Amendment No. 1 is in the name of the Minister. Amendments Nos. 2, 3, 5, 6 and 7 are related. I suggest that they be debated together. Is that agreed? Agreed.
Private Members' Business. - Health (Provision of Information) Bill, 1997 [ Seanad ]: Committee and Final Stages.
SECTION 1.
An Leas-Cheann Comhairle
Limerick East): I move amendment No. 1:
In page 3, subsection (1), lines 17 to 23, to delete paragraph (b) and substitute the following:
"(b) the Minister for Health or a health board, hospital or other body or agency participating in any cancer screening (including any breast or cervical cancer screening) programme authorised by the Minister for Health, for the purposes of compiling and maintaining a record of the names, addresses and dates of birth of persons who, for public health reasons, may be invited to participate in that programme,".
The issue here is the one to which we adverted on Second Stage and to which Deputy Cowen replied. In the debate in the Seanad this enabling section was confined to breast and cervical screening. It was pointed out to me that medical advice in the future might drive policy decisions forward to where future Ministers would bring in screening programmes for other forms of cancer, and that by not taking a wider enabling mandate here future Ministers would have to come back into the House with data protection legislation if they wanted to develop further screening programmes. The amendment here is to ensure that future Ministers for Health would not be prevented from introducing any cancer screening programme because of anything in the data protection legislation. The amendment goes on to mention specifically the ones we intend introducing, namely, breast or cervical cancer screening. Initially the issue of screening for prostate cancer was raised but research is going on now which suggests that other forms of cancer might become the subject of screening programmes even before prostate cancer. That is why I have cast the amendment so widely. I thank Deputy Cowen for his amendment which reflects the position in the Seanad and has given us an opportunity to explain and debate it again.
Some amendments are consequential on this, for example, amendment No. 6 in my name which substitutes the word "persons" for the word "women".
Amendment No. 7 proposes to delete the word "NATIONAL". In the course of the debate in the Seanad it was suggested that we may want to introduce regional screening programmes. If, for example, the National Cancer Registry Board in its next report were to produce evidence that there was a very high incidence of a particular cancer in a particular area and that it was a matter of great concern, it might be an appropriate strategy to bring in a screening programme for one area, one county or one health board area. I want to ensure that whoever is in the Department of Health could move straight away and introduce a screening programme without having to legislate, because we all know how long that can take.
Amendment No. 5 is a recasting of section 1(2)(a) cataloguing to whom one would report if one had appropriate data.
I welcome the amendments that seek to widen the scope of the legislation, which was the original intention when this debate took place in the Seanad. For all the criticism of the Seanad, the work it does is helpful. It was particularly helpful on this occasion. The many Senators who have expertise in this area added significantly to the quality of the debate on this issue.
I take on board that, as the Minister says, colon cancer and not prostate cancer may be next to be screened. The reason Senator Finneran was insistent was that he wanted to indicate that screening programmes are not specific to women only but that there can be screening programmes for gender specific cancers in men and women and for cancers that affect both men and women, and that it is important to introduce screening programmes for those as well. I take the point that funding has to be put in place and that cervical cancer screening will begin. It is to be hoped that when advances are made the incumbent in the Department of Health will have the support of his colleagues in ensuring that preventive screening measures are allowed to proceed on a wider scale than is the case at the moment. Similarly, I welcome the amendment which provides that screening will not be restricted to women but will apply to persons generally.
As amended, section 1(2)(a) states:
(2) Nothing in the Data Protection Act, 1988, shall prevent the Minister for Health or a health board, hospital or other body or agency referred to in subsection (1)(b) from providing—
(a) to any other such health board, hospital or other body or agency, for the purposes of that national programme...
Why is there a double reference to the Minister for Health? Subsection (2)(a) states that a hospital, health board or other body will not be prevented from providing information to the Minister for Health or health board. If the wording is in order from the point of view of drafting I accept that, but it seems there is tautology in that regard. I accept the Minister's bona fides that he will facilitate the position.
(Limerick East): Even though the wording seems tautologous, I received advice to that effect from the parliamentary draftsman.
Amendment agreed to.
Amendments Nos. 2, 3 and 4 not moved.
(Limerick East): I move amendment No. 5:
In page 3, subsection (2), lines 31 and 32, to delete paragraph (a) and substitute the following:
"(a) to the Minister for Health, or to any other such health board, hospital or other body or agency, for the purposes of that programme, or".
Amendment agreed to.
(Limerick East): I move amendment No. 6:
In page 3, subsection (2), lines 33 and 34, to delete paragraph (b) and substitute the following:
"(b) for the purposes of inviting persons to participate in that programme,".
Amendment agreed to.
Question proposed: "That section 1, as amended, stand part of the Bill."
Given people's fear of cancer — this matter was raised by Deputy Frances Fitzgerald — is there evidence that a programme involving an overall check up, including cancer screening, would increase the participation rate, or would that involve a significant charge on the Exchequer? Will further consideration be given to that matter given the importance of getting accurate data? With the diagnosis of cancer at an early stage through the screening process, savings would accrue to the Exchequer. Perhaps we are being penny wise and pound foolish in targeting 120,000 people. Is there evidence to suggest that only 40,000 of those people would be screened, or what percentage is expected to be successfully screened?
(Limerick East): The overall incidence of breast cancer is such that for screening to be effective, high participation rates of the target population would be essential. The percentage spoken about here is 75 per cent of the target population, that is 75 per cent of 120,000 in the first cohort, the total cohort being 240,000.
Is it expected that target will be reached?
(Limerick East): Yes, by effective advertising. This has been a women's health issue for some time. For example, the ICA has for a long time organised a campaign to ensure the Government, through the Department of Health, introduced breast screening programmes. There is great awareness among women of the prospect and the efficacy of a screening programme. General practitioners are also well tuned in to this matter and much advice which would encourage women to take up the screening option is forthcoming.
I will consider the wider issue. In organising a screening programme one would have to be specific in what is on offer. To disguise it as a general health check-up would not be appropriate. Any invitation to a screening programme must highlight, for example, that it is a breast screening programme. Having arrived for screening, it might be medically effective to have a general check up, for blood pressure, temperature and so on, but that might upset the screening programme in that there might be a problem of recording data and subsequent referral in the event that a problem arose. I have not received advice on that matter.
There is merit in the suggestion, but I would not like to commit to anything that would upset the purpose of the screening programme, which is breast screening aimed at getting very accurate results and ensuring that the programme is effective. Between 600 and 700 women die of breast cancer each year. All those lives could not have been saved by the introduction of a screening programme, but with effective screening programmes it might be possible to reduce that number by one third. I would not like to commit to anything that would interfere with the primary purpose of the legislation, but I will take advice on the matter and come back to it.
Question put and agreed to.
Section 2 agreed to.
TITLE.
(Limerick East): I move amendment No. 7:
In page 3, line 8, to delete "NATIONAL".
Amendment agreed to.
Title agreed to.
Bill reported with amendments.
Question proposed: "That the Bill do now pass."
Limerick East): I thank the Deputies who contributed to the debate, Deputy Cowen who carried the debate, Deputy Keogh on behalf of the Progressive Democrats, Deputy Moffatt and Deputy Frances Fitzgerald.
Question put and agreed to.