Mary Harney (Dublin Mid West, Progressive Democrats)

I have certainly never heard them on the public airwaves saying how terrible it is. We hear such complaints frequently about the public health care system. It is a great pity as we can sometimes undermine confidence in our own system. We have a health care system of which we can generally be very proud. While there are gaps and deficiencies, the challenge of health care reform is to put them right and create a world-class service.

It is important to note on the HSE that for many years we failed as politicians to effect the changes which are normal practice in many other countries. I include myself having been a Member of the Oireachtas for 30 years. We do very poorly in cancer outcomes compared with other European countries, mainly as a result of the fragmentation of services.

The only area of cancer treatment in which we compare favourably is paediatric cancer treatment. The reason we do as well as the best countries in Europe in treating paediatric cancer is that treatment is centrally planned despite being delivered in 16 hospitals nationally. We intend to introduce a similar system to treat adult cancers. We will establish eight cancer centres for surgery. It is not safe for a general surgeon to treat breast cancer. All the evidence nationally and internationally suggests that if a unit does not treat 150 new cases annually, the outcomes are poor. If a surgeon carries out many other types of surgery as well, it greatly reduces the potential for a positive outcome. It is for this reason, the cancer strategy focused on the creation of centres of excellence. Given the choice, a patient will put quality services before geography. If one has a sick child, one will drive anywhere to have him or her treated. We would do the same for ourselves given the option. As most people will acknowledge, it is not possible to have standards of excellence for cancer treatment duplicated in every hospital. Experts are few and far between and we must ensure they work together to facilitate triple assessments and other systems.

Earlier in this debate, Deputy Reilly asked about the 13 centres which are to cease to treat breast cancer. Of these, the three at Cavan, Navan and Roscommon have already ceased to operate. A number of others at Loughlinstown, Naas and Tullamore carried out only one procedure annually and none carried out more than 15 in a given year. The HSE has made provision for patients to be treated for symptomatic breast cancer in the centres of excellence. A great many attacks have been made on the HSE by the Opposition and from this side.

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