Dinny McGinley (Donegal South West, Fine Gael)
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I thank the Chair for affording me the opportunity once again to raise this important matter. The most important element in the successful treatment of cancer is early diagnosis. Unfortunately, early diagnosis and standards of treatment seem to depend on geographical location. Since 2000, BreastCheck screening has been available only in parts of the country. If one is aged 50 years or over and lives in Dublin or the eastern region, BreastCheck is automatically available. I am sure this programme has saved the lives of many women who are fortunate to be living in these areas. We all know and accept what a tragedy it can be for a family to have a member, particularly a mother, diagnosed with breast or cervical cancer, especially when it is at an advanced stage. Late diagnosis means more radical and severe treatment, often with limited success.

It is unbelievable that six years after its introduction, BreastCheck cancer screening is confined to so few counties. As usual, the west and the north west in particular are well and truly out of the loop. According to the latest information, places such as County Donegal cannot expect to benefit from a screening programme until 2008 at the earliest. This is completely unacceptable. Letterkenny General Hospital caters for a population of almost 140,000. In County Donegal, the country's most peripheral county, there are 50 new breast cancer cases, 70 new bowel cancer cases and 80 new prostate cancer cases annually. The medical board of Letterkenny General Hospital has taken the unprecedented decision that in the absence of an agreed permanent resolution to the issue of breast cancer services, no support services will be provided for new patients referred with systematic breast disease from 1 June next. Furthermore, all breast health clinics including review services will cease from 1 September. This is a serious development and illustrates the sheer frustration of the medical personnel attached to the hospital.

The new inpatient oncology unit in the hospital, which has been lying idle, will be used to increase medical capacity to address the current overcrowding crisis in the hospital, which is a daily occurrence. A total of 17 people were on trolleys in the hospital today. While any move that gets patients who are currently on trolleys into beds must be welcomed, it must be recognised that this is not the solution to the hospital's long-term problem or the improvement of cancer services in Donegal.

There are three main priorities in addressing the cancer treatment needs of County Donegal. It is absolutely essential to appoint a permanent breast surgeon for Letterkenny General Hospital, to ensure the roll out of BreastCheck and the designation of Letterkenny General Hospital as a satellite radiotherapy unit. In a shocking indictment of the health service, it has emerged that the absence of a radiation oncologist at Letterkenny General Hospital is resulting in unnecessary mastectomies in some cases and dangerous and lengthy delays in the treatment of certain cancers in others.

A group of medical professionals in the county maintain that many patients, in particular those receiving palliative care, are refusing radiation treatment because of the exhausting travel involved — anything up to six hours at a time to Dublin. Being a regular visitor to St. Luke's Hospital in Dublin, the number of Donegal patients journeying there for radiotherapy never ceases to amaze me. They are far removed from their families and natural environments for the duration of their treatment, which can often last up to seven or eight weeks. While many try to go home for the weekend, the Minister of State can imagine what a harrowing ordeal that long journey must be with their strength and resistance sapped by the severity of radiation treatment.

While I welcome plans to establish radiotherapy units in Limerick, Galway or even Waterford, these will be of no benefit to the north west. It is no easier to travel from west County Donegal or Malin Head to Galway than it is to Dublin. I am publicly calling for the provision of a radiotherapy unit in the north west, preferably in County Donegal, to serve the needs of cancer patients in that region. I am also calling for the appointment of a radiation oncologist, a permanent breast surgeon and a second bowel surgeon in Letterkenny General Hospital. If this does not happen, it is likely that the existing service, which caters for a population of almost 140,000 people, will diminish and ultimately disappear. There is a genuine fear among medical staff in the hospital that cancer services will disappear by a process of natural attrition rather than an act of commission. For example, if a permanent breast surgeon is not appointed, breast cancer services will go.

I am also suggesting that the Tánaiste should visit Letterkenny General Hospital to witness how inadequate and critical the situation is, not alone in the area of cancer treatment, but also the daily crisis throughout the hospital mainly due to inadequate accident and emergency facilities and a critical shortage of beds. Having been in charge of her Department for over a year, she is due a visit.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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Cuirim fáilte leis an rún seo ar Athló an Teach in ainm an Teachta McGinley, a bhaineann le forbairt na seirbhísí seo i dTír Chonaill. Thug an Teachta cuireadh don Tánaiste chun cuairt a dhéanamh ar an ospidéal sin.

Dinny McGinley (Donegal South West, Fine Gael)
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Beidh fáilte roimpi.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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Tá a fhios agam ach tá fáilte roimpi in a lán áiteanna in Éireann sa lá atá inniu ann.

Dinny McGinley (Donegal South West, Fine Gael)
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Tá an t-ádh léi.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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Since 1997, cumulative funding totalling more than €47 million has been allocated to the Health Service Executive north western area for the development of appropriate treatment and care services for persons with cancer. Cancer services in the north west are provided in Letterkenny General Hospital and Sligo General Hospital. In the former, cancer services are provided by a team of consultants comprising four consultant surgeons, one consultant medical oncologist, one consultant haematologist, one palliative care consultant, three consultant pathologists, six consultant radiologists, two senior pharmacists who specialise in oncology drugs preparation, a range of specialist nursing staff and one consultant radiotherapist three days per month.

