Private Members’ Business.

Cancer Services: Motion.

Mr. J. Higgins

I move:

That Dáil Éireann,

conscious of the fact that 20,000 new cases of cancer are diagnosed in the State each year with 7,500 dying from the disease:—

calls on the Minister for Health and Children to make a clear and comprehensive statement on current services for cancer patients in this State and to clarify in detail the position on the implementation of the national plan for radiation oncology;

notes with alarm the recently highlighted situation of a Kilkenny mother, "Rosie", with an aggressive cancer of the colon, who, being a public patient, had to wait eight months for a colonoscopy with the most serious and tragic consequences for her health and life;

condemns the fact that after ten years in power the Fianna Fáil-Progressive Democrats Government has failed to put in place a comprehensive national cervical cancer screening programme, 11 years after this was announced, while the waiting time for test results can be six months;

further condemns the fact that a comprehensive national breast screening programme is not yet in place;

calls for:

vigorous programmes for cancer prevention including education of children in schools from a young age;

urgency and added resources to put in place a comprehensive programme for the earliest possible detection, and the best possible treatment of cancer;

the immediate extension of cervical and breast screening to all areas of the country;

appropriate national screening programmes for other cancers such as colorectal and prostate cancer;

the provision of 3,000 acute hospital beds that are urgently needed to ensure cancer sufferers are not prevented from immediate admission to hospital when necessary;

the scrapping of the Government bias toward privatisation of health care through fostering tax incentivised private hospitals in the grounds of public hospitals;

regional radiotherapy centres providing access for cancer patients throughout the island of Ireland and to meet the concerns of communities in the north west and south east at the failure to provide radiation therapy for public patients;

a review of the decision to close St. Luke's Hospital in Dublin in view of the testimony of former and current patients about its contribution to cancer care; and

a fully resourced public health service with immediate access to services by all, based on medical needs.

Ba mhaith liom mo chuid ama a roinnt leis na Teachtaí Catherine Murphy, James Breen, Finian McGrath, Connolly, Sargent, Boyle agus Ó Caoláin.

Acting Chairman (Mr. Kirk)

Is that agreed? Agreed.

Mr. J. Higgins

I commend the Independent Members of the Technical Group on putting forward this important and comprehensive motion on an issue that affects a broad cohort of people in the State. The motion points to the serious deficiencies in cancer services before constructively pointing to what must be done to redress them.

I commend the Kilkenny mother, who went by the name of Rosie, who explained to the nation some weeks ago how a two-tier health service can be literally deadly for human beings. The eight months she waited for a colonoscopy can make the difference between a much longer span of life or a much shortened one. It is absolutely inexcusable that in this State, probably the richest country in the European Union, patients depending exclusively on the public health service can find themselves in such a situation. It should never happenagain.

Cancer is a terrible tragedy. Each year, 20,000 families learn that a loved one has developed the disease. Some 7,500 people die from the disease every year, ranging from the elderly to the very young. It is inexcusable, therefore, that significant preventative measures are not in place. The comprehensive cervical cancer screening programme that was promised 11 years ago, for example, is still not in place. International experience shows that such a screening programme is hugely successful in detecting the early signs of a cancer that is usually curable. Moreover, I am aware of a constituent who, having taken a test, had to wait six months for the result. This is also inexcusable.

This motion does not cast any reflection on the medical staff in the health services. Between June and November last, I watched my brother Liam Higgins, at 61 years of age, progress from a healthy looking man to a shadow, when cancer of the oesophagus claimed his life. This is an experience endured by many thousands of families each year. The care my brother received from doctors, nurses, district nurses, hospice nurses and medical staff was exceptional. What we call for in this motion is a commitment to provide the resources necessary to ensure care is available whenever it is needed and, second, that nobody should have to wait one day longer than necessary to avail of that care.

Ms C. Murphy

I begin by acknowledging that many public patients receive first-class care. Many are eager to tell me of the professionalism and kindness they encounter. We must concentrate on those who are not lucky enough to be able to say that. What is required is a plan to provide equality of access.

A member of my immediate family had reason to test the quality of the public hospital system within the past 18 months when he was diagnosed with cancer and underwent surgery at Connolly Hospital and chemotherapy at Beaumont Hospital. While he now enjoys an optimistic outcome and was very satisfied with the care he received, it was impossible to ignore the difficult environment in which the staff who tended him, in Beaumont Hospital in particular, must operate while attempting to deliver a quality health care service.

Given that our population is growing and aging and that the incidence of cancer is set to increase significantly, it is difficult to reconcile the available services against what is needed in the future. It is even more difficult to reconcile the transfer, for example, of 20,000 cancer patients annually to St. James's Hospital from St. Luke's Hospital, which is due to occur by 2010 under the cancer care strategy. There is an existing problem inSt. James's Hospital that cannot simply be ignored.

While there are many strategies, plans and theories, the issue at point is what happens in practice. There is no point having a good strategy if the delivery does not match the intention. There may be good arguments for providing a total package of care, including surgery andfollow-on treatments, in one location. However, the holistic approach in treating patients in St. Luke's, including the subsidiary services paid for out of public donations, will be absent when that transfer occurs. There is genuine upset among patients at this prospect.

We all acknowledge the need to secure the best possible outcome for patients. The problem is that the difference between plans regarding services at St. James's Hospital and the stories shared courageously by people through such fora as "Liveline" is the difference between hype and reality. There is serious evidence of a significant difficulty with the service at this stage, let alone in the future when we will lose some capacity in the system.

It used to be the case that one used private health insurance to pay for a private room in a public hospital. That is no longer the case. The availability of health insurance did not result in improving the life chances of those lower socioeconomic groups who rely on the public health system. The survival rate is still better where patients can pay for their care.

Mr. J. Breen

Deputy Joe Higgins referred to the case of Rosie in Kilkenny. This is a tragic, disturbing and shameful case. After Rosie told her story on Joe Duffy's "Liveline", the Minister for Health and Children, Deputy Harney, stated on "Questions and Answers" that hers was a once-off case. Unfortunately, however, her situation is replicated throughout the State; I am aware of three similar cases. The Minister's comment is typical of the arrogance, insensitivity and ineptitude of the Government.

Every year there are national campaigns to reduce road deaths, and we recognise that they are required. It is only recently, however, that we have seen anything close to a cancer awareness programme. This is despite the fact that the number who die annually from cancer is greater than the combined figure for road fatalities, murders and manslaughters.

In 1992, the then Minister for Health set up a committee to review cervical cancer services. Fifteen years later, we still await a national roll-out of this programme. Instead of measuring the cost of delivering such a scheme, it is time to focus on how many lives will be saved as a result of an immediate roll-out. Early diagnosis is the most important factor in treating and curing cancer, yet the Government's plan to extend radiotherapy services is already two years behind schedule and will not be implemented until 2013 at the earliest.

Between 40 and 50 women die every year because of a lack of screening services for cervical cancer. Approximately 650 to 700 die annually from breast cancer. Like cervical cancer screening services, the BreastCheck facility is not a national service. We have all heard the announcements urging women to avail of the service if they are under the age of 65. How dare the Minister endorse this age limit when research abroad shows that at least two thirds of all breast cancer cases occur in women over 65. However, the Government precludes women over 65 from availing of the BreastCheck programme. I do not know why people accept this position.

