Oncology Services: Statements.

Thursday, 8 December 2005

Seanad Eireann Debate
Vol. 182 No. 15

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Minister of State at the Department of Health and Children (Mr. T. O’Malley): Information on Tim O'Malley  Zoom on Tim O'Malley  I want to set out the current position in respect of national oncology services. Cancer is one of the most common causes of morbidity and mortality today, with more than 10 million new cases and more than 6 million deaths each year worldwide. More than 21,000 people in this country develop cancer each year and approximately one third of the population will suffer some form of cancer in the course of their lives. Cancer numbers are increasing by approximately 1.5% every year, mainly due to the growth of our population. While cancer can affect all ages, it is most prevalent in the over-65 age group. The significance of this is heightened by the fact that our population is ageing. The disease can have a devastating effect on patients, their families and the wider community. The impact of the disease on our society is substantial and provides a major challenge to our health service.

There is an awareness of the need to develop cancer services nationally in tandem with best international practice. The Government constantly strives to improve the quality of care and the outcome for cancer patients. Since 1997, additional cumulative funding of more than €720 million has been made available for the development of appropriate treatment and care services for people with cancer. This includes the sum of [358]€23.5 million which was provided in 2005 to ensure that we continue to address increasing demands for cancer services throughout the country. This substantial investment has enabled the funding of approximately 110 additional consultant posts in key areas of cancer care and an additional 327 clinical nurse specialists in the cancer services. The investment in cancer services has also led to increased activity, with the number of patients discharged from hospital with a diagnosis of cancer increasing by 100% in the period 1994 to 2003. Moreover, the number of day cases increased by 225% during the same period. The 2006 Estimates include an additional €9 million for the Health Service Executive to continue to meet the additional service pressures in cancer care, to improve the quality of care, to facilitate better access to radiation oncology services and to continue the preparation for a national cervical screening programme.

The development of breast disease services is a major priority in the development of cancer services. Breast cancers make up a high proportion of all cancer in younger women and the majority of women will be treated by the symptomatic breast disease services. Each year approximately 2,000 women are diagnosed with breast cancer in this country and in the region of 650 women die from the disease. The O’Higgins report on the development of services for symptomatic breast disease recommended the development of a new organisational structure for the provision of breast disease services. The report recommended the development of 14 specialist breast units throughout the country with a minimum case load to improve the quality of care for those women suffering from breast disease. Funding in the region of €60 million has been made available to support the development of symptomatic breast disease services since 2001. Six of the units recommended in the report are now fully operational and the remainder are at advanced stages of development.

To ensure that the women suffering from breast disease receive the highest standard of care, it is important that quality assurance structures are put in place. Last July, the Tánaiste established a national quality assurance group for symptomatic breast disease services under the chairmanship of Professor Niall O’Higgins, president of the Royal College of Surgeons in Ireland. The work of this group will be a key element in developing an improved national approach to quality assurance in the management of breast disease and an important initial step in improving and assuring quality in cancer care generally.

BreastCheck, the national breast screening programme, was introduced in 2000 and screening is being offered every two years, free of charge, to approximately 160,000 women in the 50-64 year age group in the eastern, midland, north-eastern and parts of the south-eastern areas. Since the introduction of BreastCheck, cumulative revenue funding of more than €60 [359]million has been allocated to support the programme and €12 million capital funding has been made available to provide for the necessary infrastructure.

There are approximately 130,000 women in the target age group in the remaining regions of the country. The national roll out of the screening programme is therefore a major priority. A capital investment of approximately €21 million has been approved for the construction of two new BreastCheck clinical units at Cork and Galway. BreastCheck recently advertised for key lead consultant radiologists and radiographers for the expansion of the programme and the recruitment of other key clinical posts will commence early in 2006. A design team has been appointed to work up detailed plans for two new clinical units and BreastCheck expects that, subject to obtaining satisfactory planning approval, the design process, including the preparation of the tender documentation, will be completed by mid-2006. BreastCheck is confident that the target date of 2007 for commencement of the national roll out will be met.

A pilot cervical screening programme was introduced in the mid-western region in 2000. Under the programme screening is being offered free of charge to approximately 74,000 women in the 25-60 year age group at five year intervals. The Department requested the former Health Board Executive to commission a report on the feasibility and implications of a national roll out of a cervical screening programme. The report, by an international expert, was published in 2004 and, following its publication, the Department consulted with relevant professional representative and advocacy groups as part of its considerations on a national programme. The Department will discuss options for a national programme with the Health Service Executive.

In July this year, the Tánaiste announced the Government’s approval for a national network of radiation oncology services, to be put in place by 2011, commencing in 2008. The plan will consist of four large radiotherapy centres in Dublin, Cork and Galway and two integrated satellite radiotherapy units in Limerick Regional Hospital and Waterford Regional Hospital, conditional on their conformity to certain quality assurance arrangements. These arrangements include the following conditions: satellites to be integrated with one of the four large centres to ensure maintenance of standards and adherence to protocols; radiation staff to be employed by large centres subject to agreement and arrangements where there are pre-existing employment contracts; and radiation staff to rotate in and out of large centres to maintain and develop their skills and knowledge.

The national plan will mean an investment in additional capacity to the equivalent of 23 additional linear accelerators. The capital investment involved will be approximately €480 mil[360]lion, with most of it funded through public-private partnership over the period to 2011. In this regard, the Tánaiste has asked the Health Service Executive and the National Development Finance Agency, as a matter of priority, to develop and progress public-private partnership arrangements to design, build, finance, maintain and partially operate the proposed services at Dublin, Cork and Galway, including the satellite centres at Waterford Regional Hospital and Limerick Regional Hospital, subject to discussions between the Limerick Hospital Trust and the Health Service Executive.

The Government considers that the best option in terms of improving geographic access for patients in the north west is to facilitate access for those patients to radiation oncology services as part of North-South co-operation on cancer. It was agreed that the issue of access in the short term to the radiation oncology centre at Belfast City Hospital for patients in the north west would be progressed and that consideration would be given to progressing a joint initiative for the provision of oncology services in the medium term to patients in the region from a satellite centre linked to Belfast City Hospital.

The Tánaiste met with the Minister for Health for Northern Ireland, Mr. Shaun Woodward, MP, and it has been agreed that the new Belfast Cancer Centre, which is due to open next March, will treat patients from Donegal. Details of the arrangements will be finalised in discussions involving the Health Service Executive, Belfast City Hospital and the respective Departments. This will involve assessment of the specific radiotherapy needs of cancer patients in Donegal and the development of clinical treatment protocols, including appropriate transport arrangements, to ensure best patient care. Discussions will also be necessary on the funding arrangements involving the hospital and the Health Service Executive. The issue of a satellite centre in the north west will continue to be progressed as a joint initiative involving bilateral discussions at departmental and political levels.

The national radiation oncology co-ordinating group provides advice to the Tánaiste and the Health Service Executive on radiation oncology. The group has just submitted quality standards for the provision of radiation oncology services for public patients to the Tánaiste. The Department has raised the issue of transport arrangements for patients requiring radiotherapy with the Health Service Executive to ensure that appropriate transport arrangements are put in place on a national basis for patients who are required to travel to obtain radiotherapy. Transport solutions are already a feature of the current provision of radiation oncology services and will form part of the planning and implementation of the new national plan given the significant increase in capacity involved.

The importance of cancer research and education in the delivery of high-quality cancer care [361]is increasingly recognised. Most of the preventive, diagnostic and treatment methods available in cancer care have resulted from innovative research and clinical trials over many years. Following the Good Friday Agreement the Ireland-Northern Ireland national cancer consortium was launched as a trilateral partnership between the Governments of Ireland, Northern Ireland and the United States. One of the aims of the consortium is to provide an all-Ireland infrastructure to co-ordinate the clinical trials of hospitals on both sides of the Border. Awards to the value of €3.5 million have been made to the Health Research Board to support this initiative.

Cancer control policies must be patient-centred, quality-driven and evidence-based. The introduction of the ban on smoking in the workplace has been a significant milestone in our cancer prevention policy. Almost two years on the ban is working and Ireland has set a new health and legislative precedent. The National Cancer Forum has responded to the continued priority that needs to be given to the strengthening of cancer policy and its implementation by developing a second national cancer strategy. The key goal of the first national cancer strategy was to achieve a 15% decrease in mortality from cancer in the under 65 age group in the ten year period from 1994. An evaluation of the 1996 national cancer strategy demonstrated that this figure was achieved in 2001, three years ahead of the target date. The National Cancer Forum is finalising the new national cancer strategy, which will be published soon. The new strategy will have regard to the multifaceted aspects of cancer control. The key priority in the development of improved cancer care is the provision of multidisciplinary care. The strategy would set out key priorities for the development of cancer services over the coming years and will make recommendations on a balanced organisation of cancer services nationally with defined roles for hospitals in the delivery of cancer care.

This Government remains committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland in accordance with best international standards. We believe it is important to build teams of expert clinicians working together to deliver top quality cancer care to all our patients. To this end we will continue to provide considerable investment in oncology services in the coming years.

Mr. Browne: Information on Feargal Browne  Zoom on Feargal Browne  I welcome the Minister of State and his officials to the House. He is a frequent visitor and is due back this afternoon. I compliment the former Minister for Health and Children, Deputy Martin. Although I have disagreed with him on many issues, his contribution to future cancer reduction through the ban on smoking in the workplace will be seen as a turning point. From that episode we learned that Ireland, a tiny country on the periphery of the EU, could lead the way. Other countries now follow our [362]example. We must take that tough line and put pressure on cigarette companies as we have done. There is a direct link between smoking and cancer and future generations will see a reduced rate of cancer, which will save families trauma. We should build on that, take it a stage further and move forward. The plastic bag tax was another great idea by the previous Government and, along with the smoking ban, was a great success. It is great for a change to see England following our example instead of us following them and that is the way forward.

I am disappointed that yesterday’s budget did not increase cigarette tax, which it should have done. We should do everything possible to deter people, especially young people, from smoking. The British Secretary of State for Health plans to increase the legal age for smoking from 16 to 18 years. I am not sure how it will be implemented, perhaps the same way the alcohol age limit is implemented. We should monitor that situation and if it works in England mirror it here. I am always bemused when I meet my ex-students who are now in secondary school and see them smoking and thinking they are cool, particularly girls. I have seen few boys smoking. For some reason secondary school female students think it is cool to smoke. Perhaps it is related to weight control and image. Unfortunately it leads to serious problems. A friend of mine who is in his 40s had throat cancer recently and I saw the devastating effect it had. Although he made a full recovery the treatment was very severe. We need to highlight the risks of smoking.

