Dáil Éireann debate -
Tuesday, 15 Apr 2003

Vol. 565 No. 3

Private Members' Business. - Cancer Treatment Services: Motion.

Dr. Cowley:

I move:

That Dáil Éireann:

–condemns:

– the poor budget given to cancer care since 1997;

– the failure to extend the preventative cancer programmes to all our citizens;

– the inability of all our citizens to access radiotherapy services equally;

– the total lack of a proper oncology service; and

– the total lack of a proper cancer support service;

–declares:

– that cancer care apartheid exists in Ireland;

– that Irish citizens are dying unnecessarily because of the lack of proper cancer services as evidenced by the statistics;

– that the Government is negligent in failing to provide an adequate budget for cancer care for a disease that affects one in three and kills one in four of us; and

– that the Government is negligent in refusing to allow staff recruitment commence for the Galway radiotherapy unit with the result that it will be 2006 before the unit treats patients;

– notes that leaks from the imminent and long overdue radiotherapy report proposes even more centralisation of services with no local radiotherapy units proposed to be opened except Galway;

– further notes that local units at Waterford and Limerick would save more lives and cost less;

– demands that a proper budget be provided for cancer care by Government;

– further demands that cancer preventative services be available to all our citizens;

– further demands that equality of access to radiotherapy services be assured for all our citizens;

– further demands that proper oncology and support services be developed; and

– calls for an end to cancer care apartheid in Ireland.

I am glad to move this motion. I wish to share time with Deputies Connolly, James Breen, Finian McGrath, Gormley and Ó Caoláin. This motion was on last Wednesday's Order Paper, but it got nowhere because the Government did not take it up. Thanks to the co-operation of my Independent colleagues, this motion has been moved on behalf of the Technical Group and has the support of all Opposition Members.

I wish to know what the Government's policy on cancer care funding is. Where is the priority to fund proper prevention and care regarding a disease which affects one in three people and kills one in four? We are still reading about the Taoiseach and the national stadium and we have heard the Taoiseach say he wants world-class sports facilities. Why can we not have world-class cancer care facilities with European standards? Cancer care is certainly not a Government priority and it is no wonder we are lagging behind in the statistics on death rates from the disease.

The Government gave sporting organisations €161 million in 2002 while only €23.5 million was provided for the development of cancer services. I do not begrudge sporting organisations but I begrudge the small amount given to cancer care development. We need proper funding to make up the deficit between what is possible and what is there at the moment. The figures are shocking. The latest statistics from the 1999 national cancer registry show that 20,000 people, or one in three of the population, is being diagnosed with cancer which means that every hour two more families will receive the terrible news that a member has cancer.

As early as 2015, the incidence of many cancers will double. The numbers being diagnosed with breast cancer will increase by 43% over the next 12 years which is a shocking figure. Are we prepared to tolerate this doubling in the numbers in light of current resources? There is concern given the high rates of morbidity and mortality in our national cancer registry compared to the EU average. There are also variations in those rates within the country. According to the recently published national cancer registry, there has been no reduction in the death rate from cancer, in the large numbers of people receiving no cancer specific treatment or in the large numbers of elderly people who receive no treatment at all. The large numbers of patients who live in areas not facilitated by radiotherapy services are less likely to receive treatment, while the likelihood of receiving scientifically-based treatment is a lottery which depends on where one lives. That is unacceptable.

I was always told that prevention was better than cure which is why I threatened to march on the Oireachtas in regard to BreastCheck. Within 48 hours of marching, a commitment to extend BreastCheck was given by the Minister for Health and Children, but we are still waiting for the Minister for Finance to confirm the €6 million necessary for the capital roll-out this year. The decision to roll-out BreastCheck in one part of the country rather than another meant that 195 women died unnecessarily in the south and west. A wealth of international evidence was available which proved that mortality rates from breast cancer could be cut by 20% to 30% through a breast check programme. It is wrong for the Department of Finance effectively to control the health service and I call on the Minister for Finance, Deputy McCreevy, and the Taoiseach to confirm the availability of the €6 million needed for the capital roll-out of BreastCheck this year. It is unacceptable and a recipe for further cutbacks for the health boards to be expected to take the money from their existing budgets.

A national programme for the prevention of cancer of the cervix was promised in 1999, but we are still waiting for it to extend beyond a single health board area. Given that in England the death rate from this cancer is being cut by 7% every year, it is a national disgrace that we do not have a country-wide screening programme. Cervical screening is a simple test. Even in the cases of those who have it done or can pay for the service, a waiting period of 28 weeks applies which constitutes another cancer lottery. It costs lives.

The recently formed cancer care line aims to ensure that preventative services are put in place while demanding equity in the system. Cancer care apartheid exists in this country and its most notable example is access to radiotherapy services. Last week I received a telephone call to say that a bed was available for a patient of mine who had died four days before. That was disgraceful. Here was a man who had been told he needed treatment and expected to get it, but who died waiting for a letter to arrive, which never came. If one has money, one can have these services tomorrow. If that man had money and was insured by BUPA or the VHI, he would have received the care. People are voting with their feet and nearly half of the population are members of those insurance schemes. If one lives in Ballymun or Ballydehob, one will fall victim to the same cancer care apartheid. If one does not have money, one could die waiting for treatment as did my unfortunate patient. I am not saying he would have been cured, but he would have been helped. He was recommended for the treatment and he should have received it.

The three modalities of treatment are surgery, radiotherapy and chemotherapy, but they cannot benefit someone who lives a few hundred miles from the treatment centre. It is no wonder that our cancer statistics are as they are when people have to travel so far. It is no wonder we wallow at the bottom of the European league table when only 16% of those who require radiotherapy actually get it compared to the 50% to 60% who should get it. This is a disgraceful postcode lottery in which whether one lives or dies depends on where one lives. Government policy is deciding whether people live or die.

I was in Waterford recently to speak at a demonstration. I discussed the radiotherapy unit in Galway which should be rolled out in July but which will not treat a single patient until 2006 because the Department of Health and Children has not given the go-ahead for recruitment, a process which can take up to a year and a half to complete. According to leaks and the last edition of The Sunday Tribune, which speaks authoritatively on the subject, there will be no radiotherapy units in Waterford and Limerick which is a fiasco. It does not make humanitarian, medical or economic sense. Science has moved on and countries like Ireland with a dispersed population have discovered local radiotherapy which is something we should do too as it provides cheap, effective treatment. A patient would receive a scan locally, his or her information would be passed to St. Luke's and a treatment plan would passed back within hours. The patient could receive radiotherapy locally. Mothers would not have to be away from their babies for five weeks. It is a cost effective option and Deputy McCreevy should note that in the case of these day patients there would be no bed costs and no long transport costs. The system works. People spend 12 hours travelling to receive five minutes radiation and it costs them hundreds of hours to get one hour's worth of treatment. That is ridiculous and non-cost effective. The report outlined in The Sunday Tribune should be rejected as old hat. For a fraction of the cost we could have strategically-located radiotherapy units with CATscanners, radiotherapy machines and staff.

They say we need 38 machines which they wish to locate centrally. I welcome the mention of Galway, but I do not understand why a service should be centralised when that will fail to make it easier for people to access it. Access to radiotherapy will not be improved by this measure. At the moment ten machines are available to the public which treat 350 people per machine per year, or 3,500 people in total. Annually, 9,000 patients will require radiotherapy. There is a requirement for cross-Border co-operation to ensure that those in the north-east can access cancer treatment services at Derry.

I calculate that the South-Eastern Health Board spent €28.2 million in 12 years on transport and accommodation costs for radiotherapy patients. It costs this amount of money to transport people to receive this treatment, yet for half the money, the same service could be provided locally. It makes great humanitarian, medical and economic sense. There are models in Norway, Truro and the Mater private hospital. The report states that, by 2015 and possibly 2010, the population of Waterford and the south-east will be such that the service will be needed. That is for four linear accelerators, but it would be done immediately with a unit of two.

