John Perry (Sligo-North Leitrim, Fine Gael)

I congratulate Deputy Reilly on his appointment as Front Bench spokesperson and Deputy Devins on his appointment as Minister of State at the Department of Health and Children. The Minister for Health and Children, Deputy Harney, welcomed the appointment by the HSE of Professor Tom Keane as interim national cancer control director and the designation by the HSE of eight centres for cancer surgery as a key step in implementing the Government's cancer control strategy. Galway is one of these centres and is linked to Letterkenny. This does not say much for the constituency of Sligo-North Leitrim. The Minister stated:

The decision is not about hospitals. It is not about institutions or budgets. It is about the best patient care. All of us involved in health have an ethical obligation to make decisions in the best interests of patients, before local, institutional, political or professional interests.

The statement reads well at first glance. Who could object to making decisions in the interests of patients? A closer reading raises the question of the ministerial responsibility for the standards of care to be provided in the health service. Another question is how we should define the best interests of patients.

The Minister welcomed the HSE's statement. The Minister is stating that she is not responsible for the HSE decision on the proposed re-organisation and consolidation of cancer services. There is a serious risk that national politicians may give away responsibility for all strategic health service decisions and power to medical professionals and the HSE.

The delivery of health services requires increasingly complex and specialised medical expertise, skills and knowledge. I pay tribute to those who work in our health services. In the main they give a first class service to the citizens of the State. My concerns relate to the tendency for professional bureaucracies to define problems and solutions from a perspective allied to the professional interests and without regard to the interests of patients and the community. National politicians have passed the toughest test — the general election. This House, and through it the Government, is the only fully qualified body to declare what is in the best interests of the citizen. It is not acceptable for Ministers to seek shelter behind academic gowns, no matter how ornate or distinguished.

Regarding the best interests of patients, the fundamental justification of cancer service consolidation seems to be the assertion that a patient's chances of beating cancer rises by up to 20% in specialised centres. This is a worthy objective but many people may define their best interests as having a local service with an acceptance that the patient's chance of beating cancer would increase by 15% in local centres. This trade-off is key.

I am disappointed that the radiotherapy plan announced by the Minister for Health and Children in 2005 will not be delivered in 2011 as promised but will be delayed until 2015. This is disappointing in view of the commitment given to the north-west region regarding the roll-out of BreastCheck and radiotherapy services. I refer also to the significant cutbacks in Sligo, where consultants and nursing staff are being laid off.

There are no costings for the centres of excellence. It sounds very well but there is no substance to the plan. It is like stating that one will open eight big supermarkets without a plan. Where is the detail? People may feel that professors have a certain glow about them but academic gowns are being used to shelter the Government's inefficiencies. The Minister welcomed the statement of the HSE. Who is in charge?

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