An 11-bed oncology ward was recently completed, which is supported by an oncology day case area, breast care suite and clean air pharmaceutical preparation room.

A formal multidisciplinary breast care team meets and reviews all breast patients each week. Other teams meet to discuss cases as required.

Sligo General Hospital has a dedicated inpatient oncology unit, comprising 15 beds. The hospital also has a dedicated day services unit, with an oncology day services area comprising eight beds. A consultant haematologist was appointed in 2004. In addition, the hospital manufactures its own cytotoxic oncology drugs in a state-of-the-art clean room facility. The hospital has a full range of diagnostic tools including a CAT scan and a magnetic resonance imaging, MRI facility.

The HSE north western area has a regional consultant in palliative medicine, with a second post recently approved by Comhairle na nOspidéal. This second post will cover Sligo, Leitrim and south Donegal while the existing consultant in palliative medicine will cover Donegal.

Last year, the Tánaiste announced the Government's approval for a national network for radiation oncology services to be put in place by 2011, which will commence in 2008. The network will deliver a substantial increase in current radiation oncology capacity by providing additional capacity to the equivalent of 23 linear accelerators nationally. The network will consist of four large centres in Dublin, Cork and Galway and two integrated satellite centres in Waterford and Limerick, conditional on their adherence to certain quality assurance measures.

Patients in the north west are currently being referred for radiation oncology treatment to the radiation oncology department at University College Hospital, Galway, and to St. Luke's Hospital, Dublin. A consultant radiation oncologist from St. Luke's Hospital, Dublin, visits Letterkenny General Hospital three times per month as part of the multidisciplinary care of cancer patients. A consultant radiation oncologist with significant sessional commitments to Sligo General Hospital has recently been appointed to University College Hospital, Galway, which also provides radiation oncology services to patients in the north west, mainly to Sligo, Leitrim and south Donegal.

The Government considers that in the short term, the best option in terms of improving geographic access for patients in the north west is to facilitate access for those patients to radiation oncology services as part of North-South co-operation on cancer. The Tánaiste has agreed with the Minister for Health for Northern Ireland, Mr. Shaun Woodward, MP, that the new Belfast cancer centre will treat patients from Donegal. The option for people in Donegal. to attend for radiotherapy treatment at either Galway or Dublin will continue to be available.

In respect of the Belfast development, a number of discussions have taken place at official level involving both Departments, most recently on 20 February. Both Departments have requested the co-operation and working together initiative, CAWT, to ensure the timely and effective delivery of the ministerial agreement. There is a considerable political, departmental and service commitment to delivering on this agreement. It is important that this initiative succeeds as it will support further co-operation in health care, including cancer care. To ensure effective delivery, it is essential to have the support of medical consultants, patients and representative groups locally. I know how passionately the people of Donegal feel about this issue. The Tánaiste has worked extremely hard in this regard.

As for furthering the consideration of a satellite in the north west, the first priority is to deliver access for cancer patients in the north west to Belfast City Hospital as early as possible and thereafter to build on positive working relationships to deliver on this commitment. The issue of a satellite centre in the north west will continue to be furthered as a joint initiative involving bilateral discussions at departmental and political levels.

BreastCheck is preparing for the expansion of its screening programme for women aged 50 to 64 years in the south and west. Some €28 million in capital funding has been made available to provide static screening units and five mobile units. Screening for the western region will be provided at the static unit in Galway and by two mobile units. There is a screening population of 58,000 women in the west, including 10,500 in County Donegal.

The Tánaiste recently met representatives of BreastCheck. They are fully aware of her wish to have the programme rolled out nationally as quickly as possible. For this to happen, essential elements of the roll-out must be in place, including adequate staffing, effective training and quality assurance programmes. Additional funding has been made available this year for early recruitment and training of staff.

While there are a number of other matters with which I wish to deal, my time is short. In respect of breast disease services, the Department has been advised by the Health Service Executive that agreement in principle has been reached between Letterkenny General Hospital and Altnagelvin Hospital on a model of co-operation in the provision of breast cancer services.

In addition, my colleagues, the Minister of State at the Department of Transport, Deputy Gallagher, the Minister for Agriculture and Food, Deputy Coughlan, as well as Deputies McDaid and Keaveney have met the Tánaiste recently to further these issues.

Séamus Pattison (Carlow-Kilkenny, Labour)
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I call on Deputy Walsh. He has five minutes.

Dinny McGinley (Donegal South West, Fine Gael)
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We expect progress shortly.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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It was not a bad report.

Séamus Pattison (Carlow-Kilkenny, Labour)
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I call Deputy Walsh.

Dinny McGinley (Donegal South West, Fine Gael)
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There is no radiology service north of a line from Dublin to Galway.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Order, please.

Dinny McGinley (Donegal South West, Fine Gael)
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It is not on.

Séamus Pattison (Carlow-Kilkenny, Labour)
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I call on Deputy Walsh.