Dan Boyle (Cork South Central, Green Party)
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Along with my colleagues I am grateful for the opportunity to raise this issue of immense concern in the Cork and Kerry region. The depth of the concern can be gauged by proceedings in the House yesterday. It is necessary to place on the record the vehemence of the anger of public representatives from the Cork area not only about the nature of the quality of cancer care services in the Cork and Kerry region but also the pathetic Government response that we received to a number of inquiries about the service over several years. When listening to the Taoiseach yesterday outlining a series of national statistics, we and the people we represent were meant to take some solace from the fact that one medical oncologist on call representing four hospitals serving a population of 500,000 people is somehow commensurate with the average cancer care service in the country and in particular with those in the nation's capital.

Cork has one noteworthy aspect in terms of cancer policy. It is the location of the National Cancer Registry, a dubious honour, which is more administrative than anything else. That registry points out that for several cancers the Cork and Kerry area is above the national average. Not only must we put up with the existence of such clusters among the people we represent, we also must put up with a sub-standard health service in trying to identify the degree of incidence of cancer in the area and how such cancers can be treated.

Those of us on the Opposition side of the House are not prepared to put up with this type of cant and hypocrisy any longer. The Government cannot hide behind a shield of statistics. The type of responses given by the Taoiseach and the absence of the Tánaiste and Minister for Health and Children from this Adjournment debate offers us no solace that the Government is dealing with the issue with any seriousness.

Meanwhile the people we represent continue to ask why even basic screening services such as BreastCheck, first promised before the general election of 2002, is now uncertain to be in place by the next milestone of 2007. As a Deputy for the Cork area I would like to know why at the end of November 2005 no planning application has been made to renovate the building identified to provide BreastCheck services in 2007. If that planning permission has not been sought, how can we even hope to come close to meeting the deadline for having such services available in the Cork area by 2007? This is beside the fact that the Government has chosen to roll out this programme to 50% of the country while the other 50% can continue to wait. This is not good enough.

I hope that when the Minister of State speaks, his contribution will represent an engagement and a reaction to what he will hear from my colleagues and me. I will not accept a prepared script written in the Department of Health and Children. We need to see appropriate action.

Jimmy Deenihan (Kerry North, Fine Gael)
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The letter from Dr. Seamus O'Reilly to the Tánaiste and Minister for Health and Children, Deputy Harney, which was published in yesterday's Irish Examiner was unprecedented, just as was last week's protest by 36 general practitioners in the grounds of Kerry General Hospital. The number of malignant cancers diagnosed in residents of Kerry in 2001, the latest year for which we have official figures, was 522 — 249 females and 273 males. Breast cancer with 74 cases was the predominant cancer type among women while prostate cancer was the most predominant among men with 76 cases. Estimated figures for 2002 and 2003 are 569 and 598, respectively. These figures represent a substantial increase of 22.7% over the total for 1994 when 462 people were diagnosed with cancer.

Recipients of cancer services in Kerry are also very much affected by the level of service in Cork. Since the resignation of Dr. Breathnach, a temporary oncologist visits Kerry General Hospital each fortnight. He is so overworked that he is unable to see all the patients during his visit and consequently they must either wait a further two weeks or go to Cork to be seen. Kerry General Hospital has no oncology beds for inpatients. Patients must be accommodated in general medical and surgical wards in the hospital. These wards are simply not suitable for oncology patients and certainly do not represent best practice. Although the hospital has a palliative care consultant, it has no beds for people dying of cancer and they are also accommodated in general medical and surgical wards.

While a day ward to accommodate day procedures was built and equipped five years ago, as it is not staffed it remains unopened. A high dependency surgical unit also remains closed and lies idle in the hospital. While it is fully equipped, the hospital has no staff to run it. In winter when the intensive care unit is overstretched, many patients, especially those suffering from bowel cancer, whose surgery is cancelled owing to the lack of beds in the intensive care unit could be accommodated in the high dependency surgical unit. Recently the sod was turned for a day care hospice unit in the grounds of Kerry General Hospital. However, this will be substantially funded by the people of Kerry and the committee will need to take out a substantial loan to build it. The Health Service Executive will only provide €500,000 of the total budget of €3.5 million.

