Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I indicated before the adjournment of this Bill last week that Sinn Féin would oppose it, uniquely, of all those who contributed. We are even more determined in our opposition this week. In the meantime, the management of the HSE, which is given more responsibilities in this Bill, has been exposed yet again as grossly incompetent and unfit to run a health service. It should not be forgotten that the HSE is a creature of this Fianna Fáil-led Government which set it up. The Government tries to hide behind it but central to HSE failures is the disastrous health policy of this Government.

Yesterday, due to the bravery of Melissa and Michael Redmond in speaking out, we learned of major flaws in prenatal care in this State. It has shaken the confidence of women in that care system and very understandably so. This is a terrible development because so many good people work in that system and provide excellent care. Management at the Lourdes hospital in Drogheda and in the HSE must be held accountable for the litany of failures that have come to light as a result of this family speaking out.

The internal hospital report, which was to the media, should be published in full. I seek a confirmation from the Minister in respect of that today. The report exposes bad clinical practice, outdated and inadequate equipment, lack of guidelines on scanning, no permanent trained staff attached to the early pregnancy unit and no written guidelines for early pregnancy problems.

Where was the oversight and responsibility of hospital and HSE management in allowing this to develop and continue? Both levels of management failed miserably yet again. How widespread is this problem now that we know of similar cases in Galway and Louth? How many more cases will present over the next several days?

At hospital, regional and State level, the HSE has proved to be a disaster. It needs to be replaced with community health partnerships that will be truly accountable, a development Sinn Féin sees as essential in a reformed health service.

Where is the Minister for Health and Children, Deputy Harney, in all of this? More importantly, where is she today? We have not heard a peep out of her about this situation. She treats the people with the same contempt as she treats this Dáil. This week's sitting, in which we cannot raise this matter other than under this Bill which was earlier demonstrated at the commencement of business at 2.30 p.m., is a complete farce. I have no doubt the Government's current cutbacks will only make it worse and create further tragedies or near tragedies. The embargo on public sector recruitment is putting ever greater pressure on staff, thus increasing the danger of misdiagnosis.

At the core of this is a culture of refusing to listen to patients. That is also at the core of another scandal, one which has received little attention but which I raised last week when I appealed to the Minister for Health and Children to intervene in the attempts by the HSE to evict elderly people from their home at Loughloe House in Athlone.

Last week, I pointed out two patients had died since the HSE's closure announcement of the home on 6 May. Since then, I have to report that another patient passed away in the early hours of yesterday morning in Mullingar hospital. Relatives and staff are in no doubt that the stress caused by pressure to move out of Loughloe House was the key factor in their untimely deaths. Two other residents had heart attacks and another man had a stroke.

Six people have now been hospitalised, three fatally, in one month. There should be an independent investigation into the methods used by the HSE to relocate residents. As I put on the record last week, some residents were threatened with the street if they talked to media or public representatives. Others threatened with the door if they refused to take another bed offered to them by the HSE.

I ask the Minister of State, Deputy Moloney, to communicate on my behalf, and that of a collective of concerned Deputies of all opinion including Government backbenchers, to the Minister for Health and Children, Deputy Harney, her need to directly intervene and stand down the HSE's disgraceful methods of relocating residents. As Minister for Health and Children she has a duty of care for all residents of Loughloe House and elsewhere. I urge lessons be learned from the Loughloe House tragedy to ensure the same mistakes are not repeated.

Frank Fahey (Galway West, Fianna Fail)
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I wish to share time with Deputy Browne.

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

Frank Fahey (Galway West, Fianna Fail)
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I welcome the introduction of the Health (Miscellaneous Provisions) Bill 2010, the main purpose of which is the dissolution of the board of St. Luke's Hospital and the transfer of the hospital's employees, assets and liabilities to the HSE. While a welcome development, it must be noted St. Luke's has in the past provided an outstanding oncology service. When it was the only hospital in the country treating cancer patients, much good work was done there. I recall many times being on to the hospital on behalf of patients from the west waiting for treatment. The staff at the hospital were second to none. I pay tribute to the work they did in difficult times in catering for the whole country. After this legislation is enacted, I am sure the hospital will continue to perform this outstanding work.

Great work is being done by the national cancer control programme. Its head, Professor Tom Keane, has done an outstanding job in health care management against all kinds of political, medical, vested interests' and community opposition. While I accept all of us were involved to a degree because we want to protect our own patch, the necessary changes Tom Keane brought about were essential to providing quality cancer treatment facilities across the country.

For the first time, funding has been increased to required levels. In current economic circumstances, an additional €20 million in funding for cancer care this year is quite adequate. When Professor Keane took up his position, he complimented the quality of the staff involved in cancer care, saying that Ireland is lucky to have a large cadre of well-trained clinicians, nurses, therapists and technicians skilled in oncology. All the oncologists I have met in Ireland usually returned from having been trained in some of the best cancer care centres in the world. The centre of excellence at University College Hospital, Galway, has one of the finest teams of cancer care specialists in the world, many of whom trained in the United States and elsewhere.

The work done in all centres of excellence across the country must be acknowledged. Reductions in waiting times are being addressed in an effective way for the first time. HIQA standards require all eight designated centres see 95% of urgent patients within two weeks and 95% of non-urgent patients within 12 weeks. The most recent data demonstrates all urgent cases in St. Vincent's and St. James's hospitals are seen within two weeks. The overall number of deaths from cancer has been reduced by 10%.

Survival rates for breast cancer have improved to 77.1% for women diagnosed from 2000 to 2004 compared to 72.5% for women diagnosed between 1994 and 1999. The pace in improvement of breast cancer treatment is the fastest in the OECD. The BreastCheck programme, which aims to reduce the number of deaths from breast cancer among women aged between 50 and 64 years of age, has been rolled out nationally. We had a long and tortuous campaign to get BreastCheck rolled out in the west and south west. It took much longer to roll it out there than in the rest of the country. BreastCheck is of the highest quality internationally and it is available in every county throughout the country. Since it started, some 600,000 mammograms have been carried out on women between the ages of 50 and 64 years.

The question of treatment of prostate cancer has been slow to be rolled out. Figures from the national cancer registry show that prostate cancer is the commonest form of cancer diagnosis in men, accounting for 29% of cases. The stark figures behind the percentages are that on average every year more than 2,400 men are diagnosed with prostate cancer and approximately 540 die from the disease. The national cancer programme is putting in place rapid access diagnostic clinics for prostate cancer in each of the eight designated centres. I am pleased that to date clinics have opened in St. James's Hospital, Dublin and University College Hospital, Galway. Two further clinics in Beaumont and St. Vincent's hospitals are due to open before the end of the year and the remaining four will open in 2010. Prevention and early detection are key factors in the national cancer control strategy. As yet, there is insufficient evidence to support a population based screening programme for prostate cancer. The Department of Health and Children and the national cancer screening service are keeping under review emerging evidence about prostate cancer screening, including the results of randomised trials which are being conducted internationally.

