Brian O'Shea (Waterford, Labour)
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Ar an gcéad dul síos, ba mhaith liom Fine Gael agus urlabhraí Fine Gael ar cúrsaí sláinte, an Teachta Reilly, a moladh as ucht an rún tábhachtach seo ar an cóir leighis don ailse a chuir síos. Tá sé tráthúil go maith. I compliment the Fine Gael Party and its health spokesperson, Deputy Reilly, for tabling this important motion which has been overtaken by yesterday's events and the announcement by the Minister for Health and Children and the HSE of the location of the eight specialist cancer centres. However, one must have misgivings about how the announcement will pan out. For instance, no costings or budget have been prepared for the plan, yet a target has been set, whereby 50% of the plan will be implemented by the end of 2008 and 90% by the end of 2009. Like many plans and projections set out by the Government parties for the roll-out of cancer services, this is very optimistic but I hope it happens. According to the HSE, once implementation of the plan begins, cancer services at smaller hospitals will cease within 90 days, yet half the new services provided under the plan will only be available by the end of next year, with 90% available by the end of the following year. What will happen in the interim? Existing capacity is inadequate and if some of it is withdrawn within 90 days, what will happen to patients who lose services in their areas?

Cancer survival rates in Ireland are improving but they are still below the European average. The eight specialist centres using multidisciplinary teams are anticipated to increase survival rates by 20% under the criteria laid down. This would be welcome. Professor Keane said yesterday that when the plan was fully implemented, outcomes would improve within three or five years. There is much to be commended in the new approach to the provision of cancer services but one must be sceptical about the delivery dates. Waterford Regional Hospital has been selected as one of the eight specialist centres. In 2005 we were given to understand that by 2011 radiotherapy services would be provided at the hospital but we learned recently that will happen by 2015 at best. How does this tie in with the target of 50% implementation of the new plan by 2008 and 90% by 2009? These target dates do not gel when examined carefully.

During the debate yesterday evening the Minister of State at the Department of Health and Children, Deputy Hoctor, stated Ireland had 22,000 cancer patients and the number would increase to 43,000 by 2020, with two thirds of the increase attributable to an ageing population. This is against a background of increased demand and the announcement of a new programme for which no budget or costings have been provided. The Minister of State also stated last night that the Government was committed to providing substantial additional moneys but this is very vague and up in the air. I reiterate that this statement has been made in the context of smaller hospitals ceasing cancer services within 90 days of the commencement of the new plan, as proposed by Dr. Keane.

A number of issues arise in the context of smaller hospitals and areas not adjacent to the eight specialist centres. I refer to designated transport and hostel accommodation. While this has been discussed, it is absolutely and utterly vital that the issue should be addressed and patient friendly, workable solutions put in place. With the number of cancer patients anticipated to increase by 21,000 between now and 2020 and two thirds of the increase attributable to the elderly, appropriate door-to-door transport will be required. Every effort should be made to make the system as patient friendly as possible in all cases.

The plan is welcome but the issues relating to cancer treatment have been highlighted in many documents, going back to the Hollywood report. Improvements have been made but there is a long way to go. Provision of services and patient outcomes are below the EU average. Patient outcomes will not improve unless substantial investment is made. In addition, significant planning is required to make sure staff will be available to take up the new posts that will emerge. Issues may arise fairly quickly in the context of the plan. It seems some staff will transfer from the 13 smaller hospitals that are to close, and they will take up positions in the eight regional centres. More action is required.

There is considerable under provision for palliative care throughout the country, particularly in the south-east. There is a proposal relating to it but these services are all complementary and terribly necessary in the context of comprehensive and proper patient care. I hope the thrust of this plan will come quickly and the inconveniences and difficulties experienced by patients in the smaller hospitals will be addressed.

One must question the wisdom of closing hospital services within a period of 90 days when the programme has not been implemented. I am concerned about a shortfall in the short to medium term, meaning the service will be worse in that time. It is hard to be confident that transferring staff and related operations will be done effectively, efficiently and quickly, particularly when compared to some of the other undertakings by the HSE over a period.

I very much welcome that Waterford Regional Hospital has been selected as one of the eight specialist cancer centres. However, we must get delivery of the radiotherapy unit to the hospital so we can move on to a multi-disciplinary service necessary for the best patient outcomes.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I understand Deputy O'Connor wishes to share his time with several other Deputies with the consent of the House.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I wish to share time with Deputies Flynn, Calleary, Andrews and O'Rourke.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

Charlie O'Connor (Dublin South West, Fianna Fail)
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It is traditional on these occasions to compliment the movers of the motion and I am very happy to do so for my old friend, Deputy James Reilly. Dr. Reilly and I served together over a long period on the old Eastern Health Board and the regional authority. This was a time when the health board answered questions and did not leave public representatives to hear major announcements through the media. Regrettably, those days have changed.

I tabled a question asking the Minister for Health and Children the policies she has put in place to improve cancer treatment services nationwide, her plans for the future and if she would make a statement on the matter. I received a nice letter from the Ceann Comhairle in which he kindly stated it could not be taken yesterday because the question anticipated private Members' business for the same day, which appears to give me a great deal of credit for something which I did not intend.

Deputies Reilly and O'Sullivan referred to the announcement yesterday, and it is generally welcomed as a good announcement, except that in my community in Tallaght there will be a different point of view. I do not want to just cry about Tallaght but it is the third-largest population centre in the country, with a very significant catchment area. The Adelaide and Meath Hospital, incorporating the National Children's Hospital, serves people from north Kildare down to Carnew in Wicklow. It provides a serious service.

Cancer care in the Tallaght hospital has been a major strategic development over the past five years. Although this area was always an important facet of patient care in Tallaght, the hospital board formalised it as one of the major strategies for the patient population. This development was in recognition not alone of the volume of patients with cancer coming to the hospital but of the unfortunate fact that many patients coming to the hospital were disadvantaged. This led to them presenting at a comparatively later stage of the disease.

It was therefore seen as a major challenge to the hospital to improve survival in this patient population. With this in mind a team of experts has been assembled within the hospital campus whose specialist interest is in cancer care. These individuals have spent significant periods in cancer institutions located in the United States and in Europe, including New York, Washington, Madison, Paris and Milan. They also have experience of many different dedicated cancer services in the nearby UK.

