Brian Lenihan Jnr (Dublin West, Fianna Fail)

It is also important to note the matter of expenditure. Senator O'Meara raised the hard cases that exist in the health service and the great difficulties we have in this area. If we are to develop cancer services we need to invest money but we also need to be efficient in how we spend it. That is the way forward in the health services. It is not enough simply to propose new expenditures; we must engage in a critical examination of our existing expenditures.

I am glad to note from the report on surgical procedures that the cancer forum has examined oncology surgery between 1997 and 2002 in respect of a number of site specific causes, including lung, breast, pancreas and colon cancer. The forum concluded that there are too many hospitals, given the total number of procedures that are performed in our hospitals. We do not have the patient caseload to support the current organisation of oncological services. The forum has advised that the current organisation of services is not in line with international best practice. I outlined that to the House in my opening contribution and I am now giving Senators the details in greater specificity.

This report needs to be addressed at a number of levels in our health services. The medical profession must assess the report to ensure that, in a balanced way, we reform our arrangements for organising and delivering our health services. At the level of the individual health board, we will have to examine this report to benchmark each local hospital organisation against international best practice. The forum will reflect further on the data established in this report in developing the national cancer strategy.

There has been a great deal of examination in this area and much work has been done on prevention. We intend to continue the work on prevention in relation to smoking and there are other key causal factors. Senator Henry rightly raised the question of obesity as a further factor which is tending towards cancer conditions. In relation to hospital provision, there is scope for efficiencies and much scope for improvement.