The Joint Committee on Health and Children has received correspondence from a recently formed alliance about the dangers of food and the link with cancer in later life. Manufacturers are disingenuous when they talk about the contents of food and do not give the consumer the full facts. Much education needs to take place in that area and we have a role as a Legislature to ensure that people are told the fat and salt content, etc., of products they buy. Many young children’s lunches are loaded in the wrong way in terms of food content. If they start life on a bad note there is no doubt that they will end up with severe medical problems. Senator Glynn continually raises the issue of diabetes and obesity. There is a link with cancer and we need to play our part in that area.

We should look at raising the age limit for buying cigarettes from 16 to 18. The idea of banning packs of ten cigarettes was mentioned before. I do not know what stage that is at but it would be a concrete example of how we could eliminate the attractiveness of cigarette smoking for young people in particular, which would have an effect in the future.

While the Minister’s speech contained much good news, and much good work is happening, there is confusion in the area of cancer services. Phrases he used in his speech say it all. The Minister mentioned funding to “continue the prep[363]aration for a national cervical screening programme”. That is vague and contains no definite commitment. We recently received correspondence from the Irish Cancer Society pointing out that while a full-scale national programme for cervical cancer screening was promised nine years ago, the Government is no nearer to implementing it now than it was then. The number of cases is frightening. In 2000, there were 1,090 new cases of cervical pre-cancer, 193 cases of cervical cancer and 65 deaths from cervical cancer. Ireland still has no nationwide cervical cancer screening programme. The Irish Cancer Society points out that such a screening programme could reduce the number of cases and deaths from cervical cancer by up to 80%. Cancer can be treated and people can recover fully but that is not happening. An inconsistent approach is adopted in different parts of the country. In the mid-western region free cervical screening is available to 71,000 elderly women but it is not available in the rest of the country where women are forced to pay for the screening. That is unsatisfactory.

  12 o’clock

I am bemused by the number of announcements by Ministers over the past years that BreastCheck has been fully rolled out to the whole country and yet we discover today that almost half of women are not getting the service they should be getting. The Minister’s speech states, “160,000 women in the 50-64 year age group in the eastern, midland, north-eastern and parts of the south-eastern areas”, are entitled to a free breast check but then mentions that approximately 130,000 women are not availing of it. Almost half the women in the country entitled to be screened under the BreastCheck programme are not receiving the examination. The programme has been announced time and again by successive Ministers. I am confused that money is not a problem with the programme, but staffing is. I am encouraged to hear the Minister of State talk of increased staffing in his speech, but he might clarify the problem. Is the problem with cervical screening due to funding and is the problem with breast cancer screening caused by staffing? Surely these obstacles can be overcome.

I will discuss the issue of travelling for treatment. Many people from Carlow who develop cancer can travel to Dublin to receive treatment, as we are quite lucky to have a train service. Such a service is particularly important for patients undergoing cancer treatment, who may be incontinent or nauseous after treatment. Travel in a car or bus may not be suitable, and a train has toilet facilities and is therefore more comfortable. I sympathise with people from Donegal who have no train service and must go long distances for treatment. The announcement today of co-operation with Belfast hospitals will be well received by these people.

We should be aware of people in remote areas. For example, I am not sure what happens with [364]people from west Cork, although I presume they go to Cork University Hospital for treatment. This is still quite a long distance on poor roads. Transport is a key aspect of cancer services of which we should be mindful. People may have to travel 100 miles for treatment, which may only last for five minutes, before returning home.

A private hospital being built in Carlow will have chalets around it. The idea is that people can have treatment and instead of being stuck in a hospital bed on their own and having too much time to think, which can be bad when one is ill, these people can bring their families with them and treat it as a type of holiday. They can have their short treatment and come back to be distracted in a good way by their family. I imagine if a person had to come to Dublin and stay in bed and breakfast accommodation alone for six or seven weeks while receiving treatment, it would be very lonely. This cannot be good for convalescence. People in Carlow are lucky enough that they can use the train every day and spend time with family. If a person is single or has no family, it would not be good to have to travel long distances.

What will the satellite centres mentioned by the Minister of State consist of? It is regrettable that the announcement made by the Tánaiste in July discusses the national network of radiation oncology services being put in place by 2011. That is almost six years away. These have been promised before, and I cannot understand the delay with these services, which are vital. Some 30% of Irish people will have some form of cancer in their life, and one would imagine the issue would get more priority. It is worrying that only 30% of Irish people who develop cancer receive radiography treatment. The normal global percentage is approximately 50%. This country has a high rate of people developing cancer, and not all those who develop the disease get the treatment they should be receiving. This impedes recovery and could contribute to a quicker death.

In Carlow and Waterford two private hospitals are being built. These may not initially provide radiography services, although such services may be included over time, along with more laboratories. Perhaps the Minister of State could expand on the plans for private hospitals around the country. Will these hospitals be allowed to develop their own services, perhaps in conjunction with major hospitals? This issue could be examined in tandem with my previous point of patients needing only a five-minute treatment rather than a process lasting an hour or more. It is a pity to force sick people to travel long distances when they are receiving a short treatment, especially when they may feel unwell afterwards. Outreach centres in the community, which could cut down travelling distances, should be facilitated.

Last night I browsed an American website with details of cancer facts and figures. The Government should take up this issue. The website has [365]statistics on age-related cancer deaths, complete with the breakdown by ethnic groupings. Ireland is now a multicultural society, and similar information would be useful. The Government could work on developing a website providing all the information about cancer, and I compliment the Irish Cancer Society, which has an excellent website that provides people with such information. We must unearth statistics for cancer care, as some ethnic groups would have a higher rate of cancer than others, and age is also a significant factor. It would be useful if such information was given to the public, and we could then compare the information with that of other countries in an effort to improve services. The Irish Cancer Society has pointed out that if the national screening programme included cervical cancer, deaths could be reduced by 80%, which is startling.

In October 2003, the Government published the report on the development of radiation oncology services in Ireland. It recommended different radiotherapy services, and the Minister made further announcements in July. There is much confusion on the matter as we have heard many announcements in the past. We do not have any way to benchmark the services. The announcement that the services will be arriving so far in the future, such as 2011, makes it difficult for people to gauge the progress being made. I made a point earlier about 35% or 36% of cancer patients receiving radiation therapy at some stage in their illness, and 20% of new cancer cases receiving radiation therapy as part of the primary management of the disease. In Western countries, radiation therapy is part of the treatment for 50% to 60% of cancer patients.

The Tánaiste yesterday remarked to the Joint Committee on Health and Children that the treatment of cancer in Northern Ireland is better than here. Although this was a throw-away remark it is significant. She stated that care has been rationalised, featuring fewer surgeons and more concentration of services in a few units. This has led to improved cancer treatment and we should follow this example.

It is shocking that where one lives can have a significant impact on the chances of a person surviving cancer. As we live in a small country with a small population, this should not be the case. I visited Taiwan two weeks ago, which has 24 million people, and countries such as India and China have populations of over 1 billion people. In these countries which cover large areas one could understand such a correspondence between where a person lives and cancer survival rates. Ireland is a very developed and wealthy country. According to yesterday’s budget, the coffers are quite full. In 2005 and 2006, where a person lives in Ireland should not dictate how quickly he or she recovers from cancer or if recovery actually happens. Facilities should be spread across the country on an even basis.

[366]It is shocking that a quarter of all deaths in Ireland result from cancer. Another worrying trend is the prediction of a 41% increase in the number of cancers by 2015. This excludes non-melanoma skin cancer. A patient recently went to court to vindicate her right to essential life-saving hospital treatment and care. I hope we learn from that debacle.

The Tánaiste spoke of €400 million being used in the delivery of oncology services, mainly through public-private partnerships. I have concerns about the privatisation of the health service, although I am not a left-winger or a loony socialist.

Mr. Glynn: Information on Camillus Glynn  Zoom on Camillus Glynn  We can rule the Senator out as the fourth socialist then.

Mr. Browne: Information on Feargal Browne  Zoom on Feargal Browne  I can be ruled out. Deputy O’Connor is the third socialist.

Although there is a requirement for privatised health care, and the private sector should be involved in health care delivery, there is a difficult balance to be maintained. We should not have a case where a public hospital has a private hospital beside it, with consultants working in both. Such consultants would earn far more in the private hospital so the patient will ultimately be directed there. Health issues should not be dictated by financial matters, and it is important that people with cancer receive the treatment they deserve.

Much work has been done, as is evident from the Minister of State’s speech, but it is time the BreastCheck programme was rolled out across the country and the cervical cancer issue was examined. I am aware Senator Glynn will address the issue of men’s health today. The remark made by the Tánaiste and Minister for Health and Children at the Oireachtas Joint Committee on Health and Children yesterday that a national cancer screening programme for men would not result in any benefits makes no sense. If cancer screening works for women, it will work for men. My father was diagnosed with prostate cancer in January of this year but made a full recovery. The number of men I have met since then who told me they also had prostate cancer shocked me.

We need to promote men’s health. A number of good advertisements about men’s health have been run recently, which recommend that men get themselves checked out once a year in the same way as their cars are checked once a year. Unfortunately, men tend not to visit their GPs on a regular basis. I am sure Senator Glynn will elaborate on the need to promote men’s health.

Mr. Glynn: Information on Camillus Glynn  Zoom on Camillus Glynn  I welcome the opportunity to debate oncology services in this country. I received a telephone call yesterday at 8.15 a.m. from a concerned individual about a woman aged 42 years who had been diagnosed with ovarian cancer and undergone an operation. How often do we hear people tell each other that certain [367]individuals have received bad news? This bad news invariably concerns cancer, rather than a heart condition or a severe urinary tract infection.

I am pleased the Minister of State has come to the House to outline the current situation and proposed future developments. Senator Browne referred to the apparent lack of concern about the incidence of cancer among men. There appear to be no statistics on the incidence of cancer among men, although I have endeavoured to obtain them. I recently visited Paris with colleagues to study health strategies and facilities in France. I asked about the incidence of prostate cancer and was reliably informed that it has increased. I put the same question to representatives from the VHI at a meeting of the Oireachtas Joint Committee on Health and Children and received documentation which stated that the incidence of prostate cancer has increased. What is being done about this?