It was also recognised that the major specialties involved in cancer care should be present on-site within the hospital campus. As a result, consultants in all the specialty areas involved in cancer care, including surgical, medical and radiation oncology, as well as palliative care, have been appointed to Tallaght. As such, a cancer patient entering the gates of the Tallaght hospital has the full range of specialty care available on-site. Furthermore, in line with international best practice, the many different cancer types looked after within our hospital have dedicated multi-disciplinary teams. In this manner, each cancer patient diagnosed within the hospital is given the opportunity not only to see individual specialists but to have decisions made in the context of multi-disciplinary team meetings, which has proven to be advantageous to survival.

The hospital in Tallaght has decided to look after all the major cancer types in both men and women and has set up multi-disciplinary meetings for all these types. Outside the hospital, important links have been set up with many different hospitals, including a very strong link with Naas General Hospital, St. James' Hospital, St. Luke's Hospital, Peamount Hospital and many others. It has also set up strong links with groups such as the Irish Cancer Society and the Marie Keating Foundation, and it has funding from the Health Research Board for cancer research.

In 2006, the hospital saw more than 1,500 new cancers, with many more patients suspected of having cancer coming into dedicated clinics. A major thrust over the past three years has been the establishment of a quality assurance programme in cancer care. Computer software has been purchased and seven separate appointments have been put in place to form an audit programme. Therefore, very close attention is paid to quality assurance in the patient population.

A team of dedicated nurses has also been appointed in recent years to oversee the co-ordination of cancer care within the hospital, where attention to quality of life issues is paramount. These nurse co-ordinators are trained in their field and they are a pivotal part of cancer care at the hospital in Tallaght.

In summary, the cancer care at Tallaght hospital provides a comprehensive service for a large number of cancer patients, many of whom come from disadvantaged areas. The hospital serves a rapidly increasing catchment area and provides the vast majority of cancer care for this network. It is anticipated that the National Cancer Registry will report a doubling of the number of cancers within our area in the next 15 years. Tallaght is very well positioned to meet this significant challenge.

I notice many different comments at the beginning of yesterday's debate. This morning I am making a point for Tallaght. The HSE must consider its case, although the report from yesterday has been generally accepted. Tallaght makes a strong case and it is different. The Minister of State should convey to his senior colleague that this debate is only commencing.

Beverley Flynn (Mayo, Independent)
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I welcome the opportunity to speak in this debate and the improvements made in cancer services generally in recent years. I particularly acknowledge the €1 billion investment since 1997 in cancer services, the appointment of 100 additional consultants and 300 additional clinical nurse specialists.

In the few minutes available to me this morning I welcome the new strategy, which focuses on eight centres of excellence throughout the country. I wish to highlight the case of Mayo General Hospital, where a standard of excellence has been achieved in cancer services, such as surgery, going back years. I state this on the basis of the excellence achieved, not making any arguments on geographical grounds or on the social and economic circumstances people in this House are well aware exist in the west of Ireland.

As any person who knows someone who has suffered with cancer is aware, it is critically important that the standard of outcome in Ireland is dramatically improved. This must be our top priority. One must, therefore, welcome the new strategy that was rolled out by the HSE yesterday in this regard.

I wish to refer to breast cancer services at Mayo General Hospital. In 2000 Professor Niall O'Higgins presented a report to the then Minister in which he stated the optimum level of procedures to be carried out by a surgeon in a given year is more than 50 but fewer than 100. A total of 72 breast cancer procedures were carried out at Mayo General Hospital during the past year. The radiographers at the hospital see in excess of 20 people per week and deal with in excess of 2,000 cases per year. These figures represent the key indicators laid down in the O'Higgins report in respect of achieving a standard of excellence. If a service is working, it should be allowed to continue to do so. While I acknowledge that the centre of excellence will be located in Galway, the integrated service that has been in existence for the past seven years between Mayo General Hospital and Galway should continue into the future and should form part of the new cancer strategy. I look forward to reviews being carried out that will substantiate the facts I have articulated. Those facts clearly show that excellence is being achieved at Mayo General Hospital and that the service to which I refer should continue to be provided there.

One of the issues of great importance to me, which I have highlighted in the House in recent years, relates to the roll-out of BreastCheck in the west. As everyone is aware, the west and the south are the last parts of the country in which this essential service is being rolled out. I welcome the particular dedication of the Minister, Deputy Harney, to this service. In November, the static unit in Galway to deal with breast screening will be opened for the first time. A mobile unit has been operational in Roscommon since April and thousands of women are now in a position to access breast screening services that were previously unavailable. Negotiations to locate a mobile unit at Mayo General Hospital in Castlebar are at an advanced stage. I ask that matters be expedited and that the service in Mayo commence operating before the end of this year or, at the latest, next January. The incidence of breast cancer in the west is extremely high and the fact that this service has not been available to the women of the region until now is a disgrace. It is important that the mobile service is immediately rolled out to all the other counties in the west as a matter of priority.

I welcome the fact the programme relating to cervical cancer screening will be rolled out nationally. However, I reiterate that regions such as the west must not be left behind again. When it comes to rolling out the service, the west would like to take the lead. This must be borne in mind, particularly when one considers that the region was almost eight years behind the remainder of the country and 12 years behind Northern Ireland in respect of breast cancer screening services.

For the new cancer strategy to work and for the centres of excellence to operate in regions as large as the west, it is extremely important to ensure transport services relating to the transfer of patients to and from other areas within particular regions are improved. There has been severe criticism in the area I represent in recent times because the transport services on offer there are completely inadequate. If we are serious about making progress, the entire plan must be implemented on an integrated basis.

The service at Mayo General Hospital is excellent and will be seen to be so when it is reviewed and examined. If something is not broken, we should not try to fix it.

Dara Calleary (Mayo, Fianna Fail)
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I also congratulate Deputies Reilly and O'Sullivan on their appointments. I hope Deputy Reilly has better luck than his predecessor in remaining a Member of the House.

