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Dáil Éireann debate -
Wednesday, 16 Apr 2003

Vol. 565 No. 4

Private Members' Business. - Cancer Treatment Services: Motion (Resumed).

The following motion was moved by Deputy Cowley on Tuesday, 15 April:
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.
Debate resumed on 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.
–(Minister for Health and Children).

I wish to share my time with Deputies Devins, Carey, Keaveney, Fleming and Nolan.

Is that agreed? Agreed.

I welcome the opportunity to speak on this important motion, especially because of the commitment by the Minster for Health and Children and the Minister of State, Deputy Tim O'Malley, to the whole area of cancer services. It is important that we recognise the huge and significant investment since 1997 in cancer services. More than €400 million has been spent on the development of services in this key area, especially in 2003, when €29 million is to be spent. Most people will recognise that significant improvements have been made country-wide as a result of this investment, particularly in the west. This is in no small part due to the Minister's commitment.

Being a rural Deputy, I recognise that access to services, especially cancer services, is a huge issue. However, I also recognise that no service can be designed purely on the basis of geographical considerations, although these play a significant role. The Minister is aware of this. A number of years ago, when certain recommendations in a report suggested that the breast clinic at the Mayo General Hospital may have been at risk, the Minister was quick to reassure those in the west and especially those at the hospital, that the service would continue. It has continued and has since been enhanced, a development I welcome.

Few issues are as important as the challenge posed by cancer to our health services. One in three of our citizens will develop cancer during the course of his or her lifetime, which puts the issue into context. As a member of the Western Health Board, I am very aware of this. All Members recognise it to be an important issue country-wide. Mortality rates in Ireland are higher than the European Union average, an issue that must be seriously addressed. We must continue to build on the improvements effected since the adoption of the national cancer strategy in 1996.

A number of Deputies have mentioned that prevention is better than cure. This becomes apparent when consideration is given to the way in which funding of €400 million has been spent in the past number of years. I welcome the Government's investment in cancer prevention programmes, which has exceeded €17 million. The Minister is committed to anti-smoking measures and to considering the reasons for the high incidence of cancer in Ireland. We must recognise that lifestyle plays a huge part in this. Evidence supports this contention.

We need to tackle the issue of smoking, which is the cause of a huge number of cancer-related deaths every year. Problems related to alcohol consumption must also be addressed. I fully support the Minister's proposals for dealing with smoking and I look forward to his plans for dealing with the problems associated with alcohol consumption.

It is important that some of the funding of €400 million has been allocated to the creation of 80 additional consultant posts to deal with cancer services and support staff. This has resulted in a huge number of people receiving radiotherapy and chemotherapy services. There has been a 58% increase in radiotherapy and a 30% increase in chemotherapy services.

As a woman, I commend the Minister on the recent extension nationwide of the BreastCheck programme. This is hugely beneficial for women. Over the past weeks many Deputies have tried to claim credit for the extension of the programme. The matter was extensively debated at the meeting last week of the Western Health Board, of which I am a member. We are fortunate in that the chief executive officer of the health board is the chairwoman of the National Breast Screening Board. She set the record straight, especially with regard to the Minister's commitment to this area. The Minister orchestrated the pilot programme, which proved to be so successful, and where the uptake in the service by women has increased by 75%. He also insisted on the programme becoming nationwide in conjunction with the national breast screening programme.

Why did he wait until 2003?

While others like to sit on the sidelines and try to claim credit for the introduction of the service nationwide, the credit must be firmly placed with the Minister. I compliment him on his efforts.

Why did 195 women have to die in the meantime?

Some people tried to organise marches to press for the extension of the programme. The Independent Deputy is good at knowing when announcements are to be made, at which point he starts to make wild calls for them to be implemented. He knows the Minster is committed to this programme. The Deputy is being exposed by that kind of stunt and nobody is fooled by it. He cannot criticise the Government for the lack of work done in the health area and then try to jump on the bandwagon for claiming credit for positive announcements.

The Deputy never did anything. She should be ashamed of herself.

I welcome this opportunity to speak on the provision of cancer services in Ireland. Since the report of the national cancer strategy in 1996, the previous and present Governments have invested unprecedented amounts of money in the provision of services for cancer, both for investigations and treatment. More than €400 million has been spent since 1997 and I find it demeaning to suggest that a service as vital as cancer care should be referred to as apartheid.

A state of apartheid exists in this area, despite what the Deputy says.

It may lead to good headlines and cheap publicity, but it demeans those who suffer from this awful disease. I wish to briefly allude to some of the important developments that have occurred since 1997. In excess of €39 million has been invested in the BreastCheck programme. The Minister's recent announcement of the extension of the service countrywide is welcome.

The proposer of the motion knows that any new treatment modality should be fully evaluated before it is adopted. This evaluation has been done on the effectiveness of breast screening and, as a member of the Oireachtas Joint Committee on Heath and Children, I was delighted the Minister acted so quickly on our recommendation, after we had heard from the chief executive officer and the medical director of BreastCheck that the programme should be extended nation-wide.

It would be foolhardy in the extreme for any Government to spend enormous amounts of money on a programme that did not fulfil its expectations, hence the necessity to evaluate BreastCheck. The results were very positive.

The effects of the programme were known internationally.

The Government is to be com mended for acting so quickly and decisively on the Oireachtas committee's report.

It took two years to extend the programme..

On the question of cervical screening, the first phase of the programme started in October 2000 and is currently being reviewed this year.

Some 195 women died as a result of the delay.

I ask you, Sir, to request Deputy Cowley to stop interrupting Deputy Devins.

An Leas-Cheann Comhairle

I call on Deputy Cowley to stop interrupting.

If the result of the review suggests it is an effective way of dealing with cervical cancer, I have no doubt the Minster will extend the programme nation-wide.

Specialist units have been established in each health board area to deal with symptomatic breast cancer. The consultants in this field recommend that the optimum population base for the effective operation of this vital component of breast cancer care is a population of between 250,000 and 300,000 people. This is in keeping with best international practices. The investment of €30 million in this service is proof of the Government's determination to provide the citizens of this country with the best available treatment.

The cancer consortium, established by the Minister, is a welcome development. Unfortunately, we do not know what causes cancer. An enormous level of research has been and is being carried out in this area all over the world. Certain facts have emerged. It may well be multi-factoral in aetiology, but more research is urgently needed. The decision to establish a trilateral partnership between the Republic, the Department of Health in Northern Ireland and the National Cancer Institute in the United States is one of the most innovative and important steps to uncovering the aetiology of cancer. I hope it will lead to its eventual elimination.

Prostatic cancer is one of the most common cancers to affect males. A simple blood test, or prostatic specific antigen, is the best screening method available at present. I urge all males over 50 to take this test and the Papanicolaou smear which are available free of charge to anyone with a medical card. I urge everyone to avail of these very important investigations.

In all its guises, cancer causes great morbidity and terrible mortality. This Government and the present Minister for Health and Children are committed to ensuring that our cancer services are of the highest standard in terms of prevention, early detection and effective treatment. Let us not engage in cheap publicity or headline hunt ing in the area of this awful disease. I commend the Government amendment to the House.

I am very glad the Government has the chance to record the substantial developments in cancer services in recent years. I have read in detail the Opposition motion before the House and I acknowledge the right and obligation of Members to bring forward such motions. I acknowledge also the entitlement of the Government to make amendments.

This House should congratulate the Government on its positive and verifiable commitment to cancer service provision. The Opposition is once again wheeling out the same old criticisms, complaining about what has not been done, arguing it would do more and ignoring the enormous steps this Government has made in the battle against cancer. I admit that we have a long way to go, but the continuous list of negative comments from the Opposition is unfair and fails to reflect the reality of what this and other Governments have achieved. The key aim of the national cancer strategy of 1996 was to achieve a 15% decrease in mortality from cancer among those in the under-65 age group in the ten year period from 1994. I am pleased to note that this target was achieved in 2001, three years ahead of time. How is this a failure by the Government? While it is an undeniably encouraging statistic, there is still much to achieve.

