Barry Andrews (Dún Laoghaire, Fianna Fail)

I would be impressed if Deputy McCormack could find anybody on his side of the House who has not read a script. He might find a few of them.

On the perspective of women, it is understandable that they have concerns about changes to the traditional arrangements for their care. Women in Mayo and Sligo currently enjoy rapid access to their local hospital service when they require it. They are familiar with their local hospital. They often know the nursing and medical staff and have a high regard for them. They know other women who have had breast cancer and who have had it successfully treated in their local hospital. They fear having to rely on a service that is further away and less personal. Understandably, they worry when doctors or public representatives tell them they will get a poorer service.

From the perspective of general practitioners, in Mayo and Sligo they have a long-established relationship with their local hospitals, as is the case with hospitals in towns throughout the country. They know the consultants personally and regularly meet them at clinical meetings and in other settings. That close personal relationship provides local GPs with the security of having access to a good quality and trustworthy clinical opinion when they need it. It also provides them with the means of being able to have patients seen speedily when they are worried about them. They value that access and do not wish to see it compromised.

The Minister wishes to reassure all women that the service they receive in the west will be of the highest quality and that it will be there when they need it. Under the cancer control programme the services will be organised to meet everyone's needs and the proof of a better service will be seen from the beginning of the new arrangements.

It is important to explain what the new arrangements will mean. For women who have breast cancer, travel will be required only for the initial assessment in the clinic, as the Minister said, and again for the surgery. In the case of women who require chemotherapy, this can be delivered at both Mayo and Sligo hospitals in accordance with protocols set out by the multidisciplinary team based in Galway. Far from countless visits involving long journeys, it will be possible for women to have the great majority of their care locally. All of us must reflect on whether we feed into a spiral of fear among patients who are already suffering a trauma in their lives for narrow political aims.

The multidisciplinary teams in the designated centres will carry out high case volumes. In surgery for breast cancer, for example, each centre should carry out a minimum number of 150 such surgeries. There should be no form of the disease that the surgical team has not seen. The team should predict complications and should be familiar with all relevant investigations and treatment for the disease. People attending the centres will know they are in the hands of highly skilled consultants and nurses who have access to all the resources necessary to achieve the best results possible in terms of survival rates.

In all the local debate, we must not lose sight of what we want to achieve, the best possible outcome for patients. The reorganisation of cancer services is at the heart of the delivery of the national strategy for cancer control, which was approved by the Government in 2006. Patients enjoy an improvement of up to 20% in survival if they are treated in specialist centres which provide multidisciplinary care. The new configuration of services will allow for the delivery of quality assured patient focused care, which will be in keeping with international best practice and the highest standards.

The major focus of the Health Service Executive's implementation plan to date has been on breast cancer services. Since 2000, more than €60 million has been made available for the development of symptomatic breast disease services nationally.

In June last year the Minister approved national quality assurance standards for symptomatic breast disease services under the Health Act 2007. The implementation of the standards is an essential element of the quality agenda set out in the national cancer control strategy. The aim of the standards is to ensure that every woman in Ireland who develops breast cancer has an equal opportunity to be managed in a centre which is capable of delivering the best possible outcome.

Funding of €5.8 million has been allocated from the programme in 2008 across the eight centres to support additional staff, including consultant, radiography, nursing and clerical posts. Funding has also been allocated for some necessary additional equipment.

Changes of the kind being implemented are difficult. They lead to concerns about local services and an understandable fear that the new will not be as good as the old, but we are not alone in dealing with these changes. Canada, like Ireland, has very sizeable areas that are sparsely populated and patients there often must travel hundreds of miles to attend for treatment.

The decisions on the location of the eight designated centres have been made, taking account of travel times, proximity to large urban centres and the ability of the centres to recruit and retain top clinicians. The availability of multidisciplinary teams and up-to-date technology is also very important.

There is no doubt that the designated centres will require further development.

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