Another significant factor in breast and colorectal cancer is obesity. Over the past ten years, since this Government has been in office, the rate of obesity in this country has doubled. We await the promised national diet and fitness programme specifically aimed at our children. Perhaps the penny will drop with the Minister that spending adequate money now on proper national screening and awareness and information programmes will reduce the cost of treatment in the longterm.

The announcement that St. Luke's Hospital in Dublin is to close brought about a concerted campaign to change that decision. St. Luke's Hospital should remain open and another hospital should open to alleviate the situation. I have received letters from all over the country in this regard which only proves the hardship people suffer having to travel to receive treatment. Last summer, a Clare man travelled to Dublin to get treatment for cancer. He met a man who had travelled from Donegal for treatment in the waiting room. Both of those men left Dublin and returned home without having received treatment because a scanner was not working. As I said, I do not understand why there has not been outrage and protest on a scale never seen before. No one should have to tolerate a fraction of what is happening in our health service.

We should not forget that the Minister sought out this position. She was going to sort out our crumbling health service once and for all. Instead of a crumbling health service, we now have a system that has been torn asunder. However, no one accepts responsibility for it because everything is a matter for the Health Service Executive under the Health Act 2004. The HSE is the most inept, malfunctioning and faceless organisation established by an equally inept and malfunctioning Minister.

Mr. F. McGrath

I thank the Acting Chairman for the opportunity to speak on this motion put forward by my colleagues, the Independent Deputies. Cancer care and cancer services is an important issue. It requires urgent debate and I commend my colleagues for putting it on the political and health agendas. We will put forward sensible proposals and solutions in this debate. It is not only a question of attacking the Government; it is about pointing out the reality for patients. The role of the Independent Deputies is to put forward policies and commend policies which work.

There is a crisis in regard to the sad illness of cancer. Some 7,500 people die each year as a result of cancer. This is a crisis. There can be no more debate about it. We must deal with the crisis. We all have family, friends and neighbours affected by cancer so we need the Government to wake up and take this reality seriously. However, we also need the Government to put the services in place and to get on with the job. When we put forward solutions, the Government should adopt them and get on with it.

I do not want us to have a row as in the case of the Mater site. An objective decision was made in regard to the Mater site and I say to the Minister to get on with building the children's hospital on that site. That is what the professionals and independent, objective people decided. The Minister should get on with it and stop wasting people's time. I also call on colleagues in all parties to stop wasting people's time.

I had the honour of being elected in Dublin North Central, the old constituency of the late Dr. Noel Browne. As the Minister knows, Dr. Noel Browne fought on the TB issue and really made an impact on society. We need to take a Noel Browne-type approach and to wake up to the reality that 7,500 people die from cancer each year. Thousands more people — friends and family — live with the disease, another reality we must accept. We need to take a Noel Browne-type approach to deal with this issue. We also need a community-driven, people centred response.

I commend the people working in the services, including the doctors, nurses and the consultants, many of whom do an excellent job although it might not be trendy to say so at present. We should engage in dialogue with the consultants and resolve the current problems.

We talk about putting forward sensible proposals. The Independent Deputies call for vigorous programmes for cancer prevention, including the education of children in schools from a young age. Additional resources and a comprehensive programme should be put in place for the earliest possible detection, and the best possible treatment, of cancer.

We need the immediate extension of cervical and breast screening to all areas of the country. We also need appropriate national screening programmes for other cancers, such as prostate cancer. Some 3,000 acute hospital beds are urgently needed to ensure cancer suffers are not prevented from immediate admission to hospital where necessary.

I support the motion which calls for the scrapping of the Government bias towards privatisation of health. Health should not be treated like a commodity or a business. Health care is a right. We pay our taxes each week and everybody is entitled to a quality public health service. When we talk about reforming the health services, the key words are "investment", "reform" and "more beds". I urge all Deputies to support the Independent Deputies' motion.

Mr. Connolly

I welcome the opportunity to speak in this timely debate which was most likely sparked by the situation in which Rosie in Kilkenny found herself. Many people dread hearing the word "cancer" and commonly refer to it as "the big C". It is associated with pain, suffering and much stress. If there is a suspicion at any time that somebody might be suffering from cancer, an early diagnosis should be facilitated. There is no reason people should not be sent for diagnosis as early as possible. The earlier one intervenes, the better the outcome. From a health perspective, it means better value for money. It is also good from the patient's perspective.

It is worth remembering that if we catch cancers in time, most of them can be successfully treated. It is important to remember that some types of cancer are preventable and people must take that on board. Skin cancer is quite common. We are well aware of the damage the depletion of the ozone layer can cause. There have been several warnings, yet some people persist in getting burned by the sun and do not worry about the consequences. It is possible they may develop skin cancer in later life.

Eating green vegetables and a good balanced diet also help to prevent cancer. We must accept some degree of personal responsibility for cancer. Cancers can be detected much earlier. There is the cervical screening programme, BreastCheck and a simple blood check which can indicate whether one has prostate cancer. People have a responsibility not to leave getting checked until they have symptoms. Even when some people have symptoms, they do not want to confront them. They hope they will go away and they do not want to receive a diagnosis. People have a responsibility to get an early diagnosis.

It is very hard to get older men, in particular, to go to the doctor for an annual checkup. However, when people reach certain milestones, there is an onus on them, particularly men who reach 50 years of age and women, to get regular checks.

Somebody mentioned the excellent treatment people receive in hospital. I regularly hear about the excellent care people who are terminally ill receive and the great praise they have for doctors and nurses. Most people with a terminal illness want to die at home, if at all possible. To some extent, we must re-examine the community supports available. For example, I came across a case recently where there was no hospice home care nurse available at weekends for a person who was very supportive of the services received in hospital. That is a major issue the HSE should take on board.

Mr. Sargent

Tá cúig nóiméad agamsa, agus cúig nóiméad ag mo chomhghleacaí, an Teachta Boyle.

Cuirim fáilte roimh an rún seo, agus molaim na Teachtaí Neamhspleácha as an rún a chur os comhair an Tí.

As Deputy Connolly mentioned, this issue has many dimensions. It involves the services, the way we view health and the prevention of illness. The record is not good from the Government's point of view, given that its preventative health budget is approximately 0.25% of the overall health budget, which is very low by international comparisons. As a result, we are dealing with crisis issues, given that many people have not only been living an unhealthy life but in many cases their conditions are not detected at an early stage and they are left in dire need of essential acute services, which often are not available. With the likely closure of St. Luke's Hospital and the increase in the provision of such services in St. James's Hospital being deferred until 2013, there is a sense of crisis due to the lack of services, the lack of Government direction and the lack of delivery in terms of future services.

