Dáil debates

Wednesday, 21 May 2008

The following motion was moved by Deputy James Reilly on Tuesday, 20 May 2008:

That Dáil Éireann, noting:

the announcement of a national cancer strategy;

the proposal to develop eight centres of excellence at various locations around the country;

the intention to provide every patient with the best medical care and clinical attention;

the absence of a centre of excellence north of a line from Dublin to Galway and conscious specifically of the geographical challenge and population distribution of the west-north-west region; and

the proposed closures at University College Hospital, Galway, where the centre of excellence is to be located, for the month of August this year due to severe budgetary constraints;

calls on the Government to:

proceed immediately with the provision of centres of excellence, based on an adequate and ring-fenced budget;

proceed immediately with the provision of a satellite unit at Letterkenny General Hospital and under the responsibility of the Galway centre of excellence;

retain existing safe, high quality cancer services as at Mayo General Hospital and Sligo General Hospital as satellite units under the responsibility of the Galway centre of excellence;

ensure that all centres of excellence and satellite units are the subject of an annual HIQA audit; and

continue to work closely with the authorities in Northern Ireland on the development of cancer services.

Debate resumed on amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"—strongly supports the National Cancer Control Programme which aims to ensure that all patients have the best possible outcome from their diagnosis and treatment, regardless of where they live;

notes that the programme was developed on the basis of extensive international evidence which shows that cancer survival rates are greatly increased when patients are treated by teams of experts in dedicated centres that deal with a high volume of cases;

endorses the approach taken in the programme that cancer survival must be the priority in treating patients;

notes that under the programme patients will usually only require a single visit to the specialist centre for their initial diagnosis and a second visit for their surgery, and will continue, as at present, to receive follow-up chemotherapy treatment at their local hospital;

welcomes the appointment of Professor Tom Keane and his team of clinical leaders to implement the programme;

welcomes the support of leading cancer specialists and non-governmental organisations, including the Irish Cancer Society, in the development and implementation of the programme;

notes the improvement in 5-year survival of many cancers in Ireland and reaffirms its confidence in the National Cancer Control Programme as the best way to achieve further progress for cancer patients; and

urges all concerned with achieving better outcomes for cancer patients to work together to achieve the goals of the National Cancer Control Programme."

—(Minister for Health and Children).

7:00 pm

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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If the opportunity were open to me I would of course wish to move a Sinn Féin amendment to the motion. As amended on our proposal, the substantive motion tabled by both the Fine Gael and Labour parties would read as follows:

That Dáil Éireann, noting:

the announcement of a national cancer strategy;

the proposal to develop eight centres of excellence at various locations around the country;

the intention to provide every patient with the best medical care and clinical attention;

the absence of a centre of excellence north of a line from Dublin to Galway and conscious specifically of the geographical challenge and population distribution of the west-north-west region and north-east region; and

the proposed closures at University College Hospital, Galway, where the centre of excellence is to be located, for the month of August this year due to severe budgetary constraints;

calls on the Government to:

proceed immediately with the provision of centres of excellence, based on an adequate and ring-fenced budget;

proceed immediately with the provision of a satellite unit at Letterkenny General Hospital and under the responsibility of the Galway centre of excellence;

pending the twinning of medical oncology and surgical services at Letterkenny with radiation oncology at Altnagelvin, Derry, to form a centre of excellence for the north-west cross-Border region;

retain existing safe, high quality cancer services as at Mayo General Hospital and Sligo General Hospital as satellite units under the responsibility of the Galway centre of excellence;

pending the establishment of a centre of excellence in the north east retain the Dóchas centre at Our Lady of Lourdes Hospital in Drogheda as a satellite unit under the responsibility of the Beaumont centre of excellence;

ensure that all centres of excellence and satellite units are the subject of an annual HIQA audit; and

significantly enhance cross-Border co-operation between health services, maximising the health-care resources of Ireland as a whole, particularly in the development of cancer care.

Sinn Féin is supporting the substance of the motion in the name of the Fine Gael and Labour Deputies; what I have done is indicate additions to the motion as submitted. We feel it is necessary to highlight the fact that the north-east region is also neglected under the current cancer strategy. It is necessary to set out what we see as the solution for Letterkenny and to strengthen the call for the all-Ireland delivery of services. We of course fully support the retention and further development of cancer services in Sligo and Mayo and at the Dóchas centre in Our Lady of Lourdes Hospital in Drogheda.

With regard to the plans to remove cancer services in Sligo, Mayo and Drogheda, we fully support their retention and commend local communities for campaigning to retain the services. I reject the efforts of the Minister, Deputy Mary Harney, Professor Drumm and others to guilt-trip communities and their public representatives and suggest they are somehow being irresponsible for seeking the retention of these services.

We know from our experience in Monaghan what it is like to be at the receiving end of such an approach. The proponents of total centralisation of all hospital care are far removed from the reality on the ground. Part of that reality is patients dying because there is too great a distance to travel to hospital. It means people choosing not to be treated or choosing less than optimum treatment in order to avoid the disruption to themselves and their families of travelling long distances for that treatment.

Professor Keane is being repeatedly cited by the Minister and others as an all-knowing guru in terms of planning for cancer care. His knowledge and experience are undoubted but he was brought in to implement a plan that was already in place. The Government had already decided to provide only eight cancer centres, four of them in Dublin and none of them north of a line from Dublin to Galway. This leaves large swathes of the country without proper access, and even in advance of full implementation of the plan, services at local hospitals are being cut.

The term "centres of excellence" has been bandied about and I emphasise again a point I made previously on this issue, most recently during the course of our statements last month on cancer reports. We should start from the premise that every centre where cancer care of whatever type is delivered ought to be a centre of excellence. By the Government and HSE placing the emphasis on eight centres only, they seek to promote the belief that care delivery at other sites must therefore be inferior. That is a dangerous fallacy.

Nobody is arguing for radiation oncology facilities and a full spectrum of other cancer services in every hospital in the country. Eight centres with such facilities are too few and they are, as I and others have repeatedly pointed out, totally unbalanced in terms of regional spread, leaving much of the population very badly served or not served at all.

It seems the Minister for Health and Children, Deputy Mary Harney, has her ears closed to these arguments. Last night there was a very important debate on the Adjournment concerning the thousands of men and women in the north-east region who have received letters telling them their chest X-rays and CT scans must be reviewed. They face a torturous two-month wait for results.

Major questions are raised about the conduct of the HSE and the overall responsibility of successive Ministers, including Deputy Harney, and the Department of Health and Children. Yet what did the Minister do yesterday evening at the end of the first part of this Private Members' business and with questions pending? She left the Chamber with a Minister of State not a fortnight in office to take questions on her behalf. That is consistent with the approach of this Minister and Government to health policy and management.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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I dealt with the issues last week when the Deputy was not here.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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She does not want to listen, which is her problem.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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Where was the Deputy last week?

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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She does not want to listen to the people——

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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Where was the Deputy last Thursday?

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy, without interruption.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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——or public representatives. The Minister and her colleagues in the Department and at Cabinet created what I have described previously as a quango from hell. In this case it is the monstrous quango of the HSE. She has removed democratic accountability in toto.

The Minister for Health and Children would rather listen to corporate executives in the private health business and her HSE has awarded the contract for cervical cancer tests to Quest Diagnostics, a US company that has an unacceptably high rate of errors and has been convicted of fraud.

Not only are our health services being privatised but jobs and services are being exported. Trained and trainee lab technicians in Ireland are being written off and many have had to emigrate to find work. Patients' tests are being sent out of the country to be dealt with by a questionable entity abroad. I shudder to think of the long-term consequences.

Another corporation, Fresenius, has been contracted by the HSE to carry out dialysis services. This corporation paid the biggest ever criminal and civil fraud fines to the US Government in 2000, totalling $500 million. The Fresenius scam involved fraudulent and fictitious blood-testing claims, kickbacks to dialysis facilities in return for blood testing contracts and fraudulent claims against state health insurers. This company will be based in Limerick.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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The Deputy does not know the facts.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It has been given a major role in the provision of dialysis in our health services in the mid-west and south east.

The Minister, Deputy Harney, and the HSE trust the likes of these private profiteers in the health care industry more than they trust frontline health care workers——

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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The Deputy does not know his facts. They have provided dialysis in Dublin for years.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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——in the Irish health services and the communities they serve.

People should be very clear on the position being taken by Government and Government-supporting Deputies in the vote this evening. There is nowhere for them to hide. If they vote for the Government amendment they are voting for the total centralisation of cancer services and the ending of services at Sligo, Mayo and the Dóchas centre in Drogheda. That is effectively what they will be doing.

They are voting for eight centres which will be overburdened and which will not provide comprehensive coverage across the country. I appeal to those Government and Government-supporting Deputies to make a stand tonight and especially to those in the regions north of the Dublin-Galway line which are so badly served by this plan if it proceeds. I ask them to listen to their communities and the frontline health care workers in their areas. We should remember that each of us, as a Dáil Deputy, is a messenger of the people. We have no monopoly on wisdom in respect of these matters. We have no right to dictate to those who trusted their votes in us. We have no right to act against the interests of the communities we are elected to serve. A truly all-Ireland regionally based cancer treatment service is needed. I commend such an approach to the Government, even at this late hour.

Photo of Jimmy DevinsJimmy Devins (Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Sligo-North Leitrim, Fianna Fail)
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I would like to share time with Deputies Finian McGrath, O'Connor, Calleary, Flynn, Scanlon, Healy-Rae and Dooley.

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

Photo of Jimmy DevinsJimmy Devins (Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Sligo-North Leitrim, Fianna Fail)
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This debate is about the provision of cancer services. The single most important person in the health service is the patient, or service user. The health service must be geared to provide the best outcome for the patient. That applies to the provision of cancer care as much as it does to any other area of health care. It has been acknowledged by Members on all sides of the House that the outcome for a person in Ireland who unfortunately suffers from cancer is likely to be worse than the outcome for a person with the same cancer in most developed countries. The area of paediatric cancer is an exception, however, as Ireland's results in that regard are as good as those in any other country. All paediatric cancer surgery is done in Crumlin hospital. It is obvious that the situation in relation to other cancers must be improved. That is why the Government has developed a cancer care strategy. The strategy has been drawn up, following widespread consultation, by an expert group consisting of 23 people. As the Minister for Health and Children said last night, 17 of the people in question are medically trained.

