Cancer Screening Programme: Motion (Resumed).

Wednesday, 13 April 2005

Dáil Eireann Debate
Vol. 600 No. 2

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The following motion was moved by Deputy Twomey on Tuesday, 12 April 2005:

recognises that:

—there are approximately 1,700 cases of women with breast cancer each year;

—approximately 640 women die each year from breast cancer;

—cancer screening plays a significant role in reducing deaths from cancer;

—women in the Republic of Ireland are suffering because of the failure of the Government to extend BreastCheck nationally;

—the Government misled the people in the south and west of the country in relation to the timeframe of the roll-out of BreastCheck;

—the failure of the Government to roll out the national cervical screening programme has left numerous women in Ireland go undetected for cervical cancer; and

calls on the Government to immediately roll out BreastCheck and the national cervical screening programme together with a true and accurate timeframe.

[815]Debate resumed on amendment No. 1:

“commends the Government for the significant increases in investment in cancer services, in particular the development of services for women with breast cancer and cervical cancer, and supports the Tánaiste and Minister for Health and Children in her commitment to further develop cancer services nationally.”

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  The Acting Chairman has a list of the Deputies with whom I wish to share time. I will take three minutes out of the slot.

Acting Chairman (Mr. McCormack): Information on Pádraic McCormack  Zoom on Pádraic McCormack  Is that agreed? Agreed.

  7 o’clock

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  I am pleased to have an opportunity to speak on this issue this evening. The money which was invested was invested wisely and soundly, and this has had a direct effect on the health of women in particular. However, there is one difficulty which causes great anger. A friend of mine from Galway who listens to the advertisement on the radio inviting women between the ages of 50 and 64 to avail of cancer screening gets angry when she hears the caveat at the end of the advertisement that it is only available to people living in the eastern, north-eastern and midland areas. It is understandable that this angers her. What is so different about people from the Cork or Galway regions? Why are these women not entitled to these services?

I met women at our annual conference in Cork last week who were just as angry, which is understandable. Services, particularly an excellent life-saving service such as BreastCheck, should be provided equally for everyone in the country . No one can be proud of a health service which discriminates on the basis of geography or one’s address. I am sure the Minister is not proud of this. She is keen to see the matter rectified. She has not been in the job long, but it is one of her priorities. I believe the excellent services that have been available to women on the eastern seaboard and in the midlands will soon be available to women living in the west and south.

BreastCheck has been very successful. The number of people whose lives have been saved because of early detection can be clearly demonstrated. When researching this subject, I was pleased to hear that Ireland compares favourably with figures internationally. Some 94% of women in Ireland are diagnosed with cancer without having an operation while the figure internationally is 70%. That is excellent. It is no wonder that women in the parts of the country that do not have a service are angry. The BreastCheck programme proves that prevention is better than cure.

[816]In the past month, many Deputies attended an information session on cervical cancer services. The point was well made that we need to set up a systematic operational screening service, which will save lives, rather than an opportunistic one.

Cecilia Keaveney: Information on Cecilia Keaveney  Zoom on Cecilia Keaveney  In the brief time available, I would like to outline my concerns about the current status of cancer services in the north-west region. I trust I may never need the services of the breast care team in Letterkenny, or in the rest of the country, but I cannot be sure. I raised this matter privately with the Tánaiste and the Taoiseach, therefore, I am confident that they, together with members of the Cabinet, are aware of the need for the surgeon in Letterkenny to be made permanent. I believe that decision is currently with Comhairle na nOspidéal.

The surgeon’s presence will provide an important service to women and families in the north west. However, if his status does not become permanent, there is a fear that not just breast services, but all cancer services will be under threat at the general hospital as staff move to permanent jobs elsewhere. This would not be fair to the staff who are working hard to expand provision in Letterkenny General Hospital or the population of the area. A permanent surgeon would be in a position to drive the provision of support services and links to appropriate existing facilities. The loss of the consultant radiation oncologist who has visited on a regular basis from St. Luke’s poses a serious problem. This post must be reinstated at St. Luke’s, with the post specified to support Letterkenny General Hospital. Similarly, the ability to have a mammogram within a reasonable time needs to be addressed.

There has been a debate about the location of multi-disciplinary teams. I visited major breast cancer hospitals in London with Europa Donna. I want the best service for the patient. I do not want to play politics with this serious matter. I met the team in Letterkenny and they are confident that they are in a position to adopt a multi-disciplinary approach now and in the future. They want the Department to examine what they are doing. They are confident their work will stand up to scrutiny.

The proposal that Letterkenny should link up with services in Derry has not advanced, therefore, I ask the Tánaiste to accept the proposal that the Letterkenny team work instead in a virtual sense with Sligo, which is already a designated site. I support cross-Border co-operation completely and feel that many solutions still lie in links with Belfast. However, months are slipping by and uncertainty is leading to heightened concern for all of us in the north west. This is not a woman’s issue, it is an issue for all of us. As a politician and a woman, I ask the Tánaiste to examine the case of the north west and consider the distances involved, which compounds the pain and anguish for people diagnosed with cancer. [817]Where possible and where safe to do so, services should be available close to the service user.

Similarly, we need the screening in the north west about which Deputy O’Malley spoke to ensure that those who are currently presenting very late are caught earlier. Some people may not realise that my home in Donegal is 20 miles further from Galway than from Dublin. Can we not look to the existing services in the North, where laboratories are already being used and screening has been established for decades? The Tánaiste is aware of the issues. I ask her to meet me and my party colleagues in Donegal to advance this issue and bring certainty to the people I represent. I know she understands the issue.

Mr. Nolan: Information on M. J. Nolan  Zoom on M. J. Nolan  I welcome the opportunity to speak on this motion. Each year more than 600 deaths occur from breast cancer, which accounts for approximately 18% of cancer deaths. BreastCheck goes some way towards ensuring that women, particularly in the age group 50 to 64, have a chance of being screened and checking out the problems at an early stage. The national breast screening programme began in 1998. So far a large number of women are alive who possibly would not be but for this national programme.

Identifying and treating the disease at an early stage is the purpose of the BreastCheck programme. I am pleased to note that this month the mobile unit for the south east began BreastCheck in Carlow. I understand that screening will begin in Kilkenny early next year. Since screening began, more than 167,000 women have been invited to be screened, yet it is extraordinary to think that of that number, only 120,000 have availed of the service, which is 77% of those in the age bracket 50 to 64. I am surprised that there is not 95% or 100% up-take of the service.

There is a case to be made for an even greater public awareness programme for women in this age group. While the authorities concerned have made many efforts to highlight and publicise the BreastCheck campaign, we must examine how we can reach, encourage and educate more women to avail of this service.

I am pleased the Minister intends to expand the programme to make screening available to women over the age of 64. Currently the target age is 50 to 64. When this has been achieved, perhaps the programme will be extended to the age group over 64. Professional advice suggests that it is more beneficial to screen people over 65 than under the age of 50. I listened to a radio programme recently where there were complaints that women under the age of 50 were not being invited to attend the BreastCheck screening programme.

I support the Minister and her Department in respect of the pilot cervical screening programme which was introduced in the former Mid-Western Health Board area.

The National Cancer Forum is currently preparing a new national cancer strategy and has [818]concluded that the current arrangement for delivery of cancer services is not generally in accordance with best practice and must be addressed.

International experience with regard to oncology surgery, in particular in respect of complex procedures, is that it should be limited to hospitals with adequate case volume, an appropriate skills mix and support services in the various areas of care. This is one of the reasons given as to why there is no radiotherapy unit in the south east. I support the case made by my colleagues at Waterford Regional Hospital for this particular service and ask the Minister to look favourably on it.

Mr. O’Connor: Information on Charlie O'Connor  Zoom on Charlie O'Connor  I also welcome the opportunity of making a brief contribution to the debate and compliment Deputy Twomey on his work in this regard. I may get a future chance to debate his political philosophies because, having received 5,815 votes in Wexford in the last general election, he now tells us a Labour-Fine Gael Government will solve all problems. Perhaps we could debate the matter on another occasion.

This is a serious subject and we should all support the Tánaiste in what she is trying to achieve. BreastCheck operates under the women’s charter, an integral feature of the programme’s day to day operation. It recognises women, not only as recipients of the service, but as having ownership on a partnership basis with the service provider.

Breast cancer is the most common cancer in Ireland with the exception of non-melanoma skin cancer. There are more than 1,700 new cancer cases each year and more than 600 deaths. Some 18% of cancer-related deaths are as a result of breast cancer. The risk of developing breast cancer is almost 9%, or one in 12. The greatest number of cases occurs in the 50 to 64 year age bracket.

The national breast screening programme was established in 1998 following a pilot period from 1989 to 1994. The aim of the programme was to reduce premature deaths from breast cancer by effectively identifying and treating the disease at an early stage. The programme targets women in the 50 to 64 year age group and commenced screening in March 2001 with phase 1 covering the eastern, north-eastern and midland regions. Screening has also commenced in Counties Wexford and Carlow and BreastCheck is expected to begin screening in County Kilkenny. Screening is offered free of charge to all women in the target age group in those areas. I support the extension of this programme.

I wish to speak about my constituency, Dublin South West, and areas such as Tallaght, Firhouse and Greenhills.

(Interruptions).

Mr. O’Connor: Information on Charlie O'Connor  Zoom on Charlie O'Connor  This is a serious subject so Deputies should not be flippant. I represent the people of Firhouse, Tallaght, Templeogue, Greenhills and Brittas who sent me here to do [819]my job and not to rise to heckles. Deputies should allow me to be serious.

BreastCheck operates in the Tallaght area beside the district library and civic headquarters and has looked after more than 6,000 women. People say that it provides an excellent service. Deputy Harney is familiar with Tallaght and has walked the same streets and knows that it is an issue. BreastCheck is working in a major population centre such as Tallaght. I can easily speak about Tallaght because it is the third largest population centre in the country. Tallaght Hospital caters for people from all over the region. It is important that I make the case for BreastCheck remaining in the area. Tallaght is a major population centre and a new city and BreastCheck should operate there permanently. Whatever happens in the future, account should be taken of Tallaght and the success of the service there. There is a great relationship between BreastCheck and Tallaght Hospital, which is in its seventh year.

