Róisín Shortall (Dublin North West, Labour)

I appreciate Deputy Colreavy's initial comments and thank him for them. I am sure the staff of the Houses also appreciate them. As everyone is aware, the staff are extremely helpful and supportive in the context of assisting new Members to settle in and I am sure that will continue to be the case.

I am taking this matter on behalf of the Minister, Deputy Reilly, and I welcome the opportunity to address the House in respect of it. In the first instance, I wish to refer briefly some of the key changes envisaged for health services in the programme for Government. These changes will form the context for decisions on the way that health services are organised and delivered in Ireland.

This is the first Government in the history of the State to commit to developing a universal, one-tier health service. We are also committed to reforming our model of health care in order that much more care will be delivered in the community. In this way we will seek to reduce the cost of achieving the best health outcomes and, most importantly, ensure that access to medical care is based on need, not income. In all of these changes, the Minister is committed to ensuring that quality and optimal care are at the heart of our health services, including cancer services, which must be delivered in line with best practice in a safe and quality-approved setting.

In the context of cancer services, the programme for Government contains two important commitments. First, the Minister intends to oversee the introduction of a human papilloma virus, HPV, vaccination catch-up programme for girls in secondary school. The Minister has been on record for some time as having called for this vaccine to be made available to all girls attending secondary school and he now intends to ensure this happens. Second, the Minister wants to extend the BreastCheck programme to include women who are aged 65 to 69 years of age. I am aware that this is an issue of great importance to older women. Many campaigns were carried out in recent years in the context of extending the programme to those to whom I refer. The commitment in this regard is welcome. Both of these programmes are vital in terms of prevention and early detection, which are central elements of cancer control.

Many Deputies will be aware that in 2006 A Strategy for Cancer Control in Ireland was published. This strategy was developed following considerable work by a group of clinicians and other stakeholders in the national cancer forum. It set out the rationale for the restructuring of cancer services which paved the way for the establishment of the national cancer control programme. In the interim, there has been considerable change in the way cancer services in our hospitals, in particular, are organised. It is clear that services were too fragmented and that many clinicians were dealing with patient numbers that were too low to guarantee best outcomes. For this reason, the national policy has been to centralise cancer diagnosis and surgery in eight hospitals and at a satellite centre in Letterkenny, while ensuring that chemotherapy can continue to be delivered at a more local level. This is in line with international evidence which shows that the best outcomes for patients are achieved by specialist teams operating in specialist settings and with access to ongoing education, training, research and peer review.

Breast cancer diagnosis and surgery were transferred from Sligo General Hospital to University College Hospital Galway in August 2009. However, chemotherapy services have remained in place in Sligo and are linked with the necessary multidisciplinary team at Galway. The medical oncologist in Sligo participates by means of video conference in the multidisciplinary team meetings in Galway relating to both the symptomatic service and BreastCheck. A breast care nurse based in Sligo follows up locally on women with minor complications and provides ongoing support and breast care if necessary.

Other cancer services at the hospital were not affected by the change. Other than skin cancer - which usually involves minor surgery - and a limited volume of bowel and rectal cancer cases, the vast majority of other curative cancer surgeries have never been undertaken at Sligo and are routinely referred to one of the eight designated cancer centres.

Those who opposed the transfer of breast cancer surgery from Sligo point to the distances women must travel for services in Galway or Dublin. Those who support the decision argue that women only travel for initial diagnosis and surgery and that other key services including chemotherapy are provided in Sligo. They also note that women now have their surgery in a centre which has the minimum volume of new cases recommended under the national quality assurance standards for symptomatic breast disease.

Whatever one's view, this is a key decision that was not reached lightly. The Minister intends to meet Dr. Susan O'Reilly, director of the national cancer control programme, in the near future. At that meeting, he will discuss with her a range of strategic issues relating to cancer services, including the best way forward for the provision of breast cancer services at Sligo. The Minister is committed to ensuring that the quality of care and outcomes is of paramount importance in decisions relating to health policy and cancer services. This principle will underpin all of the decisions to be made, including those relating to breast cancer services at Sligo General Hospital.

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