Government policy is deciding whether people live or die and this has been confirmed by the National Cancer Registry report. We do not have enough oncology beds, nurses and staff. There are eight radiation oncologists for the country compared with 12 in Belfast alone and 157 in Holland. Given that Holland's population is four times ours, that would mean we should have 40 radiation oncologists. Instead, we have eight, which is a disgrace.

It is time to end cancer care apartheid. It is time for the Government to put its money where its mouth is on cancer care and give a definite commitment to multi-annual funding for cancer care. Health apartheid should be ended and Galway given the go-ahead to begin recruiting staff.

The radiotherapy report was supposed to have been made available years ago and yet we still receive leaks about it. We can read about it in The Sunday Tribune. It is typical that we must wait so long for a report that means so much to many people and when the lack of a proper service costs many lives. It is typical of how the Government prioritises cancer, which is terrible and shocking. The final irony is that the report supposedly recommends another report to decide where to locate the second centralised unit in Dublin. Does it make sense to you, a Cheann Comhairle? It does not make sense to me.

We need to make cancer care a central priority. How can Ireland's families have a future if we are to be affected by a lack of funding for a service that is not delivering? We need a realistic budget for cancer care so that Ireland's families have a future and that, when people contract cancer, which one in three of us will, at least they can be assured of the best possible care.

Mr. Connolly:

At a time when work on the biology of cancer cells appears to be about to yield major advances, it is regrettable that more than 1,000 cancer patients out of 7,500 die needlessly every year. The National Cancer Registry's recent report indicates that large numbers of cancer patients, especially elderly ones, do not receive any cancer treatment. By the time the patients are listed for treatment, in many cases they have passed beyond the eternal veil and the matter of the treatment is academic. This represents a type of creeping euthanasia and leads to the suspicion that there may be an acceptable level of cancer deaths since no clear vision or goal for a cancer control system appears to be evident.

On the one hand, those with the wherewithal can purchase the treatment. The less affluent citizens must settle for joining the lottery as to whether they receive treatment, appropriate or otherwise. When cancer care policy is driven by administrative priorities, it cannot work, the public good suffers as a consequence and administrators are driven deeper into a defensive position. However, as long as the policies are ideas-driven, they are on the offensive and can work.

The three wise men in the report pinpointed the black hole in health spending resources when they reported a 40% increase in senior executive administrative posts in the three years between 1997 and 2000. In the past two years 120 different reports have been commissioned, most of which will be consigned to the waste basket.

The most recent of these was a consultancy report on Monaghan General Hospital which took three people eight days to complete at a cost of €60,000. This will be confined to the waste paper basket – all signs of it are there – because it is an independent report and recommends the restoration of services to a local hospital in a rural area.

It appears we are being hauled back more than 30 years to the situation envisaged by the Fitzgerald report of a country with only 12 to 14 general hospitals or so-called centres of excellence from which patients, including cancer patients, would be returned to local hospitals as step-down facilities – in effect, sent home to die. Many of the designated regional cancer hospitals have no oncology wards and find it necessary to treat patients in ordinary general wards.

Comhairle na nOspidéal recommended a maximum of 300 patients per consultant annually, yet according to Cork University Hospital, we have an average of 800 per consultant. This results in consultants being overworked.

The British Medical Journal has published research showing that, since a breast cancer screening programme was introduced in Italy in 1990, fewer Italian women have had mastectomies. In Ireland, BreastCheck, which is confined to women in the eastern, midland and north-eastern areas, plays a vital part in detecting nine cases of breast cancer per thousand and should be extended to all health board areas.

The Government gave a clear commitment before the general election to provide a world class health service, not a Third World service, and that it would pump the necessary resources into tackling cancer. I call on the Government to honour that commitment and devote a realistic budget to an all-out assault on the cancer scourge.

Mr. J. Breen:

The Government cannot be proud of its record on health. We are continuously told about the amount of money spent on health. How much will be spent in future? The Minister allocates budgets to different health boards yet, when asked questions, fails to answer them and refers them back to health boards without asking where or on what the money is spent. The Minister comes from Cork, a great Gaelic football county, but he would make a great rugby player because he always kicks to touch.

Mr. Martin:

I was not born in that part of Cork.

Mr. J. Breen:

The Minister's allocation to cancer since 1997 has been very poor. Surely people suffering from this deadly disease deserve more. Imagine the trauma a person, especially one living in a remote area in the west, must feel on being told by his or her local general practitioner or consultant that he or she has been diagnosed with cancer.

I will deal with my county because there are many similar to it. Imagine getting into an ambulance in west Clare and travelling to Dublin and having to endure traffic gridlock in Ennis and Limerick. The stress caused by this is enormous. Surely we in the Mid-Western Health Board area are entitled to a radiotherapy unit in Limerick or Ennis. This would cost less and save lives.

I call on the Government to provide immediate staffing for the unit in Galway and provide funding for a radiotherapy service in the mid-west as a matter of urgency. As cancer is rampant in the country, with one in every four affected, we cannot wait any longer. It will be cheaper to provide treatment on a regional basis and cut out the apparent cancer apartheid.

As we are supposed to be cherished equally under the Constitution, it is only fair to expect the same treatment for all citizens, wherever in the country they live. However, this is not happening. In the year of people with disabilities, will the Minister look after the unfortunate people dying of cancer and provide the service necessary to keep them alive?

Mr. F. McGrath:

I thank the Ceann Comhairle for giving me an opportunity to speak on our group's motion on the lack of cancer services. Before I deal with the technical detail of the motion, I wish to emphasise that we have reached a cross-roads in society and our commitment to the provision of health care.

Our health service – the taxpayers' and the people's health service – is in crisis and has major problems. It is sick but we have the opportunity to make it better. We can invest in it and radically change the structures or we can turn our backs and seek the easy way out. We can look for more tax cuts or look after our own people. It is as simple as that.

It is not good enough for the Government to say it has thrown money at it for the past five years and nothing has happened. I do not accept that argument. Most of this was catch-up money for the years of neglect. Successive Ministers with responsibility for health have known this. The bottom line is that successive Governments have failed to take the tough decisions in the interests of all the people and a quality health service.

We must face up to the waste and mismanagement of the health services. I have learned this from experience of the disability sector. We need reform, efficiency and, above all, more investment. That is the way forward and if we do not accept it society will go nowhere and we will fail our people as politicians.

We must also look at our priorities. We have seen the poor budget for cancer care since 1997. Successive Governments have failed to extend the preventative cancer programmes to all our citizens. We demand that cancer services be funded properly by Government and we demand equality of access to radiotherapy services for all our citizens. We must face up to the reality that we now have a cancer epidemic worse than the TB crisis of the past. Perhaps we now need another Noel Browne to tackle this issue head-on and to put people and patients first in delivering a service. We need this type of radical change and throwing our hands up in the air is not one of the options.

Most people accept that the Government is failing to provide an adequate budget for cancer care, given that the disease affects one in three and kills one of four. This is the reality in Ireland in 2003 and we must now do something to solve this major crisis in our health system. In the near future, we should consider the idea of an all-party approach that will make health services a right for our people. This is the progressive way forward and, above all, it is in the interest of the people. As a start to this process, I urge all Deputies to support our motion.

Mr. Gormley:

This is an extremely important motion and I have spoken on a number of occasions on this subject at the Committee on Health and Children. I am sure the Minister will be familiar with my line on the question of cancer.

There are many green philosophers who have compared the global economy to a cancer cell. A cancer cell differs from other cells in that it knows no boundaries and grows and grows. This relates to our philosophy on economic growth because we have not recognised that there are limits to it and to the way in which our economy functions. We are living in a cancer culture and experiencing what other speakers have called a cancer epidemic. In our affluent society, we can continue to invest hugely in health and combating crime, yet the associated problems continue to worsen.

