Brian O'Shea (Waterford, Labour)
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Approximately 1,000 patients every year from the south-east region must travel either to Dublin or Cork for treatment due to the lack of radiotherapy services at Waterford Regional Hospital. In 2004, some 815 patients were referred from Waterford Regional Hospital to St. Luke's Hospital in Dublin while 209 patients were referred to Cork University Hospital. In 2005, some 721 patients were referred from Waterford Regional Hospital to St. Luke's Hospital in Dublin and 205 were referred to Cork University Hospital.

Some of these patients are being referred for short radiotherapy daily sessions but because of the travel involved are forced to stay away from home while undergoing treatment. Some patients are quite ill, requiring either therapeutic or palliative treatment for their cancers. If these patients could be treated within the south-east region the issue of staying away from home and of long harrowing journeys for treatment could be eliminated or very significantly reduced.

The Taoiseach indicated on his visit to the Waterford constituency on Monday, 16 October, at the launch of the new Whitfield Clinic in Butlerstown, that Waterford is to get an integrated satellite centre for radiotherapy services based at Waterford Regional Hospital. However, the date set for this public private partnership project is 2011. By taking the public private partnership route, the people of Waterford and the south east will not have their radiotherapy service for another five years, at the earliest.

Yet, radiotherapy treatment for both public and private patients can be provided in the very near future at the University of Pittsburgh medical centre at the Whitfield cancer centre. The planning permission for Whitfield includes a condition that two linear accelerators, the equipment that provides the service, be installed at the centre. Although the two linear accelerators could be installed by now, only one is in place. However, it has been indicated by the clinic that they will proceed with the installation of the second linear accelerator even in the absence of any arrangement for the funding of public patients.

When he was in Waterford, the Taoiseach said he knew the Whitfield clinic had approached the Health Service Executive in relation to providing radiotherapy services to public patients. However, there is absolutely no indication that funding is going to be provided by the Department of Health and Children for the HSE to fund patients needing radiotherapy at the centre. The Taoiseach also said he understood the clinic and the National Treatment Purchase Fund had entered into discussions with a view to providing treatment for public patients. It is not clear if the Taoiseach's comment refers to radiotherapy. The National Treatment Purchase Fund provides for patients who have been on a public waiting list for three months. This is hardly an appropriate vehicle for cancer patients waiting for radiotherapy service.

As the one who started the campaign for radiotherapy services in Waterford, I am absolutely appalled and find it utterly unacceptable that now, when a solution is at hand to prevent cancer patients having to endure harrowing journeys or unnecessarily being away from home at a time when they need the help and support of their families and friends, the Government is not availing of this opportunity. The Government parties dither while the most vulnerable sick people continue to suffer. The people of Waterford and the south east will not stand for this.

I demand that the Minister gives an undertaking that immediate steps will be taken to provide radiotherapy for public cancer patients in the south-east region at Whitfield clinic, Waterford. The lack of urgency and commitment on the Government's part is shameful, barbaric and unacceptable. I put it to Fianna Fáil and the Progressive Democrats that failing the public patients of the region on this occasion will probably be the greatest low in the very chequered existence of the Government.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I fully recognise the motivation of Deputy O'Shea in tabling this matter for debate. However, what he is asking the Government to do sits better with the Government's open approach to independent providers than the motion debated in the House this week, which condemned me for encouraging private health provision. I am being asked to procure services for public patients from a private provider, in this case a for-profit organisation. This is a highly respectable organisation but it is a for-profit private hospital. What Deputy O'Shea is suggesting is in total conflict with what he voted for last night and what his party moved in the House this week. I respect Deputy O'Shea's motivation in tabling the matter for discussion.

The Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland. Best outcomes for patients are achieved when all aspects of cancer care, surgery, radiotherapy and chemotherapy are delivered by multi-disciplinary teams based around major centres.

The HSE is implementing the Government's decision to create a national network of radiation oncology with two centres in Dublin, one in Cork, an integrated satellite service in Waterford and one in Galway, with a satellite in Limerick. We have also now agreed arrangements to have the major centre at Belfast City Hospital offer treatment for patients from Donegal.

Public patients are being treated at a centre in Limerick that was created by the Limerick hospital trust and is being run by the Mater private hospital. The HSE is working closely with that centre so that its services are used productively and fit in with cancer policy and quality guidelines.

There has also been recent contact between the HSE and the University of Pittsburgh medical centre's Whitfield centre to explore the scope and conditions for the procurement of its radiation oncology services. The HSE will comply with relevant procurement and quality guidelines in any contracting for these or, indeed, any other services from private sector providers.

As Deputy O'Shea is aware, I am open to all solutions from the public and private sectors that deliver quality care faster to patients. That is why today I have announced the approval of a capital investment in six new linear accelerators for St. Luke's, St. James's and Beaumont hospitals, in advance of the completion of the radiotherapy PPP.

The HSE has my full support in procuring quality services for patients from private, not-for-profit, independent providers or from the public sector. I share Deputy O'Shea's view that we will be able to procure services at the Whitfield centre for patients from the Waterford region in advance of our investment opening there in 2011.

