Thursday, 23 November 2000
Seanad Eireann Debate
Dr. Henry: Thank you for letting me raise this matter for the second time in seven years. I raised the matter of a population register in the Seanad over six and a half years ago in relation to the important matter of breast screening, which was being set up in the country. I pointed out that the lack of a population register made it far more difficult to set up breast screening. Breast cancer accounts for the death of one in five women who die from cancer in this country. It is a major cause of concern that premature death is caused by breast cancer.
I regret that those who have so successfully set up Breastcheck still have the problem that there is no population register. The Minister of State will be aware that at present women are called for a mammographic examination between the ages of 50 and 65 years, but because we have no population register those running the screening programme must rely on getting data from the general medical services and the private health insurance companies, such as the VHI and BUPA. This can mean that some people are called twice because they are on two lists, which is a cause of anxiety, and others may be left out.
I am sure we want this to be the most effective form of screening possible. I do not understand why in this day and age, with the proliferation of computer data, this cannot be set up. The National Cancer Register Board produces data on deaths from tumours and leukaemias. It also encounters terrible problems in the absence of a population register. Instead of a central collection  of information on the causes of death, the board must employ specially trained nurses to go through the death certificates in various hospitals, collect the information and send it to the board.
This is an inefficient way of operating. We co-operate with the cancer strategy in Northern Ireland, where information can be immediately obtained from the hospital in-patient inquiry. All the statistics are collected centrally and the various deaths due to cancer and the types of cancer can be identified. Why does the inefficiency I have outlined continue here?
The best way we can reduce deaths by breast cancer is by screening because it gets not all, but almost all tumours before even the lump can be felt. While symptomatic breast clinics are very important, by the time people attend them they have some sign, usually a lump in the breast or some other symptoms. At the specialist clinics the people involved in the treatment of breast cancer – surgeons, oncologists, radiotherapists, physiotherapists – discuss each case together and try to tailor the best form of treatment for the woman concerned. This is why I am sometimes depressed to hear Senators call for the maintenance of very small units around the country. The Minister for Health and Children has said they do not give the best chance of good treatment to patients, although I accept there is no bigger vote catcher for Independent candidates than to stand for election on a ticket of saving the local hospital or clinic.
We must establish a population register. We may wish to start other screening programmes. The country has a very high rate of prostate cancer. How do we hope to tackle that without a register? The country also has one of the worst rates of death in men from anal/rectum cancer in the world. Only the two parts of former Czechoslovakia have a higher rate.
Will the Minister of State explain why we have not managed to establish this register, which could help us to screen for our commonest causes of death? It would also promote research into the various forms of cancer in the country. While genetic factors may be important, environmental factors may also be very important.
Mr. S. Brennan: I thank the Senator for raising this important matter. I listened carefully to what she had to say. I am not sure if the official reply before me will adequately deal with the points she raised, but I will ensure that the Taoiseach, Minister for Health and Children and my other Government colleagues are made aware of them.
The Department of Social, Community and Family Affairs maintains a register of all insured persons under the social insurance system. As soon as a person becomes known to the Department, normally when child benefit is claimed, a personal public service number is assigned to them. This was formerly known as the Revenue and Social Services number. At this stage the following categories have been allocated a personal public service number, all employees, the self  employed and people receiving social welfare payments, their spouses and children.
A person is allocated one of these numbers and retains it throughout their lifetime. Legislation was introduced in 1998 to provide for the standardisation of the RSI number as a unique public service identifier and renamed the personal public service number. The purpose of this unique identifier is to provide a better quality of service through greater ease in communicating with Departments and Government agencies and access to related services from a single point of contact, increased fraud prevention, greater administrative efficiency and effectiveness and more flexibility and better responsiveness to changing needs. The legislation also provides for  the sharing of data using the number between a range of public service agencies.
The Health (Provision of Information) Act, 1997, was introduced to allow the National Cancer Register Board and other agencies participating in any cancer screening programme to request information from persons for the purpose of compiling and maintaining a register of persons who may be invited to participate in that programme. Last year the social welfare legislation was amended to allow for the use of the number as a unique identifier in this process. I will convey the broader points made by the Senator to my relevant colleagues.
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