We must ask ourselves some fundamental questions. Why do we continue to deal with the symptoms rather than the root causes? Green politics is really about going back to the root causes of our problems. The WHO has recently published its own cancer survey which suggests that cancer rates will increase by 50% over the next 20 years. This is quite horrendous. It tells us that this is because of our consumption of junk food, smoking and our sedentary lifestyles.

One third of the predicted 15 million cases in 2020 could be prevented. Pervious speakers have said that prevention is better than cure, which is absolutely correct. We must ask what is causing the problem. The WHO has told us that 80% of cancers are environmentally linked. It goes back to the food we consume and all the fertilisers and pesticides we put on it, which have a cumulative effect. It goes back to the air we breath and we know that there is a higher incidence of cancer in urban areas in this country. It goes back to the water we drink. What do we put into our water? We put in aluminium sulphate and fluoride. Please do not tell me that this has no effect because one of the things that we are discovering is that each person is not identical and that we all have different genetic predispositions. Therefore, some people are very sensitive. Some people can consume something and get away with it while others will develop cancer. Our knowledge in this area is growing all the time.

The Minister can invest all the money he likes in the coming years but unless he considers what is causing cancer, he is on a loser. Consider the figures he has produced on the cumulative funding for cancer services. It is quite amazing how much money is being invested, yet the incidence of cancer is increasing. In 1997 the total amount the Minister invested was €8.135 million, and the figure for 2003 is €132.208 million. These are quite significant sums of money.

As others have said, one in four will die from cancer. This statistic is no different from that pertaining to other developed countries, but it emphasises the need to make cancer services a priority within our health system. Figures from the National Cancer Registry show a marked increase in the number of cases of lung cancer among women in the past eight years. It is increasing by more than 3% per year. Among men, the rate of lung cancer is falling by about 1% per year. According to the director of the National Cancer Registry, Dr. Harry Comber, women will have the same rate of lung cancer by 2015 if the present trend continues. Compared with other EU states we have higher rates of cancer of the colon and melanoma, which is cancer of the skin. The incidence of cancer is generally higher in the ERHA area for both genders, particularly males.

Why did 50% of patients with lung cancer receive no cancer-specific treatment and why were 57% of those with leukaemia not offered chemotherapy? The non-treatment rates for lung cancer in the US, for example, are in the 15% to 20% range. Two thirds of patients in the Republic with last-stage stomach cancer received no cancer-specific treatment. If they lived in the US, only one third of them would have been denied it.

We know that smoking is the single most preventable cause of cancer. It is responsible for 30% of all cancers. Environment tobacco smoke or passive smoking, which is classified as a human carcinogen by the WHO, increases the risk of lung cancer in non-smokers by 25%. If the Government goes back to the root causes, my party and I will support its initiatives in this regard. Let us get very tough on smoking because it is a significant factor.

The Committee on Health and Children has also dealt with the issue of breast cancer. BreastCheck provides free mammograms to women aged between 50 and 64 every two years. Let us look at the cause of breast cancer. In China, where people consume much less dairy product and eat more soya, they have eliminated or never even had a problem with breast cancer to the extent that we have had. Therefore, there are dietary factors involved.

There is no point in the Minister saying that more and more is being invested. He will have to have a meeting within his Department to examine the issue. The strategy has failed and he will continue to throw good money after bad for many years to come unless he really takes a hard look at it. We in the Green Party would like to remove fluoride from water, for instance, because the statistics show that we have a higher rate of cancer as a result of its addition. Some people are sensitive to it while others may not be. I ask the Minister to rethink his strategy and to support the motion as put forward.

Caoimhghín Ó Caoláin:

I commend Deputy Cowley and his fellow Independent Members for proposing this Private Members' motion. I fully support it and was glad to add my name to it, both as Sinn Féin leader in the Dáil and as health spokesperson.

I attended and spoke at the recent demonstration in Dublin organised by the Cancer Care Alliance, which is calling for comprehensive, countrywide cancer services. It was quite remarkable that two days before the march, the Minister for Health and Children announced the extension of BreastCheck, a key demand of the campaign. I welcomed that announcement and look forward to seeing it implemented without delay, with extra funding being made available where necessary to speed the process. We all recognise that further delay will place more lives at risk.

It has to be said, however, that the announcement of the extension on the eve of the demonstration speaks volumes of the piecemeal and band-aid approach of this Government to the health services. Why was this announcement not made six months ago or a year ago or two years ago, and why is it not in place now? Why should women in the west and south have to wait until 2005? How many women will suffer and die of cancer in the meantime as we await the extension of BreastCheck?

The government should brace itself because people have learned the lesson that political pressure, including public demonstrations, can and does work. There is growing discontent and growing militancy in addressing a whole raft of areas that come under the direct jurisdiction of the Minister. The cancer services march was but one recent example. In the past month people have also been on the streets demanding justice and equality in the provision of maternity services, and last week, the Mansion House was packed as people protested about the disgraceful cuts in services for people with disabilities in this very special year, the European Year of People with Disabilities. Increasingly, people know their rights, know what the denial of those rights means for them and their families and will not desist in their efforts to have their rights vindicated. People and society have changed and there is no going back.

There is apartheid – I heard an earlier speaker refer to the word – in the health services and that apartheid is very obvious in the area of cancer care. This motion seeks to end that apartheid. It is a most startling statistic that one in four of our population dies of cancer. The five-year report of the National Cancer Registry, published in 2002, contained many other startling facts. Some 50% of patients with lung cancer receive no cancer-specific treatment and 57% of those with leukaemia have not been offered chemotherapy. The incidence of lung cancer among women in this State is 66% above the EU average. The incidence of melanoma among women is up to 53% higher.

It is very worrying that while the incidence of lung cancer among men has decreased, which is to be welcomed, among women, and especially young women, it is increasing. That reflects changing patterns of nicotine addiction and poses a major challenge in terms of education and all other aspects of cancer prevention. The tragedy is that so many people with treatable cancers are not being given the treatment that could save their lives. The main reason for this is the gross inequality in the distribution of cancer services in this State. The centralisation of radiotherapy services in Dublin and Cork discriminates against people outside the broad hinterland of those two cities. Across huge swathes of the country, very ill people must travel long distances to receive the treatment they so badly need, the treatment that gives real hope of recovery to them and to their families. As always, it is the elderly, the poor and the vulnerable who suffer most in these circumstances.

The motion notes that leaks of the Radiotherapy Service Development Group report have indicated that this centralisation strategy is set to continue and that radiotherapy will only be provided in Dublin, Cork and Galway. The long overdue report should be published without delay so that the uncertainty is ended. If it is the case that the centralisation strategy is to continue then it must be opposed. People in all the regions north of a line from Dublin to Galway are being discriminated against in cancer care, as are those in the south east and the south west. It is a scandal that less than one third of the 12,000 patients who require radiotherapy each year receive it and that public patients face a three-month wait for this vital treatment.

The Minister will likely respond that these are very expensive treatments which require a critical mass of patients. We have heard that many times, and representing the constituency and region that I do, I am very familiar with these arguments. Yes, they are expensive treatments and require an increase in the number of health professionals to administer them, but I emphasise my belief that people are willing to pay for better health services through increased taxation if necessary on the basis of a fair and equitable tax system. Health is a priority for everyone.

They also want accessible care in their region based on the real conditions in this country and not on population templates and arbitrary quotas imported from abroad. If the Minister for Health and Children is willing to fight that battle with the Minister for Finance, whom he has accused of not seeing the big picture on health, then he will have the backing of Members on this side of the House and will have the applause of a huge number of people of all opinions.

I represent people in one of the regions, the north east, where there is no radiotherapy unit. People in our region must travel to Dublin for radiotherapy. We know the reality of what inequity of services means, and in Monaghan, we are at the receiving end of the dictatorial policy of over-centralisation of services with the downgrading of our hospital.

