Last week in the Taoiseach's absence, the Minister for Defence advised the House that the Hanly report had been changed and that the threat to accident and emergency services at Nenagh and Ennis hospitals had been lifted. Will the Taoiseach spell out exactly in what way the Hanly report has been changed, as the Minister claimed? Will he advise the House of the present status of the report? When David Hanly addressed the Oireachtas Joint Committee on Health and Children, he advised that 60% to 70% of cases presenting at accident and emergency units at local hospitals were of a non-urgent variety. Does the Taoiseach not accept, therefore, that 30% to 40% of cases presenting are of an urgent variety and require accident and emergency attention at the local hospitals closest to where the patients might present?

Do the changes to which the Minister referred mean that the Government has now taken on board that there is a risk in terms of urgent cases presenting at hospital sites throughout the State and that the Hanly report has been altered to meet that need? If that is the case and there is no threat to accident and emergency services at Nenagh and Ennis, will the Taoiseach advise if the same formula will be applied to Monaghan General Hospital and the Louth Hospital at Dundalk and that we will see the restoration of on-call status at both these hospitals for all accident and emergency requirements?

Today, the National Cancer Registry of Ireland published a study which, in its own words, provides strong evidence that cancer treatment and survival can depend on where one lives. It points out that the Eastern Regional Health Authority has a significantly better chance of delivering the required supports and people have a better chance of living with cancer than they do if they live in the North Eastern Health Board area, on which I depend, and in the Southern Health Board area. Is this not indicative that there is not only a two-tier health system in regard to people's ability to pay but also geographically?

The report on the communication process undertaken following the Government's decision on health service reform was published last November and I gave all the details on this issue. At that stage, we were requested to broaden the team and the scope and to listen to the concerns. The case was made that in the evening, it would be a nurse-led service and the demand was for a medical-led service. A team of 15 of the health service employers joined the health reform project office within the Department to work with it. The board of the interim health service executive was appointed in November. The first meeting took place early in the year. The national steering committee to oversee the implementation reform programme has been appointed. The implementation groups in respect of the Hanly report, the specific issue the Deputy raised, in the east coast area and in the North Western Health Board were also announced. The acute hospital network was announced at the end of January.

As part of the above, the Minister clarified that both in Ennis and in Nenagh, there would be a doctor-led service. Subsequently, that demand extended to other areas. He also clarified that there would be a doctor-led service in Dundalk and Monaghan. Obviously, that does not cover the highly specialist areas people want, but at least it deals with the accident and emergency-type or more local services provided by having a doctor on site. That dealt with the issue. That is now the policy and the Minister has stated that in a number of the health board areas he has visited. He has given letters and has stated the position clearly.

In regard to cancer, there is no doubt that if one lives near major hospitals and if something goes wrong, one is in a more advantageous position. I will not argue with Deputy Ó Caoláin on that basis. If one lives, as I do, a short distance from Beaumont and the Mater hospitals and if something goes wrong, one is more fortunate than if one lived on the Dingle peninsula, the Inishowen peninsula——

Monaghan.

——or perhaps in other parts of the country. However, that does not take away from what has been done for cancer services and, in recent years, we have spent money on them and have resourced them by providing staff, equipment and beds.

In regard to oncology services, somewhere of the order of €550 million has gone into building on the cancer strategy and providing the necessary resources. That applies to this year. Nearly 90 consultants deal with that and there is the relevant back-up staff. There has been a substantial increase everywhere in the country. As the Deputy knows, cancer patients come to the main centres for various aspects of their operative and post-operative care where the specialties are located. That is the way it is with all our main services, including heart, liver and other services. That is what the medical people believe is the best way to deal with people who are ill, the best way they can give them the service and the best way of getting people who are seriously ill back to full health. They do that for good reason, and not only in this country.

The Taoiseach has not offered any reprieve nor has he confirmed the Minister's view that Hanly has been sufficiently tweaked to guarantee the future of accident and emergency services. Does he not recognise that when he talks about a doctor, he is talking about a general practitioner? When he talks about medical, he is talking about people with medical problems and not people presenting as a result of accident and emergency who may need surgery or stabilisation prior to redirection to another major site. These are important services that our local hospital network should be able to provide.

I am sure the people of Ennis and Nenagh will be mindful of the detail of the Taoiseach's response because he has not given them the solace they believe they have received. In regard to Monaghan and Dundalk, a dark cloud still hangs over all our lives. Does the Taoiseach accept that all elected opinion has pressed for a change in this regard and for accident and emergency on-call services to be provided? Does he not recognise that in the radiation oncology service recommended network of radiotherapy centres in Dublin, Cork and Galway——

The Deputy's time has concluded. The question on cancer services is really a second question. He is allowed one question on a topical issue.