Lung cancer is a very significant problem here. It is the biggest cause of cancer death in men. In 2006, the latest year for which we have figures, some 964 men died from lung cancer. In the same year, 585 men died from colorectal cancer and 543 died from prostate cancer. Rapid access diagnostic clinics are now open in Dublin and this year will see the opening of a rapid access clinic in Galway. Unlike other types of cancer, there is evidence to support screening for lung cancer. In Ireland, 40% of all cases receive no specific cancer treatment because the disease is so advanced.

I refer to cervical cancer. Approximately 250 to 300 cases per year are diagnosed and there are between 70 to 100 deaths. In September 2008, the Government rolled out the national cervical screening programme, CervicalCheck, which has the potential to significantly reduce incidence of death from cervical cancer over time. The vaccine will be offered free of charge this year for approximately 30,000 girls now in their first year of secondary school. This is the same group of girls that would have received the vaccine under previous plans in 2009. The reason the programme is now possible is that vaccine companies have offered substantially better prices for Ireland and an innovative tender process conducted in recent weeks by the HSE has resulted in a more affordable cost to the Exchequer.

The colorectal screening programme has two great benefits: early detection of cancer, improving treatment outcomes, and the detection of pre-cancerous growths. Colorectal cancer is the second most commonly diagnosed cancer among men and women in Ireland and approximately 2,200 new cases are diagnosed every year while approximately 100 die from the disease.

Rectal cancer is a terrible disease and if the surgery is not carried out correctly one's chances of cure are permanently compromised. One interesting statistic is that there were 58 general surgeons, some of whom were rectal cancer trained, operating on five cases or less in any one year and some 17 surgeons were involved in only one case per year. Consequently, surgery is being moved to the eight hospitals and the plan is to proceed in two cases. All smaller hospitals will cease performing rectal surgery as of 1 January leaving us with the centres of excellence performing this difficult type of cancer surgery.

The appointment of the new head of cancer care, Dr. Susan O'Reilly, is very welcome. A native of Wales and trained in Trinity College Dublin, she has done a wonderful job in the British Columbia Cancer Agency in Vancouver. I have no doubt but that she will continue the very good work done by Professor Keane.

Cancer is probably an example of how we need to change in this country, how we need to stop with everyone looking for a hospital on their doorstep and how the medics involved need to change and be prepared to take initiatives. Cancer in Ireland is our success story. Let us hope that in other areas we can move on to repeat that success.

John Browne (Wexford, Fianna Fail)
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I thank Deputy Fahey for sharing time. I welcome the Bill. It affords me opportunity to speak on several issues relating to health. As Deputy Fahey stated, St. Luke's Hospital, which this Bill is about more or less, is very near and dear to all of us. We all have relatives attending St. Luke's Hospital from home. We visit there on a regular basis to see and visit constituents.

The changes envisaged under the Bill will help overall cancer services in the country. The cancer services in the eight centres are welcome. In this regard, people from Wexford generally go to Waterford. As the Leas-Cheann Comhairle will be aware, from a Wexford Hospital point of view we have been involved in services that have gone from Wexford to Waterford. We have fully supported some of the transfer of services from Wexford because we recognise that the centres of excellence are very important. However, we have no wish to see the downgrading of hospitals. We have been battling for some time in respect of Wexford Hospital on this reconfiguration trail. Some of the services in Wexford are very near and dear to the hearts of the people of Wexford and we hope they will not be transferred to Waterford or other hospitals but remain in Wexford.

I point out to the Minister of State, Deputy Moloney, that recently we held a public meeting in Wexford which was attended by between 6,000 or 7,000 people, or perhaps more. That shows the grá for the hospital in Wexford not only in the town, but in County Wexford. One must take into account that Wexford stretches up to Arklow on the Wicklow border and if many of the services are transferred out of Wexford to Waterford it would be a long journey from the Wicklow border to Waterford for those affected.

The people of Wexford call for the maintenance of services such as the accident and emergency service on a 24 hour basis, which is very important to a country that already has a population of 140,000. If one includes the summer months, given that Wexford is a holiday county, the population is increased by a further 40,000 to 50,000 people. At certain times there may be approximately 200,000 people in Country Wexford. It is very important that the Minister of State takes the message to the Minister, Deputy Harney, and the HSE that we will not lightly accept any undermining of Wexford hospital. We will fight the battle to ensure we have adequate and proper services for the people of Wexford. We are united on a political front on this issue and it is very important that the HSE and the Minister for Health and Children listen to what we say. Wexford has the population to justify a hospital of high quality such as Wexford hospital in the area of cancer services.

In 1984 I had a bowel operation. I always pay tribute to the consultant who treated me. Dr. Paddy McKiernan, who is now retired, diagnosed the problem at the time. I had a substantial amount of the bowel removed but I am here to tell the tale. As I recall, there were five people in the ward at the time and I am the only one now alive. I was the eldest of the five. Detection of cancer ailments is very important. The new system of cancer services throughout the country in the eight centres is very welcome. As Deputy Fahey pointed out, the goals of the national cancer control programme are better cancer prevention, detection and survival through a national service based on evidence and best practice. Under the programme, there are four designated cancer control networks and eight cancer centres nationally, the transfer of all breast cancer diagnostic and surgical services to the eight cancer centres only plus an outreach service in Letterkenny and the establishment of rapid access clinics to enhance access to early diagnosis and multi-disciplinary decision-making for prostate and lung cancers, which are among the most common cancers in Irish people.

It is essential that we continue to send the message about the importance of getting prostate cancer check-ups. Men are not inclined to go for such check-ups as often as they should and as a result, it is often too late when they do. We all have friends and relations who have gone for early check-ups, have had prostate cancer detected, have been treated and are well and out and about again. It is important we send the message loud and clear that people should go immediately to their doctor if there is any sign of prostate problems so that it is diagnosed and they get the treatment required, which is very successful.

The St. Senan's action group from Enniscorthy had a meeting with the Minister of State, Deputy Moloney, today. Enniscorthy is my home town and that of Deputy Paul Kehoe. A cross-party Oireachtas group has been encouraging the Minister of State to provide what was agreed a number of years ago with the then Minister of State, Tim O'Malley, which was that St. Senan's psychiatric hospital in Enniscorthy would close. We have no problem with that because for the past ten to 12 years the nursing staff, the administrative staff and the consultants have been providing outreach services throughout County Wexford for people in that old building which dates back to the 1800s.

We, in County Wexford, want an acute admissions unit, which was promised under A Vision for Change and which we expected to be delivered under it. In March 2010, it was revealed that this situation might be about to change and that the people who need acute services would have to go to Waterford. Waterford is not the centre of the universe for health services as far as I, other Members from Wexford or the St. Senan's action group are concerned. It is very important that the service is provided in the county, as promised. It is a long way from the Wicklow border to Waterford. The acute centre in Waterford caters for approximately 40 patients but we have 40 patients at any one time in County Wexford. There is no way Waterford will be able to provide the psychiatric services for the people of Wexford.