I have already welcomed the promised extension of BreastCheck but we must be assured that the Minister for Finance will provide the necessary funding of €27 million for that extension. For all our sakes, I urge the Minister to heed the people's call for health care justice. The first step he could take is to support this motion, not to seek to amend it but to join all other elected opinion in this House in a united and truly determined statement of intent. Nothing less will meet the people's needs and fears of cancer that has visited a loved one in almost every extended family throughout the land.

As a member of a family which has had that tragedy visited upon it, not only in the past but currently, I know I stand with all other elected opinion in appealing to the Minister to put his support behind this motion, as the Government has done with other worthy Private Members' motions presented in the recent past. It is no less a requirement of Government to back this proposal than it was to back another in relation to the needs of people in another land. The people of this land require this Government's support and the collective and united support and effort of all elected opinion. Cancer respects no political differences.

Minister for Health and Children (Mr. Martin):

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"commends this Government and the previous Government on the implementation of a broadly based cancer care policy which has resulted in an additional cumulative investment of over €400 million in cancer care since 1997, and which has delivered:

– extensive development of health promotion policies, particularly in relation to tobacco control;

– a substantial increase in medical, nursing and support staff;

– an unprecedented increase in investment in oncology drug treatments;

– the extension of the national breast screening programme and increased investment in the cervical screening programme;

– increased investment in radiotherapy services in Dublin, Cork and Galway;

– a significant increase in cancer related activity between 1994 and 2000, including a 58% increase nationally in the number of new patients receiving radiotherapy treatment and a 30% increase nationally in the number of new patients receiving chemotherapy treatment;

– an increase in investment in palliative care;

– the development of publicly funded clinical trials infrastructure for the benefit of patients with cancer;

and supports the Government in its commitment to further develop cancer care nationally.

I am pleased to have the opportunity to describe and put in context the extensive investment and reform programme which the Government has been promoting under the national cancer strategy and particularly since the launch of the health strategy in November 2001, and to set out the current position in relation to cancer services nationally."

The Opposition motion fails to appreciate the broad recognition among health service providers of the changes that have taken place in recent years in improving cancer care. Cancer care is too important a service to have it subjected to the "all kinds of everything" motion which the Opposition has put together.

In the middle of the 20th century, the chances of surviving cancer were low and showed little improvement from year to year. Over the past few decades, however, there have been some striking changes. In childhood leukaemia, for example, there has been a dramatic improvement in survival. Similar improvements have occurred in Hodgkin's disease, testicular cancer and melanoma. In many other cancers, improvements, although less dramatic, have been taking place. This has greatly changed the experience of cancer.

We must, therefore, begin to view cancer not as a death sentence but a condition from which people can expect to survive. Nowadays, there is real hope for patients and families. My focus is to ensure that there is access to services which deliver this experience for each and every person who is diagnosed with cancer. Effectively tackling the problem of cancer means achieving consistently high quality, specialist services for patients, their carers and their families.

The Government is committed to the development of co-ordinated and patient-focused cancer treatment. The health strategy provides a highly ambitious and challenging agenda for the delivery of major improvements in health services throughout the country and signifies the clear and high priority which I attach to cancer and cancer care as part of the overall health system. The first national goal of better health for everyone contains a number of critical objectives in relation to cancer care and I have already made significant progress on many of them.

I propose to outline the substantial developments that have taken place in recent years in all the main elements of a comprehensive cancer policy. Health promotion, prevention, primary care and acute and palliative care services have all benefited from investment and improvement.

The key goal of the national cancer strategy 1996 was to achieve a 15 % decrease in mortality from cancer in the under 65 year age group in the ten year period from 1994. I am pleased to advise the House that this figure was achieved in 2001, which was three years ahead of target. That is the litmus test in terms of the success or the dividend from the investment we made. We are three years ahead of target in terms of achieving a 15% decrease in mortality from cancer.

That said, I agree with Deputies that cancer will continue to be a major challenge to our health services because approximately 21,000 new cases of cancer are recorded annually in this country and one in three of our citizens will develop cancer in the course of their lifetime. Cancer is more common in older people and as the population gets older and as people live longer, we can expect cancer cases to increase accordingly.

Our age standardised mortality rates are higher than the EU average and there is scope for improvement to bring our rate in line with other EU countries. The reduction since 1994 in cancer mortality rates is as a result of improved diagnosis, earlier interventions and improved and more widely available cancer treatments. I expect these trends to continue as a result of developments in cancer services and continued improvements in treatments.

A particular feature of health policy development over recent years has been the development of highly focused disease specific action programmes. The national cancer strategy is a leading example of this. Since the implementation of the national cancer strategy, a cumulative figure of €400 million has been invested in the development of cancer services, well in excess of the £25 million initially envisaged in 1996 to implement the national cancer strategy.

The national cancer strategy acknowledges that the cause of most cancers is multifactorial but that there is strong evidence – I endorse most of what Deputy Gormley said – that lifestyle factors, in particular smoking, alcohol and diet, play an important role. The promotion of healthy lifestyles is a key element of the work of the Department's health promotion unit and spending by the unit since the launch of the strategy on these topics is in excess of €17 million.

Following the signature by the President of the Public Health (Tobacco) Act 2002, I established the Office of Tobacco Control on a statutory basis. That office has played a significant role in the fight against tobacco. On 30 January last, I announced my decision to ban smoking in all workplaces from 1 January 2004. I hope I get the support of all Deputies who signed this motion in the implementation of that decision. This ban will include the hospitality industry where many workers are exposed to passive smoking and, as Deputy Gormley said, they have an increased likelihood of suffering from cancer and heart disease as a result.

For all health behaviours, there is a shortage of national data representative of the various social subgroups in the Irish population. To combat this, the health promotion unit commissioned the national surveys of lifestyle, attitudes and nutrition, or the SLÁN survey as it became known, which were carried out by the Centre for Health Promotion Studies, National University of Ireland, Galway. The first SLÁN survey was commissioned in 1998 to provide baseline information on a range of lifestyle related health behaviours in the Irish adult population, with sufficient power to detect differences across age, gender and social strata.

In 2002 we re-commissioned the next phase of the SLÁN surveys, with a larger population sample. I am pleased to announce that some positive trends are emerging from this second survey, which I will announce in full tomorrow. The top line indications show that across almost all demographic categories smoking rates have fallen but this trend has been most marked among girls and young women, a key target for our recent anti-smoking initiatives. The overall rate of smoking in school-going children has fallen. While overall exposure to tobacco smoke is down, the rates of exposure at work and in pubs and clubs remain high. Alcohol once again proved to be a problem, despite an increase in the number of school children reporting to never having consumed an alcoholic drink. One of the most positive findings in the survey was the increase in the adherence to the recommended consumption levels of fruit and vegetables in all social groups, particularly men. Again, that is in line with the comments and the constructive contribution Deputy Gormley made to the debate this evening. While these trends in both smoking and diet are positive, a lot more work remains to be done, especially in the area of alcohol consumption, and I will be elaborating more on these issues at the launch of the second SLÁN survey tomorrow.

There is increasing recognition internationally of the importance of primary care in the delivery of cancer care. The primary care strategy will provide us with the capacity to ensure that people can experience a well co-ordinated and integrated package of services appropriate to their needs in their communities and their homes. It will broaden the focus of services to include health promotion, prevention and supportive care for those who have recovered from cancer, are living with cancer or are dying from cancer.

Investment to date under the national cancer strategy has enabled the funding of 80 additional consultant posts, together with support staff in key areas such as medical oncology, radiology, palliative care, histopathology and haematology throughout the country. For example, prior to the national cancer strategy, there was a total of four consultant oncologists in this country. I did not see too many marches about cancer care during those years nor did I see the same degree of agitation and so on. We had only four oncologists in the country. It is easy to attack the Government but we have come a long way from where we were in terms of treating cancer and that should be acknowledged. I would be the first to acknowledge that we have a long way to go but to hear the dismissive comments from some of those opposite in relation to the developments which have taken place in recent years was disingenuous, unfair and not a fair reflection of what has happened.

