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Dáil Éireann debate -
Wednesday, 20 Feb 2002

Vol. 549 No. 1

Written Answers. - Health Strategies.

Ivor Callely

Question:

88 Mr. Callely asked the Minister for Health and Children the progress of the cancer and cardiovascular strategies; the likely beneficial impact of such strategies; and if he will make a statement on the matter. [5693/02]

The cardiovascular health strategy, Building Healthier Hearts, launched in July 1999, sets out the blueprint for tackling heart disease in Ireland in the long-term. The overall aims include: reducing the risk factor profile in the general popu lation; detecting those at high risk; dealing effectively with those who have clinical disease, and ensuring the best survival and quality of life outcome for those who recover from an acute attack.

To date a total of €46.71 million has been allocated to the funding of the implementation of the strategy. Almost 300 additional posts were filled by the end of 2000 while a further 500 were planned for 2001. These include health promotion officers to provide guidance on smoking cessation, nutrition and physical activity across a range of settings; community and hospital nutritionists; nursing staff in the community and hospitals; technicians essential to the diagnostic service, and cardiac rehabilitation staff including co-ordinators and physiotherapists.

With regard to progress to date on health promotion, a national media campaign Ireland needs a Change of Heart, which includes an all island physical activity campaign, Get a Life, Get Active and other health promotion campaigns such as NICO, an anti-smoking initiative, were developed and launched. On 28 February 2001, I announced Government approval for the drafting of a public health and tobacco Bill to give effect to the proposals in the policy document Towards a Tobacco Free Society. At regional level, a broad range of service developments and initiatives occurred in the areas of smoking cessation, nutrition, physical activity and dissemination of good practice.

With regard to primary care, there was the introduction of nicotine replacement therapy to GMS patients from April 2001. From the launch of nicotine replacement therapy to November 2001, 33,289 prescriptions have been issued to medical card holders at a total cost of €1 million. Discussions on the implementation of the pilot phase of the programme for the secondary prevention of cardiovascular disease in general practice with all stakeholders are now at an advanced stage. It is hoped that agreement will be reached shortly. At regional level, funding has been used for the purchase of training equipment, defibrillators and ECG transmission equipment, and training has been provided for general practitioners, practice nurses and other community based staff on areas such as brief intervention techniques for patient counselling, information technology and life support.