There was no reference to cancer among men in the Minister of State’s speech. I appreciate the importance of BreastCheck and cervical cancer screening. Women’s health is extremely important as they bear and rear children and play a pivotal role in society. However, men play an equally important role and it is time that men’s health was treated as seriously as women’s health. What are the statistics regarding the incidence of prostate cancer? I am led to believe it is on the increase. What are the statistics regarding the incidence of testicular cancer and colon cancer in men? Approximately two weeks ago the Irish Cancer Society held a very interesting in-house seminar in the Houses of the Oireachtas on cancers that affect men. I asked the training unit in the Oireachtas to repeat the seminar because it merited repeating.

One of the curses of being human is that we do not know everything we wish to know. However, one of the most positive measures carried out to address pulmonary carcinoma, or lung cancer, was the ban on smoking in the workplace. The issue involved heated arguments. I remember representatives from tobacco companies telling the Oireachtas Joint Committee on Health and Children that smoking was not one of the causes of lung cancer, although it is not surprising that they did so. I, along with the former Minister for Health and Children, Deputy Martin, and others, were very proud to be invited to attend the Smoke Free Europe conference in Luxembourg. European countries are endeavouring to follow our lead with regard to a ban on smoking in the workplace. A parliamentary delegation from France recently met with the Oireachtas Joint Committee on Health and Children to ascertain how Ireland enforced the ban, so Ireland is giving a lead in this matter. However, we cannot sit on our laurels. A lot has been done but there is a lot more to do.

The report produced by the national task force on obesity is extremely important. I agree with [368]Senator Browne that we should be cognisant of what we eat and avoid eating fatty foods as far as possible. A GP in the town of Killucan in County Westmeath once told me that there should only be one frying pan per parish. This remark indicated that, many years ago, the medical profession advised against eating fatty foods.

I received two particularly depressing telephone calls in February 1998. One was from a brother of mine who told me he had been diagnosed with prostate cancer, while the other was from a sister of mine who told me that another brother had been diagnosed with lung cancer. My brother who had lung cancer died in March 1998 but my other brother is still alive and doing well. Another individual who is married to a relation of mine died of prostate cancer and was buried on 1 January 2000. That was some millennium present for his family.

Cancers that affect men must be brought to centre stage because they are not there at the moment. Men are not blameless in this matter. According to statistics, women are far more likely to address their problems — health-related or otherwise — than men. Statistics reveal that suicide rates among young men are seven times higher than suicide rates among women in the same age group. These are worrying factors.

I was contacted some time ago by an Irish company which produced breakfast cereals and informed that it is examining closely the make-up of its products. This is important because of the truism that we are what we eat. We need to be cognisant of what we eat and drink and the air that we breathe. This is why environmental tobacco smoke has been proven to be a known carcinogen. Both Houses and Government and Opposition parties can be proud that legislation outlawing smoking in the workplace went through both Houses unopposed. This clearly indicates the consensus that exists on issues relating to cancer. We may argue about the best way to tackle cancer but, as the saying goes, “That’s politics”. Great credit is due to Members of both Houses for supporting the ban on smoking in the workplace.

In its seminar in the Houses of the Oireachtas, the Irish Cancer Society addressed other cancers, such as skin cancer. Sunbeds should be used with great caution. In respect of throat cancer, we have dealt with the risks to those who smoke but it is not a good idea to consume a great deal of alcohol, especially when it is not diluted. Colonic cancer has been mentioned, but there are also cancers of the lung, bowel, bone and various blood conditions, as well as those of the reproductive systems of men and women.

The Minister of State referred to several points in the national cancer strategy of 1996 and the new strategy. He said:

This is an example of the truth in the old adage, a stitch in time saves nine. It shows what we can do when we focus on a problem.

The Minister of State also said:

When the former Midland Health Board, of which I was a member, debated cancer services we decided to break up the services and locate them in various places. I was disposed to that decision more for political than practical reasons. I was wrong because the more procedures carried out at one location, whether for symptomatic breast cancer or other cancers requiring surgery, the greater the expertise obtained there. That is not rocket science, it is common sense, which is not always that common.

Much has been said about radiation oncology services to which the Minister of State referred. With the advent of improved communications we can develop this to the ultimate. We cannot sit back and say we have done all that is required with regard to BreastCheck and cervical screening. The existing policy works pretty well but there is a group of people who feel the screening should be extended to other age groups. I accept that resources are finite but when the health of men, women or children is at stake it is imperative that we do, and are seen to do, what is right and to the long-term benefit of the population.

Phase one of the national cervical screening programme commenced in the former Mid-Western Health Board area in October 2000. Approximately 74,000 women in the 25-60 age group are being screened free of charge at minimum intervals of five years. The number of smear tests carried out annually is approximately 230,000 representing an increase of almost 20% in recent years. That is very welcome. To meet this increase requires additional cumulative funding for which the Department has provided since 2002. The Minister of State cited the figures for this funding. This enhances the laboratory and colposcopy services. In addition, the Department allocated a further €1.1 million to the programme in 2005 on an ongoing basis to complete the transition of the remaining laboratories to new and more effective testing and to support the development of quality assurance and training programmes. These are essential preparatory elements in a national roll out. My colleague, Senator White, has blazed a trail in regard to cervical screening, not only in the Chamber, but at [370]parliamentary party and Seanad group meetings. It is imperative that we extend this programme to the four corners of Ireland in so far as possible.

I am delighted to hear that people from Donegal will be able to avail of services from Belfast. That indicates what co-operation means. It is the common sense approach because while regrettably there are two administrations on this island a common approach to treating a common problem is very important. I have put a few questions about men’s health and oncology services to which I would appreciate a response.

Dr. Henry: Information on Mary E.F. Henry  Zoom on Mary E.F. Henry  I welcome the Minister of State to the House for this extremely important debate. When someone telephones to say he or she has received some bad news about his or her health, this all too frequently refers to having cancer. This is most unfortunate because the international results for the treatment of cancer have improved significantly within the time that I have been involved in medicine. It is a great pity we cannot emphasise this more strongly but it is important to note that the earlier the cancer is detected, the more effective the treatment.

In some cases, for example leukemia, the survival rate has risen from 10% to between 70% and 80%. The same is true for some of the lymphomas. While the survival rate in Ireland for these cancers matches international standards, unfortunately we are way behind those standards in survival rates for other cancers. Anyone involved in politics should try to swear that he or she will not allow the aggregation of services for cancer treatment to become a party political issue.

Without a shadow of a doubt, if there are specialist areas in designated places the results will be much better. Services as close to home as Northern Ireland are achieving better results than ours in breast, bowel and several other cancer treatments. It is irresponsible of people to seek small stand-alone centres treating maybe one or two cases of a specific cancer every year, when they know the patient’s results are not likely to be as good as if he or she were treated in a specialist centre.

People attending a large hospital such as St. James’s where there are case conferences with the chemical oncologist, the radiotherapist, the surgeon who will do the work, a physician to deal with other aspects and the anaesthetist, achieve much better results than those attending a centre that treats single cases maybe once a month. I ask those who insist that local hospitals are kept open to ensure they are not being asked to do anything in those hospitals which may have a less than satisfactory outcome for the patients.

I was glad to hear Senator Glynn raise the issue of men’s health and cancer. Some years ago the assisted human reproduction clinic in the Rotunda Hospital asked me to try to get funding for the freezing of sperm from young men with cancer, when the chemotherapy or radiotherapy [371]might render them sterile. I asked approximately for how many cases a year it expected to need funding and was told it would probably be in the region of 20. They are receiving 200 cases a year, which is a large number of young men with cancer who want their sperm frozen. When asked if he would like to avail of this service, a young man will immediately believe he will survive the cancer. The psychological, as well as the practical, effect of such a request is extremely good for the patient concerned. I am glad the Department of Health and Children supported this initiative several years ago.

A programme instructing men to consult their doctors if they feel they have a problem is very necessary. Men are extremely bad at going to the doctor. A practical advertising campaign directed at men must be started to say it is a good idea to see a GP if they find a change in their testes, for example. This is better than going six months later when the testicular cancer may have spread.

Internationally, medical experts are not sure whether the incidence of prostate cancer is increasing or that the detection rate has improved. I am inclined to believe it is the former. The prostate-specific antigen test, the PSA, has not proved as useful in screening as originally believed. To launch a national screening programme for prostate cancer may result in many false positives, leading to misdiagnosis.

Bowel cancer is an area where a national screening programme could be successfully introduced, particularly with the faecal occult blood test, a home-test kit in effect. Patients over 50 years of age could be given specific test papers for testing their faeces for three days running, at home. If the test proves negative, they are fine. These home-testing kits have been shown to be very reliable. Such a programme would greatly benefit men as bowel cancer is the most significant cause of death among males.

We still do not have a population register regarding all screening programmes. A decade ago, I asked for such a register to be established but it still has not been. Every time a screening programme is begun, there is messing around with PRSI and VHI numbers and goodness knows what else.

The screening situation for women is only slightly better. However, it is only a matter of time before someone outside the Limerick area with cervical cancer sues the Department of Health and Children because it was not picked up in a cervical cancer screening.

Ms White: Information on Mary M. White  Zoom on Mary M. White  Hear, hear. The Senator has a good point.

Dr. Henry: Information on Mary E.F. Henry  Zoom on Mary E.F. Henry  This is an important test in young women. I knew someone in her 40s who recently died from cervical cancer. The Irish Cancer Society claims there are an unnecessary 60 to 70 deaths a year from cervical cancer, even when it [372]has a high cure rate. I applaud Senator White for raising this issue in the parliamentary body.

Mr. Glynn: Information on Camillus Glynn  Zoom on Camillus Glynn  Hear, hear.

Dr. Henry: Information on Mary E.F. Henry  Zoom on Mary E.F. Henry  A cervical cancer screening programme must be introduced at once. Nine years ago we were told it was to be rolled out but no progress has been made.

BreastCheck is another important programme which must be rolled out nationwide. I am extremely glad it is not advertised too often. I wonder how I would feel if I lived in part of the country where BreastCheck is not available, only to be told by advertisements that I needed to be screened because it is a matter of life and death. Opportunistic screening is not as satisfactory as a planned programme, such as BreastCheck. The same planned programme is necessary for cervical screening. Another problem regarding cervical cancer screening is the shortage of cytologists. While there is a shortage in all cancer detection and treatment areas, it is important that this shortage is addressed.