Dr. Cowley:

We had the Celtic tiger since then, but what did it do?

Mr. Martin:

An additional 12 oncologists have been appointed nationally, including three in the South-Eastern Health Board area alone. Deputy Gormley asked why the bill keeps rising and why we have to invest more. Every time we appoint an oncologist, one can take it for granted that there will be a €2 million to €3 million bill attached in terms of oncology drugs, more activity and greater treatments. That is what is happening, and it is welcome. Other appointments under the national cancer strategy include an additional 21 consultant surgeons with specific expertise in cancer surgery, an additional 13 radiologists and an additional 13 histopathologists.

The benefit of this investment is reflected in the significant increase in activity which has occurred. For example, the number of new patients per annum receiving radiotherapy treatment has increased from 2,402 in 1994 to 3,809 in 2000. We do not have the figures for 2001 and 2002 but they will show a further increase. This means that an additional 1,407 patients per annum are accessing these services, representing an increase of 58% nationally. The number of new patients per annum receiving chemotherapy treatment has increased from 2,693 in 1994 to 3,519 in 2000, representing an increase of 30 % nationally.

Breast cancer is the individual site specific cancer which has received the most investment in recent years. Indeed, since the implementation of the national cancer strategy, approval has been granted for an additional 39 consultant posts with a special interest in breast disease across the modalities of surgery, radiology and histopathology. Since 2001, there has been a cumulative investment of €30 million in the development of symptomatic breast disease services. The benefit of this investment is reflected in the significant increase in activity which has occurred, with in-patient breast cancer procedures increasing from 1,336 in 1997 to 1,839 in 2001, an increase of 37%.

I announced the national extension of the BreastCheck programme on 27 March last, but certain Deputies should not delude themselves by thinking that the announcement was related to the march they organised and participated in. The Government has said consistently from the start of the programme that phase one would be done first, before phase two, and that there would then be an international evaluation. We have said that we will ensure that the quality is right.

Dr. Cowley:

That is ridiculous.

Mr. Martin:

I find it extraordinary that a medical doctor has made the comments that have been made by Deputy Cowley. I invite him to address the Cancer Forum and to talk to the cancer experts who have a far greater grasp of what is going on internationally in terms of cancer care.

Dr. Cowley:

That is nonsense. A wealth of knowledge is available.

An Ceann Comhairle:

Allow the Minister to speak without interruption.

Mr. Martin:

It is unacceptable that people with a particular interest and expertise in cancer care have been dismissed so lightly and derisively this evening.

Dr. Cowley:

There was no need for a pilot.

Mr. Martin:

It was not a pilot.

An Ceann Comhairle:

Deputy Cowley should allow the Minister to continue.

Mr. Martin:

The first phase involved half the country and there was a need for it.

Dr. Cowley:

No.

Mr. Martin:

There was a need for it and we have one of the best models in Europe, in terms of quality, as a result of it. It has been evaluated by independent expert validation. We have said that from the very outset.

Dr. Cowley:

It was not implemented nationally when it was started.

Mr. Martin:

The programme has proved to be very successful, but I did not hear that once tonight.

Dr. Cowley:

It covered half the country.

An Ceann Comhairle:

Deputy Cowley, allow the Minister to continue, please, without interruption.

Mr. Martin:

I did not hear that once this evening in the context of the success of the programme in the area for which it was developed. Over 75% of eligible women – a total of 83,000 women – have been called for screening. The programme has been externally reviewed and validated. A team from the European Reference Centre for Quality Assurance visited the programme last year and identified that its key strengths are outstandingly high levels of professional expertise, team working and commitment to the programme, with all disciplines working to an internationally recognised standard. It took two years to set up phase one because it is not just about money, it is about putting in place multi-disciplinary teams. Many of the people we need are not available, unfortunately, which has effects on the numbers we have out there. We had to introduce training programmes quickly to recruit a number of radiographers, for example.

The BreastCheck clinical unit in the west will be at University College Hospital, Galway, with two associated mobile units, and will cover counties Galway, Sligo, Roscommon, Donegal, Mayo, Leitrim, Clare and north Tipperary. The clinical unit in the southern area will be located at South Infirmary Victoria Hospital in Cork, with three associated mobile units, and will cover counties Cork, Kerry, Limerick, Waterford and south Tipperary. Under the extension, approximately 130,000 women in the target population – those between 50 and 64 years of age – will be eligible for screening. It is expected that the programme will diagnose approximately 400 cancers per annum among this population. The expansion of the programme to the west and the south has been costed at €27 million under the business plan submitted by BreastCheck to the Department, including capital costs of €13 million which will be provided for under the NDP capital provision programme.

Discussions are ongoing among officials of my Department, BreastCheck and relevant health agencies. Meetings took place the week before last in Cork and Galway on the detailed roll-out of the programme. It is intended to prepare an effective and cohesive model which is in the best interests of the women concerned and which builds on the quality standards applied by BreastCheck and develops effective linkages with the symptomatic services. I have had a full meeting with the board of BreastCheck on this key issue, which I identified in responses to parliamentary questions as an issue that the Government wants to resolve before announcing a decision to extend.

Dr. Cowley:

Why did it not—

Mr. Martin:

My commitment and that of my Department is evidenced by significant funding which has been provided. There has been a cumu lative investment of €40 million to date in the programme. I have also made available approximately €6 million for the construction of a new state-of-the-art screening unit at St. Vincent's Hospital to replace the current Merrion unit. The Government's commitment to the development of services for women with cancer is further evidenced by the introduction of the Irish cervical screening programme. Cervical screening is a valuable preventative health measure, when delivered. The Government is examining the feasibility and implications of a roll-out of the national programme.

Dr. Cowley:

It has been examining it since 1999.

Mr. Martin:

An external review of the pilot programme in the Mid-Western Health Board Area, which I believe needs to be refined, is also taking place. Additional resources have been made available in recent years to meet the additional demand for cervical cytology laboratory services and to develop both the laboratory and colposcopy services. An additional €2.5 million was provided in 2002 and a further €1.4 million has been allocated in 2003 for the ongoing development of these services.

I accept that we do not have sufficient radiotherapy capacity to meet existing and future demands. The provision of radiotherapy requires significant medical, scientific and support expertise and resources, in addition to extensive capital investment. I established an expert review group on radiotherapy services to ensure that we effectively plan the current and future development of this key element of cancer care. The current debate on radiotherapy services is extremely narrowly based and is confined to geographical location without any real discussion on the principles that should underpin the national provision of services.

Dr. Cowley:

That is nonsense.

Dr. Twomey:

The Minister should publish the review.

Mr. Martin:

In establishing the expert review group, I ensured that it would be multi-disciplinary and include the various modalities of care, including radiation oncologist, medical oncologist, physicist, academic, public health and patient advocate representatives.

Dr. Cowley:

Locally.

Mr. Martin:

I also ensured that we would have expert input from outside the jurisdiction. I consider it premature for the Opposition to engage in political opportunism before it has had an opportunity to examine the report.

Dr. Twomey:

We are waiting for the report.

Mr. Martin:

The Members opposite have not yet seen the essential principles that underpin the review group's work and they cannot yet appreciate and reflect on the extensive benchmarking that has, no doubt, been undertaken in relation to the provision of radiotherapy services in other countries.

I would like to refer to the centralisation of services, as referred to in the Opposition motion. Northern Ireland, which has a population of 1.7 million, has decided to centralise its radiotherapy services in Belfast with the construction of a comprehensive radiotherapy facility on the site of a major teaching hospital which will treat all cancer patients in the Six Counties who require radiotherapy. There is considerable optimism in the North about this development as it represents the best and most effective way of organising services in a manner that ensures quality – I stress the word "quality". Some people opposite me would love the political issue to be resolved by putting two machines in many different locations. They want to please everybody politically and to forget about quality, patient survival rates and outcomes.

Mr. Callely:

Hear, hear.

Dr. Twomey:

That is rubbish.