Some six in 100 women die from cervical cancer per annum. It is a very treatable cancer if detected at an early stage but very aggressive if not. Therein lies an important failure by the Government. As there is not such a screening programme in place, it is incumbent on women to seek their own screening programme. The lack of a screening programme is unacceptable. Cervical screening is not a pleasant procedure. We must learn from other countries with such screening programmes in place which require women to have smear tests every two years once they become sexually active and every five years when in a stable relationship. This is basic preventative care, which is not in place here. The length of time it takes to get the result of a test, which can take six months in St. Luke's Hospital, can mean the difference between life and death for a person. These issues must be dealt with and put right.

We raised with the Taoiseach earlier today radiotherapy services in the North in the context of the Civic Forum and the need for standards to be matched North and South. We need to come up to the bar of the standards in this area in the North which are far higher than they are in the South. In the case of aggressive category one cancers, head and neck cancers, cervical cancer and others, services in place in the North provide for people in urgent need of care, multidisciplinary team meetings are held to provide four to five weeks of daily radiotherapy while in the South the service is not provided on bank holidays. The lower service here means the difference between life and death for people. In many cases people here are generally treated very shoddily.

If one attends a hospital in Limerick, one can be referred to the Mater in Dublin for radiotherapy treatment and it is not an easy task for the person concerned to travel from Limerick to Dublin especially on a daily basis. If one lives in Donegal, one is expected to travel to Belfast for such treatment. Once a person is classified as a Northern Ireland patient, one is not even on the radar of the Department of Health and Children. That skews the figures apart from the other difficulties of having to wait one's turn if one is from the Republic and not from Northern Ireland. Essentially, one has to wait in the queue behind people from Northern Ireland.

People in Donegal are crying out for radiotherapy services in Letterkenny. The Government has said that a critical mass of 400,000 is required, but other EU member states provide a critical mass of only 250,000 is required. If we were to apply standards that apply in other countries, we would have the services here, but that would require the Government to admit that it has a serious problem and deal with it.

As the Minister for Health and Children is present, I wish to advise her that I was asked by the Donegal Action for Cancer Care group if it could have an answer to its request for a meeting with her. It made that request at the end of the summer and it has not heard from her.

Ms Harney

I have met its representatives several times, as the Deputy will be aware.

Mr. Sargent

Perhaps there has been a difficulty in communications but the group is looking forward to a reply from the Minister, which is long overdue.

Mr. Boyle

I welcome this motion in the names of the Independent Deputies and the opportunity it affords us to discuss the standard of cancer services available and the need for an effective cancer strategy here. I also welcome the fact that the Minister for Health and Children is present for the debate, as far too often during Private Members' time members of the Government have chosen not to respond directly to many Opposition Private Members' motions.

As has been outlined, access to cancer services is very much a question of luck depending on the person involved. It is a game of geographic lotto. Where a person lives determines whether he or she will have a sufficiently early identification of a condition and whether he or she has direct access to the services that will assist in their treatment. Different standards of care apply in terms of access to palliative care for many citizens who have various cancers that are inoperable. This hotch potch approach to standards of care has caused a great deal of public concern.

The Government strategy in regard to breast cancer has been mentioned but it must be reiterated that until the BreastCheck screening programme is rolled out throughout the country none of us in this House can be satisfied with the multi-standard level of care afforded to women. I represent Cork South-Central. Prior to the last general election a promise was made that BreastCheck would be rolled out to the southern and western regions. It has been promised that BreastCheck will be up and running in Cork city by July of this year. I admit that some progress has been made. A site for the facility has been identified, cleared and work has commenced on the foundations. However, given that tomorrow is 1 February, I am less than optimistic that the deadline of July for the provision of service will be met. It will probably be available by the end of this year.

I am sure the Minister will indicate that a clinical director has been appointed but the process of employing radiographers to provide that service is still under way. As the Minister is probably only too well aware, one of the main problems with our health service is identifying professionals to fill such positions in sufficient time. The indication that there is a strongly likelihood that BreastCheck will be up and running in Cork in July or August this year, as still seems to be indicated by the Minister, the Government and BreastCheck, is not likely to hold true.

The wider cancer strategy needs to be more focused. We, as a society, do not have sufficient information about the genetic and environmental factors that cause many cancers. We know that something in Celtic genes makes us more predisposed towards certain types of cancers, but not enough questions are asked as often as they should be about the environmental factors involved, namely, the anecdotal evidence of the existence of clusters of incidents of cancers among people living on the same street or in small communities. Information is not being compiled that would allow us to answer why these cancer incidents are occurring.

The National Cancer Registry based in Cork does valuable work but its statistics are based on too wide a geographical basis. They might reveal the number of people in counties Cork or Dublin who have cancer but they do not give further detail. If we are to have faith in the quality of information on this area, information is required in electoral districts of the existence of cancers, the types of cancers and the number of people affected to enable us to pinpoint to the degree possible with the technology available the existence of clusters of cancers throughout the country. Without such information, a cancer strategy will always be ineffective.

I reiterate the point made by my party leader and colleague that the size of the preventative health care and health education budgets in the Department of Health and Children make it impossible to get the message across that much can be done on an individual basis and within communities to prevent to some extent the existence of the condition of cancer. If we were to invest sufficient resources in this area, we might be largely able to avoid trying to treat the problem at a later stage in terms of hospital and palliative care.

Caoimhghín Ó Caoláin

I begin my contribution with a Government health warning, namely, PD-Fianna Fáil ideology can seriously damage one's health.

It has been confirmed by none other than the Minister for Health and Children that the Government's ideological addiction to public private partnerships has delayed the delivery of life-saving cancer services in this State. Extra radiotherapy machines are being provided for St. James's Hospital and Beaumont Hospital outside the PPP model because the Minister has been obliged to accept they could not be delivered until 2012 were the PPP process to be used.

This has been exposed by the leaking earlier this month of the so-called confidential progress report on the delivery of the national plan — again so-called — for radiation oncology from the Health Service Executive to the Minister in July 2006. The Minister was quick to issue a response outlining her version of the progress made under the plan. The HSE was also forced to issue a response, which can only be described as laughable. It described the leaked report, which was prepared in July 2006, as "an historical one". It seems that on the unknown planet on which the HSE management lives, six months ago is ancient history. However, this is only true when its suits the argument. When the other point of view suits the HSE, six months or longer is an acceptable time for a patient such as Rosie from Kilkenny, who appeared on "Liveline", to wait before receiving a proper diagnosis of cancer, even though the lateness of the diagnosis will cost that woman her life.

The July 2006 HSE report to the Minister on the progress of the radiation oncology plan states:

The overall timeline for project delivery suggested completion of the entire plan by 2011. A significant exercise has been undertaken to review this timeline. This has included significant detailed discussion with the National Development Finance Agency, the hospital planning office in the Department of Health and within the HSE. There is consensus that the target date of 2011 cannot be met.

The National Development Finance Agency has responsibility for putting in place PPP arrangements and it is being addressed by legislation that is before the House today. The HSE board was informed in December 2006 that the plan would not be in place until 2013 or 2014, were it to be delivered by PPP. The Minister for Health and Children, Deputy Harney, stated she did not accept the HSE's views. However, it was not simply the HSE's view that the timeframe set for the delivery of the project by way of PPP could not be met. The leaked report stated the overall project could not be delivered by 2011. It made reference to "having regard to current advice of the NDFA and the hospital planning office", which is a section of the Minister's Department.

