Pat Gallagher (Donegal, Fianna Fail)
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We in Donegal realise all too well the absolute necessity for the appointment of a second breast surgeon to assist and work with the surgeon currently in Letterkenny. The situation in Letterkenny is critical. I am seriously concerned about the level of service available for patients in County Donegal. Due to limited time, I will refer to a letter sent by the breast surgeon in Letterkenny to the Minister for Health on 16 January. The letter warns of the need to address as an absolute priority the current waiting list or patients will have delayed diagnosis of cancer as a result of the length of time, some in excess of a year. We must take that seriously. These are the words of the only breast surgeon in Letterkenny. The Minister received that letter in January 2017 but has done absolutely nothing about it.

What has the Government done since 25 January 2016 when the Minister of State from the county at that time, Deputy McHugh, delivered the decision of the former Minister for Health that there would be a second surgeon? That was a typical pre-election stunt and I make a charge against both Ministers who did that at the time. Advertisements for a locum continue. We want a permanent breast surgeon in Letterkenny. An advertisement for a locum will not attract any interest whatsoever. Anyone who is interested in the post will take it if it is permanent. I am making a charge here in the House that the half-hearted advertising of this position by the national cancer control programme, NCCP, and the HSE is contemptible. The continuous advertising of this post is a smoke screen. There is no interest. I was disappointed to receive a letter today from the Minister from which I will quote. The letter states that "Meanwhile, the requirements of the Letterkenny breast cancer service in the medium term are being assessed." A decision was taken in January 2016 that there would be a second surgeon and almost a year and half later, we are told it is being assessed. Why is it being assessed? The letter states "this is being done in light of the clear evidence that patients who are operated on by surgeons who carry out higher volumes of surgery achieve better outcomes". We are very happy with those who provide services in Letterkenny but they need support and we must ensure that there is no continuation of what we have been living with for the past number of years. If patients are not being diagnosed at an early stage, the delays will result in them having to travel to other areas. It has been suggested they can move elsewhere. We are not going to accept that. County Donegal is on the periphery. There should be a special package for regions. I have great respect for the Minister of State, Deputy Catherine Byrne, but, obviously, the Minister, Deputy Harris, obviously has no respect. Whatever he is doing in this city today must be very important if it is more important than the appointment of a breast surgeon in Letterkenny. We are not going to accept this. The Government and its representatives are good at public relations and putting out statements saying they are planning to do this and that but no funding is provided for it. We could well be in a more serious situation. I know that the Minister of State has come in here to deliver the script on behalf of the Minister but we want to meet the Minister and I ask the Minister of State to do that on our behalf. It is not right and proper that Deputies from Donegal should be ignored by the Minister when it is such an important issue for Donegal. We will ensure that Donegal will have a second breast surgeon. For the Minister to do a U-turn at this stage is despicable and we will not accept it. I am grateful to have the opportunity to speak on this. This is important for Donegal.

Thomas Pringle (Donegal, Independent)
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While I respect the fact that the Minister of State is here to take the Topical Issue, I am disappointed that the Minister could not see fit to come to the House to deal with this matter. The purpose of the Topical Issue debate is for Ministers to make themselves available to deal with the issues because they are important for the constituencies Members represent.

In January 2016, the Minister of State, Deputy McHugh, announced that the second breast surgeon for Letterkenny was approved and that recruitment would start straight away. We now know this was an empty pre-election promise because we have seen nothing happen since then. As has been said, almost a year and a half later we have seen no action. While this goes on, the number of referrals continues to grow. There is an average of 1,950 referrals to the breast clinic in Letterkenny every year that are dealt with a single surgeon who does Trojan work and is so passionate about looking after the patients he sees and making sure the service in Letterkenny is maintained. I know it is hard for people in Dublin to understand but it is a four-and-a-half-hour trip from Inishowen to Galway to attend the clinics there. As these are patients who are ill or are worried that they might be ill and might receive a diagnosis of cancer, it is vitally important that this service in Letterkenny continues to grow. The way to do that is to appoint the second breast surgeon, which would allow the waiting lists to be shortened. I can only think that it is a deliberate policy on the part of the NCCP and the HSE to ensure this appointment does not happen and that the waiting lists continue to grow in order that the demand will be to move the entire service to Galway.

The Minister of State will state in her reply that not enough surgeries take place in Letterkenny to justify two surgeons because that is the response we constantly, get even though the Department has agreed to appoint a second surgeon. I point out to her that were the same figures to be used by the Department and enforced around the rest of the country, approximately one quarter of the breast surgeons nationwide would not be carrying out enough operations. A total of 96 new cancers were identified in Letterkenny in 2015 while the number in 2016 was 89. To my mind, that clearly justifies the need to appoint a second surgeon in Letterkenny. It is not enough to make excuses that there are difficulties around recruitment.

Catherine Byrne (Dublin South Central, Fine Gael)
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I offer the apologies of the Minister who, unfortunately, cannot be present. I do not know specifically where he is but I have been asked to take this matter on his behalf. In 2007, in recognition of the particular and unique geographical circumstances applying to Donegal, the Department set out a clear policy direction approved by Government that the Letterkenny breast cancer service should operate as a satellite centre of University Hospital Galway. Specifically, on a sole exception basis, the Government agreed that Galway should be permitted to enter into outreach service delivery in Letterkenny as an additional activity. This exception was subject to a number of conditions, including case volumes meeting the minimum criteria and all other quality assurance standards being satisfied on the same basis as for care being delivered in Galway.

