Mary Harney (Dublin Mid West, Progressive Democrats)

I welcome the fact that the service is being rolled out to Mayo. Deputy O'Sullivan asked about the complete roll-out. That will take place by the end of next year in respect of BreastCheck.

Cervical screening will be rolled out to the entire population base this summer. It will not be done in the same manner as BreastCheck, county by county.

The outsourcing of cytology is done for two reasons. One is quality, because it will take at least two years to bring our facilities to the standard required. The second reason is cost, but it is mainly a quality issue.

Before I address the points raised about cancer, on the broader issues of health, between 1999 and 2003 life expectancy in Ireland increased by three years, the fastest increase in the developed world. That happened because of better treatments. Today, a child born in Ireland will live longer than a child born in the Netherlands, Belgium, Denmark, Germany and the United Kingdom. Fewer than half the number of people who used to die from heart disease die from it today. This is one of the biggest success stories that has dramatically impacted on life expectancy.

The OECD reviewed cancer performance here in 1994-98 and 1999-2003. Comparing the second period with the first, the survival outcomes had improved by 31% for pancreatic cancer, 24% for prostate cancer, 13% for lung cancer, 10% for leukaemia and 9% for breast cancer, which was one of the best performances. We are top of the class on children's cancer, ahead of the European average.

I say these things because we hear constant references to shambles and disaster. Some 400,000 more people are treated in our hospitals this year than was the case 12 years ago, as day cases, outpatients or in-hospital treatments. For the top 20 procedures, instead of people waiting two to five years, as was the case some years ago, it is an average of two to fivemonths.

Regarding cancer services, we know that volume equals quality. Some 250 publications state that if one is not treated in a centre with a high volume of cases on an annual basis — a minimum of 150 — the chances of surviving are diminished by 20%. That means that one in five women, who would otherwise survive, would die. This is compelling evidence and if we are interested in patient safety we are compelled to implement that.

Deputy Ring referred to 79 cases, which falls far short of 150. When BreastCheck is rolled out and that is integrated into the hospital in Galway, the new cases in Mayo will be substantially reduced. The same applies to other counties. We have made an exception for Donegal, for geographic reasons and because of dialogue and discussion we are having with the authorities in Northern Ireland on cancer care. There will be a satellite centre from Galway in the hospital in Letterkenny and, hopefully, there will be radiation and oncology facilities. The Minister for Health, Social Services and Public Safety in Northern Ireland announced last week that radiation oncology services are being rolled out to Altnagelvin. I have discussed with the Minister for Health, Social Services and Public Safety, Michael McGimpsey, our interest in jointly providing radiation oncology for the patients in the region. The Irish Government will be prepared to fund capital investment or procure services and the Minister there is very interested in that.

One of the first people I met when I became Minister for Health and Children was Margaret Murphy from Cork. I met her in the UK at a World Health Organisation, WHO, patient safety conference. Her son, Kevin, died long before I became Minister from errors in a hospital in this country. She wanted to find out what happened to her son and why, but no one gave her answers. She litigated and when she received compensation she donated it to a charity. That era is over. If mistakes occur we will investigate them, painful as it is, publish the findings and learn from them.

Deputy Shatter referred to blame culture. I have learnt from domestic expertise and international conferences I attended under the auspices of the World Health Organisation that if there is a blame culture, a doctor or nurse will not put up his or her hands if they think they will be penalised. That is what happens in patient safety cases. The countries that do best are those that encourage reporting the error to ensure the mistake does not happen again or that the capacity for the mistake can be minimised.

I do not have time to respond to all the issues raised by Deputies. The health reform programme is in its infancy. The previous organisation of services did not work, which is why we have a new regime. The new regime is in its infancy and is slower than I or Professor Drumm would wish, but progress is being made. Deputy O'Sullivan referred to my HSE, but it is my HIQA too, if she wishes to be personal. This House passed the legislation and it had the support of all the parties on the establishment of a unified system.

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