not believe the public private partnership model is suitable for the provision of any health services. Co-location raises many issues. How can services in one hospital on a campus be subject to standards while those in another are not? It is an odd situation.

I wish the Minister for Health and Children well and hope the travails of the Department do not weigh too heavily upon her. When I was Minister for Health for 12 weeks, I adored learning about the Department but I was aware of its thousand pitfalls, with vested interests waiting to render a Minister impotent. I do not believe the Minister, Deputy Harney, will be rendered this way. Deputy Harney is one mighty woman.

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