The cancer strategy draws on the evidence of cancer care programmes throughout the world. The development of cancer centres is at the core of the strategy. The phrase "centre of excellence" has been used by some people. However, I believe "cancer centre" to be a much better description of those locations where the specialised investigation and treatment of certain cancers will be carried out. Professor Tom Keane, who is a world-renowned expert, has been appointed to implement the strategy. I listened to an interview with Professor Keane on local radio last Monday when he explained in great detail how the centres will operate. He outlined specifically how the centre for the west and north-west regions — Galway Regional Hospital — will relate to Mayo and Sligo general hospitals and their catchment areas. The cancer strategy has been debated intensively since it was published. Almost all the debate has been conducted in a reasoned and passionate manner that, quite rightly, reflects the sincerely held views of those involved in the discussion.

I worked as a general practitioner in Sligo town for many years prior to my election to the Dáil in 2002 and I know the staff of the surgical unit of Sligo General Hospital. I am aware of their skill and dedication, having referred many patients to their care over the years. They are committed health care professionals. Like many people in the north west, they were disappointed to learn that initial assessment and surgery for breast cancer is to be conducted in a cancer centre. As Professor Keane said, the best available medical evidence shows that patients who have their cancers assessed and surgically treated in cancer centres make better progress and enjoy better outcomes. This important aspect of the debate must not be overlooked from the point of view of the patient. The most important consideration must be the achievement of the best possible outcome.

Issues have been raised about the implementation of the cancer strategy. Professor Keane has indicated that he is working to resolve such difficulties. Among the issues is the provision of beds in Galway Regional Hospital. People have also highlighted the difficulties encountered in travelling to Galway and back. The Minister, Deputy Harney, referred last night to the need to provide more modern and convenient transport facilities. After-care following surgery and chemotherapy for those who require it will continue to be available in Sligo. Comments have been made about the supposed downgrading of Sligo General Hospital. This is patently not the case. Four new consultants have been appointed recently and they will take up their posts between January and June of this year. A new medical assessment unit is currently being fitted out and is due to open in the near future. A development control plan, which is examining the future development of Sligo General Hospital, is being compiled. I understand that it will be available by the end of the year. Government policy aims to provide the best outcomes for those who are afflicted with the terrible disease of cancer.

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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I thank the Leas-Cheann Comhairle for allowing me to contribute to this important debate on the national cancer strategy and cancer services generally. This is a very emotive issue for some people. Sensible and clear heads are needed if we are to solve the problems in this sector. That is why I welcome the appointment of Professor Tom Keane. It is important for politicians to make decisions, in line with best practice, in the interests of patients. I welcome the decision to develop eight cancer care centres. In particular, I welcome the inclusion of Beaumont Hospital, which is in my constituency, in the list of the centres. It cannot end there, however. All the people need to unite if a quality service is to be delivered. When I speak about "all the people", I refer to cleaners, nurses, doctors, consultants, other staff, Deputies, councillors and everyone else who has a genuine interest in our health service. We all need to work hard. It is not up to somebody else to deliver on this issue, we all have to do our bit to ensure patients are put first, at the top of the queue.

We need to plan for the future. The number of people with cancer will double over the next 15 years, mainly for demographic reasons. There are 120,000 cancer survivors in Ireland at present. They comprise 3.3% of the population. These issues are covered in my agreement with the Taoiseach. He recently signed an agreement that deals with these matters. I also welcome the decision to allocate €15.9 million in grants and services to the people of Dublin North-Central in recent months. The matters which comprise the broader issue are covered in section 5 of my agreement with the Taoiseach. I warmly welcome the provision of €415 million for the implementation of the national plan for radiation oncology, which represents a serious investment in cancer services. I welcome the additional funding of €15 million that has been provided for cervical cancer screening. Those moneys have been provided in 2008 to meet the cost of the roll-out of the screening programme. An additional 30 posts have also been approved. In real terms, this means that a service can be provided to cater for 240,000 people per annum.

During this debate, we should remind ourselves of the need to consider what is good for patients. We should remind everyone that good practice needs to be top of the agenda. Scoring political points will not improve the health service. Work has begun on the major issues which need to be resolved. We need reform, investment and change that is good for the people of this country. Part of that change involves supporting the efforts of Professor Tom Keane to reform the health service. The other part involves supporting the development of the eight cancer care centres. I urge all Members of the House to vote to ensure we will have a top class health service of which we can all be proud.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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I welcome the opportunity to make a brief contribution to this important debate. I am glad that the Minister for Health and Children, Deputy Harney, is present. I believe she is here to listen to us, and she does listen. She comes to the Dáil to listen to Deputies. When the Minister of State, Deputy Moloney, was Chairman of the Joint Committee on Health and Children, we had a number of important meetings with the Minister, Deputy Harney. I congratulate Deputy Moloney on being appointed as a Minister of State. While he will be a loss to the joint committee, I welcome his appointment. It is important that we acknowledge the efforts which have been made. Like other Deputies, I acknowledge the progress that has been made by Professor Tom Keane. I have met him on a number of occasions and I know he has a particular interest in what we are debating tonight, which is important.

I will be slightly parochial, like other speakers, by referring to excellent service being provided at Tallaght hospital. The Minister is familiar with my concerns in this regard. I remind the House that cancer care is part of the corporate hospital strategy that has been approved by the medical board and the hospital board. Tallaght is the third largest population centre in the country. Over 1,500 new cases of cancer were treated at Tallaght Hospital in 2006. I am told that this number is equivalent to the major Dublin teaching hospitals. The Tallaght figure is larger than the equivalent figure for many of the hospitals which have been nominated as cancer care providers. A full multidisciplinary team is present at Tallaght hospital to deal with all cancers. I ask the Minister, Deputy Harney, to note my interest in my local hospital, which is working on behalf of people in the Dublin region as well as in counties Kildare and Wicklow.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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The words "confidence" and "trust" have been at the core of this debate. The confidence we have in our services in Castlebar arises from the access patients have to it, particularly in urgent cases. It also results from the ability and passionate interest of the surgeons in the unit and the quality of the after-care that is provided. We fought to protect the current arrangement. That debate and that fight took place against a backdrop of debate at both political and medical level about the impact of fragmentation of services on our current cancer policy and on the outcomes in Ireland. Despite the strength of the unit in Mayo General Hospital, the figures presented to us by the Minister, Deputy Harney, by the National Cancer Registry of Ireland and the OECD show that our patient outcomes are not what they should and could be, and that is why the investment in this cancer strategy is so important.

Speaking of figures, I ask the Minister to resolve the issue regarding the conflict between her figures and those from the hospitals in Mayo and, I gather, Sligo. An independent investigator needs to be appointed to do that as soon as possible. Unless we do that there will be no trust in a future system. We can build trust in that new system if the same arrangements are in place for the transfer of patients to the centre in Galway, if beds are ring-fenced in Galway for patients from Mayo and Sligo and if oncology patients will not need to wait for a bed. The 100 women who attend a clinic and the five who need a biopsy or follow-up should get a guarantee to be dealt with as soon as possible. Each of those women who get a mammogram and a check-up in Galway should be seen on one day, as is committed to in the Government amendment.

The Government amendment also commits that chemotherapy will still be performed on site at Mayo General Hospital and Sligo General Hospital, and that service will continue into the future, planned along the model, as mentioned by the Minister of State, Deputy Devins, of Our Lady's Hospital for Sick Children in Crumlin, where it is planned centrally and delivered locally, thus avoiding the necessity for people to travel for chemotherapy, the worst part of cancer treatment.

I trust in the policy in the future. I have confidence that this policy will not be initiated until Galway is ready, that the medical arrangements I have outlined are in place as has been guaranteed by Professor Keane when he addressed the Oireachtas Joint Committee on Health and Children last December and that a fair, accessible and available transport service will be in place, not just from the various counties to Galway, but specific work needs to be done on a transport policy within Galway. The current arrangements of parking at UCHG do not work and consideration needs to be given to a way of transporting patients across the city. In the long term or even before that, consideration should be given to the location of oncology facilities at Merlin Park rather than dragging people across the city to UCHG.

When Professor Keane addressed the Oireachtas Joint Committee on Health and Children in December he referred to the Canadian system of accommodation on site or near site for patients and their families. I would like to see that system initiated in Ireland and support given to the Irish Cancer Society to do that.

I have trust in the Minister. Nobody has a monopoly on the impact of cancer or the understanding of that impact. We need to ensure that through this policy that impact is reduced and that fewer people are impacted by cancer.

Photo of Beverley FlynnBeverley Flynn (Mayo, Fianna Fail)
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I welcome the opportunity to speak on this important debate. The national cancer strategy was formulated by medical consultants — the top experts in their chosen field. They are people with no other agenda but to ensure that the disease of cancer could be contained and treated in the most effective way. To them outcomes and locations are important. What matters is that lives can be saved, the quality of life of cancer patients can be enhanced and survival rates can be improved. Last night the Minister, Deputy Harney, stated that Ireland rates 18th out of 23 EU countries in terms of the one and five-year survival rates for breast cancer. Sadly, even in the latest figures available from the National Cancer Registry of Ireland women in the west are showing survival rates that are 25% poorer than those for women on the east coast.

