Mary Harney (Dublin Mid West, Progressive Democrats)

However, 23 people were put together, 17 of whom were doctors and six were non-medics. These 23 people recommended to the Government that we should have eight centres and stated where those centres should be. If we take the two hospitals mentioned, namely in Sligo and Mayo, a person with brain, lung or pancreatic cancer in Sligo or Mayo already travels. A total of 52% of all the lung cancers in the country are dealt with in St. James's Hospital.

In 2007, 7,014 surgical procedures were carried out in Sligo. We are discussing moving 79 of these, which happen to be breast cancer. In Mayo, 4,816 surgical procedures took place and we are discussing moving 58 of these. We are being accused of running down the hospitals. In 2006 in County Sligo, 477 people were diagnosed with cancer. Of these, 106 were not treated in Sligo. They were treated in other places, presumably because the specialist activity did not happen there. People had various cancers which required surgery.

Patients are already travelling from Sligo and Mayo for cancer treatment — many of them to places in Dublin — heart bypasses and many other procedures. The reason people must travel is because we cannot provide multi-disciplinary specialists and by this I mean more than one individual in a specialist area. One cannot have a designated cancer centre with one surgeon in a particular specialty. It is not adequate to provide the level of cover, expertise and service warranted to justify it being a cancer centre.

We already have many people working in these centres but they are working in a fragmented way. Until recently, breast cancer was performed in more than 30 hospitals in Ireland. In some cases, only one or two procedures were carried out each year. I do not know many women who would want to be operated on by a doctor who only did one or two surgeries a year. I do not believe any woman could be convinced, notwithstanding the data which I will deal with in a moment, that this would deliver a good outcome.

Approximately one third of breast cancers lead to mastectomies. Many women having a mastectomy want to have reconstructive surgery. This is particularly the case with regard to young women but not exclusively young women. They can have this in centres with a plastic surgeon. They cannot have it in Mayo or Sligo. A woman in Mayo or Sligo who has a mastectomy and wants to have reconstruction must have a second bout of surgery. This is not good international practice and not recommended. One should only have surgery when it is essential to do so.

No matter what small group of data we take, it cannot put to one side the data from throughout the world. More than 250 medical publications support the view with regard to breast and other cancers that volume equals quality. Unless one deals with 150 new cases a year and a surgeon performs at least one new case a week, one will not get a good outcome. Recently, I was asked a parliamentary question about this data. I referred to a website which contains it. I recommend people to check it out. It continues for pages and pages and includes data from the world's best surgeons and scientists in the best organised cancer services in the world.

I would not be worthy of the job of Minister for Health and Children if I were to set this aside, take a chance and state to the women of Mayo or Sligo that they will be second best and that we will take a chance it just might be all right when we know all of the evidence states that by having a designated centre with multi-disciplinary teams their chances are so much better. What are the chances? If one is treated in a centre with a low volume where four women survive, five will survive in a specialist centre. We are telling one woman who might die that if we treat her in a specialist centre she might be the one to survive. I do not believe any health system should take this type of chance.

When the strategy was recommended, seven patient organisations recommended, notwithstanding the inconvenience to some people which we acknowledge, that we should implement it. These organisations included the Irish Cancer Society, Europa Donna, Arc, the Marie Keating Foundation and the Irish Patients Association. It also included local cancer organisations. These organisations did not recommend that we proceed as quickly as we could for any reason other than that they knew it would deliver the best results and outcomes for women.

Last autumn, Senator Fitzgerald stated that we have the guidelines and demanded that they be implemented. She asked that the eight centres be put in place and for me to show leadership. This is what she encouraged me to do. When one shows leadership and gets on with it one is accused of ignoring certain matters. In Ireland, approximately 22,000 new cancers diagnoses are made every year and approximately 7,750 people die from cancer. We have approximately 2,500 cases of breast cancer. To provide the service that deliver the outcomes achieved in places such as British Columbia, we need to reorganise, eradicate fragmentation and make sure screening, diagnosis, surgery, chemotherapy, counselling and so on are integrated.

