Dáil Éireann - Volume 597 - 10 February, 2005

Other Questions. - Hospital Services.

  8. Mr. Ring asked the Tánaiste and Minister for Health and Children the number of persons treated with radiotherapy at a private clinic in Galway; the intended number of patients that will be treated in any one year; and if she will make a statement on the matter. [4258/05]

[1045]   Ms Harney: The Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for decisions in relation to the referral of patients to a private treatment facility, where appropriate. Factors which are relevant to such a decision include assessment of patient need, existing service availability, indemnity and quality assurance.

The Health Service Executive, western area, has informed my Department that it is working with the Galway clinic to develop protocols or care pathways to deal with patients who require radiotherapy, mainly for emergency and short-term palliative purposes. My Department has been advised that approximately 50 public patients have been referred to the clinic to date.

The western area of the executive is confident that the supra-regional radiation oncology centre at University College Hospital Galway will be fully commissioned and ready to treat patients in March 2005. Last year, approval issued for the appointment of 102 staff for this unit, together with additional ongoing revenue funding of €12 million to cater for this expansion. Approval issued for the appointment of an additional consultant medical oncologist and three consultant radiation oncologists, two of whom have significant sessional commitments to the north-western and mid-western areas. Key staffing is in place, with two consultant radiation oncologists taking up posts in February and March. The HSE western area has been requested to prepare a development control plan to facilitate the expansion from three to six linear accelerators in the medium term. The capital project team is working to develop a brief for this expansion.

As recommended in the report on the development of radiation oncology services in Ireland, the national radiation oncology co-ordinating group has been established. The group comprises clinical, technical, managerial, academic and nursing expertise from different geographic regions. The group’s remit encompasses recommending measures to facilitate improved access to existing and planned services, including transport and accommodation. The group will also advise on quality assurance protocols and guidelines for the referral of public patients to private facilities.

  Dr. Twomey: A number of local and national issues arise in regard to this question. The Minister stated that so far 50 people have been treated. How many people will be treated in this private clinic next year when the public clinic is up and running? I presume the Minister is aware that the average number of patients receiving radiation within one month of diagnosis in the west is at 3% and this increases to only 19% within two months of diagnosis. It is important to know whether the executive will cut short its [1046] contract with the private clinic and treat patients only in the public facility in Galway.

I would also like the Minister to answer some questions on the radiation oncology report, otherwise known as the Hollywood report. Although it took four years for this report to be published, one of the central points in the report was that the Minister supported centralisation of radiotherapy services and did not believe that small units were safe. A small unit is now being used, although it is a private clinic.

Another problem is that the oncologists wrote a separate report. Their submission was never acknowledged, which is surprising. What is the Minister’s position now? Is the Hollywood report being set aside and is the view of the oncologists coming to the fore? I have highlighted the issue regarding Galway. This is an extremely contentious issue in the south east and has been for the past three or four years while we awaited publication of the radiation oncology report.

  Mr. McHugh: The Minister said that the radiotherapy unit in Galway would open in March. Does that mean patients will be treated in March or will there be a lead-in time? If there is a lead-in time, will the Minister intervene with the HSA to extend treatment services in the private clinic to everybody in the region who needs radiotherapy?

  Caoimhghín Ó Caoláin: The Minister indicated that 50 patients had been referred under the national treatment purchase fund to the new private clinic in Galway. What stage are we at regarding the introduction of the radiation oncology unit in Galway? Has that yet been established and, if not, when will it happen? Have we got our priorities right? Is that not what is committed to, even in the limited form of the radiation oncology sites, two in Dublin, one in Galway and one in Cork? Many others are required.

  An Ceann Comhairle: The Deputy should be brief. We are running out of time.

  Caoimhghín Ó Caoláin: The NTPF is surely not the answer in all cases.

  Ms Harney: To be fair to Deputy Ó Caoláin, he probably did not hear my answer. The Galway facility is in place. I visited it in January. It will treat patients in March. Approximately 102 staff have been trained. The lead-in time has been going on since last summer.

We have a mixed health system in Ireland with approximately half the population in private health care insurance. We need to ensure that private facilities, provided they are up to standard — the State’s job should be standard-setting — are used to treat patients where they are available. We must see people as patients, regardless of whether they are insured and whether they have access to finance. It adds to the trauma of [1047] cancer patients and their families if they have to travel long distances for radiation treatment.

In a country of 4 million people we cannot have linear accelerators and bunkers everywhere. We need to think in terms of a national network where everything fits together, whether it is provided by the State or by the private sector.

I have the report Deputy Twomey mentioned, I received it ten days ago. It makes recommendations for the future. I want to ensure provision in the regions, including the south east and the north west. Facilities are being provided in Limerick at the moment. I want to make sure that the trauma of the experience of cancer is minimised for as many patients as possible. I understand that international experience is that to provide safe treatment, two linear accelerators are needed at any one facility. In this area it is not just the machinery and the bunker that are important but expertise and radiation oncologists. Once all that is networked together for the country, all the patients will get the benefit of that expertise. Much of it can be done in satellite centres and that is the Government’s plan. I will make an announcement regarding these matters shortly.

  Dr. Twomey: It seems the Minister is going against the recommendations of the Hollywood report and going with the oncologists’ recommendations.

  Ms Harney: I have not yet finalised my view on the report. I support the view that two centres are needed in Dublin. The report suggests a need for 35 more linear accelerators over the next few years. We need to keep an open mind regarding how we make that happen. In particular, we need it all to work together. In too many areas of health care there are stand-alone facilities which are not being used to their full potential because people are not all working together. In cancer care in particular we need people working together. That is what happens in many parts of the United States of America and elsewhere. I hope we will be able to do that in Ireland. I had a good meeting with a number of people in this area recently and we need to avail of the best expertise in this area. On the issue of the private clinic in Galway, if there is capacity and there is not enough in the public system for patients, we should use that capacity rather than force people to travel to Dublin. That does not make sense from a cost and transport point of view or from the point of view of the patient and his or her family. I want to see the private facilities used.

  Mr. Gormley: When the Tánaiste speaks about the hybrid system, private and public care, does she agree the reason more people are turning to private care and private health insurance is that they believe it confers an advantage on them. They believe the health system is so bad——

[1048]   An Ceann Comhairle: That does not arise out of this question.

  Mr. Gormley: ——that the only way they can get that care is by going private.

  Ms Harney: There is no doubt the mix system has worked well in Ireland. I am a strong supporter of people making investment in the provision of their own health care while they can. We will get more resources in that context. It is a question of ensuring that a person who does not have the possibility of becoming privately insured is not disadvantaged and that the private facilities can be used to his or her benefit as well. We can do both and we can get much more private investment in health care in terms of bed capacity and diagnostics. There are many areas where the private sector can make a contribution to delivering better services for the population.