I thank the Minister of State, Deputy Moloney, for meeting the action group today. He listened very carefully to what we said. We are looking for nothing more or nothing less than what was promised in 2007 by the then Minister that an acute admissions unit would be provided in Wexford. The suggestion at that time was that it would be provided at Wexford General Hospital. If it must be located there, then so be it but we want that service provided in the county.

Lucinda Creighton (Dublin South East, Fine Gael)
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I am pleased to have an opportunity to speak on this important Bill but I am disappointed that the Minister is not present for the debate. It would be fitting that the Minister would see fit to appear in the House to take this legislation given its important and far-reaching ramifications for the health service in the future. It is important it is noted that the Minister did not see fit to come to the House.

The purpose of this Bill is the dissolution of the board of St. Luke's hospital and the transfer of staff in the hospital and the hospital's assets and liabilities to the HSE. I take the opportunity to express some degree of concern at that development. It is well-recorded that politicians and the public have almost lost all confidence in the Health Service Executive. It is difficult to have confidence in that body.

The original concept of the HSE was a good one. The aspirations of the Minister and the Government in establishing it were well-intentioned but the objective of eliminating bureaucracy and the parochial element associated with the old-style, traditional health boards was not achieved. What replaced the traditional health boards is essentially an ever-expanding and pretty frightening monster, namely, the HSE.

What we have been left with is a complete absence of the streamlining of services. We have an inaccessible, a confusing and an often frightening system which people shudder at the thought of interacting or interfacing with. We have some very old and well-known problems with over-staffing, excessive administration and with an absence, or at least a very severe shortage, of front line services. These problems are acute and are growing by the day. There is no clarity about the division of workload within the HSE. There is a hugely demoralised workforce within the health service.

From my experience of the HSE, the delivery of health services is getting worse. I say that with a heavy heart because it is essential to provide a quality service in which people can have confidence. However, that has not been my experience. To call it a fiasco is a serious understatement but the fiasco about which we heard in recent days in regard to the ultrasound which went wrong in Our Lady of Lourdes Hospital in Drogheda is simply symptomatic of deep and ingrained problems in the health service. I know that from my experience of dealing with constituents and from the experience of my family members. My uncle contracted MRSA in a hospital in Louth and died as a result. My father contracted MRSA in another public hospital in a different part of the country and was severely debilitated as a result. I am not unique in that there are few people and few families who have not been touched by the ongoing problems throughout our health care system, if one could call it that.

It is time the Minister stood up and was counted in terms of tackling the bureaucracy and the systemic problems in the HSE. I would be the first to acknowledge that the Minister set out with good intentions, with an agenda to reform the health service and that she did so in good faith. She is a politician for whom I have a huge degree of respect and she is a competent and capable politician. It was her intention to try to effect and drive change within the health service but she soon realised that would not be possible for a variety of reasons. They include the intransigent work practices within the health service and, more crucially from the Minister's point of view, the resistance from back bench Government Deputies who will protect the status quo at all costs and resist any sight or sign of change or meaningful reform within the health service. It is not the case that the Minister lacks the drive or intent to effect change and achieve reforms, but rather that she is constrained by the main Government party, which has been in power for too long and does not want, or have any enthusiasm for reform or change. That is a sad situation, the legacy of which, unfortunately, we will have to live with for many years to come as it will take years to solve the endemic problems within the HSE.

In contrast to the HSE, St. Luke's Hospital, otherwise known as "The Haven in Rathgar", is a beacon, a shining light, in the administrative labyrinth that is the health services here. Since 1954, when it was formally established, St. Luke's has provided the best quality of care for its patients and the best possible services to cancer patients from all over the country. Every family has been touched in some way by St. Luke's Hospital. Virtually every family has had some family member or friend attend St. Luke's at some point. Yet, St. Luke's is to cease operation in 2014. It is all very well to point to expert reports, expert opinion and the most cutting edge of medical advice, but it is difficult to explain to even the most intelligent human beings why the Government wants to dismantle one of the few public hospitals that functions and does its job with aplomb and replace it with a subsumed and submerged cancer service that will be provided via St. James's Hospital. The latter does not rank as one of the top hospitals in terms of hygiene, services available or its ethos and environment.

St. Luke's has been consistently rated as one of the top, one, two or three hospitals in the country on ratemyhospital.ie. Its rating is not scientific but it matters because it is the view of patients. They take the trouble to go on-line, complete surveys and judge the service they have received. It is the patients and their family members who have selected St. Luke's and held it up as a beacon in the HSE health service quagmire.

We must acknowledge the reality. We have to take account of expert opinion and advice. Between 2005 and 2007 more than 27,000 new cases of cancer were diagnosed every year. Our population has grown quite rapidly and, unfortunately, in tandem with that the number of cases of cancer patients presenting has increased dramatically. During the 1990s and the early years of this decade Ireland fell way behind in terms of dealing with the new developments and advancement in cancer treatment. We now rank as one of the worst countries in terms of having a national plan to deal with cancer care. That is the reason I welcome the national plan for radiation oncology. It is necessary and important that we do everything in our power to implement it. I recognise the Minister's commitment to that and her ambition to implement it and, in so far as it is possible, we all have a duty to respect that and to work with it. It is an ambitious plan, which I sincerely hope - I genuinely mean that - will deliver better and improved cancer treatment facilities and care for patients throughout the country. It is imperative that I acknowledge that the strategy has been devised by some of the top medical experts, some of the most eminent cancer specialists not only in Ireland but from further afield. I would not pretend to second guess these medical experts when it comes to identifying medical need. I also would not be so bold as to second guess them in terms of outlining the types of streamlined services that are required to tackle the shortfall in radiation oncology services here. It is important that we, as politicians, examine needs and the best possible strategy to tackle cancer on a national basis and in an integrated fashion. That is the onus on us and we cannot afford to be populist in that regard.

I also understand that radiation oncology must be integrated with other cancer treatments. Essentially, radiation must be integrated with surgical and medical oncology. In essence, that is not happening in St. Luke's. I understand this is the most pressing reason for the decision to relocate radiation services from St. Luke's and to bring them under auspices of St. James's Hospital.

In that context, it is important to remind the Minister of commitments made by her predecessor, the Minister, Deputy Martin, in 2003. He said:

... that the ethos and strengths of St. Luke's must remain as key drivers nationally. How best to ensure this happens will be a key objective of mine. In the meantime, I am fully committed to ensuring that the excellent standards of care at St. Luke's continue to be supported.

The Minister, Deputy Harney, in 2005 committed that "arrangements to ensure the continuity of St. Luke's expertise and ethos in the service" would be maintained. I am confused as to how exactly that ethos will be maintained within the precincts of St. James's Hospital. I have no confidence that the ethos and the quality and the level of care, to which people have become accustomed and have come to expect, in St. Luke's will be maintained or that the dignity afforded to cancer patients there will be carried through and replicated under the auspices of St. James's Hospital. I do not have any confidence that will happen. I would like some assurances on that. That is the reason I am disappointed the Minister, Deputy Harney, is not present. I want to hear from her and I hope in her reply to this debate on Second Stage she will address this issue because we have no clarity on it. I have been raising the issue of St. Luke's in this Chamber since I was elected to it and prior to that I raised it through engagement with patients and campaigners from and in support of St. Luke's.