Yesterday was a better day as regards the provision of cancer services. The fact that one person will be in charge of the strategy announced yesterday is welcome and I hope this indicates that the approach being taken is different to those taken previously. I am particularly conscious of remarks by previous speakers to the effect that there have been many strategies, announcements and new dawns. However, I hope the appointment of Professor Tom Keane, who possesses a wealth of international expertise, means that matters will be different on this occasion, particularly when the appropriate budgets and structures are put in place. When we come to review the strategy in the years ahead, I hope the results will prove me right.

It is important — this point is relevant as regards the operations of the HSE — that Professor Keane should, from the outset, make himself available to Members of the House to discuss both the implementation and roll-out of the strategy and Deputies' and people's concerns about it. This strategy will not work if it is forced upon people. There must be consultation and information must be provided. With such arrangements in place, the strategy can be successful.

I endorse the remarks of my constituency colleague, Deputy Flynn, in respect of BreastCheck. The fact the west is only now, eight years after the initial roll out, gaining access to this service is a disgrace. The roll-out of a service such as BreastCheck, which is internationally recognised and meets international standards, should not have been carried out on a pilot basis. Cancer is not a regional issue, it is a personal matter and all citizens, regardless of where they live, should have the opportunity to beat it. I hope the roll-out of future cancer screening programmes that are based on international best practice and that have worked in other countries will take place on a national and not a pilot basis.

An important part of the strategy in respect of which additional resources should be provided is that relating to research. In recent times many younger people who do all the right things in terms of lifestyle choices have contracted cancer. In the past we were given advice on how to live and what to eat and drink and informed that we would enjoy a healthier existence. However, the number of healthy people contracting cancer in recent times is scary. The area of research must be expanded and more money must be invested in order to discover what, as highlighted by the Minister of State, Deputy Hoctor, is triggering the increase in the number of cancer cases.

I welcome the fact the programme for Government and my party's manifesto contain a commitment to increase the level of resources and funding available to the hospice movement. I am familiar with the work done at the Mayo-Roscommon hospice and the people there truly are angels in respect of the support they provide to families experiencing such difficult times. Our record in the area of palliative care is not good. However, the expansion outlined in the programme for Government and my party's manifesto and the increases provided to the hospice movement through recent budgets are welcome.

I endorse what Deputy Flynn stated in respect of transport. Responsibility for the transportation of oncology patients must be removed from the existing hospital transport programme. A separate budget must be set aside for such services in order that the needs of patients who require transport to a centre of excellence or to an existing treatment centre can be met. The current position under which groups of patients are collected by the same vehicle and obliged to endure a round trip of perhaps 100 or 150 miles before undergoing the rigours of treatment is not acceptable, does not assist in patient recovery and does not promote confidence in the system.

I fully endorse Deputy Flynn's comments in respect of Mayo General Hospital. I have witnessed the work carried out there and during the past ten years members of my family have been obliged to avail of the services provided at the hospital. There is a fantastic team at Mayo General Hospital which deals with a number of cancer treatment disciplines. It does so on the basis of the O'Higgins report and its members give huge confidence to families because of their great professionalism and dedication. The team meets basic quality standards — this is not primarily a geographical issue, although the latter is a factor — as outlined by an international cancer expert and should be given support into the future. I accept that Mayo and Galway do not often agree on matters. If, however, we can work with the new centre in Galway to maintain the existing centre at Mayo General Hospital in Castlebar and increase the standards that obtain there, a service will be done not just to Mayo but to the overall cancer strategy.

I welcome the opportunity we have been given to debate the roll-out of cancer services. This has been a significant week, particularly in the context of the announcement made yesterday. I accept that a great deal of pressure has been placed on Professor Keane with regard to delivering on the strategy. I am sure everyone in the House wishes him well because we all have an interest in him being successful in his work. I congratulate the Minister on Professor Keane's appointment. I look forward to working with her in the roll-out of the new service.

Mary O'Rourke (Longford-Westmeath, Fianna Fail)
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They were delighted.

Dan Neville (Limerick West, Fine Gael)
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Oh come on.

Dan Neville (Limerick West, Fine Gael)
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Six months waiting for treatment.

James Reilly (Dublin North, Fine Gael)
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Which do not currently exist.

Brendan Howlin (Wexford, Labour)
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Deputy Chris Andrews, without interruption.

Mary O'Rourke (Longford-Westmeath, Fianna Fail)
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I am very glad to have the opportunity to speak in this debate here today and, like others, to congratulate Dr. Deputy James Reilly, if that is not a mouthful, and Deputy Jan O'Sullivan. In particular, I congratulate the Minister who is some mighty woman, as the Ceann Comhairle and I both know. I am sure Deputy O'Sullivan will be, or is, a mighty woman too. Not to leave out Deputy Reilly, I suppose he will be a mighty man in his day.

However, I have very serious questions which require answers. First, I do not think the public-private partnership, PPP, mechanism is a suitable one for delivering cancer care. It is unwieldy and inflexible and will not be best suited to the provision of services, which is what is required in this field. It is fine for buildings, although we saw how the Comptroller and Auditor General had doubts about the five post-primary schools and the cost-effectiveness of PPPs in respect thereof. It is not a proper mechanism for delivering cancer care.

I strongly approve of the centres of excellence. As Deputy Chris Andrews noted, if somebody was very ill, not necessarily with cancer, one would wish him or her to go to a centre of excellence, irrespective of how near, trusted and valued one's nearby hospital would be. Why go there if it did not have the necessary technology, expertise and range of specialities? I strongly agree with the proposal for centres of excellence.

Although the Minister does not need my advice in this regard, often the mandarins in the Department of Finance regard rationalisation as an occasion to wield the axe and tell the giver of services that it can cut so much off them. That is not so because the setting up of the centres of excellence will require massive finance in staffing, technology, the interdisciplinary teams and other necessary services.

The second serious question relates to the Health Information and Quality Authority, HIQA. It appears that this standards body will now deal only with public hospitals and not with private ones. It is a bit odd that if one is in a private establishment, one does not come under a standard of excellence regime, but that if one is in a public hospital, one does. I am glad the public hospitals have it, but I cannot see how one is a different patient with a different ailment because one is in a private hospital. It is a great pity that amendments to HIQA will be needed so soon after its establishment. Surely this should have been seen for what it was, namely, a grave lack.

