Thursday, 20 January 2011
Dáil Éireann Debate
Deputy Pearse Doherty: The matter I wish to raise relates to the north west radiotherapy centre that was due to be built in Altnagelvin. Construction was due to be completed in 2015. The people of the north west, namely, those in Donegal and Derry, are very concerned with regard to the unilateral decision taken by the Minister for Health, Social Services and Public Safety, Mr. Michael McGimpsey, MLA, last week to the effect that construction on the centre will not now proceed. This has given rise to fears among cancer sufferers in the north west, their families and those who campaigned long and hard to bring us to the point were a centre such as that proposed for Altnagelvin was to be built on a cross-Border basis.
Under the agreement that was reached, the authorities in this State were supposed to purchase services from the Assembly in the Six Counties for the people of Donegal. This is a central plank of the State’s cancer strategy. In light of Minister McGimpsey’s decision, I am seeking that the Tánaiste and Minister for Health and Children intervene. I am not sure whether any discussions took place between the previous Minister for Health and Children and her counterpart in the North. I welcome the fact that responsibility for health and children now lies with the Tánaiste, Deputy Coughlan, who, in view of the area in which she lives, will have a clear understanding of this matter.
There is a need for both dialogue and an element of straight talking with the North’s Minister for Health, Social Services and Public Safety in respect of this matter. The Minister of State, Deputy Moloney, will be aware of the unique governance arrangements that exist in respect of the Assembly in the Six Counties. Unlike their counterparts in the South, each Minister in the Six Counties has executive authority. While the Executive in the Six Counties agrees the overall budget and the allocations for each Department, it is the responsibility of the relevant Ministers to decide how money is spent. They do not require the approval of the Executive in this regard. Those arrangements came about under the British-Irish Agreement. They were drafted in the context of our past and were designed to ensure that no section of the community or party could interfere with the budget of a Minister from another party.
Even though €25 million has been ring-fenced in the draft budget of the Executive in the Six Counties for the Minister for Health, Social Services and Public Safety to proceed with the project, the latter has taken a unilateral decision to the effect that the centre will not be built because he cannot guarantee that, post-2015, he will have the money required to cover the running costs of the facility. Of course, this presumes that Mr. McGimpsey will be Minister for Health, Social Services and Public Safety following the Assembly elections which are due to take place in May. In addition, the budget in the North is a four-year budget and it runs from 2011 to 2015. There is again, therefore, a presumption that in 2015 the money relating to the facility will still not be forthcoming in 2015.
The Department of Health, Social Services and Public Safety is the only Department in the North not to have its budget cut. This is due to the existence of what is termed the “block grant”. The position in the Six Counties is different to that which obtains here. The Assembly does not have tax-raising powers and must rely instead on the block grant provided by the British Exchequer. The money allocated under this grant is disbursed among the various Departments. As already stated, the budget of the Department of Health, Social Services and Public Safety was not reduced.
The refusal to build the centre at Altnagelvin, even though the money relating to the project has been ring-fenced, is playing on the fears of cancer sufferers in the north west. I am of the view that the North’s Minister for Health, Social Services and Public Safety is posturing and is trying, perhaps, to strengthen his hand as he enters negotiations with the Minister for Finance and Personnel on the need for additional funding. This is despite the fact that the entire block grant for the North is allocated to the Department of Health, Social Services and Public Safety.
It would be easy to take the view that this is a matter with which the northern Executive should deal. I am of the view that it is not an issue for the Executive because, in light of the unique governance arrangements that exist, the Minister for Health, Social Services and Public Safety is in a position to decide how his Department’s budget should be spent. If he decides that it will not be spent in particular areas, the northern Executive has no control over his actions. There is, however, a role for the southern Government. The need for the centre has long been recognised by the health Departments, North and South. This matter has been discussed by the North-South Ministerial Council on many occasions. I commend the Government in this State on its commitment to provide Exchequer funding to build the centre in the north west and to cover some of the operating costs. It is central for the people of Donegal and for the cancer strategy. I ask that the new Minister for Health and Children, who has this responsibility, would engage with her ministerial counterpart in the North to discuss and try to find a resolution to this issue as soon as possible.
