Pearse Doherty (Donegal, Sinn Fein)
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Before we start, can the Acting Chairman inform the House as to why the Minister for Health is not present? This is a serious issue for cancer patients in Donegal who have been denied treatments in their local hospital. The Minister was present a couple of minutes ago.

Pat Gallagher (Donegal, Fianna Fail)
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He just left.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I cannot. I am here to Chair the meeting, but I take the Deputy's point on board and will pass it on to the Ceann Comhairle and the Minister. Perhaps the Minister of State, Deputy Catherine Byrne, will tell us whether the Minister has another engagement.

Pearse Doherty (Donegal, Sinn Fein)
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I have been placing this motion for a Topical Issue debate for two weeks. It is an insult from the Government that the Minister has not turned up in person to hear the concerns that I am relaying on behalf of people in Donegal.

In recent weeks, I have been contacted by countless constituents across Donegal, each of whom has raised serious concerns about the health and well-being of their loved ones who are undergoing chemotherapy following cancer diagnoses. While each gave accounts of a relative, friend or loved one who was facing into his or her unique cancer journey, their stories shared a deeply alarming common trend - they were all being denied treatment at their local acute public hospital in Letterkenny and were instead being forced to travel four, five or, in some instances, six hours to Galway to undergo chemotherapy.

With each new call, text, e-mail or Facebook message that I received, the crux of the story remained the same. It was the story of a seriously ill cancer patient being turned away from the local oncology department and redirected some 250 km distant, forced to endure all of the difficulties - health, financial and so on - that such a journey entails.

Having heard these reports, I immediately contacted the hospital. Last week, management confirmed our worst fears, namely, that Letterkenny University Hospital was no longer in a position to accept new patient referrals for chemotherapy. In its reply, management informed me that the decision to suspend this service for newly referred patients was taken due to the resignation of a locumoncologist consultant who had been providing cover for the vacant medical oncologist post at Letterkenny. Consequently, management has stated that, in the interests of patient safety, it was not clinically appropriate to start new patients on chemotherapy regimes when the hospital could only cover three of the six weeks until the new consultant was in place. Management informs me that, after my intervention, the new consultant will be in place on 6 March.

How was this allowed to happen? Why are some of the most seriously ill people in my county being forced to endure such suffering as to have to leave their homes, communities, families and all that they know and travel hundreds of kilometres to Galway? Will the Minister of State explain to the people of Donegal, the patients, the families that are affected and the professional staff in our hospital why it seems that action has not been taken to prevent the withdrawal of these services? Why is the consultant in Galway not travelling up to Letterkenny instead of asking these sick and vulnerable patients to travel to Galway for treatment that should be available, and had been available, in their local hospital?

Pat Gallagher (Donegal, Fianna Fail)
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I concur with the protest made by Deputy Pearse Doherty. The Minister was in the House and, with all due respect to the Minister of State, is more familiar with this matter. He was at Letterkenny University Hospital twice, once privately and another time in an official capacity when he dealt with the Donegal medical academy in conjunction with NUI Galway.

I praise the excellent front-line medical and auxiliary staff of Letterkenny hospital, who perform their duties to the highest standards under the most considerable pressure on a daily basis. They are to be highly commended.

The hospital is the only general hospital in the county and caters for a population of more than 157,000 people. There are significant pressure points and strains on services within the hospital and the situation is worsening. Full capacity protocols have been exceeded 104 times in 2016 and twice already this year, and we are only at the start of the year's second month.

The failure to have a second oncologist appointed comes despite a commitment given by the then Minister of State, Deputy McHugh, on 25 January last year before the election that there would be a second oncologist. We are still waiting on that appointment. In addition, I understand that the appointment of a second breast surgeon could have been made some time ago. Other issues include the lack of bed capacity, hospital department problems, constituents waiting on trolleys, delays in the accident and emergency department having knock-on effects for procedures and a lack of full diabetic services for adults and children. Dermatological services were transferred to Sligo on a three-month basis. Eighteen months on and they are still there. The rheumatology department and urology services are not operational.

I hope the Minister of State does not tell us that our €14.6 million last year will deal with all of the issues. I have a specific proposal, which I will make when I ask my supplementary question.

Catherine Byrne (Dublin South Central, Fine Gael)
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I apologise to Deputies for the Minister not being present, but he has another engagement. I was asked to take this slot. The Deputies could have withdrawn this matter before standing if they did not want me to reply. I am here so I will reply if that is okay with the Deputies.

Pat Gallagher (Donegal, Fianna Fail)
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That is unnecessary to say.

Catherine Byrne (Dublin South Central, Fine Gael)
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I must be honest, in that what I am going to say will probably not satisfy them, but I will convey their concerns when they finish their contributions.

I welcome the opportunity to speak about the services at Letterkenny University Hospital. The hospital provides medical oncology services to patients and has two consultant medical oncologist posts.

One of these posts is currently vacant and, as has been said, it had been filled by a locum pending the appointment of a permanent medical oncologist but, unfortunately, as the Deputies also indicated, this locum recently resigned. A new locum consultant medical oncologist is due to take up post on 6 March and, in the interim, some alternative locum arrangements have been put in place. All existing patients continue to receive their chemotherapy services in Letterkenny University Hospital. All patients newly referred to the oncology clinic at Letterkenny University Hospital from 1 December 2016 are triaged by the lead medical oncologist before being seen at the most appropriate location for treatment, principally in Galway University Hospital. It is expected that the full service at Letterkenny University Hospital will resume when the new locum consultant starts on 6 March.