I look forward to supporting the Tánaiste, as I am always happy to do, and the Government amendment.

Ms Fox: Information on Mildred Fox  Zoom on Mildred Fox  I welcome the opportunity to say a few words on breast and cervical cancer and our responsibility to ensure the incidence of both is reduced in all areas of the country. Every community in Ireland says goodbye to loved ones lost to cancer. Approximately one in 13 women will develop breast cancer during their lifetime. Irish women are three to four times more likely to die from breast cancer than many European neighbours, which is a sad reflection on the priority given to the health of Irish women.

My constituents are lucky in so far as they live in County Wicklow and are therefore eligible for the BreastCheck programme. Many women have been called twice for screening and are extremely appreciative of the service. Unfortunately it is not available countrywide and the cervical screening programme is not yet available in my area.

Early intervention is the key to reducing the number of cancer fatalities. All women, whether they are a wife, mother, sister or daughter, should have access to screening as a matter of course regardless of income or address.

At a time when political correctness has been imposed to the point of complete stupidity it seems acceptable to tell women over the age of 64 that we are not concerned enough to bother screening them. The Government collects taxes for women over the age of 64 but does not give them the same health services as their 63 year old sisters. The target age group for the BreastCheck programme must be reviewed and should also focus on high risk groups, such as relatives of women with breast cancer, and prioritise them for screening whether they are 25 or 75 years.

Support services for cancer patients and their families are extremely underfunded. A number of voluntary cancer support groups, such as the Bray [820]Cancer Support Group in my area, provide an invaluable service to families affected by cancer. However, all too often these groups must fend for themselves in terms of funding and are left waiting until the last minute to see whether they will get Government assistance. No long-term plans can be made and this puts an unfair burden on voluntary organisations which carry out unseen work in every community which would not otherwise be done.

An Agreed Programme for Government recognises the need for people in all parts of the country to have reasonable access to cancer services and aims to ensure the achievement of this objective. In that vein, I urge the Minister to ensure all obstacles are removed and that the full roll-out of these important programmes happens as soon as possible.

Mr. Blaney: Information on Niall Blaney  Zoom on Niall Blaney  Following my recent calls on the Tánaiste and Minister for Health and Children, Deputy Harney, with regard to the improvement of services in Letterkenny General Hospital, I wish to further highlight the deficiencies faced there. While there are currently no plans to downgrade oncology services at the hospital. the services currently available need to be improved and additional services are also required. In the short term, Letterkenny General Hospital needs a radiological oncologist to visit the hospital on a weekly basis. The people of Donegal urgently need access to radiotherapy services in the region. It is difficult for them to access the services in Dublin or Galway because of the long travel distances involved. The hospital needs recognition and confirmation with regard to the BreastCheck programme and a permanent consultant breast care surgeon must be appointed as soon as possible together with a consultant colorectal surgeon to provide an appropriate service for patients with bowel cancer.

Elective admissions for cancer-related procedures are affected by the pressures in accident and emergency departments, as it is not possible to ring-fence beds for cancer patients. Emergency admissions for life-threatening conditions take precedence over elective admissions. All efforts are made to give cancer patients a new elective date at the earliest opportunity but delays are commonplace. The regional directors of cancer services deem these specialist services necessary as a minimum requirement in providing a modern oncology service. It is imperative that these services are recognised as immediate necessities and not as services that would be nice to have, so to speak.

While I welcomed the then Minister for Health and Children, Deputy Martin’s announcement in 2003 to extend the breast screening programme nationally, I have serious reservations regarding the timing of its roll-out in the north-west region. It is not expected to be operational in the north west until 2007, and this is not acceptable. We need this service now. There will be three mobile units also made available in respect of this service [821]for the north-west region. I call on the Tánaiste to ensure that these units are made available in Letterkenny and Inishowen on a frequent basis.

This service was implemented in February 2000 in the then Eastern Regional Health Authority, the North Eastern and Midland Health Board areas. Since then it has been rolled out to various parts of the country but, as usual, the north-west region has been left to last. As the Tánaiste is aware, we have serious problems in the accident and emergency department in Letterkenny General Hospital, which I will continue to highlight. On average 90 people attend that department daily and there are still major delays in dealing with patients there. I would be pleased if the Tánaiste could shortly visit Donegal to see first-hand the problems in the health services there.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  I am delighted to have this opportunity to speak on this important issue, the provision of the BreastCheck screening programme on a national basis. Unfortunately, breast cancer is one of the most common cancers in Ireland. Latest statistics show that more than 600 women die from this disease every year. This is far too high a figure and it is unacceptable that so many should die from this condition.

BreastCheck is a free screening service that was established in 1998. It is targeted at women between 50 and 64 years of age. This is the group most at risk from developing breast cancer. For some time I have advocated the roll-out of BreastCheck to the remainder of Ireland, that is, mainly to the west and the south. It is noteworthy that the all-party Joint Committee on Health and Children supported this position when members of the BreastCheck management team appeared before it recently.

I welcome the capital investment of €21 million approved for the construction of the two new units in Galway and Cork. The unit in Galway will be serviced by two mobile units that will cover the whole of the west, including Sligo and Leitrim. I ask the Minister for Health and Children to continue to apply pressure on the HSE to ensure the rapid provision of these units in Galway and Cork.

It is important that women throughout Ireland have available a free mammography service. Since it has been shown by repeated studies that the early diagnosis of breast cancer is facilitated by the use of BreastCheck, this facility must be made available to all women in the relevant age group as soon as possible. That decision has been made politically; it is now imperative that the HSE puts in place the necessary infrastructure. There must not be any administrative or bureaucratic delays.

I will comment on two other screening programmes which are important. Cervical cancer can be easily diagnosed by a simple test, called the Papanicolaou smear. The rapid roll-out of this screening programme will result in a substantial reduction in mortality from this serious cancer. It should be put in place as soon as possible.

[822]A growing problem for men is the increasing occurrence of prostatic cancer. This, in many ways, is a very silent killer and one which has only recently begun to get the publicity it deserves. It can be diagnosed by a simple blood test. I ask the Minister to examine the feasibility of putting in place a screening programme to ensure that both of these silent killers can be arrested as soon as possible.

Ms Flynn: Information on Beverley Cooper-Flynn  Zoom on Beverley Cooper-Flynn  As a female Deputy from Mayo and a former chairperson and member of the Western Health Board for several years, it gives me no pleasure to have to speak on this motion. It is incredible that in April 2005 we are discussing an issue that involves discrimination against 130,000 women who are in the target group within the west and southern regions who should be entitled to have the breast screening programme in their areas.

I know the Tánaiste is sincere about this issue, but when she took up her appointment as Minister for Health and Children she mentioned in her introduction speech the entitlement of people to an equality of service throughout the country. This is a glaring example of total inequality of service affecting the women of the west and southern regions.

I remember being a member of the Western Health Board when the national breast screening programme was established in 1998 and it was welcomed countrywide. Less than two years later in March 2000 that service was available in the east, the north-east and the midland regions. We are all aware of the success of that programme since its implementation. On 27 March 2003 after lobbying the then Minister extensively for the extension of that programme, he announced its extension to the western and the southern regions, yet it is now 2005, more than two years later, and the advertisement has not even been placed in the EU Journal for the appointment of the design team. Why is that? Is it because priority was not given to the provision of this screening service for women in the west and the south?

Not only has more than two years elapsed since the announcement of the extension of the programme, it will be a further two years before the service will be rolled out. It will take probably in excess of four and a half years for the extension the programme since its original announcement. Yet when it was announced in 1998 that the programme would be available in the east and the north-east regions, the service was rolled out in a period of two years. It is clear that priority has not been given to women in the west and in the south. It is easy to understand the anger of women in those regions.

Of the 130,000 women targeted in the age group 50 to 64, it is expected that there will be detection of 400 cancers every year. Some 400 lives are being put at risk. How many times have we debated in this House the terrible carnage and loss of life on our roads? Some 400 lives in the [823]western and southern regions are at risk because of the lack of a service that is already available in the eastern region. That is unacceptable. This service has been available in Northern Ireland for in excess of ten years. As a Deputy from the west, it is difficult to stomach and to understand this situation.

I heard the Tánaiste interviewed on this matter on “Prime Time” and it was clear she intended to establish the extension of this programme as one of her priorities. I heard her talk about this at the Oireachtas Committee on Health and Children, yet a briefing document today states that it is anticipated that the advertisement for the appointment of a design team will be placed in the EU Journal shortly. In 2003 when I was a member of the Western Health Board we were told the roll-out of this programme would take 18 months. It now appears that since its original announcement it will take four and a half years. That is not acceptable.

When one considers the international comparisons of mortality rates of women with breast cancer, the rate is significantly higher here and above the EU average. How could it be any different when virtually half the women are not getting a service that is vitally needed? I ask the Minister to put this service in place for women who are desperately in the need of it as a matter of priority. I take up a point Deputy Fox raised. It is important to extend the screening programme to include women, irrespective of their age, who are particularly at risk because of relatives who have had breast cancer.

I support Deputy Devins and the section of the motion calling for expansion of the cervical screening programme nationwide. While cervical cancer does not cause the same incidence of death in women as breast cancer it is a critical area. It is important to show good faith by extending this programme nationally as a matter of priority.

I know the Minister is genuine about this issue. I genuinely believe this to be the case, having spoken to her at the Oireachtas Committee on Health and Children about it. Unfortunately, actions speak louder than words. The women of the west and the south have waited long enough already. That advertisement must be placed in the EU Journal as a matter of priority. I hope this service can be rolled out in the quickest possible timeframe available.

Mr. Boyle: Information on Dan Boyle  Zoom on Dan Boyle  I wish to share time with Deputies McHugh, Catherine Murphy, Connolly, Finian McGrath and Wall.