The national ambulance advisory council has been replaced, on a statutory basis, by the Pre-hospital Emergency Care Council, PHECC, while significant investment in cardiac equipment for use in ambulances was completed. A joint working group, chaired by Comhairle na nOspidéal, produced an interim report in May 2001 on additional consultant cardiologist requirements for 2002. The final report is expected during 2002. Specific developments in hospital services included extension of the catheterisation laboratory in Cork University Hospital; a pacemaker service in the South-Eastern Health Board region; angioplasty services in the Mid-Western Health Board and provision of diagnostic coron ary angiography at Sligo General Hospital on a sessional basis. Chest pain assessment facilities were considerably enhanced in the ERHA region.
With regard to cardiac rehabilitation, all boards have begun developing cardiac rehabilitation in acute hospitals. A national steering committee to develop a hospital based heart attack register, coronary heart attack Ireland register or CHAIR, was established on 14 October 2001. As part of the implementation of the cardiovascular health strategy, "Building Healthier Hearts", a pilot project of CHAIR has been set up in the Southern Health Board region. It is envisaged that the pilot will run for one year and following its evaluation a hospital based heart attack register will be established nationally. The rate of premature death from heart disease in Ireland is significantly higher than the EU average. Through the implementation of the strategy, the objective is to reduce Ireland's levels of premature deaths from cardiovascular disease to the EU average in the medium term and, in the long-term, to reduce our rates to those of the best performers in the EU.
Major developments in the treatment and care of patients with cancer have taken place since the launch in November 1996 of the national cancer strategy. Since 1997, more than £103 million has been invested in the development of cancer services. This includes the provision of £23.5 million which was allocated between all health boards from national cancer strategy funding this year for the continuing development of oncology-haematology services, funding for oncology drug treatments and the continuing development of symptomatic breast disease services. This level of funding far exceeds the £25 million that was initially envisaged in 1996 and is a clear indication of this Government's continued commitment to the development of co-ordinated and patient focused cancer treatment in line with the recommendations of the national cancer strategy. This investment has enabled the funding of 64 additional consultant posts in key areas such as medical oncology, radiology, palliative care, histopathology and haematology, together with support staff.
Funding of £5.22 million was provided in 2001 to enable health boards to commence the development of centres of excellence for the care and treatment of symptomatic breast disease. To date, approval has been given for eight new consultant surgeon posts with a special interest in breast surgery. In 2000, national screening programmes for both breast and cervical cancer were initiated on a phased basis and both BreastCheck, the national breast screening programme, and the national cervical screening programme are currently in discussion with health boards concerning expansion of the programmes nationwide. The importance of screening programmes that are underpinned by international quality assurance criteria and best practice is a key objective and the experience gained in phase one will facilitate the process of planning and organising the roll-out of these programmes countrywide.
Regional directors of cancer services are in place in each of the health boards to oversee and co-ordinate the development of cancer services in their respective areas in conjunction with the chief executive officers of the health boards. These posts are proving to be of great benefit in assisting in the development of appropriate future cancer services. In October 1999, health Ministers from Ireland, Northern Ireland and the United States signed an historic memorandum of understanding that establishes an Ireland-Northern Ireland national cancer institute cancer consortium. Under this initiative, a research programme has been launched which will allow Irish hospitals to participate in high quality clinical trials of new therapies for cancer, helping to ensure that new and effective treatments are made available more quickly as a result of these awards.
These actions have been complemented by initiatives in the field of health promotion. The health promotion unit of my Department supports an extensive range of initiatives that have an impact on the levels of knowledge and awareness of the risk factors associated with many cancers. These include mass media campaigns on anti-smoking, alcohol awareness and healthy eating. The unit also provides funding to the Irish Cancer Society in support of cancer prevention initiatives, including the yearly Europe Against Cancer campaign.
Under the national cancer strategy, the national cancer forum was established to advise on appropriate developments and structures in the area of cancer. The term of office of the first forum expired in 2000 and I subsequently appointed Professor Paul Redmond as chairman of the second national cancer forum. The forum is representative of the medical, palliative and the voluntary organisations involved in cancer services and continues to play an important role in the provision of quality services to people with cancer. In the context of the national health strategy, I will continue to be advised by the national cancer forum in relation to the planning, development and implementation of cancer services for the country. It is currently examining a number of issues of tremendous importance to the effective progression of the development of cancer services in this country. Areas such as protocols for the care and treatment of cancer patients, information requirements, audit and evaluation of our services, genetics issues and further screening programmes are all important component parts of the appropriate future development of cancer service, and the forum, as the established expert advisory body, will report to me on these issues.
This Government is constantly striving to provide the best and most appropriate cancer services for the country. In recognition of the need to further develop cancer services, the national health strategy has identified the need for the preparation by the end of 2002 of a revised implementation plan for the national cancer strategy. This plan will be prepared by my Department in conjunction with the national cancer forum and will set out the key areas to be targeted for the development of cancer services over the next seven years. This will have regard to existing policies in the areas of symptomatic breast disease and palliative care and the forthcoming recommendations of the expert group on radiotherapy services.
In terms of directing the way in which investment takes place, ensuring integration of services and that the objectives of the cancer strategy are realised, the health strategy provides a significant opportunity for the forum to shape its work. It is also intended that the national cancer forum will work with the national hospitals agency and the health information and quality authority to ensure service quality, accessibility and responsiveness.

Michael Ring

Question:

89 Mr. Ring asked the Minister for Health and Children if he will introduce a campaign for men's health particularly highlighting the increased incidence of prostate cancer and giving details of preventative measures. [5873/02]

Michael Bell

Question:

98 Mr. Bell asked the Minister for Health and Children if his attention has been drawn to the claim made by a leading consultant urologist (details supplied) that a national screening programme for prostate cancer could result in saving men's lives; his plans for such a national screening programme; and if he will make a statement on the matter. [5771/02]

I propose to take Questions Nos. 89 and 98 together.

The National Health Promotion Strategy 2000-2005 sets out a broad policy framework for the development of health promotion. The strategy contains a number of strategic aims and identifies a range of objectives which are required to enhance the promotion of men's health. The national health strategy also recognises this need and calls for the establishment of a working group to develop a men's health policy. A consultation process will commence shortly with a view to identifying all relevant stakeholders. In December 2001, €320,000 was announced by my colleague, the Minister for Finance, Deputy McCreevy, for the Irish Cancer Society to support a study of prostate cancer, including diagnosis.

In the context of the national health strategy, I will continue to be advised by the national cancer forum in relation to planning, development and implementation of cancer services for the country. A sub-group of the national cancer forum has recently been established on generic screening. This group, chaired by Mr. Michael Lyons, chief executive officer, East Coast Area Health Board, will review all issues relating to screening, including looking at specific diseases such as prostate cancer. Their recommendations will help to inform policy developments in this area on an ongoing basis.
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