Mr. Healy:

That is nonsense.

Mr. Martin:

That is the proposition that is being put before the House this evening.

Mr. J. Higgins:

That is outrageous.

Mr. Connolly:

The Minister should withdraw that remark.

Mr. J. Higgins:

It is unworthy of the Minister.

Mr. Martin:

That is the proposition that the Opposition is putting before me.

Mr. J. Breen:

Withdraw it.

An Ceann Comhairle:

The Minister, without interruption, please.

Mr. Martin:

I suggest that the Deputies opposite challenge those who know about these issues.

Mr. Healy:

It is unworthy of the Minister.

Mr. Connolly:

Withdraw it.

Mr. Martin:

I will not withdraw it. I have outlined what is going on here.

(Interruptions).

An Ceann Comhairle:

The Minister, without interruption.

Mr. Callely:

That is putting it to the lads.

Mr. J. Higgins:

The Minister should withdraw the remark.

An Ceann Comhairle:

Deputy Joe Higgins, I am sure you will have an opportunity to make a contribution.

Mr. J. Breen:

The Minister would make a good rugby player.

Mr. Healy:

A Cheann Comhairle, I ask you to ask the Minister to withdraw the remark.

Mr. Martin:

It is a fact.

Mr. McCormack:

The Minister is inviting interruption.

Mr. Callely:

Put the patients first, gentlemen.

An Ceann Comhairle:

The Minister to continue without interruption.

Mr. Martin:

In contrast, we have—

Mr. McCormack:

The Minister is inviting interruption.

(Interruptions).

An Ceann Comhairle:

The Minister to continue without interruption.

Mr. Callely:

Hear, hear.

Mr. J. Higgins:

That is outrageous.

Mr. Healy:

It is outrageous.

Mr. J. Higgins:

He should not be allowed to get away with it.

An Ceann Comhairle:

Allow the Minister to continue.

Mr. Martin:

In contrast, a Cheann Comhairle, we have a population of 3.9 million. The debate so far has been about geography and not about the quality of services.

Mr. Healy:

That is nonsense.

Mr. J. Breen:

Where is the Minister getting that from?

Mr. Martin:

I fully expect that the expert review group will address the competing demands of quality and geographical location. International evidence suggests that radiotherapy services can best be provided in a limited number of centres.

Dr. Cowley:

Not in Ireland.

Mr. Martin:

I am certain that the future demands to provide a comprehensive service that is quality and equity driven will be extremely expensive. My objective will be to develop proposals on foot of the report that will provide us with a model of radiotherapy services—

Dr. Cowley:

Not as expensive as the report.

Mr. Martin:

—that is patient centred—

Dr. Cowley:

Not €200 million.

Mr. Martin:

—attracts and retains the best medical and scientific expertise and ensures comprehensive radiotherapy treatments—

Dr. Cowley:

What about Norway?

Mr. Martin:

—in a timely manner, while ensuring quality.

Mr. Callely:

Hear, hear.

Mr. Martin:

I am determined to plan to achieve this objective. I invite Deputy Cowley and others to talk to the chairman of the expert review group when the report is published and to have a genuine debate.

Dr. Twomey:

We would be delighted to do so.

Mr. Martin:

I invite you to challenge—

Mr. Healy:

We would be delighted to talk to anyone.

Mr. Martin:

—and somehow deal with the principles that the report will outline.

Mr. Healy:

Why will the Minister not publish the report?

An Ceann Comhairle:

Deputy Healy, please.

Mr. Martin:

We have not published the report, even though—

(Interruptions).

An Ceann Comhairle:

Allow the Minister to continue.

Dr. Cowley:

We would be delighted to meet the chairman.

Mr. McCormack:

The Minister is inviting interruptions.

Mr. Healy:

It is on the Minister's desk. Why will he not publish it?

An Ceann Comhairle:

Minister, if you address your remarks through the Chair—

Mr. Callely:

Which he is.

An Ceann Comhairle:

—perhaps you might not invite interruption.

Mr. Martin:

The debate is to the House, a Cheann Comhairle.

Dr. Cowley:

The Minister said in 2001 that we would have the report shortly, but it is now 2003—

An Ceann Comhairle:

I ask Deputy Cowley to allow the Minister to continue, please. We cannot have a situation where Deputies frustrate the Minister putting his contribution on the record.

Mr. Martin:

We have an excellent opportunity—

Mr. McCormack:

What about the Minister frustrating the Deputies?

Dr. Cowley:

The Minister is inviting comments.

Mr. Martin:

Sorry.

Dr. Cowley:

He has insulted me, a Cheann Comhairle.

An Ceann Comhairle:

Allow the Minister to continue.

Mr. Martin:

With respect to Deputy Cowley, I did not throw any insults this evening, although there were many coming in my direction earlier.

Dr. Cowley:

The Minister insulted me professionally.

Mr. Martin:

We have an excellent opportunity to get radiotherapy right for the country. Deputy Gormley mentioned the prospect of an all-party approach to this issue and I would not object to that.

Dr. Cowley:

The Minister should agree to the motion in that event.

Ms O. Mitchell:

I bet the Minister would not mind.

Mr. Martin:

Exactly. The Opposition is the last group that would want that.

Mr. Healy:

The Minister should agree to the motion.

Ms O. Mitchell:

The Government is the last group that would want it.

Mr. Martin:

Let us be sincere about this. We can avoid the mistakes of other countries because we are starting from a low base in terms of radiotherapy capacity.

Dr. Twomey:

We agree with the Minister.

Mr. Martin:

We can get it right but we must get the backbone of the service right first before we go on further.

I wish to advise the House of a number of developments in radiotherapy. In recent years, significant investment in new radiotherapy services has taken place in Dublin, Cork and Galway.

Dr. Cowley:

It is not open yet in Galway.

Mr. Martin:

St. Luke's Hospital has seen considerable renovation and upgrading. In excess of €25 million has been invested in St. Luke's Hospital enabling the purchase of significant additional equipment including six new linear accelerators. This investment ensures that St. Luke's continues to meet the demands placed on it as a world class centre for the delivery of radiotherapy.

Almost €9 million has been invested in phase 1 of a substantial new building project development at Cork University Hospital for radiation oncology services which was completed in 2002. This involved the commissioning of two new linear accelerators as well as other equipment.

A new radiotherapy department is currently under construction at University College Hospital, Galway. My predecessor, Deputy Cowen, took the decision to bring Galway on stream ahead of the first cancer strategy recommendations.

Mr. Healy:

The Minister, Deputy Cullen, announced one for Waterford in this House.

Mr. Martin:

The first cancer strategy recommended only two centres, and suggested possibly Galway.

Dr. Cowley:

Why does the Minister not open Galway?

Mr. Martin:

We moved quickly to put in place the necessary capital investment for University College Hospital, Galway, to provide a supra-regional centre which will provide services to the western and north-western areas. This development is part of the phase 2 project at University College Hospital, Galway. In excess of €100 million has been allocated to this project which is due for completion in autumn 2003.

Mr. Callely:

That is good news.

Mr. Martin:

The report of the National Advisory Committee on Palliative Care was approved by this Government in the summer of 2001. The report describes a comprehensive palliative care service and acts as a blueprint for its development. This Government has agreed to the implementation of the report's recommendations over a five to seven year period. The implementation of the report will be undertaken as part of the implementation of the national health strategy.

Additional revenue funding of €2.5 million was provided in 2003. Since September 2001 almost €11 million has been allocated to the health boards and the Eastern Regional Health Auth ority to begin implementing the report's recommendations.

In February 2003, the first all-Ireland cancer network was launched under the auspices of the Ireland-Northern Ireland National Cancer Institute cancer consortium. The network is being formed by the Irish oncology research group in Dublin, the clinical research support centre in Belfast, nine cancer centres in Ireland and one in Northern Ireland. The new co-operative group will be jointly funded by the Health Research Board in Dublin and the Research and Development Office in Belfast. The group will receive €1 million over the next two years to carry out its work. Its principal role will be to initiate and co-ordinate clinical trials in cancer hospitals in both parts of the island.

