Vol. 642 No. 1
48 Deputy Ruairí Quinn asked the Minister for Health and Children if her attention has been drawn to the research that might indicate that the vaccination of girls to prevent cervical cancer may be inappropriate in some circumstances; if there is evidence of side-effects to the vaccine; and if she will make a statement on the matter. [29976/07]
Following the introduction of human papilloma virus, HPV, vaccine internationally its safety, as is the case with all other vaccines, is being carefully monitored. At national level, the Irish Medicines Board is responsible for monitoring national and international emerging evidence about vaccine safety. The Irish Medicines Board, IMB, is also represented on the national immunisation advisory committee.
My Department has not been informed of any scientifically peer-reviewed research that indicates the HPV vaccine may be unsafe. However, I have been informed by the IMB of media reports in the US and EU that described some cases with fatalities following vaccination with the HPV vaccine. These cases have been reviewed by the authorities responsible in the jurisdictions in which they occurred and a relationship between the vaccine and these fatalities could not be established.
As is being done in other jurisdictions, Ireland is now considering the potential role of HPV vaccination in addressing the problem of cervical cancer prevention. The national immunisation advisory committee has recently undertaken a scientific assessment of the public health value of HPV following a request from my Department. The NIAC and the national cancer screening service agreed that this work needed to be complemented by a study of the cost effectiveness of the vaccine in the current Irish context. Accordingly, both organisations requested that the Health Information and Quality Authority, HIQA, undertake this study. International evidence as to the safety profile and side-effects of vaccines is considered by NIAC in formulating its advice and is kept under constant review. I understand the HIQA assessment will be completed in January.
I raised this because I was contacted about it. There are always people who object to certain vaccines and it is important we clarify it. I support the introduction of a vaccine for cervical cancer. The Minister states there is no scientific evidence that it is contra-indicated for girls with a certain family history. I am not suggesting there is an issue but I seek clarity.
A report in a medical journal suggests boys may be considered as well as girls. Has the Minister considered that? This project is included in the programme for Government. Will it be done in the early or later stages of the life of the Government, if there should be later stages?
I will be careful because I am not a clinician. I understand that all vaccines have a downside as well as a benefit and, when a vaccine comes to the market, one takes a balanced view of whether it is likely to be beneficial or marginally negative. That is the case with this, as with any other vaccine. The authorities will advise the age at which it should be given, which is 11 to 12 years for girls. It is my strong view that it should be introduced in Ireland, subject to the advice confirming that in January. If that is the case, it makes sense to seek to do it in conjunction, not simultaneously but in the same period, with the roll-out of the cervical screening programme. This is a preventative measure and the benefits of it will not be seen until at least 20 years hence. We must act now in order to have the benefits in that timeframe. We must consider whether we will give the vaccine through schools and address matters such as parental consent.
In February this year the Minister announced the introduction of the cervical cancer vaccine available free to medical card holders and young girls presenting in the 11-13 age group. What is the opinion of the Minister of recent criticism by Dr. Kevin Connolly, a paediatrician and member of the national immunisation advisory committee, of the delay in determination of the safety of the vaccines, Gardasil and Cervarix? The criticism is of the inordinate delay in bringing forward these vaccines employed in other jurisdictions, apparently successfully. While I agree we must be fully certain of the safety to avoid dangerous side effects in any group of possible recipients, does the Minister have an indication of the interim determination of the HIQA studies on the vaccines?
In the programme broadcast last night in respect of Professor Tom Keane's role in British Columbia in cancer care redress, it was clearly indicated that the incidence of cervical cancer in the region had been reduced to minimum levels as a result of a combination of vaccination and screening. The programme here involves vaccination only. What progress has been made towards including screening as a component part of the programme aimed at dealing with this terrible scourge which is faced by too many women?
A number of issues must be addressed. Deputy O'Sullivan inquired as to whether it should be made available to boys. We are awaiting advice in respect of these matters. If the advice from the national immunisation advisory committee and that which will emerge from the HIQA process, which is due in January, is positive, it would be my wish to make provision to have the vaccine introduced here. It is clear that this would not be a medical card issue and that it would be available to the entire population. All of the other population screening programmes are freely available to everyone, not just medical card holders. Cervical screening has been available in Canada since the 1960s or 1970s.
It has been available there for 31 years.
Canada was one of the first countries to introduce such a programme. The programme in question has been extremely successful, although its nature is being changed somewhat. The Minister for Finance will be making budgetary announcements in two weeks and I hope provision will be made for the roll-out of cervical screening programmes in the resources made available by him to the Department of Health and Children.