Over and over we requested assurances and guarantees from the Department, the Minister and the HSE regarding how the level of care can be maintained and how people can have confidence in the HSE to deliver that level of care and they have not been provided. The aspiration was set out by the former Minister, Deputy Martin, followed by the current Minister. They both proclaimed they were committed to delivering and maintaining this ethos but they have outlined nowhere how it is expected that can or will be achieved.

St. Luke's Hospital is set in just over 18 acres of beautiful landscaped gardens in Rathgar. It was always the objective of the patrons of the hospital that it would be a place of refuge, peace and tranquility where people from different parts of the country and south Dublin who were battling for their lives could access the best medical care, compassionate care and be afforded the greatest dignity while undergoing hugely stressful radiation, chemotherapy and other treatments. That is the unique element of the hospital, which marks it out from all the other public hospitals in the State. It is something for which people have a deep affinity and that is why there is such outrage of the prospect of the hospital's closure. It is also why many people, including me, are concerned about the proposed closure.

There are strong medical arguments in favour of moving the hospital's services lock, stock and barrel to St. James's Hospital but it is conceivable that the special conditions available to patients in St. Luke's Hospital, including the peace, tranquility and solace, will be lost forever. These conditions have a healing power in their own right and that is not hocus-pocus. Strength of will and of mind is an essential element in healing. It is not simply about medical treatments; it is also about the psychological and we cannot afford to lose that element of the healing process as well.

While the oncology service may well have to be relocated to St. James's Hospital, there is a strong case for retaining St. Luke's Hospital for recovery, rehabilitation and respite care. The time has come, particularly in light of this legislation, for the Minister to outline her vision for the site in Rathgar and for the input of the hospital in the long-term provision of health services for the city of Dublin. I plead with her not only to maintain this unique hospital for the delivery of cancer care or some other form of care but to integrate and maintain it as an essential part of the health services in the city and the country.

Paul Connaughton Snr (Galway East, Fine Gael)
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I am delighted to have an opportunity to contribute to the debate. Few people will object to the Bill but it gives us an opportunity to give great consideration to how cancer services are being reorganised. I am a member of the Joint Oireachtas Committee on Health and Children, as is the Acting Chairman, and I have been impressed by Professor Tom Keane. I am not a medical person but, from the first day I saw him, I was extremely impressed with the way he went about his business. I fully appreciate, as Deputy Creighton said, that there will always be tensions in the provision of cancer care and other Members will be much more vocal about how the national cancer strategy did not suit their areas. However, the concept of eight centres of excellence was right.

We are fortunate in my constituency that there is a centre of excellent in UCHG in Galway city but if I happened to live in counties Donegal or Sligo, I would argue it is a long way to travel for treatment. I have been in the House quite a while and hundreds of people from east Galway and the west have had to travel to St. Lukes Hospital. I have been in the hospital - thankfully as a visitor only - on many an occasion. I met these people on trains and buses as they traipsed up and down to the west, with some doing a return journey on the same day having received treatment. What is happening now is heaven on earth compared with what people had to do in days gone by. It is bad enough to be fighting for one's life. One of my great dreads is that cancer will cross my path or that of somebody close to me but the statistics show that one has to assume it will happen sooner or later. I do not have time to go into the statistics but, for whatever reason, while our population is increasing, the numbers of people dying from cancer is also increasing. I acknowledge that because of early detection and better systems of treatment, people are alive now who would not have survived ten or 20 years ago.

The public will buy into the concept of the centres of excellence but when one considers what Professor Keane and his team did in a relatively short time, it was a major shake-up for an organisation such as the HSE. I only hope in the next ten years that what happened with cancer care will be replicated in many other areas of the health service. One of the reasons for this is that Professor Keane was able to get health professionals on side from the beginning. There was no shortage of bickering, which is part and parcel of the world we live in but we are lucky many of our consultants have been trained all over the world and they came back here to work. Once they got into this system, it appeared they then knew their expertise, which is acclaimed worldwide, could be delivered on to benefit patients and it certainly appears to be working.

The cancer unit in Portiuncula Hospital, Ballinasloe, was closed because it did not deal with sufficient cases. Since it was only 30 or 40 miles away, it was transferred into the new centre of excellence at UCH Galway. One hopes the withdrawal of that type of service, which will affect all areas of the county, will be compensated for. When I refer to a new image for the HSE I hope it will be able to deliver as regards hospitals such as Portiuncula. We know they will not be doing open heart surgery or treating cancer in future, although it is silly to believe that an important albeit small hospital could not perform these procedures. It is significant what they can do, however, because of the physical traffic going through a place such as Galway, which believe me is one of the busiest places on the face of the earth. One nearly has to park half a mile away from UCH in a housing estate if one wants to visit a patient. Nonetheless, there are obviously many procedures being done in that hospital that could, perhaps, be performed more efficiently in Ballinasloe. I am calling for a redoubling of efforts in this regard.

For whatever reason the HSE is finding it extraordinarily difficult to redirect, where appropriate, what is being done in UCH to a smaller hospital such as Portiuncula, in order to allow it to fine tune its efficiencies as a centre of excellence for many other procedures. Take rectal cancer, which is an enormous problem. I fully accept that will be treated in the various centres of excellence. However, there are so many things that the smaller hospitals could and should be doing, if only the Minister, the HSE and everyone concerned would switch engines on this and let people see what could and should be done.

This would remove a great deal of the frustration and anger that is being expressed throughout the country, with people saying their local hospitals are being closed by stealth. I am not a medical person, but I believe these local hospitals will be badly needed before all this is finished. They have the expertise in areas such as accident and emergency, maternity etc. Given what has happened in UCH Galway, which will rightly be a centre of excellence for other things as well, we certainly would not need to take our eye off the ball as far as primary care is concerned, and need hospitals such as Portiuncula.

I have a fundamental problem with Government as regards the roll out of BreastCheck, and with the HSE. Thankfully, it has now happened and it is in operation in every county, perhaps with one or two exceptions. However, given that in Ireland over the last ten years there was money hand over fist and where, in many instances, the Government and its agencies did not know what to do with it, I could never understand why it took so long to roll out BreastCheck. It is enormously important and the results will show in the future that because it was rolled out, even at this late stage, it will certainly save many lives. I believe, however, that many women have died unnecessarily over the last five to ten years because BreastCheck was not in place.

Prostate cancer is an enormous issue all over the country. One of the reasons it has such a grip on men is that, for whatever reason, they do not seem to want to see a doctor as readily as women might. That is changing, but nonetheless men are slow to present. There should be no reason for this, but that is the position. Doctors tell me that men really need to become incentivised to do this promptly. I believe some 2,500 men were found to have prostate cancer last year, and 500 to 600 died. This is a significant number and it is getting worse.