We have demonstrated our support by investing significant resources in this trilateral programme. Under this scheme, awards to the value of €3.5 million have been made available to allow hospitals to recruit and train staff, improve facilities and take part in world-class clinical trials. This is a first for the country and another example of the significant advances being made in terms of research and the advent of cancer clinical trials to the bedside.

Mr. Callely:

Hear, hear.

Mr. Martin:

International evidence is that better clinical outcomes are achieved in hospitals with specialist staff, high volumes of activity and access to appropriate diagnostic and therapeutic facilities. Best results in treatment are achieved where patients are treated by staff working as part of an integrated multidisciplinary specialist team.

Dr. Cowley:

Not hundreds of miles away.

Mr. Martin:

This core principle must inform the current organisation of services and how we plan future services across the various modalities of cancer care.

I wish to refer to the work of the National Cancer Forum, a multidisciplinary group of experts appointed to advise on cancer services, including hospital services. As part of the development of a new cancer strategy, the forum has examined oncology surgery between 1997 and 2002 in respect of a number of site-specific cancers, including those of lung, breast, pancreas and colon.

The forum has concluded that there are too many consultants performing oncology surgery in too many hospitals given the total number of procedures that are performed in our hospitals. We simply do not have the patient caseload to support the current broadly-based organisation of oncology surgical services. The forum has advised me that the current organisation of these services is not in line with international best practice and it will be reflecting further on this issue as it pre pares the next cancer strategy, which I expect to receive later this year.

International evidence is that technically challenging surgery, for example, can best be supported if it is concentrated in a relatively small number of centres. This is a message that is evidenced based and needs to be directed at and pursued at a number of levels in our society. At medical level there is a clear responsibility on the profession to respond to this reality in a balanced and adequate manner. As major stakeholders in our health services, I also expect the profession to lead medical and public opinion on this subject and to challenge contrary views. I am convinced that the medical profession on a more organised basis also needs to articulate to politicians on matters of this importance. Too often, it is left to politicians to respond to pressure to pursue the organisation of services that is based on sectional interests and not on best practice. It must be understood that having a service is no longer sufficient; it must be a service that is organised in such a way that it is capable of delivering quality in line with international standards and practice. We must face the reality that we cannot continue to expect that we can deliver the highest quality of cancer services across over 30 acute hospitals. I am not prepared to stand over a service—

Mr. Callely:

It is regionally based.

Mr. Martin:

—that is designed in a manner that limits the potential of cancer care to maximise outcomes for our population. To do so would be to create an apartheid system that is simply not acceptable. That is the real apartheid that would be achieved if Deputy Cowley's views and proposals held sway, in my opinion. A new apartheid would be created, one of quality versus lack of quality.

Dr. Cowley:

We have apartheid.

Mr. Martin:

These are major challenges for politicians, the medical profession and society generally. While we must continue to invest in quality, we must also organise for quality. Best cancer care must be benchmarked against quality indicators and not indicators based on geography. In terms of our achievements in improving cancer care, I have presented information to the House today regarding increased manpower and increased activity. These are an important measure of improvements in cancer care. However, we also need to develop further our understanding of the process of care.

The ultimate objective in terms of the delivery of cancer care is that those in receipt of services experience outcomes on a par with best international standards.

Dr. Cowley:

It should be decentralised.

Mr. Martin:

Health information is fundamental to assessing and implementing quality programmes. The national health strategy provides for the establishment of an independent health information and equality authority to lead the development of health information to support these requirements. That authority will exercise a pivotal role regarding a number of key information functions. It is only through focusing on specific information developments such as this, to build on the excellent work of the national cancer registry, that we will be able to continuously demonstrate the positive impact that cancer services are having and also to identify the areas which may need to be addressed to further strengthen our cancer care system.

Last month, the Irish Society for Quality and Safety in Healthcare launched the results of the latest survey undertaken on its behalf into patient perception of the quality of health care. The health strategy contains many commitments associated with both people centredness and quality issues. It clearly identifies the need for health care providers to put the patient at the centre in the delivery of care and to take into account the views of patients regarding the care they receive.

Dr. Cowley:

That is a good idea.

Mr. Martin:

The results of the 2002 survey are positive in many respects. Patients perceive the quality of the care and service they received to be very high. Some of the findings mentioned in the survey include: 92% of patients reported being satisfied or very satisfied with the overall quality of care they received during their stay in hospital; 85% of patients reported being satisfied or very satisfied with the standard of service they received in the accident and emergency department; 90% of patients who underwent a procedure reported having it adequately explained to them; and 92% of patients expressed a high level of overall satisfaction with the hotel aspects of hospital service.

We are fortunate in this country that those involved in cancer care provide a professional and high standard of care that is broadly appreciated by those with cancer and their families. I wish to recognise this dedication and commitment. My objective as Minister for Health and Children is to ensure that the substantial investment is reflected in improvement in health outcomes for cancer patients.

The developments which I have outlined describe an overall framework through which cancer services can be developed and provided in the most co-ordinated and effective manner. I am glad of the opportunity to place on the record of the House the substantial developments that have taken place in cancer services. It is appropriate that this House should commend the Government for its positive and demonstrable commitment to cancer services. I consider that while we have achieved a lot, a lot more needs to be done.

Mr. F. McGrath:

A lot needs to be done.

Ms O. Mitchell:

I welcome the opportunity to respond to the Minister. I wonder if perhaps the Minister is the one who has given up cigarettes because he is tetchy this evening. I am not sure what is wrong, perhaps it is caused by the Minister for Finance.

Mr. Martin:

I am being assertive.

Ms O. Mitchell:

This is a serious issue. It is not often we discuss such a life and death matter in this House and an issue in which we all share the common objective of the desirability of a world-class service. We all share the best possible motives in dealing with this issue. We all want to achieve the best quality service for all. For these reasons, it is too important an issue with which to play politics and it is too complex to be decided merely by reference to party political considerations, electoral advantage or geographical considerations.

As Opposition spokesperson, it is legitimate for me and my colleagues to bring home to the Government in the strongest possible terms the need to reappraise its approach to cancer care, prioritise investment in quality treatment, invest in preventative programmes and, most importantly, bring a sense of urgency to dealing with the extent of the problem which faces us. I accept there are few votes in preventative medicine. No thanks ever accrued for saving people from diseases they might have developed, but never actually developed. The Minister would have the support of all sides of the House for screening programmes for early detection and treatment, which would not just improve outcomes but would immeasurably improve the quality of life for patients. If it is to survive, the whole focus of the health service must be towards keeping people healthy and early treatment, rather than waiting for the crisis to emerge, involving admission to costly acute hospital beds.

The Minister recently announced the extension of BreastCheck, albeit under strong pressure, which is widely welcomed. However, he did a disservice to the House and the public when he refused to identify what budget will pay for the service. He implied in reply to a question I put to him that it would come out of this year's cancer budget. Given that it was not originally provided for as part of the budget, it begs the question as to what part of the cancer service will now be postponed or delayed. I am assuming nothing will be cancelled but something must be postponed and delayed if money is going to a new service announced in recent weeks. Will the previously announced BreastCheck service for the south-east or the radiotherapy services planned for Galway be postponed or delayed? This should not be a matter of political spin or obfuscation.

The issue must be clarified, as must the thinking behind the inexplicable decision to delay the commissioning of equipment for the radiotherapy services in Galway and the further delay in the process of recruitment until the equipment is installed. To those of us who are not privy to the rationale behind this thinking, it sounds like a wanton waste of time and money, particularly as the Minister knows that even when the service is up and running in 2006 at the earliest, it will be five or even ten years before the kind of expertise patients deserve has been gained by staff, however well meaning and qualified. For many years, people will have to travel to Dublin for complex treatment.