Despite the clear evidence that reliance on PPP is hampering the roll-out of radiation oncology, the Government, in its proposed amendment to the motion before the House, again commits itself to the flawed PPP process. Overall, the amendment presented in the name of the Minister for Health and Children is nothing short of pathetic and is simply not in the real world. In my view and that of many both in the House or who will watch and read of this debate, it is indicative of a tired and failed Government.

I commend the Independent Members for tabling this comprehensive motion on cancer services. It correctly identifies the failures of the Government and sets out many of the requisite measures to ensure comprehensive cancer care services. While the full and speedy implementation of the Government's plan for radiation oncology is necessary, clearly more than that is required. In itself, that plan is insufficient and fails to deliver radiation oncology on a truly regional and national basis. The expert working group on the development of radiation oncology services in Ireland was established in May 2000 and identified what it called "the profound deficit in radiation oncology services". In 2007, nearly seven years after its establishment, there is still a profound deficit in radiation oncology services.

The aforementioned leaked report will cause further distress to thousands of cancer patients and their families nationwide who, having welcomed the Minister for Health and Children's announced plans for full delivery of services, including radiotherapy centres by 2011, now find the plan is being hampered and will not be delivered on time. The report has raised a major doubt over the Government's entire cancer strategy.

I stress again that the Government's delayed cancer care plan is not in itself sufficient and this point cannot be over-emphasised. It will locate radiation oncology services in Dublin, Cork and Galway, with satellite services earmarked for Waterford and Limerick only. The half of the island that is north of a line from Dublin to Galway will be badly served by this plan. I have made this point, as have others, to the Minister repeatedly. Patients in Cavan, Monaghan, Louth and Meath will be obliged to travel to Dublin. There is a limited plan for patients from one other Border county, namely, Donegal, to be facilitated in Belfast. It seems patients in the predominantly rural counties of Sligo and Leitrim will be obliged to travel to Galway. This is completely inadequate and again demonstrates a failure on the part of the Minister and the Government to deliver health services on the basis of equity and the right of all citizens to equal access on the basis of need, irrespective of their ability to pay or the geographic location in which they live.

A truly all-Ireland and regionally-based cancer treatment service is needed. Radiation oncology should be delivered within all the regions without exception. Cancer sufferers are being subjected to long and painful journeys for treatment. Many patients, who feel too ill to travel, consequently choose not to avail of radiotherapy. These are real cases and the Minister cannot be unaware of their number. The resources exist to deliver radiotherapy on a regional basis and the Government must go back to the drawing board.

On the basis of the Government's record thus far, as well as the Minister's tenure in office, I doubt whether either retains the will or the energy to make that short but imperative journey. Nonetheless, we have a crisis in cancer care that must be addressed. We need a revised, expanded and properly resourced plan that will ensure delivery of such services on time and throughout the regions. Given the significant surpluses already recorded, this not beyond the Government's gift. I emphasise that such a plan should not be reliant on PPPs and should be put in place without further delay.

Acting Chairman

Tá an t-am caite.

Caoimhghín Ó Caoláin

I am ready to conclude. Cancer patients do not deserve more delays or political wrangles of any description. They need the delivery of the services they require now. I urge the Minister to go back and address that need without further delay.

Minister for Health and Children (Ms Harney)

I wish to share time with the Minister of State, Deputy Tim O'Malley.

Acting Chairman

Is that agreed? Agreed.

Ms Harney

I move amendment No. 1:

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

commends the Government for the unprecedented investment in cancer control, including prevention, screening, treatment services and supportive care;

supports the Minister for Health and Children in her commitment to ensuring equitable access to high quality cancer services for patients throughout the country; and

recognises with approval:

that cancer survival is improving in Ireland for all of the major cancers;

that since the implementation of the first National Cancer Strategy in 1997, approximately €1 billion has been invested in cancer services nationally;

the additional revenue investment of €20.5 million in cancer control for 2007 and the establishment by the Health Service Executive of a National Cancer Control Programme to implement the New National Strategy for Cancer Control;

that the National Development Plan 2007-2013 includes major investment in the implementation of the Cancer Control Strategy, including modern diagnostic and treatment facilities;

the Government's continued support for health promotion programmes, including health education programmes being delivered through schools nationally;

the recent establishment by the Minister for Health and Children of a National Cancer Screening Service Board which will roll out BreastCheck to the south and west commencing in spring of this year and the Irish Cervical Screening Programme commencing late 2007, and also advise on a colorectal cancer screening programme;

the progress that has been achieved to date on the implementation of the National Plan for Radiation Oncology; the commitment of all necessary capital funding for the plan through Public Private Partnership and Exchequer sources; and the commitment of the Government and the Health Service Executive to achieve full implementation in a timeframe that accords with the Government's policies and priorities; and

progress being made in the procurement process for the initiative to develop private hospitals on the campuses of public hospitals in order that up to 1,000 beds currently reserved for private patients may be redesignated for use by public patients.

I wish to record the significant achievements of the health services in our country regarding cancer care and control, and the plans we have which will achieve the services we all want. We have to catch up after many years where failed economic policies led to enormous problems for health and social services. The successful economic policies of the Government have meant that the people of our country have generated the substantial resources to start catching up.

Since 1996, approximately €1 billion has been invested in cancer services nationally. We have made progress to date and are determined to make more. That is why our response now is to invest, as never before, to build up all aspects of cancer care and cancer control until we get our cancer services to world class standards. We are making patient safety and quality outcomes the drivers of all decisions on cancer care. That programme of investment in cancer care will be pursued relentlessly.

The finance for radiotherapy is already committed by the Government beyond any doubt. A new cancer director is to be appointed by international competition in the coming months. Good things are happening each day in cancer care. For example, the first prostate brachytherapy cases in the public health system were performed in University College Hospital Galway, UCHG, last Friday and the two patients were back at work on Monday. This is now one of the accepted forms of curative treatment for men with early staged prostate cancer. The team performing this procedure at UCHG has more than a decade experience with the technique during which it has treated more than 700 patients internationally. They are now bringing that expertise to Galway.

It is only fair to all those working hard in cancer care to record the improvements that they have made and are continuing to make. It is important that patients should have reasons for hope and optimism about cancer care. We have achieved the key goal of the 1996 national cancer strategy, which was to reduce the death rate from cancer in the under 65 age group by 15%; this was achieved three years ahead of target. More than 100 additional consultants have been appointed in key areas of cancer care. There were almost 94,000 admissions for cancer care in 2005, an increase of nearly 70% on 1997. Approximately 58,000 people were treated for cancer as day cases in 2005, an increase of 130% on 1997. In 1997, there was no cancer screening programme anywhere in the country. This year we are beginning the full national roll-out of BreastCheck to the south and west and I decided also that we would commence a cervical screening programme later this year. Additional funding of €20.5 million has been allocated in 2007 for cancer control, an increase of 74% on the comparable 2006 investment.