The launch of the national cancer strategy in November 1996 marked the beginning of major developments in the treatment and care of patients with cancer. Since 1997, approximately €400 million has been invested in the development of cancer services which is well in excess of the £25 million initially envisaged in 1996. Of this sum, €29 million was allocated in 1993 alone. This investment will ensure that we continue to address increasing demands on cancer services in oncology-haematology services, oncology-drugs services and symptomatic breast disease services. This substantial development has enabled the funding of 80 additional consultant posts together with support staff in key areas such as medical oncology, radiology, palliative care, histo-pathology and haemotology.

The benefit of this investment is reflected in the significant increase in activity we have seen. The number of new patients receiving radiotherapy treatment increased from over 2,000 in 1994 to almost 4,000 in 2000. An additional 1,407 patients are accessing these services which represents an increase of 58% nationally. The number of new patients receiving chemotherapy treatment increased from over 2,600 in 1994 to 3,500 in 2000, which represents an increase of 30% nationally. Breast cancer is the individual, site specific cancer which has received the most investment in recent years and in-patient breast cancer procedures have increased from about 1,300 in 1997 to nearly 2,000 in 2001. This is an increase of 37% nationally.

Breast cancer is the cancer with which most of us are most familiar. 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. A cumulative figure of approximately €39 million in revenue funding has been allocated to BreastCheck since 1999. The national breast screening programme was established in 1998 with the remit of reducing mortality from breast cancer by 20% over a ten year period by screening women in the 50 to 64 year age bracket every two years.

The programme commenced in February 2000 with phase one covering the Eastern Regional Health Authority, the Midland Health Board and the North Eastern Health Board. Screening is offered free of charge to all women in the target age group. To the end of December 2002, the programme had invited over 110,000 eligible women and screened 83,000 with an uptake of 75%. The Opposition has ignored the success of the programme. I was delighted to hear of the recent national extension of the BreastCheck programme. Under the extension, approximately 130,000 women in the target population of 50 to 64 year olds will be eligible for screening. The programme expects to diagnose approximately 400 cancers per annum among the population.

I commend the Minister for his dedication to providing the best cancer services. While there is no doubt that we have much to do in the future, the fact that a great deal has been achieved should not be ignored.

There is a lot more to do.

Like practically every family, mine was hit by cancer. Members of this House have been lost to cancer since I was first elected. One in three will die of cancer, but everywhere one goes people say their area is worse hit than everywhere else. I fight often at health board and other levels to ask for doctoral students looking for ideas for their doctorates to conduct geographical surveys of factors outside obesity and alcohol and cigarette consumption. They should prove one way or the other what is happening in small areas.

Early in my political career I was asked many questions by a local newspaper which wanted to know who was the person I would most like to meet. I replied that I wanted to meet the person who would invent the cure for cancer. It is incredible that in an age when hearts, livers and lungs can be transplanted, a little lump can be the end of many a person. We have spent much time on the issue of smoking in the Committee on Health and Children. It is beyond doubt that smoking is a serious contributory factor in the case of many cancers and I commend the Minister for Health and Children for his stance in this area and wish him continued success.

The staff of the cancer support units are great as my family found when dealing with cancer. Words cannot describe the kindness and tenderness of the people working at the Foyle Hospice. I wish the staff of the newly opened Letterkenny Hospice well, although the need for such a service is unfortunate. Carndonagh Community Hospital also has a hospice unit. The friends of the different hospitals are working hard to maximise Government supports. The air service links between Donegal and Dublin and Derry and Dublin provide cheap transport to people who would otherwise face a very long drive. I am glad these services can be brought back to the regions where possible.

It would be a sad day on which we politicised the issue of cancer. There is hardly a person who has not been touched by it. I remember travelling with former Senator Mary Jackman and members of Europa Donna to Guy's Hospital in London at a time when we were talking about systematic breast disease services. Everybody was fighting his or her corner and demanding that the service be provided in his or her town or hospital. I was faced with a situation in which Sligo might have been chosen as the site of the service rather than Letterkenny because it was the site of the critical mass. The message from the consultants and the experts to me was that they did not want to see the issue politicised. The patient had to be the priority. That is the only message politicians need to take home. I was under political pressure to fight for Letterkenny, but I came home with a clear message from the experts which said the service must go to the place with the critical mass. Luckily, we were able to link with Altnagelvin in Derry to create an ongoing service.

The cross-Border initiatives that have taken place are important. When I was first elected to the House, the national cancer study recommended that facilities be located in Galway and Dublin. I pointed out that I was 20 miles further from Galway than I was from Dublin because people assumed Donegal was next door to Galway. The interaction we have, be it with Belvoir Park in Belfast or any of the cancer services in the North is of benefit to us. I commend the cross-Border work and give it my full endorsement and support.

Letterkenny hospital received eight extra beds in 2002 which are fully operational. We have a request for 18 more beds to support the new medical oncology and haematology specialities in the hospital. I would like to think that the Minister would be able to look positively on this. As well as the increase of eight beds, the hospital has seen an enhancement in radiology services with the picture archive communications system; improved out-patient facilities and medical rehabilitation units; the recruitment of radiography and laboratory staff; installation of pneumatic air tube systems; an X-ray ordering and viewing system to expedite the X-ray process; and improvements in triage. In addition, consultants in palliative medicine took up duty in 2002, the consultant radiologist replacement post was filled and an additional consultant anaesthetist was appointed in 2002.

There have been many advances but there is a long way to go. I appeal to Members not to politicise what is an important issue to many families in the country.

I am pleased to contribute to this debate. Cancer has unfortunately affected many families to date and will continue to affect more into the future. One of the main issues that has not been touched on sufficiently is prevention rather than cure. The Minister in his activities, especially his wish to extend the ban on smoking in the workplace, pubs and restaurants, is running into opposition. I would like those who oppose him to put the health care of the people who use their premises and their staff who work in them first on all occasions. It is important we reduce exposure to smoking because it can lead to cancer and cause many deaths.

We have a great ability in Ireland to say we are in favour of reducing the incidence of smoking but, as soon as the Government proposes a substantial increase in the price of the packet of cigarettes, the social partners demand a substantial pay increase where it leads to an increase in inflation. Dealing with health must be put outside national pay talks because I am convinced the Minister should increase the price of cigarettes substantially in every budget, even though it has a knock-on effect on inflation. I appeal to the social partners to accept this in the interests of the health of their members. It might hit them in their pockets in the short-term, but will lead to lives being saved in the long-term if there is a substantial reduction in smoking over the years.

Much discussion has taken place about BreastCheck which is being rolled out throughout the country. This is important for early detection. One matter that is not mentioned often and is important, especially in light of the fact that the majority of Members are males, is that we are always reluctant to talk about prostate cancer despite the fact that it is something that affects many families. It is not a topic people discuss. It is one of the silent issues. Men are reluctant to go to doctors and discuss these issues and, instead, put them off until a problem arises. It can happen that if one male in a family is hit with prostate cancer, it scares the others into getting checked out. I appeal to people to be more up-front on these issues in the way people are in other countries and to go for testing early. They should not put it to the back of their minds but rather should deal with it now.

I acknowledge the tremendous investment in the health services in recent years. No one can deny it and I would not understand a person who would criticise the level of investment in this area. That said, further investment is required because we operate much higher health standards now than previously. The Minister acknowledged that more resources are needed for radiotherapy services and these must be extended.

There are two sides to the debate and one of the difficulties up to now is that, with politicians involved in health boards, the question of providing cancer services has been one of geography over and above patient care. In these issues geography is important because it is no good having a service 150 miles away as one cannot effectively avail of it. At the same time, it is important that patient care comes first in any such debate.

I know in the midland region that more than 80% of people who suffered from cancer had to travel to Dublin for treatment whereas we are now moving to the position where 80% of people will be treated in the midland region. That is the way it should be. It means fewer people will have to travel long distances for small amounts of treatment and is more satisfactory from a patient's point of view.

People must acknowledge that there has been substantial investment in this area, but more needs to be done as well. The party politics should be taken out of health because it is much too serious.

The Deputy should vote for the motion in that event.

I hope that people will concentrate more in future debates on the question of prevention rather than cure in terms of early checks for both males and females.

The Government is failing in that.

