Mary Harney (Dublin Mid West, Progressive Democrats)

——to get the best possible care.

I wish to deal with the question of Galway coping with the numbers. Galway currently has six beds for breast surgery and it will probably have to increase that to eight to provide services for the rest of the region. That is what we are talking about.

Deputy O'Sullivan constantly asks me about resources. When Professor Keane was asked to take over the implementation of a plan similar to ours in Canada, he was told by the Prime Minister there that, unfortunately, due to difficult times no new money could be provided. This year we have allocated €5.8 million to Professor Keane, which is what he asked for. Currently, he is recruiting at least 22 cancer specialists for the health care system. One can ask why it is important that we get those specialists. We are over-dependent on units with one individual, which is not good because if the individual is on leave we have to get a locum. Our system is far too dependent on locums and other issues arise in that regard. The first priority is to recruit the manpower by way of consultant specialists into the cancer control programme and that recruitment is under way. Thankfully, the new consultant contract, which was voted on overwhelmingly last week by the Irish Hospital Consultants Association, will allow us to have consultants work in a way that better meets the needs of the public health care system working in teams with clinical directors. That programme is under way.

Second, there are issues around how patients are referred. Professor Keane is working with the Irish College of General Practitioners, which has responsibility for training and education among general practitioners. As Deputies are aware, last weekend Professor Keane addressed the annual conference of the ICGP. He is working with it on referral protocols so that any urgent case can be seen within two weeks. That is a good international standard and one we want to see implemented here. If we separate what can broadly be called routine cases from urgent cases we will be able to achieve that.

I am the first to accept that the current transport arrangements between, for example, Sligo and Galway are not satisfactory. Professor Keane has allocated €0.75 million this year to the Irish Cancer Society because in other countries it is patient organisations such as the Irish Cancer Society that are seen to be the most suited to put into effect appropriate transport for patients. That is in addition to the transport arrangements we already have in place. The idea is to provide more modern and convenient transport facilities.

Professor Keane made the point himself about accommodation at St. Luke's Hospital, that we have four times more inpatient beds for radiation oncology than what is available for a similar population in Canada. Many of the patients need not be in an acute hospital environment. They could be in a hotel-hostel environment, which would be much more satisfactory from the point of view of the patients and from the point of view of being cost effective, which is important in terms of getting resources to invest in the appropriate area.

The Government's cancer programme is not universally popular. I know that, as I have had discussions with people in Sligo and Mayo. I was happy to meet an excellent group of women — all of whom had breast cancer — when I visited Mayo recently. I know how strongly people feel about the issue. We all feel strongly about it. No Minister for Health and Children worth his or her salt or who is worthy of the job, could fail to stand over the implementation of a plan based on best international evidence.

I say to Deputy O'Sullivan that when Professor O'Higgins produced his proposals seven years ago the international evidence was that a centre should deal with 100 new cases a year. That evidence has now changed to 150 new cases a year. As we know in regard to breast cancer, the developments taking place globally have been described by oncologists as revolutionary. The information, medicine, pharmaceutical products etc., are changing rapidly, which is why much better outcomes can now be achieved. We have to respond to those changes if we want to deliver the best possible quality-assured services for patients. That is what the Government is doing. That is all the Government is doing. The Government is not withdrawing anything to put in something inferior. It is looking at the best evidence, putting in place in 2008 the best possible cancer services this country can afford, and making sure in particular that as many services as can be quality assured are provided in local hospitals, such as chemotherapy. Chemotherapy services will continue to be provided in Sligo, Mayo and in many of the other hospitals where surgery is moving to the specialist centres.

We are talking about specialist centres, not centres of excellence. We are talking about centres where all the specialists in cancer care, pathology, radiology, surgery, medical oncology and so on work as a team around the highest possible number of patients to ensure they can see every possible scenario from a patient perspective. We want every health care setting to be a centre of excellence but we want surgery and diagnosis, which are the two most important aspects, to be done in the specialist centre.

Of the 100 women who will attend a breast clinic, only five will have to have a biopsy or follow-up treatment. Ninety five people will never have to come back again. That is the evidence and it is very good. We are saying that out of every 100 women from Mayo or Sligo, five of them may have to come back for a biopsy and, of that number, perhaps two or three will have to have further treatment. If in doing it that way we are able to guarantee those women that instead of only three people surviving four people will survive, I believe that is a risk worth taking and it would be irresponsible of any of us to stand in the way of its implementation.

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