I hope the HSE, in whatever way it can, through a PR or information campaign perhaps, will get the message across to men everywhere to test for prostate cancer. It is the most important thing they can do. For some strange reason an enormous percentage of men refuse to do that to this day, and we cannot blame the Minister and the HSE for that. However, we must create an environment whereby men will want to do that. I have no doubt that with the centres of excellence now swinging into action, a major job will be done on that particular cancer.

Lung cancer is another major challenge, and some 800 people die from this every year. I find this hard to understand given what the Government and the public have done as regards non-smoking areas etc. There is a major trend, however, among young people, particularly girls, towards wanting to take up smoking and that obviously will have enormous effects on their lives in years to come.

I pay tribute to St. Luke's on behalf of the many people from the west who have attended there over the years. One could say it had an unusual effect on many people, while one cannot expect someone to get excited by the fact he or she has been diagnosed with cancer. Certainly, one could not get excited at the prospect of having to drive 200 miles to a hospital among strange surroundings. Many of those people would have had nobody belonging to them in Dublin, and this was therefore a source of enormous strain and anguish for them at that point in their lives. However, because of the way they were treated when they were admitted to St. Luke's, almost everybody I know was extremely grateful for the great dignity, humanity and professionalism extended to them. I hope this ethos, which has been referred to on a number of occasions here, will be continue in St. Luke's and I have no reason to believe it will not.

Finally, I understand that Dr. Susan O'Reilly is taking over from Professor Keane. I wish her well. Her job is as big as the one Professor Keane had to face on the day he started. This job is only quarter done. Some people might say the high profile element is done, and that may well be, but there are enormous elements to be addressed under the cancer-oncology structure. I hope everything goes well for her. She has the experience and the research track record and I understand she is a formidable person. From a personal viewpoint I wish her well.

More generally, as regards cancer, I must take my hat off to the hospice organisations around the country for the wonderful job they do for people who are terminally ill and living out their lives in great dignity because of the support they are getting. I am thinking of places such as the Galway Hospice Foundation, which has done so much with so many people. It is a testament to people's opinion of it that most hospices were started on the basis of voluntary contributions. Some of the best voluntary efforts I have ever seen have been to establish and to procure funding for the hospice centres. People perceive this, now they have been up and running for many years. It is terrible to think that one may be obliged to use them. However, that is how life is and for those who know that medical science cannot do any more for them and who wish to live out their lives with dignity and respect, it is great to think there are men and women who dedicate their entire lives to helping such people. It must be a great source of satisfaction for families to know their loved ones are being so well looked after.

Joe McHugh (Donegal North East, Fine Gael)
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I welcome the Minister of State, Deputy John Moloney, to the Chamber and acknowledge the pending meeting with representatives from the Duchenne muscular dystrophy group. I have just been informed that a delegation from that group will meet the Minister for Health and Children, Deputy Mary Harney, and I acknowledge the Minister of State's ongoing involvement. I have been highlighting this issue with the Minister of State on a regular basis, both inside and outside the House.

At the outset, I affirm Fine Gael's support for this Bill, which serves to further implement the national cancer strategy that was first established in 1996 by a Fine Gael Minister for Health, Deputy Michael Noonan. I wish to pick up on a few points raised by Deputy Paul Connaughton and obviously there are swings and roundabouts in respect of centres of excellence. As a Galway representative, Deputy Connaughton highlighted the positive aspect of Galway being a radiotherapy centre for the west. However, when employing hindsight and when extrapolating on all the reasons Ireland entered a phase of what one might call the adoption of international best practice, I believe there will be a fundamental analysis of the mistakes made here when we took international best practice as a winning formula not simply for health, but for many other sectors. I do not believe one can compare like with like and I refer in particular to Professor Tom Keane as head of the national cancer strategy. One cannot compare the Canadian experience and health model to the model in Ireland because we do not have a similar type of public transportation infrastructure. Obviously, I allude to the position in County Donegal, in which cancer patients must rely on paramedics to go to Dublin and must engage in five-hour trips in the back of an ambulance. When comparing like with like, international best practice may be a misnomer.

Ireland's number of consultant radiation oncologists per million citizens is the lowest in western Europe. Each consultant supervises a case load four times larger than those suggested in a number of international guidelines published in the mid-1990s. A total of 319,599 Irish citizens were diagnosed with cancer between 1994 and 2007, of whom 11,102 were patients from County Donegal. A 41% increase in the number of cancers is expected between 1994 and 2015, excluding non-melanoma skin cancer. There will be a major increase in the number of patients with the more common adult cancers that require radiation oncology treatment such as breast, prostate, lung and non-melanoma skin cancers.

As I noted earlier, 11,102 Donegal residents were diagnosed with different forms of cancer between 1994 and 2007, out of a total of more than 319,000 Irish citizens who were similarly diagnosed during that time. I have extrapolated a few figures from the National Cancer Registry and have compared the results for a few different counties to six seats in the Dáil. A total of 897 patients in County Donegal were diagnosed with lung cancer, compared to 798 in County Kildare. There were 1,127 Donegal prostate cancer diagnoses, compared to 1,098 in County Kerry. A total of 204 leukaemia cases were detected in County Donegal, versus a comparable figure of 140 in County Meath. An obvious trend emerges in this respect.

The reason I have extrapolated these figures is because of the anecdotal evidence I encounter every time I go to a wake in County Donegal. I attended a wake in my native parish last weekend at which the son-in-law of a man who had just passed away from cancer asked why more people from County Donegal are in St. Luke's Hospital than from anywhere else. While this is anecdotal evidence, it must be investigated. The Department should investigate this issue because it is a question on the lips of every citizen in County Donegal. When one visits St. Luke's Hospital, one will find statistics to prove that more patients from County Donegal go through its doors than from any other county in Ireland. It is a worrying statistic and is a trend that is highlighted in the figures from the National Cancer Registry. There is anecdotal evidence in every parish in County Donegal and the Department must investigate it. People speculate that it could be a result of the outfall from Chernobyl. Obviously the issue of diet is raised but people in Donegal do not eat any different foods than the rest of the country. Consequently, this issue should be investigated and I call publicly on the Department of Health and Children to investigate this serious issue in County Donegal.

The national cancer strategy is imperfect and I refer to concern that none of the eight centres of excellence will be situated north of the Dublin-Galway line. Moreover, there are demographic arguments for a centre of excellence north of this line. I note the view expressed last week by Professor John Crown, head of cancer services at St. Vincent's Hospital, who stated last week that having four centres in Dublin and none in the north west is crazy. The cross-Border organisation Co-operation and Working Together, CAWT, has informed me that a commitment exists to consider the radiotherapy services provided in the north west. However, a few questions arise therefrom. What is the current position on a north-west arrangement? Second, will the respective Ministers, Deputy Harney and Mr. McGimpsey MLA, sign the agreement for a radiation unit to serve the north west in Altnagelvin Area Hospital? If so, when and on what date? In the ongoing absence of a radiation unit, will the Minister guarantee that Donegal patients will continue to be afforded the opportunity of going to St. Luke's, to Belfast or to Galway? The key question on the lips of Donegal residents and of my constituents in Donegal North-East is whether there will be equal access. If a radiotherapy model based in Altnagelvin Area Hospital, County Derry, is agreed to, will there be equal access for the good citizens of County Donegal? As for ongoing work at Letterkenny General Hospital, the new medical assessment unit and an accident and emergency unit are under construction at present. However, fear also exists in respect of the downgrading of services at this hospital and I ask the Minister of State to allay such fears.

