John O'Donoghue (Kerry South, Ceann Comhairle)
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I remind Members that the floor of the House is not a debating chamber. People must leave in silence and allow Deputy Perry the opportunity to speak on the matter he wishes to raise.

John Perry (Sligo-North Leitrim, Fine Gael)
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The HSE is proceeding with the planned removal of oncology services from Sligo General Hospital. This week the Minster of State at the Department of Health and Children, Deputy Devins, stated publicly that he condemned the HSE plan to downgrade Sligo General Hospital. Later that same day the Minister, Deputy Harney, endorsed the HSE plan for centres of excellence. I tabled this matter to get some clarity on the cutbacks proposed for Sligo General Hospital.

The HSE's planned removal of oncology services from Sligo General Hospital will over time drive that hospital into a lower division. On Monday of this week the Minister of State at the Department of Health and Children, Deputy Devins, stated on a local radio programme that he condemns the HSE's plan to downgrade Sligo General Hospital. People in the region served by that hospital are becoming alarmed at the HSE's plans to transfer services elsewhere and to downsize the hospital. The effect of all this uncertainty has been to destroy the morale of the professional medical and nursing staff. There is much talk of centres of excellence, but it is planned that a centre of excellence in Galway will be downgraded from a five day to a three day service. That is what is being discussed in Galway.

The HSE's proposal to downgrade Sligo General Hospital is not acceptable and it will not be accepted by the people of the region. It will be at the Government's peril to proceed to remove the breast cancer services from Sligo General Hospital. First, we had the budget cutbacks. The Minister and the Minister of State at the Department of Health and Children told us there would be some budget cutbacks, but they said there would be no service cutbacks. A range of local health service professionals have stated that service cutbacks are now a fact of life. While budget cutbacks are bad enough, at least there is hope that when the budget position improves the services that were cut will be restored. However, the issue of most concern to me is the planned permanent ending of a range of health care services in Sligo General Hospital, starting with the transfer of breast cancer services to other locations.

The factual position is that the area manager has been given until the end of this month by the HSE to produce a plan for ending breast cancer services in Sligo General Hospital and for their transfer elsewhere. I ask the Minister of State to confirm or deny this statement. I am disappointed that the Minister, Deputy Harney, or the Minister of State, Deputy Devins, is not present to take this matter. That is not a reflection on the Minister of State present, but I am very disappointed about that.

I believe that the transfer of breast cancer services from Sligo General Hospital is the start of a process of transferring the full range of oncology services from that hospital. The HSE logic that drives the transfer of one cancer service will be slowly applied to the full range of oncology services. This will result in the downgrading of Sligo General Hospital by a process of 1,000 cuts.

The local Fianna Fáil politicians are bewildered and confused about what is happening to oncology services in Sligo General Hospital. It seems impossible for the Progressive Democrats-Independent-Fianna Fáil-Green Party Government to accept responsibility for standards of service in health.

In the past few months we had the Shannon fiasco and we are still wrestling with who knew what and when. Let us not make the same mistake with health cutbacks in Sligo General Hospital. The Minister responsible for health sector reform, who is not present, must take firm control of the situation. The Minister established this arrangement and must ensure that it delivers a health service that is in the best interest of citizens and delivers real value for all the extra taxpayers' money being spent.

The people of Sligo and the medical staff in Sligo General Hospital need to know what is happening. The Minister for Health and Children must tell us clearly what is going on. The Minister of State with responsibility for children is present but it is very much regrettable that the Minister is not here to take this matter.

It is not good enough for the Minister for Health and Children to act like a junior Minister in the Department of Finance, effectively acting as a courier in the delivery of €15 billion to the Health Service Executive, and take no responsibility for such expenditure. The confusion between the Minister and the Minister of State, Deputy Devins, must be removed. Clarity is needed.

A fantastic service is available in Sligo General Hospital and I appeal for the retention of the oncology services there. While there is much talk of centres of excellence, a plan is being debated as I speak, a proposal to remove those services to Letterkenny General Hospital and to the centre of excellence in Galway. This week it is planned to downgrade the services in Galway from a five day to a three day service. Will the Minister confirm whether the HSE has been instructed to downgrade a mammogram service, attended by 30 patients per week, in a centre which also has an excellent oncology service?

I am disappointed that the Minister of State, Deputy Devins, whom I saw in the Chamber five minutes ago, is not present, that he did not have the courtesy to wait to take this matter and that he referred it to the Minister of State with responsibility for children. Where is the Minister, Deputy Harney? She has delegated all the functions to the HSE.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy's time has expired.

John Perry (Sligo-North Leitrim, Fine Gael)
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I sincerely hope that the Minister of State's reply will clarify the position because a large public meeting will take place on this matter in Sligo tomorrow night and the people will certainly need answers.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank Deputy Perry for raising this important issue. I am taking this matter on behalf of my colleague, the Minister, Deputy Harney, who is unavoidably absent.

John Perry (Sligo-North Leitrim, Fine Gael)
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She was absent on the last occasion as well.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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Ministers have Government commitments. I welcome this opportunity to set out the current position on the restructuring of cancer services with particular reference to Sligo General Hospital. The HSE has appointed Professor Tom Keane as national cancer control director to lead and manage the establishment of the national cancer control programme. The delivery of cancer services on a programmatic basis will ensure equity of access to services and equality of patient outcome irrespective of geography. This will involve significant realignment of cancer services to move from the present fragmented system of care to one which is consistent with international best practice in cancer control.

The decisions of the HSE on four managed cancer control networks and eight cancer centres will be implemented on a managed and phased basis. The HSE plans to have completed 50% of the transition of services to the cancer centres by the end of 2008 and 80% to 90% by the end of 2009. The HSE has confirmed that services will not be transferred until appropriate capacity has been developed in the receiving centres.

Sligo General Hospital has a dedicated inpatient oncology unit, comprising 15 beds, and a dedicated day services unit, comprising eight beds. The HSE has informed the Department that in 2006, Sligo General Hospital had 285 patient discharges from its inpatient unit and 3,849 discharges from its day care unit.

The HSE has designated University College Hospital Galway and Limerick Regional Hospital as the two cancer centres in the managed cancer control network for the HSE western region which includes counties Sligo, Leitrim and Donegal. The designation of cancer centres aims to ensure that patients receive the highest quality care while at the same time allowing local access to services where appropriate. Where diagnosis and treatment planning is directed and managed by multi-disciplinary teams based at the cancer centres, much of the treatment, other than surgery, can be delivered in local hospitals such as Sligo. Cancer day care units will continue to have an important role in delivering services to patients as close to home as possible.

Patients from Sligo needing radiotherapy are referred to the radiation oncology unit at University College Hospital Galway for treatment. The HSE has informed the Department that in 2006, University College Hospital Galway treated almost 1,000 radiation oncology patients. The number of treatments increased from 11,300 in 2005 to 18,500 in 2006. The hospital expects treatments provided to increase by 7% this year over last year. The Department and the HSE have been working closely on the examination of procurement options in order to expedite the delivery of the national plan for radiation oncology. The Minister has been assured that the HSE will have in place radiation oncology capacity to meet the needs of the population by 2010. After 2010 the HSE will continue to increase capacity to ensure that these needs continue to be met. The Minister is fully confident that this will be achieved through a combination of direct Exchequer provision, public private partnership and, where appropriate, the use of the private sector.

In conclusion, the Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland in accordance with best international standards. The developments outlined will ensure that a comprehensive service is available to all patients with cancer in the western region, including Sligo.