It again brings into question the issue of co-location. I was a reluctant convert to it and remain extremely reluctant now because if one is in the private end of a co-location campus, one is not subject to verifying standards, but if one is in the public hospital, one is. Does one run from one hospital with one's hat on saying "We're HIQA" and go to the other hospital on the adjoining or same campus to be told that one does not come under HIQA? That is a grave lacuna which must be attended to.

I agree with Deputy Calleary on the need for transport services for those receiving cancer care to be separated from transport services for other patients. A patient attending radiotherapy or chemotherapy treatment may be in a run-down state. Transport to a centre of excellence which the patient may be attending should be tailored to his or her needs. It should not be given as a form of patronage but as an inherent right within one's care programme. Professor Tom Keane has been described as a tsar, a term which has bad connotations in historical terms. However, if he is all-powerful and can get matters resolved, we can go along with whatever title is given to him.

When will private hospitals be subject to HIQA's strictures? I do not believe the public private partnership model is suitable for the provision of any health services. Co-location raises many issues. How can services in one hospital on a campus be subject to standards while those in another are not? It is an odd situation.

I wish the Minister for Health and Children well and hope the travails of the Department do not weigh too heavily upon her. When I was Minister for Health for 12 weeks, I adored learning about the Department but I was aware of its thousand pitfalls, with vested interests waiting to render a Minister impotent. I do not believe the Minister, Deputy Harney, will be rendered this way. Deputy Harney is one mighty woman.

Dan Neville (Limerick West, Fine Gael)
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I wish to share time with Deputies Shatter, O'Mahony, Breen, Crawford and Enright.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

Dan Neville (Limerick West, Fine Gael)
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Approximately 22,000 cases of cancer are registered each year, from which 7,000 people will die. I support Deputy O'Rourke's comments on transport provision for cancer patients. Over 50% of cancer patients are over 65 years of age. How does a 65-year old patient travel from Mullingar to Dublin or from Letterkenny to Galway for treatment if a specialised transport service is not available? Concerns have already been expressed on special travel arrangements for patients from the mid-west to Dublin for specialist treatments. There is a reluctance by the HSE at local level to recognise the need to provide comfortable travel to treatment centres for patients.

The 2006 national cancer forum recommended that HIQA establish a national quality framework for cancer control in both the public and private health services. Despite the serious deficiencies in breast cancer care in Barringtons Hospital, a private Limerick hospital, it was made clear yesterday that the new cancer services supremo will have no remit over cancer services provided exclusively in the private sector. Up to 50% of the population is covered by private health insurance but the quality of their services will not be supervised. The Minister must revisit this.

In today's The Irish Times, Dr. Muiris Houston states:

. . . this means that both Minister for Health Mary Harney and the HSE have sanctioned a reverse two-tier system of care for cancer patients. While public patients will benefit from the new cancer control strategy, those who choose the private sector will be treated in a system with no explicit quality control mechanisms.

The message to patients is clear: despite the push from Government and in particular the Minister to privatise medical services in the Republic, neither the Department of Health nor the HSE are, as yet, willing to assume responsibility for the quality and safety of services provided by the private sector.

Will the Minister address the rationale behind exposing private sector patients to less than best practice, as happened at Barringtons Hospital?

The health services are in a shambles. Ward closures have recently occurred in certain hospitals due to cutbacks. Recently, a family member had to attend the Mid-West Regional Hospital but could not be admitted because no bed was available.

Cutbacks have also affected suicide resource officers, responsible for providing suicide-related information and training in communities. The Minister of State at the Department of Health and Children, Deputy Devins, will be aware of the applied suicide intervention skills training, ASIST, programme. It has been cut back because the Department has informed the organisers they cannot continue providing courses in hotels. If that is the Minister's commitment to suicide prevention, it is a bad start for him.

Alan Shatter (Dublin South, Fine Gael)
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Our health services, particularly our cancer services, have excellent doctors and nurses, many of whom work under appalling conditions with inadequate equipment. Many of them see the need for surgical operations to be undertaken but such operations are cancelled due to the pressures imposed on hospitals. Our cancer services, like the rest of the health service, are essentially dysfunctional. Survival rates for most cancers are substantially below the EU average.

The recent revelations from Barringtons Hospital starkly illustrate these problems and the gross inadequacies of health services administration and the Department of Health and Children. It is extraordinary that in January 2006, an assistant secretary in the Department of Health and Children set out seven specific concerns about cancer services at Barringtons Hospital but for a year and a half the issue was batted between the Department and the HSE while no action was taken. It was not until August 2007 that we learned of the plight of a 51-year old woman who had been given the all-clear in 2005 but was subsequently diagnosed with breast cancer. I do not accept the Minister's claim that she did not know anything of this until August 2007. She is responsible for running her Department. She is responsible for essential health services. If a difficulty of this nature had arisen in January 2006, why was the Minister not informed? Why did she not know what was going on within her Department? Why did she not know that the HSE was refusing to carry out an investigation? How many women's lives were placed at risk by the extraordinary dereliction of duty of the Minister for Health and Children in dealing with the Barringtons Hospital issue? The Minister needs to address this issue to a greater degree than she did yesterday.

In the area of radiotherapy and cancer services some patients are waiting up to five and six months for essential treatment. The HSE has been refusing to send public cancer patients awaiting treatment to nine of the country's 26 linear accelerators, which are run by private operators. This refusal to outsource life-saving radiotherapy is completely illogical in circumstances in which the HSE and the Department of Health and Children are engaging with the private sector with a view to providing co-located hospitals. It is perverse and indefensible as a matter of policy.

Linear accelerators are used to shrink and destroy tumours in cancerous tissues. Best international practice dictates that cancer patients should not wait more than six weeks for such essential radiotherapy. A situation whereby patients may have to wait for up to six months is a national disgrace. Nine machines, which the HSE refuses to use, are based in hospitals where these procedures could be readily provided. They are only being used in exceptional circumstances. These are located in the Mater Private Hospital, the Beacon Hospital, St. Vincent's, the Hermitage Clinic in Dublin and in the Galway Clinic. The Minister should explain why patients' essential treatment is being delayed when facilities are available within the private sector that should be used and could be availed of to protect the health of patients, ensuring they have the treatment they require.