It is proposed that initial diagnosis and surgery will take place in the designated centre and the follow-up treatment will be carried out in the hospitals in Sligo, Mayo, Mullingar and the other locations mentioned in accordance with protocols that will be devised at the specialist centre. That is best practice and it delivers good results. Out of every 100 women who travel to Galway from Mayo or Sligo, 95 will not need to return but if the five who may be diagnosed with cancer and need surgery are not given the best chance at the start, the process cannot be undone. One can never recover down the line with chemotherapy if the diagnosis and initial surgery is not correct. That is what all the experts tell us and there is a compelling argument for us to take on board the best expertise available to the Government and the health service and put that into effect.

I was asked about resources for Galway University Hospital, which has 2,500 staff. From time to time, 100 beds are occupied by patients awaiting medical or radiation oncology treatment. That is not best practice because most of the treatment should be provided on a day case basis. That is why Professor Keane is reorganising the service. The issue is reorganising the manner in which the service is provided to make sure it is focused on delivering the best result for patients and not on more beds or staff. The 100 beds occupied in GUH are not necessary and fewer hospital beds are required for such patients. St. Luke's Hospital in Dublin has 300 beds for radiation oncology while the hospital in British Columbia, which caters for the same population, has approximately 60 inpatient beds.

We are spending a great deal of money but, unfortunately, it has not been put in the right direction. Recently, the Government advertised for 120 new consultants for the health care system, more than 20 of whom will be cancer specialists in the eight centres of excellence. Additional specialist breast surgeons will not be appointed to centres that are not designated because it does not make sense to do so. When doctors work in a critical mass environment dealing with cancer, significant positives flow from that.

Senator O'Toole referred to performance indicators and survival rate is the one that matters in the context of cancer services. In the first instance, we must organise around volumes of 150, for example, for breast cancer while there will probably be only one centre for both prostate and brain cancer, one or two centres for oesophageal cancer and perhaps only one centre for lung cancer because the volume of patients to achieve good results only warrants these numbers. That will mean patients travelling but if it improves the chances of these patients having a positive outcome by 20% or 25%, many of them will do that.

I fully accept the need for modern transport that meets the needs of patients and that is why the Irish Cancer Society is involved in a new transport initiative. Only yesterday I met Mr. John McCormack, chief executive of the society, which will provide in conjunction with cancer centres, similar to its counterparts in many other countries, resources for the provision of transport where a bus service would not make sense and where individuals want to make their own arrangements through a family member, neighbour or another form of private transport. The ICS is also developing a volunteer effort, which works well in Canada and other European countries. I have witnessed this working well elsewhere and people might like to contribute to this effort.

Recently, at the request of Senator Feeney, I made an allocation to Sligo hospital to provide a new bus for patients who must travel to Galway for radiation oncology treatment because she brought to my attention the substandard nature of the current bus. More dedicated transport initiatives are needed to meet the highest transport standard.

Two additional beds will be provided for breast cancer patients from counties Mayo and Sligo in GUH. I am often criticised because there is 90% to 100% occupancy in hospitals, which people say is dangerous. It is normal practice for hospitals such as GUH to reduce activity during August for maintenance and refurbishment work and other reasons. That does not affect cancer or other specialist services or the accident and emergency department. That is normal practice around the world. Many elective hospitals that do not deal with emergencies, cancer or other specialties in Europe close during August. I assure Senators it will have no affect on the availability of capacity.

Professor Keane did this job in British Columbia and we are lucky to have his medical expertise and people's skills in putting this plan into effect in Ireland. He is ahead of the target set, which was to make a 90% transition from the current system to the new arrangements over two years. By the end of this year, all breast surgery will move to the designated centres. He is moving on to prostate and lung cancer services and he expects to complete their transition during 2009. By any standard, that is a major outcome in a short period and it is a performance indicator.

Many Members feel strongly about the issue but I appeal to them not to confuse the local with the best outcome. If I were to take a chance and leave the service as it is, I would not be able to live with myself when I know the evidence worldwide is so compelling. The countries that have done this achieve the best results and Ireland has the capacity to achieve similar results. Every cancer patient, regardless of where he or she is from, should be given the same chance of survival as the patients from Dublin, Galway or Cork.