Medical experts advise that the closure of St. Luke's Hospital is desirable and Fine Gael accepts that by 2014, it will not be operating as a cancer treatment hospital. However, due to the high numbers of its residents who attend it, County Donegal unfortunately has a special relationship with St. Luke's Hospital. The hospital has always sent a consultant to Donegal once a fortnight for consultations with cancer outpatients. Previous speakers have referred to the unique culture at St. Luke's Hospital. Psychosomatic medicine is an interdisciplinary medical field and it is impossible to quantify its effects. Consequently, while one bows to medical expertise when considering oncology treatment, one must rely on what one hears, experiences and knows when addressing psychosomatic considerations. Although the hospital is in the middle of the city, it gives calmness to its patients and their visitors. Its buildings, staff, gardens, parking facilities, medical facilities, religious features and pathways contribute to the atmosphere to which many speakers have referred. Patients who do not need constant care stay at the Friends of St. Luke's Hospital hostel, at which their families also can stay.

All Members are familiar with the prayer, "God grant me the serenity to accept the things I cannot change, courage to change the things that I can and the wisdom to know the difference". The lay-out of St. Luke's allows longer-term patients and their families to give newer patients and their families courage and wisdom. The atmosphere confers serenity and acceptance. Patients rely on one another and learn from one another. Patients' families rely on other patients' families and the staff are patient, honest and firm. This compares to the chaos that applies in some other hospitals.

Bernard Durkan (Kildare North, Fine Gael)
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Hear, hear.

Joe McHugh (Donegal North East, Fine Gael)
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Legislation for motorway service stations was introduced in this House last year. One can see new service stations being built on the M1 following the enactment of the legislation. There is no reason for the Government not to consider small stopover centres at the mid-way point between the north west and Dublin because we will not be able to provide services in every back yard around the country and patients will require transport to centres of excellence. We should afford people dignity if they are in a state of ill health and making arduous journeys. Providing a stopover facility would allow them to get a cup of tea. Such a facility would not even have to be staffed. There is no need for extra personnel or resources. We are talking about a stopover to which paramedics would have a key. That is something worth considering in terms of affording dignity to patients.

Deputy Connaughton referred to palliative care and the voluntary work carried out in hospices. The models designed by voluntary groups throughout the country are a model of best practice we should examine. We should consider the genesis of the hospice movement and the types of transportation infrastructure that was introduced on a voluntary basis. The people on the ground know what is best. When introducing legislation we should look at what is happening on the ground in terms of best practice rather than getting caught up in international best practice. What is best in Finland, Sweden and Canada will not work in this country. We have a population of more than 3.5 million and we are living in a country with poor infrastructure in terms of public transport.

Bernard Durkan (Kildare North, Fine Gael)
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Hear, hear.

Joe McHugh (Donegal North East, Fine Gael)
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That is something we need to address. On that note, I will finish.

Willie Penrose (Longford-Westmeath, Labour)
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I am pleased to have an opportunity to contribute to the debate which allows for discussion of subjects beyond the scope of the Bill which provides for the dissolution of St. Luke's Hospital and other significant amendments to various Acts within the health area.

Professor Keane has done extremely good work in this area. We should accept that the identification of the eight centres of excellence predated his arrival. If one is seriously ill, one wishes to get the best treatment. Centres of excellence allow for a significant throughput of people, the upgrading of skills on a regular basis and the availability of multidisciplinary teams to ensure that patients get the most appropriate and best treatment. One only gets one opportunity to address a health issue and it is important that one is treated in the quickest, most efficient and effective way by those who have the required professional skills and equipment available.

County Westmeath is above the Dublin to Galway axis but we have a good road infrastructure to bring patients to Dublin and Tullamore. In the same way as the Minister of State, Deputy Moloney, I have no qualms about travelling to Tullamore if that is designated as the centre of excellence for the people of Westmeath. What is important is to get the best and most effective services for patients in the area. However, an issue arises in the north west and it would be churlish not to admit it. The road infrastructure and transport networks are not up to standard. Centres of excellence are a great idea if the infrastructure is in place but it is not feasible for people from the north west to travel to Galway and other places that are already under significant pressure in terms of admissions. Infrastructure must be put in place in order for the proposals to work and if that is not done then difficulties will arise for patients in Donegal and Sligo in particular.

One could ask why this country has been loath to take up services available elsewhere such as air ambulances to ensure that patients are transported quickly and get the appropriate treatment as soon as possible. Surely it is not beyond the bounds of possibility to have such services based around the country. They are important in the context of ensuring people suffering from neurological complaints or difficulties get to Beaumont Hospital where the top neurosurgeons are available to look after them as soon as possible or to facilitate the transfer of cancer patients for treatment. We must try to broaden our horizons in this regard in that we must ensure people are not isolated from centres of excellence. This area should have been examined far more assiduously to ensure the needs of people in the north west would be catered for much more comprehensively than they have been.

It will be no surprise to the Minister of State, Deputy Moloney, to know I will refer to the debacle on the Midlands Regional Hospital, Mullingar, an extremely important hospital in terms of the treatment of a significant population, amounting to 120,000. It serves the expanding population in Longford and Westmeath. A commitment was made in the mid-1980s that when Longford hospital closed, the one in Mullingar would become the focal point for this very significant geographical area. It has grown.

In 1993, the then Minister for Health, Deputy Howlin, commenced phase 2A, and Deputy Noonan was Minister for Health and Children when it was completed in May 1997. Something happened thereafter that has never been explained and it has caused great concern and wonderment among the populations of Longford and Westmeath. They wonder why the phase 2B process, which had already been costed and taken on board in terms of value for money, which issue has been addressed in various reports issued today, was not completed and why the four-storey building built under phase 2A was left unused and covered in the droppings of crows and blackbirds for many years. It had almost become defaced. People were wondering for many years why it was built and left there, particularly because significant public moneys were invested therein. The people's expectations were legitimate in all respects due to the fact that they are entitled to the best facilities available. The people of Longford and Westmeath also pay their taxes and were entitled to the best facilities. The project was left on the back burner and subject to snail's-pace development. There was a degree of tardiness.

There was always suspicion over why the project was slowed down. People asked whether there was a political spoke put in the wheel that slowed it down. It did not progress with the rapidity it warranted, particularly because a significant element of the building had already been put in place. From a value-for-money perspective, it should have proceeded apace and should not have been sidelined. There should not have been obfuscation or delaying.