The Saolta University Healthcare Group remains committed to continuing the Letterkenny service as a fully integrated part of the symptomatic breast disease service in Galway, including through a joint multidisciplinary team approach. The Letterkenny service has been run by a single consultant who also undertakes general surgery at the hospital. Support is provided by Galway-based Saolta consultants who travel to carry out clinics in the Letterkenny service to meet needs arising. The Letterkenny service has been under some pressure to meet key performance indicators of late. While a particular focus has been maintained on urgent referrals, challenges are arising regarding addressing non-urgent breast cancer referrals in a timely way. A locum consultant surgeon will be in place for a period from mid-May and this appointment will help to alleviate the backlog. Meanwhile, the requirements of the Letterkenny breast cancer service in the medium term are being assessed. This is being done in the light of the clear evidence that patients who are operated on by surgeons who carry out higher volumes of surgery achieve better outcomes.

In addition, efforts to recruit GP support and further advanced nurse practitioner support for the Letterkenny service are continuing. The possibility of medium-term requirements being addressed in co-operation with health services in Northern Ireland is also being explored, including the possibility of having a shared locum consultant. This would build on the co-operation already in place in the radiation therapy services at the North West Cancer Centre in Altnagelvin Area Hospital. This centre opened in November last year and is providing access to radiation therapy services for people from both jurisdictions.

A radiologist post for Letterkenny University Hospital has been advertised. A locum radiologist is also being sought to provide cover for the radiology service. Radiographer numbers in Letterkenny have increased and the hospital will continue to develop its radiography service to meet the needs of patients. The Minister recently met patient representatives from Donegal to discuss cancer services in the north west and further such meetings are planned. He remains committed to the continued provision of high-quality, timely services for patients attending breast cancer services in Letterkenny University Hospital.

Pat Gallagher (Donegal, Fianna Fail)
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I thank the Minister of State for responding but not for her response. We are very proud of the service that has been provided at Letterkenny University Hospital and I pay tribute to all of those who are involved. However, they are under serious pressure. Until Deputy Pringle and I received this letter, we were of the view that it was only a matter of time before the appointment of a breast surgeon to Letterkenny University Hospital. Then we are told that there would be a locum from May until we do not know when. Now we are told the situation is being reassessed. This is a U-turn. I make the charge against the then Minister for Health, Deputy Varadkar, and his Minister of State, Deputy McHugh, who announced the post weeks before the election. There was no sincerity there. Both must stand up and tell the people of Donegal why they deceived them. These are the people we represent and we are not going to accept this. We want to ensure the Government fulfils its commitment on this post. We talk about numbers and outputs but it is no different to any other part of the State. We believe Donegal to be a special place - it is a special place and it deserves this recognition. All I ask is for the Government to deliver on its commitment.

Thomas Pringle (Donegal, Independent)
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I thank the Minister of State for delivering the response and hopefully she will take the message back to the Minister that we are not satisfied with the answer that has been provided. The response states:

[T]he requirements of the Letterkenny breast cancer service in the medium term are being assessed. This is being done in the light of the clear evidence that patients who are operated on by surgeons who carry out higher volumes of surgery achieve better outcomes.

Perhaps the Minister of State will indicate where this clear evidence is to be found. As I said earlier, some 25% of surgeons across the service in the so-called centres of excellence actually carry out less than the 50 operations touted as being the desired number to justify having a breast surgeon. The figure of 50 operations is not backed up by any clinical evidence or any research internationally. Clearly, it is an arbitrary figure picked by the HSE to stifle the development of services at facilities such as Letterkenny University Hospital. This is wrong.

The Ministers need to deliver on their promises. I have attended some of the meetings that took place with previous Ministers regarding the cancer services at Letterkenny University Hospital. We hear plenty of kind words and sentiment at those meetings but we see no delivery. To my mind, there must be something going on behind the scenes. Is it that the system is being allowed to run down to such an extent that people will be happy to go to Galway and that the HSE will then have achieved what it wants in closing the service in Letterkenny University Hospital?

Catherine Byrne (Dublin South Central, Fine Gael)
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I wish to make a number of comments. Deputy Gallagher has requested a meeting with the Minister and I will certainly pass on that request. It is my understanding from the reply that every effort is being made to fill the post but, unfortunately, it has not yet been filled. The Deputies have clearly indicated their concerns in respect of the service in Letterkenny University Hospital. As a woman, I want to add my voice to that. I really believe that it is important to give women peace of mind. It is an awful time in a woman's life when she is asked to attend a breast clinic and the only thing that can quench the fear is the fact that she can get a speedy diagnosis, one way or the other. I understand perfectly that when women are in the position of going to breast cancer clinics, they need to be given peace of mind. I will relay the Deputies' points on to the Minister.

I cannot comment on the Deputies' comments about an announcement regarding a consultant post prior to the general election. I have no comment on that but I do not believe that anyone would try to deceive anybody on such a serious issue as the appointment of a senior breast consultant coming up to an election.

I thank both Deputies on behalf of the Minister, who sends his apologies for not being in the Chamber. I will make sure that he has a copy of my notes when I return to my office so he can respond, and especially to the request by Deputy Gallagher for a meeting to take place with Deputies in Donegal.