I would like to recall the last Sunday in October when more than 7,000 people marched in a protest in Castlebar against the transfer of surgical services to Galway. Seven very courageous women, many of whom are in the Gallery this evening, Mary McGreal, Mary Fahey, Ann McDonnell, Kathleen Warde, Mary Callanan, Teresa McDonnell and Ann Shields, all cancer survivors, organised and led the march because they had been treated excellently in Mayo General Hospital by Dr. Barry and his team, and they did not want to see that service lost to Mayo. They were not alone. I gave a pledge that day to do all in my power to retain those services in Castlebar. I submitted a proposal which I brought to the HSE, the Minister and the then Taoiseach. That plan would have seen Castlebar become an integral part of the Galway network. Cancer surgery could be retained in Castlebar and Mayo patients would still have access to specialised services in Galway. However, on 11 March the hospital manager, Tony Canavan, announced that he and his consultant colleagues——

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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Not the consultants.

Photo of Beverley FlynnBeverley Flynn (Mayo, Fianna Fail)
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——had arrived at a decision in the best interest of the women of Mayo to start to engage with Professor Keane in transferring breast cancer services to Galway. This was a decision made by clinical experts for very good reasons and I have no argument with it. I admit I was disappointed, but I commend Tony Canavan on issuing a statement and explaining to the people of Mayo why they made their decision and expressing their disappointment at the loss of a valuable service to Mayo General Hospital. I also commend the consultants for the clinical leadership they showed by putting the women of Mayo first.

I want every woman in Mayo, whether a public or private patient, to have the same opportunity to get the best possible care available in Ireland for cancer. They are entitled to a service that gives them the best chance of survival that this country has to offer. What is planned is that a woman would have her initial diagnosis and surgery in Galway. There will be a Mayo clinic within the Galway clinic with designated theatre and clinic times. There will be ring-fenced beds for Mayo patients. The clinic will be managed by Mayo staff, with the same consultants and the same staff, maintaining the valuable relationships and personal contact that women enjoy in Mayo General Hospital. They will not be just numbers, they will be people and they will have that personal contact.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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Where will they get them?

Photo of Beverley FlynnBeverley Flynn (Mayo, Fianna Fail)
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They can be referred and booked in through Mayo General Hospital. They can even use the same phone number to get that service. Only when all this is in place and when Professor Keane is in a position to stand over that service can anything be transferred from Mayo General Hospital. This is the commitment that the Taoiseach and the Minister have given in the House. All follow-up activity will take place in Mayo General Hospital. There is a proposal to enhance the oncology unit in Mayo General Hospital. Space has already been identified and work on the proposal is ongoing. This will enhance the service of chemotherapy at Mayo General Hospital. It will be centrally planned but locally delivered. It will be a consultant-led service. The proposal to develop the service in Mayo General Hospital over time will result in greater medical oncology presence on site at the hospital than currently exists. Follow-up mammograms will take place in Mayo General Hospital and all equipment for which funds were raised locally will be retained in the hospital.

I met a number of women on the protest a number of weeks ago when BreastCheck was launched and they raised valid concerns with me. What happens when a woman's temperature increases and she develops a fever after chemotherapy?

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy should conclude.

Photo of Beverley FlynnBeverley Flynn (Mayo, Fianna Fail)
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I have been assured by Professor Tom Keane that these women can be treated for this condition in Mayo General Hospital with the correct protocols being in place. I have also been assured——

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy is using up other people's time now.

Photo of Beverley FlynnBeverley Flynn (Mayo, Fianna Fail)
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—— that emergency surgery, not usual in the case of breast surgery but more common in colon cancer, can and will be performed in Castlebar by Mayo consultants. Patient safety is at all times a priority. Who among us would deny a Mayo woman a better chance of recovery from cancer by having part of her treatment carried out in Galway?

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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Does the Deputy believe that?

Photo of Beverley FlynnBeverley Flynn (Mayo, Fianna Fail)
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Is there a Deputy in this House who would not travel 500 miles to save the life of a wife, daughter or child who has developed cancer? That is what we are talking about today.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I call Deputy Scanlon.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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That was not the Deputy's speech in Castlebar.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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If the Deputy were not in Fianna Fáil she would not believe it.

Photo of Beverley FlynnBeverley Flynn (Mayo, Fianna Fail)
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The Opposition Deputies did not have a single word to say when they lost——

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Time is very tight.

(Interruptions).

Photo of Beverley FlynnBeverley Flynn (Mayo, Fianna Fail)
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A Fine Gael and Labour Government——

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy should allow other Deputies to speak. Time is at a premium.

Photo of Eamon ScanlonEamon Scanlon (Sligo-North Leitrim, Fianna Fail)
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I am glad to have the opportunity to speak tonight. I had been involved in and was very committed to the campaign to retain breast cancer surgery in Sligo General Hospital in recent months. With my colleagues, I lobbied the former Taoiseach, Deputy Bertie Ahern, and wrote to Professor Tom Keane and the HSE. I also worked very closely with my constituents on the issue. The people of Sligo and Leitrim, myself included, felt very passionately that we were well served by our local hospital in this regard. It is with great disappointment that I acknowledge in the House tonight before the local campaign group that my efforts have not been successful.

I must accept, however, that international best practice dictates that the best outcome for patients are achieved in clinical centres of excellence. That has been a very difficult decision to accept and it has been a very tough few weeks for me, both politically and personally. I am supporting the strategy because it is the right thing to do. The cancer control strategy is in the best interest of patients. It puts the patients' safety first. As an elected representative it is my duty to put the safety and best interests of my constituents first regardless of how unpopular that might make me.

Last night the Minister spoke about the improvement in patient outcomes that has been achieved by specialising brain surgery and paediatric cancer services in Our Lady's Hospital for Sick Children in Crumlin. This model is operating with considerable success whereby every child who develops cancer has his or her diagnosis established and treatment planned at Our Lady's Hospital for Sick Children. For many children, significant components of their treatment are delivered by one of 16 local hospitals under the supervision of, and in accordance with, the care protocols agreed with Crumlin hospital. In the same way, chemotherapy and other post-surgery treatment will be delivered in Sligo. Hence I am confident that the establishment of the cancer control networks will deliver the same results for those suffering with cancer.

No services should be moved from Sligo to Galway until all necessary facilities are in place. It is vital that capacity, consultants, beds and parking facilities are all set up in advance of any move. That is important for patients' safety and is necessary in order for people in Sligo and Leitrim to buy into the strategy. I have received assurances that Sligo patients will be able to avail of treatment in Dublin should they so wish. That is an option that may suit some people.

We have a duty to ensure that our health service delivers the best possible care for public patients. Private patients have a choice to go wherever they wish. Cancer affects people from all walks of life and from all income brackets. No cancer patients should suffer further because they do not have health insurance. Public patients must have the same access to expert medical advice and be given the same chances as the 60% of the population who now have private health insurance.

I was honoured to be elected by the people of Sligo-North Leitrim to represent them in Dáil Éireann. I have served my constituents honestly and tirelessly. I have made their views known to Government and to stakeholders and I will continue to do so from within Government.

The national cancer control strategy is not based on geographic locations, but on population centres. An independent report on the issue found that women treated in specialist centres in Dublin have a 25% better survival rate than women treated outside a specialist cancer centre. As the Minister indicated last night, that means that where four women in a specialist centre in Dublin will survive, only three women who have been treated elsewhere will survive. In supporting the strategy, I am supporting better outcomes for women with breast cancer in both Sligo and Leitrim and throughout the country.

Photo of Jackie Healy-RaeJackie Healy-Rae (Kerry South, Independent)
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I thank the Leas-Cheann Comhairle for allowing me to speak on this important matter. I have been flabbergasted and shocked that Fine Gael and Labour thought fit to table this motion in the House but never mentioned Kerry General Hospital in Tralee.

Photo of Joe McHughJoe McHugh (Donegal North East, Fine Gael)
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That is because it is not in the north west.

Photo of Jackie Healy-RaeJackie Healy-Rae (Kerry South, Independent)
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Fine Gael has representatives in Kerry.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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We will do that next week.

Photo of John PerryJohn Perry (Sligo-North Leitrim, Fine Gael)
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That is your job.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy should be allowed to speak without interruption.

Photo of Jackie Healy-RaeJackie Healy-Rae (Kerry South, Independent)
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Can Fine Gael explain to the Ceann Comhairle, the Minister for Health and Children and the 2,400 patients that attend Kerry General Hospital every week how it left that hospital out and included every other place treating cancer in the country?

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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The reason is that it is not in the north or the north west.

Photo of Jackie Healy-RaeJackie Healy-Rae (Kerry South, Independent)
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Deputy Kenny should not bluff. He will bluff a lot of people but he will not bluff me. He should tell the Ceann Comhairle why he did not include Kerry General Hospital.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Deputy Healy-Rae should address his remarks through the Chair.

Photo of Jackie Healy-RaeJackie Healy-Rae (Kerry South, Independent)
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Deputy Kenny has made one of the biggest blunders since he came into this world — he has made a lot of blunders — and his famous full-back alongside him.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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We will see the blunders when the vote comes. That is what counts.

Photo of Jackie Healy-RaeJackie Healy-Rae (Kerry South, Independent)
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There is strong evidence that only centres that see and treat in excess of 50 new cases per year get the best results. In 2005, Kerry General Hospital treated 60 new cases. It treated 65 new cases in 2006 and 55 new cases in 2007.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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Deputy Healy-Rae's Government wants to close it.

Photo of Jackie Healy-RaeJackie Healy-Rae (Kerry South, Independent)
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The specialist centres should have triple assessment. Kerry General Hospital already has triple assessment and it sees 950 women presenting for the first time with a breast lump each year. Between those new cases and the follow-up appointments, approximately 2,400 women a year attend the breast clinic in Kerry General Hospital. Fine Gael's Private Members' motion ignores the cancer services in Kerry General Hospital.

Fine Gael has made a blunder and it is trying to put a patch on it like a tube in a bicycle. Do the Members sitting below me realise——

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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This is a serious business. We are talking about women's lives.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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Hear, hear.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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Stop that old rubbish.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy should be allowed to speak without interruption.