The Minister of State did not refer to the genetics of cancer. More women with breast cancer might be saved if there were genetic profiles of women who appear to have a family history of breast cancer. This is a serious problem. The first degree relatives, such as a mother, occasionally a father or sisters, should be in a position to have the genetic make-up of a cancer examined. These women should be screened to see if they have the same genetic profile. A considerable number of families have a predisposition to breast cancer. Breast cancer and ovarian cancer genetics are closely linked. Unfortunately, the cure rate with ovarian cancer, because it is normally discovered at a late stage, is not the best. In Tallaght Hospital, a clinic was started for counselling and establishing genetic profiles of various family members of people who appeared to have a family history of breast cancer. Unfortunately, within months, there was a year and a half waiting list, which is not satisfactory.

I am glad the Minister of State referred to the link between cancer and obesity. For a long time, fat was considered simply as blubber with no more effect than making it difficult for running up and down the stairs. However, it is now known to produce substances similar to endocrine hormones, which can have serious effects on the body. That nothing has been done about the obesity report is very disappointing. The Department of Health and Children must tackle this problem as, unfortunately, we are getting fatter by the hour. In a recent debate the Government was taking credit for some matters. I pointed out it should also take credit for the fact that when it was elected in 1997, the obesity rate among adults was 8%, but when it was re-elected it was 14%. By the next election, it will be at 18%.

Senator Glynn was correct on the risks of alcohol consumption, particularly undiluted [373]alcohol. We have had success with smoking and there has been a reduction in pipe-smoking. Regarding cancer of the bladder, again, men must be told blood in their urine is a sign of something and that they should see a GP. There is a high incidence of oral cancers in Ireland because the dental health service was not as good as it should have been. Regular visits to the dentist will ensure oral cancers are detected.

Access to good public transport is the main factor that militates against specialised centres for cancer treatment. A friend of mine, who had radiotherapy in Cork, told me it was profoundly depressing to see notes on a board in the unit asking for lifts to Sneem or Lismore. Public transport is not the best in some parts of the country. However, with better co-operation with Northern Ireland’s health services, there are some improvements. For a Donegal patient, there is better access to Belfast than to Dublin.

I hope all politicians will take note of my call to avoid making the dispersal of specialised cancer treatment centres a political issue in the next election. We must take the advice from the experts in this area. I believed that long-distance radiology and instruction regarding radiotherapy might be more possible than apparently it is. It must be remembered the top priority is the best outcome for the patient. We must avoid making this serious issue a political football.

Acting Chairman (Ms O’Meara): Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  Before I call on Senator White, I wish to welcome a former Member, Mr. Martin J. O’Toole, to the Visitors Gallery.

Ms White: Information on Mary M. White  Zoom on Mary M. White  I thank the Minister of State at the Department of Communications, Marine and Natural Resources, Deputy Gallagher, for attending the debate and compliment him on the tremendous work he is doing in his portfolio. It was fascinating to listen to Senators Glynn and Henry whom I thank for their professional contributions. From working in the health services, they will have much greater knowledge of medical issues than other Senators.

Every week, one woman presents with cervical cancer in St. James’s Hospital in Dublin who would not have done so if a national screening service was in place. Ireland has one of the highest rates of cervical cancer in Europe. A regularised cervical cancer screening programme prevents the development of the disease because it recognises it in its pre-cancer stage. As a result, the condition can be treated successfully before the cells become cancerous and spread. The Irish Cancer Society estimates that a national screening programme would reduce cases of cervical cancer and deaths from the disease by up to 80%.

At present, free cervical cancer screening is only available to 71,000 eligible women who live in the mid-western health region. Other eligible women, a group numbering nearly 1 million, who live outside the region must choose to attend and [374]pay for what is known as opportunistic screening, which can be prohibitively expensive and ineffective in reducing cervical cancer rates. It may be worthwhile to explain to the young people present in the Visitors Gallery what opportunistic screening means. An example of this practice would be when a person undergoes a test for cervical or breast cancer, having been asked to do so while visiting a general practitioner with a sore throat or flu. I did not know what opportunistic screening entailed until I started studying this issue about six months ago but it is not the correct approach to cancer screening.

Several weeks ago I visited the National Maternity Hospital’s colposcopy clinic in Holles Street, which is run by Dr. Grainne Flannelly, consultant in obstetrics and gynaecology and member of the national committee of the Irish Cancer Society. It was a heart-wrenching experience. The women who visit the clinic have been diagnosed with cervical cancer and are fully aware that it kills one in every three women diagnosed with the disease. Dr. Flannelly informed me that women attending her clinic are terrified. The worst aspect of this problem is that cervical cancer is preventable. If we had a national screening programme, many women would not have to endure this trauma.

To roll out a national screening programme would cost approximately €18 million, a tiny amount in the context of the billions of euro spent on the health service. Senator Glynn and I and our colleagues in the Fianna Fáil Parliamentary Party will continue to raise this issue at our meetings. In a nutshell, our objective must be to persuade the Tánaiste and Minister for Health and Children, Deputy Harney, to engage with this issue and press the button which allows €18 million to be spent on a national screening programme.

Breast cancer has overtaken lung and colorectal cancer to become the second most common cancer after skin cancer and affects more than 2,000 women in Ireland each year. In 2001, 2,020 women were diagnosed with breast cancer and 645 women died of the disease. As with cervical cancer, early detection leads to better outcomes. When one considers our failure to roll out cancer screening programmes nationally, given the money available to us, one must conclude that we live in a primitive country.

As Senators will be aware, I drew up a document entitled A New Approach to Child Care. I am currently drafting a new programme entitled A New Approach to Ageing and Ageism and have made considerable progress towards finalising it by February. The prevalence of ageism in the health service should have caused a revolution by now. The current, restricted breast cancer screening programme is only available to those aged 64 years and under. Why was 65 years taken as a cut-off point for the eligibility criteria [375]to participate in the programme? The authorities would not get away with such a decision today.

The conventional wisdom, that the chances of contracting cancer decline as one grows older, has been turned on its head by more recent research. Outdated research from the 1980s indicated that the risk of breast cancer for women aged over 65 years was relatively low, yet Cancer Research UK has published research indicating that 75% of breast cancer occurs in women aged over 65 years. These are disturbing statistics. Cancer screening should be freely available to all women who are at risk of the disease, regardless of age.

My intention is not to exclude men or male cancer from this debate. I look forward to placing men’s health on the agenda of the House in the new year.

Mr. Glynn: Information on Camillus Glynn  Zoom on Camillus Glynn  Hear, hear.

Ms White: Information on Mary M. White  Zoom on Mary M. White  Breast cancer screening should be open to all women aged up to around 70 years, as per European guidelines, although I do not agree with prescribing an age limit. Age should not preclude people from receiving medical treatment. It is barbaric to provide that a person aged 70 years or over should not receive treatment. Who is to decide that a person of a certain age is less entitled to medical treatment than a younger person? That is a ridiculous proposition and, as Senator Henry noted, a woman may yet take a case before the courts if she finds herself unable to access cervical or breast cancer screening programmes.

Cancer is a terrifying disease, particularly for those women diagnosed every year with the condition. The State must do all in its power to raise cancer awareness to ensure all vulnerable groups are screened free of charge on a regular basis and to provide comprehensive services to those who have been unfortunate to be diagnosed with this devastating disease.

Government and Opposition Senators must put pressure on the Tánaiste and Minister for Health and Children to ensure the cervical screening programme is rolled out nationally and the national breast cancer screening programme is in place by 2007. The Acting Chairman, Senator O’Meara, will be aware from the pressure she and other Senators have applied on the issue of child care that putting the heat on Ministers works. It is ridiculous to argue that the Seanad cannot achieve anything. One can secure results if one puts one’s mind to it.

Mr. Ryan: Information on Brendan Ryan  Zoom on Brendan Ryan  Debates such as this can sometimes be wasted by Government bashing, of which I propose to do a little, because there is much more to the issue. I wish the Government had made greater advances in many areas, some of which I will mention. Although there is no point in failing to acknowledge progress, a number of questions arise. I am not trying to diminish the significance [376]of advances in service provision but the interventions which make it less likely that people will develop cancer in the first instance are also extremely important.

Our grandchildren will look back and wonder how we ever allowed a society to evolve in which everybody was forced to breathe vast quantities of smoke generated by other people. Having experienced smoke-free public places here, I recently visited a restaurant in Britain where a wall of smoke suddenly hit me. I recall the Irish hospitality industry claiming that tourists would stay away because of the smoking ban, but the reverse is the case. As more countries see the sense of it, countries that do not have a smoking ban equivalent or identical to ours, will discover that tourists will stay away from them.

A prominent American medical journal — I do not mean a popular journal, but a peer-reviewed one — published figures showing that in a large US city where a smoking ban equivalent to ours was introduced, the incidence of heart attacks dropped by one third in 18 months. This has nothing to do with cancer, but we will discover that as we restrict the situations in which people are exposed against their wishes to demonstrably carcinogenic materials, there is a decline in the incidence of related maladies. It will probably be far more significant in saving lives than if we even had the world’s best oncology service.

In dealing with such services, we should not forget that we can do many things in various areas that will reduce the incidence of cancer. One such step is to fund increasingly aggressive research into environmental factors, such as workplace and domestic exposure to various chemicals. The last time I checked the statistics, I found that approximately 60,000 chemicals were known to exist, although the figure has probably risen to 70,000 now. Of all of those, not more than 400 or 500 have been thoroughly assessed. All we can say about the remainder is that we do not know because we have not proven that they are harmful. I teach this subject, so what that means is that we do not yet know whether those chemicals are good or bad. Every carcinogenic substance has been identified simply by the fact that people got cancer from it. We still have no way of examining a chemical and forecasting its hazardous nature. Western society must investigate further the potential carcinogenic effects of many things that we may currently take for granted.

In 50 or 60 years, we will no longer be willing to be exposed casually to God knows what sort of chemicals. I say that as a chemical engineer with considerable pride in my profession. I am not a guilt-ridden chemical engineer, but the sort of practices that my profession insists upon in dealing with the chemical industry should be the same for people outside that profession. Nobody working in a modern pharmaceutical plant would tolerate the levels of exposure to chemicals that people take for granted in their private lives. For instance, most people had ammonia around their [377]houses for years, but the level of exposure to ammonia that a chemical plant would tolerate is much lower than what would be acceptable domestically.

It is a pity that we have not created a situation — some people love to say “incentivised”— whereby people are not put off by the cost of checking for and dealing with excessively high levels of radon gas, which is a proven carcinogen. It would be much cheaper for the State to fund such investigations and the remedial measures, rather than waiting for some people to contract lung cancer and then face the enormous cost of treating a potentially, and tragically often, fatal tumour.

