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Dáil Éireann - Volume 586 - 27 May, 2004

Adjournment Debate. - Hospital Services.

  Dr. Cowley: I am grateful for the opportunity to raise on the Adjournment. The Minister for Health and Children did not appear before the Joint Committee on Health and Children today, as arranged, to answer concerns about the [987] Hollywood report on radiotherapy. This does not augur well for any new responsibilities the Joint Committee on Health and Children may have to fill the vacuum or democratic deficit caused by the removal of the democratically-elected members from the health boards.

This is a very important matter. There is a major problem. The Minister was in the Dáil and did not speak about the radiotherapy report or answer questions on the alternative report because he said he was going to meet the Joint Committee on Health and Children. The message was that the Minister was not available to meet us today nor would he be available next month or the following month and had other business to do in Europe. As far as I am concerned that is not acceptable. Thomas Paine who inspired the revolution in France and the US said: “A body of men holding themselves accountable to nobody, ought not to be trusted by anybody.”

The Joint Committee on Health and Children is a part of the Oireachtas. Its task is to shadow the various Departments. It is composed of Senators and Deputies. The Minister has a responsibility to come before it. Under the new structure being suggested, the Joint Committee on Health and Children will be part of the accountability procedure but this does not augur well for the future.

The national cancer registry report proved once again that cancer survival depends on where one lives in Ireland. There are major deficiencies in the north-west, mid-west and the south-east. That the Hollywood report did not address the access problem is not acceptable. We have heard of various plans for private radiotherapy units in the south-east but none of these has any commitment to looking after persons with cancer who do not have money. If one has money one can have that service tomorrow, if not, one has to wait months for it. This is cancer care apartheid. Those who have money get a different service from those who do not have money.

We are entering another tier of cancer care apartheid. One will get the multidisciplinary care — the surgery, chemotherapy and radiotherapy — as recommended in the report, if one lives in Dublin, Cork or Galway but not in the south-east, mid-west or in north-west. Even when the Galway unit opens for the north-west, it will be further away than Dublin. What is proposed is not acceptable. Those in the north-west are annoyed at what is happening. They are putting up with a lifetime of pain and opting for more radical surgery and a lesser chance of cure rather than make the long journey to Dublin. Why make people travel to Dublin, where they do not wish to go, from Donegal or Waterford when the service could be provided locally at the same cost or less? Does that make sense? Ill people are not able to make the 22 journeys that are required to treat prostate cancer.

The staff costs are the same no matter where the unit is located. A unit could be provided in [988] any area at a cost of €8 million. For example, a unit could be provided in either Waterford, Donegal and Limerick. Why does the Minister insist on spending €34 million on a unit in Dublin to where people will have to make long journeys by ambulance and arrive in a nauseous state? Is it fair that ill patients must travel such distances 22 times? A patient of mine who required radiotherapy died before he received a letter offering him it. That is a scandal. If he had money, he would have accessed that service and would have enjoyed a better life instead of dying in pain.

That is a shame and what the Minister proposes is more of the same. That is not acceptable to the people in the south-east. The people will rise up and take to the street because the Government has let them down. The people in the north-west and the mid-west have been let down as well.

  Mr. B. Lenihan: The report let them down.

  Dr. Cowley: The Minister let them down. The Minister refers to the survey of patients, but 44% of patients surveyed travelled fewer than ten miles, a further 16% travelled fewer than 30 miles but a number significantly less than 13% spent more than two hours travelling. While the report acknowledged that 64% had difficulty travelling to treatment, clearly when the majority of patients selected had travelled fewer than ten miles one way and the largest representation of patients came from Cork and Dublin, travelling was not an issue in the way it was for patients who travelled long distances. The patient survey was flawed. Similarly, the Hollywood report is flawed. What the Minister is doing is not acceptable and I ask him to reconsider the situation and give a commitment for radiotherapy units to the people of the south-east and the north-west.

  Mr. Martin: Due to unavoidable commitments, I was unable to appear before the Joint Committee on Health and Children today, although I understand there was no meeting. I am happy to reschedule a date in the future and look forward to meeting the joint committee to discuss in detail my plans for the development of radiation oncology nationally. I have discussed it already with the committee, most recently during the Estimates debate last month when the radiotherapy report was discussed. Normally such meetings are scheduled to suit both the members and the Minister in terms of being in a position to attend.

  Dr. Cowley: The Minister kept putting it off.

  Mr. Martin: My office indicated some weeks ago that I would not be in a position to attend the committee meeting today.

  Dr. Cowley: Not from the Minister.

[989]   Mr. Martin: With respect, I would like the opportunity to speak. The Deputy interrupts me all the time. I would appreciate it if I was given the opportunity to speak. I did not interrupt the Deputy. Why was the meeting scheduled for today when my office had indicated some weeks ago that I would not be able to attend?.

