Tuesday, 4 December 2007
I thank the Cathaoirleach for accepting this matter for debate and I thank the Minister of State, Deputy John McGuinness, for being in the House to respond. I am highly concerned about a recent report that indicated that only six patients with cancer have availed of the 50 places that were sought and obtained by the Irish Government in the state-of-the-art facility in Belfast.
The Minister of State is aware of the perception of isolation in County Donegal in respect of its geographical location, which is far from both Dublin and Galway. This is highly relevant to the issue of health. While the Minister of State is more involved with the issue of jobs, such perceptions are relevant to both subjects. The Government has moved to relieve this geographical isolation in a number of ways. For example, at general practitioner level there has been the advent of pilot projects that cross the Border. As for cancer care, while I wish to see the roll-out of BreastCheck, I have suggested previously that consideration should be given to a linkage with the existing service in Derry as an interim measure. However, I recognise the support that is being given to allow women who are worried to attend clinics in Belfast for mammograms and I trust the roll-out of BreastCheck in County Donegal will come quickly.
I recognise the Government's support of the surgery in Letterkenny and congratulate the team there. The permanent appointment of a surgeon for Letterkenny who is linked to the Galway facility is an important move to provide a critical patient mass that will increase survival rates for patients. All Members know that a critical mass and such multidisciplinary teams are the best way to ensure the sharpest knives and keenest eyes.
The next piece of the jigsaw is radiation oncology. While I am aware of the ongoing important talks on having a satellite service in the north west, interim support was given in the form of the link to Belfast. This leads me to the key question. Given the journey time and distance to Dublin and Galway — the latter is 20 miles further from my home than is Dublin — and given the effort made to break down many borders and the consequent political success of equal access for 50 patients, why, more than a year later, can one not discern the patient gain from this closer and equally professional location?
Is there a problem in Belfast? Are patients not getting access or priority in comparison with patients from the Six Counties? Should this be the case, it raises fundamental questions on the ability to work on an equal footing in respect of the satellite unit for the north west. The answers need to be clear at this point. This does not fit with what I have been told to date by officials of the Department of Health and Children or by the Minister, Deputy Harney, where the emphasis has been on partnership and equality of treatment for those places that have been acquired. Since I raised this issue last week in County Donegal, a number of people have asked me the reason those with bowel cancer are being told they are not entitled to go to Belfast. Such people are very anxious that I should get answers this evening regarding the lack of take-up of the 50 places.
Last year, the question posed by local media was what would happen were more than 50 patients to present themselves. The answer I received was that since this is a pilot project, if more places were needed, more places would be negotiated. What has gone wrong? Will the Minister of State undertake to draw the attention of the Minister for Health and Children, Deputy Mary Harney, to the need to ensure the 50 places will remain open to patients and will not be withdrawn owing to the lack of uptake to date? Is the reason for the lack of take-up clinical, medical, psychological or due to a lack of patients being informed? The Minister of State should enable me to ascertain the reason.
The opinion of the daughter of one patient is that patients in Letterkenny General Hospital are not being actively encouraged to go to Belfast. She believes that during consultation about radiotherapy treatment with a consultant from Dublin, the option of Belfast was mooted but skipped over. Patients are expected to make a spur-of-the-moment decision and are not given the benefit of time to consider the advantages and disadvantages of travelling to Dublin or Belfast for their treatment. It is assumed automatically also that if a patient chooses Belfast, he or she must have friends or relatives there. The same is true when a patient opts to travel to Dublin. However, none of this criticism detracts from the care given. Should patients choose Belfast, they are duly referred to a consultant there.
This person did not think patients had enough information before going for their radiotherapy consultation to make them aware they had a choice and that accommodation in and transport to Belfast were provided as well as for Dublin. The mother of this person recently finished her radiotherapy treatment in Belfast and my information is based on her experience and that of others whom she met. She considered the radiotherapy unit and the accommodation facilities in the Glenview building at Belfast City Hospital to be excellent, as was the support network. In addition, as the facilities are much closer to home, this cut down on travelling times. She understands the facilities in Dublin are excellent too, but the journey time is longer. That is the reaction of the daughter of one patient who was through the system.