An Leas-Cheann Comhairle: Information on Séamus Pattison  Zoom on Séamus Pattison  That is agreed.

Mr. Boyle: Information on Dan Boyle  Zoom on Dan Boyle  I am pleased to have this opportunity to contribute to this debate. As a Deputy representing Cork South-Central, I especially welcome the tabling of this motion by Fine Gael, highlighting a huge disparity in terms of the identification and early and effective treatment of [824]what is a serious health condition for many of my constituents as well as many others in the south region. The same argument holds true for those who are waiting for the roll-out of BreastCheck in the western regions.

The Tánaiste will be all too aware that in Cork there seems to be a sad trend in Government policy on this issue and on the treatment of cancers in general. We have seen the very public resignation of the consultant oncologist, Oscar Breathnach over what he saw as the lack of effort in introducing a cancer treatment ward at Cork University Hospital. While some movement may now take place, we have continuing uncertainty regarding the children’s leukaemia unit at the Mercy University Hospital.

By far the most serious deficiency in terms of an effective health policy in the identification and treatment of cancer exists in the failure to roll out BreastCheck to the rest of the country, including the southern region, until what is promised to be 2007. I refer to this as a promised date as much uncertainty exists as to whether that target will be achieved. As other speakers have said, we have yet to see an advertisement in the EU Journal, which will be followed by a period for the planning process and ensuring the building required to house the appropriate facilities can be operational by 2007. I have had the opportunity of speaking on this matter with the chief executive of BreastCheck and I understand his logistical problems regarding a complete roll-out. However, there must be an acceptance of responsibility, which responsibility I believe is born out of political incompetence and the lack of political will to address this matter.

Cork has one facility concerned with cancer in that it is the location of the National Cancer Registry. It is a somewhat dubious honour to have within our boundaries a national institution which allows us to measure the incidence of cancer while not having the proper facilities to help us with the early identification and treatment of this serious disease. Statistics I have received from the registry seem to indicate that the discrepancy regarding early identification and treatment of breast cancer, particularly in Cork, has already had an effect even before BreastCheck is operational there. The most recent statistics for the eight-year period from 1994 and 2001 show that while the incidence of breast cancer in the Cork region was at or slightly below the national average and certainly below that for the former Eastern Regional Health Authority area, the mortality rates for breast cancer are higher in Cork than the national average and higher than those for the former Eastern Regional Health Authority area.

The incidence of breast cancer in the high age group category, from 50 to 69, increased nationally from approximately 250 per 100,000 to 285 per 100,000. While that is a sad trend, I hope that the existence of BreastCheck in even part of the country helps to alleviate the problem. For all age groups the figure was approximately 85 per [825]100,000 rising to 105 per 100,000. In the former Eastern Regional Health Authority area those comparative figures were 288 per 100,000 rising to 336 per 100,000. Figures for mortality from breast cancer show that in 1994, there were 93 deaths per 100,000 people in the high age group across the country, which decreased to 80 per 100,000 by 2001, a decrease of 13 per 100,000. However, in the Cork region the mortality figure increased from 68 per 100,000 to 86 per 100,000, an increase of 18 per 100,000. The Tánaiste should ask her officials why the national figures showed a reduction but the Cork area had a massive increase.

The decrease is even more marked in the former Eastern Regional Health Authority area where the death rate in the high age group was 103 per 100,000 reducing to 72 per 100,000 in an eight-year period, a reduction of 31 deaths per 100,000. In the Cork region, which is without a BreastCheck facility or proper cancer care infrastructure, the deaths increased by 18 per 100,000. As a Deputy in that region, I find those statistics unacceptable and believe the Minister and her Department have much explaining to do.

Mr. McHugh: Information on Paddy McHugh  Zoom on Paddy McHugh  The motion is the best illustration of the inequity in society one could possibly imagine. It vividly illustrates the nature of Irish society as seen through the eyes of Government. By the partisan manner in which the Government has addressed the national roll-out of BreastCheck, it has firmly illustrated that a two-tier society exists within our shores. One can only decipher that the first-class category of woman resides in the east coast area and those women are served first while the Government action deems that the second-class category of woman resides in the west as they are served second. By its handling of the issue the Government has not only confirmed this to be the case, by its refusal to rectify the situation it is actively ensuring that such a two-tier society will survive into the future.

As a Deputy for Galway East which is firmly in the west, I record my objection and that of my constituents to being treated as second-class citizens. Why are the women of the west treated as second-class citizens by the Government when it comes to the availability of BreastCheck? No amount of rhetoric will cloud the truth of this issue. Five years ago, the first phase of the BreastCheck service was delivered to the first-class women in the east coast area. Now, five years later, the Government shows no sign of delivering to the west in the foreseeable future so that the women in the west can begin to lose their second-class citizen tag. We are now told it will take a minimum of two years before BreastCheck is rolled out to the western region. This will mean a minimum of seven years between the introduction of BreastCheck in the east coast area and its expected provision in the west. There can be no justification for such a delay. Given that the early detection and treatment can reduce dramatically [826]the death rate arising from the disease, the failure of the Government to deliver to the women of the west is inexcusable. I look forward to the Tánaiste addressing as a matter of urgency the deficiencies of past years concerning this important matter.

Ms C. Murphy: Information on Catherine Murphy  Zoom on Catherine Murphy  The focus of our health service is on illness to such an extent that I often wonder if the Department of Health and Children is appropriately named. BreastCheck is one of the initiatives that focuses on health through keeping women healthy. We all benefit from that approach and I would like to see more and not less of that approach. We all benefit directly from preventative health care in many ways. In this case women benefit directly from an early diagnosis which gives them the best possible chance of survival and means they require less radical intervention. A woman’s family also benefits substantially for many years. Early diagnosis also results in a woman spending less time in hospital and I do not need to remind the Tánaiste and Minister for Health and Children that we all benefit from freeing up hospital beds.

I understand it will cost approximately €25 million to roll out the screening programme nationally. However, even considering the matter in a cold and unemotional way, failure to invest this money represents a false economy. I am certain if a cost benefit analysis were carried out, the cost of extending the service would be neutral. By adding the extra time spent in hospital, the extensive additional treatment often with expensive drugs, reconstruction surgery and the additional follow-up costs, the savings would be substantial.

The advertisement for BreastCheck is probably the only one I have ever heard on a health related topic to have a health warning included. The advertisement features Marian Finucane advertising the service and advises women they have nothing to fear and that an early diagnosis will result in an excellent prospect of cure. The final part advises people that in some parts of the country they cannot avail of the service. Women in the west and south are rightly outraged. However, women in the region served by BreastCheck have also noticed the unequal access to this service. While they are not campaigning for equal services for all, they are aware of and dislike this discrimination. There is no good or practical reason the BreastCheck service cannot be extended. The delays to date have been unacceptable and the service must be rolled out at the earliest possible date.

Mr. Connolly: Information on Paudge Connolly  Zoom on Paudge Connolly  The BreastCheck service, which was introduced on a pilot basis in 2000, offered many women the possibility of early diagnosis of breast cancer and, as a result, had the potential to reduce the incidence of mortality due to breast cancer. Cavan-Monaghan was fortunate that the service was rolled out in the north east. Figures released in January 2004 [827]indicate that 10,700 ladies availed of the service in the north east in 2002 and 75% of those notified of an appointment turned up for a breast check. One of the startling facts to emerge was that an abnormality was detected in approximately one in 120 women who availed of the service, requiring them to return for further appointments. This frightening statistic indicates what has been missed in other areas where the programme has not been rolled out.

The Government has failed to deliver the promised national roll-out of the BreastCheck service. It was stated this would require the placing of advertisements in the EU Journal. I understand that once notification is placed in the journal, a further two years are required to roll out and operate infrastructure.

As Deputy Catherine Murphy noted, a recent public awareness campaign featuring television and radio advertisements raised expectations among women that the BreastCheck service was available nationally. On making inquiries, however, they discovered this was not the case, which has caused anxiety. It is possible to have breast cancer for a number of years before detection and by the time it is detected by a general practitioner, it may have progressed too far. It is a medical fact that earlier intervention leads to more successful outcomes. In addition, early detection is more cost effective and significantly improves quality of life, on which we cannot put a price.

The causes of breast cancer are known. Women aged over 50 years are most at risk. Every year, approximately 60,000 women in Europe die of the disease and 150,000 new diagnoses are made. These are frightening figures. It should be possible to fast-track at risk groups such as women from families with a genetic disposition towards breast cancer.

Cervical screening should not be overlooked in this debate. The at risk group for this disease are ladies aged above 60 years, a group which does not, in general, avail of the cervical screening service. Women of child bearing age are more likely to turn up for screening appointments. An interesting statistic from the United States indicates that cervical cancer mortality there has declined by 70% in the past 50 years, largely due to the country’s screening programme. In addition, between 5% and 10% of those who fail to turn up for screening appointments account for approximately half the mortality rate due to cervical cancer.

Mr. F. McGrath: Information on Finian McGrath  Zoom on Finian McGrath  I am grateful for the opportunity to speak to this important motion on breast cancer. Sadly, for many of us this is a live issue for family and friends. It is an issue I am well aware of from first-hand experience. Like other Deputies, I have been touched by the breast cancer epidemic and the courage and bravery of the many women affected. It is the duty of all politicians to respond in a caring and professional [828]manner. I salute mná na hÉireann who deal with breast cancer every day and the consultants, doctors, nurses and health care staff who work on the front line every day saving the lives of our friends and family members. Ignoring these brave men and women is not an option and I urge all Deputies to support the motion and, better still, make its demand a reality for citizens.