I want to refer briefly to the manage cancer committee strategy. Quite clearly the Minister originally had no intention of announcing it yesterday. Quite clearly she announced it only in response to the motion tabled by this party and it is clear that the thought process and organisation necessary to implement it has not been applied. Extraordinarily, the officials in charge of providing for the strategy announced yesterday that they do not know what the budget is or what the costings are. Ninety days are given for ending cancer services in specific hospitals that up to yesterday had not been consulted and in circumstances where no arrangements had been made. Quite clearly the timeframe promised yesterday will not apply.

I believe in and support the provision of centres of excellence, but it is absolutely crucial that free transport is provided to patients who need to travel long distances. There has been an utter failure to make an announcement in that regard. The call by the Irish Cancer Society for that type of service should be met and the Minister should confirm to this House that it will be provided.

I welcome the comments made by Deputy O'Rourke this morning. Many of us share with her the real concerns she expressed about the use of the public private partnership system to provide essential services that should be rolled out by 2010-11 and which we may not see until 2015. It is an issue that requires further thinking and a reverse course by the Government.

John O'Mahony (Mayo, Fine Gael)
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I welcome the opportunity to contribute to this debate on the delivery of services for cancer patients, or rather the non-delivery or late delivery of same if one happens to come from the west or north west. Of course we all welcome yesterday's announcement of the implementation of the national cancer control programme, with specialist centres of excellence for the delivery of treatment. However, the difficulty is the timeframe for its delivery.

No service already in existence should be withdrawn until a better one is provided. Yet we heard the Minister say last night that there had been no breast cancer services at Roscommon General Hospital for the last 18 months. On the basis of that experience, we should not hold our breath regarding the timeframe for these centres of excellence. Services have already gone at some hospitals around the country, even though the new specialist centres are still some way off. This should not have happened.

It is not acceptable that a cancer patient is less likely to have access to essential services such as radiotherapy, chemotherapy or hormonal therapy if he or she lives in the west of Ireland because of the variation of access to services regionally. It is not acceptable that patients are less likely to survive breast, bowel or prostate cancer if they live in the west of Ireland because of the unequal spread of services. The BreastCheck programme, it was promised, would be available to every woman by the end of 2007. This will not happen before 2009 and the last areas to have it freely available will be in the west, including Mayo. Of course we welcome any announcement of mobile units for breast screening in Mayo, as we do the completion of the static BreastCheck unit in Galway. The waiting time has been too long, however, with the 2005 deadline being extended to 2007 and now it is 2009 for some.

The HSE yesterday announced the withdrawal of cancer treatment services in 13 hospitals, including Roscommon and Portiuncula in Ballinasloe. This announcement has increased fears about the withdrawal of services in other hospitals around the country. Mayo General Hospital is providing a top quality specialist treatment service which should continue under the proposed new structures as a managed cancer network such as the Mayo Clinic model in Rochester, Minnesota in the United States. Under this model the Mayo Clinic is the parent centre and surrounding hospitals provide high quality audited oncological practices, working through protocols for patient care decided on at multidisciplinary meetings. Video conferencing facilities are already on site at Castlebar.

Can we be assured that when these specialised cancer centres are up and running there will be well-resourced transport provision for patients who have to travel to such centres, not like the transport services that have been cut to the bone in recent months? Cancer patients have to fork out hundreds of euro for taxis when going for hospital check-ups after their initial treatment.

Are we to be guaranteed that cancer services will not be affected by the range of cutbacks in the health service in general, as we have seen in Sligo and Ennis in recent days and as we have heard about in Galway this morning? We want such guarantees and assurances from the Minister.

Pat Breen (Clare, Fine Gael)
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I welcome the opportunity to speak on this timely debate on a motion tabled by the new Fine Gael spokesperson on health, Deputy Reilly. I congratulate him on his initiative. As a medical doctor, his experience will be invaluable. Deputy Reilly has already taken up my invitation to visit Ennis tomorrow, to see at first hand the state of the health services there. He will be meeting consultants and hospital managers and will be told how a mammography unit located at Ennis General Hospital has been decommissioned.

The Minister announced yesterday that services at 13 hospitals throughout the country will be closed. I hope she is aware that the mammography service at Ennis has been closed since last October and women in County Clare have to travel to Galway and Limerick to be screened. Geographical factors in west Clare are such that women must travel long distances to Limerick Regional Hospital to avail of the service. The distance between Kilbaha or Carrigaholt to Limerick Regional Hospital is 80 miles. There is a taxi service but it costs a great deal of money and there is no bus or other public transport service to take women to the hospital. We all know one cannot park one's car at the hospital. If the HSE concentrates all its resources into centres of excellence, people will have to wait a long time to avail of services. Unfortunately, the Minister does not realise this.

I spoke to a woman in Kilbaha two weeks ago when this issue was raised. She asked why this development was to affect the people of west Clare and why they were to become more disadvantaged than anyone else. The mayors and Oireachtas Members of County Clare had a meeting with the Minister last week, during which she spoke of mammography services and her intentions regarding the roll-out of BreastCheck. She said last week she would be in a position within a week or so to announce when BreastCheck services would be available for County Clare. If she is present to sum up this afternoon, will she make this announcement?

The health services in County Clare are in chaos and there has been a continual downgrading thereof. The county has a growing population of more than 100,000. In the 1980s there were 122 beds in Ennis General Hospital and there are now 88. We have lost maternity services and we are now losing our cancer services. We were told last week the 24 accident and emergency beds in Ennis General Hospital will be a thing of the past when the model the Minister proposes comes into place.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank Deputy James Reilly for raising this important issue and congratulate him on his presentation. With more than 22,000 new cancer patients registered each year and more than 7,000 deaths, proper research, early diagnosis and proper treatment must be our goals regardless of party or politics. I have no objection to centres of excellence, which may, in the long term, offer the best results, but we cannot remove the services already under pressure until we have proper new ones in place. We were told by the Minister, Deputy Mary Harney, that she would not remove any services until this was achieved.