I also hope that, when it comes to the difficult debate on the tobacco legislation, the Opposition will support it fully in the interests of public health.

This is an important debate on a serious matter. Like Deputy Fleming, I would be disappointed to think that a political football would be made out of such a serious and important issue. I support the call for smoking bans—

It is called a tumour.

The Deputy should support the motion.

I will give the Deputy an opportunity to speak and will not interrupt him, so I would ask him to have some manners.

I support the calls made recently for smoking bans. They would go some way towards alleviating what has been identified as a contributory factor to lung cancer in particular.

The Minister of State will be very aware of the huge cost of drugs, especially in the area of cancer treatment. Can savings be made in this area? I know that this and previous Governments have not been slow to invest in our health services. The area of cancer research and treatment is one that costs the Department of Health and Children a great deal of money.

I wish to acknowledge and record the huge amount of work and invaluable service hospice units give patients and also the amount of work done by home care teams and organisations. They run a very caring and professional operation. Any family affected by cancer will acknowledge the role of these organisations. The occasion should not pass without acknowledging the role these people play.

There has been a great deal of controversy recently about the extension of radiotherapy units throughout the country. The south-east made a call and Waterford, in particular, feels aggrieved that such a unit has not been earmarked for Waterford Regional Hospital. While I support the call for a radiotherapy unit for the south-east as a representative from the area, I question whether Waterford is the ideal location for it. It is on the coast and, if one moves south of the city, one is into St. George's Channel. Perhaps a location like Kilkenny might be geographically better for the investment of a huge amount of money in one of these facilities.

I wonder why.

The Government has in recent years invested significant amounts of money in the health care area, especially in the cancer strategy. This was published in November 1996 and the strategy was set up with the aim of reorganising cancer treatment services and promoting a strong patient focus to ensure equality of access. It has met with considerable success in this regard. They have also identified the fact that resources should be devoted to screening and early detection. In that regard, I welcome the extension of breast screening to counties Carlow, Wexford, Waterford and south Tipperary. The establishment of the Ireland-Northern Ireland-NCI Cancer Consortium in October 1999 has been of great benefit. The expertise this group has drawn on has gone some way towards ensuring the early detection of cancer.

Like other speakers, I call on the males of our society who seem to be slow to have examinations, particularly to detect cancer. Females seem to be far more likely to have themselves examined. Investment and funding are not the answer to the problem. There needs to be education as well.

I would like to share my time with Deputies O'Shea and Penrose.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

I found it intriguing to listen to the two previous speakers, who suggested that health and politics should be separated. Deputy Nolan made this call and proceeded to make a strong argument to have a radiotherapy centre relocated to his constituency. Deputy Fleming benefits from the fact that a previous Minister for Health and Children was in his general geographic area. I suggest that the two Deputies should examine the role of the Minister for Health and Children, his relationship with his constituency and his record concerning the appointment of people to boards that were within his gift before they start lecturing us.

I warmly welcome this Private Members' motion by the Independent Deputies. It is supported by all the Opposition parties, including the Labour Party. In particular, I congratulate Deputy Cowley for his determination and dedication to this issue. I also commend Jane Bailey, who has been such a champion for good cancer care. The Labour Party supports this motion and the campaign surrounding it because it recognises that every family has been touched in some way by cancer. Cancer is a death sentence for some who contract it. For others it is a challenge to survive, overcome and battle against. Regardless of the outcome, every cancer patient needs the best care and treatment and the best possible chance for recovery that society can provide. It is regrettable that that is not what every cancer patient gets.

A debate on the issue is necessary on a number of grounds. It is an opportunity to acknowledge the work of the health professionals, which is generally of the highest possible standard, and to acknowledge the support groups like Europa Donna and the Irish Cancer Society, which are extraordinarily dedicated. However, it is also an opportunity to highlight the deficiencies in the service which cause undue hardship and delay in treatment.

The reality is grim for people who have to travel long journeys for radiotherapy that can take as little as ten minutes to receive. It is also grim for seriously ill public patients who wait months for treatment while private patients have speedy access to care. It is a reality that inspired hundreds of people to march on the streets of Dublin and thousands of people to march in Waterford in support of decent cancer care services.

We marched for three key demands: the extension of breast cancer screening to the half of the population that does not have it; proper oncology services; and radiotherapy services to be easily accessible for patients regardless of where they live. The Minister for Health and Children took pre-emptive action on the first demand and announced that BreastCheck would be extended to the rest of the country. Many people, including myself, welcome the news. However, it is important that we see the Minister's statement for what it is.

It was long scheduled.

It is essentially a restatement of his commitment to the extension of BreastCheck, and it has been stated many times in principle in the health strategy and parliamentary questions. He made a similar commitment in his speech last night. However, there is no specific timeframe and not one cent is allocated for the project. We know how much it will cost but we do not know where the money will come from. Furthermore, there will be no additional money this year because the Taoiseach has made it clear that there will be no Supplementary Estimate for this purpose. Unless he takes the money from the already committed budget for cancer services, the Minister for Health and Children does not have a budget for BreastCheck this year.

The women of Munster, Connacht and Ulster are no different from women on the east coast, yet it continues to be the case that their lives are being put at risk. More than 110,000 women have been screened already and there has been a 75% uptake where BreastCheck is currently in play. This is a tremendous vindication of the need for the service and an indication of the commitment and interest of women. However, one cannot provide a cancer screening service without money. We know that BreastCheck is of an excellent standard and it is certainly good value for money, but it does not run without funds. It is a question of whether the Government will produce the money swiftly to ensure that there is no delay.

It would take €27 million to extend BreastCheck nationally, half the price of a Government jet. In Munster, it would cost about €11 million to introduce it, roughly the same amount of money the Minister has spent commissioning reports and setting up commissions since 1997.

The Minister is committed and will deliver.

Had this money been spent when it should have been, 268 women would have been detected through BreastCheck in Munster alone. Each year in Ireland, more than 600 women die from breast cancer. According to the evidence, early detection could and would have saved the lives of up to 20% of them.

We will continue to press the Government on this issue. Since the general election, Government promises have been systematically broken. We were told there would be no cutbacks in health, that hospital waiting lists would end by the year 2004, that the ceiling for medical cards would be lifted and that the grave inequality within our health service would be addressed. None of these promises was kept. Instead, hospital beds are being closed, services to cancer and renal patients are being curtailed and community services, including services as diverse as psychological services and home help provision, are being slashed. The needs of people with disabilities in their special year are being brushed aside as there is no budget or new places.

Why are we selecting the issue of cancer? We are doing so because it is so widespread and because so much can be done to help people survive cancer that is not being done. I welcome the appointment of new hospital consultants. Their appointment shows that a targeted strategy can bring about benefits. I remind the Minister that this strategy was initiated by Michael Noonan when he was Minister for Health. Its success contrasts starkly with the failure of the Minister for Health and Children to spend other moneys within his budget either wisely or well. There is a lot more to do.

There are questions to be asked of the Minister even in respect of current legislative provisions. The Public Health (Tobacco) Act 2002 provided for greater controls on the sale of cigarettes, yet there is little evidence of any of the measures being applied. Cigarettes are still displayed prominently as ever in shops and we are now hearing rumbles within Fianna Fáil against the Minister's long-promised commitment to ban smoking in pubs and restaurants. I, and other Members of the House no doubt, are inundated by pleas from interested groups and individuals who have simply lost faith in the Minister. We are anxiously pressing home the message that these measures are a vital part of the battle against cancer and that they must not be watered down. The Labour Party will continue to support these measures even as the Minister's own backbenchers conspire to undermine his ambitions.

That is not true.

We all know what is going on and there is no point in the Minister of State, Deputy Callely, arguing his case. It is important that we set down certain markers for the future. Three major reports have been withheld as a result of an ongoing internecine war between the Minister for Health and Children and the Minister for Finance over the future of our health service. One report was commissioned by the Minister for Finance and the other two by the Minister for Health and Children. I am sure Deputy McGuinness, in his paranoia, notes that the Brennan commission is headed by the wife of the Minister for Justice, Equality and Law Reform, Deputy McDowell. Not one health professional working at the coalface is represented on or participating in that commission.

