John Perry (Sligo-North Leitrim, Fine Gael)

I congratulate our Fine Gael Party leader, Deputy Enda Kenny, our health spokesperson, Deputy James Reilly, and the Labour Party in bringing forward this important motion. It concerns the retention of cancer services at Sligo General Hospital. This situation is now at a critical juncture. I will first examine the two key ideas behind the proposed eight centre model of breast cancer care. The report on services for breast disease, dated March 2000, recommended 14 breast cancer centres, including one at Sligo General Hospital. Why then has the recent cancer strategy reduced the number of centres to eight?

Two particular figures are widely used to justify the proposed eight centre model. One figure suggests that the specialised breast units have a 20% improved survival rate. The other figure suggests that a specialist breast cancer unit must have 150 or more new cases per year.

Of the 20% improved survival figures, the report on the development of services for breast disease in 2000 stated:

Evidence demonstrating correlation between workload . . . and survival exists. In some cases, a 20% improved survival has been noted in patients treated in specialised Breast Units compared to those not treated in such centres.

The use of the words "in some cases" does not convey a point of sufficient substance to justify the national strategy.

On the point that a specialised breast cancer unit must have 150 or more new cases per year, let us examine the origin of that figure. It comes from the breast unit guidelines issued by the European Society of Breast Cancer Specialists. The paper states that a breast unit must have a critical mass of a medical specialist, including two breast surgeons, two radiologists and two pathologists. The paper adds that such a unit is expensive and therefore must have a high throughput of patients, leading to the figure of 150 or more new breast cancer cases. In other words, first staff the unit then look for the patients. A Government strategy for cancer care must consider all the factors, including geography. The paper also states that individual breast cancer surgeons must personally carry out the primary surgery in at least 50 breast cancers per year to maintain expertise.

Sligo General Hospital reported 70 new breast cancer cases in 2006 and 95 in 2007 to the cancer registry in Cork — these are certified figures — and expects to report more than 100 new cases this year. The hospital inpatient inquiry scheme database cites the total number of breast cancer surgical procedures carried out at Sligo General Hospital as 65 in 2005, 57 in 2006 and more than 80 in 2007.

A recent study carried out by senior medical staff at Sligo General Hospital compared outcomes for breast cancer patients in Sligo General Hospital with outcomes for patients in the SEER database. That is the largest United States database and is generally recognised as a gold standard to use when comparing outcomes. That paper clearly demonstrates that the outcomes for Sligo patients are either identical or superior to those achieved in the US.

That hospital study has the up to date figure. The very old, if not ancient, comparison figures used by the Minister last night in the House have no validity. I am astonished that she came into the House for this debate and gave figures that are eight years old. That is appalling. Likewise, her figures on the 20% recovery rate were equally appalling as that data is eight years old also. Closing down cancer centres with a few cases does not apply to Sligo General Hospital. The current caseload, the record of successful outcomes and the expertise of the multidisciplined team fully justifies a centre in Sligo General Hospital.

The current cancer strategy is the recommendation of an expert group. In recommending an eight centre model, with four of the proposed centres being located in Dublin, the purely scientific analysis went out the window. If the science behind Professor O'Higgins's report was rigorously applied, there would be just one, and possibly two, breast cancer care facilities in Dublin. In the case of Dublin, the science was complemented by a political judgment to arrive at four centres. Policy in national health care is a political matter. TDs represent the people. It is our job to reflect the will of the people, and we have the will of the people in the Gallery tonight.

Governments request advice from experts. We have plenty of experts in this Government — €1 million per week is spent on experts and consultants — but trade-offs require political balancing and that can only be done by elected politicians. It is the job of experts to advise; it is the job of Government to decide. Let us be clear about where the responsibility for the downgrading of Sligo General Hospital lies. It lies with this Government and its Ministers.

The proposed eight centre model examines the problem of cancer care solely from the perspective of the disease and its treatment. Cancer is not a simple disease. Effective treatment is not just about dealing with abnormal cells. Cancer care is about healing the total person. The good news is that cancer is more survivable than ever but even in the best case the disease is a heavy burden on all those affected. We must go beyond just treating the disease and address all the needs of the patients, their families and friends if the treatment of the patient is to be fully successful.

The Minister for Health and Children has stated that the key objectives of the national cancer control programme are to ensure equity of access to services and equality of patient survival, irrespective of geography. Irrespective of geography indeed. The people of Dublin are not expected to travel to another hospital approximately 10 km from their home for cancer care but the Minister sees no difficulty asking people in the north west to travel up to 250 km or more from their homes for cancer treatment.

For patients, families and friends, ease of getting to and from hospitals is a serious problem that must be fully considered. The decision to close cancer services at Sligo General Hospital ignores the cancer care for the population north of a line from Galway to Dublin. That is not acceptable. The strategy runs counter to all the Government's talk of regional development and is seen in the region as having a cross-Border dimension. Speaking at a recent conference, the Minister for Foreign Affairs stated that mainstreaming North-South co-operation is a central part of policy delivery in every Department. Talk is cheap.

The Minister for Health and Children has stated that the potential for further cross-Border co-operation on cancer care would be progressed through a North-South feasibility study. The population of County Fermanagh has the potential to contribute to the population base for a centre of care in Sligo. It would be a monumental tragedy for the region to have cancer services removed from Sligo General Hospital only to discover next year that a cross-Border regional review of cancer needs further confirms the case for a cancer treatment centre in Sligo.

The cancer care strategy now being implemented is seriously and fundamentally flawed. Equity of access cannot be delivered by ignoring geography. The current strategy ignores the breast cancer care needs of the entire population north of a line from Galway to Dublin. Currently, 4,000 mammograms and 2,000 colorectal examinations are carried out at Sligo General Hospital. If the breast cancer care services are removed, all oncology services will be removed. I say to the Minister of State, Deputy Devins, that what is left will not be worth talking about.

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