There are so many gaps in our provision of oncology services, most notably for those women living outside the privileged BreastCheck areas. There is a continuing failure and delay in rolling out that service. Senator White is right about the limited age range within which the BreastCheck service is provided. The current limited BreastCheck service needs to be extended around the country, but there is no point in pretending that it is adequate. As Senator White said, women over 64 years of age cannot access the service. The cut-off point at 65 is one of the things that most upsets Age Action Ireland.

There is increasing evidence of a real threat to a significant number of younger woman from breast cancer. The capacity of mammograms to identify tumours in younger women is a real issue. We must deal with these matters not on the basis of prioritisation, but in terms of whether or not they work. Mammograms work for older women, but I am not sure they are so successful for younger women.

It is depressing to think that so many women die from cervical cancer when there is such a straightforward way of identifying it in time at a pre-cancerous stage and thus saving so many lives through proper screening. It seems that cervical cancer is even easier to pre-diagnose than breast cancer. I am bothered by phrases such as “the Department of Health and Children is discussing options with the Health Service Executive about a national cervical cancer screening service”. We have had several reports, but we should be moving beyond discussing options.

This is not a huge country. In many other countries, an area the size of Ireland would constitute a single health service region and what they would call a pilot study we would see as a national programme. We should accept that not everything here has to be done on a micro-scale, although it is a small country. It is potentially possible to roll out matters nationally because this is not a big country, but we do not have to do things that may be necessary in a country the size of the United States. For example, we do not have the huge geographical and climate variations of larger countries.

We need to be much more proactive with regard to prostate and testicular cancers. Prostate cancer is a long-standing issue that Senator Glynn [378]has raised and I am glad he has done so. It needs to be addressed because it is a major threat to men’s health. Testicular cancer is a problem for younger men in particular. It is an issue on which one will encounter giggling and discomfort, but young men need to be reminded that self examination is by far the best way of identifying testicular cancer at an early stage when it can be dealt with. I admire one young sportsman in particular, from my own county, who had the courage to say he had been diagnosed with testicular cancer. Hopefully his action will help to blow away the taboos surrounding testicular cancer. Although it kills young men, that cancer is eminently treatable if it is diagnosed in time. There is, however, a fear factor as well as a quasi-sexual factor related to machismo. Hard-hitting public information campaigns could help enormously in this respect.

Irish people are particularly susceptible to skin cancer. I have never fully figured out in terms of evolution and genetic mutations how we ended up being susceptible to it in our climate, but we cannot do much about that. The checking and treatment procedures for skin cancer need to be reiterated. It is difficult to get people to accept that skin cancer can kill, but it does. Among others, it killed Dr. Michael Smith, an eminent former Labour Party colleague of mine from north-west Cork.

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Each of the cancers to which I have referred, requires a different national response. For example, I do not want to hear that we will have a pilot programme to educate men about testicular cancer. We are a small country so we can do it nationally and we should do it now. Genuine concerns need to be highlighted. It is a spooky fact — I do not wish to identify any of the people involved — but at one stage, of the 60 Members of this House, 54 of them men, three had partners being treated for breast cancer. Those are the sorts of figures that bring home to one just how extensive breast cancer is. Our mortality rates are still higher than those of other countries. I am glad to read in the Minister’s script that they are going down, and I compliment the health services and the Government on that, although a good deal of it may be connected with such simple things as people stopping smoking. However, I am glad, although our mortality rates for those diagnosed with cancer are still unacceptably high by international standards, a theme to which I will return.

Regarding service provision, we must balance two things, the first being the undoubted fact that one cannot disperse every single oncology service to every single part of the country. One will not achieve an optimal service in that manner. The corollary is that if one says that certain people will have to travel long distances, one must incorporate travel into the service. One cannot have it as an addendum, as Senator Henry described. I found her comment hair-raising that one sees [379]notices on a board in a radiotherapy unit asking whether anyone can provide a lift home to Sneem or wherever. That should not happen.

We can integrate services and make it no more difficult for a woman with breast cancer in Donegal than the time involved, but there should not be a great gap so that people worry about how they get there or back. If they are suffering from nausea, there is no reason not to have accommodation for them if they wish. I cannot accept that, since it does not constitute a service. As long as one has such hair-raising, heart-rending stories, one will have continual demands for the dispersal of services everywhere. I understand that the much-trailed provision of services in Belfast to people in Donegal is conditional on the availability of beds and not guaranteed. That is not adequate, and it is the sort of thing that gives people nightmares.

I want a technical answer to this question, which I am trying to depoliticise. The Government has taken a decision on private provision in the health service. We have been told that one needs a range of expertise to achieve optimum outcomes in service provision, including a minimum caseload. In the first instance, even in the best possible model, if one has two parallel services, dividing patients between them, one ends up with two small groups, therefore reducing the possibility of achieving the minimum caseload that we are told is necessary to guarantee a high level of expertise.

Second, one ends up with parallel services providing those ranges of expertise, one has people who spend half their time in one and half in the other, or, more likely, one has two parallel services, neither of which is complete. That is a characteristic of countries such as the US, where one has many hospitals trying to provide all the services and competing against each other. The upshot is that the US spends 15% of its GDP on an inadequate health service. It has a lower life expectancy than most European countries and a higher level of infant mortality.

I appreciate the Acting Chairman’s indulgence. When we plan for the provision of a new health service by a consultant oncologist, let us incorporate non-consultant hospital doctors, nursing and secretarial services so that the expertise and time of the consultant oncologist go on treating people with cancer and not on paperwork, diary-keeping, appointment-making or telephone-answering. It is a terrible waste of high-level expertise if one does not plan such a service as a unit and integrate it with the various back-up services.

Mr. Minihan: Information on John Minihan  Zoom on John Minihan  I am glad to have a few moments to discuss the inherently troubling issue of cancer and cancer care. The National Cancer Registry reports that in 2001, the most recent year for which data is available, there were 22,473 cases of cancer in this country. Cancer is the second highest cause of death in Ireland. Approximately [380]30% of people now alive will eventually suffer from cancer. Over the years it will strike about three out of four families. Those facts will trouble us all. We in this House must ensure that the issues surrounding cancer and cancer care are expanded upon and considered in a wider health policy context. This morning’s statements are an example of how that process can work, and I welcome the opportunity to speak on the issue.

The prevalence of cancer exercises the minds of health care professionals across the globe. In our statements today we must not forget that, as the NCR points out, cancer is not one disease but a group of more than 100 diseases characterised by the uncontrolled growth and spread of abnormal cells. Different types of cancer have different causes. They have different rates of occurrence, and there are different chances of survival.

This is a composite problem. The Government must do its part in dealing with the prevalence and impact of cancer on people and families in this country. We cannot question the Government’s commitment to making the fullest possible range of services available to deal with cancer and cancer-related care. The Government has also made a clear commitment to making those services accessible to cancer patients throughout Ireland in accordance with best international practice. That is how it should be, and it is to be commended. Meeting that commitment means having real determination. In agreeing that a major programme is required rapidly to develop clinical radiation oncology treatment services to modern standards, the Government has demonstrated its intention and determination.

In this specific policy area, like so many in health care, the Government correctly relies upon the relevant experts to advise it on how to proceed. That not only ensures that policy decisions are informed by the best and most up-to-date medical knowledge, but also removes the political and parochial from high-level decision-making, another thing that must not be forgotten, especially where radiotherapy services are concerned. For example, regarding radiotherapy, the national radiation oncology co-ordinating group, NROCG, provides advice to the Government and following that process, the HSE has responsibility for the management and delivery of the related health and personal social services.

Expertise is required, welcomed, received, considered and acted upon. Let us take the report on the development of radiation oncology services in Ireland, for example, which was prepared by a multidisciplinary group of experts. It has received approval — something that may already have been mentioned — from such international bodies as the US National Cancer Institute and the American Cancer Society. What is more important to patients is that significant progress is being made in implementing the report’s recommendations. While international acclaim for the report is welcome, it is the pursuit of best international standards for cancer patients [381]throughout the country that is of immediate and paramount concern. I am reassured that the Government is determined to achieve those standards. I also share the view that, although the immediate priority has been the provision of significantly enhanced cancer care services in the major conurbations of Dublin, Cork and Galway, the question of networked satellite locations is also addressed.

At this point, I turn to that specific topic, the location of cancer care services. The Tánaiste and Minister for Health and Children has made it clear that there is a significant responsibility on our health services to ensure that patients, particularly cancer patients, are adequately supported clinically and, where necessary, with proper transport arrangements.

Patient transport is a hot topic and was referred to throughout this debate, but any measure that can minimise the stress and discomfort of cancer patients, their families and carers must be considered.

In the first instance, patients must not be referred unnecessarily to Dublin for treatment. Second, the Health Service Executive must put in place appropriate transport arrangements for patients requiring radiotherapy. The Tánaiste has correctly placed the delivery of appropriate and effective cancer care at regional level at the centre of oncology service policy. One could be left with the impression from some statements that the Department has not pursued the question of transport arrangements with the HSE but that is not the case. The Department has raised the matter with the HSE. The HSE has been asked to ensure appropriate transport arrangements are in place. That must be done on a national basis and be available to all appropriate patients who require to travel long distances to obtain radiotherapy.

I am aware of the importance of regional services provision to patients, their families and carers. In Cork, as in many areas, much progress has been made and since the implementation of the national cancer strategy in 1997, approximately €80 million in accumulative additional funding has been made available to the southern region and an additional 11 consultants and support staff have been appointed across that region. I am delighted approval has been secured to proceed to the next phase of the development of the €47 million oncology, cardiac and renal centre, which will include a dedicated 30 bed oncology ward and is planned to commence construction in mid-2006.

I wish to express my support also for the efforts to give effect to the establishment of a ten bed medical oncology unit in Cork University Hospital, which is a tertiary referral centre for radiation oncology services. The people of the southern region and I were delighted additional ongoing revenue funding of €3 million was allocated in 2004 to cater for this expansion. A further boost for the region was delivered when [382]the third linear accelerator commenced treatments in March 2005 and the fourth commenced treatments in October. A total of 29 additional staff have been recruited for that service. The expansion of the services under the national plan announced by the Tánaiste last July will increase the number of linear accelerators from four to seven and greatly improve access to radiotherapy treatment for cancer patients throughout the Cork and southern regions. I commend the Tánaiste, the Department and the HSE for that progress.

