Dan Boyle (Green Party)

Recently Professor Tom Keane, who has been appointed to implement the national cancer strategy, met the Green Party parliamentary party as part of his ongoing consultation around the country. I found him a very impressive individual. He has come, with his experience and background, from British Columbia. The benefit of that experience is meant to be directly applicable here. British Columbia is a region of Canada that has a population similar to the island of Ireland and it implemented a similar type of regional cancer strategy. Interestingly, it chose to have eight centres, although British Columbia is geographically many times size the island of Ireland. The geographical distances between those centres are far larger than that between any of the proposed centres here.

Professor Keane made a few interesting points, the first being about the nature of reforming and changing a health service. Additional resources were made available in the cancer care services of British Columbia by altering the types of expenditure. The number of beds was reduced and rather than putting that saving back into the general fund, it was reallocated into diagnostic services, community care and after care services. We have not used this approach enough in reforming our own health services. Having someone like that in the Irish health service gave me great confidence that we might be heading along a direction we have not had an opportunity to go in the past.

Another point Professor Keane made, and this has not been communicated strongly enough, is that while we refer to the eight centres as "centres of excellence", he thinks that is not the most appropriate term. He is talking more about centres of specialist care in cancer treatment. Using the word "excellence" creates an expectation that wherever the centre is located has something super-duper, so to speak, and way in excess of anything available. In making that point he stressed that what does not seem to be getting across is that these centres will have the entire range of services that need to be available for cancer care, including all the diagnostic aids, continuing care, after care and surgery, which is the most important element of what will happen in the centres. That does not mean parts of those elements will not exist in the rest of the country. The surgery will take place solely in the eight designated centres but elements of the diagnostic, continuing and after care will continue to take place in the various parts of the country where they now happen. While much of the debate focuses on the eight centres, it continues to be a national strategy because all elements of cancer care will be provided somewhere, somehow in all parts of the country.

The implementation of this strategy is at the heart of the motion. Part of my family background is in the north west. My father was an islander from Donegal. He passed away of cancer eight years ago. He received all his treatment in Cork and was fortunate to do so. He had three incidents of cancer over a 20-year period and the incident that led to his passing away occurred while he was holidaying on the island. The manner of his passing indicated to me the degree to which there tends to be a regional imbalance in health care services. It is more difficult in a remote area such as an island. When my father passed away the island's ambulance was not in operation. He was carried from one part of the island to another on the back of a trailer with hay and was taken off the island by the lifeboat. He was then transported 30 miles from Burtonport to Letterkenny General Hospital. Fortunately for him he was in a coma during all this but it somewhat lessened the dignity of his passing away and represented to me an illustration of the need to have high quality health services wherever we are on this island. This was eight years ago and things have improved; we have a better ambulance service. However finely tuned the health service is in dealing with areas of low population and remoteness, it will be difficult to provide a high level of service.

This is at the heart of the national cancer strategy. We have to ensure that wherever people live they get the treatment they need how and when they need it and that the questions of geography and dignity are properly addressed. A fair attempt is being made to do that. There is a lacuna in the north west. Not only is it a remote part of the country, the population of the area is smaller than in other regions. Those factors have to be assessed in deciding which locations are best. I would like to think the cancer strategy is being structured with a Letterkenny node and that the possibility of increased links between the health services in the Republic and the North of Ireland would offer opportunities, especially with Altnagelvin Hospital in Derry. This makes perfect sense in the context of a holistic approach to health care on the island. If there is a medium-term strategy that could put this in place, it will address the gap that remains because of the remoteness and the population size in that part of the country. Thought is being given to that. It is difficult to marry our health system with the National Health Service in Northern Ireland but we are talking about cross-Border bodies and wherever such synergies can be achieved, we should work towards doing so.

I have a personal reservation on the application of the eight centres from the current, more diverse approach to cancer care service distribution. In the south west, Cork has been identified as the regional centre and moves are taking place to move cancer care services from Tralee to Cork. There is a logic in that. Cork has been designated and Tralee is part of the south west region. I find it difficult to understand the logic of the fact that the Cork regional centre is to be located in one campus in Cork University Hospital, CUH. This means some services currently being provided to a very high standard in the South Infirmary-Victoria Hospital, which already seems to have a liaison with the construction of the BreastCheck facility which is located next to it, will be moved across the city to CUH. If someone can explain to me why that has to take place and in the given time span, it would make more sense to the people of Cork. I understand Cork is the regional centre but I am not necessarily convinced that means location in one building. This is just a localised example of how the cancer strategy is being implemented. I accept this will cause difficulties when the regional centres are being moved from A to B.

I appreciate the opportunity of supporting the Government amendment and of asking some of the questions. We all wish to see the best cancer treatment system in the country and it is our collective intention in this House to work towards that.