The promises the Minister made two years ago are clearly in shreds and there is no reason we should believe her in respect of the newly proposed strategy and its frightening consequences. The only part of the so-called strategy about which we are sure is that 13 hospitals treating patients at present will be stopped from doing so without making alternative services available. Unfortunately, three of these, Louth County Hospital, Cavan General Hospital and Our Lady's Hospital, Navan, are in the north-eastern region.

One lady had to wait 12 months for a simple breast check although her family history was very serious. How much longer will others have to wait? Further to the Minister's announcement, it is clear that Our Lady of Lourdes Hospital in Drogheda will not have any service in the longer term, meaning that people from north Monaghan and west Cavan will have to travel 100 miles or more to get a test. There are no railroads in that area. The Minister may not be aware that we do not have public transport services. Clearly, circumstances are even worse in areas such as Donegal, Leitrim and Sligo. Patients in these counties must depend on Belfast City Hospital.

Every day of every week we hear of more cases of cancer. If I had time, I could list cases in which there was a failure to make a diagnosis on time, thus leading to early death. It is very easy to claim that results are better in bigger hospitals but, as we know clearly in County Monaghan, the history under this Government is that deaths outside the hospital do not matter because the Minister and HSE can deny responsibility.

The Minister promised that the cancer network would be delivered by 2011 but a review of the project has found it is unlikely to be delivered before 2015. Meanwhile there are huge gaps in the availability of services. For instance, prostate cancer patients must sometimes wait up to five months for radiotherapy.

For many patients who have received successful treatment in the existing hospitals, including Our Lady of Lourdes Hospital in Drogheda and Tallaght Hospital, the winding down of services is a disgrace. Can we believe the approach of the Government? Where health is concerned, it is certain that we cannot. The Minister is a total failure.

Olwyn Enright (Laois-Offaly, Fine Gael)
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I wish Deputies James Reilly, Jan O'Sullivan and Jimmy Devins well in their new posts.

Sadly, the word "cancer" is probably the most feared word we can hear in Ireland and this is why we have such responsibility to ensure the very best treatment is available. Early detection and treatment is vital but it is clear that is not possible everywhere and in respect of everyone. Promises have been made consistently throughout the past decade but there has been little or no delivery; instead, there have been scares, scandals and slow progress.

The suspension of mammography services a month ago in Midland Regional Hospital, Portlaoise, led to great unrest among women and their families who had availed of the services there in recent years. Some 3,000 mammograms and 2,500 breast ultrasound procedures were carried out since November 2003 in the timeframe under review. I welcome the review and hope something positive comes from it. I am not about to add to the alarm but my real concern is that a pattern can evolve for almost four years before it is noticed. I cannot prejudge the outcome and know from being in contact with the HSE that the review is progressing, but real investment in our services could possibly have prevented this. I ask the Minister to ensure the review is completed as soon as possible so the service can be reinstated in Portlaoise. There is no doubt that this, together with the Barringtons Hospital review, has led to what Deputy James Reilly described as a crisis of confidence. I have spoken to many women who have since questioned or are worried about their results from mammograms and ultrasounds.

I welcome the fact that women in my constituency have the opportunity to avail of the BreastCheck service, but I continue to deplore the fact that it is not available throughout the country. It is unacceptable that it has taken so long. I hope this Government lives up to its most recent commitment to roll it out nationwide. The much lauded radiotherapy service plan became nothing more than a football kicked from the HSE to the Department of Health and Children, or between Professor Drumm and the Minister, and, more often than not in recent years, kicked to touch. The clear lack of consultation between the two has left us with a significant delay and nothing to allay people's concerns. The target date for roll-out, 2015, will be just short of two decades after Fianna Fáil and the Progressive Democrats coming into power.

Many of my colleagues have referred to transport in respect of centres of excellence. The Members on the other side of the House should note that the public simply does not believe it will be offered the transport necessary to bring patients to centres of excellence. I support the concept but real proof will have to be provided to demonstrate transport will be available. We have seen cuts in this area in practically every other area of the health service. The Government has a duty to ensure that, if centres of excellence are to be built, people will be provided with a means of travelling thereto.

I welcome the fact that the cervical screening programme is to be rolled out. Ireland has one of the highest death rates from cervical cancer. All expert medical opinion points to the need for early detection if one is to have a good chance of survival. Sixteen practice nurses have been trained in general practitioners' surgeries throughout the midlands for the past two years but have not been able to provide the service. In January we learned of a huge backlog. Is the Minister genuine in her commitment to provide the service nationally next year? I want her to offer a clear explanation to the House on how the results of treatment will be made known. Can she guarantee there will be no backlog given that thousands of extra women are entering the service?

Terence Flanagan (Dublin North East, Fine Gael)
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I support my party's Private Members' motion, sponsored by Deputy Reilly, which condemns the delays in the delivery of radiotherapy facilities and calls on the Government to deliver services for cancer patients as a matter of urgency. As previous speakers mentioned, over 7,000 people die from cancer and approximately 22,000 new cases of cancer are registered each year. Cancer patients do not have time. Time is of the essence in the detection and treatment of cancer in so far as it affects the quality of life, suffering or survival of patients. The failure of Fianna Fáil to deliver reliable cancer services means that hundreds of women face the trauma of having their cases reassessed. It is crucial in the case of the Barringtons Hospital debacle in Limerick, for example, that all investigations are conducted swiftly in order that meaningful action can be taken to provide reliable services that people can trust.

Fianna Fáil continues to fail the people by not recognising the urgent need to develop integrated cancer screening and treatment programmes. It is imperative for the Government to take real action before more lives are lost to cancer. The lack of a world class health service, as promised many times by Fianna Fáil, was the biggest issue during the recent general election campaign. The Minister for Health and Children needs to make the difficult decision to tackle the bloated bureaucracy in the health service, rather than continuing to make sweeping cutbacks at the frontline of the health sector. The decisions made since Fianna Fáil's return to power have led to a deterioration in the health service.

