Joe McHugh (Fine Gael)
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I welcome the Minister of State, Deputy Tim O'Malley, to the House again tonight. He is a busy man as he was also here last night on the Adjournment. The Minister of State is probably aware of the high profile campaign on cancer services which has been ongoing for some time in the north west. The campaign covers retention of current cancer services and also considers the expansion of a range of ancillary cancer services for the people of the north west. I will not cover old ground I have previously covered with the Minister of State. As he is aware, proposals have been made for radiotherapy centres in Waterford and Limerick. We have existing services in Dublin, Cork and Galway. The north west is completely disenfranchised in terms of an equitable radiotherapy service. We are aware of arrangements with Belfast for patients from County Donegal, with the proviso that bed space must be available. However, Northern Ireland has a jurisdiction that caters for 1.5 million people. Belfast is not and will not be a centre to cater for the needs of the people of the north west. It is incumbent, therefore, on the Government to provide a satellite radiation centre in the north west because it is pivotal to the needs of the people there. It would cost €15 million to set up the centre. A key meeting will take place on 6 June between administrators of Altnagelvin, Galway and Letterkenny hospitals to discuss the potential of sharing services and the permanent appointment of a breast consultant surgeon in the north west.

At primary level, breast screening is not provided in the region. Donegal women do not have that luxury or option similar to women in the east. At secondary level, the appointment of a permanent breast consultant surgeon at Letterkenny General Hospital is urgently needed and this call is being echoed loudly and clearly by the people of Donegal. Recently, a demonstration took place in the town on a wet Sunday afternoon. More than 15,000 people turned up to highlight their frustration and anger and to demand equitable health services for their peers and families in the region. A radiation service must be provided at tertiary level. A satellite radiation unit is needed, which could operate on an east-west basis between Altnagelvin and Letterkenny hospitals and which could also incorporate Galway and Sligo hospitals.

Cancer patients are acutely aware that all specialist services cannot be sporadically provided throughout the State on a piecemeal basis. People appreciate such services must be located centrally where the expertise is available. All we are looking for in the north west is a level playing field and appropriate cancer services. Will the Minister of State intervene prior to the meeting on 6 June? The Minister for Health and Children visited Letterkenny last Monday and stated there would be an outcome after 23 June. However, between now and then, we need to know where we stand regarding the facilities that will be provided in the region.

A range of people are involved in this process. Ultimately the patient is the key part of the equation but the Government and the administrative and nursing staff and consultants are also involved. What is the consultants' favoured option regarding the relationship between Letterkenny, Altnagelvin, Galway and Sligo hospitals? We need to know where the consultants and the Government stand because nobody is standing at the moment. Everybody is sitting down and they are not delivering. A pathway needs to be found so we know where we are going in this regard.

Tim O'Malley (Limerick East, Progressive Democrats)
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I welcome the opportunity to address the issues raised by the Senator and to set out the current position on the development of services in the north west and at Letterkenny General Hospital, LGH, in particular. Since 1997 cumulative funding of more than €47 million has been allocated to the north western area for the development of appropriate treatment and care services for people with cancer.

Cancer services at LGH are provided by a team of consultants and other professionals as follows: four consultant surgeons; one consultant medical oncologist; one consultant haematologist; one palliative care consultant; three consultant pathologists; six consultant radiologists; two senior pharmacists — specialists in oncology drugs preparation; a range of specialist nurse staff; and one consultant radiotherapist, three days per month. An 11-bed oncology ward was recently completed and officially opened by the Minister on Monday last. This development is supported by an oncology day case area, breast care suite and a clean air pharmaceutical preparation room.

The Senator raised the question of additional beds for LGH. The provision of a 30-bed modular short-stay ward at the hospital has been announced and this project will be funded from the accident and emergency department initiative moneys. Planning permission is being sought with contractor procurement being carried out over the next few months. These additional beds will alleviate the overcrowding experienced in the emergency department and day services unit. This will result in enhanced patient experience, and facilitate a return to full capacity of the day services unit. It is intended that these beds will be available to the hospital for the coming winter period.