The current reality, as the Tánaiste and Minister for Health and Children is aware, is that each year approximately 1,700 cases of breast cancer are detected and 640 women die of the disease. Cancer screening plays a significant role in reducing deaths from cancer and women are suffering because of the failure of successive Governments to extend BreastCheck nationally. In addition, the Government misled people in the south and west regarding the timeframe of the roll-out of the programme. I concur with Deputy McHugh’s defence of the rights of women in the west and his criticism of the lack of services available to them and deplore the failure of the Government to roll out the cervical screening programme nationally. This has resulted in the failure to detect cervical cancer in numerous women. I call on the Government to immediately roll out BreastCheck and the national cervical screening programme within a specified timeframe.

The bottom line is that the breast cancer epidemic must be tackled and research on the causes of cancer supported and developed. The medical profession has made major improvements in saving lives and extending the lifespan of those who would have died 20 years ago. I commend and thank them for saving the lives of members of our families. We appreciate and value their magnificent work and dedication. This is one of the main reasons I never attack or criticise the quality staff who work on the front line of our health service, whom we have a duty to support. Scoring cheap political points by attacking the health service or those who work in it is not an option. I have in mind several debates in recent months during which a series of attacks were made on consultants.

I call on the Government to act by opening up beds and investing in our accident and emergency departments. I call for radical reform, with patients and health care staff placed at the core of changes. I have made contributions on this issue in earlier debates. I urge all Deputies to support this motion and put our health service first. We should carry on the great tradition of the late Dr. Noel Browne who once represented my constituency of Dublin North-Central. If the House is serious about doing so, it will support the motion.

We need a health service based on equality rather than financial resources, but sadly we are drifting in the direction of the latter position. We need equality and respect for human dignity. It is a scandal that hundreds of people have been lying on trolleys in accident and emergency departments in recent days. I will not accept the con[829]tinuation of this problem and call on the Tánaiste to implement current plans to address it.

There are many excellent examples in other European Union countries of health services based on equality and justice for all citizens. This State is drifting towards the position of adopting the United States model. I urge caution in this regard. Many of us on the left have been challenged about funding the health service. We should not run away from the question of taxation. While it may not be fashionable to say so, some people are prepared to pay extra tax if a quality health service is guaranteed. We must face that reality.

It is unacceptable that we lose 640 brilliant women to breast cancer each year. Many thousands of women, on their own initiative and showing great courage, have prevented the position deteriorating further. As I stated, women must live with this issue on a daily basis. I urge all Deputies to support the motion and put our health service first.

Mr. Neville: Information on Dan Neville  Zoom on Dan Neville  I wish to share time with Deputies Naughten, Perry and Stanton.

I welcome the opportunity to speak on this important health issue and commend my party colleague, Deputy Twomey, for introducing the motion which highlights the seriousness of the problem of breast cancer. Each year, 1,700 women are identified as having the disease and 600 of them die as a consequence of it. One cannot but say that anything that is necessary to reduce the level of suffering and death should be acted on as a matter of urgency by the Government. Promises made in this respect over the years have not been fulfilled. It is difficult to understand why the present situation should continue when it is known that the roll-out of BreastCheck services would significantly reduce the levels of breast cancer in the population. This is particularly the case at a time when we are constantly informed that the Government’s coffers are full and the flow of money to the Exchequer is at a level never previously experienced in the State.

There are serious questions as to why the roll-out has been delayed for such a long time. Capital funding for the roll-out of BreastCheck was not allocated until 18 months after the Department of Health and Children announced a national extension. It is difficult to understand why that delay should have taken place, given the seriousness of the issue, which has been acknowledged by previous Ministers for Health and Children Moreover, BreastCheck’s own press release indicated that its understanding of the roll-out timeframe was at odds with that of the Tánaiste’s Department. This kind of disarray typically underestimates the implications of the delay in rolling out these services. Irish women must now wait until 2008 for all to be treated equally for breast cancer screening. Will the Tánaiste indicate why the timeframe cannot be reduced? Can [830]the roll-out of BreastCheck be implemented within a shorter timeframe?

Women in Northern Ireland have had this facility for 15 years which has resulted in a decrease in deaths from this disease by one fifth. Within a Southern context, one is talking about saving up to 120 lives per annum from breast cancer deaths. By 2008, after 15 years of screening, Northern Ireland will have carried out a considerable life saving exercise. However, by then in the Republic of Ireland, hundreds of women will have lost the battle with breast cancer and hundreds more will have endured devastating radical surgery with its consequential suffering and physical and mental trauma. The late diagnosis of cancer will require more severe chemotherapy and women will have suffered the side-effects of radiotherapy to bring advanced cancer under control, when the services of BreastCheck could have ensured that the experience was avoided for many women. Many women will have had their uterus removed because of cancer which spread before treatment, denying some women the chance to have children. Moreover, some children will have been denied the chance to have a mother, as Deputy Twomey outlined when proposing this motion. The costs to the quality of life of all women who endure cancer treatment will be impossible to measure.

The changes in our society and behaviour make the roll-out of cervical cancer screening more urgent than is generally acknowledged. Cervical cancer has a number of risk factors, including smoking and the number of sexual partners. For this reason, screening should begin six months after a woman becomes sexually active. It is relatively easily performed by smear tests, thousands of which are carried out each year in the form of opportunistic screening by the patients’ doctors. In this context, opportunistic means that the patient asks for the test and the GP offers it to the patient. We should have positive proactive screening for cervical cancer and full and comprehensive treatment for breast and cervical cancer as urgent public health policy. I urge the Tánaiste to address the issue in a much shorter timeframe than is proposed.

Mr. Naughten: Information on Denis Naughten  Zoom on Denis Naughten  I thank and congratulate Deputy Twomey for tabling this apt and timely motion. One of the most serious broken promises inflicted on the public by this Government has been the failure to implement their promise to have the national BreastCheck programme operational throughout the country by 2005. Every year, 640 women die from breast cancer in this country. However, last month the Tánaiste stated that the national extension of the BreastCheck scheme will not be in place until 2007, rather than 2005 as was initially promised.

In my constituency, I have a difficulty with the situation whereby there may be two women who have the same risk factors for breast cancer. As one women lives on one side of a road and consequently happens to be in County Westmeath, she [831]can get BreastCheck on demand. However, because the other woman lives on the other side of the white line in the middle of the road, she will not get a service until 2008 at the earliest. This is the reality. It is hugely disappointing that a woman is discriminated against because of her geographical location. Why have the BreastCheck organisation and the Department of Health and Children been at odds over the timescale for the delivery of the extension?

In the meantime, 58,000 women in the west within the target population are currently being ignored. Last week, I received a telephone call from a constituent, who is in a high-risk category and who was referred by her GP to Galway for a mammogram. When there, she was told to return to her GP and get a referral to see a consultant first, before she would be considered for a mammogram. This is the reality of what is happening. The woman was treated like this because she comes from the wrong side of the River Shannon. Geography should not dictate health priorities. Of the 58,000 women who are eligible for the service in the west, approximately one sixth are from County Roscommon.

Deputy Twomey has highlighted that if the breast screening service was implemented properly, the lives of 55 women per year could be saved. At least 110 women will lose their lives because of this delay. That estimate is based on a timetable that remains aspirational. We still have the missed deadlines, mixed signals and misleading promises from the Government as to when the implementation will actually happen. It provides a clear indication of the disarray within the Government regarding planning. To give an example, in September 2004, the former Minister for Health and Children, Deputy Martin, announced that €20 million was being allocated for the capital investment that was required in both Cork and Galway to put the BreastCheck service in place. In December 2004, BreastCheck submitted proposals to draw down that capital investment to the Department of Health and Children. However, it is still waiting for the approval of the plans so that it can place an advertisement in the EU Journal in order to proceed and have the design proposals submitted and construction commenced. For four months, the Department has not made a decision on its proposals. BreastCheck’s chief executive has made it quite clear that at the minimum, it will take two years from the date of approval to get the screening programme up and running. We are planning for two years from now and the clock is ticking because it has taken the Department four months to make a decision. We are still unsure what the decision will be.

As far as the issue of cervical cancer is concerned, I too am annoyed by the fact that there is not a national roll-out. However, I am more annoyed by the fact that while we do not have breast screening in County Roscommon we used to have cervical screening. There used to be a [832]service provided in the county on a quarterly basis, but it was withdrawn one year ago. There is no service in place now because we were informed that the national service would be put in place. Consequently, the former Western Health Board withdrew the service that was already in place. In the meantime, women have been denied the service, which has worsened rather than improved. It has become progressively worse over the last 12 months. There is an 80% reduction in cervical cancer where screening is put in place. It is about time we prioritised these issues and began to invest. I ask the Tánaiste to provide approval for such funding.

Mr. Perry: Information on John Perry  Zoom on John Perry  I thank Deputy Twomey for raising this very important issue. Despite having a budget of €12 billion within the Department of Health and Children, it is clear that as far as the delivery of services is concerned, a two tier health service exists. The roll-out of BreastCheck makes this evident. What is striking is the extreme contrast between what the Government has said it will do and what it has done. The National Cancer Strategy of 2001 stated that screening programmes for breast cancer and cervical cancer would be extended nationwide. However, women are suffering because of the Government’s failure to extend the BreastCheck programme.

  8 o’clock

The delay in rolling out the programme is costing lives. This is not a sensationalist statement; it is a fact. Cancer accounts for approximately one in four deaths annually in Ireland. Approximately 20,000 new cancer cases are reported each year. This state of affairs is quite disappointing when one looks at the Department’s budget of €12 billion. It is very difficult to explain why a service that is run in one part of the country cannot be run in other parts. It is also difficult to explain the Department’s inability to find the trained personnel to operate the service. The failure to extend BreastCheck cannot be ignored. Cancer is a growing problem that affects all sections of the community, either directly or indirectly. The Government continues to place lives at risk by failing to establish structures which the Opposition and the people demand. It is wrong to inform a woman with cancer that her life could have been saved had she been diagnosed earlier. What can one say to that person and her family? Reports show that by 2015, the incidence of many cancers will double. This does not represent progress. Early detection of cancer through screening is one of the most effective means of cancer prevention. Clinical trials of specific screening methods have shown them to be the most effective for breast cancer and cervical cancer. It is disgraceful that this Government continues to avoid the facts surrounding this issue.

