Phil Prendergast (Labour)

I welcome the Minister. She is the Minister whom I have had the opportunity to meet most often in this House. That is a measure of the level of need to have her here regarding the health services and her commitment to coming here and giving at least an ear to what has to be said. It is very difficult to remove the emotive aspect of cancer services from the equation. I am aware that many people have suffered the loss or the diagnosis of close family members, which is difficult to deal with. The statistics on the prevalence of the different types of cancer are horrific. While I will not go into detail, it appears the very prevalence of cancer makes it seem as if it is not so horrific for the person hearing that diagnosis. This can cause another aspect of emotional loss and grieving that is probably not factored into the relationship with the diagnosis of cancer and its treatment, the therapies and the location where the best care can be given.

I take the point on when a child becomes ill. I worked mostly with very young children and babies and I know that when a child becomes ill, one would cross the world to get best service. I must acknowledge this, which is not to take from any case being made.

The strategy for cancer control in Ireland proposes to put in place a system which will see a reduction in the incidence, morbidity and mortality of cancer in comparison with the other European countries by 2015. It is a very good target to have set. We will see the establishment of eight centres of excellence which will deal with the diagnosis and treatment of the more common forms of cancer, with each centre serving an average of 500,000 of the population. There will also be a comprehensive provision for the treatment of rarer cancers in specific locations. I am fully supportive of this strategy in the context of developing and advancing expertise in the diagnosis and treatment of cancer. It would be unfair of me not to acknowledge this, having worked in the health service for so long.

While the provision of centres of excellence based on population works very well in the southern half of Ireland, this should not be the sole consideration in deciding the location of such a centre. In the northern half of the country, due to the lower population density, clients are sometimes hugely disadvantaged by the distance they have to travel to avail of treatment. A special case surely must be made in this area to make treatment more accessible to service users and to reduce the discomfort and disruption to very ill patients in need of regular treatment.

I take issue with the manner in which the eight centres of excellence were chosen. It seems that in the four HSE areas these centres will be located on the site of the existing regional hospital, which is not a particularly sensible approach. Most of these hospitals are in coastal locations and less accessible than would have been the case had they been located some distance inland. During the protracted situation in regard to the divided services in Clonmel and Cashel and the regional services in Waterford, on one occasion I was caught out when the bridge was up and I had to get to the hospital quickly because there was an emergency to be dealt with. I had to hope that the bridge would be back in place soon, which was a discomfort to me as a professional. I can only imagine the situation of the woman in premature labour, but we got there in time and everything was fine, thank God.

For service users to have to negotiate towns and cities that are already choked with traffic is another dimension when one needs to get to a hospital desperately, or when there is a concern about keeping an appointment and whether one will lose one's place in the queue. There is much to be said for having a new facility on a greenfield site. There is no reason a hospital has to be located in a town or city and it may be easier to access one on a greenfield site, both in routine and emergency situations, once the area is well serviced by roads. I accept this is not a small detail.

In the past, cancer care and treatment was provided at a local level by skilful and dedicated consultants. While Professor Tom Keane had issues with the provision of cancer care in smaller hospitals, I commend the consultants who managed to do so very successfully for many years. Thousands of people throughout Ireland were very well treated and can thank their local medical personnel for the fact they survived and got great treatment and care in smaller hospitals.

There is a valid point in regard to the consequences of a lack of experience in diagnosing cancer due to a low turnover of patients. We have seen the impact of such a systems failure on the women of the midlands caught up in the recent situation. One must not underestimate the stress and trauma caused to these women who had to undergo revision of their test results and to their families. I hope that with the provision of care through centres of excellence we will never see such a situation arise again. Awareness is a major factor in this regard. Quality audits should be in place and they should be put in place sporadically so all staff are subject to unannounced audit and should have no fear of that. I would have no fear of it.

In my own constituency, we have already seen the transfer of an excellent breast cancer care service from South Tipperary General Hospital to Waterford. It is essential that adequate groundwork has taken place to ensure the hospital has both the infrastructure and staffing levels in place to service the additional area of expertise. While the Health Service Executive denies it has a continuing embargo on staff recruitment, I am concerned that the directive in place indicating that staff may be hired within financial constraints does and will have implications for the setting up and maintenance of any new service.

Underpinning the centres of excellence, we clearly need to extend the screening process for treatable cancers, including widening the range and age groups for these tests. For example, in the case of breast cancer, it is expected that the 2,000 cancers treated annually will be reduced once BreastCheck, the national breast cancer screening programme, is fully rolled out. However, as BreastCheck encompasses only women in the 50 to 65 year old age group, it will have no impact on the 67% of cancers which were diagnosed in the over 65s. The Minister agreed this was to be extended to the age of 69 at a previous meeting of the Joint Committee on Health and Children and I hope this might be addressed in her response to this debate. The age group serviced by BreastCheck needs to be widened to include these women to ensure early diagnosis and treatment and, ultimately, a better prognosis.

In conjunction with extending the range of available tests, I acknowledge the importance of the front-line role of the general practitioner in the early diagnosis of cancer through the identification of symptoms during physical examinations and the provision of routine screening for cancers such as prostate cancer and cervical cancer in the surgery setting.

I am disappointed to note that despite the reservations voiced by me, among others, about the possible granting of the cervical screening contract, the Minister has signed the contract with Quest Diagnostics. This was ill advised considering the misgivings raised about the company's practices. On a more significant note, this decision will have long-term implications for cytologists and pathologists in Ireland who will have reduced access to the reading and screening of cervical smears. They will be completely deskilled in reading these.

I thank the Minister for coming to the House and I thank the Acting Chairman for allowing me to contribute.