Paul Connaughton Snr (Galway East, Fine Gael)

I am delighted to have an opportunity to contribute to the debate. Few people will object to the Bill but it gives us an opportunity to give great consideration to how cancer services are being reorganised. I am a member of the Joint Oireachtas Committee on Health and Children, as is the Acting Chairman, and I have been impressed by Professor Tom Keane. I am not a medical person but, from the first day I saw him, I was extremely impressed with the way he went about his business. I fully appreciate, as Deputy Creighton said, that there will always be tensions in the provision of cancer care and other Members will be much more vocal about how the national cancer strategy did not suit their areas. However, the concept of eight centres of excellence was right.

We are fortunate in my constituency that there is a centre of excellent in UCHG in Galway city but if I happened to live in counties Donegal or Sligo, I would argue it is a long way to travel for treatment. I have been in the House quite a while and hundreds of people from east Galway and the west have had to travel to St. Lukes Hospital. I have been in the hospital - thankfully as a visitor only - on many an occasion. I met these people on trains and buses as they traipsed up and down to the west, with some doing a return journey on the same day having received treatment. What is happening now is heaven on earth compared with what people had to do in days gone by. It is bad enough to be fighting for one's life. One of my great dreads is that cancer will cross my path or that of somebody close to me but the statistics show that one has to assume it will happen sooner or later. I do not have time to go into the statistics but, for whatever reason, while our population is increasing, the numbers of people dying from cancer is also increasing. I acknowledge that because of early detection and better systems of treatment, people are alive now who would not have survived ten or 20 years ago.

The public will buy into the concept of the centres of excellence but when one considers what Professor Keane and his team did in a relatively short time, it was a major shake-up for an organisation such as the HSE. I only hope in the next ten years that what happened with cancer care will be replicated in many other areas of the health service. One of the reasons for this is that Professor Keane was able to get health professionals on side from the beginning. There was no shortage of bickering, which is part and parcel of the world we live in but we are lucky many of our consultants have been trained all over the world and they came back here to work. Once they got into this system, it appeared they then knew their expertise, which is acclaimed worldwide, could be delivered on to benefit patients and it certainly appears to be working.

The cancer unit in Portiuncula Hospital, Ballinasloe, was closed because it did not deal with sufficient cases. Since it was only 30 or 40 miles away, it was transferred into the new centre of excellence at UCH Galway. One hopes the withdrawal of that type of service, which will affect all areas of the county, will be compensated for. When I refer to a new image for the HSE I hope it will be able to deliver as regards hospitals such as Portiuncula. We know they will not be doing open heart surgery or treating cancer in future, although it is silly to believe that an important albeit small hospital could not perform these procedures. It is significant what they can do, however, because of the physical traffic going through a place such as Galway, which believe me is one of the busiest places on the face of the earth. One nearly has to park half a mile away from UCH in a housing estate if one wants to visit a patient. Nonetheless, there are obviously many procedures being done in that hospital that could, perhaps, be performed more efficiently in Ballinasloe. I am calling for a redoubling of efforts in this regard.

For whatever reason the HSE is finding it extraordinarily difficult to redirect, where appropriate, what is being done in UCH to a smaller hospital such as Portiuncula, in order to allow it to fine tune its efficiencies as a centre of excellence for many other procedures. Take rectal cancer, which is an enormous problem. I fully accept that will be treated in the various centres of excellence. However, there are so many things that the smaller hospitals could and should be doing, if only the Minister, the HSE and everyone concerned would switch engines on this and let people see what could and should be done.

This would remove a great deal of the frustration and anger that is being expressed throughout the country, with people saying their local hospitals are being closed by stealth. I am not a medical person, but I believe these local hospitals will be badly needed before all this is finished. They have the expertise in areas such as accident and emergency, maternity etc. Given what has happened in UCH Galway, which will rightly be a centre of excellence for other things as well, we certainly would not need to take our eye off the ball as far as primary care is concerned, and need hospitals such as Portiuncula.

I have a fundamental problem with Government as regards the roll out of BreastCheck, and with the HSE. Thankfully, it has now happened and it is in operation in every county, perhaps with one or two exceptions. However, given that in Ireland over the last ten years there was money hand over fist and where, in many instances, the Government and its agencies did not know what to do with it, I could never understand why it took so long to roll out BreastCheck. It is enormously important and the results will show in the future that because it was rolled out, even at this late stage, it will certainly save many lives. I believe, however, that many women have died unnecessarily over the last five to ten years because BreastCheck was not in place.

Prostate cancer is an enormous issue all over the country. One of the reasons it has such a grip on men is that, for whatever reason, they do not seem to want to see a doctor as readily as women might. That is changing, but nonetheless men are slow to present. There should be no reason for this, but that is the position. Doctors tell me that men really need to become incentivised to do this promptly. I believe some 2,500 men were found to have prostate cancer last year, and 500 to 600 died. This is a significant number and it is getting worse.

I hope the HSE, in whatever way it can, through a PR or information campaign perhaps, will get the message across to men everywhere to test for prostate cancer. It is the most important thing they can do. For some strange reason an enormous percentage of men refuse to do that to this day, and we cannot blame the Minister and the HSE for that. However, we must create an environment whereby men will want to do that. I have no doubt that with the centres of excellence now swinging into action, a major job will be done on that particular cancer.

Lung cancer is another major challenge, and some 800 people die from this every year. I find this hard to understand given what the Government and the public have done as regards non-smoking areas etc. There is a major trend, however, among young people, particularly girls, towards wanting to take up smoking and that obviously will have enormous effects on their lives in years to come.

I pay tribute to St. Luke's on behalf of the many people from the west who have attended there over the years. One could say it had an unusual effect on many people, while one cannot expect someone to get excited by the fact he or she has been diagnosed with cancer. Certainly, one could not get excited at the prospect of having to drive 200 miles to a hospital among strange surroundings. Many of those people would have had nobody belonging to them in Dublin, and this was therefore a source of enormous strain and anguish for them at that point in their lives. However, because of the way they were treated when they were admitted to St. Luke's, almost everybody I know was extremely grateful for the great dignity, humanity and professionalism extended to them. I hope this ethos, which has been referred to on a number of occasions here, will be continue in St. Luke's and I have no reason to believe it will not.

Finally, I understand that Dr. Susan O'Reilly is taking over from Professor Keane. I wish her well. Her job is as big as the one Professor Keane had to face on the day he started. This job is only quarter done. Some people might say the high profile element is done, and that may well be, but there are enormous elements to be addressed under the cancer-oncology structure. I hope everything goes well for her. She has the experience and the research track record and I understand she is a formidable person. From a personal viewpoint I wish her well.

More generally, as regards cancer, I must take my hat off to the hospice organisations around the country for the wonderful job they do for people who are terminally ill and living out their lives in great dignity because of the support they are getting. I am thinking of places such as the Galway Hospice Foundation, which has done so much with so many people. It is a testament to people's opinion of it that most hospices were started on the basis of voluntary contributions. Some of the best voluntary efforts I have ever seen have been to establish and to procure funding for the hospice centres. People perceive this, now they have been up and running for many years. It is terrible to think that one may be obliged to use them. However, that is how life is and for those who know that medical science cannot do any more for them and who wish to live out their lives with dignity and respect, it is great to think there are men and women who dedicate their entire lives to helping such people. It must be a great source of satisfaction for families to know their loved ones are being so well looked after.

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