Jan O'Sullivan (Limerick East, Labour)

I stress that we are not in favour of maintaining unsafe services. That is why we only advocate this one exception and why we have included in our motion yearly audits of all designated centres, both full centres of excellence and outreach centres. The disregard for the lives of women and men who have been misdiagnosed because of bungling, bad organisation and governance, poor resources or ill-chosen locum staff must never happen again. The lessons of Portlaoise must be learned and the recommendations of the series of reports on misdiagnosis must be rigorously implemented.

It is an important part of the motion that there be yearly audits of all centres. There have been a litany of appalling incidents in various parts of the country where cancer has been misdiagnosed. We had three reports on Portlaoise, the Rebecca O'Malley report and the Barringtons Hospital report and we await a report on Cork and Galway. There have been a litany of reports and serious and important recommendations, and they must be implemented.

All those recommendations have resource implications. I hope the Minister will answer the question of where are the resources required to build up the centres. Where are the resources for Galway and the other centres? How can patients in the north west with cancer symptoms or those who are worried about the disease be confident that the excellent services they now have confidence in will be replaced by a similar level of service in Galway if their local centres are closed? We have raised the issue many times in this House but we were never given clear answers on the provision of resources. We know Professor Keane will return to Canada at the end of next year but we have not been given any assurances that what he sets up will continue in a way that provides the necessary resources.

I wish to return to the issue of Letterkenny. It is clearly Government policy that an outreach centre will provide a good and safe service in Letterkenny, which I welcome. How will the triple assessment and the multidisciplinary teams be delivered in Letterkenny and what is the level of expertise that will be available on-site? How will the clinicians who will be working in Letterkenny and Galway operate? I assume the Minister can answer all these questions. I assume she can stand over the safety of the proposal for an outreach centre in Letterkenny. If she can answer such questions, I do not understand why these services cannot be delivered in Sligo, in Mayo or in both places. If the Minister believes services can safely be provided in Letterkenny, surely she can give us answers in relation to the other centres. That is what this motion is about — the provision of safe and reliable services in all the centres.

I would like to reflect on the Government's habit of accepting proposals lock, stock and barrel without examining the detail of what is proposed or ensuring that such proposals can be fully implemented. A report produced by Comhairle na nOspidéal several years ago suggested that accident and emergency care be provided in secondary hospitals 24 hours a day, seven days a week. The proposals in the more recent Hanly and Teamwork reports were completely different, however. We are expected to swallow the various reports whole, without any question. When it was suggested there should be eight designated centres under the cancer strategy, that plan was accepted and minds were closed. Those who felt strongly that the plan was jeoparding their safety and care had no opportunity to make the case for their strong belief that some services should be retained in the north west under the cancer strategy. When we tried to open up a debate to try to have the matter considered, we felt we were beating our heads against a brick wall.

It is worrying that reports are simply accepted as gospel and that is it. As I said earlier, the same thing happened when the Hollywood report on radiotherapy was published. We were told it would be neither sensible, practical nor a good use of resources to offer such services anywhere other than Dublin, Cork and Galway. We have now shown that an alternative model can work. It was reported today that Professor Tom Keane has said that far too many patients are being given radiotherapy on an inpatient basis. If cancer care centres were provided in more locations, radiotherapy could be provided more frequently on an outpatient basis.

I question the Government's philosophy of accepting reports without question. Such reports tend to be implemented in a hands-off manner. I want to refute the suggestion that anyone who questions that approach is somehow mischievous, politically motivated or not working in the best interests of patients. All of us are primarily concerned with the best interests of patients. I submit that people in Belmullet and other extreme parts of the north west who have cancer and have to travel for services think that Galway is a long way away. Therefore, the Minister should open her mind to the development of another main centre, or of a series of outreach centres.

I would like to comment on another couple of aspects of cancer care before I conclude. The BreastCheck service has not been delivered to all parts of the country. While some of the mobile units have been rolled out, not all of them have been. People in the north west, like people in my own region, have not yet been able to avail of the services of BreastCheck. It is clear that they are suffering as a result of unequal treatment. The sooner BreastCheck is rolled out in all parts of the country, the sooner all the women of Ireland will have a fair service. Last week, the Joint Committee on Health and Children discussed palliative care services, which are unevenly distributed throughout the country. While the region I represent is one of the better regions in that regard, many other regions are not properly served. It is a question of fairness, geography and treating patients in the north west with the same level of respect as their counterparts in the rest of the country.

It is important that the motion proposes that we "ensure that all centres of excellence and satellite units are the subject of an annual HIQA audit" to ensure they are safe. We all wish to ensure that the services which are delivered are absolutely safe and fulfil the criteria which have been set out in the cancer strategy. I urge the members of the Government to open their minds and to give the people of the north west an opportunity to avail of safe cancer services near their homes.

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