Dáil Éireann debate -
Wednesday, 27 Nov 2002

Vol. 558 No. 2

Adjournment Debate. - Cancer Screening Programme.

Ms O'Sullivan:

I thank the Minister for coming to the House to take this matter. It is important to state that, if a cancer is detected early and appropriately treated, in approximately 90% of cases it can be cured.

The Minister is aware that Limerick General Hospital is one of the 13 centres of excellence identified by the National Cancer Forum for the treatment of breast cancer. Approximately €1 million has been provided but the total cost of having the centre of excellence fully staffed will be €5 million. The presence of such a centre provides women with symptoms of breast cancer with the best appropriate care in a holistic atmosphere. The team of specialists recommended includes a lead consultant, a breast surgeon and support team, breast care nurse specialists, a pathologist, a radiologist, a medical oncologist and radiographers who specialise in mammography. An important aspect is that the team works together and, as this is their specialist area, the level of expertise is high.

The balance of the resources is required to fully set up the centre in Limerick. The Minister will be aware that the clinical oncologist in Limerick, Dr. Gupta, has achieved much to date. I will not be churlish in acknowledging what has been achieved but much remains to be done. This issue was discussed for more than an hour at the last Mid-Western Health Board meeting and involved medical specialists, including Dr. Gupta and a variety of people from the board. There was a strong view that this matter be brought to the Minister with a view to getting the funding to set up the centre of excellence as appropriate.

The extension of BreastCheck to the rest of the country is important as it not included for the Limerick area. I would like to see that rolled out as soon as possible, something I am sure the Minister supports. I understand that it is likely the mammographies in the mid-west will be carried out in Cork and Galway. The Minister may correct me on that but that was the impression at the board meeting. Where a woman needs treatment she should be referred back to her own region rather than being kept in either Cork or Galway. Radiotherapy has been a live political issue and I know the Minister is expecting a report soon.

Minister for Health and Children (Mr. Martin):

I will have it in January.

Ms O'Sullivan:

As one of the major regions not supplied with radiotherapy facilities, I ask that the mid-west be considered for inclusion when decisions are made. Where medical experts suggest radiotherapy as the most appropriate treatment for a patient, it has been shown in many cases that because it is not accessible in the local region patients choose a different treatment.

In what has been achieved so far, the centre of excellence that has begun in Limerick is probably one of the best in the country. The level of determination and commitment shown by Dr. Gupta and his staff is second to none. This project is ready to go if it can get the funding and resources. It is a matter of being told the additional staff can be recruited and the work can continue. I urge the Minister to provide the necessary funding to fully develop the centre of excellence in Limerick.

Mr. Martin:

I thank the Deputy for raising this matter on the Adjournment of the House and for giving me this opportunity to set out the current position in relation to the development of breast cancer services generally and in the Mid-Western Health Board area in particular.

In December 2000, the Mid-Western Health Board formally adopted a report on the development of symptomatic breast disease services for the region. The board has agreed to develop its symptomatic services at Limerick Regional Hospital. Referral to the breast clinic at Limerick Regional Hospital allows rapid access to a consultant surgeon, mammography and rapid processing of results. All relevant members of the team attend weekly multi-disciplinary meetings. Financial approval has recently issued to the Mid-Western Health Board for the appointment of a general surgeon with a special interest in breast surgery. In addition, two breast care nurses have been appointed to Limerick Regional Hospital. The new oncology unit at the hospital is a model of good planning and recognises patient needs as the main priority. Additional resources will be made available to the board in 2003 to continue to meet oncology demands in the region.

I met Dr. Gupta a year ago and was very impressed with his plans and the degree to which he had secured the agreement of people across the region. Coming to such an agreement has dogged other regions, but he has managed to convince people of the merits of the centre and has engaged them in the correct fashion. I secured additional funding for 2002 and I hope to be of assistance again next year.

Since 1997, over €103 million has been invested in the development of services, well in excess of the £25 million initially envisaged in the national cancer strategy 1996. I think it is working well and because of the likes of Dr. Gupta and others coming into the service, the quality of treatment is now much better. An additional sum of €29 million is being allocated in 2003 for cancer services. This will enable us to address increasing demands in cancer services in such areas as oncology-haematology services, oncology drug treatments and symptomatic breast disease services. We realise that we have established a number of centres that have full-year costings and development needs.

Since 1996, approval has issued for 80 additional consultant posts in key areas such as medical oncology, radiology, palliative care, histopathology and haematology. This includes approval for 13 new consultant posts with a special interest in breast disease. People often wonder where the money has gone but these additional posts demonstrate the increased focus on quality, which we never had before, in our cancer services. This investment is a major element of the implementation of the recommendations of the O'Higgins report on symptomatic breast disease. We have invested considerably in this programme and further investment will be made.

BreastCheck, the national breast screening programme, commenced screening in March 2000, with phase one of the programme covering the Eastern Regional Health Authority, Midland Health Board and North-Eastern Health Board areas. The decision to proceed on a phased basis is a reflection of the complexities involved in the screening process and it is essential that the programme be driven by international quality assurance criteria and best practice. The experience gained in phase one will facilitate the process of planning and organising the roll-out of the programme nationwide, to which I am committed. To the end of August this year, almost 92,000 women had been called for screening and more than 68,000 women had been screened, representing an uptake of 74%.

We are anxious to expand the programme but the BreastCheck board believes that anyone screened within the screening centres should be treated there. If we are establishing centres of excellence, it does not make sense to have women bypass their own centre to go to Cork or Galway. This is what has come forward from BreastCheck. It has its views about the continuation of quality services and standards and wants to oversee that. The Department will hold meetings with BreastCheck to discuss this issue with a view to the best utilisation of financial resources. There must be a synergy between the development of centres of excellence and the facilities of the BreastCheck board. The Cancer Forum is formulating a new cancer strategy.