Seanad debates

Tuesday, 11 March 2008

10:00 pm

Photo of Marc MacSharryMarc MacSharry (Fianna Fail)
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I welcome the Minister of State, Deputy Smith. I call on the Minister for Health and Children to review and revise the cancer care strategy to ensure that cancer care services at Sligo General Hospital, including breast surgical and diagnostic procedures, are maintained and enhanced. There has been much comment on this issue in the media in recent days. The contributions on "Prime Time" last Thursday, Professor Drumm's remarks at last week's meeting of the Oireachtas Committee on Health and Children, Professor Tom Keane's comments on "Morning Ireland" yesterday and the remarks made by the Minister for Health and Children, Deputy Harney, last night all indicate that the HSE has absolutely no intention of taking on board the points raised in this House in the context of maintaining cancer care services, including surgical and diagnostic procedures, in the north west. This is totally and completely unacceptable. It is my sixth time to raise it in the House, while many colleagues from all parties have raised it in this House and the other House. It is extremely frustrating and disappointing.

It is an understatement to say that the entire population of the north-west region is disappointed. Approximately 250,000 people, in counties Sligo, Leitrim, Donegal, west Cavan and parts of Mayo, live in a region that will, in effect, be left without an excellent service that has stood up to scrutiny. How would the HSE know about the service when, by its own admission, it has failed to undertake an audit of service, infrastructure or outcomes? The outcome of the service provided to 480 patients in Sligo was recently benchmarked against the outcome of the services covered by the surveillance, epidemiology and end-result, SEER, database, which is run by the US National Cancer Institute. The survey found that the outcomes in the north west were as good as, if not better than, those in the SEER database. The HSE has not undertaken such an audit of service because it is not interested in it. All it wants is to shut down certain services, thereby disenfranchising the entire north west. The HSE has not consulted the existing health professionals in the area, despite the fact that they provide a proven multidisciplinary approach, with triple assessment and all the necessary services and undertakings which are consistent with services of excellence. The HSE seems to have something against the north west. It is not remotely interested in the region.

I would like to rebut a number of points made by HSE staff in media interviews over recent days. When Professor Tom Keane was interviewed on "Morning Ireland" yesterday, he said that the debate on this decision is over. A number of consultants in the north west have told me that the debate never took place. The decision to promote eight centres of excellence was made by a cabal within the HSE, albeit based on the executive's so-called international best practice, by selectively choosing aspects of some reports and not others. I do not want anyone to suggest that I do not support the centres of excellence or that I am demanding services in every corner. It is wrong to disenfranchise a section of the country — 250,000 people — but the HSE has decided that this area should not be serviced. Professor Keane's suggestion that it is fantastic that the HSE intends to supply grants is an insult to the intelligence and integrity of the people of the north west of Ireland. I do not accept it.

Professor Keane also said that travel is not an issue. One need only ask people in their 60s, 70s and 80s about the distress caused by having to travel long distances to be diagnosed and treated to know that Professor Keane is wrong in this instance. It is simply inexcusable that we are allowing this to occur. It is clear from the definitive points that have been made over recent days — by the Minister, Deputy Harney, on television last night, Professor Keane on the radio yesterday, and Professor Drumm last week — that the direct intervention of the Taoiseach, through the Minister for Health and Children if necessary, is required if the constitutional right of the people of the north west of Ireland to share the same rights as anybody else in this country is to be upheld. I do not see how anybody, on the basis of any selective interpretation of the facts, can disenfranchise or dilute the level of human rights to which we are entitled under our Constitution. It is simply unfair and unacceptable.

I entered elected politics six years ago. I was born a Fianna Fáil supporter and I will always be one. My family has been associated with Fianna Fáil for many decades. I have never known it to be Fianna Fáil policy to seek to deprive the people of the north west of a service that is equitably available in every other part of the country. On the contrary, Fianna Fáil was established to ensure that the people of the north west get the same level of service and equity of access as every other part of the country. In my view, it has always sought to do that. Why and when did that change? I plead with the Minister of State to deliver the message loud and clear that I am demanding that the people of the north west receive the same quality of treatment as the other citizens of this great nation. The people of the region, who pay the same taxes and support the same politicians, of all parties and none, who come to this House to legislate and introduce measures on their behalf, deserve better. On behalf of the people of the north west, I appeal to the Minister of State to join my plea to the Taoiseach and the Minister for Health and Children to deliver levels of service to the people of the north-west region which are in line with those delivered within the Fianna Fáil tradition over the decades since the foundation of the State.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank Senator MacSharry for raising this important issue. This is not the first time I have heard him outline in great detail the need to provide and retain services in the north west. I will reply to the Senator on this issue on behalf of the Minister for Health and Children, Deputy Harney, who is unavoidably absent. I welcome this opportunity to set out the current position in respect of the restructuring of cancer services, with particular reference to Sligo General Hospital.

