To achieve the Department's aim of providing senior trained doctors around the clock in all acute hospitals necessarily implies rationalising the hospital network. A surgeon who works almost exclusively on breast or bowel cancer has much better results than a general surgeon. Three or four working together have far better results than some one working in isolation. There needs to be a catchment area of some 200,000 to 300,000 people for doctors working in an acute hospital to maintain their expertise. There is probably a threshold below which people served by an institution get less than acceptable care.
Battles continue at local level.
The Midlands Health Board, with a population of 200,000 and three general hospitals, two years ago acted on a plan drawn up by TCD oncologist Prof Donal Holywood and attempted to establish a regional centre of excellence for cancer services in Tullamore. This was coincidentally the home town of the then Minister for Health, Mr Cowen, although it had originally been nominated when Fine Gael's Mr Michael Noonan was minister. Portlaoise protested strongly. Physicians in the area argued that the new service should be split between Portlaoise and Mullingar. It was the geographical centre of the region, and that is where the regional oncology unit is now sited.