Jan O'Sullivan (Limerick East, Labour)

I want to begin by assuring the Minister and Professor Tom Keane that we have no intention of reopening consideration of the cancer strategy or setting it back in any way. I note that in the media Professor Keane suggested that is what we might be trying to do. We want to make one change only, a change that we signalled from the start. We in the Labour Party fully support the proposal to establish so-called centres of excellence, where diagnostic and surgical cancer services and after-therapy will be delivered in designated specialist units, backed up by triple assessment and provided through multidisciplinary teams. We welcome and embrace the proposals in the strategy designed to improve outcomes for patients.

We support the work of Professor Tom Keane. However, Professor Keane will not always be with us — I gather he will return to Canada in approximately a year and a half — and we will not give uncritical support to the Minister unless we are satisfied, on behalf of patients, that the necessary resources are developed in each centre to deliver the excellent care to which patients are entitled. There should also be extra capacity for the increased number of patients who will travel to be treated in these centres.

I am very concerned because there is no assurance with regard to resources. There is a famous quote from the Minister, Deputy Dermot Ahern, that there was not "one red cent" to develop a hospital in the north east. Unfortunately, we have no information that the resources required will be provided in Galway or the other designated centres. Will we have the staff, beds, theatres and other supportive arrangements required if we are to have centres of excellence in those locations?

Professor Keane is quoted in one of the newspapers today as saying the number of centres is "immaterial". He implies there could have been any number of centres, as he came to implement what had been decided.

Those who recommended those eight centres are not infallible and their report is not gospel. It is a matter of fact that a previous expert report suggested 11 centres was the right number. Who are we to believe? Who did these people consult and who suggested the eight centres? What information did they use and who exactly made the decision for eight centres? Why did they know more than Professor O'Higgins and his team, which suggested a larger number of centres a couple of years before that?

Looking at the map of Ireland, one would have to question why four of the proposed centres are in Dublin while there is none north of the line between Dublin to Galway. One must question why that decision was made. That is a very large part of the country with no centre of excellence.

That aspect of the recommendations is wrong. I believed that and said so when it was announced and I still believe it. It is true, as the Minister stated, that people will travel long distances if they know they will get the best service by doing so, but they should not have to travel such disproportionately long distances in the north west in comparison to everybody else in the rest of the country. It does not make sense that four centres will be in Dublin and none in the north west.

I question who made these decisions and if they were totally objective in reaching the proposals. I will refer to an issue in my region. Only a few years ago, on the publication of the Hollywood report on radiotherapy, we in the mid-west were told in no uncertain terms that we would not have radiotherapy services. They were to be delivered in four super centres, with two in Dublin, one in Cork and one in Galway. The report concluded that the Irish population did not justify having any more centres. Nobody from the mid-west was on that body, which was large. However, people in the mid-west and the south east were well aware of the suffering of very ill people who had to travel long distances for approximately six minutes at a time of radiotherapy. We did not accept the judgment of those who made such decisions safe in the knowledge that they were within a short distance of treatment.

In Limerick, we fundraised and set up a radiotherapy service which initially paid for both public and private patients out of a fund raised by the Mid-West Hospitals Trust. When it was up and running and had proved its worth, with a unit in Waterford, it was brought into the approved cohort of service and under the public purse for public patients. Nobody is saying those units should not be there but they would not exist if we had taken no for an answer and accepted the so-called expert report.

I will repeat my question. Why are there four centres in Dublin and none in the north west? Let us not pretend that these decisions are entirely objective. Let us not pretend either that a satellite centre in Letterkenny will fulfil the safety criteria but one in Sligo will not. If the multidisciplinary teams and triple assessment safeguards that are the accepted standards of care can be provided in an outreach centre in Letterkenny, whether linked to Galway, Belfast or anywhere else, they can also be provided in Sligo or Mayo. Deputy Reilly indicated the safety outcomes with figures he has with Mayo.

The Labour Party would favour one full, ninth designated centre in the north west. That has been rejected by Government. Instead the outreach centre model has been favoured. If that is to be the model, and the advice to Government is that it is a safe model, it should also be comprehensive in addressing the population of the north west.

The cancer campaigns in the north west are led primarily by patients and medical practitioners. It is an insult to them to suggest, as has been said before, that any of us is somehow playing politics with this issue. Those who can be accused of that are the people who say one thing in their constituencies and do something else in Dáil Éireann. I was present when we had a debate on cancer services approximately two months ago. People behind the Minister suggested we needed a service in the north west and stood up for their own region. However, when the Minister replied to the debate she did not refer to those contributions but accused us on this side of the House of playing politics with the issue.

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