Photo of Jackie Healy-RaeJackie Healy-Rae (Kerry South, Independent)
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——that the Minister for Health and Children knows that the people of Kerry put their money where their mouth is? They collected €1.4 million to buy the most modern and up to date equipment for Kerry General Hospital. The people of Kerry put their money where their mouth is, even though many people think there is nothing but bog and rushes in Kerry. The motion clearly shows that Fine Gael, and the Labour Party too, are not aware of that. I will tell Fine Gael, and its Deputy in south Kerry will tell them because he is telling them a lot of things, not to forget the 2,440 women in Kerry General Hospital who have to get the best possible health care. I and the other Government parties have great faith that the Minister for Health and Children and her assistants will look into every aspect of what happened in Tralee. When other people were wandering around loose, the people of Kerry bought the equipment with their own money. That is the story.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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It is always difficult to follow Deputy Healy-Rae in terms of his presentation.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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It is not too difficult tonight.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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That standard is not too high.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Deputy Dooley should be allowed to speak without interruption.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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I welcome the opportunity to participate in the debate. The information on cancer that is available predicts that the number of people with cancer will double in the next 15 years. That is a disturbing prediction in terms of the impact it will have not just on society, but on our entire culture. If we do not address the issue now, it is difficult to understand how we will be able to cope with such an increase in cancer in 15 years. A concise and coherent strategy needs to be put in place, backed up with an action plan. The appropriate funding needs to be put in place also. The strategy must be focused on the best outcome for patients. As other speakers have said, patients must be at the centre of the process. The strategy must be patient-focused and it must look at the potential to save lives.

A number of Deputies said this issue was about women's lives. Clearly, cancer affects people across the population and has the potential to double in numbers. The strategy is about saving those lives and we have an opportunity to put it in place. I fully support the plan as outlined by Professor Keane. If we do not take the type of approach he suggests, we will have a serious problem within 15 years. If that happens, the problem will continue with no input from this House or proper planning. This side of the House is often accused of not putting in place clear strategies and we are accused also of not setting out strategies prior to this one. When the Government does that, it is still accused of not getting it right. What is most important is the outcome for the patient.

From a constituency point of view, the strategy does not propose that a cancer treatment centre should be located in County Clare. However, we are pretty well served by access to both Galway and Limerick and that is welcome. I have sympathy with those areas that are losing cancer services. It is extremely difficult from a political point of view. When I first learned that Ennis General Hospital would lose its mammography services, I, too, was deeply concerned but, like others, when I sought the advice of clinicians and consultants it was clear that, apart from any local political issue, the best outcome from the patients' point of view was to travel to either Limerick or Galway. The reason is that enough patients were not using the service in Ennis to keep the skill levels of those utilising the equipment up to speed or to keep the system or the machinery calibrated.

I support the strategy that is being adopted. I support the Minister wholeheartedly in the efforts she is making. She has been a pillar of strength in regard to this matter. She has assisted all of us in terms of the difficulties we had in coming to an understanding of the reason the strategy must be put in place. I support her in that regard.

Photo of John PerryJohn Perry (Sligo-North Leitrim, Fine Gael)
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I am sharing time with Deputies Ring, McHugh, McGinley and McCormack.

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

Photo of John PerryJohn Perry (Sligo-North Leitrim, Fine Gael)
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I congratulate our Fine Gael Party leader, Deputy Enda Kenny, our health spokesperson, Deputy James Reilly, and the Labour Party in bringing forward this important motion. It concerns the retention of cancer services at Sligo General Hospital. This situation is now at a critical juncture. I will first examine the two key ideas behind the proposed eight centre model of breast cancer care. The report on services for breast disease, dated March 2000, recommended 14 breast cancer centres, including one at Sligo General Hospital. Why then has the recent cancer strategy reduced the number of centres to eight?

Two particular figures are widely used to justify the proposed eight centre model. One figure suggests that the specialised breast units have a 20% improved survival rate. The other figure suggests that a specialist breast cancer unit must have 150 or more new cases per year.

Of the 20% improved survival figures, the report on the development of services for breast disease in 2000 stated:

Evidence demonstrating correlation between workload . . . and survival exists. In some cases, a 20% improved survival has been noted in patients treated in specialised Breast Units compared to those not treated in such centres.

The use of the words "in some cases" does not convey a point of sufficient substance to justify the national strategy.

On the point that a specialised breast cancer unit must have 150 or more new cases per year, let us examine the origin of that figure. It comes from the breast unit guidelines issued by the European Society of Breast Cancer Specialists. The paper states that a breast unit must have a critical mass of a medical specialist, including two breast surgeons, two radiologists and two pathologists. The paper adds that such a unit is expensive and therefore must have a high throughput of patients, leading to the figure of 150 or more new breast cancer cases. In other words, first staff the unit then look for the patients. A Government strategy for cancer care must consider all the factors, including geography. The paper also states that individual breast cancer surgeons must personally carry out the primary surgery in at least 50 breast cancers per year to maintain expertise.

Sligo General Hospital reported 70 new breast cancer cases in 2006 and 95 in 2007 to the cancer registry in Cork — these are certified figures — and expects to report more than 100 new cases this year. The hospital inpatient inquiry scheme database cites the total number of breast cancer surgical procedures carried out at Sligo General Hospital as 65 in 2005, 57 in 2006 and more than 80 in 2007.

A recent study carried out by senior medical staff at Sligo General Hospital compared outcomes for breast cancer patients in Sligo General Hospital with outcomes for patients in the SEER database. That is the largest United States database and is generally recognised as a gold standard to use when comparing outcomes. That paper clearly demonstrates that the outcomes for Sligo patients are either identical or superior to those achieved in the US.

That hospital study has the up to date figure. The very old, if not ancient, comparison figures used by the Minister last night in the House have no validity. I am astonished that she came into the House for this debate and gave figures that are eight years old. That is appalling. Likewise, her figures on the 20% recovery rate were equally appalling as that data is eight years old also. Closing down cancer centres with a few cases does not apply to Sligo General Hospital. The current caseload, the record of successful outcomes and the expertise of the multidisciplined team fully justifies a centre in Sligo General Hospital.

The current cancer strategy is the recommendation of an expert group. In recommending an eight centre model, with four of the proposed centres being located in Dublin, the purely scientific analysis went out the window. If the science behind Professor O'Higgins's report was rigorously applied, there would be just one, and possibly two, breast cancer care facilities in Dublin. In the case of Dublin, the science was complemented by a political judgment to arrive at four centres. Policy in national health care is a political matter. TDs represent the people. It is our job to reflect the will of the people, and we have the will of the people in the Gallery tonight.

Governments request advice from experts. We have plenty of experts in this Government — €1 million per week is spent on experts and consultants — but trade-offs require political balancing and that can only be done by elected politicians. It is the job of experts to advise; it is the job of Government to decide. Let us be clear about where the responsibility for the downgrading of Sligo General Hospital lies. It lies with this Government and its Ministers.

The proposed eight centre model examines the problem of cancer care solely from the perspective of the disease and its treatment. Cancer is not a simple disease. Effective treatment is not just about dealing with abnormal cells. Cancer care is about healing the total person. The good news is that cancer is more survivable than ever but even in the best case the disease is a heavy burden on all those affected. We must go beyond just treating the disease and address all the needs of the patients, their families and friends if the treatment of the patient is to be fully successful.

The Minister for Health and Children has stated that the key objectives of the national cancer control programme are to ensure equity of access to services and equality of patient survival, irrespective of geography. Irrespective of geography indeed. The people of Dublin are not expected to travel to another hospital approximately 10 km from their home for cancer care but the Minister sees no difficulty asking people in the north west to travel up to 250 km or more from their homes for cancer treatment.

For patients, families and friends, ease of getting to and from hospitals is a serious problem that must be fully considered. The decision to close cancer services at Sligo General Hospital ignores the cancer care for the population north of a line from Galway to Dublin. That is not acceptable. The strategy runs counter to all the Government's talk of regional development and is seen in the region as having a cross-Border dimension. Speaking at a recent conference, the Minister for Foreign Affairs stated that mainstreaming North-South co-operation is a central part of policy delivery in every Department. Talk is cheap.

The Minister for Health and Children has stated that the potential for further cross-Border co-operation on cancer care would be progressed through a North-South feasibility study. The population of County Fermanagh has the potential to contribute to the population base for a centre of care in Sligo. It would be a monumental tragedy for the region to have cancer services removed from Sligo General Hospital only to discover next year that a cross-Border regional review of cancer needs further confirms the case for a cancer treatment centre in Sligo.

The cancer care strategy now being implemented is seriously and fundamentally flawed. Equity of access cannot be delivered by ignoring geography. The current strategy ignores the breast cancer care needs of the entire population north of a line from Galway to Dublin. Currently, 4,000 mammograms and 2,000 colorectal examinations are carried out at Sligo General Hospital. If the breast cancer care services are removed, all oncology services will be removed. I say to the Minister of State, Deputy Devins, that what is left will not be worth talking about.

Photo of Jimmy DevinsJimmy Devins (Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Sligo-North Leitrim, Fianna Fail)
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That is not true.

Photo of John PerryJohn Perry (Sligo-North Leitrim, Fine Gael)
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We have a compelling case to make as to why Sligo General Hospital should be developed as one of the centres for breast cancer services. The current volume of breast cancer cases validates this case.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy must conclude.

Photo of John PerryJohn Perry (Sligo-North Leitrim, Fine Gael)
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Sligo General Hospital is already achieving outcomes comparable to world class standards. The hospital has a dedicated clinical team with top class breast cancer expertise. All medical consultants and GPs in the region——

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy is eating into other Deputies' time.

Photo of John PerryJohn Perry (Sligo-North Leitrim, Fine Gael)
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——fully endorse the retention of breast cancer services in the hospital. These points make an unanswerable case for the retention of these services. The decision to close cancer services is a political one.

Photo of Máire HoctorMáire Hoctor (Minister of State, Department of Environment, Heritage and Local Government; Minister of State with special responsibility for Older People, Department of Social and Family Affairs; Minister of State, Department of Health and Children; Tipperary North, Fianna Fail)
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They are not closing.

