In recent weeks there has been much public debate about the quality and adequacy of cancer care services. It is fair to say that public confidence in these services is low. The solution proposed by almost everybody is the notion of centres of excellence. It is the strategy being put forward by the Government and the HSE, and all political parties as well as most medical professionals have subscribed to the idea.

However, I am not clear as to what the Government means by "centres of excellence". How many such centres will there be? Professor O'Higgins spoke about 12 in his first report but the HSE now seems to have eight in mind. The announcement by the executive in September identified eight "designated cancer care centres". Will these be the eight centres of excellence? Has the Government approved those eight centres? What is the position regarding the north west? The Minister of State, Deputy Jimmy Devins, seemed to indicate that Sligo will be added to the list at some point. Will there be nine centres of excellence rather than eight?

In regard to the timescale, the HSE has stated that all cancer care services will be transferred to these eight centres by the end of 2009. Where does this leave cancer care services that are being provided in private facilities? Is it intended that they will continue separately or will they also be transferred to the centres of excellence? How will we know that a centre of excellence has been deemed to be such? Will there be some statement to the effect that there is now a centre of cancer care excellence in Hospital X? Is there some formal process by which it will be communicated to the public that these centres of excellence are in operation?

What is the budget? The chairman of the working group overseeing the plan, Mr. O'Brien, says that no costings or budget have yet been worked out for its implementation. Professor Keane, the interim director of the cancer care programme, says transitional funding will be needed in the next two years to bring the centres of excellence into being. However, it seems no budget has been identified. How will they be funded?

I will try to answer as many of the Deputy's questions as possible. In June, the Minister for Health and Children approved the national quality assurance standards for symptomatic breast disease services under the Health Act. The aim of the standards is to ensure that every woman who develops breast cancer has an equal opportunity to be treated in a centre that is capable of delivering the best possible outcome. In September, arising from the designation of cancer centres and to comply with those standards, the HSE directed 13 hospitals with low case volumes — fewer than 20 procedures — to cease breast cancer services immediately, to be followed by a further staged reduction in the number of hospitals providing cancer services from 22 to eight.

Several of these hospitals have in practice already discontinued or are in the process of discontinuing symptomatic breast services. The National Hospitals Office has already planned the redirection of this symptomatic case load. Additional groups of hospitals will be similarly directed, and this process will go on, as the Deputy observed, for the next year or two. That will be done in line with the further development of quality assured capacity in the eight designated centres. The HSE plans to have completed 60% of that transition from the current 22 to eight designated breast centres by the end of next year, and 90% by the end of the following year.

Discussions between the HSE and the four managed cancer control networks will focus on identifying the capacity issues for the eight designated centres so that a detailed transitional plan can be put in place to facilitate a progressive and carefully managed transfer of services in the next two years. That work has not yet been undertaken but it is the next issue. The HSE announced last week that within weeks, breast care services will be transferred in some of these hospitals and this will happen progressively.

In regard to cost, the development and improvement of diagnostic and treatment services for breast cancer patients is a major priority development for cancer care services. The national breast screening programme, combined with the quality-assured symptomatic breast disease services I have mentioned, is a key element of the cancer control programme. Resources totalling €60 million have been put into this already.

The next stage begins when Professor Keane takes up his role on Monday. When he examines the work over the next six weeks or so, he is expected to designate the national clinical leaders for radiation, surgery and medical oncology. Arrangements are in hand to enable him to take control of all cancer services between now and the Christmas period. From 1 January he will take charge of all existing cancer services and related funding and staffing.

He will start with the work done to date and take over everything as it progresses into 2008. As I understand it, he intends to designate the locations for a range of cancer specialties by early January, so he must make that call at that time when he is fully briefed on the position and the ongoing work. As soon as he arrives, he will engage in detailed planning to facilitate these designations and the orderly phased transfer of services between the locations. He plans to have completed 50% of that transition of services to cancer centres next year and 90% of the transition by the following year.

The Taoiseach has described how we will have fewer centres providing cancer services. He has not said how these remaining eight or nine centres will be better. That is what the public wants to know about. For the past week or more we have been speaking about centres of excellence, and the expectation is that these will be better facilities than we have currently. How will they be better?

For example, last week it was announced that the service in Mullingar was to be discontinued and patients would be transferred to the Mater Hospital. What has happened in the Mater that will lead to a better service? Has it received extra equipment as a result of this? Will there be extra staff or is it just a case of the hospital having extra patients? How will the service be better in hospitals that will simply have extra patients?

The Taoiseach noted Professor Keane is due to start on 1 January. What budget will he have to provide the new and better services people are being led to believe will be provided? The difficulty is that there is now a general concern about the quality and availability of cancer care services, and there is a programme to reduce the number of centres where such services are being provided. This is being led on the basis that there will be centres of excellence but how will these centres be better?

Is this just a rationalisation of the number of centres and a reduction in the number of centres without the service in the larger centres necessarily being better?

Professor Keane will take over the entire budget. Every year we have allocated more resources, both in capital and on the current side. Much of this relates to staff. Last week I may have said 120 consultants were taken on, but 111 consultants have been taken on. The problem is these consultants are spread about in the system. It is important to emphasise that the decision to reorganise the service is about achieving optimum outcomes. It is not in itself a value judgment on work being done in the existing centres, some of which have a relatively large caseload at present but will not be part of the future centres.

The bottom line is that to achieve the very best outcomes, we must concentrate all cancer work in just the eight centres. That necessarily means that there must be reorganisation and resources must be applied. The discussion on management, designation and operational procedures must take place before these centres move. The relevant individuals will be involved with that.

We have progressively been reducing the number of centres, and we have already moved the number to 13. The object is to quickly designate the clinical national leaders for radiation, surgical and medical oncology. This is to ensure that in each centre there will be people who will be responsible, who will have a primary role along with Professor Keane. They will be responsible for radiation, surgical and medical oncology services.

We have been told there are multidisciplinary teams in some centres at present but this will bring such teams to work together. They will have the resources and the throughput. The argument is that the more patients being dealt with in centres, the more expertise is built up and we get quality staff. Without denigrating staff at any centres, this system attracts people with expertise and competence who can carry caseloads. They clearly need other facilities but that issue is being dealt with by the management of the various hospitals and the HSE.