I have no qualms about other hospitals receiving their fair share. Like the Minister of State, Deputy Moloney, we are very proud to see the orthopaedic and ear, nose and throat facilities in Tullamore hospital. There are excellent consultants, nurses and other staff in that hospital doing excellent work. The hospital covers the Minister of State's area. He is probably a bit closer to it than I am. It is excellent and we accept and applaud it. The hospital needed modernisation also and it is not begrudged that. The politics of begrudgery does not come into play and has no place in respect of health; however, the politics of ensuring we get our fair share comes into play. I was sent here to articulate that view on behalf of the people of the Longford-Westmeath and make no apology for doing so. This is the people's forum in which I can make their case.

The snail became slower in respect of phase 2B. The phase was divided into stages, with phase one involving a rescheduling that was to be completed in 2008, having commenced in October 2006. The completion was to result in an increase in the bed complement from 215 to 244 beds. I acknowledge that there were additional moneys for the refurbishment of the existing wards, the medical surgical ward at level 0 and a delivery-gynaecology ward at level 2. Wards were to be fitted out, including a new paediatric ward on level 0, a new day surgery-gynaecology ward on level 1, a new obstetric ward on level 2 and a new medical ward, incorporating an acute stroke unit, on level 3. Stage one was to see "the existing paediatric and obstetric wards in line with SARI guidelines to provide a surgical ward on level 1 and a medical ward and palliative care unit on level 3". That was excellent.

Work was proceeding very well and phase 2B2 was brought into play. Then the whole project became subject to independent cost-benefit analyses. We all knew the analyses should recommend that the work proceed. The project, which was the most over-analysed, over-evaluated and over-scrutinised project ever to take place in Ireland, was then referred to the hospital capital steering committee, and formal confirmation was awaited from the committee concerning the status of this development. How many times did a project that had been in the pipeline for 12 or 13 years have to be subject to analysis and evaluation? Does the HSE keep evaluating in the hope it will produce a negative analysis? That is what always made me very suspicious about the HSE. I knew it could never get a negative analysis in regard to the hospital because the project was vital to the people of Longford-Westmeath.

In the past five years, Mullingar hospital has become one of the top three in the country for efficiency and effectiveness. Last week it was second. What is the hosptial to do to secure its future and ensure it is in a position to provide vital services and utilities for the people of Longford and Westmeath?

We are unsure of the current position. The surgical service is only to deal with emergencies for the next two months. The surgical facilities are very fine and the consultants are excellent. The nurses and ambulance and paramedical services are wonderful. One could not have better staff. They work way beyond the call of duty and at 125% efficiency. The people of the region wonder why what I describe is happening. Why does the Minister have to try to save money? One only gets one run at health. It is the one area in which money must be spent.

People ask why the surgical service is being abandoned for two and a half months. Is it feared that it may be shifted altogether, despite the efficiency and effectiveness highlighted in all the various reports? The people will be asking this in their thousands next Saturday on the streets of Mullingar as part of a march commencing at 2 p.m. at the hospital. This will send a clear message to the HSE, the Government and anybody else in the corridors of power that we expect that all our facilities will be maintained and enhanced, and that additional facilities will be put in place.

I do not want to bore the House with figures as this is not the appropriate forum; suffice it to say that Mullingar hospital has 185 acute beds, despite being promised up to 300. It got €64 million or €65 million last year and €59 million this year. There are 14 day beds. The average length of stay in the hospital is three days, the best in the country. The number of inpatient discharges in 2009 was 18,866, the day cases outturn was 7,235, and the number of attendances at the accident and emergency unit, which is one of the best, was 32,841. The number in Tullamore was 5,000 fewer, at 28,241, yet there are fewer staff and beds at Mullingar hospital.

The staff in the Mullingar accident and emergency unit, where I attended as a patient, are doing great work. The nurses react to emergencies and work extremely hard to put people into beds, only to find the beds are non-existent, thus requiring them to put patients on trolleys. The nursing staff do not want to be doing this; they want some of the 41 acute beds that were closed last November reopened.

While the Minister must come into the House and give me the HSE answer, I believe what Deputy Rabbitte said some days ago, namely, that it is about time those who make the decisions should be answerable. The buck should not always stop with the Minister, I do not subscribe to that. Ministers come in here for me to rant at them, and I do not like doing that. The people who make the decisions are the people who should answer.

I do not believe a single word that comes from the HSE. If it wrote to me today, I would throw the letter in the fire because I have no faith in it. If it fools me once, I am the fool; if it tries to fool me twice I am not going to buy it. The HSE tells me it can get 14 day beds in Mullingar but 41 acute beds are closed. The 14 day beds are for people who need a minor surgical procedure. Mullingar is most efficient at turning people out so the 41 beds are vital. The nurses in accident and emergency, who are working competently and professionally as a unit, would love to see some of those beds opened. They want additional staff. Why should they, in spite of their efficiency, have fewer staff than comparable hospitals that do not handle as many patients? There were 33,000 admissions to the accident and emergency department and they all received the best care and attention from expert staff. We are concerned about these developments and we are sending a signal that we will not accept any attempt to downgrade the Midland Regional Hospital in Mullingar.

There is talk of reconfiguration and reviews. Do they want to waste more money reconfiguring? We have spent millions of euro on a hospital and all we need is to put the additional staff in place and open the beds. People do not want to go hospital, they have to go there. That is why those facilities are important to the area. The road structure in Mullingar is reasonable but those from north County Longford, where the road infrastructure is not as good and there is no public transport, would have to travel to Tullamore, an additional 39 kilometres. We will not accept that when there is already an effective, efficient unit in Mullingar. Time is of the essence when someone needs urgent treatment. There is no reason why anyone would ever contemplate interfering with any of the hospital's facilities.

Almost 3,000 children were born in the maternity unit in the hospital in 2009, with less than 23% of those by Caesarian section, one of the top results in the country. There are excellent maternity, obstetric and paediatric facilities in the hospital, with wonderful consultants, doctors, nurses and attendants. People work as a team providing a great service, making sure patients get the best treatment.

The Midland Regional Hospital in Mullingar is the only major hospital between Dublin and Sligo. It is an important facility and it is ready to be a centre of excellence in maternity care. There is no better place. It could accommodate up to 5,000 children being born. If we are going to talk about centres of excellence, Mullingar should be in the vanguard. We should enhance the facilities there and I appeal to the Minister of State, who is doing his best in his portfolio and who is fighting his corner, to remember that the Midland Regional Hospital is one of the most effective and efficient hospitals in the country. Services must be retained there and we are ready for enhanced additional facilities.

Bernard Durkan (Kildare North, Fine Gael)
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At the outset I pay tribute to the generations of medical, surgical and nursing personnel who have served in the health services over the years. They have given a great service, responding above and beyond the call of duty. I served on the Eastern Health Board many years ago and it was a good way to learn about the health services. I suggest similar experience for anyone who hopes to administer health services in the future.