Cancer survival is improving in Ireland for all the major cancers. I know that the statistics show that too many people still die prematurely from cancer in our country. For some cancers, such as breast cancer and cervical cancer, approximately the same numbers of deaths have occurred in each of the years between 2000 and 2005. However, that is not the valid and effective measure of overall survival rates in a growing and aging population. We currently have approximately 120,000 survivors, 3.3% of the population. The National Cancer Registry compared cancer survival data between 1995 and 1997 with data between 1998 and 2000. Our overall relative survival from cancer increased from 48% to 50% for women and from 38% to 44% for men. Both of these increases are statistically significant. For women, there were increases in survival in the four commonest cancers, namely, breast, lung, colorectal and lymphoma. Survival improved for almost all cancers for men.

Today I announced the appointment of the first board of the National Cancer Screening Service. We are going to develop totally integrated national cancer screening programmes in areas where the clinical evidence shows that cancer screening works reliably and delivers real results for patients. The new board will maximise the expertise in BreastCheck and the cervical screening programme. It will ensure improved efficiency and develop a single governance model for cancer screening. The total allocation to the new service is €33 million which is a 71% increase in the 2006 allocation to the programmes.

I am committed to ensuring that BreastCheck is rolled out to the remaining regions in the country as quickly as possible this year. I have allocated additional revenue funding of €8 million for this year to meet the additional costs involved. I have also made available an additional €26.7 million in capital funding for the construction of two new clinical units, five additional mobile units and the provision of state-of-the-art digital equipment. Construction commenced on both sites in Cork and Galway in early November last year.

Some 60,000 women were screened by BreastCheck in 2005, which represents a 19% increase over 2004. I expect 70,000 women to be screened this year. Of those screened in 2005, 318 cancers were detected. From the commencement of screening in February 2000 to August 2006, BreastCheck diagnosed and arranged treatment for 1,867 women with breast cancer. The first round of screening will commence in the south and west in the spring.

An effective national cervical screening programme will result in a substantial reduction in the incidence of cervical cancer. It is my objective to have such a programme rolled out, beginning late this year, based on an affordable model. From January 2001 to the end of December 2006, approximately 57,000 women attended for screening in the pilot screening programme in the mid-west. I have allocated additional revenue funding of €5 million in 2007 to facilitate the national roll-out of this programme. Significant preparatory work is well under way. It involves the introduction of new and improved cervical tests, improved quality assurance training and the preparation of a national population register. I have included a requirement in the legislation establishing the new board to implement special measures to promote participation in its programmes by disadvantaged persons and difficult to reach groups. This is of particular relevance in preventing and controlling cervical cancer.

Many Opposition Deputies referred to St. Luke's Hospital, Kilkenny. It is regrettable that any patient referred to a hospital with possible symptoms of cancer would be subject to a delay in diagnosis. This is especially the case as the earlier a diagnosis of cancer is made the earlier treatment can commence and the prognosis is usually better. I have been assured by the Health Service Executive that a patient referred to St. Luke's for endoscopy and considered urgent will be given an immediate appointment and will be seen within one to two weeks. Urgent cases are forwarded directly to the medical consultant for prioritisation. General practitioners are encouraged to make contact directly with the medical consultant. The HSE has made available capital funding of €300,000 to build a new modular endoscopy unit at the hospital and is referring patients to the National Treatment Purchase Fund to reduce waiting times for non-urgent cases.

Real progress is now being made in implementing the national plan for radiation oncology. We already see the return on the substantial investments in Cork and Galway. In Cork University Hospital 1,845 new patients were treated over the four linear accelerators in 2006. This constituted 35,302 treatments, an increase of almost 5,800 treatments over the previous year. The waiting time for patients to receive treatment has halved from eight to ten weeks to three to four weeks. In University College Hospital Galway, almost 1,000 patients were treated in 2006, representing a 76% increase over the previous year. The number of treatments increased from 10,500 in 2005 to 18,500 in 2006. University College Hospital Galway expects treatments provided to increase by 7% this year.

In December last year I met with the chairman and chief executive officer of the HSE and I agreed the executive should examine options to speed up the pace of the plan. I reiterate that the funding for this plan is totally secured by the Government's decision of July 2005. This is the first time a major capital project for cancer care has been fully funded years in advance. The job now is implementation without delay.

It is my objective and that of the HSE to see the earliest delivery of the plan in the best interests of cancer patients throughout the country. I am determined the HSE will deliver on this plan in 2011 as originally scheduled. It is a challenging timetable and I will provide the HSE with the necessary support and approvals to deliver on it.

The main developments to date include the procurement of additional capacity in the shape of two linear accelerators for St. Luke's Hospital, Rathgar, which are scheduled to be delivered around the end of 2007. They also include the provision of interim facilities at Beaumont Hospital and St. James's Hospital, which will be delivered by early 2009. The capital requirements amount to €45 million. Four leading international experts have been appointed to validate the population needs assessments, technical specifications, process mapping and other outputs. Additional revenue funding of €3.25 million has been provided in 2007 to support the implementation of the national plan. This funding will support the appointment of five additional consultant radiation oncologists, seven specialist registrars and five support staff.

Patients are now being referred to the radiation centre at Limerick Regional Hospital. The operators at Limerick are fully signed up to integrating their service delivery within the radiation oncology department at University College Hospital Galway. A service level agreement is being finalised at present between the HSE and the private Whitfield Clinic in County Waterford. It is a good example of the public and private sectors working together for an immediate solution. This will support the referral of public patients for radiation oncology treatment while we build the public radiation oncology facility at Waterford Regional Hospital. The NDP will also support a new day ward with 20 treatment places at Waterford Regional Hospital. Planning of this facility is under way and construction is scheduled to commence next year.

As regards patients in the north west, a service level agreement is now in place for the referral of approximately 50 radiation oncology patients annually from Donegal to Belfast City Hospital and a number of patients have already been referred for treatment.

The decision to transfer St. Luke's Hospital to St. James's was taken by the Government in the context of its consideration of the national plan. The board of St. Luke's Hospital and its executive management team are fully committed to supporting the Government's decision. We value and will build on the expertise and ethos of St. Luke's in this transfer. A transfer along similar lines took place last year in Northern Ireland when radiation oncology services transferred to Belfast City Hospital, a major academic teaching hospital.

In conclusion, I am glad to put on the record of the House the substantial developments that are taking place in cancer control and my determination, as well as that of the Government, to ensure cancer care is brought up to a top class standard in our country. With focus, determination and persistence, this goal will be achieved.

Mr. J. Higgins

It will not happen by the privatisation of health care.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

My colleague the Minister for Health and Children has set out very clearly the significant achievements of this Government in cancer control. We have invested in all elements of cancer care and in all regions. These achievements have benefited patients throughout the country.

The Minister referred to the independent analysis of our progress in improving cancer survival undertaken by the National Cancer Registry. This Government is not complacent over its successes in this area. A recent report, published in June 2006 by the registry, predicts that cancer numbers in Ireland will have increased from 22,000 a year at present to 43,000 by 2020. The number of potentially fatal cancers will more than double, from 13,800 to 28,800, in the same period. Approximately two thirds of this increase is expected to be due to the increasing number of elderly people in the population and the remainder to upward trends in the incidence of some of the common cancers.