Minister of State at the Department of Health and Children (Deputy John Moloney): I apologise to Deputy Doherty for the absence of the Tánaiste. I welcome the opportunity to set out the current position in regard to the proposed radiotherapy centre at Altnagelvin and radiotherapy services nationally. On average, approximately 24,000 new cases of invasive cancer, including non-melanoma skin cancer, are diagnosed each year. Current trends indicate that the number of cancers diagnosed each year is likely to double in the next 20 years.
It is against this background that the HSE’s national cancer control programme is being implemented. Its goals are better cancer prevention, detection and survival through a national service based on evidence and best practice. Part of the programme is the implementation of the national plan for radiation oncology, which was originally agreed by Government in July 2005. The plan is designed to provide the national infrastructure for radiation oncology for the next 25 years.
Phase 1 of the plan involves the construction of new facilities at Beaumont and St. James’s hospitals, with four linear accelerators in each. These new centres were completed at the end of last year. The two facilities, together with St. Luke’s Hospital in Rathgar, now form the St. Luke’s radiation oncology network for Dublin-mid-Leinster and Dublin north-east. This will provide sufficient capacity to deal with patient needs until at least 2015. Phase 2 of the national plan for radiation oncology will provide additional radiation oncology capacity at St. James’s and Beaumont hospitals, Cork University Hospital and Galway University Hospital, with satellite centres at Limerick regional and Waterford regional hospitals.
To deal with the specifics raised by Deputy Doherty, there are particular geographic concerns that need to be addressed for patients in the north west. For that reason, the Government also decided in July 2005 that the best option for improving geographic access to radiation oncology services for patients in the north west was through North-South co-operation. It was therefore decided to facilitate access to Belfast City Hospital for patients needing radiation oncology treatment. A service level agreement has been in place with Belfast City Hospital for the provision of radiation oncology services to patients from Donegal since 2006.
The Government also decided it would consider a joint venture between North and South for the provision of services from a satellite centre in the north west, linked to Belfast City Hospital. In 2008, Mr. Michael McGimpsey, Minister at the Department of Health, Social Services and Public Safety in Northern Ireland announced that a new satellite radiotherapy centre would be established at Altnagelvin Hospital in Derry, linked to Belfast City Hospital, as part of Northern Ireland’s plans for the provision of radiotherapy services beyond 2015. At that time, the former Minister, Deputy Harney, agreed to fully explore the opportunity presented for further collaboration in the delivery of those services.
The business case for the development at Altnagelvin has now been finalised and is under consideration by the Minister, Mr. McGimpsey. I am pleased to confirm that the Irish Government has committed to providing a significant capital contribution to the project. This contribution recognises the fact that approximately one third of the patients who will attend the Altnagelvin centre will be from Donegal and the surrounding areas. In addition, the national cancer control programme will contribute on an agreed basis to the operating costs in respect of patients from the Republic of Ireland who attend this service.
The Government is committed to working in partnership with colleagues in Northern Ireland on the development at Altnagelvin. The Department of Health and Children and the HSE have nominated representatives to the various sub-groups overseeing the development of this project. The discussion of patient pathways will include input from clinicians at Letterkenny General Hospital and St. Luke’s Hospital who are currently involved in the delivery of radiotherapy services to patients in Letterkenny. The Government’s financial contribution to the project was confirmed to the Minister, Mr. McGimpsey, in the past few weeks.
The Government is committed both to the radiotherapy centre at Altnagelvin and to the development of radiotherapy services nationally. Approximately half of cancer patients will require radiotherapy at some point in their illness and the aim is to ensure best outcomes for these patients regardless of location.
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