When we get a right-wing agenda emerging not just from the Progressive Democrats but, in particular, from the Minister for Finance, there are many causes of concern and worry. We already see what the cutbacks are doing in terms of patient care. We can see that people suffering conditions like cancer are being forced to wait because the capacity in the hospitals is being reduced in order to meet the requirements of the cut backs that the Government has set, despite the great promises that were made to the Irish electorate.

The people will not forget this. The people will not forget the fact that at the last general election Fianna Fáil went out and told them stories and fabrications that at the end of the day were nothing more than promises that could be set aside, thrown aside and put away once the election was won.

That is not true.

Ba mhaith liom an Grúpa Teicniúil a mholadh leis an rún tábhachtach seo ar chúrsaí leighis do dhaoine ara bhfuil ailse a chur os comhair na Dála. Tugaim mo lán-thacaíocht don rún.

I raised the matter of the urgent need for a radiotherapy unit at Waterford Regional Hospital on the Adjournment on Tuesday, 11 February. The previous Saturday there had been a report in The Irish Times indicating that the expert group on the future of radiotherapy services would recommend that service would only be provided in Dublin, Cork and Galway.

Last weekend The Sunday Tribune carried a report which clearly stated that the newspaper had seen the expert group report. It went on to state that the report rejects the development of new radiotherapy services at Waterford and Limerick. It appears that the newspapers know the contents of the expert group report before the Minister does. In reply to the Adjournment debate in February, the Minister of State, Deputy Callely, stated, “I understand that the work of the expert review group is nearing completion and will be submitted to the Minister for Health and Children shortly.” In his script last night, the Minister for Health and Children made no reference as to when the expert group report is to be submitted to him.

However, he criticised the Opposition for engaging in opportunism even before they have had an opportunity to examine the report, see the essential principles that underpin its work and appreciate and reflect on the extensive benchmarking they have no doubt undertaken in relation to the provision of radiotherapy services in other countries. This statement by the Minister must take the accolade for this Dáil term in regard to brass neck. He is referring to a report which has taken longer to complete than the Old Testament. The Minister has been promising its imminent completion for well over two years. The Minister is asking the Opposition to suspend judgment until it has the report. Does this mean that the Minister intends to publish the report and allow for a full public debate before he goes to Government with recommendations which in all probability will be rejected by the Minister for Finance?

The stalling of this report has been an utter disgrace. It is causing anger and frustration, not least in Waterford and the south-east region. It is causing great upset and sewing the seeds of despair. With regard to the south-east, if the expert group recommends a radiotherapy unit for Waterford the job then begins to press the Government for early delivery. If, as all the leaks indicate, the expert group recommends against a radiotherapy unit then the campaign in the south-east must employ other ways of reaching an early successful conclusion.

If, as The Sunday Tribune stated last week, the expert group reveals that the south-east region will have a population to justify the development of a four-machine unit within a decade or so, then now is the time to develop a unit rather than reacting to a much bigger crisis down the line. Waterford Regional Hospital already has chemotherapy and surgery available for the treatment of cancer. The Labour Party, in its election manifesto in 2002, proposed regional cancer centres, with the first in Waterford, and support services in large towns. The basic rationale was that the appropriate combination of treatment would be available to all patients close to home.

I have raised in this House on previous occasions the fact that due to the lack of radiotherapy facilities at Waterford Regional Hospital, some breast cancer patients have opted for mastectomies. The same is true of at least one other health board area. It is absolutely unacceptable in any civilised society that women opt for mastectomies rather than spending long periods away from home receiving radiotherapy treatment in Dublin or Cork.

Some 75% of breast cancer patients should receive radiotherapy but in the south-east only 48% received it. The latest figure which I have for new cancer patients in the south-east region is approximately 1,000, with 400 to 500 of these patients requiring radiotherapy services. Radiotherapy treatment is generally administered for short daily periods over a number of weeks. Treatment can be accessed by travel to and from the centre on a daily basis. This is a greater or lesser ordeal depending on distance. If the distance is too far then patients must stay in or near the centre. This is of course always contingent on places being available.

Having to stay away from home is cruel and inhumane at a time when patients are at their most vulnerable and need their families and friends around them. I call upon the Minister to publish the expert group report and let the people discuss it and pass on their conclusions to him and his Department.

I compliment the Technical Group on bringing forward this motion and Deputy Cowley for pursuing it so vigorously. The national health strategy developed by the Government in 2001 promised us, "A health system that is there when you need it, that is fair, and that you can trust, a health system that encourages you to have your say, listens to you and ensures that your views are taken into account." People in Westmeath have come to take such commitments by the Fianna Fáil/PD coalition Government with a large dose of salt.

The deplorable story of Mullingar General Hospital highlights the reality that the national health strategy's aspirations were never intended to be fulfilled. In 1998, phase 2A of the Mullingar Hospital was completed and commissioned with a new accident and emergency unit, an X-ray unit, an out-patient department and so on. The building also included a new five-storey block which, it was planned, would be fitted out to provide badly-needed extra beds and other facilities for this very busy hospital.

Five years on there has been no action on this unused space. Overcrowding at the hospital can at times be severe and during winter months there are tremendous demands upon patients, doctors, nurses, attendants and everybody else. All we have got from the Minister is answers that obfuscate. Ask him for a timescale and one gets what I call departmental bromides purporting to be a ministerial response. The Minister should tell us when the money is coming, when the job is starting and how long it will take – three simple answers to three simple questions – rather than giving us obfuscation. I know what obfuscation is when I see it.

The arrogant response of the Minister for Health and Children is in keeping with his stance on the development of hospital services in general and of radiotherapy services in particular. The vital importance of appropriate cancer treatment in Ireland is readily put in perspective by reference to a few established facts about cancer experience in our country. Nearly one quarter of all deaths in Ireland in 1999 were caused by cancer; Ireland has consistently had, since 1980, a much higher death rate from cancer than the EU average; and the rate of cancer deaths has been increasing steadily since 1950, when it was only 11 % of total deaths, and there is no evidence that this will change in the future.

In such a context it is essential that our health care services for cancer patients especially be patient centred. The diagnosis that a member of a family has cancer is a great shock for both the patients concerned and for their families. Treatment can often be lengthy with unpleasant side effects and may involve surgery, radiotherapy and chemotherapy. People going through such a stressful experience need as much help as we can give them.

When ill and needing treatment we all prefer to be treated as close to home as possible. This preference becomes an absolute necessity where cancer is concerned. Family support and a familiar environment can be vital factors in the recovery of cancer patients. For example, if a cancer patient needs radiotherapy treatment, the treatment may only take five minutes per day but may have to be repeated every day for a month, leaving patients feeling exhausted. Given the unpleasant side effects frequently associated with cancer treatment, long travel times to and from treatment will exacerbate a patient's distress and may delay recovery or, worse still, result in the patient abandoning the treatment.

I have said that our health care services must be patient centred. What does this mean or imply where cancer treatment is concerned? It means in the first instance that patients, current or former, must be involved in the decision processes when treatment facilities are being debated and decided. The National Cancer Forum, which advises the Minister for Health and Children on cancer services at present, includes a selection from the great and the good of cancer treatment professionals and some public servants but does not include, as it should, a significant number of lay persons with experience both directly or in their family of cancer. The national health strategy, in promising, "a health system that encourages you to have your say, listens to you, and ensures that your views are taken into account", was in fact taking the correct approach. What a pity that this approach was taken by a cynical Government which did not intend to deliver on this and other commitments.

Much of the public discussion to date on cancer treatment has focused on how many centres should provide treatment. The medical profession involved in cancer specialties seems to favour fewer and larger treatment centres despite patients' needs for easy hospital access. The report on breast cancer services by the sub-committee chaired by Professor O'Higgins suggests that patients' need for easy access can be addressed by subsidising their travel, by laying on an organised transport service or by using support groups to provide voluntary arrangements. This smacks of a "let them eat cake" approach and is an unacceptable solution to the distressing predicament of cancer patients and their families. The case being advanced for larger and fewer hospitals and specialist units is not patient centred but is arguably centred on hospitals as power centres. There is no economic evidence that larger hospitals or specialist units are more cost effective than smaller ones. There is no incontrovertible clinical evidence, adequately adjusted for case mix, that large hospitals and units always lead to better patient outcomes.