Yesterday's announcement of the establishment of a national cancer control programme was undermined by the lack of an accompanying implementation plan, clear deadlines or costings. It is disappointing that there will be a reduction in the number of hospitals which provide cancer treatment, from the current 13 to eight. As an immediate priority, the Minister should ensure the radiotherapy plan she promised in 2005 is delivered, as promised, immediately, not in 2015, which would be a disaster. The Minister's priority should be to save lives. She should consult the HSE without delay and deliver treatment services for cancer patients as quickly and efficiently as possible.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I thank all the Deputies for their contributions during the debate. I congratulate Deputies Reilly and Jan O'Sullivan on their appointment as health spokespersons for their respective parties. I do not doubt that we will have many discussions across the floor of the Chamber in the coming months.

The Government's amendment to the Fine Gael motion is based on a recognition of its achievements in cancer care in recent years and the measures it is taking to develop the national plan for radiation oncology as an integral element of the national cancer control programme. The amendment acknowledges the need to plan, reform and ensure we have sound evidence based policies for the short and medium term. When one considers that the number of cancer cases will double in the years to come, it is clear that such policies are especially needed. My colleague, the Minister of State, Deputy Hoctor, outlined in the House last night the Government's significant cancer control achievements which have been based on a sustained increase in cancer funding. I would like to allude briefly to some of those achievements.

That there are approximately 120,000 survivors of cancer in Ireland is a reflection of the improved systems of cancer diagnosis and more successful forms of cancer treatment now available. Additional funding of €20.5 million, an increase of 74% on the comparable figure for 2006, has been allocated for cancer control in the current year. Some 100 additional consultants and 360 additional clinical nurse specialists have been appointed in key areas of cancer care. In 2006 over 96,000 inpatient and day patients were discharged from hospital following a diagnosis of cancer, which represents an increase of over 75% on the corresponding figure for 1997. Over 60,000 people were treated for cancer as day cases in 2006, an increase of over 140% on the figure for 1997. I ask the House to recognise these achievements. More patients are being treated. Our health system is detecting more cases of cancer at an early stage.

Patients interact with the cancer control system at various stages — they may attend hospital for screening and treatment and avail of supportive or palliative care. Patients require a seamless transition between the various stages of cancer care. The basic organisational principle that underpins the HSE's national cancer control programme is that services should be organised and delivered around the patient, regardless of the setting. As the Minister, Deputy Harney, said last night, we need to achieve equity in the delivery of cancer care, regardless of where and how the patient interacts with the health system. The development of cancer services is at the heart of the Government's delivery of its cancer control strategy. It is imperative that the HSE's decisions on the designation of four managed cancer control networks and eight cancer centres are implemented without delay. Patients are much more likely to survive if they are treated in specialist centres which provide multidisciplinary care. The new configuration of services will allow quality assured and patient focused care to be delivered in keeping with international best practice and the highest standards.

We need to place a stronger emphasis on health promotion and the prevention and early detection of cancer. Ancillary care will be maximised to reduce any unnecessary dependence on inpatient care and ensure patients do not have to spend more time than necessary away from home. Cancer patients will receive multidisciplinary care from cancer specialists in radiology, surgery, medical and radiation oncology, pathology and oncology nursing. The specialists will work together as an integrated team. These developments which will reform the delivery of cancer services will be led by the new interim director of cancer control, Professor Tom Keane, whom I congratulate on his appointment yesterday to that new position.

A number of Deputies spoke last night about the timescales for implementation of the new programme. I will set out the implementation targets set by the HSE. In respect of the breast cancer centres, 60% of the remaining transition will have been completed by the end of 2008, the first full year of the programme, and a target of 90% has been set for the end of 2009, the second full year of the programme. In respect of cancer centres, it is anticipated that there will be a 50% completion of transition by the end of 2008 which will increase to between 80% and 90% by the end of 2009. The Minister for Health and Children has asked the medical——

Brendan Howlin (Wexford, Labour)
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I ask the Minister of State to conclude because I have to call Deputy Burke.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I would like to say some more in response to other queries raised. I will try to respond to the Deputies concerned at some future stage.

Ulick Burke (Galway East, Fine Gael)
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I would like to share time with Deputies Perry and Reilly.

Brendan Howlin (Wexford, Labour)
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Is that agreed? Agreed.

Ulick Burke (Galway East, Fine Gael)
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I congratulate Deputy Reilly for introducing this timely motion in the House. The announcement made by the Minister yesterday represents another failure to be added to the Government's long list of failures. The Minister has extended her stated timeframes on many occasions — she is incapable of meeting deadlines. The Government which has been in office for 100 days has given us a clear indication that the health service is in further chaos and crisis.

Everybody agrees with the suggestion that it is great to have centres of excellence. I would like to illustrate the point I am making by mentioning an example in my home county of Galway. The Government claims that a service which is being taken from Portiuncula Hospital in Ballinasloe will be provided in a centre of excellence at University College Hospital, Galway. Those who have gone to the hospital in Galway are familiar with the waiting lists there. I would like the Minister of State, Deputy Devins, to note that a patient who returned from abroad last May after being diagnosed with cancer had to wait for two months to receive treatment at the proposed centre of excellence in Galway. Does the Government intend to compound that problem by transferring what is done at Portiuncula Hospital in Ballinasloe to University College Hospital, Galway?

The Minister has kicked for touch by making this proposal at a time when there is an embargo on all HSE appointments. In such circumstances, how can this plan be implemented properly in the manner intended? We have been told that transitional funding is to be made available for this project. What does "transitional funding" mean in the context of the current crisis and cutbacks? It means there is effectively no funding.

If funding is diverted from hospitals where this treatment cannot be performed it will be transferred to the centres. How will that benefit us? We are told that €500 million is available to implement this scheme over a period and that its effectiveness will be assessed in two years. This means that, post-election, we are implementing the first stage of the Hanly report. We are denying Portiuncula Hospital and all similar hospitals. Other hospitals have lost accident and emergency services and now, gradually and slowly but surely, the Hanly report will be implemented by the back door. This is regrettable and represents a downgrading of hospitals that can no longer provide these services. It is too bad if a patient must wait for two months before treatment is provided in one of the centres of excellence.

No transport is provided from rural areas to centres of excellence. The transport service for cancer patients has been discontinued. What provision is there for those who must travel the furthest distance from this vast area in the west of Ireland from northern Donegal to Clare? Some may require the service up to three times per week.

