Mary Harney (Dublin Mid West, Progressive Democrats)

Senator Fitzgerald asked about the implementation strategy. I have a meeting tonight with Professor Keane and am due to have a five-hour meeting with him on Thursday. He will come forward with the implementation plan early in the new year. He spent some time here before he agreed to take the position and he knows a lot of the clinicians and other people who work in the HSE. He wants to meet a lot of people and enter into dialogue on the way in which services can be relocated from smaller hospitals to the centres of excellence and from the centres back to the smaller hospitals. In the west, for example, many patients who are travelling to Galway for treatment could have their procedures performed in Portiuncula, Roscommon, Castlebar or Sligo. The intention is to move services that do not need to be in the cancer centres out to the smaller hospitals and to move cancer-related activities into the centres.

We must do as much as we can at local level. Some of the diagnostics may be carried out locally, with tests taken at a local hospital and read at the centre by the experts. That is not uncommon in other countries. Obviously, chemotherapy will be provided. The one area in which we are top of the class worldwide is in the treatment of children's cancer. That is because it is centrally planned in Crumlin and administered in 15 or 16 hospitals around the country. As the experts in Crumlin are involved in planning and supervising care, we are at the top of the class. That is what we want to do with other cancers as well.

Senators asked why I am happy about outsourcing. We have two accredited laboratories in Ireland. At the moment 300,000 opportunistic smears are taken every year. When the cervical screening programme rolls out next year we will be doing 240,000 per year. That is less than what we are doing at the moment. We have 80 cervical cytology specialists although we do not need anything like that number. I am asked why we do not have more, but we actually have more than we need. For the moment, to improve the speed of response — because six months is not a speedy response — the service was outsourced via a procurement process and awarded to Quest in the United States. This is an accredited laboratory with very high standards and the results are returned quickly. If we are to put the patient first, we must think of innovative ways of getting the results to the patient. In my experience, patients do not care how something is funded or who organises it. What they care about is getting treatment fast when they need it and, in particular, being provided with a quick diagnosis.