Whatever the technical, clinical and economic arguments, the approach which must be adopted is to put patients' needs first and develop policy around those needs. For example, rather than make traumatised cancer patients travel a distance for their treatment, let us provide more regional treatment facilities, as Deputy O'Shea said, and support these with travelling doctors, if necessary, and with tele-medicine, where appropriate. This area needs resources and instead of giving tax cuts to the rich, let us put the money where it is needed and look after people who require these services.

I wish to share my time with Deputies Ferris, Sargent and Boyle.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

I commend the Technical Group, particularly Deputy Cowley, on introducing this motion. I am sure every Member of this House has experienced the pain and trauma associated with cancer and the turmoil it causes to a family and, indeed, to a community when word goes out that somebody has cancer. Fear and terror are probably the emotions most to the fore at such times.

Imagine then the additional worry and concern of cancer victims when they discover that there are very poor facilities available to treat them. It is bad enough if one lives in Dublin, although hard luck if one arrives at St. Luke's Hospital, the only specialist cancer hospital in the State, to find that one cannot be treated with radiotherapy because of the €1 million cut in the hospital's budget this year. There is a €1 million cut when it should be getting millions in budgetary increases. If one is from outside Dublin, especially if one lives along the western seaboard, then one's goose is truly cooked.

When we debate this issue, it is difficult to imagine the trauma and pain without looking at some cases. I noted Deputy Cowley spoke about a particular individual. I had a very good friend, Alan Mullen, who was diagnosed with cancer and given one month to live. When he went to Beaumont Hospital for chemotherapy, not only was there not a stand on which to hang the chemotherapy medicine bag – he had to place it on a window sill above his head in an overcrowded room with other chemotherapy patients – he had to bring his own cushion with him because when he sat on the hard plastic seats, the pressure of his weight on his bones hurt him. That is the reality for patients in this traumatic situation and the level of treatment which these people who are dying receive. Unfortunately, he died three months later. The treatment he received at the hands of the medical services left little with which he could be impressed.

I acknowledge the 70 oncology appointments the Minister has made which, although welcome, are not nearly enough. I readily accept that other Members represent constituencies which are far worse off in terms of facilities or, at least, in terms of distance from facilities than the one I represent but none represents constituencies with cancer rates higher than County Louth. I heard a Deputy from the Government benches state that everybody thinks their area is the worst and has the highest cancer figures which I have no doubt is probably true but, unfortunately, my county is in the dreadful position of having statistical support for that claim. The National Cancer Registry figures for 1999 yet again verify that Louth cancer rates are increasing and continue to be 12% to 13% above the national average. In case people wonder why that is, I will outline the reason.

Our people are being poisoned by the nuclear reprocessing plant in Cumbria and this Government is doing little or nothing about it. According to the Radiological Protection Institute of Ireland, radiation levels on the County Louth coast are 150 times higher than those on the west coast. This Government and successive Governments have been quite literally criminally negligent in allowing the THORP plant to be com missioned when they could have brought a court case to Europe to prevent it. That job was left to four individuals in County Louth who are doing that job for the Government and who are pursuing it for its neglect in this instance.

People in Louth who live with the current unacceptable cancer rates in the county despair that they are now faced with an incinerator that will, undoubtedly, pose a serious health risk to at least 100,000 people living in Drogheda, which is now the biggest town in Ireland, and in the Balbriggan, north Dublin and County Meath areas. These incinerators continually release cancer-causing dioxins into the atmosphere.

The fight against cancer is a multi-billion euro industry and when one sees money like that, one can be sure there will be vipers in the wings. Sure enough, the pharmaceutical industry is hoovering up those millions of euro. I am not convinced the pharmaceutical industry is playing the part it should in trying to find a solution to the cancer plague affecting so many of our people.

The National Cancer Registry's figures are running four years in arrears. The most up to date figures, which are due to be published in June, only bring us as far as 1999 – so much for having an up to date picture of the cancer endemic in this country.

In supporting this motion and the fact it has drawn attention to issues which are relevant throughout the State, I would like to focus on some which are specific to my own county of Kerry. In 2001, the Irish Cancer Society report referred to Kerry as one of the worst affected parts of the country with nearly 900 people being diagnosed with the disease each year. Yet the county also experiences serious difficulties in regard to access to services. At present there are fears that even the current level of services may be under grave threat given the financial constraints under which the Department is operating.

Many of my constituents are concerned that in this environment, the cancer treatment services in Tralee General Hospital may come under threat if the hospital is forced to make more cutbacks. The Minister assured me in reply to a question I tabled recently that the national task force on medical staffing will make no specific recommendation regarding cuts to Tralee. I welcome that assurance yet last week there was an announcement that Tralee would lose 30 beds for the summer months as well as curtailing elective surgery and out-patient services. What guarantees are there that these services will be restored? I am not doubting the Minister's word on the specific matter of the report of the task force but it proves hospitals are under immense pressure and that while cuts may not be part of the policy or the strategic objectives, they may be forced on the hospitals due to lack of funds.

It is in this context that many people, including members of staff, are worried that cancer services at Tralee may also come under threat. There are also concerns about the future of the oncology unit which was established in 1999 and which is now operating at full capacity. There have been assurances that the services will not be affected but will the increase on demand be met if funding is not available?

At present Tralee shares a palliative care consultant with Bantry General Hospital and Marymount Hospice in Cork. Support staff were to be put in place from January 2003. A needs assessment report will be presented to the Southern Health Board tomorrow. The Kerry Hospice has offered to match funds to ensure that the necessary dedicated beds and services are made available, so people will be watching intently to see whether the health board is able to provide its share of the funding.

I appreciate that the health board is under considerable pressure and, at times, is forced to make difficult decisions when the ultimate responsibility lies with central Government and its failure to provide adequate funding. A good example of this is that in September 2002, the Southern Health Board approved the appointment of an additional surgeon with special expertise in treating breast cancer. It called on the Minister to approve it and make the funding available last January but this has not yet happened. There is a temporary third surgeon, but this is not the post recommended by the board. The post is being paid for with money from the waiting list initiative.

The same question arises regarding the BreastCheck programme, which is generally regarded asa significant asset in the fight against cancer in women. People in Kerry have been demanding that the service be extended to the county, but to no avail, so far. An expansion of the programme has been promised for 2005, but what confidence can we have that this will take place if, as appears to be the case, the current climate of fiscal rectitude continues?

I would also like to raise the concerns that people have regarding cervical smear tests. The present arrangement, whereby samples are sent to a laboratory in County Antrim, has proven to be a significant help. It has served to cut back significantly the amount of time that people are forced to spend on waiting lists. It is a poor substitute for a national screening programme with access to all the necessary facilities, however. It is a good example of the ad hoc manner in which too many of our services are forced to operate, given the current resource constraints.

Another issue which requires urgent attention is the need to update and increase radiotherapy services. An expert working group, which was established in 2000 to examine the area, has yet to publish its report. It is essential that this work be completed to evaluate properly the current situation, to plan for the future and to ensure that a significant number of those who are recommended for radiotherapy can access such treatment. St. Luke's Hospital in Dublin, which is a leading radiotherapy centre, is encountering increasing pressure to meet the demand for services. What is being done to address this situation in terms of new investment and the recruitment of trained staff? The deficiencies in the latter respects are highlighted by the fact that the new unit at University College Hospital, Galway, which will be ready for occupation at the end of the summer, will not be able to operate for another three years due to a lack of staff. This scandalous situation not only highlights the lack of funding, but also the lack of foresight and planning in the Department.

Ba mhaith liom buíochas a gabháil leis an Teachta Ferris as ucht a chuid ama a roinnt liom. I thank Deputy Cowley and my Independent colleagues in the Technical Group for bringing forward this motion on cancer care services, which the Green Party wholeheartedly supports. It is vital that the cancer epidemic – it is right to call it an epidemic – in this country should be taken seriously by the Government. Many families, including my own, are not unaffected by cancer. It is important in this debate that we direct our attention at those areas where needs are not being met and not being highlighted.