There are approximately 1,700 cases of breast cancer in women each year. This figure represents up to 12 people dying each week from breast cancer. These figures cannot be asserted often enough because they reflect the lives of people I [833]represent. The Government has misled people in the south, west and north west regarding the extension of BreastCheck. How can such a miscalculation have been made that the extension of BreastCheck must now be pushed out to 2007? I am sure that in 2007, another report will be needed before BreastCheck can be extended. As a representative of south Leitrim, I see the effects of the Government’s failure to keep its promises. In 2003, we were promised that BreastCheck would be rolled out in the south, west and north west by 2005. Now we are told that it will be rolled out in 2007 and we know that the original promise to extend the programme by 2005 was an untruth as people in the south and west will have to wait two and a half years for it. BreastCheck will be an invaluable service when it is fully established but it is incomprehensible to think that people in the west must tolerate a lower quality of services. People with cancer in the west must travel to hospitals in the east for treatment.

What is particularly horrific is the way the Government needs to be constantly pushed to provide a service which will save lives. The Tánaiste has the ability to move this process forward in her new role as Minister for Health and Children. The extension of BreastCheck is one of the most important jobs facing her as Minister. She needs to take ownership of this issue. The list of promises made and not fulfilled by the Government is sickening to read. It must be twice as difficult for a woman who has been diagnosed with cancer in the last four years to be told that her chances of survival would have been higher had she been diagnosed earlier. This is not good enough in a country with the wealthiest economy in Europe. How can the Tánaiste occupy the position of Minister for Health and Children and allow this to happen?

We have seen enough reports by now. The former Minister for Health and Children, Deputy Martin, spent €1 million per week on consultants’ reports. We need action rather than another report. This is the direct effect of the Government’s failed promises and we will continue to push it in this House to live up to its promises and help people where it counts. The number of women dying as a result of cervical cancer could be reduced by 80% if a national screening service were correctly introduced. The 2007 date must be brought back.

Numerous parliamentary questions have been tabled by Fine Gael on this issue and each time its Deputies have received replies which state that a definite decision cannot be made until careful planning and consultation have been undertaken. We have had enough consultation. We need the BreastCheck service in the north west and Sligo.

Mr. Stanton: Information on David Stanton  Zoom on David Stanton  I commend Deputy Twomey on bringing forward this motion and I am delighted to see the Tánaiste here listening to what [834]Deputies have to say on the matter. Last week, I attended the funeral of a young woman. The House must excuse me if I become emotional about this because the woman was 41 years of age and had three small children. She fought breast cancer for three years and as I looked at her in her coffin, I thought to myself that she should not be there. The real tragedy and crime is that she never got a chance because there was no screening service where she lived in the south. This service was promised but it was never introduced. When I saw the woman’s three very young children, they were numb and did not really know what was going on. I spoke to her brother-in-law today and he asked me why the Government appeared to be on another planet with regard to the extension of BreastCheck. He was bewildered that the Government did not appear to see the need for the service. I am not saying this man’s sister-in-law would have lived if BreastCheck had been available to her but it could have made an enormous difference if her cancer had been detected early on. This is a life-and-death issue for women and their families. Our wives, mothers or sisters could be at risk. We are asking the Government to move quickly to ensure that women throughout the country have a chance.

Cork, which is the second largest city in the country, has no cancer screening service. In addition, cancer services in Cork are very poor. Doctors and nurses involved in cancer services in Cork are under terrible pressure, so much so that one medical oncologist, Dr. Oscar Breathnach, resigned because of the pressure. I raised the case recently on the Adjournment. We can see adults suffering greatly from cancer but it is so much more heart-rending to see a child with cancer. Professor Kearney from Mercy Hospital is retiring shortly but there does not appear to anyone to replace him. I raised the issue in the form of a parliamentary question but received a response from the Department that indicated that there was some form of bureaucratic problem involved in recruiting someone to replace him. This is not acceptable. When someone like Professor
Kearney retires, he should be replaced straight away. His retirement was flagged long ago so there was sufficient time to choose his successor.

The Government has been in office for eight years, during which we have had a booming economy. There is no reason the money should not have been put into these services. I do not wish to be cynical but medical cards were supplied to people over 70. While I do not begrudge them that, there were votes to be gained from such a measure. Did the Government carry out some kind of focus group test and decide there were no votes to be gained from providing cancer screening? People from my part of the country have sought cancer screening for a very long time. When the Tánaiste responds to my comments, she should explain why BreastCheck has not been [835]extended to Cork. She should tell us the reason for the delay in rolling out the programme. The people of Cork deserve an answer. This issue is beyond politics; it is a matter of life and death. Young women, in particular, suffer needlessly. The Tánaiste has our support on this but she must act quickly.

Tánaiste and Minister for Health and Children (Ms Harney): Information on Mary Harney  Zoom on Mary Harney  I thank Deputy Twomey and Fine Gael for tabling this motion. Unfortunately, I was unable to attend last night’s debate owing to a private, personal commitment. I thank Deputy Twomey for not criticising this.

I have very strong opinions on this subject. One does not have to be a female to empathise with the need to provide breast screening nationwide. One would like to think that, when a programme is rolled out, it can be rolled out nationally, but unfortunately matters are not that simple. There is no doubt that my predecessor in the Department of Health and Children, Deputy Martin, made significant progress in the area of cancer care. For instance, an additional €132 million was invested in cancer care in the southern area over the past seven years while the amount was €178 million in the west, north west and mid-west. That sounds like an enormous amount of money, and it is, but it does not solve all the problems of cancer care.

Population screening programmes, where appropriate, must be embraced in the Irish health care system. Cervical screening has been introduced in the mid-west but has not been expanded beyond there. In the time since its introduction, 78,000 women have been screened. Of Irish cancer deaths, approximately 2% are due to cervical cancer. There is a role for the general practitioner in this area and it is on the agenda for the upcoming negotiations on the contract, particularly where GMS patients are concerned. It is the most effective way to proceed, from a patient satisfaction point of view and from a cost perspective. We must empower and involve the general practitioner more in health preventative programmes.

As the Deputies have said, breast screening is available in the east and the midlands but not yet in the areas of future expansion, Galway and Cork, which would cover the rest of the country. It will be in place by 2007. The funding required is approximately €21 million and will be part of the capital programme I will announce shortly. We will not work as we previously did, when we separated capital provision from the revenue implications and had many buildings lying idle for years beyond understanding. When we press the button for the capital facility, we must ensure we have factored in the revenue implications of that. That is why there will be no announcement until the whole capital programme for the year is announced in a couple of weeks. That will ensure [836]consistency and integration between capital requirements and revenue implications.

It is no secret that the roll-out of BreastCheck to Cork and Galway will be in that programme. As the Deputies are aware, we must appoint a design team, put the facilities in place and recruit the staff at the same time to ensure there is no gap between the provision of the building, with the bricks and mortar and machinery, and the personnel. At the end of the day, while facilities are required, the most important element in cancer care is the expertise of the oncologists, radiologists and others who form part of a multidisciplinary team.

Those worst affected are in the 50 to 64 age group. I sympathise with those who say we should go beyond and below those ages, particularly where there is a family history of cancer. Deputy Twomey is a doctor, but many people will ask someone to describe their family history and they will tell them in turn what might or might not happen to them. There are significant factors, of which breast cancer is one. We have achieved an 80% survival rate from the previous rate of 72% five years ago. That is significant progress.

I remain committed to rolling out this programme nationwide. I do not like to hear the advertisements either. They are excellent but when they say “only available” at the end, it reinforces the view that there are different systems for people in different counties. However, every population screening programme I have examined was rolled out on a phased basis for obvious reasons.

On cancer care in particular, we must ensure that safety is paramount in how and where something happens and that people do not undergo surgery when it may be unnecessary. We all know that early diagnosis reduces dramatically the radical nature of the treatment that might follow, whether it is surgical, medical oncology or radiation, and the chances of surviving and being cured are much higher. I thank Deputy Twomey and Fine Gael for tabling the motion and I remain committed to ensuring this happens as speedily as possible.

Mr. Ring: Information on Michael Ring  Zoom on Michael Ring  I wish to share time with Deputies McGinley and Twomey.

An Ceann Comhairle: Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  Is that agreed? Agreed.

Mr. Ring: Information on Michael Ring  Zoom on Michael Ring  The next time a pilot programme commences in the Department of Health and Children will the Tánaiste ensure it begins in the west rather than the east or wherever the Minister of the day is from? The west always has to wait and play second fiddle in respect of services. Someone such as Deputy McGinley must spend many nights in St. Luke’s Hospital visiting sick patients from Belmullet, Castlebar and elsewhere. It is a long way from there to Dublin and the hospital is a lonely place. As a hospital, St. [837]Luke’s is well run and clean, but when people are five or six hours distant from their loved ones and their homes, it is not a nice place to be. I ask the Tánaiste and her Department to start the next pilot scheme in the west.

On the issue of BreastCheck, what aggravates people are political promises made by Governments. The Tánaiste has not been in the Department very long. She is saying the right things about BreastCheck and I hope she will do the right things. It is important that the Government commitment in this regard is rolled out nationally and that women will have the opportunity to be checked as swiftly as possible. As the Tánaiste has said, statistics have shown that these people can be treated and there is a good recovery of cancer patients. It is important that they are reached quickly.

In County Mayo, during a time when there was nothing like this in Ireland, women in the past could have a smear test in a hospital without an appointment. County Mayo has not had a smear clinic for the past three years. Will the Tánaiste and her Department examine why this is so if, in times when we did not have money or services and many people were sick, someone could go to a hospital to have a smear test?

In the Sacred Heart Home in County Mayo there are fully fitted-out rooms for hospice services. Over the past two or three years, the former Western Health Board and now the Health Service Executive advertised for a GP on five or six occasions, and I am not exaggerating. A service there was run by retired doctors. Everything worked well and everyone was happy but the health board stopped it for insurance or other reasons. The GP would take on the hospice unit and would be given part of a practice but no one will take up this offer. Will the Tánaiste examine this issue so that the funding will be put in place?