I will take a brief final supplementary from Deputy Reilly.
I will be as brief as possible.
The Deputy should do so. We are already one minute over time on this question.
I wish to refer, first, to the costings relating to the vaccine and Dr. Connolly's concerns regarding our ability to deliver a vaccination programme should the Minister decide to proceed with it. What will be the costings for the roll-out of cervical screening programmes? I spoke to the Minister six weeks ago about this matter in the House when I stated it was unlikely that she could succeed because there were no laboratories in place. Smears testing services are being outsourced. There is only one accredited laboratory in the country.
A question please, Deputy.
I will be as brief as possible.
A question, please.
Tá an ceist ag teacht.
It had better come quickly because I intend to move on.
Is there a budget in place in respect of the roll-out of a cervical screening programme? Is the Minister in a position to guarantee the House that it will be rolled out by March next year? In light of the cutbacks taking place, is there any real credibility to her claim that she will roll it out?
A large advertisement appeared in the Sunday Independent last weekend in which company directors, whether their companies are large or small, public or private sector, were urged to take good care of everybody and ensure they were fully compliant before it was too late because they would be responsible. The Minister has a contract with the people to deliver health care services. She promised them that there would be no cutbacks and that any cutbacks would not hurt patient care but there were and they have done. How does she intend to come good in respect of her promises?
We will spend over €15 billion this year and spent €14 billion last year. We will spend €1.2 billion more than last year. I do not regard that as a cutback. It is the duty of the HSE to remain within the budgetary allocation voted to it by the House out of taxpayers' money and be able to meet the demands on services——
The cutbacks should hit administration, not services.
There has been a great deal of discussion regarding the report published last week by the OECD which indicated that spending in Ireland grew faster than in any other country.
Because it started from such a low point.
We are spending 8.9% of our national income, the average in the OECD, even though——
We have only just reached that percentage.
The Minister to conclude her final reply. We must proceed to the next question.
It would be easy to roll out all these vaccines in Ireland. The cost of a vaccine is the smaller——
Roll out a cervical screening programme first?
We could also roll out the screening——
The Minister promised it would be introduced ten years ago.
Will the Deputy, please, allow the Minster to conclude her reply?
The issue is that clinicians' and general practitioners' fees are substantially higher than in, for example, Northern Ireland, Britain or other jurisdictions. The cost relating to the vaccine is usually the smaller part of the overall figure.
What about cervical screening?
The same applies to screening in respect of the taking of smears, etc. All of these things are more expensive here
It did not apply ten years ago.
They are more expensive, as the Deputy knows.
That does not wash.
49 Deputy Kathleen Lynch asked the Minister for Health and Children if it is still proposed to introduce the fair deal for nursing home care on 1 January 2008; her views on whether there is time for appropriate consultation on the detail of the scheme in that timeframe; and if she will make a statement on the matter. [29968/07]
52 Deputy Phil Hogan asked the Minister for Health and Children if her proposed fair deal for nursing home care will be introduced as planned on 1 January 2008; and if she will make a statement on the matter. [29992/07]
I propose to take Questions Nos. 49 and 52 together.
The legislation for the new nursing home support scheme, a fair deal, is being drafted. The intention is to publish the Bill as soon as possible and to have it in place by 1 January 2008.
The Minister originally announced her proposals for the new nursing home support scheme in December 2006. Information leaflets, a guide to the fair deal and a frequently asked questions document have all been available to the public since. In addition to dealing with queries and representations from interest groups, public representatives and members of the public, the Department also met a number of interested parties, including the social partners, the IFA and the Irish Senior Citizens Parliament.
I met representatives of nursing home owners and various senior citizens groups which are all concerned about the timeframe involved. I wish to ask a few questions in respect of their concerns. The first relates to the standards that will be drawn up by HIQA will not, as I understand it, be available when the legislation is introduced and will only be produced later. Is it not strange that the fair deal will come into play before the standards relating to it appear?
My second question relates to whether senior citizens will have a choice of nursing homes. I understand the National Treatment Purchase Fund will be given the role of deciding on and allocating nursing homes to individuals. I would be concerned about this because a facility might be located a long distance from a person's home or a person might not wish to be sent to a particular home. It may eventually be the case that large nursing homes will take in many people because it will probably be cheaper to proceed in that way. The people to whom we are referring will live in these homes.
My third question involves family homes and the percentage of the value of a family home that will be taken subsequent to the death of the person who owns it. There are serious concerns with regard to this aspect of the matter. How will a spouse or another member of a family who remains in the family home and might be on social welfare payments or a low income pay this percentage? There are many questions relating to this matter and I do not believe there will be adequate time for consultation before 1 January.
