Pádraig Mac Lochlainn (Sinn Fein)
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Recently in the Dáil my colleague Deputy Pearse Doherty raised the issue of chemotherapy patients from County Donegal yet again being forced to travel to Galway because of the failure to recruit a consultant in Letterkenny University Hospital. The Minister for Health, Deputy Simon Harris, was not present that day to deal with the issue and Deputy Pearse Doherty expressed his outrage. He received a massive response in County Donegal. With all due respect to a very decent Minister of State, Deputy Marcella Corcoran Kennedy, whom I know, I am disgusted that the Minister is not here to deal with the issue, particularly when he knows of the anger expressed in County Donegal the last time he did not show up. This is the second time there is a big issue in County Donegal related to cancer services and he is not here to deal with it in person. I hope we will receive a very detailed response.

By way of background, two years ago the crisis in breast cancer diagnostics and surgical operations in Letterkenny was brought to the Government's attention. There was a meeting of the cancer campaign groups, Oireachtas Members, the HSE, Saolta and senior Department of Health officials to try to resolve the issues involved. It was agreed that a second consultant breast cancer surgeon would be allocated to the hospital because the demands on the consultant surgeons were absolutely untenable. A year later, in January 2016, the Minister of State, Deputy Joe McHugh, confirmed that the then Minister for Health, Deputy Leo Varadkar, would shortly advertise the position and that the issue would be resolved a year after the crisis had manifested. We are now two years on and I am led to understand the National Cancer Control Programme is blocking the appointment and that the issue will not be resolved. The numbers of cancer patients in County Donegal were mentioned. We said the breast cancer surgeon was dealing with 3,000 cases per annum. The backlog is growing all the time. People are fiddling while Rome burns. I ask for a timeline and confirmation as to when a breast surgeon consultant will be appointed in Letterkenny to take the pressure off the consultant to whom I referred to make the service sustainable and give a guarantee to the people of County Donegal. Recently the North West Cancer Centre was opened. Services in counties Derry, Tyrone and Donegal are working together. If there is a shortage of numbers to justify the appointment of a second breast cancer surgeon in County Donegal, we should look at combining counties Derry, Tyrone and Donegal to have the critical mass required.

This issue needs to be sorted out. It has been ticking for two years. I need confirmation, on behalf of the people of County Donegal, that it will be sorted once and for all.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank the Senator for raising this very important issue and giving me the opportunity to update the House on it.

In 2007, in recognition of the particular and unique geographical circumstances applying to County Donegal, the Department set out a very clear policy direction, approved by the Government, that Letterkenny breast cancer service should operate as a satellite centre of University Hospital Galway. Specifically, on a sole exception basis, the Government agreed that University Hospital Galway should be permitted to enter into outreach service delivery in Letterkenny as an additional activity. This exception was subject to a number of conditions, including case volumes meeting the minimum criteria and all other quality assurance standards being satisfied on the same basis as for care being provided in Galway.

The Saolta hospital group has always expressed a strong commitment to continuing the Letterkenny service as a fully integrated part of the symptomatic breast disease service in Galway, including through a joint multi-disciplinary team approach. The Letterkenny service has been run by a single consultant who also undertakes general surgery at the hospital. Support is provided by Galway-based Saolta consultants who travel to conduct clinics in the Letterkenny service to meet needs arising.

Recently, with surgical vacancies arising in the hospital and patient referrals increasing slightly, the Letterkenny service has been under some pressure to meet key performance indicators. While a particular focus has been maintained on urgent referrals, challenges are arising in addressing non-urgent breast cancer referrals in a timely way. Steps taken to address this included using locum consultants to undertake clinics, increased clinics undertaken by Galway-based consultants and the referral of some women, with their agreement, to University Hospital Galway. In mid-2016 a locum surgeon was in post in Letterkenny for a period and this had a significant impact on waiting lists. With his departure, further measures are required to address the issue.