As the House is aware, Professor Tom Keane has been appointed to lead and manage the establishment of the HSE's national cancer control programme. Professor Keane, who has ambitious plans, has made significant progress in implementing the programme. The key objective of the programme is to ensure equity of access to services and equality of outcome regardless of geography. It will involve a significant realignment of cancer services to move from the present fragmented system of care to a system that is consistent with international best practice in cancer control. The HSE's decision to provide for four managed cancer control networks and eight cancer centres will be implemented on a managed and phased basis. The HSE plans to have completed 50% of the transition of services to the cancer centres by the end of 2008 and between 80% and 90% of the transition by the end of 2009.

The HSE has designated University College Hospital Galway and Limerick Regional Hospital as the two cancer centres in the managed cancer control network for the HSE western region, which includes County Sligo. The designation of cancer centres aims to ensure that patients receive the highest quality care while allowing local access to services, where appropriate. If diagnosis and treatment planning is directed and managed by multidisciplinary teams based at the cancer centres, much of the treatment other than surgery can be delivered in local hospitals, such as Sligo General Hospital. For example, chemotherapy and support services will continue to be delivered locally. Sligo General Hospital has a dedicated 15-bed inpatient oncology unit and a dedicated eight-bed day services unit. Cancer day care units will continue to have an important role in delivering services to patients as close to home as possible.

The implementation of the national quality assurance standards for symptomatic breast disease will ensure that every woman in Ireland who develops breast cancer has an equal opportunity to be managed in a centre which is capable of delivering the best possible results. The standards provide that each specialist unit should manage a minimum number of 150 new breast cancer cases per annum. Sligo General Hospital had 57 such cases in 2006. The National Hospitals Office will transfer full responsibility for all symptomatic breast services to the national cancer control programme by the end of this month. The programme recently completed a detailed review of resource requirements to create capacity for the progressive transfer of all symptomatic breast cancer services to the eight designated cancer centres, with the objective of completing 60% transfer by the end of this year and 90% transfer by the end of 2009. Funding of €5.8 million has been allocated from the programme across the eight centres to support additional staff, including consultant, radiography, nursing and clerical posts. Funding has also been allocated for some necessary additional equipment.

The Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland, in accordance with best international standards. The developments I have outlined will ensure that a comprehensive service is available to all patients with cancer in the western region, including County Sligo. Senator MacSharry has outlined cogently and clearly his faith and trust in the services which are being delivered at Sligo General Hospital. As I have said, Senator MacSharry has raised this important issue on a number of occasions in the context of the success of the unit in Sligo General Hospital. Constituents in the western part of my county who have attended Sligo General Hospital have been extremely happy with the level of service provided there over the years. I will ensure Senator MacSharry's comments are brought to the attention of the Minister for Health and Children, Deputy Harney.

Photo of Marc MacSharryMarc MacSharry (Fianna Fail)
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I thank the Minister of State for his reply and fully appreciate that he will bring the issues to the attention of the Minister for Health and Children, but I also ask that they should be brought to that of the Taoiseach.

I raise a point of correction. In 2006 there were 57 or so cases in Sligo while there were 93 in 2007. I do not necessarily want a centre of excellence in Sligo but I want one in the region. There would be case levels in excess of 170 to 250 in the region, depending on whether one includes Mayo. I appreciate the reply but it was clearly done by those in the HSE who back up and are sticking to the argument that Sligo had only 57 cases in 2006. It had 93 cases in 2007, so we are not comparing like with like. I do not know why the HSE is set against the north-west region.

This is a huge issue which also affects west Cavan in the Minister of State's constituency. We must be true to the people. I appreciate the Minister of State will bring the points to the attention of the Minister for Health and Children and I must insist that the matter be brought also to the Taoiseach's attention.

Yesterday, Professor Keane said people were voting with their feet on this issue, which was extremely disingenuous. He was talking about Beaumont Hospital, possibly connected to the Portlaoise scenario. There is absolutely no evidence to suggest people currently attending a symptomatic breast clinic in the north-west region have voted with their feet and stated they do not wish to be treated in that region. It was disingenuous of Professor Tom Keane to say that.

I thank the Minister of State for his response and accept he will bring the points to the attention of the Taoiseach and the Minister for Health and Children.