Joe McHugh (Donegal North East, Fine Gael)

I welcome the Minister of State, Deputy John Moloney, to the Chamber and acknowledge the pending meeting with representatives from the Duchenne muscular dystrophy group. I have just been informed that a delegation from that group will meet the Minister for Health and Children, Deputy Mary Harney, and I acknowledge the Minister of State's ongoing involvement. I have been highlighting this issue with the Minister of State on a regular basis, both inside and outside the House.

At the outset, I affirm Fine Gael's support for this Bill, which serves to further implement the national cancer strategy that was first established in 1996 by a Fine Gael Minister for Health, Deputy Michael Noonan. I wish to pick up on a few points raised by Deputy Paul Connaughton and obviously there are swings and roundabouts in respect of centres of excellence. As a Galway representative, Deputy Connaughton highlighted the positive aspect of Galway being a radiotherapy centre for the west. However, when employing hindsight and when extrapolating on all the reasons Ireland entered a phase of what one might call the adoption of international best practice, I believe there will be a fundamental analysis of the mistakes made here when we took international best practice as a winning formula not simply for health, but for many other sectors. I do not believe one can compare like with like and I refer in particular to Professor Tom Keane as head of the national cancer strategy. One cannot compare the Canadian experience and health model to the model in Ireland because we do not have a similar type of public transportation infrastructure. Obviously, I allude to the position in County Donegal, in which cancer patients must rely on paramedics to go to Dublin and must engage in five-hour trips in the back of an ambulance. When comparing like with like, international best practice may be a misnomer.

Ireland's number of consultant radiation oncologists per million citizens is the lowest in western Europe. Each consultant supervises a case load four times larger than those suggested in a number of international guidelines published in the mid-1990s. A total of 319,599 Irish citizens were diagnosed with cancer between 1994 and 2007, of whom 11,102 were patients from County Donegal. A 41% increase in the number of cancers is expected between 1994 and 2015, excluding non-melanoma skin cancer. There will be a major increase in the number of patients with the more common adult cancers that require radiation oncology treatment such as breast, prostate, lung and non-melanoma skin cancers.

As I noted earlier, 11,102 Donegal residents were diagnosed with different forms of cancer between 1994 and 2007, out of a total of more than 319,000 Irish citizens who were similarly diagnosed during that time. I have extrapolated a few figures from the National Cancer Registry and have compared the results for a few different counties to six seats in the Dáil. A total of 897 patients in County Donegal were diagnosed with lung cancer, compared to 798 in County Kildare. There were 1,127 Donegal prostate cancer diagnoses, compared to 1,098 in County Kerry. A total of 204 leukaemia cases were detected in County Donegal, versus a comparable figure of 140 in County Meath. An obvious trend emerges in this respect.

The reason I have extrapolated these figures is because of the anecdotal evidence I encounter every time I go to a wake in County Donegal. I attended a wake in my native parish last weekend at which the son-in-law of a man who had just passed away from cancer asked why more people from County Donegal are in St. Luke's Hospital than from anywhere else. While this is anecdotal evidence, it must be investigated. The Department should investigate this issue because it is a question on the lips of every citizen in County Donegal. When one visits St. Luke's Hospital, one will find statistics to prove that more patients from County Donegal go through its doors than from any other county in Ireland. It is a worrying statistic and is a trend that is highlighted in the figures from the National Cancer Registry. There is anecdotal evidence in every parish in County Donegal and the Department must investigate it. People speculate that it could be a result of the outfall from Chernobyl. Obviously the issue of diet is raised but people in Donegal do not eat any different foods than the rest of the country. Consequently, this issue should be investigated and I call publicly on the Department of Health and Children to investigate this serious issue in County Donegal.

The national cancer strategy is imperfect and I refer to concern that none of the eight centres of excellence will be situated north of the Dublin-Galway line. Moreover, there are demographic arguments for a centre of excellence north of this line. I note the view expressed last week by Professor John Crown, head of cancer services at St. Vincent's Hospital, who stated last week that having four centres in Dublin and none in the north west is crazy. The cross-Border organisation Co-operation and Working Together, CAWT, has informed me that a commitment exists to consider the radiotherapy services provided in the north west. However, a few questions arise therefrom. What is the current position on a north-west arrangement? Second, will the respective Ministers, Deputy Harney and Mr. McGimpsey MLA, sign the agreement for a radiation unit to serve the north west in Altnagelvin Area Hospital? If so, when and on what date? In the ongoing absence of a radiation unit, will the Minister guarantee that Donegal patients will continue to be afforded the opportunity of going to St. Luke's, to Belfast or to Galway? The key question on the lips of Donegal residents and of my constituents in Donegal North-East is whether there will be equal access. If a radiotherapy model based in Altnagelvin Area Hospital, County Derry, is agreed to, will there be equal access for the good citizens of County Donegal? As for ongoing work at Letterkenny General Hospital, the new medical assessment unit and an accident and emergency unit are under construction at present. However, fear also exists in respect of the downgrading of services at this hospital and I ask the Minister of State to allay such fears.

Medical experts advise that the closure of St. Luke's Hospital is desirable and Fine Gael accepts that by 2014, it will not be operating as a cancer treatment hospital. However, due to the high numbers of its residents who attend it, County Donegal unfortunately has a special relationship with St. Luke's Hospital. The hospital has always sent a consultant to Donegal once a fortnight for consultations with cancer outpatients. Previous speakers have referred to the unique culture at St. Luke's Hospital. Psychosomatic medicine is an interdisciplinary medical field and it is impossible to quantify its effects. Consequently, while one bows to medical expertise when considering oncology treatment, one must rely on what one hears, experiences and knows when addressing psychosomatic considerations. Although the hospital is in the middle of the city, it gives calmness to its patients and their visitors. Its buildings, staff, gardens, parking facilities, medical facilities, religious features and pathways contribute to the atmosphere to which many speakers have referred. Patients who do not need constant care stay at the Friends of St. Luke's Hospital hostel, at which their families also can stay.

All Members are familiar with the prayer, "God grant me the serenity to accept the things I cannot change, courage to change the things that I can and the wisdom to know the difference". The lay-out of St. Luke's allows longer-term patients and their families to give newer patients and their families courage and wisdom. The atmosphere confers serenity and acceptance. Patients rely on one another and learn from one another. Patients' families rely on other patients' families and the staff are patient, honest and firm. This compares to the chaos that applies in some other hospitals.

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