Another area of cancer care services that has been of some prominence recently is the treatment or, more accurately, the detection of breast cancer. The House will be aware of — I am sure Members will join me in welcoming — the fact that planning is under way for the development of the necessary infrastructure for the national roll out of the BreastCheck programme. I understand BreastCheck has advertised for key lead consultant radiologists and radiographers for the programme, and the recruitment of other key clinical posts will commence in early 2006. A design team has been appointed for the construction of two static clinical units, one at the South Infirmary-Victoria Hospital in Cork and the other at University College Hospital, Galway. While planning approval remains to be secured, I share the expectation that the design process, including the preparation of tender documentation, will be completed in early 2006 and that we will meet the target of roll out in 2007. That target is justified.

Yesterday’s budget further illustrated that the Government is determined to target public spending effectively. The investment I have outlined will ensure that screening and follow-up treatment is available to approximately 72,000 women throughout the southern region, including approximately 34,000 women in Cork alone. The investment in CUH has provided tremendous results and I share the concerns often expressed in the media and elsewhere that we must get value for money. Return on investment in health services is often characterised as a type of black hole for funding but the most recent health funding for CUH has provided, in the first ten months of this year alone, over 16,000 radiotherapy treatments. In additional, over 3,300 day inpatient haematology cases and over 4,000 day and inpatient oncology cases have been treated.

It is not only a question of return in terms of quantity. The highest quality of cancer care is provided in CUH. That is illustrated by the fact that CUH was named as Ireland’s first and only designated centre in integrated oncology and palliative care earlier this year. Furthermore, CUH is one of only eight centres in Europe chosen to receive this designation from the European Society for Medical Oncology for the excellence of its supportive treatment for cancer patients. The delivery of quality health care requires the good work and dedication of many people, from [383]the Tánaiste, the Ministers of State, the HSE and, at the front line, the staff of hospitals.

I wish to record my admiration and support for the work undertaken and carried out by the superb staff of CUH. The HSE southern area is, to its credit, currently developing a regional group comprising all acute hospitals in the area to ensure the service is delivered in a unified manner. I hope the new network structure will give acute hospitals the opportunity to work together to provide the best possible cancer services for the communities they serve. To that end, I am encouraged to learn that meetings have been scheduled between the HSE and the director of cancer services in the southern area to discuss the further development of cancer services. I am also encouraged by the discussions currently taking place on options for roll out of the cervical screening programme nationally, as mentioned earlier by the Minister of State, Deputy Tim O’Malley.

I welcome the statements this morning, in particular from the Minister of State, and the measures taken by the Tánaiste regarding oncology services. I urge Members of the House to express their support for the steps that have been taken. Cancer is a terrible occurrence for sufferers, their families, friends and carers. It is a complex medical area, and one that poses challenges for practitioners worldwide. The Government has recognised the complexities and has sought, received and acted on expert advice. The national radiation oncology co-ordinating group and the HSE are to be commended and supported in this work.

I have referred to the issue of the location of services and the transport of patients, and hope that the progress sought is delivered as soon as possible. Patients must not be unnecessarily referred to Dublin for treatment, and the HSE must make available appropriate transport arrangements for patients requiring radiotherapy.

I have dedicated a good portion of my contribution to oncology services in Cork and the southern region for good and specific reasons in light of recent media reports. Cork is a clear illustration of the targeted investment practice employed by the Government. It shows how consultation provision can be expanded. It demonstrates how significant progress is being made in providing new staff, new wards and new beds. It highlights the way important oncology services such as BreastCheck are being developed and delivered. It shows that remarkable return on investment in health, in terms of quantity and quality, can be achieved and is evidence of the powerful work taken on and delivered by health personnel in the region. I welcome this debate and encourage the Government to stay on its course and continue its impressive and important work in developing oncology services across the country.

[384]Mr. Cummins: Information on Maurice Cummins  Zoom on Maurice Cummins  I wish to share my time with Senator McHugh.

Acting Chairman: Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  That is agreed. Does the Senator wish to divide his time equally?

Mr. Cummins: Information on Maurice Cummins  Zoom on Maurice Cummins  Yes. I welcome the Minister of State at the Department of Health and Children, Deputy Seán Power, to the House. I am sharing my time but have much to say on this subject. I have enjoyed the debate. Prevention is obviously better than cure at all times and while I commend the current screening programmes, they must be expedited. The BreastCheck initiative must be completed and operational nationally rather than in some counties only.

The provision of oncology services is a significant issue in Waterford city. Rightly or wrongly, it has been an election issue. Approximately 20,000 people went to the streets of Waterford to fight for equality of access to radiotherapy and oncology services. As a result we have secured a commitment, which we hope the Government will honour, that radiotherapy services will be provided in Waterford and the south east.

I must mention a specific case in which I was recently involved. The Department seems to be kicking to touch; it blames the HSE when events are going badly but accepts plaudits when they are going well. A constituent of mine was referred to the regional hospital by his home care hospice nurse five weeks ago because she believed he was developing a clot. He entered the hospital at 5 o’clock that evening. I received a telephone call from his wife at 11 p.m. to the effect that he still had not been seen in the accident and emergency department. He was eventually seen at midnight but this type of occurrence should not happen. I attended that man’s funeral last week, which should inform the House about the serious need for radiotherapy services, accident and emergency units, etc. Cancer touches every family in our communities. Very few families avoid the trauma of a loved one suffering cancer.

I commend the Government. We are starting from a very low base as regards the provision of oncology services. We are making some progress but we must expedite matters. I examined the Minister of State’s suggested programme, namely, that we will spend over €400 million in a capital programme in the next ten years, most of which will be provided through public-private partnerships. The plan is dependent on private capital. Is this correct? When one compares this capital investment of €400 million to the astronomical figure envisaged in respect of Transport 21 it is mind-boggling. Health should be the priority of any Government.

The Hollywood report stated 35% to 36% of cancer patients in Ireland receive radiotherapy at some stage of their lives, which compares with 50% to 60% of patients in other countries in Europe and the West. There is a distinct variation [385]in the interval between cancer diagnosis and the commencement of radiation therapy in Ireland. The report showed that where one lives often impacts on the level of service one receives. It also stated 8% of patients undergoing radiotherapy for breast cancer had their first treatment within a month if they lived in the Dublin area compared with only 3% if they lived in other areas. We must address this issue.

I acknowledge we are making some progress. We must also examine the shortage of specialists in this area; more oncologists and nurses are needed to deal with specific areas. Now is the time to address the issue, not the future. People are dying unnecessarily due to lack of services.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  Much needs to be said in such a short time but I will focus on the primary aspect of BreastCheck in particular. According to the Minister of State, there will be a commencement of the national roll-out of BreastCheck in 2007 but what does this mean? Should we not be in the process of rolling it out now? I do not understand what commencement of the national roll-out of BreastCheck in 2007 means. This sends out a negative and sinister signal to 130,000 women who are not availing of the service at present because, as stated by my colleague, Senator Cummins, they live in a certain part of the country. In the 2004 programme 50,000 women on the east coast availed of BreastCheck, 1,687 needed to return for assessments and 309 were diagnosed with cancer. Interventions were made and they are undergoing treatment. However, 130,000 women in the north west and west cannot avail of BreastCheck and have been told today that the roll-out will commence in 2007. I request clarification on this issue.

I will make a specific point about secondary care. Currently, Letterkenny has a temporary surgical oncologist but needs a permanent one as staff cannot otherwise create reliable action plans. I wish to focus on tertiary care and an important point about radiotherapy treatment, on which I want immediate clarification. The Tánaiste met the Minister for Health in Northern Ireland, Mr. Shaun Woodward, MP, and it has been agreed that the new Belfast cancer centre, which was due to open next March, will not treat patients from County Donegal. This centre will treat people from a population base of 1.5 million but the Tánaiste and Minister for Health and Children has stated Mr. Woodward said it will not treat Donegal patients. This is a fallacy as Mr. Woodward, speaking on Highland Radio, stated categorically that the Belfast centre will treat patients from County Donegal if a bed is available. Northern Irish patients will come first while patients from counties Donegal, Sligo and Leitrim will come second if beds are available. This is the most sinister development of cancer care services in this country, where we can lie to the people and tell them——

[386]Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  Senator McHugh is playing with words.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  ——they will be treated.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  If a bed is available.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  Why did it not state that?

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  It applies to the people of Northern Ireland too.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  Why was the word “if” not included?

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  This applies to everybody.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  There is a difference between “will” and “if”.

Acting Chairman: Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  Senator McHugh without interruption.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  Senator McHugh is playing with words.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  Will this guarantee patients from Donegal treatment in Belfast? It will not. It should state “if”, not “will”.

Acting Chairman: Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  Senator McHugh, your time is concluded.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  I want clarification on that because this is sending out false signals and inaccuracies to the people living in the north west, who pay their taxes but cannot get investment in roads or cancer services or funding for 70 extra beds in Letterkenny General Hospital. My colleague, Senator Cummins, hit the nail on the head, that we do not have a population base big enough to cater for public-private partnership and, as a result, no private investor is willing to come in to Donegal or the north west on any project, be it roads, health, etc. That is why we did not get gas connection and proper road infrastructure.

Acting Chairman: Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  Senator McHugh must conclude.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  That is a problem. We should be subsidising people who pay their taxes and deserve equitable treatment. Equitable treatment is all we seek.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  I wish to share three minutes of my time with my colleague, Senator Kitt.

Acting Chairman: Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  Is that agreed? Agreed.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  I welcome the Minister of State, Deputy Seán Power, and thank him for coming in to take this matter. It is a bit cheap of the Opposition to play politics with such an emotive issue as cancer.

[387]Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  We are not playing politics. We are representing our people.

Acting Chairman: Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  Senator McHugh has had his opportunity to speak.

Mr. Cummins: Information on Maurice Cummins  Zoom on Maurice Cummins  Senator McHugh has not been political.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  I have not been political; I simply want clarification.

Acting Chairman: Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  Senator Feeney without interruption.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  Whether one lives on this or the other side of the Border, hospitals — this would apply to any hospital — cannot treat patients unless beds are available. Mr. Woodward, MP, is correct in saying “if there is a bed available” because nobody can be treated in the absence of a bed.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  That is not in the Minister of State’s speech, which states that they will be treated. Will all Donegal women be treated?

Acting Chairman: Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  Senator McHugh, I would ask you to desist.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  The issue of cancer is an emotive one. It is a horrible aggressive illness, one by which all of our lives have been affected. Senator Cummins had a tragedy in his immediate family and I sympathised with him. We have stood here on many occasions and I always felt we were singing from the same hymn sheet. Everybody wants the best for cancer patients in this country and that is what today’s debate is about.