Last year 3,000 patient visits were made to the oncology day unit at Kerry General Hospital and more than 800 new cancer patients were seen in the Cork and Kerry region. Dr. O'Reilly, who is now the only consultant medical oncologist serving a population of 500,000, following the departure of Dr. Breathnach, feels the region needs four consultants rather than two.

If BreastCheck was available to women in Kerry, the number of people visiting Kerry General Hospital would be much higher. In the counties where BreastCheck was rolled out 90% of women between the ages of 50 and 64 who were called for a mammogram attended the clinic. Evidence suggests that mammograms every two years reduce breast cancer rates by up to 30%. If the service was rolled out in Kerry, 10,000 women would be eligible for free screening and I am sure more people would be diagnosed with cancer.

It is recognised that the early detection of cancer by screening is one of the strategic areas of cancer prevention. Treatment in County Kerry is symptomatic, because women are only treated when their general practitioner refers them for a mammogram to Kerry General Hospital, following the discovery of a lump. There are no screening services in the county. As Dr. O'Reilly pointed out in his letter to the Minister, women in Kerry and Cork are subjected to more extensive surgery, radiotherapy, chemotherapy and hormonal treatment because of late detection.

I ask the Minister of State to arrange that a consultant oncologist be provided on a weekly visit basis to Tralee General Hospital because of the increasing level of cancer in the county. We also need a day ward and staff immediately to accommodate day procedures. Finally, the Kerry-Cork region needs four consultant oncologists, not just two.

Bernard Allen (Cork North Central, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this serious issue tonight. I am staggered and amazed that the Tánaiste and Minister for Health and Children is not here to answer the questions being raised by the elected Members of the people of Cork and Kerry. Her absence shows both arrogance and contempt for those people. Effectively, she is giving the two fingers to the fears, anxieties, worries and concerns of the people of the region, who are very upset by what was disclosed through the letter of Dr. Seamus O'Reilly on last Monday's Irish Examiner.

That letter outlined in graphic detail the crisis in cancer care in the Munster region and the ongoing delays in rolling out the national breast cancer screening programme in south Munster. The details of the letter were upsetting and disturbing, but not surprising because many of us involved in public life have been aware of the appalling and unacceptable situation for quite some time, right across the services. Many of us have raised these matters in the Dáil on more than one occasion.

The Government has attempted to place the heavy hand of secrecy on the details of how our health services operate. The abolition of the health boards and the axing of public representatives from the health services have helped create a veil of secrecy over much of what is happening.

The fact that a consultant oncologist working for a population of half a million people had to write to the Minister for Health and Children shows how desperate the situation is. To add insult to injury, the Taoiseach in the Dáil yesterday, in response to serious questions posed to him by the Leader of Fine Gael, Deputy Kenny, tried to defend the indefensible and attempted to explain away his Government's appalling record of undelivered promises in the southern region.

Mr. O'Reilly's letter stated that patients had been left to die at home because there is no room for them in hospitals, and when in hospitals they have been subjected to third world conditions. The Taoiseach also tried to rubbish my claim that there is a two-year waiting list for mammograms. If I have time I will read into the record a letter I received this week from the director of hospital services in the southern region to a parliamentary question I submitted to the Minister for Health and Children about a particular patient. The Tánaiste did not reply to the question, but passed the buck to the Health Service Executive from which I got a response much later. I was aware that the person, who had been referred for a mammogram by her general practitioner, had been told that she would have to wait two years for her mammogram. The response to my question confirmed that.

This highlights again the apartheid that exists in our health services where, if people can pay, they will get almost immediate attention, even in our public hospitals. However, if they are, unfortunately, dependent on the public health service, they will be told to wait in line, often for many years. The Tánaiste and Minister for Health and Children must explain the long delay in introducing the BreastCheck programme in the southern region. Unfortunately, she is not here this evening, although I would have expected her to be. She must publicly state that she accepts personal responsibility as Minister for Health and Children for the appalling conditions described by Dr. Seamus O'Reilly. She should be here to apologise publicly to the families who have lost loved ones and those who have suffered severely because of the inadequacies in the services described by Dr. O'Reilly. In accepting full responsibility for what has happened, she should set out a definite timetable for the upgrading of the services.