Photo of John PerryJohn Perry (Sligo-North Leitrim, Fine Gael)
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For the Minister of State, Deputy Devins, and Deputy Scanlon, the vote on this motion represents their last chance to show where they stand. These are the two people who can save breast cancer services in Sligo General Hospital. It is time for them to take decisive action in support of the retention of breast cancer service in Sligo General Hospital. I call on them to be decisive. The Minister of State, Deputy Devins, knows exactly what I am saying.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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It is not appropriate for those in the Gallery to applaud.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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I ask the Minister for Health and Children, Deputy Harney, to correct the record of this Dáil. On a number of occasions she has given incorrect figures regarding the level of surgery in Mayo General Hospital. Today, the general manager has faxed information to her officials. If the officials are not giving the Minister the correct number of cases, then she had better do something about it. I ask her to correct the record of the Dáil. It is not fair on the hospital, the consultants and the team in Mayo General Hospital which is working very hard.

Last night the Minister spoke about Tipperary-Waterford. I spoke to my colleague, Deputy Tom Hayes, who said the people in Tipperary were not happy having to go to Waterford. The Minister did not tell the Dáil, however, that they were very upset in Waterford to learn that patients were to go there from Tipperary, without additional staff and resources. There was a row there.

Photo of Máire HoctorMáire Hoctor (Minister of State, Department of Environment, Heritage and Local Government; Minister of State with special responsibility for Older People, Department of Social and Family Affairs; Minister of State, Department of Health and Children; Tipperary North, Fianna Fail)
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That is not true.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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It is not true.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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That is what I was told by Deputy Hayes.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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Deputy Ring is wrong.

Photo of Máire HoctorMáire Hoctor (Minister of State, Department of Environment, Heritage and Local Government; Minister of State with special responsibility for Older People, Department of Social and Family Affairs; Minister of State, Department of Health and Children; Tipperary North, Fianna Fail)
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The Deputy should withdraw that because it is not true.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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We have not hear much from Deputy Hoctor in her job as Minister of State for the past few years. I ask her to be quiet for a few moments and let me complete my few words.

(Interruptions).

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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I want to say——

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I want to make the point to people in the Visitors Gallery that it is not appropriate to applaud in our national Parliament.

Deputies:

It is not appropriate to lose services either.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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I want to tell the Minister why the women and people of Mayo have no confidence in her and no confidence in going to Galway. I shall give two or three simple examples. There is a woman in the Visitors Gallery tonight who had to go on local radio this morning, crying and praying for her loved one, who is in a very bad state in Mayo General Hospital for the last number of weeks, waiting for a bed in Galway. If that operation could have been carried out in Mayo General Hospital, it would have been done. I had a simple case in my constituency, which I shall again put on the record of the Dáil. A woman was called for oncology service for next September, although she has been dead for 17 years. Yet the Minister expects the women of County Mayo, Sligo and Letterkenny to believe she is offering them a better service in Galway.

I know the Minister was aggravated the last time I mentioned that Professor Tom Keane was on €600,000 to do the job. If the man was committed to staying here and ensuring this was going to work, I should have some respect for and actually believe the Minister. However, he will draw down the money, set up the service and, like the Minister for Health and Children, he will have no accountability for anything. He will have no accountability because he will be back in Canada again, and when we table Dáil questions to see how this system is operating and how Professor Keane is doing, we will be told he is no longer here.

I want to thank those in the Visitors Gallery for coming here over the past two days. Many of these women cannot afford to be here.

Photo of Máire HoctorMáire Hoctor (Minister of State, Department of Environment, Heritage and Local Government; Minister of State with special responsibility for Older People, Department of Social and Family Affairs; Minister of State, Department of Health and Children; Tipperary North, Fianna Fail)
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Go on, play to the gallery.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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Many of them want to be at home in Mayo looking after their children. Many of them are not particularly well and they would prefer to be in Mayo. The reason they are here is that they went through Mayo General Hospital. We have excellent surgeons in Mr. Kevin Barry, Dr. Mary Casey and Mr. Ronan Waldron and the Minister is now going to remove our surgeons from Mayo to Galway, although Galway cannot cope as it is. She expects our women to believe her when she says the service is Galway will be better than they are getting in Mayo General Hospital. That is why they are here tonight, because they know what they have and they cannot believe any more promises from Fianna Fáil, the PDs or this Government supported by the ragbags of Independents, because they do not believe them any more.

(Interruptions).

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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In another case, a woman constituent who became ill has four family members working in very senior jobs in the HSE throughout the country. The decision they made about their mother was that she would not going into any hospital in this country, because they were afraid she would contract MRSA. That is the confidence the people of Ireland have in the health service, and in the Minister and people like her.

I call tonight on Deputies Beverley Flynn and Dara Calleary. I want to tell Deputy Flynn that she was elected by these women as an Independent, not as a Fianna Fáil Deputy. She went through the lobbies before regarding her father, and I admire her for that. I am asking her tonight to come with us and go through the lobby for the women of Mayo, who selected and elected her as an Independent. She told them in Castlebar that she would support them and be with them. I want to know whether she will come up here for the women who want services in Mayo General Hospital.

(Interruptions).

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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The Minister, Deputy Harney, talks about leadership. I want to ask Deputies Beverley Flynn, Dara Calleary, Eamon Scanlon and Jimmy Devins not to mind the Taoiseach, Deputy Brian Cowen, and Fianna Fáil. Come with us and show we want the service retained in Mayo General Hospital, and in Sligo, with a satellite service in Letterkenny, because the service is better in those centres than that promised by a Government we cannot trust.

(Interruptions).

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Can I ask the people in the Visitors Gallery——

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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On a point of order, I was waiting for Deputy Ring to finish, but I want to intervene on behalf of somebody who is not a Member of this House, namely Professor Keane. I want to correct the record, as I did before, and it is important that I should do it.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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The Minister can do it later in her own time.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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Professor Keane is earning less than any consultant——

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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He is earning €600,000.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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No, he is not.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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These are matters the Minister can clarify in later contributions.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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I want to say this, because it is very important.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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It is not a point of order, and we need to continue with the debate.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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It is very important because the man is not in this House. He has come to this country for two years——

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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This can be clarified in later contributions.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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——and is earning exactly the same salary that he had in Canada. The organisation which seconded him, the British Colombia Cancer Agency, is getting that money, as I have told the Deputy before.

(Interruptions).

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I call Deputy McHugh.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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I shall take on the Minister in any quarter in any place. We have had enough of her for the last six or seven years. She has failed as Minister and we have had enough of her.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Deputy Ring will please allow Deputy McHugh. Time is very tight in this debate.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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Deputy Ring should not try to damage someone who is not here.

(Interruptions).

8:00 pm

Photo of Joe McHughJoe McHugh (Donegal North East, Fine Gael)
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I welcome the initiative of the party leader, Deputy Enda Kenny, and Deputy Reilly in tabling this motion. It is a question of confidence at a time when patient confidence is at an all-time low. I have questions to ask on behalf of my constituents and the general public. Will Government policy on cancer services be of a high quality, co-ordinated and efficient? If past performance is an indicator of the future, I doubt it very much. Will services be population or patient focused? The irony of centralising cancer care is that members of the predominantly healthy 25-44 age group live in the suburbs of these proposed centres, whereas the predominantly ageing population are in the peripheral rural areas. How does international best practice in advanced nations align itself to Ireland's situation? All things being equal, it fits well. However, given the Third World transport infrastructure in this country, all things are not equal. In terms of a cancer vision, will there be a clear direction that improves the patient's journey? I do not mean a journey on the back of a bus or in an ambulance. I mean a patient's journey from screening to diagnosis to rehabilitation and recovery. The people of the north west do not share the Minister's confidence in the vision she holds at the moment.

I want to discuss cancer services at Letterkenny General Hospital. Having secured outreach status from University Hospital Galway, the cancer team at Letterkenny is developing all the time. At present, we have three pathologists, three specialists in neurology, a permanent oncologist, a locum oncologist and a soon to be appointed breast care surgeon, proving that multidisciplinary team meetings are possible with the assistance of advanced communications technology. As the Minister will be aware, every Thursday meetings take place via telelinks to discuss mammograph, ultrasound and biopsy results through advanced communications technology. Why can this not happen also in Castlebar and in Sligo?

Donegal is unique in that it has a cross-Border element. Where the ongoing radiotherapy negotiations are concerned, there is an underlying issue regarding openness and transparency. Serious questions arise over determining a suitable location for a radiotherapy service and the people on both sides of the Border have not been consulted. While we are told a feasibility study is ongoing, the details are sketchy. I welcome the fact that the Minister for Health and Children, Deputy Harney, and the Minister for Health in Northern Ireland, Mr. Michael McGimpsey, are meeting but it is not advisable to pinpoint a location without prior investigation after only two meetings.

The focus of this motion is on patient care and the cancer patient journey. While we accept on this side of the House that specialist cancer surgery requires a conglomeration of experts at a fixed location to where people will travel, there are other elements to cancer recovery that the Government is failing to consider. This is where the Government is losing the argument. So much can happen locally in conjunction with local hospitals with respect to negotiation with general practitioners. I refer to prevention, screening, diagnosis, treatment, rehabilitation, supportive care and palliative care. These comprise the vision on paper but, in reality, the people do not have confidence in the system.

I cite an example of a woman who went for a mammogram last week in Letterkenny General Hospital. While waiting for her test results for 15 minutes, 14 women went for mammograms. I know this because the woman in question was my mother. She went for a check on her own initiative as a private patient because there is no BreastCheck service in the north west. How in the name of God does the Minister expect one centre in Galway to look after the whole north west if 14 women are going through the system in Letterkenny in a 15-minute period? As the Minister well knows, the clinic in question is now operating on a Saturday as well as from Monday to Friday.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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The treatment of cancer is but one of many crises erupting almost daily in the health service. To name but a few, there are serious problems with waiting lists and critically ill patients lie on trolleys for days; patients are being misdiagnosed; there is a scandal over hospital bugs, including MRSA; there are cutbacks in essential services such as the home help scheme and services for the disabled; and there is a nursing home scandal. The litany of failures is almost endless. The availability of cancer treatment concerns us most.

