Déirdre de Búrca (Green Party)

I welcome the Minister to the House and thank her for attending this important debate. The motion addresses the important issues of the delivery of cancer services throughout the country and the recently announced freeze on recruitment in the health service. The recruitment freeze raises a central question. What should be the optimal size of the health service and, in particular, what should be the appropriate ratio between direct care staff and administrative-managerial staff? There was a legitimate expectation that the abolition of the health boards, a decision with which many Senators may not have agreed, would result in the establishment of new structures with much leaner administrative and managerial sides and much greater emphasis on direct care staff. Unfortunately, this does not appear to have happened. It is clear that in some areas of the health service, staff levels are excessive while in others, staff numbers appear to be inadequate.

The announcement of a freeze on recruitment has caused many medical professionals to express strong concerns that it will impact negatively on patient care. The Minister has stated publicly that this need not be the case. Will she expand on her statement and indicate whether various hospitals will get guidelines or assistance from the HSE regarding how it might trim its budgets without negative impacts on patient care?

The way in which the announcement was made was abrupt and done without sufficient consultation with the relevant stakeholders. The health unions have complained to the Health Implementation Board about how they believe some of the agreements reached under the social partnership process have been breached. Be that as it may, industrial relations problems may emerge and compound existing difficulties in the health service.

The decision in question was made approximately three quarters of the way into the accounting year, which is far from ideal in terms of general practice. I hope other decisions will be made with a degree more consultation with the relevant stakeholders. While the Green Party is in Government, I hope we will be able to use our influence to try to ensure that occurs.

Cancer is a chronic disease. While there have been welcome increases in recovery rates, a high level of mortality is associated with it. This necessitates the centralised specialised services we have been discussing. They are extremely expensive and add significantly to the financial burden on our health services. The Green Party would argue that they are end-of-pipe services and that more emphasis should be placed on prevention. The role of environmental conditions should be examined closely.

The cumulative impact of lifestyles, eating habits and pollution from transport and industrial discharges go some way towards explaining why clusters of specific cancertypes are noted in particular parts of the country but not elsewhere. The cancer register highlights where cancers occur, but it does not provide a reasonable or acceptable explanation as to why.

More must be spent on cancer research. Ireland spends approximately €4 per person on cancer research while the United Kingdom spends approximately €15. To a greater extent, we could examine the possibility of carrying out more cancer research and addressing the environmental component of the disease.

The main issue being discussed is the availability of cancer services. It is an important matter because much depends on location, such as early identification and appropriate treatment. That situation is not acceptable. In broad terms, the Green Party supports the announcement of the eight specialised cancer units. Such treatment is essential in cancer care, but it leads to a difficulty in that the more centralised the service, the further people must travel. While my constituency of Wicklow is in the greater Dublin area, it is primarily a rural county. Difficulties are posed to constituents who must travel from the south of the county to Loughlinstown Hospital or Naas Hospital for medical treatment. If centralised centres are to be put in place, family-oriented accommodation centres for the relatives of people with long-term illnesses must be provided to make their stays comfortable. This would address some problems.

On the question of centralising health services, we should also be going in another direction. While we need to centralise specialised services, we should localise our health services to a greater extent and provide more local primary health care services that emphasise accessibility, have a multidisciplinary approach and can deal with the minor and ordinary conditions with which people present. Due to high mortality levels, we should provide a network of hospices and home care services to support the new structures to be put in place. We have concerns about the age-specific focus of BreastCheck and believe it should be changed. The dates provided to Cork and Galway for the roll-out of BreastCheck services have passed, so the roll-out should be expedited.

Regarding pathology labs, we have discussed the delays and problems surrounding the results of cervical tests. The issue was raised with me by a number of constituents, but there is no legal requirement for hospital or pathology labs to be accredited to international or European Union standards. This leads to concerns about errors and delays in the tests. On 5 June, the National Hospitals Office announced that cervical smear tests would only take one month to be analysed from the end of June onwards. Unfortunately, this has not come about, as the return of cervical smear test results takes between two and six months.

On behalf of the Green Party, I support broadly the introduction of centralised cancer services. I was delighted to hear John McCormack supporting it on radio this morning, but if we continue to centralise all health care facilities, support services are needed and we must examine the localisation of primary health care in rural constituencies where people must travel long distances.