Síle de Valera (Clare, Fianna Fail)

The Minister apologises for being unable to be here this evening and he has asked me to reply to the debate on his behalf.

As the House is aware, the report on the development of radiation oncology services was published in October 2003. The recommendations of the report, which have been accepted and endorsed by the Government, provide the only sustainable plan for the future development of radiation oncology services nationally. The development of these services on the lines recommended in this report is the single most important priority in cancer services in the acute setting. In developing its recommendations, the expert group undertook an extensive review of the organisation of radiation oncology services in countries such as Sweden, Norway, the Netherlands, Britain, Canada and Australia. The predominant view of the group, based on international guidelines of best practice, was that radiation oncology services would be best developed in the context of a clinical network model of large centres where new treatment centres have appropriate staff and equipment resources based around a minimum four to six linear accelerator treatment capacity.

The development of a modern radiation therapy centre is an extremely complex process which requires the installation and integration of high technology treatment equipment and the parallel appointment of an extensive range of health care professionals, particularly in the fields of radiation oncology, radiation therapy-therapeutic radiography, medical physics, engineering and information technology and oncology nursing. The group developed a series of guidelines to facilitate the future identification of suitable locations for the development of additional radiation therapy facilities. These include a sufficient patient population existing within a proposed catchment area to support the existing and future development of a radiation oncology service.

The resident population of a catchment area and, as a consequence, the extrapolated patient caseload is an important indicator of future patient referral, access and use of a radiation oncology centre. The group agreed in principle with the existing international recommendations that a population of greater than 650,000 should be, where possible, the minimum preferred population necessary to support a radiation oncology unit. Based on the 2002 census, the current population of the South Eastern Health Board area is 414,000. The minimum preferred population of itself is not sufficient without adherence to additional guidelines highlighted in the report, which include appropriate staffing and location at or linkage to a university teaching hospital.

Having considered the report, the Government agrees that a major programme is required to rapidly develop clinical radiation oncology treatment services to modern standards. Furthermore, the Government has agreed that the first phase of such a new programme should be the development of a clinical network of large centres located in Dublin, Cork and Galway, providing services for adjoining regions. These centres will collectively have the staff and treatment infrastructure to permit a rapid increase in patient access to appropriate radiation therapy and will form the backbone of the future service expansion. This Government agrees with the report's conclusion that this is the best model to rapidly provide a radiation oncology service. In addition, the Government has also decided that in the further development of services, consideration should be given to developing satellite centres in the south east, mid-west and north west. Such consideration will take into account the international evaluation of satellite centres, the efficacy of providing this model and the need to ensure quality standards of care.

I wish to take this opportunity on behalf of the Minister to outline the significant progress which has been achieved to date in the implementation of this report since its launch last October. The report recommends that there should be two treatment centres located in the eastern region, one serving the southern part of the region and adjacent catchment areas and one serving the northern part of the region and adjacent catchment areas. The Chief Medical Officer at the Department of Health and Children has been asked to advise the Minister on the optimum location of radiation treatment facilities in Dublin. A detailed request for proposals issued last week to relevant hospitals. Hospitals have until 8 October 2004 to submit proposals for the organisation and development of radiation oncology services in the context of the delivery of supra-regional services.

The immediate developments in the southern and western regions will result in the provision of an additional five linear accelerators. This represents an increase of approximately 50% in linear accelerator capacity. We have also provided for the appointment of an additional five consultant radiation oncologists. This includes three additional consultant radiation oncologists at the emerging centre in UCHG, two of whom have significant sessional commitments to the Mid-Western and North-Western Health Boards. Two additional consultant radiation oncologists will be appointed at CUH, with significant sessional commitments to the South-Eastern and Mid-Western Health Boards. Recruitment for these posts is underway. We currently have ten consultant radiation oncologists nationally. This will result in a significant increase in the number of patients receiving radiation oncology in the short term.

On the development of an equitable service that provides equal access for all, I wish to take this opportunity to assure the House that the principles of equity and access will underpin the development of future services. Radiation oncology centres will be required to provide services on an equitable basis which will ensure that patients of equal need will have equal access, regardless of where they live. This task is not without challenges. It will require the development of innovative transport and accommodation arrangements for patients in outlying regions.

The national radiation oncology co-ordinating group was established by the Minister on foot of the expert group report. The group comprises clinical, technical, managerial, academic and nursing expertise from different geographic regions. The group's remit encompasses the development of proposals to facilitate improved access to existing and planned services, including transport and accommodation. The group is currently developing proposals in this area which will involve consultation with all health boards.

Recently, the Minister approved €1 million in funding to develop a national tele-synergy network for oncology services involving the current and planned providers of radiotherapy at St. Luke's Hospital, Cork University Hospital and University College Hospital, Galway. These hospitals will operate as major tele-oncology nodes within a clinical network of hospitals linked to other hospitals outside their health board or authority functional areas, referring patients to the radiation oncology centres for clinical treatment or related services.

The aim of the network is to improve service delivery and efficiency, to better use consultants' time, reduce consultant and patient travel and support earlier and better diagnosis. This will have important benefits for radiation oncology services in the south east. Tele-medicine is a key enabling technology to improve the networking of radiation oncology centres with outreach hospitals, thus supporting expert case review, multidisciplinary meetings, education and research.

The developments under the expert group report describe an overall framework through which radiotherapy services can be developed and provided in the most co-ordinated and effective manner. The expert report on the development of radiation oncology services marks a significant milestone in radiation oncology services nationally and its guidelines and recommendations are essential in the development of these services for cancer patients over the next number of years.