Cancer is the health scourge of the 21st century and it is the most unwelcome illness of all. Unfortunately we can expect it to come knocking on our door sooner or later. Very few families have not been affected directly or indirectly. It can be devastating to be diagnosed with cancer. In this regard, I need only mention the late Nuala O'Faolain and how she reacted to her terrible diagnosis.

However, we all agree on one point, that the best possible treatment should be available for those who are struck by the dreadful disease. There is general agreement that centres of excellence are the best way forward in providing treatment. The Government's policy in designating centres of excellence is fundamentally flawed in that it lacks geographic balance. It is a spectacular oversight to leave almost half of this country without even one such centre. North of the Dublin-Galway line, there is a barren desert as far as the strategy is concerned. There will be no centres of excellence in that region. Even worse, there are definite plans to dilute the already existing cancer services in places such as Sligo. That part of the country represents almost 20% of the State's population. On a per capita basis, the region should be entitled to two centres of excellence.

Not alone is the north left without a centre of excellence but the BreastCheck programme has not yet been extended thereto. Although the Minister announced more than a month ago expenditure of €10 million on digital mammography services, it is unbelievable that BreastCheck has not yet been made available in the north west, including Donegal.

I welcome the decision to have a satellite unit in Letterkenny General Hospital under the responsibility of the Galway centre of excellence. However, I urge the Minister to ensure the facility is provided immediately. All those in south Donegal are dependent on the cancer treatment facilities in Sligo General Hosptial. An excellent service, in terms of diagnosis and treatment, is being provided under the wise guidance of Professor Tim O'Hanrahan. The people of south Donegal are shocked and opposed to any reduction or withdrawal of cancer services in Sligo General Hospital. They want the services to be retained and enhanced. There is no reason Sligo should not have a satellite facility associated with Galway in which to deliver treatment.

Our aim should be to provide treatment to patients as near to their homes as possible. The designation of Galway as a centre of excellence for all the west will create a logistical nightmare. Transport from the north to Galway is completely inadequate. There are no train or air services and this makes matters extremely difficult for patients suffering from cancer. As other Members stated, the circumstances in Galway create further difficulties in that basic facilities such as parking spaces are not available. All of these factors lend support to having an additional centre in the north west.

There is a complete absence of radiotherapy services in north Donegal and this represents the remaining gap to be filled. I made one of my regular visits to St. Luke's Hospital last night. Before I entered at all, I met three patients from Donegal, two male and the other female. The latter was a 34-year-old mother whose children were at home, yet she was spending seven or eight weeks in Dublin.

Negotiations are taking place at political level between North and South and I urge the Government and HSE to bring them to a conclusion as soon as possible. Patients from my part of the country should not have to travel 200 miles for six, seven or eight weeks. The service they require should be provided in their own region.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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I speak from the Galway perspective and will outline the difficulty the Minister's proposal will create at University College Hospital, Galway, UCHG. Already this year there are proposals for closure of some wards and theatres at the hospital for the month of August, basically due to financial considerations. If a centre of excellence is to be provided in Galway, which, as stated in our motion, we support, funding will have to be ring-fenced for the purpose. Our motion states existing safe and high-quality cancer services should be retained at Mayo and Sligo general hospitals and that all centres of excellence and satellite units should be subject to an annual audit by the Health Information and Quality Authority. Despite assurances by speakers on the Government side, such a system is not in place. This is the crux of the problem.

I cannot understand how the plans for an expanded centre of excellence will work at UCHG. Already the staff — including doctors and nurses — is working under severe strain. Our spokesperson on health, Deputy Reilly, outlined some figures in the debate last night that merit repeating. He quoted the following:

We enclose the figures for the number of patients waiting on trolleys for an inpatient bed in the [emergency department] at UHG for the month of April 2008. You will see that this month we have had a total of 444 patients on trolleys at 9 am [throughout the month]. This compares to a total of 188 for the same period in 2007. This is an increase of 136% at a time when the HSE is meant to be moving towards a zero tolerance for trolley waits in Emergency Departments, as recommended by the Task Force Report.

Deputy Reilly suggested that the overcrowding at UCHG is seriously affecting patient care, as I know from experience. Overcrowding and the placing of patients on trolleys has been highlighted continuously by me and the staff at the hospital over several years. Despite our best efforts, no steps have been taken to address this serious issue.

To give an example of how circumstances are worsening, in the first four months of this year there were 1,283 patients on trolleys at 9 a.m. compared to 890 for the same period last year. The problem is getting worse by the day. All those patients were on trolleys overnight, in some cases for more than 30 hours. How does the Minister propose to eliminate this serious situation before she creates a centre of excellence? This is the crucial question for Galway.

At present, one cannot get into the car park at the hospital at any time of the day without encountering serious queuing delays. Alternatively, one is obliged to drive out of the city to park and then walk or get a taxi to the hospital. There is double parking, parking on yellow lines etc. and one cannot park a bicycle at the hospital at present.

The centre of excellence should have been built as a purpose-built building at Merlin Park Hospital, where facilities would be available and where all the major roads lead——

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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There is space.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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——rather than trying to put a gallon into two pints at University College Hospital, Galway. It simply cannot be done. Moreover, there is no assurance from the Government that finance will be ring-fenced for this purpose.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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This debate reminds me of the cancer debate that took place in the midlands during the 1990s. The difference is that the then Minister, Deputy Michael Noonan, outlined that strategy and his Government's Deputies and councillors opposed it. Consequently this debate is nothing new. It pertains to independent medical advice from the National Cancer Forum, which I fully support this evening as I then did.

Peculiarly, the same players are involved, namely, the patient, who often is forgotten, the Government, the National Cancer Forum, the public and politicians. The same three issues operate this evening as was the case then, that is, location, location, location. Nothing much has changed in this regard.

The arguments in support of the National Cancer Forum remain the same. Regardless of people talking about political involvement and people being under pressure, the same three issues jump out at me this evening as in 1997. The three vital components are that this constitutes independent medical advice, it is not political and most importantly, it is for the patients' benefit.

I do not understand how Members of the Opposition can ignore the fact that of——

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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The Minister of State's party has been in office since 1997.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Please allow the Minister of State to speak.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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While Deputy McCormack is a master of butting in, he should try to listen for a change.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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I must do so when the Minister of State is telling lies.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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If the Deputy can point out a single lie, I will come back to it.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy may not make that charge. The Minister of State, without interruption.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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For the information of Deputy McCormack, the 23 members of that forum are independent people. They are not card-carrying members of Fianna Fáil, the Progressive Democrats or the Independent Members. Moreover, 17 of them are doctors. It is clear this issue pertains to the level of assessment of the independent medical advice on which the Government is acting.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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None of them is from the north west.

Photo of Joe McHughJoe McHugh (Donegal North East, Fine Gael)
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Are the people stupid?

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Please allow the Minister of State to speak.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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Challenging independent medical advice would be going down the wrong road. I support this strategy and as the national strategy is being rolled out, I welcome the fact that a person of the calibre of Deputy Mary Harney is Minister. I believe her to be a person with integrity and ability with a commitment to deliver an excellent service throughout the State.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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God help us.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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More importantly, I believe the same Minister is possessed of compassion and realises what the issues are in this regard. I also wish to acknowledge the contribution of my colleagues, Deputies Scanlon, Flynn and Calleary, as well as the Minister of State at the Department of Education and Science, Deputy Devins. Obviously they have seen the import of the independent medical advice from the National Cancer Forum that Members should believe, rather than attempting to have a regional perspective.

In a similar fashion to the debate that occurred in the midlands some years ago, unfortunately people use figures to distort the argument.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Absolutely.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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I refer——

(Interruptions).

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Allow the Minister of State to speak. One minute remains to him.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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——to the figures used by Deputy Ring. I will not play to the Gallery although it is a popular party piece to use. There have been claims in recent weeks and during last night's debate in particular, in respect of the accuracy of the information used by the Minister. The information in the possession of the Minister for Health and Children, Deputy Mary Harney, was and remains rock-solid.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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The manager sent up the figures.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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I can tell Deputy Ring about the information sent by the manager. First, no new data have been received. The Mayo analysis shows that their figures included more procedures than simply mastectomy or oncology——

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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What about the patients on trolleys?

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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——and more diagnoses than cancer. The Deputy is aware of this——

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Minister of State should speak through the Chair.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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——but comes in pretending he does not have the facts.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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I have the facts and I know the facts.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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The manager also agreed they were measuring different things and that the data cited by the Minister last night are correct.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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This is not true.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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These are the facts and the worst aspect of this debate is the Deputy knows these are the facts.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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They are not true.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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However, he prefers to play to the gallery for a cheap level of support. This is about women's lives and not about Deputy Ring topping the poll at the next election.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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The Minister should ask what they were told in Castlebar.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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The figures are available. They stack up and were arrived at independently.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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The Minister of State should go away.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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I would much prefer to support procedures that will save——

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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This is the reason there are so many tribunals.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Please allow the Minister of State to speak.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Laois-Offaly, Fianna Fail)
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——lives rather than seats. I commend the Minister in her attempt to roll out a proper cancer service.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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What about the people on trolleys?

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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I welcome the opportunity to speak on this important topic and I am grateful to those who shared time. Were Members to discuss calmly what is before them, it would be important not to distort or misquote the National Cancer Forum's report of 2006. In the report's executive summary, it does not say that only eight centres should be established. The exact words used are "about eight such centres". Again, recommendation No. 28, after discussing the question of volume and the size of population necessary to support a centre, uses the phrase "about eight such centres". Therefore, the obduracy in being unwilling to move from eight centres to a ninth, the case having being made, must be justified. However, it is not justified by a reliance on the National Cancer Forum's report of 2006.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Hear, hear.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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There is no reference to "only eight" centres. This bears out a point that my colleague, Deputy Jan O'Sullivan, made last night, which is that an earlier report suggested 11 centres. Although only a few minutes are available to me, I wish to make a few points on how this obduracy is not helpful in respect of a health policy.