The Taoiseach must also, during his visit to Cork next weekend, meet Dr. Seamus O'Reilly so that he can hear at first hand the details of the upsetting conditions at the Cork University Hospital. A meeting with Dr. O'Reilly would bring the Taoiseach back to reality as he is at present living in a world of spin and denial that comes from being too long in high office.

Unfortunately, I do not have time to read into the record the contents of the letter I mentioned, but it is available for scrutiny, if anybody wishes to read it.

Billy Kelleher (Cork North Central, Fianna Fail)
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I acknowledge the co-operation of everybody involved in trying to get this debate tonight. There were scenes in the Dáil yesterday that would not achieve anything, so it is important that we have come here to highlight in a calm and rational manner the concerns of people and members of the broader public.

Health is an emotive issue, but when dealing with cancer and the suffering of patients and their loved ones and families there is huge distress and concern. It is important that we outline a clear defined strategy or timetables for what we want to achieve. If our objectives are not achieved, the reasons must be outlined. For example, one must ask why Dr. Breathnach resigned and why we are unable to fill that post with a full-time consultant oncologist instead of the locum there currently. These questions must be asked and answers provided. One of the major problems is that there is much obfuscation with regard to services and many people highlight issues on an ad hoc basis. We need a defined and clear strategy to outline what we have achieved to date and where we want to go. People have genuine concerns in this regard.

There are several issues at stake with regard to cancer treatment and care. I know the cardiac-renal-oncology unit has got the go-ahead, but the majority of people are not aware of that. From what I can gather, even Dr. O'Reilly was not aware of that. Is there a breakdown in communications or do people just not want to hear what is happening? When we make decisions we must outline how long it will be before they are implemented and the service is provided to the public. Everybody in the health service must be provided with this information. I am amazed that the senior consultant oncologist was not made aware or did not know that funding had been made available for the cardiac-renal-oncology unit. The provision of information is a major step in trying to address many of the problems we have in the former southern health board region with regard to cancer care.

There are also major concerns with regard to BreastCheck. I know the roll-out is happening and that the Department has secured the international training site and planning permission will soon be sought for it. There is progress. Everybody accepts that we cannot roll out the full BreastCheck system nationally in a matter of weeks. It takes time. Personnel must be put in place and planning permission for buildings etc. must be secured.

The delivery of projects is another issue we must address. It takes a long time from the time of the decision to arrange funding, design, tender and final construction of facilities. Surely there should be some mechanism in place for major projects of critical importance to people's lives to be fast-tracked. We fast-track roads and various other projects, but there seems to be a delay process with regard to health projects. Is there any mechanism by which we can use hospital grounds already available for a fast-track approach to securing planning permission? There is concern about these issues and while I accept that the Opposition must raise genuine concerns, people should not try to confuse the issue.

A deadline of 2007 was set for the roll-out of BreastCheck and the programme was originally announced in 1999. It was never envisaged that it would be completed in a matter of years. It was stated a number of years ago that it would be in Cork by 2007. Government Deputies took a great deal of political heat in that regard because people were very concerned about screening for breast cancer, just as they are concerned now about screening for cervical cancer. People know that if preventative treatment is available or if cancer can be detected in time, there will not be such a high level of demand for forms of intervention like radiotherapy, chemotherapy and surgery. There are genuine concerns in this regard.

Dr. O'Reilly's letter has highlighted many issues. We can debate whether some of the statements in the letter, such as those relating to the renal and cardiac oncology unit, are factually accurate. Dr. O'Reilly's comments have raised legitimate concerns. I welcome this debate. I hope the Minister of State, Deputy Tim O'Malley, will give us details of a positive and clearly defined strategy so that we can return to Cork to tell the people exactly what has happened and what will happen.

Kathleen Lynch (Cork North Central, Labour)
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This debate is long overdue. It is a shame that what happened yesterday had to occur to enable this debate to take place. Not enough time has been allocated to allow Members to speak about all the things that are wrong with the health service in counties Cork and Kerry. As Deputy Kelleher said, it seems that certain people do not want to hear a message of frustration, delay, procrastination and promises which have not been fulfilled. We need to take a serious look at what is happening. The Minister for Health and Children received a letter from a consultant in a very sensitive area. I am sure the man in question had more to do than write lengthy letters about matters of concern to him, but he felt compelled to write the letter I have mentioned nonetheless. He said in the letter that he has to treat his patients in conditions which are so bad that he was compelled to write a damning letter to the Minister, who did not respond other than to say that some aspects of the letter were factually incorrect. I do not think the letter was factually incorrect.

