Michael McGrath (Cork South Central, Fianna Fail)

I welcome the opportunity to speak on this important issue. The problems which arose in the delivery of breast cancer services at the Midland Regional Hospital in Portlaoise are proof, if we needed it, that our approach to cancer care must change, and quickly. Having read the reports, the essential message is that we cannot achieve anywhere near the highest standards in breast cancer care if we spread resources across a multiplicity of hospitals throughout the country. The same holds true for all other forms of cancer.

The three reports that have been published make the case in a compelling manner for the full implementation of the national cancer control programme. The clinical standards at Portlaoise, which resulted in a higher than normal delayed diagnosis of breast cancer, are unacceptable. I extend my best wishes to the nine women directly affected.

If we are to be honest, this situation may be replicated in other non-centre of excellence hospitals delivering cancer services throughout the country. For this reason, I strongly support the implementation of the national cancer control programme and the transfer of all major cancer treatment to eight designated centres of excellence which provide treatment for all forms of cancer involving diagnostic, surgical, medical and radiation oncology services.

In Professor Tom Keane, the interim director of the national cancer control programme, we have a leading expert in his field and an Irishman who has excelled in the provision of cancer care services in British Columbia. He is ably qualified and well positioned to deliver the programme we seek.

The eight centres of excellence will gain public support. Patients are voting with their feet and are voluntarily going to the eight centres. If it comes down to a choice between attending a hospital which is convenient but where clinical standards are not in keeping with best practice or attending a hospital which is inconvenient but where the best patient outcome is assured, people will travel to the centre of excellence for the highest standard of cancer care. The expert group chaired by Professor Niall O'Higgins recommended a minimum throughput of 150 new cases per year in order to maintain the highest standards of breast cancer care. Are we to shred that report for the sake of political expediency? If we ignore the evidence which is so clear, we will put patients' lives at risk and sow the seeds of further problems and give rise to further examples of what happened at Portlaoise. Areas with centres of excellence must have a minimum population of 500,000 to have the required volumes to maintain the highest standards. There is intense competition for top clinical professionals across the globe. We must focus our resources on these centres. Systemic therapy services, including oncology and chemotherapy, will continue to be delivered locally. That point appears to have been lost. People believe they will receive no cancer services in their local hospital. This is simply not true.

The HSE cannot be beyond criticism. The systemic weaknesses of governance, management and communication referred to in the Fitzgerald report are very serious and must be addressed immediately by the HSE which must move to a new level of performance. The clinical issues will be dealt with by the cancer programme and the introduction of the centres of excellence, but the management issues must be dealt with by the HSE. This is an organisation with a budget of €15 billion this year and we must have confidence that it is in a position to deliver the quality of health service we deserve.

Politicians on all sides of the House have a role to play in restoring confidence in cancer care. Nothing will be served by seeking a head on a plate. We should not play politics with this most important issue. Politicians in all parties must state clearly their full support for the implementation of the national cancer control programme. This support must be unequivocal. As the Minister indicated, there is no point in looking back. This is about the future and putting a proper system and service in place.

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