I do not believe the Minister for Health and Children can, within the Constitution, resile from obligations on a rights basis, a point I have made elsewhere.

Deputies:

Hear, hear.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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That is, citizens are entitled to an equality of treatment. Therefore, the onus is on the Minister to justify the inflexibility that is being imposed by way of a recommendation to the HSE. Again the advice of a former Attorney General on this point was that no Minister — I have been a Minister — can hand to an agency responsibilities that are constitutionally the responsibilities of that Minister.

Deputies:

Hear, hear.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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The difficulty with the HSE is that it is not proofing its proposals for budget balancing against the rights that already are there under the Health Acts and which are available to citizens. The HSE has no right simply to state it intends to balance its budget. It is open to citizens to test this in the courts and it is my hope they will do so.

One of the great difficulties in this regard, irrespective of who is Minister for Health and Children, is that without a floor that accepts the constitutional guarantee to a minimum of health care available to all citizens on an equal basis, one cannot have a policy. This brings one to the issue of the arbitrary figure. In fairness to the national cancer forum, it did not specify 500,000 people. It suggested "about 500,000" people and discussed the case above and below the limit. Consequently, those who wish to take the suggested approximate figures contained in the report in black and white and suggest they are absolutes again are resiling from the report itself. A logical case has been made and the most reasonable response to this week's debate would be to return to the report and take the interpretation that is possible by offering a ninth centre, given the strong case that has been made.

I repeat that it has been pointed out empirically that the alternative is to impose an unfair burden on those who already are over-burdened in Galway. This is the reason that when one talks of equality of access, one must take into account the road structure, the amount of time spent travelling and the delivery of the service. We went through this before when we discussed neurosurgery and the right of regions to deliver equality of access to medical rights for their citizens. That is why, even at this stage, I appeal to those speaking on the Government side to at least consider the case supported in the report——

Photo of Máire HoctorMáire Hoctor (Minister of State, Department of Environment, Heritage and Local Government; Minister of State with special responsibility for Older People, Department of Social and Family Affairs; Minister of State, Department of Health and Children; Tipperary North, Fianna Fail)
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It is not supported in the report. See page 45.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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——for having about eight centres of excellence——

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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A minimum of 500,000 people.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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The Minister has no right to say that they said only eight centres of excellence. They did not say only eight.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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Hear, hear.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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I repeat, the Minister has an obligation under the Constitution to deliver to the HSE a policy on health. I hope the Minister finds herself in the Supreme Court if she is unwilling to do her duty.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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Hear, hear.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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I thank the Members who have contributed to this debate. When the Taoiseach, Deputy Cowen, came into this House on his first day in office, he said we should not be obliged and restricted by the acceptance of independent reports. He said we should have the courage to change them if we believe they are not correct. He said he gave a declaration to the people of south Offaly that the constituency boundary was never breached since the foundation of the State. This is an opportunity for the Government to show the courage he speaks of because this is not only a medical position but a political decision and the Minister knows it.

Deputy Healy-Rae is sitting outside the barrier in the House. The reason Tralee is not included in this motion is that I have reason to believe it is part of his secret deal with the previous Taoiseach, which is worth millions to the country.

Photo of Jackie Healy-RaeJackie Healy-Rae (Kerry South, Independent)
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My deal is none of Deputy Kenny's business.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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Perhaps he should unveil the deal so the people of the country can see what it contains.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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If he actually has a deal.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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That is why Tralee is not included in this motion.

I am appalled at the attitude of Government Deputies who said this fight was lost when statements were issued by management. Members of hospital management do the jobs they are supposed to; politicians reflect the views of the people and make political decisions in the best interests of the community. I inform the Minister, Deputy Harney, that I would not stand here and defend this motion in the name of Fine Gael if I did not believe that the standards of surgery, clinical outcome and survival stand up. The Minister has not proven anything in this debate to date to demonstrate that the service in Sligo or in Mayo General Hospital should not continue.

Last week, I met Professor Keane and when I told him that Letterkenny is being set up as a satellite entity on geographical grounds, rather than medical grounds, he said: "I am very upset about this." He is here as a facilitator to implement a Government policy that has been handed to him. Whether there were ten, five or 20 centres he would implement the policy and the Minister knows this is the case.

When Deputy Bertie Ahern came before the House on his last day as Taoiseach, he said he had made representations to Professor Keane and they could not be changed. Who, in the name of God, is in charge in this country? The reason these people are in the Gallery is that they do not believe the Minister, Deputy Harney, anymore and I will tell her why this is the case. This morning, I spoke of people with no voice — those in palliative care, those who need psychiatric assessments and those under the charge of the Chairman of the Joint Committee on Health and Children, who vowed to get back the €25 million that was allocated to the Minister but has not been spent on front line services.

The Minister can carry this message to the Taoiseach — his vow to Deputy Reilly that he would silence me in this House will not be carried through. I will not be beaten down in standing up for those with no voice or in outlining the case for people who need and deserve services and who have had the services they receive stripped away.

Photo of John PerryJohn Perry (Sligo-North Leitrim, Fine Gael)
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Hear, hear.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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In Monaghan, Dundalk and Navan services have been stripped away and replaced by mythical entities that the Minister for Justice, Equality and Law Reform tells us there is not a red cent in the coffers to support. The Minister told us the accident and emergency situation would be sorted out in 18 months — then it was a crisis and now it is even worse. The Minister has failed on palliative care, she has failed on a fair deal for nursing homes, children under five wait months for assessments and children wait years for orthodontic treatment. As a Minister, she has failed in her duty.

The figures must be sorted out. I have the seven reports from Mayo General Hospital here and they show that 95 patients, including 92 new and three recurrences, were diagnosed and treated there.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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Yes.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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If that is a lie, the Minister should phone the manager and clinicians there tomorrow and talk to them because she has never told this House what a procedure involves, what is meant by the word "procedure" and whether these figures are relevant.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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The Minister never talks to anyone.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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These people are professionals and she is doing down their professionalism by denying that these figures are factual and that these files exist.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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Correct the record.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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What will happen now that Deputies Calleary and Flynn have said all of these things will happen before the service is moved to Galway? We will have transport arrangements, new facilities and a Mayo clinic in Galway, although there is no mention of a Sligo clinic in Galway. All of these wonderful things will happen before the service moves. Today's letter from the HSE to me states: "It is agreed that the transfer of breast cancer services from Castlebar hospital will occur in early September 2008." That is 14 weeks away. The letter goes on to state: "The national cancer control programme has committed not to move the service until we are satisfied that the quality of the service and access to that service is at least comparable to what is currently available in Castlebar." It states "at least comparable to what is currently available", but the Minister told us that this service will be demonstrably better than any service in Mayo or Sligo. This is palpably not the case and the Minister is not being true to either her political remit or her ministerial responsibilities.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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I ask the Deputy to read the document to which he refers.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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Deputy Scanlon must walk up those steps in five minutes, as must the Minister of State, Deputy Devins, and Deputies Calleary and Flynn. A year ago this week, Deputy Flynn said, as an independent Deputy, that she would have a deal for the people of Mayo that would be good for them and good for Mayo. She said she would have even more clout as an independent and on 5 March she made her clarion call when she said the only plan on the table was hers. She said: "I am now calling for a united approach to honouring that promise and I know that I speak for the people of Mayo in calling on my Oireachtas colleagues to back my proposal and to display the unity of purpose which the people of Mayo have a right to expect." That is the position the Deputy put to 7,000 people in the Traveller's Friend.

Photo of Beverley FlynnBeverley Flynn (Mayo, Fianna Fail)
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The Deputy never did back my proposal.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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We are going to do that tonight.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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The Minister can amend this case in two seconds. She wanted consensus and I will give her consensus. She has never offered to talk about these problems with this side of the House. She went to Castlebar recently, but fled the scene before answering these questions.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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Deputy Kenny did not even turn up.

Photo of Enda KennyEnda Kenny (Leader of the Opposition; Opposition Spokesperson on Northern Ireland; Mayo, Fine Gael)
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We will call her to account in five minutes.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Deputy Reilly has two minutes.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I insist that I have five minutes. If other speakers went over time——

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy has two minutes. The Deputy will obey the Orders of the House, as I will, and this means I must put the question at 8.30 p.m.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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We are wasting more time. I had a speech prepared to outline why the Minister's figures are wrong but I outlined that last night. I have an e-mail from Miriam Wiley of the Economic and Social Research Institute, ESRI, and I will read part of it.

Where there is discrepancy between data reported the only way that that can be resolved is by access to the two sources. In this instance it seems to me that would mean that the data source for the hospital would need to clarify how the findings reported there were reached and likewise the Department of Health and Children would need to clarify the process involved in identifying the data reported from that source.

The data source for the hospital has clarified how the findings reported there were reached. It is implicit that the ESRI can only collate what is transmitted to it and what has been transmitted to it is incorrect regarding Mayo General Hospital. If this has been replicated around the country, the implications are obvious. We are planning a health service on misinformation.

Why does the Minister persist in using figures from the years 1994 to 2001 to compare outcomes for women on the west coast to those of women on the east coast when there was no breast cancer service, no surgeon and no oncologist in these areas until 2000?

If one checks the figures relating to five years survival in breast cancer patients for 2002, one finds that the rate is 88%, which exceeds the European average as reported in The Lancet Oncology last year. It also compares favourably to American data.

I pointed out that there is more than one way to deliver a centre of excellence. It can be done in the absolute fashion chosen by the Minister or it can be done through satellites, as the Sloan-Kettering hospital in New York has done, as mentioned by Deputy Flynn. In these areas all patients before they commence treatment are discussed by the entire team at both the centre and the satellite and this is what gives the best outcome. The Government has already opted for this option in Letterkenny. I have further outlined the appalling record of the Government in keeping its word and the record of the HSE and its ability to deliver safe, effective and timely health care.