This anticipated increase in cancer numbers will place a major additional burden on cancer services and must be considered in current planning for cancer control. The Minister and the Government are committed to significant additional investment based on an integrated strategy that seeks to improve prevention, early detection, treatment and support services for cancer.

We have in place a national cancer control strategy, which the Minister launched last June. The aim of the strategy is to reduce our cancer incidence, morbidity and mortality rates relative to other EU countries by 2015.

The HSE is establishing a national cancer control programme to manage, organise and deliver cancer control on a whole population basis. The programme will have a strong emphasis on prevention and early detection, integrated across primary, hospital, supportive and palliative care. The service plan of the HSE for this year sets out the detailed deliverables of the programme. They include the establishment of the leadership team to implement the programme, including the director of the programme and key medical leaders at network level. The Minister referred to an overall investment for cancer of €20.5 million in 2007. This funding will also improve access to diagnostic services, support additional medical oncology and improve transport services for cancer patients.

Many cancers and cancer deaths are preventable. As many as one third of cancers could be prevented by public policy initiatives and the promotion of healthy lifestyles. Early intervention can make the difference. Cutting down on tobacco consumption and improving diet could help to save many lives. The Government has decided that it needs to put renewed emphasis on prevention as well as treatment. We cannot accept the future predictions for cancer incidence without redoubling our efforts to prevent as many cancer cases and cancer deaths as possible.

Ireland has led the way in Europe and beyond in implementing legislation to address the tobacco epidemic. There is widespread agreement that the smoke-free at work legislation has been hugely successful. From 31 May 2007 it will no longer be legal to sell cigarettes in packs of less than 20. The Minister for Finance decided to increase the tax on a packet of 20 cigarettes by 50 cent in the context of budget 2007. This increase was coupled with a decision to plan for further increases in tobacco excises for a period ahead, so as to keep the level of tax increasing in real terms and with a call on the social partners to discount some or all of the effect of such price increases in fixing on the relevant inflation benchmark. The HSE has also announced it is to step up enforcement activity on sales to minors.

The national survey of lifestyle, attitudes and nutrition, SLÁN, carried out every four years, is one of the most comprehensive pieces of research undertaken in this country into health and lifestyle. It has provided the Department with invaluable data for priority setting in health promotion initiatives and programmes which inform the Department's future policy and programme planning. The 2006 survey is at data collection stage and consists of face-to-face interviews with a randomly selected 10,000 participants. The Departments of Health and Children and Education and Science have established the social, personal and health education support service, SPHE. This is based on the importance of the school as a setting for promoting health. The SPHE curriculum is Ireland's most significant commitment to health promotion in schools. It is a broad-based health education programme that aims to enhance the self-esteem and decision-making skills of young people. All schools, both primary and post-primary, up to junior certificate level must make provision for the SPHE curriculum. A curriculum for senior cycle is being developed.

Screening for certain types of cancer plays a crucial role in the detection of pre-cancerous and early disease, saving lives and reducing morbidity. This year, we will have in place a national breast screening service and a national cervical screening service. I am aware of reports of delays in obtaining results of cervical smear tests. These delays have not arisen under the Irish cervical screening programme, but relate to smear tests referred by general practitioners to hospital laboratories, which are the responsibility of the HSE. The HSE has informed the Department that the majority of laboratories will process urgent requests for cervical smear tests in less than two weeks.

To reduce the backlog of cervical smears awaiting testing, the HSE is referring approximately 25,000 smear tests to a laboratory in the US. The HSE has sent samples from Cork University Hospital to the US and results were returned last week. CUH is preparing to send a further 2,000 smear tests to the US on 7 February. The HSE has commenced discussions with the other testing centres and the Royal College of Surgeons is working closely with the HSE to transfer tests to the US.

The HSE is also making arrangements to ensure proper follow-up of women with abnormal smears. The HSE has reviewed hospital services, including cytology, and is planning on the basis of a four-week turnaround time in reporting. The roll out of a national cervical screening programme planned for later this year is the most efficient population approach to prevent and control cervical cancer.

Colorectal cancer is the second most common cancer in Ireland and is a significant public health problem. The National Cancer Forum has monitored emerging evidence and trends in other countries in respect of colorectal cancer screening. The forum has advised that substantial work is required to address a range of issues as a prerequisite for the development of a screening programme.

The national cancer screening service, established by the Minister on 1 January, has an advisory function in respect of screening for cancers generally. The Minister will ask the service to advise on the implementation of a national colorectal cancer screening programme, specifically on the population to be screened, at what intervals screening should take place and the requirements for a quality assured and well organised cost-effective symptomatic service.

Deputies referred to the need for prostate cancer screening. Prostate cancer is the second most common cause of cancer deaths in men. There are approximately 11,150 new invasive prostate cancer cases annually. It is predominantly a disease experienced by older men, with the majority of cases occurring in the 70-74 year age group and the majority of deaths in the 80-84 year age group.

The National Cancer Forum has concluded that there is insufficient evidence to recommend the introduction of a population-based prostate cancer screening programme in this country. The forum has recommended that this issue should be reassessed when results are available from randomised control trials being conducted internationally. This position is consistent with the recommendations adopted by the European Union, which advocate the introduction of cancer screening programmes that have demonstrated their efficacy having regard to professional expertise and priority setting for health care resources.

I am supportive of the Irish Cancer Society's Action Prostate Cancer campaign, which was launched in April last year by the Minister for Health and Children. Information on the signs and symptoms of prostate cancer is essential in the early detection of the disease.

The National Development Plan 2007-13 includes major investment in the implementation of the national cancer control strategy. This will involve significant investment and development of facilities to treat people affected by cancer. Infrastructural investment will include state-of-the-art diagnostic and treatment facilities, including day and outpatient facilities and facilities for the administration and preparation of cytotoxic drugs.

The national plan for radiation oncology will be funded under the NDP. Rapid developments are taking place in terms of diagnostic imaging, which provides a better biological molecular understanding of cancer. New technologies support better and more accurate diagnoses and, hence, more effective treatments. Funding will also be made available for these technologies.

Patients are being referred to the radiation centre at Limerick Regional Hospital. The operators at Limerick are fully signed up to integrating their service delivery with the radiation oncology department at University College Hospital Galway. This is an important element of the implementation of the Government's national plan for radiation oncology.

The service level agreement is being finalised between the HSE and the University of Pittsburgh Medical Centre Whitfield Clinic in County Waterford. This will support the referral of public patients for radiation oncology treatment pending the commissioning of the radiation oncology centre at Waterford Regional Hospital as an integral part of the national plan for radiation oncology. The NDP will also support a new day ward with 20 treatment places at Waterford Regional Hospital. Planning of this facility is under way and construction is scheduled to commence next year.

I wish to refer to the position at St. James's Hospital and the deferral of some cancer operations. There are significant pressures on intensive care unit and high dependency unit beds. This is due to a large number of medical emergencies presenting and inpatients whose conditions have deteriorated during treatment. This has affected the hospital's capacity to carry out some operations on patients who are in need of intensive care nursing after their operations. Based on an assessment of medical need, some operations needed to be deferred.

