James Reilly (Dublin North, Fine Gael)

That is hardly a hospital with sufficient capacity to take on a regional centre. The €5 million which is to be spent on the eight centres divides into €625,000 per unit, which is not the sort of money needed to deliver the excellence Galway hopes to provide. These issues arise before I even begin to discuss the parking difficulties experienced around University Hospital, Galway. Many patients have to park on Headford Road and walk or take a bus to the hospital. University Hospital, Galway, is already €4.5 million over budget and last year it experienced 30 new cases of MRSA. This is evidence of overcrowding and a hospital at the limit of its capacity.

I received a letter which emanated from doctors working in Galway regional hospital. It is addressed to the management of that hospital and states:

We enclose the figures for the number of patients waiting on trolleys for an inpatient bed in the [emergency department] at UHG for the month of April 2008. You will see that this month we have had a total of 444 patients on trolleys at 9 am. This compares to a total of 188 for the same period in 2007. This is an increase of 136% at a time when the HSE is meant to be moving towards a zero tolerance for trolley waits in Emergency Departments, as recommended by the Task Force Report.

There is no doubt that this continued overcrowding in the Emergency Department is adversely affecting patient care. Recent independent research from Australia suggests that this persistent overcrowding is resulting in anywhere between 10 to 20 unnecessary deaths per year for a population the size of Galway [assuming a population of 230,000]. The implication that there are one or more unnecessary deaths per month in Galway University Hospital as a result of the persistent overcrowding is a very worrying one.

I will not read the remainder of the letter into the record because it is not particularly relevant. However, the staff at the hospital are highlighting a problem that is being ignored.

As stated earlier, I do not believe in the ability of the Government to deliver on its promises or even in its political will to do so. All we need do is consider the position at Mallow General Hospital, where a third surgeon was let go and where patients were told to go to Cork University Hospital. However, the surgeon at the latter has said he has no additional resources to deal with these people and that they should not come to him. Therefore, the excellent 24-7 service in place at Mallow General Hospital will be reduced to a nine to five, Monday to Friday service.

There is also the situation at Monaghan and Cavan hospitals. When the accident and emergency department at Monaghan Hospital was closed for 18 months, 17 people died on the road between Monaghan and Cavan while bypassing their own hospital. Monaghan is to close, Cavan is to take the load. There are 3,000 admissions to Monaghan annually and 5,000 to Cavan. The latter does not have additional capacity; it has a new ward but no staff. Cavan Hospital's budget is €9 million down on last year. Its emergency department is considerably smaller than that in place at Monaghan. The coronary care unit at Monaghan has been audited by Professor Michael Walsh of St. James's Hospital, who found it to have excellent outcomes. I mention these facts as further evidence of the Minister's modus operandi, which is to strip away the service people enjoy today on the promise of something wonderful to come tomorrow. However, tomorrow never comes.

As has been pointed out by surgeons, the same patients will be seen by the same surgeon, oncologist, radiologist and pathologist in Galway as are now being seen in Mayo and Letterkenny. How will that improve outcomes? We know what it will do — inconvenience and hurt patients and force them to travel long distances. How does the Green Party feel about this much increased carbon footprint? At present, all the aforementioned specialists are linked by technology to the centre. Furthermore, the plans for the Letterkenny satellite centre, which we wish to proceed, are based exactly on the Mayo General Hospital model. As the manager in Letterkenny informed me, the only difference will be that there will not be the same proximity of access as exists in Mayo. We want to see the same links established between Sligo General Hospital and Galway University Hospital as those which exist in respect of the other two hospitals to which I refer.

I return to the issue of trust and the Minister's statement that operations were carried out in respect of only 37 cases of breast cancer at Mayo General Hospital in 2007. An extensive trawl has been carried out — this was reviewed by both the manager of the hospital and the surgeon — and the fact is that 90 cases were dealt with last year. Of these, 92 were new and three involved recurrences. Some 73 of these patients were diagnosed and treated at Mayo General Hospital in 2007, six were diagnosed at the hospital and had reconstructive surgery — involving the surgeon from Mayo — at University College Hospital Galway and a further six were diagnosed and had appropriate non-operative care at Mayo General Hospital. In addition, nine patients who were diagnosed in 2007 were treated in 2008. One further patient who was diagnosed at Mayo General Hospital was treated in Dublin.

