Mary Harney (Dublin Mid West, Progressive Democrats)

I thank the House for providing me with an opportunity to speak about the cancer control plan. I will try to answer as many of the issues raised by Senators as I can.

The cancer control plan is about one thing and one thing only and that is patient survival. Ireland comes 18th out of 23 European countries in terms of survival from cancer. The only area of cancer where we are top of the class is children's cancer. Why are we at the top with regard to children's cancer? Why do we compare favourably with Europe and the US with regard to children's cancer? It is because children's cancer services are centralised in Crumlin where diagnosis and initial surgery takes place. Much of the follow-up chemotherapy takes place in 15 other hospitals. I strongly believe if the trade-off is between survival and travel, few patients and their families would not travel in order to survive or would put the local area before better survival rates.

Places in the world which have the best survival rates include British Colombia, which has the same population as Ireland and which has four centres in the southern part of the province. Senator Boyle earlier stated it has eight. I visited them because we were so impressed with their results. It is a publicly funded system. People travel thousands of miles to obtain the best treatment in Canada and so it is that it has one of the best outcomes in the world.

We are discussing eight designated centres, not eight centres of excellence. Every health service should be a centre of excellence whether it is a general practitioner's surgery or a local hospital performing minor and elective work. We are discussing having eight designated centres where all of the surgical and diagnostic specialists will work together in multi-disciplinary teams.

Medicine used to be organised on the basis that we had general surgeons. We have moved well away from this. Most surgery has begun to specialise. We want to aspire in Ireland to what they have in British Colombia, Europe, the United States and Australia which are the countries which perform best. They have breast surgeons, brain surgeons for cancer and lung surgeons. They do not have general surgeons who might do a bit of breast surgery.

This is not about the skills of any individual. No service can be organised on the basis of any individual's skill or personal commitment. We cannot have a service organised around one or two people. As somebody stated, if this person is sick or on leave we do not have a service at all. Given the population of Ireland we cannot justify more than eight centres. Some people have stated this is four too many and we should have only four centres.