In the short term steps are being taken to appoint a full-time locum consultant breast surgeon as soon as possible and Galway-based Saolta consultants will increase their level of support for the Letterkenny service. Meanwhile, the requirements of the Letterkenny breast cancer service in the medium term are being assessed. This is being done in the light of the clear evidence that patients who are operated on by surgeons who carry out higher volumes of surgery achieve better outcomes. Efforts have been made to recruit GP support for the Letterkenny service and will be renewed. The appointment of an advanced nurse practitioner is also being pursued. The possibility of further co-operation with health services in Northern Ireland will be explored in the future, building on the level of co-operation achieved in the case of the North West Cancer Centre at Altnagelvin Area Hospital. The centre was opened in November last year and is providing access to radiotherapy services for people from both jurisdictions in the north west.

I emphasise that the Minister, Deputy Simon Harris, is very committed to providing high quality, safe health care for patients in Letterkenny University Hospital. A significant number of capital projects have been carried out, or are planned, including a medical academy, a blood science laboratory, expansion of the recovery unit and renovations to provide accommodation for a pharmacy, a respiratory laboratory and a cardiac investigations facility. The Minister is committed to the continued provision of high quality, timely services for patients attending breast cancer services in Letterkenny University Hospital.

Pádraig Mac Lochlainn (Sinn Fein)
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The Minister, Deputy Simon Harris, should be here, considering his failure to be in the Dáil to take the recent related Topical Issue raised by my colleague Deputy Pearse Doherty. I seek clarification. It has been stated steps are being taken to appoint a full-time locum consultant breast surgeon. In my dictionary "locum" means a replacement. It is not a second full-time position to work in tandem with the single consultant who is there and who, as everybody knows, has been under ferocious pressure for two years.

The people of County Donegal welcomed the opening of the North West Cancer Centre in Derry and would welcome the combining of counties Derry, Tyrone and Donegal to provide the critical mass of population required to ensure patients would not have to travel from County Donegal to Galway or Dublin, as they have had to for years. What has been forced on people in County Donegal is inhumane, indecent and wrong. We want to know whether there will be a second full-time consultant breast surgeon, not a locum, something that was promised to us in the mouth of the general election in January last year. We heard a statement to that effect from the Minister of State, Deputy Joe McHugh, on behalf of the then Minister, Deputy Leo Varadkar, and it was welcomed by the cancer campaign groups. We have sat and waited. In the last week Deputy Pearse Doherty and I have been advised by the cancer campaign groups and senior people within the hospital that the filling of the position has been blocked. I would like to have it confirmed that there will not be a locum but a second full-time consultant breast surgeon to work with the large number of patients - as I said, 3,000 - who are being dealt with by the team there. There are hundred and hundreds on what is a growing waiting list. Therefore, we need assurances. Will there be two consultant breast surgeons in Letterkenny University Hospital? We do not locums or to see drop in and out arrangements. Will there be two consultant breast surgeons in order that it can be a stand-alone service which will work in partnership with chemotherapy and radiotherapy services? That is what we need to strengthen services in Letterkenny.In Donegal and the north west we want to ensure that cancer patients, from diagnostics right through to radiotherapy, can be treated within the region and do not have to travel. We want equality of cancer care and equality of access for our cancer patients, and the Minister needs to assure us that these things are on the way. I do not mean locums, nor replacements, nor part-time drop-ins but equality of access for patients in Donegal.

I wish the Minister for Health was here as he is directly responsible for these things but I call on the Minister of State to give the necessary assurances. If possible, she can get the Minister to contact my office to do so himself.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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The Letterkenny service has been run by a single consultant but in 2016 a locum surgeon was in position to address waiting lists. I have been advised that the short-term steps which have been taken include the appointment of a full-time locum consultant breast surgeon. The Galway-based Saolta consultants will also increase their support for the Letterkenny service. However, I appreciate that the Senator requires clarity and I will endeavour to get that for him.

I convey the apologies of the Minister for Health, Deputy Simon Harris, for not being here but he was unavoidably engaged elsewhere.