A new purpose-built emergency department and 12-bay medical assessment unit is at design stage. This unit incorporates a dedicated X-ray room to improve diagnostic services within the department. It is intended that the planning application for this development will be submitted before year end. The capital plan of the HSE, recently agreed by the Minister, includes provision for additional ward space over the proposed new emergency department, which will be incorporated into the overall project.

When the Minister visited the Donegal area earlier this week she said:

Everyone in this country, regardless of where they live, should have access to the best possible health services. This is especially so for cancer services. The most important thing for patients is getting the best treatment. Outcomes for patients drives our policy and investment in cancer care. I am determined that everyone diagnosed with cancer will get top quality treatment, as near to their home as possible.

The Minister and I remain confident that the HSE can achieve these objectives.

The Senator raised the appointment of a permanent breast surgeon at LGH. A standalone breast service at the hospital is not an option as it does not, according to recognised cancer experts, have a large enough volume of new patients with breast cancer to achieve the high quality of services to which the women of the area are entitled. The HSE's preferred option is a partnership to be developed between Altnagelvin Hospital in Derry and LGH. There are strong links between these two hospitals and Altnagelvin Hospital is wholly committed to developing a workable solution with LGH. A process of discussion is in place.

The director of the National Hospitals Office and the network manager for the HSE western area are to meet with the respective management and clinical teams next week to seek to progress a partnership arrangement that can develop the best breast care in the region. It is understood that the model of care being sought will include combined multidisciplinary team meetings to discuss patients in both jurisdictions. Decisions on each patient will be examined collectively, involving the appropriate treatment and follow up. The HSE advises that it will also explore the option of a similar model with University College Hospital, Galway.

Consultant staff at Letterkenny General Hospital will refuse, as of tomorrow, to accept new referrals of breast cancer cases. Discussions at hospital level have taken place to seek a deferral of this action. Last Friday, the director of the National Hospitals Office wrote to the chairman of the medical board at the hospital advising that the HSE is pursuing a resolution of the issue of how best to provide breast cancer care to the population of Donegal. The director gave a commitment that the matter will be drawn to a definitive conclusion before the end of June, a little more than four weeks away. The Minister has urged HSE management to complete discussions on the future organisation of breast services by this date. The director also asked that any proposition to cease existing services from tomorrow should be withdrawn in the interests of assuring best patient care. However, medical consultants refused to rescind their decision.

The HSE, in the interests of women who will be diagnosed with breast cancer from tomorrow in Donegal, is making alternative arrangements. This is essential to ensure a service is maintained for women in Donegal with breast cancer.

I consider the action of a small number of medical consultants to be most regrettable, especially given that the HSE is making significant efforts to resolve the issue in the interest of women with breast cancer. I urge the consultants involved to reconsider their decision and to participate fully in the discussions next week. These discussions should take place in a positive environment and not against the backdrop of a refusal to provide services to vulnerable patients.

The Tánaiste met with representatives of BreastCheck and they are fully aware of her wish to roll out a quality assured programme to the country's remaining regions as quickly as possible. Additional Exchequer funding of €2.3 million has been made available to BreastCheck to meet the additional costs involved. The Tánaiste also approved an additional 69 posts and BreastCheck is in the process of recruiting essential staff. BreastCheck recently appointed clinical directors for the south and west, who will take up their positions later this year. Additional capital funding of €21 million has been made available to construct two new clinical units in the southern and western regions and to provide five additional mobile units and state-of-the-art digital equipment. BreastCheck is in the process of short-listing applicants to construct these units and is confident it will meet next year's target date for roll-out to the southern and western regions.

In coming years, nearly €50 million will be invested in health facilities in County Donegal, including nearly €28 million for additional beds and a new accident and emergency department at the hospital. Since 1997, this Government has quadrupled the budget of Letterkenny General Hospital and enabled the appointment of more than 550 additional staff. That is a clear expression of our confidence in the health services for County Donegal and we will spend more on further improving the services for Donegal people in coming years.