The implementation of this plan involves a new structure being established over a mountain of other structures under Professor Drumm. Resources that should be at the coalface are now being hived off to provide paper trails for the policy of implementation. It will not be a success and the Minister should revisit this matter. There are no waiting lists for people in Ballinasloe and they must suffer continuous waiting lists under the new scheme.

John Perry (Sligo-North Leitrim, Fine Gael)
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I congratulate Deputy Reilly on his appointment as Front Bench spokesperson and Deputy Devins on his appointment as Minister of State at the Department of Health and Children. The Minister for Health and Children, Deputy Harney, welcomed the appointment by the HSE of Professor Tom Keane as interim national cancer control director and the designation by the HSE of eight centres for cancer surgery as a key step in implementing the Government's cancer control strategy. Galway is one of these centres and is linked to Letterkenny. This does not say much for the constituency of Sligo-North Leitrim. The Minister stated:

The decision is not about hospitals. It is not about institutions or budgets. It is about the best patient care. All of us involved in health have an ethical obligation to make decisions in the best interests of patients, before local, institutional, political or professional interests.

The statement reads well at first glance. Who could object to making decisions in the interests of patients? A closer reading raises the question of the ministerial responsibility for the standards of care to be provided in the health service. Another question is how we should define the best interests of patients.

The Minister welcomed the HSE's statement. The Minister is stating that she is not responsible for the HSE decision on the proposed re-organisation and consolidation of cancer services. There is a serious risk that national politicians may give away responsibility for all strategic health service decisions and power to medical professionals and the HSE.

The delivery of health services requires increasingly complex and specialised medical expertise, skills and knowledge. I pay tribute to those who work in our health services. In the main they give a first class service to the citizens of the State. My concerns relate to the tendency for professional bureaucracies to define problems and solutions from a perspective allied to the professional interests and without regard to the interests of patients and the community. National politicians have passed the toughest test — the general election. This House, and through it the Government, is the only fully qualified body to declare what is in the best interests of the citizen. It is not acceptable for Ministers to seek shelter behind academic gowns, no matter how ornate or distinguished.

Regarding the best interests of patients, the fundamental justification of cancer service consolidation seems to be the assertion that a patient's chances of beating cancer rises by up to 20% in specialised centres. This is a worthy objective but many people may define their best interests as having a local service with an acceptance that the patient's chance of beating cancer would increase by 15% in local centres. This trade-off is key.

I am disappointed that the radiotherapy plan announced by the Minister for Health and Children in 2005 will not be delivered in 2011 as promised but will be delayed until 2015. This is disappointing in view of the commitment given to the north-west region regarding the roll-out of BreastCheck and radiotherapy services. I refer also to the significant cutbacks in Sligo, where consultants and nursing staff are being laid off.

There are no costings for the centres of excellence. It sounds very well but there is no substance to the plan. It is like stating that one will open eight big supermarkets without a plan. Where is the detail? People may feel that professors have a certain glow about them but academic gowns are being used to shelter the Government's inefficiencies. The Minister welcomed the statement of the HSE. Who is in charge?

James Reilly (Dublin North, Fine Gael)
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I congratulate Deputy Devins on his appointment as Minister of State and Deputy O'Sullivan on her appointment as spokesperson on health.

I refer to Deputy Devins's comments on cutbacks at Sligo General Hospital and the manner in which it was done by the HSE. I castigated him at the time because he should have been in a position to effect some change but I acknowledge that he had concerns. Perhaps this is because he is a doctor and can see the effect of cutbacks. The Minister, Deputy Harney, could not see this last night and believes that nurses only take holidays in the summertime. Hence, we can get rid of all the nurses despite spending much money bringing nurses from the Philippines and India. It is equally upsetting to hear that none of the Fianna Fáil colleagues of Deputy Devins from the Sligo area appear concerned.

The cervical smear cancer screening programme was first mooted in 1999 and the roll-out was to begin the following year. Eight years later we are no further down the line. We have another target and another commitment. I question the commitment in light of outsourcing the reading of these smears to the United States. If we were intent on delivering this service we would establish the capacity to read the smears in this country. We have not done so. What will happen when we have a deluge of smears on the desks of pathologists and histopathologists? They will be unable to cope.

The Minister states that she only heard about the situation at Barringtons Hospital in August but the Department knew about it 19 months previously. It was passed from the Department to the HSE. All the lights are on in Hawkins House and in Naas but no one is at home. Nobody takes responsibility and the Minister does not know about it. Someone is not doing his or her job and this health service does not have proper leadership. It is not good enough. I do not wish to be emotive or to scaremonger but people are dying through lack of service. People close to me are terminally ill with cancer.

The Minister referred to the Medical Council. The Medical Council has no role in a situation where people are being referred up to Dublin from a private hospital only to be referred back down to Limerick. This is an issue within the control of hospital administration. As Deputy O'Rourke pointed out, we do not have proper control or accreditation over private hospitals and this situation highlights this fact. If this is to be addressed by HIQA then it had better get on the job quickly.

The Minister informed the House that the HSE told her that the radiotherapy facilities would be ready in 2010 yet the HSE's chief executive officer, Brendan Drumm, has stated it will not be possible to provide them by 2011 and the date will be 2015. He stated that the public-private procurement is a difficult way to achieve anything. His opinion is supported by the Department of Health and Children's hospital planning agency and the National Development Finance Agency. The Minister ignores all these people and tells this House something completely different to what they have stated publicly. I do not accept this.

I refer to the HSE press release which on careful reading is quite comical in some respects. It states there will be a transition of cancer services from the current settings and this will occur on a phased basis with patients being reassured that each transfer will be carried out in a planned manner. It states that services will be withdrawn sequentially from hospitals which do not meet the defined criteria. However, the next line states that as a result, the HSE has formally requested the following hospitals with low case volumes to no longer provide multidisciplinary symptomatic services with immediate effect. Where do all these patients go on Monday morning? Where do the patients at Naas General Hospital, Tullamore General Hospital, St. Columcille's Hospital and Mallow General Hospital go?

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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Shame on the Government.

James Reilly (Dublin North, Fine Gael)
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It is a case of live horse, eat hay. The Government will take the services you have today because it will promise you excellence some time in the future and in the meantime, God be with you.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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It is a pig in a poke.