Geraldine Feeney (Fianna Fail)

I will not.

We must move away from the days of having or wanting a centre of excellence in every town, village or county. We must not continue to espouse this policy. Professor Drumm talked about clinicians having to accept that they must operate evidence-based systems focused totally on quality outcomes for patients. This, in addition to quality assurance, is what it is all about.

Some 60% of breast cancer cases are treated by doctors who treat fewer than ten cases per year and this cannot be allowed to continue. I say this on foot of having spoken to the clinicians, surgeons and oncologists in the Memorial Sloan-Kettering Cancer Centre. They believe it is not right and that our continuing to operate in such a vacuum will result in an increased number of deaths. We will not have good outcomes if we continue as we are doing.

I was interested to read that Professor Paul Redmond has asked for strong political, medical and executive leadership in addition to significant investment. The Government is committed in this regard and will make the necessary funds available. However, Members on all sides should show political leadership and move forward as required. There is an onus on all parties to ensure we provide what is best for people suffering from cancer.

Of course there will be uncertainty regarding the capacity of smaller hospitals to adapt and implement further changes in the delivery of cancer care, especially where complex cancers are concerned. The smaller hospitals do not have the expertise to deal with complex cancers and one cannot compare a surgeon, male or female, who deals with ten cases per year with one who deals with 30 or 40 cases per month. There is clear evidence that those who receive surgical treatment for many common cancers in centres with a high throughput experience better outcomes and have a greater chance of surviving their cancer.

Last week or the week before, I read that 70% of surgical interventions from prostate cancer may be unnecessary. It is in this regard that a centre of excellence would come into its own. It would show us what kinds of treatment and care are best in respect of individual cancers.

The strategy is all about patients, patient care and patients winning and the implementation of its proposals cannot be achieved outside a centre of excellence. It was stated that 20,000 people develop cancer in Ireland each year and that 7,500 die of it each year. If we had better cancer care, this number would decrease.

As I stated, I had an opportunity to visit the Memorial Sloan-Kettering Cancer Centre when I was in New York. Even its presentation pack was impressive. Five of us visited the hospital and my four colleagues were just as impressed as I was. We were met by clinicians who were the most experienced in their field. The centre's presentation pack is entitled A History of Commitment and it certainly portrays commitment. The clinicians are extremely committed to their particular areas of interest. The centre trains many young Irish trainee doctors and we would have its expertise if we were to adopt its approach.

We visited a pediatric unit and a general adult unit in the centre and also looked at its scanning equipment. The paediatric unit was by far the saddest unit. It was so sad to see such young children, from neonates to young teenagers, in need of treatment. Everybody seemed happy and I did not see any sad faces. If there were sad faces, they were those of the Irish visitors who were so taken by what they were seeing and being told. The paediatric unit in particular interested me because we had been told its method of treating of paediatric cancers was the blueprint and way to go. We have some of the best outcomes in the treatment of paediatric cancers in the whole of Europe.

I support the current campaign for a radiotherapy unit for the north west, to be based in Sligo. The Tánaiste and Minister for Health and Children, Deputy Harney, told us when we met her that one linear accelerator unit would not suffice for Sligo and that two would be required. There is a school of thought in Sligo that suggests one is sufficient but when I was in the Memorial Sloan-Kettering Cancer Centre, I took the opportunity to ask the experts and discovered that the Minister was correct. They confirmed her advice that two linear accelerator units would be required in a radiotherapy unit based anywhere outside a main centre of excellence.

It is important that there be centres of excellence with expertise. Practitioners with expertise will have time to keep an eye on the radical developments in cancer treatment and research.