The Minister and his colleagues have claimed that significant amounts of money are being spent. While this is true, it is also true that significant amounts of money are needed. Members of the Government parties have acknowledged that more money should be provided, as the rate of cancer is increasing at an alarming rate. Money needs to be spent in a number of areas where it is badly needed, including research. The effects of electromagnetic radiation and various other dietary matters need to be investigated. There is no doubt that funding is necessary for prevention. Investment in the BreastCheck programme, which has been mentioned by many speakers, is badly needed to prevent the worst excesses of breast cancer and other cancers. There is also a need, as Deputy Cowley and others have mentioned, to invest in further treatment. The hospice movement also needs to be supported. I have helped to raise funds for St. Francis's Hospice in Raheny on many occasions. It seems that a great deal of fund-raising is ongoing to help the provision of cancer services.

While a number of Deputies have spoken about BreastCheck, I wish to speak about prostate cancer, something that has not been mentioned to such a great extent. There is no "ProstateCheck", as such, but I think it is needed. Deputies who read the magazine with The Sunday Times last Sunday will have learned that 90% of men in the United Kingdom do not know what the prostate is, never mind what it does. One third of British men will have developed prostate cancer by the age of 50. Such figures alarmed me when I read them. Figures relating to Ireland, which I found on the Internet, show that the rate of prostate cancer in this country is higher than in Britain, Northern Ireland or the EU average. There is no doubt that there is a clear need for mass screening to save the lives of those who are threatened by prostate cancer.

The famous digital rectal examination method of detecting prostate cancer is regularly referred to and may sound impressive, if that is the right word, but it is certainly not very effective. When one reads documentation relating to this area, one discovers that a prostate-specific antigen test can be taken using blood samples. This is a real example of a question of cost, however, as the cost of the DRE test is the same as the cost of a rubber glove, whereas the cost of the PSA test is £181 in the UK. There is no doubt that money counts in this regard. Those on the Government benches who say that it is not a matter of money, but a matter of awareness, are being quite flippant about it. Money is quite critical in the detection, or otherwise, of cancer at an early stage. Approximately 1,130 men develop prostate cancer in Ireland each year. It accounts for about 11% of all cancers affecting males and is the most prevalent cancer, other than skin cancer, according to the figures I saw on the Internet today. About 500 men die as a result of prostate cancer each year. It is worrying that a growing number of younger men are developing prostate cancer.

I appreciate the work of the national cancer registry, as a result of which we can acquire the figures I have mentioned. Although the registry has been operating for just seven years, its figures have helped us to become aware that there is an increased incidence of cancer. It may be that the increase has been caused by Sellafield, pesticides or dietary changes. The concerns mentioned by Deputy Morgan regarding County Louth are shared in north Dublin. The proposed incinerator near Duleek is a further concern in that regard. The Government must recognise, ultimately, that this is not just a case of treatment and research, because a level of awareness that does not exist at present is needed. I ask the Government to provide the funding that is needed to fight prostate cancer and breast cancer. Awareness among men of the problems of prostate cancer needs to be increased to the level that exists, rightly, among women in the case of breast cancer and other cancers.

During the debate on this motion, my colleague, Deputy Gormley, pointed out that there is a growing incidence of cancer worldwide. In particular, he mentioned the difficulties of the Government and the Minister, who are running to stand still as a result of the extent and the nature of this problem. The Minister chose to misrepresent much of what my colleague said in his contribution. In pointing out the nature of the problems caused by cancer, he was not ignoring the central argument of this motion, that the distribution of resources determines whether people receive proper cancer treatment in this country. We know that lifestyle, environment and genetic disposition are factors, but the geographical location and economic status are the biggest factors in determining whether an Irish person will survive an incidence of cancer.

They are not the biggest factors.

I will cite an example in my family, which shows how early diagnosis and treatment can successfully treat cancer and stave it off for 20 years. I am convinced that this success resulted from the fact that the person involved had access to private medical insurance. I say that as someone who has chosen not to invest in private medical insurance, despite the fact that all other members of my family have taken that route. Perhaps I will change my mind about this matter when I look back on it in later years. I have a personal sense of discomfort that a health system has to be backed up by people buying insurance for services that the State should adequately provide. This is at the heart of the proposed motion.

The situation in Cork, where the Minister and I come from, needs to be recognised. Other speakers have talked about the national cancer registry figures for Counties Dublin and Louth. County Cork is also in that category of being above the national average. While there might be anecdotal evidence as to the reasons for the high incidence of cancer on the east coast, there has been no attempt to survey why cancer exists—

Deputy, your time is concluded.

On a point of order, we have heard about Kerry, Louth and Cork – by the time the debate is over there will not be a county that does not have the highest incidence of cancer.

May I briefly register that I was meant to have five minutes?

No, Deputy, because you are using up the Minister's time. He has already lost one minute.

May I just briefly finish my central point?

I would prefer if you would not because it is now 8.11 p.m.

It is the last point I want to make and it would help inform the Minister.

Sorry, Deputy, I do not think it is fair. The Minister has already lost one minute and a half at this stage. He has only three and a half minutes.

I only started speaking at 8.08 p.m.

If you wish to challenge the time you will have to find another way of doing it. I have two clocks and they show that the Deputy is now 57 seconds over the time allotted to the slot.

I have not used the five minutes allocated to me.

That is a matter for the group. There was a 20 minute slot and 21 minutes have been used.

The burden of the Opposition speakers' contributions to this debate have been that the Government has in some way failed to implement the national cancer strategy. The Minister for Health and Children gave an excellent account of himself last night and I do not need to repeat what he said. The key goal of the strategy in 1996 was to achieve a 15% decrease in mortality from cancer in the under-65 age group in the ten year period from 1994. As the Minister advised the House last night, this figure was achieved in 2001, three years ahead of target.

That was before he came into office.

I accept that the aetiology of cancer is a very complex subject and we can all give many opinions on it but that is what happened.

I wish to address the question of prevention. I welcome Deputy Gormley's contribution last night and many other speakers who welcomed the fact that we must concentrate on preventive measures. The Minister has demonstrated his commitment with the establishment on a statutory basis of the Office of Tobacco Control. The Minister today launched the second national survey of lifestyle, attitudes and nutrition called SLÁN. This survey has highlighted positive trends. One of the key pertinent findings was the decline in the number of Irish persons currently smoking. At the time of the last survey, 31% of the population engaged in cigarette smoking and it is now reported to be down by 4% to 27%. The rates of cigarette smoking have declined across virtually every demographic category. The statistics are in the report and in the statement I have circulated to Members. It is very important to build on this momentum by banning the use of cigarettes in licensed premises and other places of entertainment. That is vital if we are to give further critical mass to this issue.

The future development of radiotherapy services—

Will Deputy Davern support that ban?

Please allow the Minister of State, Deputy Healy.

I am speaking for the Government.

There was a report in the local newspapers that he was opposing it.

We would appreciate the Deputy's support on the issue. He might give it to us for once.

That is no problem.

I thank the Deputy and I appreciate his offer. During the debate in the Seanad this afternoon and in this House, the development of radiotherapy services was a particular and understandable focus of debate. There is general agreement on all sides that our radiotherapy services need to be expanded to meet current and future demand. We await the imminent report with great interest. We must be informed by the expert analysis, the international benchmarking and the recommendations of the expert report. We are coming from a very low base. I can appreciate why Deputies say it is terrible for any patient from rural Ireland to have to travel to Dublin for treatment. However, we cannot establish this service in every provincial location; it will not be the solution recommended to us by the experts. The patient must come first and ahead of any local sectional medical interest or local medical establishment. We have to provide a top class service in provincial areas. Northern Ireland has only one radiotherapy service.

I wish to share my time with Deputies Twomey, Harkin and Cowley. I speak in support of the motion and specifically to address the issue of the radiotherapy unit in Galway. I wholeheartedly welcome the fact that the radiotherapy unit is being provided in Galway as referred to in the Minister's speech last night.

I note with alarm that the Minister made no reference to the section of the motion stating:

"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."