The manager of Cork University Hospital said on this evening's "Six One News" that a planning application for the BreastCheck facility at the hospital will be made early in the new year. That news will come as a surprise to some women in Cork who have been campaigning for the BreastCheck service to be rolled out there, because it was made clear to them in June of this year that the schedule that had to be met if BreastCheck was to be rolled out in 2007 would not be met if a planning application for BreastCheck was not made by October. The clear commitment to make the application by October so that the facility would be up and running by 2007 was made after a group of women in Cork, who are annoyed by the apartheid in Irish life that means the BreastCheck service is not available to them, picketed the annual general conference of the Progressive Democrats.

Will the Minister of State tell the House why the health of women in Leinster is more important that the health of women in Munster? It defies logic. The roll-out of the BreastCheck programme has been announced three times. The commencement date of 2007 was mentioned for the first time when the current Minister, Deputy Harney, took office. The women of Munster should bear in mind that the plans for the roll-out of the BreastCheck service are three months behind schedule.

I would like to tell the House why I was so annoyed yesterday. I spent all day Monday and most of Tuesday telephoning Cork University Hospital to try to get a bed for an extremely ill man who has been waiting for weeks to get a bed. His consultant said he should be given a bed, his wife was at her wit's end and his general practitioner was doing all he could, but they still needed to contact some politicians. One would not imagine that there would have been any difficulty, given that the man was at the top of the priority list, but he could not get a bed because there is a shortage of bed capacity in Cork University Hospital and the people in the accident and emergency department who were on trolleys needed to be cleared first. I learned just before I came to the House yesterday that the hospital authorities had found a bed for the man in question, for which great credit is due to them. The family of the man will always be grateful for their assistance. The success in that case is beside the point, however, because there are hundreds of similar cases throughout the country.

Ireland is the richest country in Europe, but it has the worst health service in Europe. The Minister for Health and Children continues to tell us it is not her responsibility, but it is very much her responsibility — that is what she gets paid for and what she is given the glory for. It is her job. I ask the Minister to get the finger out for the sake of the people waiting for beds, including those on trolleys, and especially the approximately 60 women who die every year in preventable circumstances. She needs to put in place the kind of health service that the people who created the Celtic tiger deserve and to which they are entitled.

Tim O'Malley (Limerick East, Progressive Democrats)
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I apologise on behalf of the Tánaiste and Minister for Health and Children, who cannot attend this debate because she has a prior engagement that was arranged a long time ago.

Bernard Allen (Cork North Central, Fine Gael)
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The apology is not accepted.

Tim O'Malley (Limerick East, Progressive Democrats)
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I am pleased to have an opportunity to set out the current position in respect of oncology services in the southern area and to respond to the issues raised by the Deputies. I do not intend to defend or to attempt to defend the provision of inappropriate care for cancer patients, who are entitled to quality cancer care regardless of whether they live in the southern region of the HSE or elsewhere. The Tánaiste shares the Government's objective of continuing to invest in the development of cancer services. I intend to set out details of the significant investment in such services in the southern region. It is important to stress to the House that the issues raised by Deputies Boyle, Deenihan, Allen, Kelleher and Lynch relate to the management and delivery of health and personal social services, which are the responsibility of the Health Service Executive under the Health Act 2004. This is fully consistent with the legislation, which was approved by the Oireachtas.

It is important that the House is made aware of the full picture, in fairness to the service providers, those working with cancer patients and cancer patients themselves. The initiatives to which I will refer reflect significant work by health service employees who are fully committed to the provision of good and effective cancer care. The HSE issued a statement yesterday summarising such developments. I emphasise that all the issues outlined are being addressed within the region through the appropriate management and governance structures which have been established and are acceptable to management and clinical staff. Since the implementation of the national cancer strategy in 1997, approximately €80 million cumulative additional funding has been made available to the southern region with an additional 11 consultants and 44 clinical nurse specialists being appointed across the region.