These doctors have cleaned up. We cannot give them enough money because they are being paid for the GMS and other schemes and it would be difficult for them to take on another, but I ask the Tánaiste to put a package in place that will make it acceptable for some doctor to take on this task. It is sad that people who wish to use a hospice to allow them to die in their own county must go to Roscommon or Galway when the beds and facilities are there and when the public subscribed with their own money. All that we need now is a GP to administer the hospice.

The Tánaiste has given a commitment on BreastCheck that I do not doubt but I want her commitment to be carried through. The only time women marched on the streets was when the Taoiseach felt the rap of the women of County Mayo when he went there before the last general election. It is not an exaggeration to say that 2,000 or 3,000 women protested when he visited the county. It was the only protest held in the whole country because we had been told how well [838]it was all going. The women of Mayo came out to protect the cancer service in Mayo General Hospital. The Tánaiste is a woman and she respects the point of view of women. When women take on an issue, they will not give up. I call on the women of the west and those in parts of the country where BreastCheck is not available to get organised and to go out and protest. The Tánaiste has given a commitment to provide €21 million which is small money in the context of the overall health budget. It will take two years for BreastCheck to be available nationally.

Mr. McGinley: Information on Dinny McGinley  Zoom on Dinny McGinley  Everyone agrees the most important element in the successful treatment of cancer is early diagnosis. Unfortunately in this country, early diagnosis and the standard of treatment seem to depend on one’s geographic location. Since 2000, BreastCheck screening has been available in limited parts of the country. If one lives in Dublin or in the eastern region, BreastCheck is automatically available from the age of 50 years onwards. I am sure this programme has already saved the lives of many women who are fortunate to live in these areas. We all know and accept what a tragedy it can be for a family if a member, particularly a mother, is diagnosed with breast or cervical cancer, especially when that cancer is at an advanced stage. Late diagnosis means more radical and severe treatment, unfortunately often with limited success.

It is unbelievable that five years after its introduction, BreastCheck cancer screening is confined to so few counties. As usual the west, and particularly the north west, is well and truly out of the loop. According to the latest information, places like Donegal cannot expect to benefit from a screening programme until 2008 at the earliest. This is completely unacceptable.

Letterkenny General Hospital caters for a population of almost 140,000 people. In Donegal, the country’s most peripheral county, there are 50 new breast cancer cases, 70 new bowel cancer cases and 80 new prostate cancer cases annually. I accompanied Deputy Twomey, whom I compliment on tabling this motion, on his fact-finding visit to Letterkenny Hospital a fortnight ago. We were presented with a very grim picture indeed of the inadequacy of treatment available to cancer patients there. While the incidence of cancer in the county is increasing, the level and standard of treatment is seriously lagging behind what is available in many other parts of the country. This is not a reflection on the care being provided in Letterkenny General Hospital by a dedicated, committed and caring medical and nursing staff. It is a question of some of the basic elements of treatment being unavailable.

In a shocking indictment of the health service, it has emerged that the absence of a radiation oncologist at Letterkenny General Hospital is [839]resulting in unnecessary mastectomies, in some cases, and dangerous and lengthy delays in the treatment of certain cancers in others. A group of medical professionals in the county maintain that many patients, particularly those receiving palliative care, are refusing radiation treatment because of the exhausting travel involved — anything up to six hours at a time to Dublin.

Like Deputy Ring, I am a regular visitor to St. Luke’s Hospital in Dublin and I never cease to be amazed at the number of Donegal patients there for radiotherapy. They are all far removed from their families and natural environment for the duration of their treatment which can often last up to seven or eight weeks. While many of them try to get home for the weekend, one can imagine what a harrowing ordeal that long journey must be for them with their strength and resistance sapped by the severity of radiation treatment.

While I welcome plans to establish radiotherapy units in Limerick, Galway or even Waterford, these will be of no benefit to the north west. It is no easier to travel from west Donegal or Malin Head to Galway than it is to Dublin. We have been told plans are being considered to enable Donegal patients to obtain radiation treatment in Belfast. That is nothing but a red herring. I understand that facilities in Northern Ireland are just about adequate to treat its own patients without any extra influx from Donegal or the north west.

I call for the provision of a radiotherapy unit in the north west, preferably in Donegal, to serve the needs of cancer patients in that county. I also call for the appointment of a radiation oncologist, a permanent breast surgeon and a second bowel surgeon in Letterkenny General Hospital. If this does not happen, it is likely that the existing service, which caters for a population of almost 140,000 people, will diminish and ultimately disappear. There is a genuine fear among medical staff in the hospital that cancer services will disappear by a process of natural attrition rather than by an act of commission. For example, if a permanent breast surgeon is not appointed, then breast cancer services will go. The consequence of this is that medical oncology will go, leaving Letterkenny with a very fragmented service. This is completely unacceptable.

I recognise that the Tánaiste has only taken over as Minister for Health and Children in recent months but we have great hopes that she will address this problem throughout the country, including the north west.

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I ask the Ceann Comhairle to look at the Government amendment to our motion because it does not even address what is contained in the Fine Gael motion.

[840]An Ceann Comhairle: Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  The Chair has no role in that.

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  The Fine Gael motion relates to screening for cervical and breast cancer through BreastCheck. The Government amendment only refers to services for breast cancer and cancer services generally which is not the purpose of our motion.

The Tánaiste knows that one in four men and women will get cancer at some stage in their lives. In focusing on cancer which affects women and which can be screened before it affects them, we should look at our near neighbours in Northern Ireland. Breast cancer screening has been available in Northern Ireland for more than a decade while cervical cancer screening has been available in Northern Ireland and the UK for almost three decades. In the Republic, breast cancer screening is available to only half of the women and there is no national cervical screening programme. Many people believe there is a cervical screening programme in the Limerick region but it is only a pilot programme.

Some 20 years ago, the mortality rates for cervical cancer here, that is, the number of people who died as a result of it, were half the rates of the United Kingdom. That has as much to do with the risk factors associated with cervical cancer as anything else. Now across all the regions of the UK mortality rates for cervical cancer are lower than those in Ireland. In the UK, the numbers of people dying from cervical cancer has dropped dramatically over the past 20 years but the numbers of people dying from it in this country have increased. This is a fact and the Government must face up to it. There is no point burying one’s head in the sand. It is the reason doctors are calling for screening. We are trying to prevent cancer before it takes hold of people’s bodies and destroys their lives through death or serious illness. That is why the Tánaiste and the Government must take this seriously. It is the responsibility of Government and not, as Deputy Devins tried to imply, of the Health Service Executive.

As has been pointed out by speakers from Donegal, Mayo, Cork and the south east, the lack of radiotherapy services has led to more radical surgery being carried out on a number of women. They do not want to endure the journeys necessary in order to avail of radiotherapy services. Some people have endured considerable sickness from chemotherapy because their cancer was at a stage which required much more serious treatment. The Tánaiste knows that women must have glands removed and get radiation burns and all sorts of side effects because their cancer is diagnosed too late.

Some younger women are outside the remit of the cancer screening programme. However, if we had a good screening programme and encouraged people to think about screening, they would look [841]after their health. We might be lucky and people might present themselves to doctors for opportunistic screening even if they are outside those age groups because they would be aware of what was going on. That is what we are trying to teach people in regard to screening. There is a considerable public health element to this, that is, teaching people to take responsibility for their own health, as well as providing a screening programme which prevents diseases such as these. These are terrible diseases. Cervical cancer, which is the most amazing can be diagnosed and cured very satisfactorily before it becomes a problem. In the diagnosis of cervical cancer there is what is called CIN, 1, 2 and 3 and carcinoma in situ can still be treated before making a diagnosis [842]of cancer 1, 2 or 3. Effectively, it is an illness we can deal with. The same goes for breast cancer.

An Ceann Comhairle: Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  The time for this debate has concluded.

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I acknowledge the Tánaiste’s good wishes towards Deputy Kenny, the Fine Gael Party, and other Members and her acknowledgement that we also have a caring agenda and that caring is not the preserve of the Fianna Fáil Party.

Mr. J. Breen: Information on James Breen  Zoom on James Breen  She will join the party of which the Deputy is a Member.

Amendment put.

[841]The Dáil divided: Tá, 71; Níl, 55.

