Déirdre de Búrca (Green Party)

I welcome the Minister for Health and Children to the House. I acknowledge this is the second time she has been to the House in the past few weeks to debate the important issue of the reform of our health services.

The Minister began her speech by referring to the recent appalling misdiagnosis of a group of women with breast cancer. This has highlighted the shortcomings in our cancer care services. Ireland needs to follow international best practice in establishing managed cancer control networks consisting of primary, hospital, palliative and supportive care. I am delighted the Minister acknowledged that not all elements of such a network need to be at a remote distance from the patient and some can be provided closer to where the patient lives.

The 2006 national cancer strategy aims to equip each of the HSE's four regions with a broad self-sufficiency of services to treat the most common forms of cancer. It aims to establish eight special cancer centres in each of the four HSE regions to provide integrated treatment service for all forms of cancer including diagnostic, surgical, medical and radiation oncology services, centred around a multidisciplinary approach. The challenge lies in the transfer from a model of a much more locally dispersed cancer care service to a more centralised, specialised model of care.

I do not envy the Minister this challenge but one area where Members can assist her is in political leadership. Having been a local politician for eight years, I recognise there can be much concern and reaction in local communities when a local hospital is threatened with losing its cancer care services. It can be difficult for a local politician to stand up and say it may be necessary. It is the role of local and national politicians to educate, inform and persuade their constituents that this is necessary because the outcomes are 20% better from centralised cancer care services. That is a simple message that we all have a responsibility to deliver. It is not always easy but we must do it, even in the face of well-motivated campaigns against the closure of local services.

That, however, does not let the Government off the hook. We need to ensure that the transition from the local to the centralised service is managed properly. The provision of alternatives must be managed so that local services are not closed down in the absence of properly resourced centralised facilities. To date 13 hospitals which deal with approximately 20 patients every year have been told that their cancer services must close. That will be good in the long run but the large hospitals will pose a greater problem. Under the new criterion hospitals that continue to deliver cancer care services must treat 150 newly diagnosed patients per year. It is a greater challenge to close hospitals of this size than small ones.

Unless the new facilities are provided at the same time as old hospitals are to be closed it will be impossible to persuade constituents that this is in their interests and in the interests of better health outcomes, even if local politicians fully support the strategy. Services that are already overstretched will be under even further pressure and will not have the facilities or staff to deal with the added patient load and this will not result in better health outcomes. This will be a big challenge. The transition will incur significant extra short-term costs but this will involve only the concentration of the capacity in, not an addition to, centralised facilities. We must recognise, however, that the transition will be expensive.

Travel is a concern for people who must access services at a distance. Many of those with cancer are aged 65 years or more and travelling to access the services is a problem for them and for their visiting relatives. That raises the issue of providing family friendly accommodation where people receive treatment over time although the Minister said that hopefully this time will reduce. It may be possible to provide services such as chemotherapy in local hospitals. The Minister must consider which parts of the cancer care services should be centralised and which can be provided locally.

The programme for Government contains a commitment to provide for personal health checks to include the referral of men for early screening for prostate and other cancers. It will be important to increase the capacity of urological services to tackle prostate cancer. I agree with the Minister on the importance of expediting the roll out of BreastCheck which results in the early diagnosis and treatment of women. Ireland has the third highest rates of deaths from breast cancer in the OECD. Approximately 2,000 women a year are diagnosed with breast cancer. This roll-out is particularly necessary in the west and south where there is no proper cover. The programme also includes a commitment to introduce a universal entitlement to a cervical cancer vaccine when this becomes available. This holds out the possibility of putting an end to cervical cancer within a couple of generations.

I welcome the appointment of Tom Keane to implement the national cancer care strategy. That will be a significant challenge. We must support him as well as we can. He comes from British Columbia which, although it is the size of France and Germany combined, has only four specialist cancer care centres. I wish him every success in his new role and hope that we will be able to support him in what he is trying to achieve.