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A commitment by Health Service Executive (HSE) chief executive Brendan Drumm to publicly identify, within 48 hours, those centres for breast cancer treatment that operate to standards of best practice is a significant and courageous response to the crisis of confidence that besets the system. It will make him no friends, while antagonising powerful vested concerns. But it places consumer interests at the heart of the health system and allows patients to make informed choices about their treatment.

A succession of faulty cancer diagnoses at Portlaoise hospital is causing immense distress to individuals and families in that community. That situation could be replicated elsewhere because of inadequate scanning equipment and a shortage of specialist personnel. By identifying those centres the HSE is prepared to stand over for their quality of service and multi-disciplinary teams, Professor Drumm will be inviting patients to vote with their feet. At the same time, he has provided assurances that basic cancer care services - such as the provision of chemotherapy - will continue to be provided at all existing centres.