I was shocked to hear the Minister of State, Deputy Tim O’Malley, speak of 6 million deaths worldwide and a 1.5% increase every year in the number of deaths through cancer. He spoke of the increase being put down to a growth in population. Every day I hear of more friends of mine being diagnosed with cancer. I always wonder whether its prevalence is due to the fact that cancer is on the increase or we are getting older. I feel our environment has a role to play in the prevalence of cancer and that factors such as diet, work, environment and stress are adding to the prevalence of cancer.

Other speakers have said much of what I was going to say. The earlier the detection of cancer, the better the chance of survival. We need only look at our counterparts in Northern Ireland to see the great results they are getting, particularly in the areas of breast cancer and bowel cancer. I agree with Senator Henry when she stated that standalone centres or units cannot be encouraged. Those of us politicians who are out there fighting to hold on to small units should examine our conscience and ask why are we doing it. There is a definite result from Northern Ireland now showing that specialised units are the way to [388]proceed. Units where there is a multidisciplinary team, with all the expertise that such teams can give, are the way forward.

Some 25% of all deaths in the Republic of Ireland are caused by cancer. About three years ago I stood on this very spot and was delighted to speak about the new oncology ward at Sligo General Hospital and the change it made for the people of the north west. Yesterday I spoke to staff in the oncology unit. Today I can tell the House that the oncology unit to which I refer has grown and a day ward has been added. The oncology unit has 16 beds and is worked and managed by a wonderful team. Unfortunately, we have lost our consultant to a bigger unit in Galway but we have a new consultant oncologist coming next February or March. We are lucky to have an excellent locum and haematologist running the unit. While I have the ear of the Minister of State, I wish to say that we are delighted with what we have. Patients in Sligo are saying they could travel to New York, Paris, Rome or anywhere in the world, and would not get the treatment they are getting from that dedicated team in Sligo.

The unit in Sligo was an old ward that was turned into an oncology unit. Our counterparts in Letterkenny had a greenfield site. They built up their unit. Theirs is a dedicated unit and is a much better structure than what we have in Sligo. We only have two side rooms. When somebody comes in with an infection, they run the risk of spreading that infection. If somebody comes in with low immunity, he or she needs to be isolated. The two rooms are being used on an ongoing basis and we really need another two or, possibly, three rooms. I acknowledge it is not all about money but what we need here is a little money and a little leverage to allow them to build this new structure.

Three months ago we opened the new inner relief road in Sligo and I am delighted to tell the House that the Mayor of Sligo, Councillor Rosaleen O’Grady, organised a fundraising walk where 4,500 people took to that new road to walk for cancer services. She handed over a cheque as recently as last week for €72,300 for the ongoing upgrading of breast screening and cancer equipment. I take my hat off to Councillor O’Grady and her team and to the people of the north west who so generously support all of this. It is all down to people coming together in the best interests of cancer patients.

I heard Senator Browne speak of Ministers coming out saying that BreastCheck has been rolled out all over the country. I have never heard anybody saying it has now been rolled out all over the country. There is a programme in place and it is coming into every area.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  When?

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  If Senator McHugh will listen, I will tell him.

[389]An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  Senator Feeney without interruption.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  I am delighted to report that we had a meeting with the Tánaiste and Minister for Health and Children, Deputy Harney, only three weeks ago. As a woman living in Sligo, I would hope that by the end of 2006 we will have BreastCheck in Sligo.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  And all areas of Donegal?

An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  Senator Feeney without interruption.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  It will certainly happen but we will not achieve this by making cheap political jibes.

Mr. McHugh: Information on Joe McHugh  Zoom on Joe McHugh  It is not political. It is about women getting a service to which they are entitled.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  I certainly believe in the Tánaiste and Minister for Health and Children, Deputy Harney, and I have no reason not to. She has always delivered for the north west and I have no reason to believe that will change. I am glad BreastCheck will be rolled out in the north west by the end of 2006.

Some 96% of women who go for BreastCheck come out clear and never need to be referred. For the 4% who are referred, it is certainly a worrying time. However, there are resources available. The biggest difficulty is the lack of manpower. One can do so much with money but if one does not have the manpower, these services cannot be put in place. Advertisements are placed on an ongoing basis seeking to recruit staff for units in the north west.

Oncology trained pharmacists are a rare commodity in my neck of the woods. I am glad to say that we have one in Sligo General Hospital. We also have excellent specialised nursing staff, some of whom have oncology diplomas. They work extremely hard and will do everything to ensure——

An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  Is the Senator sharing her time?

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  Yes. I have already indicated that.

An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  I apologise. I must ask the Senator to conclude, because she has exceeded the time allotted.

Ms Feeney: Information on Geraldine Feeney  Zoom on Geraldine Feeney  Very well. I will conclude to allow my colleague to speak.

Mr. Kitt:  I thank Senator Feeney for sharing her time. I also thank the Minister of State at the Department of Health and Children, Deputy Seán Power. I want to contribute to this debate because some months ago, I raised an issue with the Minister of State in the House concerning a [390]minor item which is of great importance to me and the people of Tuam. I refer to the provision of funding for two beds for respite or palliative care in Tuam. The background to this matter is that two beds were available in the Bon Secours Hospital in Tuam, known as the Grove Hospital, which unfortunately closed in April 2001. In addition to losing the hospital, we lost the two palliative care beds. The Tuam Cancer Care Committee, a hard-working voluntary organisation, was disappointed, as was I, when this project suffered due to the hospital’s closure.

When I raised this issue with the Minister of State some months ago, I made the point that the then Western Health Board spent €450,000 in capital expenditure on renovations to Áras Mhuire, a new building, to facilitate the two-bed unit. In addition, 2.2 staff were sanctioned by the health board. However, the Irish Nurses Organisation was unhappy with the staffing level and sought an increase to 5.5 staff, to ensure an adequate quality of care for patients at Áras Mhuire, including the two-bed unit. I understand that the sum of €150,000 in additional funding per annum was sought for staffing. The Minister of State may recall that I mentioned an anonymous donation of €100,000, which would have been made available to fund these two beds.

My speech will probably differ from the one which I originally intended to make because approximately one hour ago, I received an e-mail from the Department of Health and Children to the effect that this morning, the Tánaiste made a speech noting the availability of a sum of €9 million in funding for specialist palliative care. Certain projects were mentioned, such as Blackrock Hospice, under the management of Our Lady’s Hospice in Harold’s Cross, Milford Hospice and St. Francis's Hospice in Raheny. I noted with interest that €1 million has been designated for the midlands and western region. I hope that Tuam is included in that figure, because palliative care is badly needed in Tuam and the north-east Galway area. As I told the Minister of State, if the then health board intended to spend €450,000 in capital expenditure to upgrade Áras Mhuire and to equip the two-bed unit, it is important to provide an additional €150,000. I hope it is included in the sum of €1 million mentioned by the Tánaiste.

I wish to make a brief comment in respect of BreastCheck. I want to pay tribute to Senator Cox, who worked extremely hard in starting the BreastCheck campaign in the west of Ireland. Along with many members of voluntary organisations, she collected hundreds of petitions and presented them to the Tánaiste and to the Department of Health and Children. Senator Cox was also active in this regard during the course of the last Seanad, as she was in respect of child care. I do not state this simply to wear the county colours, as I know she and her committee worked hard. I am glad we have made some progress in terms of providing BreastCheck in the west of [391]Ireland. I again thank the Minister of State and I hope he will be able to tell me that the palliative care programme includes funding for Tuam.

Ms O’Meara: Information on Kathleen O'Meara  Zoom on Kathleen O'Meara  I will speak briefly on this important debate. I acknowledge that much has been done in respect of both the delivery of cancer services and in preventive care. It has already been observed that in the future, the smoking ban will be regarded as having been one of the most significant moves we could have actively taken in respect of a public health issue. While the campaign for the smoking ban was in full swing, I came across some figures which revealed the extent to which St. James’s Hospital in Dublin was occupied by people suffering from smoking-related illnesses.

While the cost to the public purse is one matter, another issue concerns the extent of mortality arising from smoking, which is clearly preventable. In addition, we are now aware that some cancers may be linked to lifestyle issues and we have much more to do in terms of encouraging people to be more active, to consider what and how they eat and to look at their lifestyles generally as far as the incidence of cancer is concerned.

The second point I wish to discuss is the question of BreastCheck. It is the major reason I have chosen to speak in this debate. Recently, at my invitation, the chief executive of BreastCheck, Tony O’Brien, spoke in Nenagh to a group of women who came together — as similar groups have done elsewhere — to campaign and agitate for the rolling out of BreastCheck in our area. While people discuss this issue in respect of the west and the north, they may not be aware that the western region includes north Tipperary.

North Tipperary will be served by the Galway unit of the breast screening programme. I have always stated that it is an excellent, high-quality programme, which is why we want it extended to cover all areas. The delays in the roll out of BreastCheck have been scandalous. The will to have BreastCheck rolled out simply did not exist when it was needed. While it could be available now, in 2005, instead we are obliged to wait until 2007 at the earliest. As Mr. O’Brien spoke in Nenagh, it became clear to me that the programme’s roll out will hopefully begin in 2007 in the western region. However, it will be rolled out over a period of two years. Hence, it will begin somewhere in the western region in 2007 and will continue until 2009. Therefore, north Tipperary may not be reached until 2009. That is the reality, even if the current best estimates and targets are met.

There are 45 undetected cancers in north Tipperary as we speak, based on screening figures from elsewhere in the country, for the population group consisting of 45 to 64 year olds. Hence, 45 women in north Tipperary are unaware that they have cancer and may not know for a number of [392]years. This is the consequence of the delay in rolling out the screening programme. While I have no doubt that it will be magnificent when rolled out, as the standards of delivery elsewhere have been excellent, this is the reality we face.

The third point I wish to make is in respect of the current delivery of services. Clearly the issue of distance from a centre is highly significant. On occasion, although recently not as frequently as I would wish, I use the train to travel to Dublin. One meets an extraordinary number of people who travel to Dublin for cancer treatment on a day return basis. That is better, as other Members have noted, than being obliged to drive from northern Donegal or from Sneem in County Kerry to Dublin. Hence, it is extremely important that the delivery of cancer services be made accessible. It should be brought to people, rather than making it virtually impossible for people to access it.