I also met nursing home owners in recent times and I am aware of their concerns. The NTPF is still in the preparatory stages of finalising the forthcoming legislation. We propose to introduce the legislation as soon as possible and expect the advertisement relating to nursing homes to be placed in the near future. I understand people's concerns in that regard. Applications to provide nursing care will be approved in time. Nursing home owners will be obliged to meet a certain standard, of which they will be notified in due course.
As regards the fair deal and people's homes, people remaining and living in their own homes while their loved ones are being cared for should not be concerned. It will only be when a loved one dies that the question of the percentage will become pertinent.
What will happen in the case of a person still living in a house after his or her loved one dies?
It only becomes relevant when the house passes on. In other words, following the death of the loved one being cared for in a nursing home. The Deputy will be happy to hear that people will not be put out of their houses.
What would be the position of an unmarried 40 year old daughter living in her parents' house where both parents had died? Would she be allowed to remain until she was 90? Am I correct in understanding that no money would be drawn against the value of the house?
Only if she were the carer.
She would be allowed to remain only if she were the carer of the person or persons originally admitted to the nursing home.
If it were her family home, surely she would be entitled to live there and not be obliged to try to raise a mortgage in order to pay the State. It seems extraordinary——
At present, people in this situation are obliged to sell their houses. People are not obliged to opt for this scheme, it is voluntary in nature.
We are all aware that there is going to be a major problem with regard to the funding of nursing homes. My difficulty with what I have seen so far of the Bill is that it refers to drawing down other resources before the family home is touched. How will this apply in the case of small businesses and farms? Will people be obliged to sell their businesses and use up all their assets before their family home comes into play? What will happen, for example, in the case of a young man who is running a shop with his mother and who decides to take over the business and invest money in it?
I cannot understand how the Minister or the House can envisage a situation, particularly in the aftermath of Leas Cross, in which we will seek further funding from people in respect of their care in their old age without first ensuring the standards of care in the relevant institutions will be set in stone. People entering nursing homes and their loved ones must be able to rest assured that they will be looked after in the best possible way. How will the NTPF set fees if it does not know what standards are reached? I wish to declare to the House that I have a 25% interest in a nursing home. The points which concern me are care of the elderly and the standards that will be applied.
Age Action Ireland is extremely concerned. The elderly is the first group to have this eligibility approach foisted upon them. Hundreds of thousands of euro are spent on cancer and cardiology patients but they are not asked to sell their homes. This issue requires a great deal of further discussion and elaboration. It works for some small groups of people but it certainly does not work for many others. I hope we have the time to discuss this matter and tease it out.
As Deputy Reilly has a quarter share in a nursing home he is aware of the fact that inspections take place in private nursing homes at least twice a year. We already achieve a standard. If a house is already transferred it is not an issue with regard to the payment of nursing care. We anticipate the HIQA standards will be ready by June next year.
Will the Minister of State clarify what is the role of HIQA with regard to private nursing home facilities? Will she assure the House that HIQA has a role in ensuring full inspection and accountability of all State funded places, be they in public or private nursing homes, for senior citizens and other residents of such facilities? The Government is committed to extending the remit of the social services inspectorate to include residential care for older people. What progress has been made with this proposition?
The Health Act 2007 provides for the establishment of the Health Information and Quality Authority, which will provide the standards of nursing care in public and private nursing homes. Private nursing homes are already subject to inspection. It is expected that HIQA standards will be in place next year at which point they will be rolled out.
The Government is committed to extending the remit of the social services inspectorate. Will the Minister of State indicate whether it will include residential care for older people and what progress, if any, has been made on this?
It will happen next year and will include residential nursing homes.
Highly reputable nursing home owners who wish to care for their patients are extremely concerned that if the standards are not in place when the fair deal starts they may not have patients sent to them by the National Treatment Purchase Fund because they may not be the cheapest. They may have more nurses employed per patient and better standards in other ways than those who see it purely as a business. This is the most significant concern but not the only one with regard to the system being established before the standards are in place. I am concerned that the nursing home with the cheapest price is what the National Treatment Purchase Fund will choose. In the absence of standards, the cheapest price may not mean a good nursing home for patients.
I agree that the cheapest price may not mean the best standard. We will rely on the NTPF to ensure that in the tendering process the best standard is assessed on an individual basis for each nursing home which enters into the contract.
We need real assurance on this matter. I am extremely concerned about it.
In conjunction with this, I hope we have similar investment in community initiatives to keep people at home. Nobody likes to go into a nursing home because it means a loss of independence. The HSE has been inspecting nursing homes for some time. However, we have not been reassured by what is happening. The HSE inspecting its own homes is not proper.