Information on Dermot Ahern  Zoom on Dermot Ahern  Ahern, Dermot. Information on Michael Ahern  Zoom on Michael Ahern  Ahern, Michael.
Information on Noel Ahern  Zoom on Noel Ahern  Ahern, Noel. Information on Barry Andrews  Zoom on Barry Andrews  Andrews, Barry.
Information on Seán Ardagh  Zoom on Seán Ardagh  Ardagh, Seán. Information on Niall Blaney  Zoom on Niall Blaney  Blaney, Niall.
Information on Johnny Brady  Zoom on Johnny Brady  Brady, Johnny. Information on Martin Brady  Zoom on Martin Brady  Brady, Martin.
Information on Seamus Brennan  Zoom on Seamus Brennan  Brennan, Seamus. Information on John Browne  Zoom on John Browne  Browne, John.
Information on Joe Callanan  Zoom on Joe Callanan  Callanan, Joe. Information on Ivor Callely  Zoom on Ivor Callely  Callely, Ivor.
Information on John Carty  Zoom on John Carty  Carty, John. Information on Donie Cassidy  Zoom on Donie Cassidy  Cassidy, Donie.
Information on Beverley Cooper-Flynn  Zoom on Beverley Cooper-Flynn  Cooper-Flynn, Beverley. Information on Brian Cowen  Zoom on Brian Cowen  Cowen, Brian.
Information on John Cregan  Zoom on John Cregan  Cregan, John. Information on Martin Cullen  Zoom on Martin Cullen  Cullen, Martin.
Information on John Curran  Zoom on John Curran  Curran, John. Information on Noel Davern  Zoom on Noel Davern  Davern, Noel.
Information on Síle de Valera  Zoom on Síle de Valera  de Valera, Síle. Information on Tony Dempsey  Zoom on Tony Dempsey  Dempsey, Tony.
Information on John Dennehy  Zoom on John Dennehy  Dennehy, John. Information on Jimmy Devins  Zoom on Jimmy Devins  Devins, Jimmy.
Information on John Ellis  Zoom on John Ellis  Ellis, John. Information on Michael Finneran  Zoom on Michael Finneran  Finneran, Michael.
Information on Dermot Fitzpatrick  Zoom on Dermot Fitzpatrick  Fitzpatrick, Dermot. Information on Seán Fleming  Zoom on Seán Fleming  Fleming, Seán.
Information on Mildred Fox  Zoom on Mildred Fox  Fox, Mildred. Information on Pat the Cope Gallagher  Zoom on Pat the Cope Gallagher  Gallagher, Pat The Cope.
Information on Jim Glennon  Zoom on Jim Glennon  Glennon, Jim. Information on Noel Grealish  Zoom on Noel Grealish  Grealish, Noel.
Information on Mary Hanafin  Zoom on Mary Hanafin  Hanafin, Mary. Information on Mary Harney  Zoom on Mary Harney  Harney, Mary.
Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán. Information on Máire Hoctor  Zoom on Máire Hoctor  Hoctor, Máire.
Information on Joe Jacob  Zoom on Joe Jacob  Jacob, Joe. Information on Cecilia Keaveney  Zoom on Cecilia Keaveney  Keaveney, Cecilia.
Information on Billy Kelleher  Zoom on Billy Kelleher  Kelleher, Billy. Information on Peter Kelly  Zoom on Peter Kelly  Kelly, Peter.
Information on Tony Killeen  Zoom on Tony Killeen  Killeen, Tony. Information on Seamus Kirk  Zoom on Seamus Kirk  Kirk, Seamus.
Information on Tom Kitt  Zoom on Tom Kitt  Kitt, Tom. Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Lenihan, Brian.
Information on Michael McDowell  Zoom on Michael McDowell  McDowell, Michael. Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas.
Information on John McGuinness  Zoom on John McGuinness  McGuinness, John. Information on John Moloney  Zoom on John Moloney  Moloney, John.
Information on Donal Moynihan  Zoom on Donal Moynihan  Moynihan, Donal. Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael.
Information on Michael Mulcahy  Zoom on Michael Mulcahy  Mulcahy, Michael. Information on M. J. Nolan  Zoom on M. J. Nolan  Nolan, M.J.
Information on Éamon Ó Cuív  Zoom on Éamon Ó Cuív  Ó Cuív, Éamon. Information on Seán Ó Fearghaíl  Zoom on Seán Ó Fearghaíl  Ó Fearghail, Seán.
Information on Charlie O'Connor  Zoom on Charlie O'Connor  O’Connor, Charlie. Information on Willie O'Dea  Zoom on Willie O'Dea  O’Dea, Willie.
Information on Liz O'Donnell  Zoom on Liz O'Donnell  O’Donnell, Liz. Information on John O'Donoghue  Zoom on John O'Donoghue  O’Donoghue, John.
Information on Dennis O'Donovan  Zoom on Dennis O'Donovan  O’Donovan, Denis. Information on Noel O'Flynn  Zoom on Noel O'Flynn  O’Flynn, Noel.
Information on Batt O'Keeffe  Zoom on Batt O'Keeffe  O’Keeffe, Batt. Information on Ned O'Keeffe  Zoom on Ned O'Keeffe  O’Keeffe, Ned.
Information on Fiona O'Malley  Zoom on Fiona O'Malley  O’Malley, Fiona. Information on Tim O'Malley  Zoom on Tim O'Malley  O’Malley, Tim.
Information on Tom Parlon  Zoom on Tom Parlon  Parlon, Tom. Information on Peter Power  Zoom on Peter Power  Power, Peter.
Information on Dick Roche  Zoom on Dick Roche  Roche, Dick. Information on Mae Sexton  Zoom on Mae Sexton  Sexton, Mae.
Information on Noel Treacy  Zoom on Noel Treacy  Treacy, Noel. Information on Mary Wallace  Zoom on Mary Wallace  Wallace, Mary.
Information on Joe Walsh  Zoom on Joe Walsh  Walsh, Joe.  


[841]Níl
Information on Dan Boyle  Zoom on Dan Boyle  Boyle, Dan. Information on James Breen  Zoom on James Breen  Breen, James.
Information on Thomas P. Broughan  Zoom on Thomas P. Broughan  Broughan, Thomas P. Information on Richard Bruton  Zoom on Richard Bruton  Bruton, Richard.
Information on Joan Burton  Zoom on Joan Burton  Burton, Joan. Information on Paul Connaughton  Zoom on Paul Connaughton  Connaughton, Paul.
Information on Paudge Connolly  Zoom on Paudge Connolly  Connolly, Paudge. Information on Joe Costello  Zoom on Joe Costello  Costello, Joe.
Information on Seymour Crawford  Zoom on Seymour Crawford  Crawford, Seymour. Information on Sean Crowe  Zoom on Sean Crowe  Crowe, Seán.
Information on Jimmy Deenihan  Zoom on Jimmy Deenihan  Deenihan, Jimmy. Information on Bernard Durkan  Zoom on Bernard Durkan  Durkan, Bernard J.
Information on Martin Ferris  Zoom on Martin Ferris  Ferris, Martin. Information on Paul Nicholas Gogarty  Zoom on Paul Nicholas Gogarty  Gogarty, Paul.
Information on John Gormley  Zoom on John Gormley  Gormley, John. Information on Tom Hayes  Zoom on Tom Hayes  Hayes, Tom.
Information on Seamus Healy  Zoom on Seamus Healy  Healy, Seamus. Information on Philip Hogan  Zoom on Philip Hogan  Hogan, Phil.
Information on Brendan Howlin  Zoom on Brendan Howlin  Howlin, Brendan. Information on Paul Kehoe  Zoom on Paul Kehoe  Kehoe, Paul.
Information on Kathleen Lynch  Zoom on Kathleen Lynch  Lynch, Kathleen. Information on Pádraic McCormack  Zoom on Pádraic McCormack  McCormack, Padraic.
Information on Shane McEntee  Zoom on Shane McEntee  McEntee, Shane. Information on Dinny McGinley  Zoom on Dinny McGinley  McGinley, Dinny.
Information on Finian McGrath  Zoom on Finian McGrath  McGrath, Finian. Information on Paddy McHugh  Zoom on Paddy McHugh  McHugh, Paddy.
Information on Liz McManus  Zoom on Liz McManus  McManus, Liz. Information on Olivia Mitchell  Zoom on Olivia Mitchell  Mitchell, Olivia.
Information on Arthur Morgan  Zoom on Arthur Morgan  [843]Morgan, Arthur. Information on Breeda Moynihan-Cronin  Zoom on Breeda Moynihan-Cronin  Moynihan-Cronin, Breeda.
Information on Catherine Murphy  Zoom on Catherine Murphy  Murphy, Catherine. Information on Gerard Murphy  Zoom on Gerard Murphy  Murphy, Gerard.
Information on Denis Naughten  Zoom on Denis Naughten  Naughten, Denis. Information on Dan Neville  Zoom on Dan Neville  Neville, Dan.
Information on Aengus O Snodaigh  Zoom on Aengus O Snodaigh  Ó Snodaigh, Aengus. Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  O’Dowd, Fergus.
Information on Jim O'Keeffe  Zoom on Jim O'Keeffe  O’Keeffe, Jim. Information on Brian O'Shea  Zoom on Brian O'Shea  O’Shea, Brian.
Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  O’Sullivan, Jan. Information on Séamus Pattison  Zoom on Séamus Pattison  Pattison, Seamus.
Information on Willie Penrose  Zoom on Willie Penrose  Penrose, Willie. Information on John Perry  Zoom on John Perry  Perry, John.
Information on Ruairí Quinn  Zoom on Ruairí Quinn  Quinn, Ruairí. Information on Pat Rabbitte  Zoom on Pat Rabbitte  Rabbitte, Pat.
Information on Michael Ring  Zoom on Michael Ring  Ring, Michael. Information on Seán Ryan  Zoom on Seán Ryan  Ryan, Seán.
Information on Trevor Sargent  Zoom on Trevor Sargent  Sargent, Trevor. Information on Joe Sherlock  Zoom on Joe Sherlock  Sherlock, Joe.
Information on Róisín Shortall  Zoom on Róisín Shortall  Shortall, Róisín. Information on Emmet Stagg  Zoom on Emmet Stagg  Stagg, Emmet.
Information on David Stanton  Zoom on David Stanton  Stanton, David. Information on Billy Timmins  Zoom on Billy Timmins  Timmins, Billy.
Information on Liam Twomey  Zoom on Liam Twomey  Twomey, Liam. Information on Mary Upton  Zoom on Mary Upton  Upton, Mary.
Information on Jack Wall  Zoom on Jack Wall  Wall, Jack.  

[843]Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Kehoe and Stagg.

[843]Amendment declared carried.

Question put: “That the motion, as amended, be agreed to.”

Mr. Kehoe: Information on Paul Kehoe  Zoom on Paul Kehoe  As a teller, under Standing Order 69 I propose that the vote be taken by other than electronic means.

[844]An Ceann Comhairle: Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  As Deputy Kehoe is a Whip, under Standing Order 69 he is entitled to call a vote through the lobby.

Question again put: “That the motion, as amended, be agreed to.”

[843]The Dáil divided: Tá, 69; Níl, 52.