Given the long lead-in time for radiotherapy services, it is unsatisfactory that the expert group report has not yet been published. It has been quoted from by the Minister, widely leaked and commented on in the newspapers. I have read press statements of people responding to it but it still has not been published. It is equally unsatisfactory that it appears not to make recommendations about services outside the three national centres identified. It is incomprehensible, if true, that it recommends a further report. This is just not acceptable as we have been waiting for years. Where the services will be ultimately located is a political decision. It is a costly and complex service with a long lead-in time.

Expert advice, rightly sought by the Minister, is essential. I do not understand why an expert group would seek to pass the buck or why it would postpone matters. It is another excuse to defer decisions that are crucial. It is an excuse for postponing investment decisions in a service which has a lead-in time of ten years. The vacuum is filled by demands from all over the country, including hospitals engaging in turf wars about where the services will be located. This is not how these decisions should be made.

I ask the Minister to seriously consider the demands of this motion and what is being said by people throughout the country. He should consider in an open and flexible way how services should be delivered to ensure everyone has access to a quality service. He should take into account the fact that it is unacceptable that people should have to travel long distances. Radiotherapy services, in particular, are not just a treatment service, they are a pain-relieving service. People who cannot be transported should be able to avail of these services, therefore, we must be far more flexible in this regard than in the past. Perhaps he should look at moving multidisciplinary teams to other locations rather than moving patients. That may mean an investment in equipment in many other locations. However, equipment gives a good return over many years. I accept it would be more difficult to put together multidisciplinary teams. I ask the Minister to listen to the sense of the motion which requests a comprehensive service of the highest quality for everyone in the country.

Mr. Neville:

I welcome the opportunity to speak on the motion and congratulate the Technical Group on tabling it.

It is now clear that the Minister has abandoned the national cancer strategy. Some 29,812 people died in Ireland in 2001, 7,577, or one in four, of whom died from cancer. We have the third highest cancer rate in Europe and many of those who die are on so-called waiting lists. It is difficult to tell someone who is on a waiting list for cancer treatment that one will make representations on his or her behalf and try to assist. One must tell them they will be called off the list because they cannot get preference to people who are placed before them, and people die in these circumstances.

Screening for breast cancer, cervical cancer and prostate cancer, which has great potential to reduce the incidence of cancer, is practically non-existent. The Minister has not yet indicated where the money will come from for the extension of the BreastCheck service. The Minister for Finance said today there is no money available to end the current strike action by public health doctors. While we welcome the announcement to extend the BreastCheck service, from where will the money for the service come? How can the Minister doubt our scepticism when he has a Minister at his back saying there is not a single shilling for anything else?

Some 16% of cancer patients in Ireland receive radiotherapy, while the EU average is 66%. The highest figure in Europe receiving radiotherapy treatment is more than 80%. These statistics prove that the Government has abandoned the 1996 national cancer strategy.

Under the Minster's stewardship, patients with cancer have had to resort to court action to vindicate their rights to lifesaving hospital treatment and care. That is surely an indication of how the national cancer strategy has been abandoned. The Minister has described this as unacceptable as if he was a disinterested observer rather than a member of the Government charged with responsibility for the provision of timely and appropriate care.

For a person with cancer, stress and the physical and psychological difficulties experienced can create tensions and such a person is anxious to get timely and appropriate care. We know that cancer can develop rapidly in some people. People need immediate care – waiting lists are inappropriate for cancer sufferers as they know their life is increasingly threatened as time passes. The record of the Government in this area is abysmal. No attempt has been made in the past five years to change the way our health service operates to deliver more cohesive and accessible patient care.

The current Government and the previous one has had more money available than any previous Administration, yet cancer services have not been taken care of. It is indefensible that patients suffering from cancer in 21st century Ireland have to wait for essential treatment because of the lack of hospital beds. It is disgraceful that eight years after its launch, the national cancer strategy is not further advanced. It is offensive for the Minister to blame hard-pressed hospitals for delays in the delivery of services rather than his own inaction.

The Government has failed to give priority to cancer services that would see more people survive cancer, have an enhanced quality of life and enjoy more years with their families and loved ones. Life is precious. Everybody wants to extend their life and someone diagnosed with cancer wants immediate treatment so that they might have the opportunity to share a longer life with their loved ones. We all know of people who lived for 15 or 20 years having received good and immediate care. The longer one waits for essential treatment, the less time one is likely to have to spend with loved ones.

I welcome the BreastCheck programme. While the Bill establishing the children's ombudsman may be the responsibility of the Minister for Justice, Equality and Law Reform, I note that this position will not be filled for at least another 12 months. We hope that BreastCheck is not put on a similarly long finger.

In the provision of cancer services in this country there is paralysis of analysis. We are still waiting for the report of the expert group on radiotherapy. It was promised in both February 2001 and February 2002. Meanwhile, University College Hospital Galway continues to be the world's only designated comprehensive cancer centre that can offer any type of radiotherapy. We have the potential to provide world-class cancer services in this country. We have highly skilled, highly motivated, compassionate and dedicated health professionals. We have wonderful palliative care facilities and incredible patient support services. I am sure the Minister of State, Deputy Tim O'Malley, will agree that we have as excellent a palliative service in the Milford Hospice Care Centre as there is in any area of the country. I pay special tribute to the work that is being carried out there. We all know family members and friends that have experienced that palliative care. While there is immense goodwill and generosity from the public, we lack the political will, action and leadership to deal with the situation.

The Government has paid lip service to the cancer strategy. The sad fact is that the Minister's inaction is costing lives. Set against a backdrop of the list of achievements, such as that offered tonight, the Government's failure to implement the vital strategy is a shameful breach of faith to cancer patients, their families and those who care for them.

I will now focus on the provision of radiotherapy service in the mid-western area. I am sure I will have the support of the Minister of State, with whom I spent seven years on the Mid-Western Health Board. He was a most positive figure and one of the best members of the board during my time on it. I had the honour on several occasions of seconding his candidature for the chairmanship of the board.

Mr. Durkan:

Correct.

Mr. McHugh:

Perhaps it is time to return the compliment.

Mr. Neville:

As the Minister knows, the mid-west region has sought radiotherapy services for a long time. The Minister of State will be able to confirm that this came to light during the last election campaign. While it would be easy to say the issue was raised at every second door, I am not exaggerating when I say that the absence of radiotherapy services in the mid-west was raised at at least one door in ten when I was canvassing.

People in Dublin do not understand how difficult and traumatic it is for people living in the mid-west to access services in Dublin or Cork. There had been a proposal to establish a radiotherapy service in the mid-west for the benefit of cancer patients in the area. It was a unique proposal and was adopted by the health board at its meeting on 17 January. The proposal is that a public private partnership between the Mid-Western Health Board, the Mid-Western Hospital Development Trust and the Mater Private Hospital, Dublin, should be established in the region. This is an example of the mid-west making a proposal on how to provide the services there. It is asking for the Minister's support rather than coming to him with a begging bowl and asking him to provide the service.

The Mid-Western Health Board proposes to provide a site adjacent to the existing cancer centre at the Mid-West Regional Hospital. Planning permission exists for a radiotherapy unit in the hospital. The development trust will provide approximately €6 million for the building and equipment and the State would not have to provide any money for construction of the building. The Mater Hospital will be responsible for the operating costs of the service.

There are currently four centres, with two private facilities providing radiotherapy. Three of the centres are in Dublin and Cork and this does not meet the demand that exists. The result is long waiting lists for people in the mid-west region in particular. They have difficulty in obtaining treatment due to the distances involved and often have to spend six weeks away from home while availing of cancer treatment in Dublin or Cork. The Minister will appreciate that this is extremely stressful for cancer patients and their families. We are proposing the establishment of a local unit that will transform the lives of those patients and their families.

The Minister will be aware that three years ago he appointed an expert group to examine the need for radiotherapy services. Perhaps he will tell me at a later stage what is happening in that area.

Debate adjourned.