The health service reform programme is based on the Government’s decision of June 2003. This decision was based on the audit of structures and functions in the health system carried out by Prospectus and the report of the commission on financial management and controls in the health service. Both reports identified necessary organisational improvements to strengthen the capacity of the health system to meet the challenges of implementing the programme of development and reform set out in the health strategy document, Quality and Fairness: A Health System for You.

The health service reform programme has been brought to the attention of all members of health boards and the regional authority. The Government agreed that health boards and the Eastern Regional Health Authority would be abolished as part of the overall health reform programme. The Health (Amendment) Bill 2004 is an interim measure which provides for the abolition of the membership of the seven health boards, the Eastern Regional Health Authority and the three area health boards. It also provides for the abolition of the distinction between reserve and executive functions, with the assignment of those functions designated as reserve functions of the chief executive officers of the boards and the authority or the Minister for Health and Children, as appropriate.

The Bill’s publication represents a further phase of the implementation of the reform programme for the health services and is a clear demonstration of the Government’s commitment to implementing the proposals in the reform programme, which include the establishment of the Health Service Executive on a statutory basis, scheduled for January 2005.

The Government accepts that there is a need to strengthen existing arrangements for consumer panels and regional co-ordinating advisory committees in representing the voice of service users. These structures incorporate patients, clients and other users, or their advocates. They will work to provide a bottom-up approach to understanding the needs of service users at a regional planning level. These existing models are at different stages of development and will continue to be enhanced. These mechanisms will serve to bring the patients-clients’ views and inputs to bear in the decision making process.

I am aware that concerns have been expressed regarding the issue of public participation within the restructured health system. I have already indicated my intentions to bring forward proposals to provide opportunities for democratic input in the context of the new structures. I have given some consideration to the most appropriate [990] mechanisms to support the development of appropriate interfaces at regional and local level between locally elected representatives and the Health Services Executive with a view to including provisions for these mechanisms in the legislation being drafted.

The provisions are likely to include establishment of a series of regional fora to facilitate local representatives in raising issues of concern on health services within the region with the new executive. These fora would allow local representatives to comment on and raise issues related to the development and delivery of health services locally and regionally. Membership of the fora would be based on participation of a small number of nominees in respect of each local authority in each regional forum. The number has not been determined yet. Members of the fora would also have the facility to raise particular issues with the executive.

My overall objective in putting in place such arrangements is to ensure that the voice of public representatives will continue to be heard in the development of health services. The members of the local councils will be nominated by the county councils and corporations. I am working, and have been working with the association of health boards in refining these proposals. These mechanisms would be designed to complement and reinforce the role of the Oireachtas Joint Committee on Health and Children in reflecting the views of public representatives in the ongoing oversight of the health system.

The health strategy set as one of its objectives greater community participation in decisions about the delivery of services. The Health Boards Executive in association with my Department issued guidelines to the health boards on community participation which set out the principles and framework for structures for such participation. To date, most of the health boards have set up consumer panels that deal with a wide range of issues such as development and delivery of services. Two boards have also established regional advisory panels for older consumers and their carers. It is my intention that these structures will be established on a statutory basis in a Bill which I intend to bring before the House later this year.

On the radiation oncology service in particular, I have outlined to the House and the committee on many occasions Government policy in this area. I have also outlined the significant progress that has been made in implementing the report on the development of radiation oncology services in Ireland.

  Dr. Cowley: What about the north-west?

  Mr. Martin: The Joint Committee on Health and Children has already heard detailed presentations from a number of clinicians on radiation oncology services. One of the participants was Professor Donal Hollywood, who chaired the expert group that produced the [991] report on the development of radiation oncology services in Ireland. In his presentation to the committee, he set out the basis of the model for the development of radiation oncology services nationally which ensures both quality and equity. The report, which has been endorsed by Government has received significant additional endorsement from prestigious bodies such as the American Cancer Society and the National Cancer Institute in the US. The faculty of radiologists of the Royal College of Surgeons in Ireland has advised the chief medical officer of my Department that the report and its comprehensive recommendations have been endorsed by the faculty. No less a figure than the renowned oncologist expert, Deputy Cowley, disagrees with the eminent bodies who know what they are talking about when it comes to cancer care and oncology.

The implementation of the report’s recommendations is my most important priority in cancer services in the acute hospital setting. I have provided additional resources this year to begin to implement the report’s recommendations.

The immediate developments in the southern and western regions will result in the provision of an additional five linear accelerators. This represents an increase of approximately 50% in linear accelerator capacity. We have also provided for the appointment of an additional five consultant radiation oncologists. Recruitment for these posts is under way. We have ten consultant radiation oncologists nationally. This will result in a significant increase in the numbers of patients receiving radiation oncology in the short term. For the first time ever, the people in the west under Fianna Fáil and the Progressive Democrats will get a radiotherapy service that they never had before and they will not have to travel to Dublin once the service is in place. That should be welcomed by Deputy Cowley and not denigrated.

We will develop a national integrated network of radiation oncology, based on equitable access regardless of location and an effective national quality assurance programme.

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