Seanad Éireann - Volume 187 - 17 October, 2007

Cancer Services.

  Senator Marc MacSharry: I welcome the Minister of State, Deputy Gallagher, and am delighted to have the opportunity to raise this Adjournment matter, which refers to the need for the Minister for Health and Children and the Government to ensure cancer services at Sligo General Hospital are maintained and improved to include a satellite service for radiotherapy. I know the Minister of State is aware of this issue and that it is one which is close to his heart.

This is a very serious issue in the north west where this week we learned that Dr. Mary Hynes of the National Hospitals Office has written to the health managers in the region asking for the plan for the cessation of breast diagnostic and surgical procedures in the hospitals in the north-west region. I implore the Minister of State to exert all possible influence on the HSE to have this decision reversed as a matter of the utmost urgency.

Today in a live radio debate, Tony O’Brien, chairman of the cancer control networks, was in a position to admit to me that these decisions were taken without an audit of services in the hospitals in question. The Minister of State knows Sligo General Hospital effectively has a centre of excellence in terms of breast care. Over 4,000 mammograms and approximately 80 breast operations are done each year.

I fully support the concept of centres of excellence. However, I do not believe that in the establishment of the HSE, we set out to disenfranchise the people of the north-west region and to undermine the 50 years’ work by so many public representatives in that area from all parties and none, although it must be said from Fianna Fáil more than others because it has been in Government more often. Such expertise took so long to accumulate and be learned. I refer also to the infrastructure which has been put in place.

Tony O’Brien is a management specialist and not a health professional. I implore the Minister of State to put the people first in this instance because it is about people. North of a line from Dublin to Galway and west of Mullingar, there will be no centre of excellence. However, we already have one in the context of breast care in Sligo General Hospital. We have excellent consultants and yet we seek to downgrade that service.

Under the cancer control strategy, we suggest we will financially disincentivise hospitals which do not comply quickly enough. Surely this Fianna Fáil-led Government did not set out to achieve this. I appeal that common sense prevail in the interests of people. We do not want to send these 4,000 people to Galway. If they had to go there, where would they park apart from anything else? The infrastructure is not in place, yet it is in place in Sligo. No audit of service took place and there [559]was no consultation with the existing consultants specialising in this area. Surely this is not the way to do business.

As I said, Tony O’Brien admitted to me on live radio that the consultants in the area were not consulted and that there was no audit but that it was intended to do one now. How can we announce that we are shutting down a service which took 50 years to set up without considering the people, consulting the experts in that area and without an audit of service to ascertain what is the best?

I appeal to the Minister of State to use all his influence and that of the Government on the HSE to have common sense prevail. The cancer care strategy talks about Ireland having a network of equitably accessible state-of-the-art cancer treatment facilities. Surely we are not talking about Animal Farm equality where some people are more equal than others. We, in the north west, would buy into centres of excellence and would be quite happy for Galway to be one. However, we should not set out to do that by diluting and undermining the great services we already have. Let it be an honourable, professional and expert satellite to the services in the centres of excellence. I accept that by international best practice standards centres of excellence are the way to go in terms of clinical trials and research and development.

Oncology and surgical procedures and a centre of excellence are already available in the likes of Sligo. Why should we undermine that? Surely it would cost less to enhance the service and to make it even better so that it could act as a satellite to Galway for the people of the north west, north of a line from Dublin to Galway and west of Mullingar. It would sit with Government policy in every other way, including in terms of the national spatial strategy.

It would also acknowledge the human factor. We cannot just make a clinical decision without taking accessibility and transport into account. We are not talking about the BUPA person but about the council house dweller on the minimum wage who does not have a first cousin in Galway or uncle in Dublin with whom he or she can stay. We must be true to the people. I know the Minister of State will do all he can.

  Deputy Pat The Cope Gallagher: I thank Senator MacSharry for raising this important issue and for giving me the opportunity to outline the position on Sligo General Hospital.

As the House is aware, the HSE has appointed Professor Tom Keane as national cancer control director to lead and manage the establishment of the national cancer control programme. The delivery of cancer services in this way will serve to ensure equity of access to services and equality [560]of patient outcome irrespective of geography. This will involve significant realignment of cancer services to move from the present fragmented system of care to one that is consistent with international best practice in cancer control.

The decisions of the HSE on 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 80% to 90% by the end of 2009.

Sligo General Hospital has a dedicated inpatient oncology unit comprising 15 beds and a dedicated day services unit comprising eight beds. The HSE has informed the Department that in 2006, Sligo General Hospital had 285 patient discharges from its inpatient unit and 3,849 discharges from its day care unit. The HSE has also designated University College Hospital Galway and Limerick Regional Hospital as the two cancer centres in the managed cancer control network for the HSE’s western region, which includes counties Sligo, Leitrim and Donegal. Letterkenny Hospital is linked to the centre in UCHG because of its unique geographical circumstances.

The designation of cancer centres aims to ensure that patients receive the highest quality care while at the same time allowing local access to services, where appropriate. Where diagnosis and treatment planning are 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 that in Sligo. Cancer day care units will continue to have an important role in delivering services to patients as close to home as possible. Patients from Sligo needing radiotherapy are referred to the radiation oncology department at UCHG for treatment.

The HSE has informed the Department that in 2006, UCHG treated almost 1,000 radiation oncology patients. The number of treatments increased from 11,300 in 2005 to 18,500 in 2006. The hospital expects treatments provided to increase by 7% this year over last year.

The Department and HSE have been working closely on the examination of procurement options to expedite the delivery of the national plan for radiation oncology. The Minister for Health and Children, Deputy Mary Harney, has been assured that the HSE will have in place radiation oncology capacity to meet the needs of the population by 2010. After 2010, the HSE will continue to increase capacity to ensure that these needs will continue to be met. The Minister is fully confident that this will be achieved through a combination of direct Exchequer provision, public private partnership and, where appropriate, the use of the private sector.

[561]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. I hope the developments which I outlined here today will ensure that a comprehensive service will be available to all patients with cancer in the west, including Sligo. I assure Senator MacSharry that I will relate the very strong views he expressed on Sligo General Hospital to the Minister and the HSE at the first available opportunity.