I acknowledge that this is an unsatisfactory situation causing patients and their families stress. The HSE has advised that these patients are given high priority and it is hoped to accommodate them within a week. The HSE has offered full support to the hospital in terms of assistance to fast-track patients to other settings to free up intensive care unit beds. ICU capacity at the hospital has been increased by more than 50% in the past three years. The HSE is in discussion with the hospital with a view to further increasing high dependency capacity at the hospital.

The developments I and the Minister have outlined are a clear indication of the progress that has been made in addressing the burden of cancer in our community and demonstrate the Government's commitment to the provision of quality cancer care nationally.

Dr. Twomey

I wish to share time with Deputies Enright and McGinley.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Dr. Twomey

It is sometimes depressing to stand on this side of the House and listen to the Government justify what it has not done. In some respects, it is like watching the Government get away with murder. Some of what has been said tonight reinforces that point.

In the course of the Minister's speech, she tried to claim success for a gross failure. She tried to say that her announcement of the appointment of the first board of the national cancer screening service was an achievement. The board will investigate the development of cervical cancer screening and examine whether to extend BreastCheck nationwide. It is a gross failure in a Third World country, never mind a country like Ireland. For the past 30 years, one could cross the Border and avail of cervical cancer screening services.

Breast screening has been in place there since 1993. The Minister, while claiming success from failure, said that she has established a board today to look into the development of this policy. It is similar to the HSE announcement that accident and emergency statistics have improved slightly since last year. This time last year the crisis in accident and emergency was a national emergency. Again, however, the HSE and the Minister claim success from failure in their treatment of patients in the health care system.

In the disgusting and disastrous case of Rosie from Kilkenny, a lady who had a colonoscopy delayed for seven months and was then diagnosed with cancer, she effectively became another victim of the health service, having been given a death sentence as a result of her bowel cancer. The Minister and the Minister of State's response is that it is regrettable. It is more than regrettable; what they have done to patients is despicable.

The next line in the Minister's speech showed the incompetence and lack of regard for what is happening. She stated that she had been assured by the Health Service Executive that a patient referred to St. Luke's Hospital for endoscopy and considered urgent will be given an immediate appointment and seen within one to two weeks. What is urgent? As far as I am concerned, every patient I send for a significant procedure is urgent. Will the Minister tell me how to decide when a patient is urgent and when he or she is routine? That is nonsense. We cannot define "urgent". We should see every patient in a reasonable timeframe so this sort of nonsense does not happen.

If the Minister goes to the trouble of looking at these transcripts, I would like to point out that the lady in question was not looking for an endoscopy; she was looking for a colonoscopy. The Minister does not even know what the patient was supposed to get — it was a colonoscopy. Perhaps the Minister might explain to me tomorrow night when she replies when a colonoscopy is not urgent. We could then make sense of the fact that patients all over the country are having their colonoscopies delayed by up to six months.

I will explain to the Minister of State what a colonoscopy involves. If a patient comes to me complaining of weight loss and bleeding from the back passage, it could be piles or it could be a bowel tumour. I cannot tell if the tumour is significantly high up the bowel — obviously, I cannot see that far. That is why we carry out colonoscopies. Can the Minister tell me when it is not urgent when a patient is bleeding from his or her back passage? Can she tell me when I can say to the patient that he or she can wait seven months? I cannot do that and I have been practising medicine for 20 years, but perhaps the Minister has a better idea of these things than me.

The Minister stated that real progress is being made in the implementation of the national plan for radiation oncology. Is that the radiation oncology plan the Minister, Deputy Martin, published or the plan the Minister performed a U-turn on in July 2005? Neither of them is going very far. The Minister, Deputy Martin's plan is gone, after we waited four years for it, while the Minister's plan turned out to be a sham. There was no policy. The HSE came out and stated it could not implement it. The board of the HSE, demonstrating the political interference involved, stated that management was wrong. It was interesting that the National Finance Development Agency was discussed today because that agency came out and stated that the management was right — the plan was a sham. The Government in its arrogance, however, stands over it. It does not care and says it does not matter. It is just another person in the litany of patients who are dying after ten years of Fianna Fáil-Progressive Democrats Government. This is the best it can do.

The Minister mentioned that four leading international experts have been appointed to validate the population needs assessment, technical specifications, process mapping and other outputs. Four international experts were not appointed to look into the decision to choose the Mater Hospital for the national children's hospital but that decision will stand for 50 years and cost €500 million. That is not just disjointed Government but total incompetence and that is how this Administration works.

I have published two policy papers since becoming Fine Gael spokesperson on health. The first dealt with primary care screening to cover every area. It covered blood pressure, because for every person diagnosed with a blood pressure problem, another person is missed. It covered diabetes, where the same is true. It covered cholesterol, which has a huge impact on heart disease, and it covered bowel cancer, cervical cancer and breast cancer. It can be done without establishing another group or commission but the Government does not want to do it. It comes out with soundbites instead.

Along with the Labour Party, we announced a patient safety authority. This policy will not set the world on fire or generate headlines but the consequences of not having such an authority can be seen in the headlines every day — MRSA, Leas Cross and Rosie in Kilkenny, just one of 40,000 people who stepped forward to say that because the Government is so incompetent, she will die. The Government just sits there, however, as smug as can be, saying we can wait another year or even until 2011 because it will not do anything in the meantime. The Government is letting patients die, even before we try to address hospital hygiene.

I am sick to death of smug Ministers, Deputies Martin, Roche and Cullen, saying on television that the Opposition has no policies. The Government has no policies. The Minister's speech referred to the implementation of the national cancer strategy in 1997. That strategy was published in 1996 by the rainbow Government. Patients are being treated according to a strategy the last Government drew up. It is amazing the Government acknowledges that because its national cancer strategy does not have any implementation plan. When it comes to patient safety, the Government ta lks about HIQA. Already I can see backbenchers getting shaky about it because even they know, although they do not put too much time into the area, that it cannot work and will fall apart.

The Minister acknowledged that the patient safety authority announced by Fine Gael and the Labour Party was far superior because she set up a commission to look into the plan, although it was not established to implement it. That shows how bloody useless the Government is when it comes to looking after patients.

There is even more to it. Look how screening is working. What is stopping the Government from making BreastCheck available in the west of Ireland? Does it have a psychological barrier at the Shannon? BreastCheck should be national by now, as should cervical cancer screening. The Government talks rubbish that it will send tests to the United States and try to reduce times to within two weeks if cases are urgent. When is a smear not urgent? The Government is great at talking but does not know what it is talking about. Britain screens its entire population and can have results returned within weeks.

On a programme about endoscopies, which the Minister should not confuse with colonoscopies, it was stated that the system would try to reduce the waiting time for patients who needed endoscopies from six to four weeks, not six to four months. The Government, however, thinks it is doing a great job if an urgent endoscopy can be carried out in two weeks when it does not even know what is an urgent endoscopy. The only colonoscopy I would consider urgent is when the patient is like that poor individual Mr. P. J. Walsh, who was bleeding out of his mouth and had a burst duodenal ulcer. He could not wait two weeks, he could not even wait two hours. That is so urgent the operation is needed immediately.

