Enda Kenny (Mayo, Fine Gael)

For the information of the Minister, I stayed for this debate because I have to go to Brussels this evening, which means I will not be present when she takes questions. I welcome this debate on cancer services and hope it will result in her being able to answer the questions raised by Deputies.

Women are not fools and they are not going to attend a service they consider to be substandard or which does not offer the best chances of survival. However, the issue is not confined to women because every woman is a daughter, sister, wife or girlfriend of somebody else. It also affects men in that sense.

I have been pilloried in regard to the extent of my acceptance of centres of excellence. While I support the concept of such centres, competing forces are at play and clarity and decisiveness of agenda are needed. The Department of Health and Children has been removed from the mainstream on the issue and is only now re-emerging.

The HSE is a creature of Government, set up by the Government to implement Government policy. However, when the HSE was set up it abandoned the Hanly report — a report to which my party objected — and pursued its own initiative, giving the impression that the HSE is a creator of policy. It seems, arising from the very unfortunate case in Portlaoise, that there is now a new rush to create the aforementioned centres of excellence. Obviously they should be put in place as expeditiously as possible but the Portlaoise situation is being used as an example of why we need the centres of excellence. However, the very legitimate question remains as to what people, and women in particular, are to do in the meantime.

According to the latest update on the Portlaoise case, the consultant radiologist whose practice gave rise to the review remains on administrative leave. When the Taoiseach spoke here this morning he said that the radiologists in Dublin examined the same images as those examined by the radiologist in Portlaoise and found seven cases of misdiagnosis. I do not care what international best practice is, we can improve on it, either by having digital mammography, as referred to by Deputy James Reilly, or a second radiologist reading the images. If, in the case of Portlaoise — regardless of bad imaging or dirt in the machine — two radiologists had read the mammograms and if there was any instance of concern, doubt or a belief that something was present, the seven cases would not have got through the screening process. That is the kind of standard of integrity and professionalism that women need. They need to have a demonstrable belief that the service they are getting is as good as can be obtained anywhere else. It is not about 75% of people, as the Taoiseach said this morning, getting a very high standard of service. It should be about 100% of people getting the very best service possible to give them the best opportunity to survive. I understand that six more cases of the 19 under review have been confirmed as positive for cancer. That speaks for itself.

The creation of the HSE has brought about an over-managed, over-manned and, in some cases, over-paid system. Now we have Professor Keane coming here from British Colombia on a two-year contract to implement the new cancer services strategy for breast cancer. That is a very difficult schedule for him. In the 13 cases where services were closed down, there was a very low incidence of activity and that was, unquestionably, the right thing to do. However, when the Health Information and Quality Authority carries out its audit of performance next spring, what will be the position in the case of a hospital, for example, Tralee General Hospital, that measures up to the standards of excellence now, where there is triple assessment, a full multidisciplinary team and where 100% of cases are assessed, discussed and given the highest standard of treatment possible? If a hospital achieves the standards set out in the National Quality Assurance Standards for Symptomatic Breast Disease Services, what will be the impact of the HIQA audit of performance, assuming the hospital measures up in everything except volume, because it cannot have the volume required by the standards when it is not serving a population of 300,000? If, on every other level, a hospital measures up to the standards set, will that have any impact or will the fact that the Government has already made a decision to develop only eight centres of excellence be the overriding factor?

I know my own constituency best and have had intensive involvement with the consultants, radiologists and surgeons at Mayo General Hospital. The O'Higgins report was based on the movement of surgical services to centres of excellence but it is not the surgical element of the service which has failed here, but the diagnostic element, whether it was undertaken in Cork, Galway or Portlaoise. That is a cause of serious concern.

The HSE announced details of its cancer programme on 26 September where it outlined the various services to be provided. It referred specifically to the outreach activity which is proposed for Letterkenny. The presentation states that outreach activity "if undertaken, should be incorporated in a rigorous process and outcome audit as though the activity took place at Galway to ensure that the provision of such an outreach service does not serve to place patients availing of it at any disadvantage compared with patients treated in Galway". I accept that; this is as it should be. It is precisely the reason that, in Mayo General Hospital, seven years ago agreement was reached with the professionals in Galway that the Mayo hospital would be an outreach centre monitored and supervised by, and working in co-operation with, Galway University College Hospital.

In the intervening years, my analysis of the Mayo service indicates that it measures up to the standards set out by the HSE, with the exception of not being able to achieve a volume of 150 new cases per year because the population base does not allow it. The consultant surgeon at Mayo General Hospital, Mr. Barry, has already carried out 80 procedures this year, based on a population of 100,000. The facilities at the hospital are excellent. A questionnaire was sent to Mayo General Hospital recently. The following questions and answers are of interest:

Is there a breast multi disciplinary team meeting held in your hospital? Answer: Yes.

What percentage of new patients with breast cancer are discussed at the mdt meeting? Answer: 100%

What percentage of new, benign, patients are discussed? Answer: Between 10% and 20%

Who attends at the multi disciplinary team conference? Answer: The consultant breast surgeon, the consultant pathologist, three consultant radiologists, the consultant medical oncologist, the clinical nurse specialist, the oncology liaison nurse, the oncology nurse, five NCHDs and five female surgical ward nurses.

All of the aforementioned people attend when every case of new cancer is discovered, assessed and discussed at the hospital. That happens in consultation with the professionals in Galway, who have a very strong liaison with Mayo General Hospital. Yet, the centre at Mayo is to be closed down. If a hospital has reached the required standards already, why should the excellence that has been achieved be stood down? That is why 10,000 people took to the streets and not, as Deputy Niall Blaney argued, because of political opportunism. It is because they believe in the service they have and do not want it taken away. If somebody from the HSE, Professor Keane, or some other expert told me that the service currently provided in Mayo is inferior, inadequate and life threatening to women — the colon and rectal cancer services will also go, once the breast service is moved — that would be fine, but the hospital has already achieved the high standards set by the HSE. Women voluntarily took to the streets because of their belief in the service, which is closely related to Galway and was deliberately set up thus so that a situation like the one in Portlaoise could not arise, where an inferior service is delivered. High standards are employed and there is clarity of agenda and decisiveness. That is what we need on a country-wide basis.

I ask the Minister for Health and Children to address this matter in her reply, although I will not be in the House to hear her. The HSE proposes to set up an outreach centre in Letterkenny based on the model successfully operating for the past seven years between University College Hospital, Galway and Mayo General Hospital. In these cases, where the rates of survival and standards of assessment, diagnosis and treatment measure up, I see no reason to take that away in the context of setting up of the centres of excellence the Minister proposes.

I mentioned six more cases being confirmed in Cork. They have been confirmed as needing further assessment.

See this speech in context