That has come about because the Western Health Board requested approval from the Department of Health and Children in 2001 to commence the recruitment of staff for the radiotherapy unit and that approval was refused. We are three years from 2006. The unit will be completed in July or August this year. Millions of euro of taxpayers' money has been invested in a building which will become a white elephant until 2006. I invite the Minister to clarify this unacceptable situation. Will the Minister confirm the date of completion of the unit, the planned opening date, whether the relevant staff have been recruited and when the first patients will be treated in the unit?

I ask the Minister to set out clearly the date for the commencement of the BreastCheck programme in the west. Last night the Minister again announced the roll-out of BreastCheck but he gave no commencement date.

Will the Minister of State answer those questions?

The Deputy has silenced me.

I thank the Minister for extending the Caredoc scheme to County Wexford. This is an important move for the future of primary care in our county. I also acknowledge the hope for the future of all Irish women now that BreastCheck has finally been extended nationwide. The Minister's commitment to reducing the risk of passive smoking to workers in the hospitality industry will be supported by those of us who would rather see people live healthy lives than successfully sue their employers in years to come for exposing them to the known health hazards of passive smoking. This would certainly form the basis of a class action if one was to be taken.

The Minister is far more likely to read negative remarks about the Public Health Act from his own backbenchers. The Minister can rest assured that despite all the manufactured crises we have seen in this Dáil, nobody will vote against him.

This motion is about the lack of cancer services because there is still a significant weakness in the provision of these services, despite what the Government has stated tonight. There has been progress but we have also seen substantial improvements in the design of cars over the last 30 years. Improvement in health care should be expected, not seen as some fantastic achievement.

Hear, hear.

There is an impression that we in the south-east are playing politics with the radiotherapy services. Indications are that the report believes that by 2010 we will have the population numbers to justify a radiotherapy unit. It would take the next seven years to establish this unit if we started today. There has been much talk about the multi-disciplinary approach. We have the surgeons, oncologists, palliative care team and haematologists available in the south-east. We have all that is needed to set up the multi-disciplinary approach. All we need is the radiotherapy unit. Even a commitment to set up a unit would be good enough for the people of the south-east at this stage. If the Minister believes in providing a comprehensive cancer service, he will be very supportive of this suggestion and not try to play it down with talk of case mix and population numbers. He should act in a proactive manner.

Last night the Minister challenged some of us on this side of the House by saying he would like to arrange a meeting with the expert review group. I would like to take up that opportunity. I ask him tonight to arrange this meeting with people from this side of the House, including some of the experts to whom I have spoken. I have not reached this conclusion on my own. I spoke to experts in the field who said there is enough of a case mix in the south-east to justify the unit. This is not something I pulled out of my head to make political capital, it is something we have discussed. I would be more than delighted to take up the Minister's offer to meet the expert review group. The only people who cannot bring themselves to give a fair chance to the people of the south-east is the Government. They are the only people who seem to say that we are asking for too much.

Last night the Minister implied that medical people like myself and Deputy Cowley are more interested in politics and geography than in the health services. It would be more appropriate for him to defend his policies than participating in this type of misrepresentation.

Deputies

Hear, hear.

Personalised attacks on the medical and surgical profession are becoming the hallmark of the media spin in the Department of Health and Children. Perhaps the Minister believes the spin himself because there was a very interesting sentence in his speech last night. He said that too often it is left to politicians to respond to pressure to pursue the organisation of services – reading between the lines, this means cutbacks – based on sectional interests and not on best practice. These are the same politicians who have problems reforming health boards or partake in this underhand method of reducing hospital services in the north-east. I have seen nothing proactive about politicians since I came into politics.

Some of my patients who travel to Dublin must take a train to Dublin and a bus to St. Luke's Hospital because they are denied hardship payments for taxis to and from the train station. These people suffer from tiredness, lack of energy, nausea and vomiting. These cancer victims must often go back to work sooner than they would like because the maximum disability payment is €130 per week. No one can survive on that money, particularly if they are trying to support a young family.

No matter what we have heard tonight, there is apartheid in the health services. There is apartheid between urban areas and the regions and between those who are well off and those who are not. I do not care what people say about taking politics out of cancer treatment; if we leave things as they are people will die at an unmerciful rate. We must acknowledge that there is a huge problem in this area and I would like to have heard more proactive comments from the backbenches than I heard earlier on. No doubt some of these backbenchers will go back home to their constituencies playing the game that everything is fine.

I would like to make a few brief points in the short time allocated to me. Last night the Minister described the motion as an "all kinds of everything" motion but, of course, this is a well known ploy. The deliberate use of words or phrases to downgrade or dismiss the motion allowed the Minister to try to excuse himself from addressing the very substantive and serious issues raised in what I consider to be a very carefully considered and well thought-out motion. However, we cannot allow that to happen because, in the final analysis, the buck stops with the Minister. He has the full and final responsibility for delivering our cancer care services. As this motion clearly illustrates, the service falls well short of what it should be. The reality of cancer care in Ireland is that we are one of the richest countries in Europe, yet we have one of the worst outcomes for cancer patients. While the Minister has made some progress, it is too little, too late, for too many people.

In his reply last night he admitted that there is scope for some improvement in our mortality rates in line with other EU countries. That sounds like something one would see in a school report – there is scope for improvement; must do better – C minus. As one of the wealthiest countries in Europe, we should be achieving an A grade.

The Minister also said last night that the number of new patients receiving radiotherapy treatment had increased by 58%. However, as he said this evening, we were starting from a very low base. Even with that increase, we are still way behind the numbers that need to access radiotherapy. In Ireland approximately one in five patients accesses radiotherapy. The Minister referred a number of times last night to best practice at international level, yet international figures suggest that one in two will benefit from radiotherapy. This means that many cancer patients who need radiotherapy will not get it. Telling these people about a 58% increase is of little use. Telling people in the west and north-west who suffer from cancer that the radiotherapy service due to be finished in Galway this summer will not open until 2006 is not good news. If he really wants to allay the fears of women in the west, north-west and other regions about the BreastCheck service, will he please tell them now when the service will be in place, how much it will cost and when it will be funded?

The Minister accused those of us who support the motion of wanting to please everyone politically and forgetting about quality patient survival rates and outcomes. In other words, he accused us of making this a political football and of having no concern for patients. That statement is unacceptable from the Minister, but it indicates a trend. Just one week ago, when the Minister for Education and Science was responding to the motion on cutbacks in expenditure in the school building programme, he also said the motion was politically motivated. The theme seems to be that when one has to answer difficult questions and account for one's stewardship as a Minister, one should just accuse the Opposition of political opportunism. That does not let the Minister off the hook because, as I said earlier, he has the responsibility to deliver cancer care services. This motion points out that many of the services are inadequate and all we are asking is for him to deliver proper services.

Deputies

Hear, hear.

This motion is about people, not politics. To say otherwise is a terrible insult to the people who proposed it. I thank my Independent colleagues, the Technical Group and the other Opposition parties for their support and co-operation. If things were right, the Government would also support the motion.

I was intrigued to hear someone say the Minister acquitted himself well last night. I do not agree. He spoke about all the investment in cancer care. As evidence of this he quoted the significant increase in the numbers of new patients per annum receiving radiotherapy. He quoted an increase from 2,402 in 1994 to 3,809 in 2000 but he did not have the figures for 2001 or 2002. He said we should not worry about that because it will be okay. It is not okay because at least 7,000 new cancer patients each year need radiotherapy. It is absolutely unacceptable for the Minister to cite the wonderful increase in figures. He spoke about the oncologists who are being appointed, which I welcome. However, there is just one radiation oncologist for the whole south-east area and north Dublin, covering a population of 600,000. There are not sufficient oncology beds, nurses or other staff.

We have eight radiation oncologists for the entire country, Belfast alone has 12 and Holland has 157. Given that Holland has four times our population, we should have 40 such posts at that rate. Brilliant young radiation oncologists are being trained for export. They are going abroad because they cannot get jobs at home. People are dying as a result and the Minister should address this issue.

I welcome the Minister's statement that there is not proper access to radiotherapy, because it is a start at least. He is trying to defend the indefensible by trying to justify the current centralised service. As I pointed out last night, the National Cancer Registry showed no reduction in the mortality rate, that older people are not being treated for cancer and a large percentage of people are not getting cancer treatment at all.