The plan with which we have been presented seems to be based on misinformation at best and disinformation at worst. One would want to be particularly guileless, gullible and naive to accept the Minister's plan as currently outlined. I reiterate that the concept of excellence is one we fully support. However, it is the Minister's manner of pursuing it that we reject.

Figures have been produced which show that outcomes for breast surgery in the west were 25% worse than was the case on the east coast. However, these figures relate to the period 1994 to 2001. It is interesting to note that the breast service at Sligo General Hospital and Mayo only commenced in 2000. I have in my possession the outcome figures for Mayo General Hospital for 2002 — they are the latest available — which show a five-year survival rate among patients of 88%. This compares very favourably with the European average for breast cancer of 70%, as published in The Lancet Oncology.

It is suggested that Mayo would lose only two breast cancer operations a week, which would lead one to believe approximately 100 patients a year are being diagnosed. This is what surgeon and manager of Mayo General Hospital have stated. However, there are 1,200 new cases seen each year at Mayo General Hospital. These people will all be obliged to travel to University College Hospital Galway. This does not include the thousands of reviews dealt with annually at Mayo and Sligo.

There really is no possibility of what is proposed being achieved at University College Hospital Galway without massive investment being made. To be honest, I do not think it makes sense to oblige the numbers of people to whom I refer to travel to see the same staff. The case for satellite centres has already been accepted by the Government in respect of Letterkenny. Why dismantle the very model on which it was based, namely, that at Mayo, where safe, effective care is being delivered and excellent outcomes achieved? The motion specifically seeks an audit of all centres and their satellites, thus ensuring best outcomes for women so that a centre which is not performing can be closed. This is the feeling of the doctors themselves — that is how confident they are of the service they provide. The confidence to which I refer is shared by the people.

I wish to deal with the issue of satellite centres in general and the fact there is more than one way to deliver excellence. The Sloan-Kettering Hospital in New York, one of the largest cancer hospitals in the world, deals with 2,000 cases a year. The total number of cases dealt with in Ireland each year is 2,500. The Sloan-Kettering Hospital has a centre in Manhattan, three satellites and five community-based cancer treatment centres. So successful is this system that the authorities at the hospital are considering the addition of a further satellite in upstate New York over 100 miles from the main centre.

The basis of the plan to provide breast cancer care at Galway is that staff will turn patients around in two to five days. However, the average stay at the Sloan-Kettering unit, which is one of the best in the world, is six days. Doctors at Mayo and Sligo hospitals can turn patients around in two to three days. However, they will always encounter difficult cases such as, for example, a lady who lives on the side of a hill and who has no infrastructural support and no family. Such a woman could not go home in such circumstances, particularly because she would have no one to help change her dressings. There is no provision in the plan for additional accommodation where patients can be monitored and have arrangements put in place to support their early discharge into the community. The patients to whom I refer would still have surgical drains attached to them, their wounds would not be healed and so on.

It has been stated — it was also mentioned at the ICGP by Professor Tom Keane — that GPs can be trained in Canada to do this work. What was not stated is that GPs must be taken off site for two months and replaced by locums. I informed the Minister previously that there is a manpower crisis in the area of general practice but she refused to make provision for even 30 additional places on the training schemes. We currently train 120 GPs each year. However, 50% of GPs will retire in the next 12 years and it has been stated that we will need 300 new GPs each year for the next five years just to stand still, not to mention discussing their taking on extra work. On a personal basis, I would like to see them take on such work. It will be a long time before we can afford to release GPs for the length of time envisaged in order to allow them to be trained on the schemes to which I refer.

Everything I have stated is clear evidence that the plan to move to Galway is unsustainable as currently envisaged. The people of Mayo and Sligo have a safe service and they wish to retain it.

Voluntary transport services do not offer a realistic option in today's Ireland, particularly when one considers that citizens are time poor and are obliged to commute long distances and spend many hours in congested traffic while travelling to and from work. How will people find time to offer voluntary travel services to cancer patients? At €750,000, the budget for travel looks very slim when compared to what I understand to be the €10 million spent annually on transport for kidney dialysis patients.

The people of Mayo and Sligo have access to a service that is delivering safe and effective care and excellent outcomes. The authorities at Letterkenny Hospital are evolving their model, which is based on that which obtains in Mayo. Why does the Minister want to endanger women's lives by closing the service before proving that what is to replace it will work? All her talk relates to patient safety but all her actions scream "Save money, not lives".

I commend the motion to the House.

See this speech in context