We had occasion to rub shoulders and, often, to rub noses and cross swords with many of those in the higher echelons of the health service. It was to good effect, however, because it resulted in our reasoning what was best for the patient and best for the country. It did well. We lived through times before the boom when money was scarce but despite criticisms, patients were delivered many services at a difficult time by people who were committed to their jobs. I pay tribute to them.

I am in a minority of one in that I profoundly disagree with the proposal on St. Luke's Hospital. No fiddling about will change my mind. I agree with Deputies Connaughton, Creighton and McHugh, who referred to the reliance of the seriously ill on a service that stood the test of time when it was the only place available. Staff in the institution delivered an exceptional service, above and beyond everything that was known. Now, it appears we must move on.

We hear a lot about moving on in this country for some reason but we do not seem to move very far and we do not always move upwards. This is not a criticism of the Minister of State, who has a clear knowledge of the health service. The institution that now handles the delivery of health services throughout this country has failed miserably. It has failed in its mission statement and has failed to deliver services to the people. The HSE is incapable, it is the wrong format, it does not work and it cannot work. A single organisation cannot deliver health services to the entire country. That is what I thought when it was set up.

I opposed the abolition of the health boards. The reason they were abolished was because politicians on them asked stupid questions about service delivery. It was suggested that politicians on the health boards were holding up progress, suggesting that hospital services be improved in their respective areas. This was politics and that was not allowed. What has happened since then? They were abolished and replaced by a body that costs five times more and is remarkably less efficient. I cannot understand how that can happen. We heard Deputy Penrose referring to this moments ago. If this was comedy people would laugh about it but it is not comedy; it is a farce that so much money, time and effort has been put into providing a service for which there was great demand. Nothing happens in the end except it slows to a crawl and eventually it will dissipate into the wind and people will forget about it. I am totally opposed to what happened.

The lack of accountability and responsibility worries me. I do not know how we got to the situation where an elected Member of Parliament can table a question and is told the Minister has no responsibility. With the largest single budget in this State, there must be responsibility and accountability. I disagree with my good friend and colleague, Deputy Penrose, because I believe the Minister is responsible and must always be responsible. The Minister brings the budget to the House and apportions it to various bodies under his or her aegis. In order to protect the Minister, those in Government, Opposition and the institutions of the State, the Minister should at all times be accountable to the House for every cent. That is not too hard to accept but I cannot understand what is going wrong. The system protects Ministers. When the question arises as to what is happening in an area or why it is happening, the answer should be readily available in order to protect the institution, the Department and the Minister.

A culture has grown up in recent years of thinking that horrible, creepy politicians with long necks and red noses cannot be allowed to ask questions and run institutions because they would not understand it.

Charlie O'Connor (Dublin South West, Fianna Fail)
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Some eight minutes remain.

Bernard Durkan (Kildare North, Fine Gael)
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I could talk for one hour on this topic, as could everyone else, because we do not get many opportunities to discuss it in this House. The concept of centres of excellence has been much vaunted and tossed around this country in recent times. I do not understand what they mean by this. What is meant by it, but not said, is that major investment will take place in eight centres throughout the country in respect of oncology and other treatment areas. This is supposed to be cost-effective. Why would one have investment in ordinary locations where ordinary people live in different parts of the country? It is unthinkable to invest money in places like that. What about the primary needs of the patient? What about the need to deliver services to the patient where the patient lives? Regarding the relocation of the National Children's Hospital to the northside, on which I am sure the Acting Chairman has views-----

Charlie O'Connor (Dublin South West, Fianna Fail)
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I do.

Bernard Durkan (Kildare North, Fine Gael)
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-----the Minister said that when a child is ill, a parent will bring that child anywhere to get treatment. That is not true. The parent will bring that child to the nearest location where the treatment is available. This is because, as Deputy Penrose said, time is of the essence. One does not have time to be fancy footed about the matter at that stage. If the child has an illness that requires instant treatment, the parent will bring that child to the nearest hospital. That is where the parents hope something can be done. If an additional five minute journey is required, the parent might not get through traffic lights, things might not happen in their favour and there may be a road stoppage or a pothole. It is a case of minutes at this stage, as any parent who took a child on an emergency rush to the hospital will testify. I cannot understand why we lost sight of this and the notion of centres of excellence 50 or 100 miles apart is developing.

It is suggested modern transport will handle the difficulties and that we will have a helicopter service. We had these aspirations during the Celtic tiger era when the Celtic tiger was roaming up and down the country, with evidence of its existence at every crossroads. What did we get? Nothing. The health service has disappeared through the floor and hospital beds are being closed all over the country. The current Administration, on whatever basis it is meant to stand, has failed to deliver services to the people of the country.

I did not address co-location and I am surprised it has not been mentioned to any extent so far. I do not understand where it came from and I cannot understand why existing hospitals will be sacrificed, with some sold and some demolished, in order to make way for co-location where public hospitals and private hospitals are side-by-side on the same ground. This is duplication. What will happen when they close half of the beds in both hospitals? That is what will happen if it continues on the way it is now.

I despair at the progress in the health sector over the past number of years. An eminent surgeon made a comment I agree with, saying that all health institutions should be centres of excellence. We are not supposed to have a second and third tier health service. If we have centres of excellence and they work the way they should in theory, there will be investment in high technology and everything required in the centre of excellence. Below that, there will be another tier. There will be less investment and it will not be a clean hospital. The tiles on the floor will not be cleaned or polished. How will its third tier status be determined? In the situation where a patient is on the road in an ambulance, the minutes count. It will not be possible to travel 50 or 60 miles required to get to the centre of excellence. It may not be possible to travel for hours and in this scenario a serious problem emerges. I cannot understand why administrators do not understand this.

No orthopaedic procedures are taking place in Naas General Hospital. It shares its services with Tallaght hospital. The theory in the beginning was that the backup services would rotate between Naas and Tallaght so that patients from the surrounding areas could travel to Naas. An invisible hand seems to make many decisions in this country and it took control of the thinking on this matter so that the hospital services were closed down. There is a clean-air operating theatre and the most up-to-date equipment in the world in Naas General Hospital. It was put there for a purpose but it is unused.

The sad part is that I cannot get a question answered in the House. We can continue asking questions of the Minister to indicate the total cost of private health insurance but we cannot get an answer. What has gone wrong with this country? I cannot understand it. When I came into this House, if a Deputy tabled a question of that nature and was not answered, there was uproar and the House came to a standstill the next day. The Minister would be asked to resign because he or she failed to do a ministerial duty. I cannot understand where we have gone wrong and how ineffective we have become. Members on the Government and Opposition benches have allowed this to happen and we need to be alert to it at all times.

The degree to which we accept second-grade decisions and a fob-off when we ask straightforward questions is our downfall. It has declined to the point where we no longer exist or need to exist. In that case, someone should organise a secondary parliament, the HSE parliament, where people could get elected, ask questions and get answers to questions. They could then deliver services they were supposed to deliver in the first place.