Fidelma Healy Eames (Fine Gael)

I wish to address the crisis of confidence affecting breast cancer services and the way in which the HSE has handled this. I represent the west. The current realities for women with breast cancer living in the west are as follows: we have the worst health outcomes from breast cancer in the country; we are years behind the rest of the country; and a woman in the west has much less chance of survival from breast cancer than in any other part of the country. This is not right.

Women from all areas of the country are in the Chamber but Senator Feeney and I are the only two living in the west. Should our chances be any less than any of my female colleagues in this Chamber? I think not. This is how unjust and unequal the delivery of cancer care facilities is and has been. Why is this the case? It is due to the lack of access to cancer care services in our region. To date BreastCheck is not operational in the west yet the first unit opened in the east in 1999.

We are way behind national policy in implementation terms. This is clearly political and a result of the lack of political decision-making in favour of the west, so much so that the women of the west are at risk of being 16% behind the national average with regard to survival from breast cancer. This is not right and is a clear indictment of the Government and the Minister for Health and Children, who have neglected women in the west and their families since 2000.

While I welcome the announcement that a much needed dedicated cancer care centre will be established in Galway, I seek specific details on when it will be established, whether funding is available and, if so, if this funding will feature in this year's budget. We have heard promises before.

A high volume cancer centre with a range of expertise — multidisciplinary teams — available to best assess in the patient's favour is the best way forward. A small, private institution with low volume and low throughput, Barrington's Hospital, for instance, could never be reliable in terms of patients' results. It is madness that private hospitals remain unregulated in that they are not accountable to the Health Service Executive or the Department of Health and Children. According to a letter from the HSE national director in the office of the chief executive officer, the reason is that they are not under the aegis of the HSE. This means, once again, that patient health is further put at risk owing to a lack of timely intervention by the HSE, despite formal requests to do so by a surgeon in Limerick, Dr. Gupta. As Senator Fitzgerald pointed out, the Department was aware of complaints for 19 months but it took one woman's persistence and bravery to highlight the problem. It was then that other stories began to emerge. It is little wonder that women are nervous and members of the public have lost faith in the entire system.

Funding for cancer care has been delivered in an unco-ordinated manner. University College Hospital Galway does not have a dedicated space for breast cancer services, which are located in various parts of the building. The problem facing a surgeon is that he or she is not guaranteed access to beds or outpatient facilities. Patients in Galway have reported being frequently more concerned about securing a bed than receiving their cancer diagnosis. In the event of a car accident or other emergency, the beds are required elsewhere.

For these reasons, I strongly support the establishment of a cancer care centre with dedicated space, functioning beds and a range of in-house expertise. Research supporting this approach has been available for a long time. The NationalBreast Cancer Research Institute in Galway has been preaching this message for years.

What is the Minister for Health and Children doing with resources? She is sending a mixed message by trying to offload care into private hospitals and resourcing private health care through tax breaks, the National Treatment Purchase Fund and the co-location policy, which members of the public clearly oppose. Earlier this year, I carried out a study in Galway city which confirmed that 80% of residents do not want a private hospital built on public lands in University College Hospital Galway. On the contrary, they want available resources to be invested in the public hospital.

The Health Service Executive, on the other hand, refers to centres of excellence. To date, the results in this regard have been piecemeal and unco-ordinated, which ties into the current debate on the seriousness of HSE cutbacks. While I agree that efficiencies are needed, Professor Drumm, in his attempt to remain within budget, is in one fell swoop taking a machete rather than a scalpel to the health system. Management in Sligo General Hospital have certainly interpreted it in this way by cutting 40 staff, most of whom work on the front line.

Professor Drumm has been in post for more than two years. After many studies and audits, he should know clearly where the problems are in the health service. The financial management he oversees across the health system must be questioned three quarters of the way through the financial year. What happened to quarterly and half-yearly reviews? I can only guess it was too politically sensitive to give us the bad news when a general election was in the offing. This type of management is not acceptable. The buck stops with Professor Drumm and the Minister, both of whom must come clean on their intentions. Does the Minister have faith in the public health system or has she given up on it? Will she implement a policy which proves she is committed to the system? Can Professor Drumm communicate his intentions across the system to his line managers or is the system too unwieldy? Can he communicate in a way that ensures we have safety in the health system and patients are not put at risk?

In the past week, I have spoken to many health care workers who doubt the budgetary overrun will be corrected by 1 October. Some speculate the current measures will last until 1 January. It is time to be clear. People need to know not only that critical services will not be hit but that services such as speech therapy in the community, occupational therapy and public health will remain unaffected by these measures. I want to know in what direction the health system is moving.