Paul Gogarty (Dublin Mid West, Green Party)
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The Minister is fully aware that more than 400 medical card patients were told at short notice that they had to change doctors by 1 November 2006. These clients live in Newcastle, Rathcoole, Saggart and Brittas, and as far afield as Clondalkin, Lucan and Tallaght. They have been enjoying a high level of patient care from their doctor for as long as 14 years. After all this time, however, it turns out that Dr. Graham is not qualified to practice as a general practitioner under the GMS scheme. Despite his qualifications as a consultant, EU legislation, as a member of the Minister's staff informed a meeting recently, prevents him from providing general practitioner services to medical card clients in his own right. I know the "whys" and "wherefores" and I also know that changing EU directives cannot be undertaken at short notice. Sometimes they cannot even be implemented in the long term but I am concerned about patient care. If patient care is truly at the heart of the Department's and the HSE's remit, a solution can and must be found.

I have met many of Dr. Graham's patients who are adamant that they do not wish to transfer to the doctors recommended by the HSE. Instead they want to continue being treated by him as their current GP. They insist they will not allow their medical records to be transferred. Many have personal reasons for this, which I do not wish to go into here, even under Dáil privilege. There are also issues of access and further issues regarding the suitability of the proposed new surgery, which some people have described charitably as a stable. However, the most important reason for wanting to maintain the status quo is that hundreds of clients have built up a long-standing relationship with Dr. Graham and they can see no logical reason for that relationship to be torn apart now. They trust their doctor and, for older patients in particular, trust is an important issue.

So far the HSE is not in favour of turning. It has behaved in a negative way. When my office contacted the HSE to get more information on the situation I was fed a cock and bull story. I was told the reason Dr. Graham would not be working as a medical card GP any more was that he had not applied for the position. As an elected representative, I expect more than to be treated in this manner. The poor treatment of Dr. Graham's patients is the most important issue, however. I urge the Minister to force the HSE to meet Dr. Graham's patients and come up with a workable solution that will acknowledge the situation regarding his continuing practice but will also allow him to continue to work with his medical card clients under whatever terminology and position is appropriate.

At the recent public meeting to which I referred, I highlighted the rapid manner in which the Government was able to introduce legislation when it was found to be illegally charging elderly people for nursing home care. It would be great if the Government applied itself so creatively to the needs of patients within the health service. The buck stops with the Minister. She should use her good offices to ensure that a solution is reached which is agreeable to all and which will allow Dr. Graham to continue providing his important services.

I do not want to hear excuses. The Minister and I share the same constituency. If she wants to use legal terms or say it is a matter for the HSE or that her hands are tied, that is up to her, but, if so, she will have let a lot of patients down. I hope the Minister will have some good news in her reply for our constituents. She should put patients' care first and let the people be treated by someone they know and trust. There are ways around this situation and they need to be explored.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I know the area well and I happen to know the various parties as well. This is the local village where I grew up. This is not a question of Irish law, it concerns an EU directive. If I broke the rules and overruled EU directives, which I am not empowered to do, Deputy Gogarty and his colleagues would be the first to criticise me.

One of the Health Service Executive's functions is to make contractual arrangements with general practitioners to provide services under the GMS medical card scheme. Since 1995, entry to the GMS scheme for general practitioners has been carried out through open competition and interview, following the advertisement of posts in national and medical newspapers. All suitably qualified persons may apply for these positions.

Applicants for GMS GP contracts must satisfy the provisions of EU Directive 93/16/EEC, which stipulates the requirement in respect of vocational training for persons seeking to be considered for such posts throughout the European Union. In accordance with that directive, the arrangements for the recruitment of general practitioners have operated well for over ten years.

The qualifying criteria are well known to all doctors who wish to secure a contract within the QMS scheme. Many who do not comply go through the training in order to comply. The arrangements have ensured that a large number of well qualified, highly competent contractors provide modern, comprehensive and high quality services to public patients at primary care level.

The Health Service Executive has advised that the general practitioner providing services to medical card and GP visit card holders in Newcastle resigned in November 2005. While the process to fill the this vacancy was being conducted, a doctor from the area, who had been acting in the capacity of a private assistant to the recently retired GP, was contracted by the HSE in a locum capacity to provide services to the medical card and GP visit card patients. This was clearly an interim arrangement until the permanent post was filled and would have been understood to be so.

The HSE advises that five doctors applied for the post in Newcastle initially but that only one doctor actually attended for interview. The HSE has now completed the recruitment process and, with effect from 1 November 2006, the panel of medical card and GP visit card holders will be assigned to the successful candidate who will provide a GP service at both Rathcoole and Newcastle.

The arrangements to be implemented in Newcastle will bring significant improvements in services to the people of the area. The new doctor will provide clinics from an existing practice initially and within a short period intends establishing a new practice premises near the village centre. He intends to provide a full range of care, including special chronic care clinics, and he will be assisted by a female general practitioner.