Dinny McGinley (Donegal South West, Fine Gael)
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I welcome the opportunity to raise this matter on the Adjournment. I regret that the Tánaiste has left, but she has spent much time in the House today. On Monday, she visited Letterkenny General Hospital to become familiar with general medical services in the county, particularly at the hospital, including the lack of adequate cancer services in the north west.

It would be an understatement to say that matters in Letterkenny General Hospital took a turn for the worse this morning. As they indicated a number of months ago, consultants are refusing to take on new breast cancer patients. This is an unprecedented step and shows the frustration of hospital staff. It is designed as a final wake up call about the urgency of addressing the situation. The consultants have been calling for the appointment of a permanent breast surgeon at the hospital and, now that their 1 June deadline for a response has not been met by the Department of Health and Children, they will not treat new patients referred from this morning. It is deeply regrettable that in the wake of the Tánaiste's visit, no progress was made by her Department in seeking to avert this action.

This is yet another blow to the provision of cancer services in County Donegal, which are already diminished by the absence of radiotherapy services and the BreastCheck programme. Government inaction has now led to the inferior cancer services available to the people of County Donegal and the whole north west being reduced even further.

We have become immune to the vague responses of the Tánaiste, her Department and the Health Service Executive. The delay in rolling out BreastCheck to the north west is not acceptable and the suggestion that they should travel to Belfast for radiotherapy is inadequate for Donegal patients. Tragically, the absence of radiotherapy services closer to home has led to many women enduring radical and traumatic surgery instead of the arduous journey for treatment. Many more women will do so in the future and, unfortunately, many women and men could lose their battle with cancer if the Government continues to fail the people of the area, in particular the people of Donegal.

The Donegal Action on Cancer Care group is spearheading a countywide campaign to improve cancer services in the area. A fortnight ago, a march and a meeting were organised in Letterkenny, which attracted more than 10,000 people, the silent majority as it were expressing their dissatisfaction with the inadequacy of cancer services in the county.

Donegal Action on Cancer Care has put forward a five point programme for Donegal designed to improve cancer services and medical services in general. The first point in that programme is the immediate appointment of a permanent breast surgeon in Letterkenny General Hospital, the absence of which has brought about today's crisis. The second point relates to the provision of a satellite unit for a radiation unit for the north west. It is amazing that when the radiation strategy was laid out several years ago, there was not even one centre north of the Dublin-Galway line. We were told to depend on Belfast, which has not yet come to fruition and is not the answer to our problem. On breast screening, it calls for urgent remedial action to be taken to reduce the backlog of women waiting for mammograms in the current absence of roll-out of BreastCheck in the north west. As a matter of urgency there must be funding designated for patients and their families who must travel for treatment. All Donegal patients who require radium treatment must travel to Dublin. On Tuesday I spent two hours in St. Luke's in Dublin and there were at least 12 Donegal patients there away from their families. I am not denigrating the accommodation or care but it is important that those undergoing cancer treatment are in the bosom of their families. If this was available in the north west, they could go home to the families every week.

This is not the first time I have raised this and I have raised it again today because of what has happened this morning. I appeal to the Minister of State, who has replied to this before, to give the people of Donegal some hope, particularly the 70 women in the county who are diagnosed with breast cancer every year. From now on, no new patients will be accepted in Letterkenny and alternative arrangements must be put in place.

Tim O'Malley (Limerick East, Progressive Democrats)
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I welcome the opportunity to address the issues raised by the Deputy and to set out the current position with cancer services in Letterkenny General Hospital.

In a public statement made earlier this week, when the Tánaiste visited the Donegal area, she said everyone in this country, regardless of where they live, should have access to the best possible health services. This is especially so for cancer services. The most important thing for patients is getting the best treatment. Outcomes for patients are what drive our policy and investment in cancer care. I am determined that everyone diagnosed with cancer will get top quality treatment, as near to home as possible. The Tánaiste and I remain confident the HSE can achieve these objectives.

The Deputy has raised the appointment of a permanent breast surgeon at Letterkenny General Hospital. A stand alone breast service at Letterkenny General Hospital is not an option as it does not, according to recognised cancer experts, have a large enough volume of new patients with breast cancer to achieve the high quality of services that the women of the area are entitled to receive. The preferred option of the HSE is for a true partnership to be developed between Altnagelvin Hospital in Derry and Letterkenny General Hospital. There are already strong links between these two hospitals. Altnagelvin Hospital is wholly committed to developing a workable solution with Letterkenny General Hospital.

The director of the national hospitals office and the network manager for the HSE western area are to meet with the respective management and clinical teams next week to seek to progress a partnership arrangement that can best develop breast care in the region. It is understood the model of care being sought will include combined multidisciplinary team meetings to discuss patients in both jurisdictions. Decisions on each patient will be examined collectively involving the appropriate treatment and follow up. The HSE advises it will also explore the option of a similar model with University College Hospital Galway.

The medical team at Letterkenny General Hospital will continue to attend to breast cancer patients referred to them before today and awaiting their first appointment. However, medical consultants at Letterkenny General Hospital are refusing, as of today, to accept any new referrals of breast cancer cases. Discussions at hospital level have taken place to seek a deferral of this action. Last Friday, the director of the national hospitals office wrote to the chairman of the medical board at the hospital advising that the HSE is actively pursuing a resolution of the issue of how best to provide breast cancer care to the population of Donegal. The director gave a commitment that the matter will be drawn to a definitive conclusion before the end of June, just over four weeks from today.

The Tánaiste has urged the HSE management to complete discussions on the future organisation of breast services by this date. The director also asked that any proposition to cease existing services be withdrawn in the interests of assuring best patient care. I understand that medical consultants refused to rescind their decision. The HSE, in the interests of women who will be diagnosed with breast cancer has made alternative arrangements.

Letterkenny General Hospital has advised general practitioners in Donegal that urgent new referrals of breast cancer patients should be referred to Sligo General Hospital or University Hospital Galway. Arrangements have been made with these hospitals. There is a tradition of patient referral to these hospitals.

General practitioners have also been advised that they may wish to refer patients to other hospitals, if appropriate. This clarity is essential to ensure there continues to be a service in place for women with breast cancer in Donegal.

The action of a small number of medical consultants is most regrettable, especially as the HSE is making significant efforts to resolve the issue in the best interest of women with breast cancer. I am asking that the consultants involved reconsider their decision and participate fully in the discussions next week. These discussions should take place in a positive environment and not against the backdrop of a refusal to continue to provide services to vulnerable patients.

In the coming years, almost €50 million will be invested in health facilities in Donegal, with almost €28 million being spent on additional beds and a new accident and emergency department at the hospital. This Government has quadrupled the budget of Letterkenny General Hospital since 1997, enabling the appointment of more than 550 additional staff. This is a clear expression of our confidence in the health services in Donegal and we will spend more to make the services even better in the coming years.