The Department has been advised by the HSE that approval was granted two weeks ago to proceed to the next phase of development for the €47 million oncology, cardiac and renal unit which includes a dedicated 30-bed oncology ward. The advertisements have been placed in the EU Journal for builders to apply for inclusion on a list of those to be invited to tender for the construction of the new unit and it is planned to commence construction in mid-2006. Arrangements are also being made at present to establish a ten-bed medical oncology ward within Cork University Hospital.

A range of oncology services are provided at hospitals in counties Cork and Kerry. The consultant appointments in the oncology area since 1997 include two consultant medical oncologists with sessional commitments to CUH, the South Infirmary Victoria Hospital and the Mercy University Hospital, one filled on a locum basis pending the permanent filling of same; one additional consultant radiation oncologist and a second post re-advertised; two consultant surgeons with a special interest in breast disease, one at CUH and one at the South Infirmary Victoria Hospital; one consultant radiologist with a special interest in breast imaging at CUH; three consultant histopathologists, two at CUH and one at the Mercy University Hospital; and one consultant haematologist at CUH-Mercy University Hospital-Kerry General Hospital.

This year alone, the following posts have been approved for the HSE southern area and are in the process of being filled: one consultant surgeon with a special interest in colorectal surgery; one consultant plastic surgeon with a special interest in breast reconstruction; one consultant respiratory physician; one consultant in palliative care; and one consultant paediatric haematologist. This investment in Cork University Hospital has resulted in the following treatments in the first ten months of this year: more than 16,000 radiotherapy treatments; more than 3,300 day and inpatient haematology cases treated; and more than 4,000 day and inpatient oncology cases treated.

Affirmation of the quality of cancer care at CUH was evidenced by the fact that the hospital was named earlier this year as Ireland's first and only designated centre in integrated oncology and palliative care. CUH is one of only eight centres in Europe chosen to receive this designation from the European Society for Medical Oncology for the excellence of its supportive treatment for cancer patients.

In Kerry General Hospital, activity figures for the first ten months of this year include almost 2,500 chemotherapy day cases treated; 1,700 breast care OPD clinics with access to mammography, ultrasound and other diagnostic facilities; and more than 700 gynaecology-colposcopy day cases treated.

In 2004, approval was granted for €3 million full year funding and additional staff to expand radiation oncology capacity at CUH. I understand that the third linear accelerator commenced treatment in March 2005 and the fourth commenced treatment in October. Twenty-nine additional staff have been recruited for this service, including a third consultant radiation oncologist. A fourth consultant radiation oncologist post for this unit has been advertised.

The expansion of radiation oncology services under the national plan announced by the Tánaiste last July will increase the number of linear accelerators from four to seven and will greatly improve access for cancer patients throughout the southern region to radiotherapy treatment. I am also aware that an order has been signed for a picture archiving communications system which will assist inpatient services communications in CUH.

Planning is under way for the development of the necessary infrastructure for the national roll-out of the BreastCheck programme. BreastCheck recently advertised for key lead consultant radiologists and radiographers for the programme and the recruitment of other key clinical posts will commence early in 2006. BreastCheck is confident that the roll-out of the programme will commence in 2007. When the programme is rolled out, mobile units will be available to screen eligible women in the 50 to 64 age group throughout the southern area. This investment will ensure that screening and follow-up treatment is available to approximately 72,000 women throughout the southern region, including approximately 34,000 women in County Cork.

The HSE southern area is developing a regional hospital group comprising all acute hospitals in the area to ensure the delivery of a unified service. The new network structure will give acute hospitals the opportunity to work together to provide the best possible cancer services for the communities they serve. It is my understanding that a meeting has been arranged between the HSE and Professor Paul Redmond, director of cancer services in the southern area, to discuss the further development of cancer services.

The House will appreciate that the developments I outlined are as a result of good planning within the hospitals in the region and are based significantly on the efforts of the regional cancer director. He has used his office to progress these developments in the interests of cancer patients.

The Tánaiste has made an allocation in the 2006 Estimates of an additional €9 million to the HSE to continue to meet the additional service pressures in cancer care, improve the quality of care, facilitate better access to radiation oncology services and continue the preparation for a national cervical screening programme. The Government remains committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland in accordance with best international standards. We believe it is important to build teams of highly expert clinicians working together to deliver top quality cancer care to patients. To this end, we will continue to provide considerable investment in oncology services in the coming years.