Tommy Broughan (Dublin North East, Labour)
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Question 51: To ask the Minister for Health and Children if she has secured funding in budget 2008 for the development of the designated cancer centres under Professor Tom Keane; when she will announce funding plans for developing capacity in the designated centres; and if she will make a statement on the matter. [29959/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I refer the Deputy to my reply to Question No. 44 of today.

Jan O'Sullivan (Limerick East, Labour)
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Does the Minister agree the units which are to become centres of excellence do not have adequate resources to treat their current patients and that their waiting times fail to meet best practice guidelines? For example, Professor Gupta, who practises in my own area, has publicly stated that he needs additional resources in order to meet best practice requirements.

The Minister indicated that money would be available in the budget. Will that include provision for needs such as transport and accommodation and will the homework be completed in that regard before the budget is announced?

If resources are being moved, most of the locations due for closure could experience a surge in different types of cancer treatment. Certain staff are not easily relocated because they are already doing work that does not relate to cancer. Are these issues being taken into consideration and will adequate funding will be provided to implement the cancer strategy?

Mary Harney (Dublin Mid West, Progressive Democrats)
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A lot of work remains to be done. Professor Keane has set targets of completing 50% of the transition by the end of next year and 90% by the following year. That is an ambitious programme but I believe he will have buy-in from the clinical community. Those who have chosen to be specialists in cancer care want to work in centres where they can pursue their clinical passions with like-minded colleagues. In the area of breast cancer, for example, I understand 70 surgeons currently performbreast cancer operations whereas we probably only need 12. Clearly, most of the surgeons who are generalists rather than breast cancer specialists will transfer to general surgery.

Jan O'Sullivan (Limerick East, Labour)
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They will remain where they are.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Yes. We would like the specialist breast cancer surgeons to move to the centres and Professor Keane will be engaging them in dialogue in that regard. I understand that significant enthusiasm and interest have been expressed. We want activity to move from the centres to the hospitals where cancer surgery comes into the centre. Many people in these eight hospitals could have their surgery facilitated in different hospitals if the capacity was in place. It is a matter of moving some stuff out and other stuff in. The 13 places that have already closed dealt with in the order of 55 surgeries last year, or one per week.

An additional €1 billion has been spent on cancer treatment over the past ten years. Professor Keane will have control of that budget and of course more money will be available for cancer. Additional funds will be allocated for every speciality but cancer will receive special attention because of the aging of the population. However, to place all the emphasis on additional funding rather than what is already in place would be a mistake.

The transport issue is being reviewed by the HSE not only for cancer but also in respect of health services generally. The accommodation issue is also very important. I was impressed by the accommodation provisions made in British Columbia, which reported great patient satisfaction.

James Reilly (Dublin North, Fine Gael)
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It would be erroneous of the Minister to place all her emphasis on existing resources instead of discussing additional funding. Has she not placed Professor Keane in an invidious situation? He has just arrived, yet decisions have already been made about where the centres will be located and the number to be established. He will have to unravel those arrangements if he does not agree. People certainly find it bizarre to see nothing north of a line between Galway and Dublin. Will he encounter the same problems as Professor Drumm in terms of trying to reorganise something that is already half-organised? Why will four centres be located in Dublin when only one third of the population reside in the greater Dublin area?

Glib references have been made to transport, which will be a massive issue. Someone dear to me just completed radiotherapy and, even though he did not have to travel far, he was shattered each day. Making somebody travel two or three hours by train and then face the same journey in reverse is not a prospect we can relish with any degree of humanity.

The Minister spoke about the services she closed down. Some services will clearly have to be discontinued but to close them before the new centres are up and running and seen to deliver is not acceptable. This is like Hanly all over again. It is no use to say that we will close the local accident and emergency unit and send patients up the road to Limerick but we will fix up the services in Limerick at some point in the future. The people who need services need them today or next week. We can see what happened subsequent to the closure of Ennis hospital, which required patients to travel to Galway. The following week, the regional hospital in Galway raised the prospect of reducing breast cancer services from five to three days per week because of cutbacks.