Health apartheid exists throughout the country. Cancer care apartheid exists in Ballymun, Ballycroy, Tallaght and so on. One must wait for three months for treatment unless one has money. My patient died waiting for a letter in the post which never came. This is a disgrace for which the Minister is responsible. He speaks about multi-disciplinary units, with which I agree. Despite the money the Minister claims to have spent, these multi-disciplinary units do not exist. However, they should exist. He put money into breast cancer, with which I agree, but he should do the same for bowel and prostate cancer.

Cancer figures in Ireland will double in the next 20 years. Given the inadequate services which currently exist, how will we deal with a doubling of cancer statistics within 20 years? Unless the Minister provides a multi-annual programme for cancer care, we will not be at the races. We cannot cope currently and we will not be able to cope in the future unless the Minister takes action. The Minister allocated €23.5 million to the development of cancer services, to be divided among 11 health boards, while €160 million was allocated to sport. The Taoiseach is talking about spending €350 million to €500 million on Stadium Ireland. It is a total and utter disgrace.

The Minister has had the cheek to say that the debate has been about geography, not the quality of service. That is rubbish. There are models available. There is a model in Norway and there is one in Ireland in the Mater Private Hospital. The Minister says it is nonsense and political fodder to be talking about two machines in Waterford. There are already two machines in the Mater Private Hospital. The people of Waterford would love to have the service.

For less than half of the €200 million for the plan, the Minister could have all these things locally. He could save this money and get 50:50 cash back. The €400 million of cumulative costs is utter nonsense – it is a fabrication. Every surgeon that ever put a knife into anyone with cancer is included in that, as are the nurses and palliative carers.

No, it is additional.

Amendment put.

Ahern, Michael.Andrews, Barry.Ardagh, Seán.Aylward, Liam.Brady, Johnny.Brady, Martin.Brennan, Seamus.Browne, John.Callanan, Joe.Callely, Ivor.Carey, Pat.Carty, John.Cassidy, Donie.Cooper-Flynn, Beverley.Coughlan, Mary.Cregan, John.Cullen, Martin.Curran, John.de Valera, Síle.Dennehy, John.Devins, Jimmy.Ellis, John.Fahey, Frank.Fitzpatrick, Dermot.Fleming, Seán.Gallagher, Pat The Cope.Glennon, Jim.Grealish, Noel.Hanafin, Mary.Haughey, Seán.Jacob, Joe.Keaveney, Cecilia.Kelleher, Billy.Kelly, Peter.Killeen, Tony.

Kirk, Seamus.Kitt, Tom.Lenihan, Brian.Lenihan, Conor.McCreevy, Charlie.McDaid, James.McDowell, Michael.McEllistrim, Thomas.McGuinness, John.Martin, Micheál.Moloney, John.Moynihan, Donal.Moynihan, Michael.Mulcahy, Michael.Nolan, M.J..Ó Cuív, Éamon.Ó Fearghaíl, Seán.O'Connor, Charlie.O'Dea, Willie.O'Donoghue, John.O'Donovan, Denis.O'Keeffe, Batt.O'Keeffe, Ned.O'Malley, Fiona.O'Malley, Tim.Parlon, Tom.Power, Seán.Ryan, Eoin.Sexton, Mae.Smith, Brendan.Treacy, Noel.Wallace, Mary.Walsh, Joe.Wilkinson, Ollie.Woods, Michael.Wright, G.V..

Níl

Allen, Bernard.Boyle, Dan.Breen, James.Broughan, Thomas P.Bruton, Richard.Costello, Joe.Cowley, Jerry.Crawford, Seymour.Crowe, Seán.Cuffe, Ciarán.Deasy, John.Durkan, Bernard J.

English, Damien.Ferris, Martin.Fox, Mildred.Gogarty, Paul.Gormley, John.Gregory, Tony.Harkin, Marian.Hayes, Tom.Healy, Seamus.Higgins, Joe.Higgins, Michael D. Hogan, Phil.

Níl–continued

Howlin, Brendan.Kehoe, Paul.Kenny, Enda.McCormack, Padraic.McGrath, Finian.McGrath, Paul.McHugh, Paddy.McManus, Liz.Mitchell, Gay.Mitchell, Olivia.Morgan, Arthur.Moynihan-Cronin, Breeda.Murphy, Gerard.Naughten, Denis.Neville, Dan.Ó Caoláin, Caoimhghín.Ó Snodaigh, Aengus.O'Dowd, Fergus.

O'Keeffe, Jim.O'Shea, Brian.O'Sullivan, Jan.Penrose, Willie.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Ring, Michael.Ryan, Eamon.Ryan, Seán.Sargent, Trevor.Sherlock, Joe.Shortall, Róisín.Stagg, Emmet.Timmins, Billy.Twomey, Liam.Upton, Mary.Wall, Jack.

Tellers: Tá, Deputies Hanafin and Kelleher. Níl, Deputies Cowley and Gregory.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."

Ahern, Michael.Andrews, Barry.Ardagh, Seán.Aylward, Liam.Brady, Johnny.Brady, Martin.Brennan, Seamus.Browne, John.Callanan, Joe.Callely, Ivor.Carey, Pat.Carty, John.Cassidy, Donie.Cooper-Flynn, Beverley.Coughlan, Mary.Cregan, John.Cullen, Martin.Curran, John.de Valera, Síle.Dennehy, John.Devins, Jimmy.Ellis, John.Fahey, Frank.Fitzpatrick, Dermot.Fleming, Seán.Gallagher, Pat The Cope.Glennon, Jim.Grealish, Noel.Hanafin, Mary.Haughey, Seán.Jacob, Joe.Keaveney, Cecilia.Kelleher, Billy.Kelly, Peter.

Killeen, Tony.Kirk, Seamus.Kitt, Tom.Lenihan, Brian.Lenihan, Conor.McCreevy, Charlie.McDaid, James.McDowell, Michael.McEllistrim, Thomas.McGuinness, John.Martin, Micheál.Moloney, John.Moynihan, Donal.Moynihan, Michael.Mulcahy, Michael.Nolan, M. J.Ó Cuív, Éamon.Ó Fearghaíl, Seán.O'Connor, Charlie.O'Dea, Willie.O'Donoghue, John.O'Donovan, Denis.O'Keeffe, Batt.O'Malley, Fiona.O'Malley, Tim.Parlon, Tom.Ryan, Eoin.Sexton, Mae.Smith, Brendan.Treacy, Noel.Wallace, Mary.Walsh, Joe.Wilkinson, Ollie.Woods, Michael.Wright, G. V.

Níl

Allen, Bernard.Boyle, Dan.Breen, James.Broughan, Thomas P.Bruton, Richard.Costello, Joe.Cowley, Jerry.Crawford, Seymour.Crowe, Seán.Cuffe, Ciarán.

Deasy, John.Durkan, Bernard J.English, Damien.Ferris, Martin.Fox, Mildred.Gogarty, Paul.Gormley, John. Gregory, Tony.

Níl–continued

Harkin, Marian.Hayes, Tom.Healy, Seamus.Higgins, Joe.Higgins, Michael D.Hogan, Phil.Howlin, Brendan.Kehoe, Paul.Kenny, Enda.McCormack, Padraic.McGrath, Finian.McGrath, Paul.McHugh, Paddy.McManus, Liz.Mitchell, Gay.Mitchell, Olivia.Morgan, Arthur.Moynihan-Cronin, Breeda.Murphy, Gerard.Naughten, Denis.Neville, Dan.

Ó Caoláin, Caoimhghín.Ó Snodaigh, Aengus.O'Dowd, Fergus.O'Keeffe, Jim.O'Shea, Brian.O'Sullivan, Jan.Penrose, Willie.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Ring, Michael.Ryan, Eamon.Ryan, Seán.Sargent, Trevor.Sherlock, Joe.Shortall, Róisín.Stagg, Emmet.Timmins, Billy.Twomey, Liam.Upton, Mary.Wall, Jack.

Tellers: Tá, Deputies Hanafin and Kelleher; Níl, Deputies Cowley and Gregory.
Question declared carried.
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