My final point pertains to a subject raised by other Members, namely, the issue of public versus private health care. We are now witnessing the division between public and private care. I have considered the delivery of private care carefully and I believe we should be extremely careful in this respect. I do not support it for a number of reasons. One such reason is that it is extremely bad value for public money. Public money will leak into the private system, as it already does. However, one will not get good value from it, as private hospitals only deliver a narrow range of services. They do not contain accident and emergency units. For example, I was informed by a senior official from what was the Mid-Western Health Board region, now the HSE region for the mid-west, that the answer to the bed capacity problem in Limerick Regional Hospital was the building of a private hospital. However, a private hospital will take a minimal number of patients and will only accept those patients who are easily managed. If, for example, a person is coming out of a private hospital and slips and breaks his knee or leg, the private hospital will be unable to treat him. He will have to be brought by public ambulance to the public hospital which, of course, will have fewer resources allocated to it because of the existence of the private hospital.

This policy makes no sense. It is the worst possible policy decision to create a parallel private hospital system which is profit driven, not health driven. They are effectively hotels, not hospitals. When we look back on this we will see it as a great waste of public money. It will not deliver a quality health service and is a really bad idea.

Mr. Kenneally: Information on Brendan Kenneally  Zoom on Brendan Kenneally  I have sought this debate on a number of occasions and I am happy to contribute to it. Everybody is aware there are problems with oncology services nationally but they are far more acute in the regions away from Dublin. I will outline what the problems are and, in doing so, will draw from my experience in the south east.

[393]Recently, there was a farcical situation in Cork where an oncologist resigned because of the lack of infrastructure in the south-west region, leaving only one medical oncologist to cover the region. It is particularly ironic that the person now bearing the brunt of providing a service for the Cork and Kerry area is the person who had previously resigned from his post in Waterford Regional Hospital because of the lack of resources there. This demonstrates that the problem extends throughout the regions.

The cancer strategy stated that the four main cancers — breast, bowel, lung and prostate — would be treated in regional centres. It is estimated that by 2015 there will be a 31% increase in the incidence of these cancers yet there is still no proper oncology ward at Waterford Regional Hospital. Facilities there are so basic and conditions so cramped that it was necessary to knock down a wall in the day room to provide additional space. It is still too small to accommodate beds so patients are getting chemotherapy while sitting on chairs. This would be regrettable in a country of modest means but given our unprecedented wealth, it is nothing less than shocking and a disgrace.

If the new cancer strategy is implemented, it will mean the restricted chemotherapy and surgery being carried out in Kilkenny and Wexford at present will be transferred to Waterford. Waterford Regional Hospital is already in a chaotic state and this development cannot go ahead until the hospital has a proper day ward and oncology ward. If people are to be encouraged to come from Kilkenny and Wexford to Waterford, they must be reassured that they are going to a hospital where there are proper facilities. It is my understanding that the Government is at present breaching its guidelines in this area because patients on chemotherapy should be looked after in dedicated areas.

Waterford Regional Hospital is awaiting design team approval to proceed with services in the region but, in the meantime, patients continue to suffer. The Department has claimed that the delay is attributable to the HSE but the HSE claims the blame lies with the Department. Patients are stuck in the middle of the wrangling and are suffering. There is nothing new in one agency blaming another, passing the buck and not being accountable but I often wonder if those who have the stated function of expediting a caring and effective health service realise that by their deficiencies they are causing hardship for real people, not just names on a list.

My time is restricted so I cannot say as much as I wish about radiotherapy. The reason radiotherapy facilities are needed in the south east is that they will achieve the best outcome. It is estimated that there is a 20% better chance of recovery if radiotherapy is available in conjunction with chemotherapy and surgery. I thank the Minister for her initial, if limited, response to the complaints from the south east. Two linear acceler[394]ators are to be provided in the proposed new private hospital in the grounds of Waterford Regional Hospital. There is also an undertaking that there will be public access to these. This is what everybody has clamoured for and the hope is that they can be delivered in the short term.

I plead with the Minister to do all she can to implement this decision in the shortest possible time span. I also urge the Minister to ensure adequate public access to these facilities, in line with the commitments given to the campaign and to the public. I cannot overemphasise the importance of this in view of the genuine and continuing hardship being caused for people by obliging them to travel long distances for a vital treatment and one that is relatively inexpensive to provide. It is even more heartbreaking that this unnecessary hardship comes at a time when patients are already vulnerable due to their condition.

At present, designated transport is required for patients travelling to Cork and Dublin for radiotherapy treatment. A sub-committee of the Hollywood committee discussed this for a long time but no report has been forthcoming nor, unfortunately, is there any sign of a report emerging. The Tánaiste recently launched the group that was set up in Waterford to provide transport within the region to link with transport onward to Dublin and Cork. This is a local initiative but there is no functioning national plan. No solution has been put forward by the HSE and no funding has been provided. Now there is talk of conducting another study, which is ludicrous given that this matter has been examined over the past two years. It is essential that a proper transport system is put in place sooner rather than later.

Minister of State at the Department of Health and Children (Mr. S. Power): Information on Seán Power  Zoom on Seán Power  I listened with great interest to the Senators’ contributions on oncology services. Members of the Houses are often accused of being irrelevant but this debate is one with which most families throughout the country can identify. Few families have not been affected in some way by cancer.

This Government remains committed to making the full range of cancer services available and accessible to cancer patients throughout the country, in accordance with best international standards. Our commitment can be seen in the considerable investment made in cancer services since 1997. To continue this commitment into the future, the Tánaiste has allocated an additional €9 million in 2006 for oncology services nationwide. This will bring the additional cumulative investment since 1997 to approximately €900 million.

The Department of Health and Children and the Health Service Executive are currently making progress with the arrangements for the full implementation of the national plan for radiation oncology services announced by the Tánaiste last July. It is expected that these arrangements will be completed and in place by 2011. In the mean[395]time, the process for the initial provision of two interim on-site modular demountable units on the site of St. Luke’s Hospital to facilitate maintenance and appropriate development of the service is well advanced. The timeframe for the completion and commissioning of the two new demountable bunkers and machines is early to mid-2007, depending on the provider selected, and the approximate projected cost is €20 million.

The Department has asked the HSE to ensure that appropriate transport arrangements are put in place on a national basis for patients who are required to travel to obtain radiotherapy. Transport arrangements will form a significant part of the national plan for radiation oncology services. With regard to the provision of radiotherapy in private facilities, the national radiation oncology co-ordinating group has submitted quality standards for the provision of radiation oncology services for public patients and these are currently being considered by the Department.

There was reference to the meeting of the Tánaiste with the Minister for Health in Northern Ireland. They have agreed that the new Belfast cancer centre will treat patients for radiation oncology. Details will be finalised in discussions involving the HSE, Belfast City Hospital and the respective Departments.

Ms O’Rourke: Information on Mary O'Rourke  Zoom on Mary O'Rourke  When will they be announced?

Mr. S. Power: Information on Seán Power  Zoom on Seán Power  I expect an announcement to be made soon in that regard. Much concern was expressed by Senators about men’s health. Two of the cancers which have a major impact on men’s health are prostate and colorectal cancers. There are approximately 1,150 new cases of prostate cancer annually in Ireland. The majority of cases occur in the 70-74 year age group. Currently, there is insufficient evidence to recommend the introduction of a population based prostate screening programme but international evidence is being kept under review and should it become obvious that we should change, we will be happy to do so.

  2 o’clock

Colorectal cancer caused 13% of cancer deaths in men between the 1994 and 2001 and 11% of cancer deaths in women in the same period. While faecal occult blood testing is well evaluated, a major deterrent to its use is the large number of people that must undergo testing to save one life. Its efficacy, therefore, makes it unsuitable as a population screening tool. International evidence has been kept under review. In particular a pilot programme was recently introduced in the UK and we await the results of it. The incidence of cancer is increasing but this is mainly due to an increasing and aging population. National population based screening programmes are introduced only where there is clear evidence of the benefits to the whole population.

[396]A number of Senators mentioned cervical screening. The pilot programme available in the mid-west region offers screening to approximately 74,000 women and approximately €4 million is provided annually to support it. The target age group comprises approximately 1 million women throughout the country and the introduction of a national programme is a significant undertaking that will require major resources. The cost of a national programme for a full year will be over €20 million and will require detailed and careful planning. It is important that the necessary infrastructure is introduced before the programme is introduced. I have discussed this issue with various groups who have explained their desire to have the national screening programme rolled out. I am well aware of the demand for cervical screening throughout the country and the matter will be seriously examined.

The report by the international expert included an evaluation of the pilot programme, quality assurance, laboratory capacity and organisation in the establishment of national governance arrangements. Following the publication of the report the Department consulted with and sought the views of the relevant professional and advocacy stakeholders, including the Irish College of General Practitioners, An Bord Altranais, the Academy of Medical Laboratory Science, the faculty of pathology of the Royal College of Physicians of Ireland, the Women’s Health Council and the Irish Cancer Society. The Department welcomes the constructive contributions made by these groups.

As we must plan the next stage of the extension, considerable preparatory work has taken place and substantial investment has been made into laboratory and colposcopy services. The number of smear tests carried out annually is approximately 230,000 and represents a 20% increase in recent years. To meet this increased demand additional cumulative funding of €14.5 million has been provided by the Department since 2002 to enhance the laboratory and colposcopy services. In addition, the Department allocated a further €1.1 million to the cervical screening programme on an ongoing basis to complete the transition of the remaining laboratories to new and more effective testing and to support the development of quality assurance and training programmes. These are essential preparatory elements for a national roll out.

The report recommends a major redesign of our laboratory services to support the national roll out and we must examine how best and most effectively to organise the programme. The introduction of the programme will generate increased concerns about the disease and we must ensure we have the necessary infrastructure in place to meet this. The Tánaiste is committed to the roll out of a national cervical screening programme and the Department is now in the process of discussing options for the roll out with the Health Service Executive.

[397]An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  I remind the Minister of State that this business was to end at 2 p.m.

Mr. S. Power: Information on Seán Power  Zoom on Seán Power  At political and departmental level we are committed to the development of breast disease services and this can be seen from the level of funding provided in recent years. Since 2000, additional funding totalling more than €120 million has been made available for the development of breast screening and symptomatic breast disease services. A number of Senators raised concerns and asked for clarification in various areas. Unfortunately, time does not allow me to respond here but if they contact my office we will be happy to clarify the issues raised. I thank the Members for their constructive contributions to a sensitive and important topic.


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