People in the west are up in arms because they believe that the existing cancer services work, writes Lorna Siggins, Western Correspondent
Minister for Health Mary Harney may never have had to travel from Belmullet to Galway for a hospital appointment, and Ann McDonnell and Mary McGreal hope she never will.
However, were Harney to do so as an ordinary voter next week, she would have to rise with the robin, negotiate hazardous secondary roads, hit long tailbacks from the Mayo-Galway border . . . and she might just catch a glimpse of sunrise in the queues for University College Hospital, Galway's (UCHG) car park.
Small but significant daily realities like these tend to have no place in grand plans drawn up by Government. One such plan, the new national cancer control programme announced jointly by the Minister and the HSE, is welcomed by McGreal, McDonnell and members of a number of cancer-support groups in the west of Ireland.
Why, then, have they been marching over it? The issue for the groups and several thousand supporters who took part in demonstrations in both Sligo and Mayo over the past few days is that they are already very happy with the service currently being provided in both counties. They also believe that up to 250,000 people may be adversely affected if the existing treatment network in Donegal, Sligo, Mayo and Galway is dismantled.
"We are all in favour of centres of excellence if they can improve treatment," McGreal, spokeswoman for several Mayo breast cancer support groups, says. "It is just that we think we already have a centre of excellence at Mayo General Hospital in Castlebar."
That wasn't the case seven years ago, when the report on cancer services by Prof Niall O'Higgins was published and advocated streamlining of services, with 13 specialist centres across the State.
McGreal recalls how angry she felt at the time, as she was returning home from hospital after breast cancer surgery. She had to travel to UCHG for chemotherapy, but traffic then was considerably lighter. "It was, and is, not a good journey at all if you are sick.
"We got together back then, we mounted a huge campaign, and we now have a first-class unit here, with our own surgeon, a multidisciplinary team which works very well as a satellite of UCHG, and with specialist equipment which was financed with voluntary fundraising," McGreal says. "Ironically, this new plan proposes setting up a satellite in Letterkenny, Co Donegal, on the model of Mayo, and phasing Mayo's satellite unit out!"
Ann McDonnell, a breast cancer survivor in Belmullet, echoes McGreal. "I live 50 miles from Castlebar, and for outlying areas like Carrowteigue and Blacksod, the hospital in Castlebar is a long enough journey," she says.
"I don't believe UCHG wants all of Mayo descending on it now for cancer treatment, when it already has one of the longest public waiting lists in the State."
HSE West has been at pains to counter some of the publicity generated over the issue in the past couple of weeks - most notably, a claim by Fine Gael leader Enda Kenny that Mayo General could start to lose its cancer treatment services within three months.
Last week, junior health minister and Sligo-based TD Dr Jimmy Devins told Ocean FM radio that he was "absolutely outraged" at the decision to phase out cancer surgery at Sligo General Hospital.
HSE West says that successful cancer centre models abroad were examined as part of the decision to designate eight centres of excellence for cancer treatment - UCHG (with "some linkage to Letterkenny") and Limerick Regional Hospital being the designated centres for its region.
"There are currently around 2,000 cases of breast cancers in the public hospital system. However, it can be expected that BreastCheck, the National Breast Screening Programme, will reduce this number of symptomatic presentations over time by between 33 per cent and 50 per cent," HSE West says.
BreastCheck, which has been delayed in its State-wide roll-out, is expected to start taking its first appointments at UCHG in several weeks, according to Harney's party colleague, Galway West TD Noel Grealish (PD).
In transmitting the information last Friday, Grealish even went so far as to identify women in "Annaghdown, Moycullen, Spiddal, Slievevaneena, Tullykyne and Wormhole" as being among the first to expect their screening letters.
HSE West says the eight centres were identified, taking into account existing levels of activity in some larger centres and the minimum throughput (150 new cases per year) in the report of the expert group chaired by Prof Niall O'Higgins.
While some 13 regional centres have been asked to discontinue breast cancer surgery altogether, such as Portiuncula in east Galway, others such as Mayo General Hospital and Sligo General have been asked to do so on a phased basis.
According to HSE West, this transition will be "planned" and resources to deal with the additional workload at UCHG's centre will "need to be put in place before services are transferred from Mayo General or Sligo General".
It doesn't put a timeframe on this, but says that it is expected to take "several years to complete".
Mr Kevin Barry, consultant general and breast surgeon at Mayo General Hospital since 1999, says the clinical network in the west has worked very well, recognising poor infrastructure and geographical considerations. This is largely due to the symbiotic relationship which Mayo General has developed with UCHG, he says. This year, some 79 cases of breast cancer involved operations at Mayo General Hospital, a rise of 66 on the previous year.
Prof Michael Kerin, professor of surgery at NUI, Galway, says the fundamental issue is the need to guarantee a good outcome for people who have been diagnosed with cancer.
"Ultimately what care anyone is given depends on the resources they are given, and it is quite clear that the number of small units functioning currently is untenable," Kerin says.
At the same time, Kerin believes there may be room for flexibility - in relation to satellites for instance - within an integrated system of top quality care. Much will depend on the overall budget for the new cancer control programme.