Bernard Durkan (Kildare North, Fine Gael)
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Question 116: To ask the Minister for Health and Children the individual, body, group or agency currently influential or most influential in the determination of the location and delivery of vital health services throughout the country; if most consideration is given to economic, medical or patient care and delivery of service expeditiously to the population as required; the template or templates which now form the basis for the formation and delivery of health policy in the future; if these coincide or are at variance with the various reports commissioned by her Department over the past eight years; if it is her intention to develop the services in line with the recommendations of any or either of such reports or an alternative; if her attention has been drawn to the widespread public concern and growing lack of confidence in some aspects of the service; if she has proposals or measures to address these issues; and if she will make a statement on the matter. [28041/07]

Bernard Durkan (Kildare North, Fine Gael)
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Question 202: To ask the Minister for Health and Children the template to which her Department is currently operating the general hospital services with particular reference to the multiplicity of reports commissioned including the ten year report, the Hanley Report and the Brennan Report; if she is working towards one or all of these models; the extent to which this will bring about closedown, replacement or co-location; and if she will make a statement on the matter. [30298/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 116 and 202 together.

Government policy is to provide safe, high-quality services that achieve the best possible outcomes for patients in line with best practice. This objective guides the configuration and development of services and outweighs all other considerations. This is not a resource issue, but a patient safety one.

The delivery of hospital services needs to be re-balanced so that, in the future, those services that can be safely delivered locally are delivered locally, more complex services requiring specialist input are concentrated at regional centres, and highly specialised services are delivered in national centres.

This issue has come to the fore most recently in the case of cancer care. There is an abundance of strong, international evidence to show that patients with cancer have the best chance of survival if they are treated by clinicians who treat a large number of patients with a similar condition per year. To secure these benefits requires a consolidation of cancer treatment services to a smaller number of centres.

A clear case for the re-organisation of the delivery of cancer services in Ireland was articulated by the National Cancer Forum, a multi-disciplinary group of experts. Having reviewed patterns of surgical activity in Ireland, the Forum concluded that "the current arrangements for the delivery of cancer services are not generally in accordance with best practice and cannot be recommended to deliver best-quality cancer care".

The Strategy recommended a move towards eight cancer centres nationally to ensure that cancer patients have access to consistently high quality care and the best chance of survival.

The HSE Advisory Group on Cancer Control, also a multi-disciplinary group of experts, advised on the hospitals to be designated as cancer centres nationally. The decisions of the HSE in relation to four managed cancer control networks and eight cancer centres will be implemented on a managed and phased basis. Professor Keane, interim Director of the National Cancer Control Programme, took up his post this week. The delivery of cancer services on a programmatic basis will serve to ensure equity of access to services and equality of patient outcome irrespective of geography. Professor Keane will be engaging in detailed planning to facilitate the orderly phased transfer of services between locations.

Last June, I approved National Quality Assurance Standards for Symptomatic Breast Disease Services under the Health Act 2007. The aim of the standards is to 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 outcome. As a first step in implementing the Standards, the Executive has directed thirteen hospitals with low case volumes (less than twenty procedures per year) to cease breast cancer services immediately, to be followed by further staged reductions in the number of hospitals providing breast cancer services.

In summary, the optimum configuration of health services is a complex and difficult issue. It needs to be managed in a consistent and coherent manner to ensure that we provide high quality and safe services to the population.