That is how a health service should work. It should not work like this, with the spoofing the Minister and Minister of State have come out with tonight. They are pure wafflers and spoofers who are murdering patients because of their incompetence.

Ms Enright

I welcome the opportunity to contribute to the debate. I concur with everything Deputy Twomey said. I would like to concentrate on screening for both breast and cervical cancer, which I have raised on many occasions. The Government parties have provided an unsatisfactory response to date, although I must welcome the Government's belated examination of the issue. I acknowledge the Government has taken a number of steps in the right direction, including the announcement of a new board. However, I question the timing of the announcement and the long delay in addressing this issue. It is time the Government parties paid more than lip service to cancer screening.

The Minister reiterated that the Government is committed to rolling out BreastCheck. I heard the same parties saying they were committed to rolling out the programme before I ever entered politics, and the service is no better than it was years ago. A Fine Gael Minister for Health, Deputy Noonan, initiated the first national cancer strategy in 1996, which, as Deputy Twomey said, the Government parties are working on. If the strategy had been implemented, as envisaged, both BreastCheck and the cervical screening programme would have been rolled out nationwide by now.

Women in my constituency can avail of BreastCheck if they fall within the relevant age categories but women in Deputy McGinley's county cannot do so. My mother-in-law cannot avail of a service to which my mother is entitled. Who in the HSE or the Government decides that one woman in the age category is more entitled to the service than another women elsewhere in the State? I would not like to be the bureaucrat or Minister making such callous decisions to exclude a huge proportion of the female population from the programme.

However, every woman in my constituency is not fortunate in that they cannot avail of the cervical screening programme. Ireland has one of the highest death rates from this cancer in Europe, with 73 deaths per year. Such screening must be made available throughout the State and it must form part of a proper national screening programme. Women are not given the option of a regular smear test unless they pay for it through their general practitioner. While it is a painless procedure, no woman looks forward to it. A national campaign is needed to remind women of the need to undergo this test so that they will make the appointment rather than leave it up to those who can afford it to be tested, which is the position outside the mid-west region. That is totally and utterly unacceptable.

The international agency for cancer research has estimated that an organised programme of national screening for cervical cancer in Ireland would achieve a reduction of 80% in mortality rates. That equates to saving 60 lives per year. I worried when I heard the Minister refer to an affordable model for this programme and she did not spell out what she means by that. The testing element of the programme is not costly but the treatment of those who are found to have the cancer is much more expensive. However, the Government places little value on the 60 lives that could be saved annually when it refers to an affordable model for such a programme, otherwise it would have been rolled out nationwide by now. It is even more frustrating that, while 16 nurses in the midlands have undergone training in this area, they have been waiting for the past two years to participate in the programme and have not been given the authority by the Government to do so.

Reference was made by a number of Government speakers to the importance of diet in cancer prevention. However, I ask them to ask the Minister for Education and Science why schools being built under the PPP programme are being allowed to install Coca-Cola and Mars bar vending machines. Whether the principal wants these machines, the schools are allowed to bring them in. If the Government is serious about this, it needs to engage in joined-up thinking. There is no point in one Minister saying one thing while another puts something entirely different into practice.

Mr. McGinley

I appreciate the opportunity to contribute to this important, burning and emotive debate on the lack of cancer services in my constituency. The people of Donegal and the entire north west know better than most the glaring inadequacy of health services under this Fianna Fáil-Progressive Democrats Government and nowhere more so than where cancer services are concerned. The exposure of the Minister for Health and Children's national plan for radiation oncology as a sham, which cannot be delivered as promised, cut all the deeper in Donegal where cancer patients have suffered from wholesale Government neglect. That plan, for example, which was announced with much fanfare, neglected to include the north west in any meaningful way. If one draws a line between Galway and Dublin, one can see that the Government has made no commitment to provide a radiation unit north of that line.

Cancer patients do not have time. Whether in the context of detection or treatment, time is of the essence when it comes to the impact on patients' quality of life, suffering or survival. Women in Donegal and the north west, in general still await the roll-out of BreastCheck screening services, which are absolutely vital to the early detection and successful treatment of breast cancer. As a result, Donegal women are being denied their best chance to avoid the trauma of radical surgery. By the same token, the absence of a national cervical screening programme, 11 years after it was announced, is denying women all over the country access to screening, which should be their right.

According to the National Cancer Registry, in County Donegal between 1994 and 1999 the annual number of female breast cancer cases was 53, with an annual death rate of 18, that is, one in three. On average, 1,600 new cases of breast cancer are discovered each year and between 1994 and 2000 breast cancer was the most common cause of cancer death in women. Cancer survival in Ireland is close to the European average for the common cancers, with the exception of breast and lung cancer, for which survival is well below the average.

Donegal cancer patients, once they have been given that dreadful diagnosis, are then faced with the absence of radiotherapy services in the north west and they must endure arduous journeys for treatment in other parts of the country. This has led to women in Donegal choosing — if one could call it a choice — traumatic surgery rather than undergo the grind of the travel and the days and weeks away from their homes. According to the Cancer Care Alliance, the uptake of radiotherapy for patients in the north-western area is below the national average which means that many Donegal patients will lose their battle with cancer because of the lack of services in their area.

The Government's solution of sending Donegal patients to Belfast for treatment represents no progress for many cancer patients in the county for whom a journey to Belfast is as long and arduous as a trip to Dublin. It is absolutely vital that we have radiotherapy services in the north west. Fine Gael has committed to the delivery of regional cancer treatment services to those who desperately need them in locations based on population needs and proper long-term planning. It is clear that the north west has the critical mass to justify a radiotherapy centre and the Government's refusal to reconsider a radiation oncology solution for the area is a most hurtful blow to the people of Donegal.

While there have been positive indications regarding the appointment of a permanent breast surgeon in Letterkenny General Hospital, the retention and improvement of cancer services there is an absolute must. There is no doubt that with all the waste of taxpayers' money, the arrogant attitude of those too long in power and the incompetent handling of vital public services, the delivery of health services is the greatest failure of the Government. This is a particularly tragic failure where cancer patients are concerned.

Thanks to the ongoing neglect of the north west, these realities are all the harsher for patients in Donegal. Fine Gael and Labour have combined to put forward new proposals that will make a difference to these patients, including the provision of 2,300 new hospital beds around the country, 1,500 convalescent, rehabilitation and long-stay community beds and 1,500 new consultants. It is only by implementing the policies of the alternative Government, which will increase capacity as well as reforming the way that hospitals and doctors work, that patients can hope to receive appropriate health services.

This is a burning issue in Donegal. We have been ignored by the Government and its predecessor. Prominent Government Members who served as Ministers for Health and Children for many years, such as the Minister for Enterprise, Trade and Employment, Deputy Martin, and the Minister for Finance, Deputy Cowen, all ignored the needs of the north west. People have taken to the streets and are demanding action but we have not yet seen any response from this Government. Commitments have been made from this side of the House by Deputy Twomey when he visited Letterkenny on one of his first missions after being appointed health spokesman but we are still awaiting a commitment from the Government. The patience of the people of Donegal is wearing thin.

Debate adjourned.

Dáil Éireann debate - Wednesday, 31 Jan 2007