Tony Killeen (Clare, Fianna Fail)

I thank Senator Kenneally for raising this matter on the Adjournment and for giving me this opportunity to set out the current position on the provision of radiation oncology services nationally. I wish to reiterate the position as set out by the Tánaiste, that the Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland. To this end, the Government will provide considerable investment in radiation oncology facilities in the coming years. The central aim is to ensure access by cancer patients throughout the country to high quality radiation oncology in line with best international standards.

The submission referred to by the Senator was made by the Irish Society of Medical Oncologists to the National Cancer Forum in the context of the development of a new national cancer strategy and was discussed by the forum at its meeting in May 2003. The National Cancer Forum is the national advisory body on cancer services and is a multi-disciplinary group of experts, including representatives of all modalities of cancer care.

The context of these discussions was the current fragmented delivery of cancer services nationally. In developing the new national cancer strategy, the forum's considerations have been informed by the broad strategic context in which the cancer strategy exists, a comprehensive review of the current status of cancer care, a review of the literature evidence concerning key aspects of the organisation of cancer services and a review of international models of care. The forum has concluded that the current arrangements for the delivery of cancer services are not generally in accordance with best practice and cannot be recommended to deliver best quality cancer care.

As regards radiation oncology, the Government's policy is informed by the report entitled "The Development of Radiation Oncology Services in Ireland". The expert group that developed the report comprised a range of experts involved in the provision of radiation oncology in Ireland, North and South. Some of the leading experts in their respective fields were represented on the group, including radiation oncologists as well as physicists and radiation therapy expertise. Two patient advocate representatives were also members, one from the Irish Cancer Society and the other from Aid Cancer Treatment. The report has been the subject of significant national and international endorsement from organisations such as the Irish Cancer Society, the American Cancer Society and the National Cancer Institute in the United States.

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, the United Kingdom, Canada and Australia. The predominant view of the group, based on international guidelines of best practice is that radiation oncology services would be best developed in the context of a clinical network model of four large centres in Dublin, Cork and Galway, where new treatment centres have appropriate staff and equipment resources based around a minimum 4-6 linear accelerator treatment capacity. This report was discussed and unanimously endorsed by the National Cancer Forum at its last meeting on 17 September 2004, as the framework for the future development of radiation oncology services in this country.

Significant progress is being made in implementing the recommendations of the radiation oncology report. Approval has issued for the appointment of an additional five consultant radiation oncologists and recruitment is under way. These developments will significantly improve access to radiotherapy for patients in the south east and elsewhere.

As recommended in the report, the national radiation oncology co-ordinating group has been established. The group comprises clinical, technical, managerial, academic and nursing expertise from different geographic regions. The group's remit encompasses recommending measures to facilitate improved access to existing and planned services, including transport and accommodation. The group will also advise on quality assurance protocols and guidelines for the referral of public patients to private facilities.

Funding of up to €l million is being made available to develop a national telesynergy network for oncology 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.

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. Geography will not be a barrier to equal access. Radiation oncology centres at major teaching hospitals will be required to provide outreach services to hospitals in adjoining regions. This is currently the case and as more consultant radiation oncologists are appointed it will be necessary to ensure that there is an equitable spread of outreach services.

The model proposed by the report on the development of radiation oncology services in Ireland will provide a framework that meets the following national and international standards: it will adhere most closely to World Health Organisation, US national institutes of health and gold standard of cancer treatment being delivered within the context of a comprehensive cancer centre model; it will enable the development of specialist clinical teams with both tumour-specific and technology-specific expertise; it mandates the development of more extensive and integrated multi-disciplinary care; it meets the stated and expected medical and paramedical training programmes and their associated national and international accreditation mechanisms; it facilitates the most rapid implementation of new radiation technologies, particularly those with significant complexity and expense; and, fundamentally, it will address the issue of access where a profound shortage of national treatment capacity no longer becomes the dominant limiting factor.

I wish to reiterate the Government's commitment to providing the full range of cancer services for people throughout Ireland. In its decision last year on radiotherapy services, the Government remained open to the provision of a satellite radiation oncology unit in Waterford and elsewhere. The question of networked satellite locations will be kept under active review. New ideas and suggestions are continually being made and they are given fair consideration within the need to avoid a haphazard overall outcome.

We are determined to deliver enhanced services for the whole population as soon as possible. We will keep an open mind on how this objective can be achieved, bearing in mind the recommendations of the expert group, and our objectives of achieving best clinical outcomes for patients and making services both accessible and available to all cancer patients.