Dara Calleary (Mayo, Fianna Fail)

We all welcome the new strategy and the centres of excellence. It is unfortunate this debate is happening in the context of the occurrences in Portlaoise and possibly in Cork. I join other Members in expressing my hope that those occurrences will not be repeated and I send my best wishes to the women involved.

Like Deputy Kenny, I know only too well the services on offer at Mayo General Hospital but would rather not have had to in the past number of years. All cancer services currently available in Mayo General Hospital are delivered in conjunction and in association with Galway, which is a proposed centre of excellence. This is done as part of a formal network arrangement which was brokered by the Department of Health and Children in 2000. Indeed, the arrangement in place was so successful that it is being used as the model in this new cancer strategy for the outreach arrangements in Letterkenny.

The arrangement means that all cancer cases referred to Mayo General Hospital are considered in conjunction with the teams at UCHG. There are formal consultations on a daily basis and there is a weekly multidisciplinary team, MDT, meeting held on site in Castlebar involving oncologists from Galway, surgeons, radiologists, nurses and other staff in Castlebar. Each case referred in that week to Mayo General Hospital is discussed and the appropriate treatments are agreed and undertaken in Castlebar.

This arrangement and the manner in which it has developed over the past seven years is delivering positive outcomes on a daily basis to cancer sufferers in the west. No cancer sufferer who has used that facility in the past number of years is currently disadvantaged or was mistreated because of its location.

This year over 80 breast surgeries will be carried out at Mayo General Hospital. In the context of the population of Mayo, that is quite a substantial number. All breast surgeries in Mayo General Hospital are done by one surgeon and another surgeon takes care of colon surgeries. Both Dr. Kevin Barry and Dr. Ronan Waldron are highly qualified excellent surgeons in international demand at conferences because of their work and their work on the network. If both surgeons are to transfer to the new centre of excellence in Galway, they will each perform fewer surgeries annually thus reducing their individual exposure to each treatment.

In addition to the surgeries, 2,000 mammograms and 1,500 colonoscopies will be completed at Mayo General Hospital this year. There is a policy in Mayo General Hospital of double reading of these examinations to ensure accuracy. We have five consultant radiographers in Mayo General Hospital, three of whom have specific training and education in breast treatment. They can provide a diagnosis within 24 hours if required and that is an absolute weapon in the fight against cancer. One can see why we passionately believe we already have a centre of excellence in Mayo General Hospital delivering positive outcomes on a daily and weekly basis to the highest possible standards. We look forward to the HIQA audit next spring which will confirm our feeling on that. I welcome the Minister's remarks that the existing services are excellent because there was annoyance in Mayo General Hospital that because centres of excellence were being created, there was an implication the services currently on offer were not good.

The new proposals will mean breast surgery, colorectal surgery, mammograms and colorectal examinations will be withdrawn from the hospital and transferred to Galway. Post operative treatment, such as chemotherapy etc., may no longer be consultant supervised. It is fair to expect that the staff involved in the delivery of services in Mayo General Hospital will leave the hospital in pursuit of their chosen specialties. Patients will have to travel from all around Mayo to Galway for surgery which is currently available in Castlebar under very high standards and conditions, as I have outlined. For many, a trip to Galway can be a five-hour one.

I wish to give the House an idea of what is actually involved. A constituent wrote to me in regard to her treatment at Castlebar and her subsequent treatment in Galway. She said:

The treatment in Castlebar was dealt with by Mr. Barry and his team in an extremely friendly and efficient manner. Having it in such a central location meant that my husband, family and friends were able to visit on a regular basis, which naturally made the whole experience far more bearable. This would not have been possible on anything like the same scale if my treatment had taken place [elsewhere] as maintaining a full-time job while travelling for the periods mentioned below would be completely untenable.

The radiotherapy I subsequently underwent in Galway was again performed to a very high standard. [We endorse the standards of care in Galway.] However, the daily return trip was an ordeal, to put it mildly. With city traffic to take into account, it was necessary to allow 5-6 hours per day for travelling, regardless of the time spent inside the hospital. This took place from three to five times per week for six weeks. If [this strategy] is followed, patients would have to undergo these travelling conditions for such common procedures as mammograms, as well as for the surgery involved in cancer cases. In my view, this would represent a major step backwards, impacting upon an extremely vulnerable group of people.

I endorse the views of that constituent in regard to the reduction of services under this proposal.

The model we have in Mayo General Hospital and the model proposed for Letterkenny on the back of it was originally backed on to, and was done in association with models in Scotland and in North America, in particular the US. The model which has evolved is an Irish solution to Irish conditions. We hear of international best practice and international excellence but given the conditions we have in terms of transport facilities or lack of them in terms of road infrastructure and otherwise, we must look at a very Irish condition. We do not have the highways they have in the United States to get people to centres.

I welcome the opportunity for questions and answers later and will ask a number of questions, if possible. The HIQA audit, which will be forthcoming next April, will add to the reputation of Mayo General Hospital and show that the services on offer are of an international standard and are delivering positive outcomes. What impact will that have on the national cancer strategy?

I query the method of selection of the eight current centres of excellence. I am particularly concerned that not one of those centres is located on a line north of Dublin to Galway. It does not make any sense that the eight centres of excellence are all located in one part of the country. Were the centres of excellence chosen by the membership of the national cancer forum, membership of which is drawn from centres of population or hospitals on that line? What role did the national cancer forum have in the selection of the eight centres of excellence?

I welcome the fact we are creating the position of director of the national cancer strategy and I wish Professor Keane every success. Was there an international competition for that position? Did recruitment for that position take place across the oncology community throughout the world? Was the vacancy made known around the world?

Will non-surgical treatments in the new cancer strategy, such as chemotherapy, be consultant supervised in a situation where the centres of excellence are established? When can we expect full details on what will be involved in these centres of excellence? Will there be extra buildings, facilities, beds and staff? It is very difficult to try to justify a centre of excellence and the selection of such a centre when one cannot even park one's car in University College Hospital Galway when going for treatment. It is well-known that there are not sufficient car parking spaces for patients and people visiting them. That is not to downgrade the treatment available in the hospital where the team performs to its very best. If one is a cancer sufferer going for chemotherapy, the least one can expect are basic facilities, such as easy access and being able to park one's car without having to drive around for 40 minutes to an hour, which we hear from patients on a daily basis.

We all agree with the centres of excellence. However, I disagree with my colleagues in that the protests last weekend were not political and people did not go out for the sake of protesting. There were 7,000 people all of whom had experience of, and daily dealings with, the services available. There were people who put their faith and their lives in the hands of the team at Mayo General Hospital, to whom many of them owe their lives.

Family members of mine have been through that hospital and cancer centre in the past ten years and I stand over the current level of treatment there. The centre works and delivers outcomes. If we are to use that model to expand the cancer service into the north west, it does not make any sense to lose what we have in Mayo General Hospital.

See this speech in context