There is a great deal of talk of a 32-county Ireland and there is a concern about isolation in the north west. This is a solution to some of the difficulties presented. I hope the Minister of State, Deputy McGuinness, has answers from the Minister for Health and Children why this option has not been taken up and whether it is intended that cancer patients of all types would gain from the facility should they wish to use it. From what I have heard, I do not believe there are only six patients who want to go to Belfast. Go raibh maith agat.
John McGuinness (Minister of State with special responsibility for Trade and Commerce, Department of Enterprise, Trade and Employment; Carlow-Kilkenny, Fianna Fail)
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I omitted to mention to Senator Ó Domhnaill that I appreciate his comments and suggestions and that I will bring them to the attention of the Minister.
I thank Senator Keaveney for raising this matter on the Adjournment. The Government decided in July 2005 to improve geographic access for patients in the north west to radiation oncology services. It was decided to facilitate access to Belfast City Hospital and to progress consideration of a joint venture for the provision of oncology services in the medium term to patients in the north west from a satellite centre in the north west linked to Belfast City Hospital.
Cancer patients in the north west requiring radiation oncology treatment are referred to either St. Luke's Hospital, Dublin or University College Hospital, Galway. As the House is aware, a service level agreement is also in place for the referral of radiation oncology patients from Donegal to Belfast City Hospital.
The Health Service Executive has informed the Department of Health and Children that a mid-term review of this arrangement was held in September. At that point, 12 patients had used the service. This represents 24% of the initial estimate of patient demand. The HSE expects that uptake will continue to increase, but the figure of 50 was an initial upper estimate of demand and not a target, as this facility is offered for the benefit of those patients whose circumstances would be suited by the shorter journey to Belfast and the possibility of mid-week or daily return home. However, this is only one factor in a patient's decision and may not be the most important one for each individual.
The actual uptake for Belfast is a matter of individual patient choice following advice from a consultant. It was never expected that the majority of Donegal radiotherapy patients would choose to go to Belfast rather than Dublin given family and social connections, transport links, and the fact their initial consultation is with a consultant from St. Luke's Hospital. The HSE has advised that this service effectively commenced in March 2007. Patients are seen by the visiting consultant radiation oncologist in Letterkenny General Hospital who is attached to St Luke's Hospital, Dublin, and those whom he considers would benefit from radiotherapy are offered the choice of having their treatment in Dublin or Belfast.
The HSE has informed the Department also that transport arrangements have been put in place to facilitate patients who wish to go to Belfast. Patients who go to Belfast report satisfaction with their experience. The initial phase of this agreement comes to an end on 31 December, following which a comprehensive review of the service is to be carried out.
This agreement reflects the significant commitment by Government to developing North-South co-operation in health. The Minister for Health and Children, Deputy Harney, met Minister Michael McGimpsey of the Department of Health, Social Services and Public Safety in Northern Ireland on 28 November last. The potential for further cross-Border co-operation and collaboration on cancer care and, specifically, provision of a satellite centre for radiation oncology in the north west linked to Belfast City Hospital was discussed in the context of a joint North-South feasibility study on the potential for future co-operation.
The Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland, including Donegal. There is considerable political, departmental and service commitment to delivering on this agreement with Belfast City Hospital. It is important this initiative succeeds as it will support further co-operation in health care, including cancer care.
I thank the Minister of State for his response. There is no doubt people want this service to work. Perhaps he would ask the departmental officials to respond to the specific questions I asked. I refer in particular to whether the radiation oncology service is specific to breast and prostate cancer or whether it includes bowel cancer. This is an issue for a small number of patients who have been in touch with me. If it is an option for them, they are more than willing to go to Belfast.