Information on Dermot Ahern  Zoom on Dermot Ahern  Ahern, Dermot. Information on Michael Ahern  Zoom on Michael Ahern  Ahern, Michael.
Information on Noel Ahern  Zoom on Noel Ahern  Ahern, Noel. Information on Barry Andrews  Zoom on Barry Andrews  Andrews, Barry.
Information on Seán Ardagh  Zoom on Seán Ardagh  Ardagh, Seán. Information on Niall Blaney  Zoom on Niall Blaney  Blaney, Niall.
Information on Johnny Brady  Zoom on Johnny Brady  Brady, Johnny. Information on Martin Brady  Zoom on Martin Brady  Brady, Martin.
Information on John Browne  Zoom on John Browne  Browne, John. Information on Joe Callanan  Zoom on Joe Callanan  Callanan, Joe.
Information on Ivor Callely  Zoom on Ivor Callely  Callely, Ivor. Information on John Carty  Zoom on John Carty  Carty, John.
Information on Michael Collins  Zoom on Michael Collins  Collins, Michael. Information on Brian Cowen  Zoom on Brian Cowen  Cowen, Brian.
Information on John Cregan  Zoom on John Cregan  Cregan, John. Information on Martin Cullen  Zoom on Martin Cullen  Cullen, Martin.
Information on John Curran  Zoom on John Curran  Curran, John. Information on Noel Davern  Zoom on Noel Davern  Davern, Noel.
Information on Síle de Valera  Zoom on Síle de Valera  de Valera, Síle. Information on Tony Dempsey  Zoom on Tony Dempsey  Dempsey, Tony.
Information on John Dennehy  Zoom on John Dennehy  Dennehy, John. Information on Jimmy Devins  Zoom on Jimmy Devins  Devins, Jimmy.
Information on John Ellis  Zoom on John Ellis  Ellis, John. Information on Michael Finneran  Zoom on Michael Finneran  Finneran, Michael.
Information on Dermot Fitzpatrick  Zoom on Dermot Fitzpatrick  Fitzpatrick, Dermot. Information on Seán Fleming  Zoom on Seán Fleming  Fleming, Seán.
Information on Mildred Fox  Zoom on Mildred Fox  Fox, Mildred. Information on Pat the Cope Gallagher  Zoom on Pat the Cope Gallagher  Gallagher, Pat The Cope.
Information on Jim Glennon  Zoom on Jim Glennon  Glennon, Jim. Information on Noel Grealish  Zoom on Noel Grealish  Grealish, Noel.
Information on Mary Hanafin  Zoom on Mary Hanafin  Hanafin, Mary. Information on Mary Harney  Zoom on Mary Harney  Harney, Mary.
Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán. Information on Máire Hoctor  Zoom on Máire Hoctor  Hoctor, Máire.
Information on Joe Jacob  Zoom on Joe Jacob  Jacob, Joe. Information on Cecilia Keaveney  Zoom on Cecilia Keaveney  Keaveney, Cecilia.
Information on Billy Kelleher  Zoom on Billy Kelleher  Kelleher, Billy. Information on Peter Kelly  Zoom on Peter Kelly  Kelly, Peter.
Information on Tony Killeen  Zoom on Tony Killeen  Killeen, Tony. Information on Seamus Kirk  Zoom on Seamus Kirk  Kirk, Seamus.
Information on Tom Kitt  Zoom on Tom Kitt  Kitt, Tom. Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Lenihan, Brian.
Information on Michael McDowell  Zoom on Michael McDowell  McDowell, Michael. Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas.
Information on John McGuinness  Zoom on John McGuinness  McGuinness, John. Information on John Moloney  Zoom on John Moloney  Moloney, John.
Information on Donal Moynihan  Zoom on Donal Moynihan  Moynihan, Donal. Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael.
Information on Michael Mulcahy  Zoom on Michael Mulcahy  Mulcahy, Michael. Information on M. J. Nolan  Zoom on M. J. Nolan  Nolan, M. J.
Information on Éamon Ó Cuív  Zoom on Éamon Ó Cuív  Ó Cuív, Éamon. Information on Seán Ó Fearghaíl  Zoom on Seán Ó Fearghaíl  Ó Fearghail, Seán.
Information on Charlie O'Connor  Zoom on Charlie O'Connor  O’Connor, Charlie. Information on Willie O'Dea  Zoom on Willie O'Dea  O’Dea, Willie.
Information on Liz O'Donnell  Zoom on Liz O'Donnell  O’Donnell, Liz. Information on John O'Donoghue  Zoom on John O'Donoghue  O’Donoghue, John.
Information on Dennis O'Donovan  Zoom on Dennis O'Donovan  O’Donovan, Denis. Information on Noel O'Flynn  Zoom on Noel O'Flynn  O’Flynn, Noel.
Information on Batt O'Keeffe  Zoom on Batt O'Keeffe  O’Keeffe, Batt. Information on Ned O'Keeffe  Zoom on Ned O'Keeffe  O’Keeffe, Ned.
Information on Fiona O'Malley  Zoom on Fiona O'Malley  O’Malley, Fiona. Information on Tim O'Malley  Zoom on Tim O'Malley  O’Malley, Tim.
Information on Tom Parlon  Zoom on Tom Parlon  Parlon, Tom. Information on Peter Power  Zoom on Peter Power  Power, Peter.
Information on Dick Roche  Zoom on Dick Roche  Roche, Dick. Information on Mae Sexton  Zoom on Mae Sexton  Sexton, Mae.
Information on Noel Treacy  Zoom on Noel Treacy  Treacy, Noel. Information on Mary Wallace  Zoom on Mary Wallace  Wallace, Mary.
Information on Joe Walsh  Zoom on Joe Walsh  Walsh, Joe.  


[843]Níl
Information on Dan Boyle  Zoom on Dan Boyle  Boyle, Dan. Information on James Breen  Zoom on James Breen  Breen, James.
Information on Thomas P. Broughan  Zoom on Thomas P. Broughan  Broughan, Thomas P. Information on Richard Bruton  Zoom on Richard Bruton  Bruton, Richard.
Information on Joan Burton  Zoom on Joan Burton  Burton, Joan. Information on Paul Connaughton  Zoom on Paul Connaughton  Connaughton, Paul.
Information on Paudge Connolly  Zoom on Paudge Connolly  Connolly, Paudge. Information on Joe Costello  Zoom on Joe Costello  Costello, Joe.
Information on Seymour Crawford  Zoom on Seymour Crawford  Crawford, Seymour. Information on Sean Crowe  Zoom on Sean Crowe  Crowe, Seán.
Information on Jimmy Deenihan  Zoom on Jimmy Deenihan  Deenihan, Jimmy. Information on Bernard Durkan  Zoom on Bernard Durkan  Durkan, Bernard J.
Information on Martin Ferris  Zoom on Martin Ferris  Ferris, Martin. Information on Paul Nicholas Gogarty  Zoom on Paul Nicholas Gogarty  Gogarty, Paul.
Information on John Gormley  Zoom on John Gormley  [845]Gormley, John. Information on Tom Hayes  Zoom on Tom Hayes  Hayes, Tom.
Information on Seamus Healy  Zoom on Seamus Healy  Healy, Seamus. Information on Brendan Howlin  Zoom on Brendan Howlin  Howlin, Brendan.
Information on Paul Kehoe  Zoom on Paul Kehoe  Kehoe, Paul. Information on Kathleen Lynch  Zoom on Kathleen Lynch  Lynch, Kathleen.
Information on Pádraic McCormack  Zoom on Pádraic McCormack  McCormack, Padraic. Information on Shane McEntee  Zoom on Shane McEntee  McEntee, Shane.
Information on Dinny McGinley  Zoom on Dinny McGinley  McGinley, Dinny. Information on Finian McGrath  Zoom on Finian McGrath  McGrath, Finian.
Information on Paddy McHugh  Zoom on Paddy McHugh  McHugh, Paddy. Information on Liz McManus  Zoom on Liz McManus  McManus, Liz.
Information on Arthur Morgan  Zoom on Arthur Morgan  Morgan, Arthur. Information on Breeda Moynihan-Cronin  Zoom on Breeda Moynihan-Cronin  Moynihan-Cronin, Breeda.
Information on Catherine Murphy  Zoom on Catherine Murphy  Murphy, Catherine. Information on Gerard Murphy  Zoom on Gerard Murphy  Murphy, Gerard.
Information on Denis Naughten  Zoom on Denis Naughten  Naughten, Denis. Information on Dan Neville  Zoom on Dan Neville  Neville, Dan.
Information on Aengus O Snodaigh  Zoom on Aengus O Snodaigh  Ó Snodaigh, Aengus. Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  O’Dowd, Fergus.
Information on Jim O'Keeffe  Zoom on Jim O'Keeffe  O’Keeffe, Jim. Information on Brian O'Shea  Zoom on Brian O'Shea  O’Shea, Brian.
Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  O’Sullivan, Jan. Information on Séamus Pattison  Zoom on Séamus Pattison  Pattison, Seamus.
Information on Willie Penrose  Zoom on Willie Penrose  Penrose, Willie. Information on John Perry  Zoom on John Perry  Perry, John.
Information on Ruairí Quinn  Zoom on Ruairí Quinn  Quinn, Ruairí. Information on Pat Rabbitte  Zoom on Pat Rabbitte  Rabbitte, Pat.
Information on Michael Ring  Zoom on Michael Ring  Ring, Michael. Information on Trevor Sargent  Zoom on Trevor Sargent  Sargent, Trevor.
Information on Joe Sherlock  Zoom on Joe Sherlock  Sherlock, Joe. Information on Róisín Shortall  Zoom on Róisín Shortall  Shortall, Róisín.
Information on Emmet Stagg  Zoom on Emmet Stagg  Stagg, Emmet. Information on David Stanton  Zoom on David Stanton  Stanton, David.
Information on Billy Timmins  Zoom on Billy Timmins  Timmins, Billy. Information on Liam Twomey  Zoom on Liam Twomey  Twomey, Liam.
Information on Mary Upton  Zoom on Mary Upton  Upton, Mary. Information on Jack Wall  Zoom on Jack Wall  Wall, Jack.

[845]Tellers: Tá, Deputies Kelleher and Kitt; Níl, Deputies Kehoe and Stagg.

[845]Question declared carried.


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