Mary Harney (Dublin Mid West, Progressive Democrats)

I apologise to Deputy Reilly for not answering the question on resources. The National Hospitals Office is undertaking an audit of existing resources, examining each hospital and isolating the money spent on cancer care. The intention is that Professor Keane will control the budget. That is how it worked in British Columbia and the only way it would work here. Professor Keane will come here on secondment from the British Columbia Cancer Agency, from which we have purchased his services because we were impressed with the service which is viewed as a world leader. The region has approximately 4.3 million people, peripheral issues similar to ours and Professor Keane is Irish educated. He was successful in British Columbia and we availed of the agency's offer to help. There was no global advertisement to find a cancer guru. The arrangement is for two years and one of his tasks will be to appoint a successor. He will have a deputy director and staff from oncology, radiology and other specialties.

The audit is under way. A lot of money will come from redirecting resources, as happened in Canada and elsewhere. In 1996 Northern Ireland began to reduce the number of places where breast surgery took place from 19 to five and the number of surgeons from 50 to 19. Over 70 surgeons perform breast surgery in Ireland, even though we only need approximately 20-25. In places such as Tallaght or Blanchardstown where world experts work we envisage the experts moving to the centres. If one has expertise in cancer care, one will want to work in the designated centres.

Regarding a guarantee of safety, HIQA is the patient safety agency. Its task is to enforce and monitor the application of standards and advise me on them across a range of areas, including breast cancer. It is an independent statutory body, separate from the HSE, which provides health services. When the Commission on Patient Safety and Quality Assurance reports, we can apply the same standards to the private sector as we apply to the public sector. We have already written to the insurers and independent hospitals regarding standards. We do not have the legal wherewithal to enforce them until the commission reports.

We have closed down 13 places. The centre in Roscommon, with which Deputy Naughten is familiar, closed 18 months ago. There was a major buy-in clinically and in the wider community because people knew it was the right thing to do. Patient advocacy groups such as the Irish Cancer Society and Europa Donna and women at the Marie Keating Foundation event which many of us attended two weeks ago told us that they did not care where the centre was, they wished to go to the best place. There is a considerable buy-in, by women in particular. That is not to underestimate the difficulties of transport which are being addressed.

Some 2,000 of women contract breast cancer, the vast majority of whom receive a speedy, expert service according to all the research. Survival rates have increased from 72% to 78%. A 6% increase over a five or six year period is extremely significant. Ten years ago only one in four women who contracted breast cancer had their operations performed by surgeons who carried out at least 50 procedures each year. Now, three out of four women have their surgery performed by such surgeons. I want to reach the stage where 100% of women — this is why the service can only be provided in larger centres — will have their breast surgery performed by surgeons who carry out at least 50 procedures each year. All the evidence shows that outcomes and survival rates improve when surgeons with this level of experience carry out procedures.

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