The Minister indicated to the House that she would discuss the budget with the Minister for Finance. I hope she will find the additional funds necessary to make this plan successful so that it does not become, like cervical screening, a mere aspiration.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am not dealing with aspirations but with change and reform, which are what the transformation programme is about. When I hear Deputy Reilly's questions, I sometimes wonder if he favours or opposes reform or whether he sits on both sides of the fence.

James Reilly (Dublin North, Fine Gael)
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I am not in favour of removing services until their replacements have been established. I and members of the public will be pleased when the new services are up and running.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The transport and accommodation issues are central to making this plan a reality. Appropriate accommodation is needed for those who must travel long distances from home for radiotherapy whereas surgery is a once-off experience. The idea is that both developments will take place at the same time. As the centres are built up, they will have considerable capacity and expertise. We are not starting on greenfield sites. Some of the top clinicians in the world, both doctors and nurses, are working in the cancer area and their number has increased significantly in recent years. We want to organise within these centres and, in particular, retain all cancer functions in one place. As a result of the manner in which some of our hospitals are managed, cancer patients in some hospitals are located on every ward or floor, which is inappropriate. We want dedicated beds ring-fenced for cancer patients. Professor Keane and the medical colleagues he will bring on board to assist him will have responsibility for implementing the plan. It will be realised.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In her initial response, the Minister referred to moving "some stuff out" and other "stuff" in. Does she agree that this is a wholly inappropriate use of language to describe issues which directly impinge on people's lives? Does she understand that the decisions she takes affect the prospects of survival of people around the country?

The Minister is proceeding with the closure of hospital services without the so-called centres of excellence first being in place. How many centres of excellence for cancer care does she envisage will be rolled out? Is she aware that today a large body of people from Sligo gathered outside the House in protest at the prospect of the closure of a centre of excellence at Sligo General Hospital? What does she say to them? Does she have any assurance for the people of the north west regarding the provision of cancer care services at Sligo General Hospital? Is she aware that all shades of elected opinion in this House clearly indicated to the people who gathered outside the gates their support for the retention and development of the cancer service at the hospital? Will the Minister outline precisely what are the plans in this regard and give an assurance to the people of the north west that the services at Sligo General Hospital will be retained and developed?

Finian McGrath (Dublin North Central, Independent)
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I welcome the designation of Beaumont Hospital as one of the centres of excellence. When is it envisaged that the developed services in Beaumont Hospital will become available? Will they commence in early 2008 or at a later date?

I welcome the appointment of Professor Keane and ask the Minister to encourage all her ministerial colleagues to support his efforts to reform the health service. When is it envisaged that we will see the impact of the reforms he will roll out?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The more appropriate term for the new centres is "specialist centres" because the use of the word "excellence" implies we do not have excellence. We have an excellent breast surgeon — Dr. O'Hanrahan — in Sligo General Hospital. All our national experts, from Professor Niall O'Higgins down, as well as a large body of international evidence — I understand 250 medical journals are published on cancer — suggest that volume equals quality. It is not simply a matter of a single physician, whether a surgeon, a pathologist who has a specialty or a radiologist, but of numbers of people working together. All the evidence suggests that one's chances improve by more than 20% when one is treated in these centres.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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A comprehensive team is in place in Sligo General Hospital.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I did not choose the locations for the centres. They were selected by experts, including the Irish Cancer Society, Europa Donna and a patient advocacy group active in this area.

On Deputy Finian McGrath's question, the changes will begin to take effect at an early date. I hope, in the first instance, that we secure buy-in from the clinical community. While this will not be forthcoming from everybody, the feedback I have received suggests many clinicians are excited about what is happening. We will get considerable buy-in from the clinical community early next year.

Professor Keane has done this work before and is immensely qualified. My colleague, the Minister of State, Deputy Jimmy Devins, will meet him shortly to discuss issues of concern to him. Professor Keane, who is very supportive of the centres, does not come new to Ireland. We have received assistance from British Columbia since I visited the province nearly two years ago. The individuals concerned did not arrive on Monday as we have already taken a great deal of advice from them. I was highly impressed during my visit to British Columbia where one will hardly find a person who does not praise the province's cancer services even though many people must travel long distances to access them.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The issue we must address is in Ireland.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I agree.