Maria Corrigan (Fianna Fail)

I welcome the Minister to the House and thank her for making herself available. As other speakers have said she has been very generous with her time, rightly so, given the issues at hand, and we appreciate her presence.

This debate takes place in the context of recent events regarding the diagnosis of breast cancer. There are many other cancers and they all take a considerable toll on the country and population. Over 100,000 patients are treated for cancer every year in Ireland and 22,000 new cases diagnosed, yet Ireland does not compare favourably on outcome or mortality rates. Over 7,500 people will die of cancer this year. Approximately 1,500 will die of lung cancer, 650 will die of breast cancer, almost 900 will die of colorectal cancer and 65 will die of cervical cancer. I strongly believe that the national cancer strategy reflects the commitment to create a national framework that will ensure better diagnoses and better outcomes for patients. It is essential that we have a higher quality of care and, as the first step in the implementation of the national strategy, I welcome Professor Tom Keane's appointment, though I echo Senator Feeney's point that no individual can be a panacea for cancer services. It is encouraging that he has experience in implementing a regional strategy in a similar geographic and demographic area and I extend him every good wish in the job ahead.

The centralisation of care and the establishment of centralised specialist centres are core tenets in the national strategy and must find unequivocal support in the House as there is no room for parochial politics in this matter if we truly seek improved outcomes and improved quality of care. Research clearly shows that outcome is proportional to the size of the case load facing health professionals. Recent research from Tyneside in the United Kingdom, published in July, studied colorectal surgery and demonstrated that lower mortality rates apply in high-volume centres than in low-volume centres. It also showed that patients who went through high-volume centres received more appropriate surgery. In other words, the decision making was more accurate. For these reasons alone, it is fundamentally important that we in political life strongly support specialised and centralised centres of care.

The research also indicates that as long as decisions are made by specialised multidisciplinary teams in centralised specialist centres, aspects of adjuvant and neoadjuvant treatment, such as radiotherapy and chemotherapy, can be carried out at satellite or remote centres provided that practitioners reach critical mass in terms of their case loads. This research offers hope for certain centres throughout the State that have demonstrated their ability to meet quality standards.

Professor Keane faces significant challenges in implementing the national cancer care strategy. One of the most pressing of these challenges relates to accident and emergency services. What will happen in future to patients who present at local accident and emergency departments? For example, 20% of colon cancer patients who undergo surgery, or some 300 per year, initially present at accident and emergency departments. The procedure ordinarily is to go straight to theatre. However, if such surgical work is no longer to be undertaken on a planned basis at certain hospitals, staff will face a dilemma as to whether it is safe for patients who present in such circumstances to be sent to theatre. Professor Keane must ensure there is no ambiguity in this regard and that everybody is clear on what constitutes best practice. It is often the case that the transfer of patients to another hospital is not straightforward. Emergency cases tend, by their nature, to be more complex. There are logistical issues to be considered in transporting patients, as well as the possibility of a crisis en route.

Another issue to consider is the impact the strategy will have on the training of doctors. Under the new arrangements, for instance, many general surgical trainees will not get any exposure during the course of their training to those cases handled by the specialist centres. If these doctors happen to be on duty when a patient requiring such specialist treatment presents in an accident and emergency department, there may be an issue in terms of their skill and competence to respond appropriately. One option is to consider sub-specialising general surgery. Another solution might be to establish 24-hour, seven-days-per-week rotas that assign a named specialist to cover each region and to put in place a dedicated procedure whereby relevant cases will be assured of a compulsory, immediate and unequivocal transfer to the centre in which the named specialist operates. Taking this approach means we must accept the risk associated with transferring patients. However, this must be weighed against the risk posed when treatment is administered by an unskilled person.

Other challenges include dealing with benign cases, the treatment of which requires the surgical skills necessary in treating cancers. If these hospitals are no longer treating cancer patients, however, it is questionable whether they will attain the critical mass necessary to maintain competence to undertake such procedures. Other Members have spoken about issues relating to travel. In addition, we must address the status of the current case loads in the specialist centres.

I ask the Minister to make available as soon as possible the licensed vaccine for cervical cancer. Its availability renders completely unnecessary the 65 deaths per year from cervical cancer.

An important component of the national cancer care strategy is research. We must be realistic in terms of expectations and honest about the limitations that exist. Much has been made of the revelations regarding mammograms, but we must acknowledge the considerable technical limitations in this regard. Internationally there is a 12% miss-rate in respect of diagnosis via mammograms. If we employ the double reading standard of care, we can reduce the number of false negatives from 9% to 6%. As a result of technical limitations, however, there will be a percentage of patients whose cancers will not be detected. One option is to consider using an MRI reading or similar. There are various pros and cons in regard to such an approach. Funding for research, as is provided by the Health Research Board, offers the opportunity to reduce technical limitations and thus ensure better practice.