The Minister acknowledges the concerns of patients and the inconvenience associated with having to travel for chemotherapy treatment. However, patients continue to receive quality treatment and the HSE has assured him that every effort is being made to resume normal service at Letterkenny University Hospital at the earliest possible date. In relation to services more generally at Letterkenny University Hospital, my colleague, the Minister for Health, is aware of the need to provide services that are accessible to patients in Donegal and to minimise patient travel time where possible. There has been significant capital investment in Letterkenny Hospital in recent years. I can advise the House that most of the works required to repair the flood damage sustained by the hospital in August 2013 are now complete. In addition, a significant number of other capital projects are operational. They include the medical academy, blood science laboratory, replacement of sterilisation equipment, expansion of the recovery unit, provision of additional space for expansion of the dialysis unit and renovations to provide accommodation for a pharmacy, respiratory laboratory, cardiac investigations facility, medical records and mental health. The Minister opened the new state-of-the-art blood science laboratory, the new medical academy and the clinical skills laboratory when he visited the hospital just before Christmas.

Letterkenny also benefits from the development of a number of cross-Border initiatives in conjunction with Altnagelvin Hospital in Derry, whereby patients can access necessary services in Derry. The cross-Border cardiology service provides emergency primary PCI services for the treatment of patients from County Donegal with a diagnosed heart attack at Altnagelvin Hospital in Derry. From May to 20 December 2016, some 23 patients from County Donegal received treatment under the scheme. In addition, the north west cancer centre at Altnagelvin Hospital opened in November last year and will provide access to radiotherapy services to people in the north west, including patients from the Republic. As of 6 January 2017, six patients from the Republic have commenced their care pathways for this facility.

Pearse Doherty (Donegal, Sinn Fein)
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There is no need for the Minister of State to apologise to me. I am not a person requiring chemotherapy who has to travel for 45 minutes to Letterkenny General Hospital only to find that it is closed for my treatment and I have another four hours journey ahead. The people who deserve the apology are the cancer patients of Donegal who have been denied a chemotherapy service in recent weeks.

The response I got is pathetic. I knew everything that was in the response. In fact, I know more than was said. Serious questions must be asked. I understand there is a gap that needs to be filled when people resign, but the HSE has told me it can fill three out of the six weeks between now and 6 March until the new locum is appointed. In that case, why have patients been denied chemotherapy services in Letterkenny General Hospital since Christmas?

I hope the Minister of State will never have to find out what it is like for those patients and their families who have recounted to me the experience of what the journey was like for them. Their appointments were scheduled for 8 o'clock in the morning-----

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Deputy Doherty must conclude.

Pearse Doherty (Donegal, Sinn Fein)
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I will finish on this.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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No, I am sorry but the Deputy has exceeded his time. He must abide by the Chair.

Pearse Doherty (Donegal, Sinn Fein)
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I will finish on this sentence. Their appointments are at 8 o'clock in the morning and they must do a five-hour journey. The response from the Government is pathetic. I expect the Minister to take a hands-on approach to ensure cancer patients are no longer treated in this way in the future.

Pat Gallagher (Donegal, Fianna Fail)
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I am also disappointed. There was no reference in the reply to the questions about the breast surgeon, lack of diabetes services, dermatology services, rheumatology services and urology services. I have one message for the Minister of State to take to the Minister. I request that he appoint a review team to immediately go to Letterkenny and conduct a root and branch review of the hospital services, budgets and where the services are lacking. The team must work in conjunction with the front-line services and with management but report directly to the Minister. When the recommendations are made to the Minister, he should then implement them and provide the necessary funds. Although it has not been mentioned in this reply, to say €14 billion has been allocated to the health budget this year is of no interest. We are interested in ensuring that the people we represent in our county receive the best services. Rather than say what we got in the past we want to look forward. A team should examine the matter objectively, report to the Minister and the Government should respond. That should be done in a matter of weeks.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I know it is frustrating for Members when I call on them to conclude when they raise very important issues but I am trying to keep within the time limits. I apologise to Members in that regard as I know they are trying to represent their constituents on a very serious issue. Does the Minister of State wish to respond?

Catherine Byrne (Dublin South Central, Fine Gael)
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I do not mind. I note what the two Deputies have said. With the greatest of respect to them, their knowledge of the area they speak about is far greater than mine. Although it might be against my will, I agree with them that I would not like anybody to have to travel more than 200 miles for a service.

While a relevant point has been raised, the Minister also raised a relevant point in the reply in saying somebody will be appointed on 6 March. I know that is probably not of any satisfaction to those who have to travel but I assure them that I will bring many of the points, in particular some of those raised by Deputy Pat The Cope Gallagher about the review team, to the attention of the Minister, Deputy Harris.

I am sorry if Deputy Pearse Doherty already knew the information outlined in the reply. I will bring back the concerns of both Deputies to the Minister. I apologise, through the Chair, for the fact the Minister, Deputy Harris, was unable to be present.

Pat Gallagher (Donegal, Fianna Fail)
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As there is a minute remaining, I urge the Minister of State to recommend the appointment of a review team to the Minister.

Catherine Byrne (Dublin South Central, Fine Gael)
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I have made a note of it. I will pass on the suggestion to the Minister.