Brian O'Shea (Waterford, Labour)

Ar an gcéad dul síos, ba mhaith liom Fine Gael agus urlabhraí Fine Gael ar cúrsaí sláinte, an Teachta Reilly, a moladh as ucht an rún tábhachtach seo ar an cóir leighis don ailse a chuir síos. Tá sé tráthúil go maith. I compliment the Fine Gael Party and its health spokesperson, Deputy Reilly, for tabling this important motion which has been overtaken by yesterday's events and the announcement by the Minister for Health and Children and the HSE of the location of the eight specialist cancer centres. However, one must have misgivings about how the announcement will pan out. For instance, no costings or budget have been prepared for the plan, yet a target has been set, whereby 50% of the plan will be implemented by the end of 2008 and 90% by the end of 2009. Like many plans and projections set out by the Government parties for the roll-out of cancer services, this is very optimistic but I hope it happens. According to the HSE, once implementation of the plan begins, cancer services at smaller hospitals will cease within 90 days, yet half the new services provided under the plan will only be available by the end of next year, with 90% available by the end of the following year. What will happen in the interim? Existing capacity is inadequate and if some of it is withdrawn within 90 days, what will happen to patients who lose services in their areas?

Cancer survival rates in Ireland are improving but they are still below the European average. The eight specialist centres using multidisciplinary teams are anticipated to increase survival rates by 20% under the criteria laid down. This would be welcome. Professor Keane said yesterday that when the plan was fully implemented, outcomes would improve within three or five years. There is much to be commended in the new approach to the provision of cancer services but one must be sceptical about the delivery dates. Waterford Regional Hospital has been selected as one of the eight specialist centres. In 2005 we were given to understand that by 2011 radiotherapy services would be provided at the hospital but we learned recently that will happen by 2015 at best. How does this tie in with the target of 50% implementation of the new plan by 2008 and 90% by 2009? These target dates do not gel when examined carefully.

During the debate yesterday evening the Minister of State at the Department of Health and Children, Deputy Hoctor, stated Ireland had 22,000 cancer patients and the number would increase to 43,000 by 2020, with two thirds of the increase attributable to an ageing population. This is against a background of increased demand and the announcement of a new programme for which no budget or costings have been provided. The Minister of State also stated last night that the Government was committed to providing substantial additional moneys but this is very vague and up in the air. I reiterate that this statement has been made in the context of smaller hospitals ceasing cancer services within 90 days of the commencement of the new plan, as proposed by Dr. Keane.

A number of issues arise in the context of smaller hospitals and areas not adjacent to the eight specialist centres. I refer to designated transport and hostel accommodation. While this has been discussed, it is absolutely and utterly vital that the issue should be addressed and patient friendly, workable solutions put in place. With the number of cancer patients anticipated to increase by 21,000 between now and 2020 and two thirds of the increase attributable to the elderly, appropriate door-to-door transport will be required. Every effort should be made to make the system as patient friendly as possible in all cases.

The plan is welcome but the issues relating to cancer treatment have been highlighted in many documents, going back to the Hollywood report. Improvements have been made but there is a long way to go. Provision of services and patient outcomes are below the EU average. Patient outcomes will not improve unless substantial investment is made. In addition, significant planning is required to make sure staff will be available to take up the new posts that will emerge. Issues may arise fairly quickly in the context of the plan. It seems some staff will transfer from the 13 smaller hospitals that are to close, and they will take up positions in the eight regional centres. More action is required.

There is considerable under provision for palliative care throughout the country, particularly in the south-east. There is a proposal relating to it but these services are all complementary and terribly necessary in the context of comprehensive and proper patient care. I hope the thrust of this plan will come quickly and the inconveniences and difficulties experienced by patients in the smaller hospitals will be addressed.

One must question the wisdom of closing hospital services within a period of 90 days when the programme has not been implemented. I am concerned about a shortfall in the short to medium term, meaning the service will be worse in that time. It is hard to be confident that transferring staff and related operations will be done effectively, efficiently and quickly, particularly when compared to some of the other undertakings by the HSE over a period.

I very much welcome that Waterford Regional Hospital has been selected as one of the eight specialist cancer centres. However, we must get delivery of the radiotherapy unit to the hospital so we can move on to a multi-disciplinary service necessary for the best patient outcomes.

See this speech in context