I mentioned a transport system based on volunteerism. Only this morning we had a heated debate between the Fine Gael leader, Deputy Enda Kenny, and the Taoiseach, who failed to answer the question of what has happened to funds allocated by the Government through the Department to the HSE for specific purposes. This money was designated for the hospice and the mental health services but was hived off for other uses.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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For bonuses.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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The Taoiseach talks of reform of the public service, but this happened under his watch as Minister for Finance. This was money which would have given people who were terminally ill some comfort and dignity at the end of their days, money which could have improved the appalling state of our mental health services. No one asked for extra money, just that the money allocated would go to the purpose for which it was designated.

During the course of that debate the Taoiseach indicated that he would silence the Opposition. We know from comments made off the record how dearly he loves us and how highly he holds us in esteem, but I guarantee he will not silence the Opposition because we live in a democracy.

Deputies:

Hear, hear.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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While Fianna Fáil may accept a dictator, this nation will not.

Deputies:

Hear, hear.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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What we have in this motion is a situation best described by the old proverb "A bird in the hand is worth two in the bush." The people of Mayo have a bird in the hand — a service that delivers excellent care they are happy with. The people of Sligo have the same excellent service and they wish to retain it. The people of Letterkenny are evolving their own model. What they are being offered today is two birds in the bush in the form of University College Hospital Galway — an excellent hospital but one which is under-resourced and overcrowded. The consultants at the hospital have written a letter to their manager saying that by their estimation——

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I must put the question.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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——one to two people a month are losing their lives unnecessarily because of overcrowding in the accident and emergency department and in the hospital generally. The hospital is €4.5 million over budget, has 100% occupancy in its surgical and medical wards and sees 30 new cases of MRSA every year. The number of overnight stays in April 2008, as mentioned, increased by 136% compared to the same month in 2007. According to the Irish Association for Emergency Medicine, if we extrapolate these figures to the rest of the country, we find that 360 people are dying unnecessarily every year. Is it fair to the people of Galway to impose 2,500 patients from Mayo and 2,500 from Sligo on top of a creaking system?

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I am sorry, Deputy, but the time is well expired.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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The bottom line is that in life you hold on to what you have and you do not let go of it until you see something better sitting on the plate in front of you. In this instance all we have is a plan, without the resources to make it happen. I ask again that Deputies from the north west — Deputies Beverly Flynn, Dara Calleary, Eamon Scanlon, Jimmy Devins, Mary Coughlan, Pat The Cope Gallagher, Niall Blaney and James McDaid — vote with their consciences and their hearts and not be brow-beaten into voting for something they do not believe in.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I must now put the question.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I will finish now. I am asking the Minister to allow the people of the north west and the west to keep the excellent service they have until she can make something better available to them, something that is real, not a mirage that seems to be more about trying to save money than saving lives.

Deputies:

Hear, hear.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I commend the motion to the house.

Photo of P J SheehanP J Sheehan (Cork South West, Fine Gael)
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Where are all the Government Deputies now?

Amendment put.

The Dail Divided:

For the motion: 75 (Dermot Ahern, Michael Ahern, Noel Ahern, Barry Andrews, Chris Andrews, Seán Ardagh, Joe Behan, Niall Blaney, Áine Brady, Cyprian Brady, Johnny Brady, Thomas Byrne, Dara Calleary, Pat Carey, Margaret Conlon, Seán Connick, Mary Coughlan, John Cregan, Ciarán Cuffe, Martin Cullen, John Curran, Jimmy Devins, Timmy Dooley, Michael Finneran, Michael Fitzpatrick, Seán Fleming, Beverley Flynn, John Gormley, Noel Grealish, Mary Hanafin, Mary Harney, Seán Haughey, Jackie Healy-Rae, Máire Hoctor, Billy Kelleher, Peter Kelly, Brendan Kenneally, Michael Kennedy, Tony Killeen, Séamus Kirk, Michael Kitt, Tom Kitt, Brian Lenihan Jnr, Conor Lenihan, Martin Mansergh, Micheál Martin, Jim McDaid, Tom McEllistrim, Finian McGrath, Mattie McGrath, Michael McGrath, John McGuinness, John Moloney, Michael Moynihan, Michael Mulcahy, M J Nolan, Seán Ó Fearghaíl, Darragh O'Brien, Charlie O'Connor, Willie O'Dea, Noel O'Flynn, Rory O'Hanlon, Ned O'Keeffe, Christy O'Sullivan, Peter Power, Seán Power, Dick Roche, Eamon Ryan, Trevor Sargent, Eamon Scanlon, Brendan Smith, Noel Treacy, Mary Wallace, Mary White, Michael Woods)

Against the motion: 62 (James Bannon, Pat Breen, Tommy Broughan, Ulick Burke, Joan Burton, Catherine Byrne, Joe Carey, Deirdre Clune, Paul Connaughton, Noel Coonan, Joe Costello, Simon Coveney, Seymour Crawford, Michael Creed, Lucinda Creighton, Michael D'Arcy, John Deasy, Jimmy Deenihan, Bernard Durkan, Damien English, Olwyn Enright, Frank Feighan, Charles Flanagan, Terence Flanagan, Eamon Gilmore, Tom Hayes, Michael D Higgins, Phil Hogan, Brendan Howlin, Enda Kenny, Ciarán Lynch, Pádraic McCormack, Shane McEntee, Dinny McGinley, Joe McHugh, Arthur Morgan, Denis Naughten, Dan Neville, Caoimhghín Ó Caoláin, Aengus Ó Snodaigh, Fergus O'Dowd, Jim O'Keeffe, John O'Mahony, Brian O'Shea, Jan O'Sullivan, Willie Penrose, John Perry, Pat Rabbitte, James Reilly, Michael Ring, Alan Shatter, Tom Sheahan, P J Sheehan, Seán Sherlock, Róisín Shortall, Emmet Stagg, David Stanton, Billy Timmins, Joanna Tuffy, Mary Upton, Leo Varadkar, Jack Wall)

Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies David Stanton and Emmet Stagg.

Amendment declared carried.

Question put: "That the motion, as amended, be agreed to."

The Dáil divided by electronic means.

Photo of David StantonDavid Stanton (Cork East, Fine Gael)
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Given that this is such an important motion and in light of the strong views expressed by Government Deputies on the matter, I wish to afford them the opportunity to walk through the lobbies. As a teller, under Standing Order 69 I propose that the vote be taken by other than electronic means.

Photo of John O'DonoghueJohn O'Donoghue (Ceann Comhairle; Kerry South, Ceann Comhairle)
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As Deputy Stanton is a Whip, under Standing Order 69 he is entitled to call a vote through the lobby.

Question again put: "That the motion, as amended, be agreed to."

The Dail Divided:

For the motion: 74 (Dermot Ahern, Michael Ahern, Noel Ahern, Barry Andrews, Chris Andrews, Seán Ardagh, Joe Behan, Niall Blaney, Áine Brady, Cyprian Brady, Johnny Brady, Thomas Byrne, Dara Calleary, Pat Carey, Margaret Conlon, Mary Coughlan, John Cregan, Ciarán Cuffe, Martin Cullen, John Curran, Jimmy Devins, Timmy Dooley, Michael Finneran, Michael Fitzpatrick, Seán Fleming, Beverley Flynn, John Gormley, Noel Grealish, Mary Hanafin, Mary Harney, Seán Haughey, Jackie Healy-Rae, Máire Hoctor, Billy Kelleher, Peter Kelly, Brendan Kenneally, Michael Kennedy, Tony Killeen, Séamus Kirk, Michael Kitt, Tom Kitt, Brian Lenihan Jnr, Conor Lenihan, Martin Mansergh, Micheál Martin, Jim McDaid, Tom McEllistrim, Finian McGrath, Mattie McGrath, Michael McGrath, John McGuinness, John Moloney, Michael Moynihan, Michael Mulcahy, M J Nolan, Seán Ó Fearghaíl, Darragh O'Brien, Charlie O'Connor, Willie O'Dea, Noel O'Flynn, Rory O'Hanlon, Ned O'Keeffe, Christy O'Sullivan, Peter Power, Seán Power, Dick Roche, Eamon Ryan, Trevor Sargent, Eamon Scanlon, Brendan Smith, Noel Treacy, Mary Wallace, Mary White, Michael Woods)

Against the motion: 62 (James Bannon, Pat Breen, Tommy Broughan, Ulick Burke, Joan Burton, Catherine Byrne, Joe Carey, Deirdre Clune, Paul Connaughton, Noel Coonan, Joe Costello, Simon Coveney, Seymour Crawford, Michael Creed, Lucinda Creighton, Michael D'Arcy, John Deasy, Jimmy Deenihan, Bernard Durkan, Damien English, Olwyn Enright, Frank Feighan, Charles Flanagan, Terence Flanagan, Eamon Gilmore, Tom Hayes, Michael D Higgins, Phil Hogan, Brendan Howlin, Enda Kenny, Ciarán Lynch, Pádraic McCormack, Shane McEntee, Dinny McGinley, Joe McHugh, Arthur Morgan, Denis Naughten, Dan Neville, Caoimhghín Ó Caoláin, Aengus Ó Snodaigh, Fergus O'Dowd, Jim O'Keeffe, John O'Mahony, Brian O'Shea, Jan O'Sullivan, Willie Penrose, John Perry, Pat Rabbitte, James Reilly, Michael Ring, Alan Shatter, Tom Sheahan, P J Sheehan, Seán Sherlock, Róisín Shortall, Emmet Stagg, David Stanton, Billy Timmins, Joanna Tuffy, Mary Upton, Leo Varadkar, Jack Wall)

Tellers: Tá, Deputies Pat Carey and John Curran; Níl, Deputies David Stanton and Emmet Stagg.

Question declared carried.