Feargal Quinn (Independent)

I welcome the Minister to the House and appreciate that she comes here regularly. She answers our questions and seems to have figures at her fingertips that she does not have to read from a prepared script. On her last visit here, very recently, I expressed my support for her objectives.

Some seven or eight years ago I visited a number of hospitals to inquire how we will get around the big problem facing us. This long predates the Minister's current situation and responsibilities. I am a great believer in delegation and passing responsibility to where the action is and where customers, in this case patients, are located. I came to the conclusion at that stage, as did the Minister, that health boards were not the solution because every town, community and county wanted its own hospital and centre of excellence. I support the Minister's moves in recent years to try to achieve her goal in this regard and the national cancer strategy, announced last autumn, is an example of this.

The national cancer strategy indicates that breast cancer services should be centralised in eight cancer centres based on clinical excellence and the number of newly diagnosed breast cancer patients per year. The logical assumption is that smaller units will close and services relocate to a larger unit. A figure of 150 new cancer cases per year is the minimum for a designated cancer centre.

Let me take one instance of a concern my attention was drawn to in Cork. The situation in Cork is unique in that two hospitals, Cork University Hospital and the South Infirmary — Victoria University Hospital, currently provide breast cancer services. The newly built and recently opened BreastCheck unit is located adjacent to the South Infirmary — Victoria University Hospital unit and is effectively an integral part of it. The breast cancer unit in the South Infirmary — Victoria University Hospital is currently the largest unit in the country and handled 220 newly diagnosed patients last year. This year it is on target for somewhere between 300 and 320 patients, excluding BreastCheck patients, who make up another 100. The South Infirmary — Victoria University Hospital has a well organised multidisciplinary team and is one of the few units in the country to meet the Health Information and Quality Authority, HIQA, standards with good, well-established data collection for quality assurance. The Minister has often mentioned that numbers equate to quality. Cork University Hospital deals with about 80 newly diagnosed cases per year and has only one breast surgeon. It is the regional trauma centre and the wards are often full of trauma and fracture patients. Other surgeries, including cancer surgery, get cancelled or postponed.

I welcome the Minister of State at the Department of Health and Children, Deputy Barry Andrews, to the House as he has not been here in my time. Our problem is that Cork University Hospital has been chosen as the designated breast cancer centre for Cork and that services will cease at the South Infirmary — Victoria University Hospital. The consultant medical staff in the Cork hospitals would be happy with this if a purpose-built facility adequate to cope with the clinical workload of around 500 new cancer cases per year existed in Cork University Hospital but it does not and would take years to plan and build. A unit dealing with 500 new cancer cases may even be too big, given the multidisciplinary meetings and outpatient clinics that would be associated with this workload.

Professor Tom Keane came to Cork recently and, while previously he had indicated he would be data driven, to use his term, in his implementation of the cancer strategy, he subsequently backtracked on this and is going to implement the strategy to the letter of the document. He indicated that all breast cancer services would be relocated to Cork University Hospital by May next year, which I believe to be an impossible timescale as there has been no engagement with any clinicians in the process.

Moving a large unit into a smaller one is bizarre, to say the least, and patient care will be adversely affected by moving services to Cork University Hospital. The service would be better located at the South Infirmary — Victoria University Hospital in the short to medium term while a longer term, properly resourced strategy is put in place.

I apologise if I have concentrated on a particular instance and I hope it is an exception, rather than a typical example of what may happen elsewhere. The amendment to this motion supports the fundamental objective of the Government's health policy, which, it says, is the achievement of the best clinical outcomes for all patients throughout the country. We will assume that Cork achieves that fine objective. This case may be only one instance but the figures that have been brought to my attention suggest that if this is happening elsewhere the matter needs immediate attention. I assume the case in Cork is the exception to the rule. I have great admiration for what is taking place and I believe the HSE is getting on top of this. Last time she was here the Minister gave us figures and judging from her words today I believe she is confident that she and the HSE are getting on top of this. I have used the case of Cork and ask to be excused for concentrating on one instance, but if it is an example of what is happening elsewhere it needs serious attention. If it is something that is an example of a unique exception the Minister may be able to handle it.

The objectives of the HSE and those mentioned by the Minister today are supported by all of us. The manner of achieving those objectives is crucial and I believe the Minister is confident we will succeed, though we need the support of everyone in the country to do so.