This is why HIQA was established as an independent inspection body to investigate public and private nursing homes. Deputy Reilly will appreciate that we know people live longer and in a healthier state if they remain at home for as long as possible. The Government has an excellent record of achievement in this. This year, we had the successful introduction of home care packages throughout the country whereby nurses, physiotherapists and occupational therapists attend to a person in his or her own home. We intend to continue and increase this in the coming year.
50 Deputy Andrew Doyle asked the Minister for Health and Children her plans to enforce the food labelling regulations regarding country of origin in the wholesale and retail sectors. [27007/07]
56 Deputy Andrew Doyle asked the Minister for Health and Children the resources available to enforce the regulations on food labelling, including ingredient list requirements and country of origin requirements, in terms of manpower and budget. [27006/07]
I propose to take Questions Nos. 50 and 56 together.
The Food Safety Authority of Ireland is responsible for enforcing food law, including the Health (Country of Origin of Beef) Regulations 2006, SI 307 of 2006, which were amended in February 2007. These regulations are enforced by environmental health officers of the Health Service Executive on foot of a service contract with the Food Safety Authority of Ireland. Approximately 400 environmental health officers work on the enforcement of food legislation.
Checks on compliance with food labelling, including the Health (Country of Origin of Beef) Regulations 2006, are undertaken in conjunction with routine hygiene inspections. Accordingly, it is not anticipated that additional costs will be incurred. I am advised that the number of inspectors and level of inspection to implement these regulations is sufficient.
Guidelines for the implementation of the regulations have been issued to the HSE and an explanatory leaflet has been circulated by the HSE to food business operators. The Deputy may wish to note that these regulations do not relate to food safety but rather to consumer information.
What steps do the Minister of State and the Department propose to take with regard to the mislabelling of food products imported to this country and represented to the consumer as Irish in origin when clearly they are not? A substantial amount of meat produce circulating in supermarket chains here is labelled as Irish or EU but does not come from the European market. It is imported into the European market and presented as EU produce and then imported into Ireland and repackaged and presented as Irish in origin. A great deal of information is available on this. What is the Department doing to stamp out this practice? Does the Minister of State agree it is pointless to have labelling if we cannot have confidence in what the labelling tells us?
Is there a degree of hypocrisy in addressing the issue of labelling when significant elements of the State's services, specifically areas of the health services, directly purchase food products from outside the European Union for the requirements of people here? We must lead by example and present the Irish people with food products in which they can have confidence and those grown at home are the best.
Legislation is in place to deal with mislabelling and I and departmental officials are anxious to obtain information on mislabelling. I have no reason to doubt what Deputy Ó Caoláin stated and I assure him it will be dealt with. There is no question of environmental health officers or the Food Safety Authority of Ireland ignoring this. If it is brought to the attention of the Food Safety Authority of Ireland or detected by any of the 400 environmental health officers carrying out routine inspections, it will be dealt with under existing legislation. In regard to State bodies purchasing from outside the EU, these organisations are bound by public procurement regulations.
The enforcement of food labelling regulations is a cause of significant concern among consumers. In regard to the wider debate on the connection between diet, food and cancer deaths, does the Minister of State accept that serious questions are being asked, particularly by the medical professions, and that citizens are becoming as worried as they are about alcohol and smoking? Is he aware of these concerns?
All ingredients should be listed on the label so that people can make a choice. The issue of dietary requirements is also important in the context of health. There is no question of the FSAI suggesting those with responsibility for labelling should not provide all the necessary information. We have taken a recent initiative in regard to labelling country of origin for poultry, pork and mutton after consulting the relevant parties. However, we will have to share our views with the European Union, which will make a unanimous decision on the matter. We are preparing the appropriate provisions and within a matter of months will present our proposals to the EU. However, we will need the support of 24 other member states if we are to be successful.
In regard to meat, what is the point of imposing standards on Irish farmers for places of origin and antibiotics when imported Brazilian beef is not subject to the same stringent requirements? We do not know where it comes from, other than a large continental area called Brazil, nor do we know the conditions in which the cattle were reared.
The Deputy will be aware that regulations and statutory instruments require Brazilian beef to carry country of origin labels when it is sold in this country.
What about hormones and antibiotic use?
The Minister for Agriculture, Fisheries and Food and I have responsibility for the matter. We are holding consultations on it to ensure Irish consumers can have confidence in the food they eat.
51 Deputy Thomas P. Broughan asked the Minister for Health and Children if she has secured funding in budget 2008 for the development of the designated cancer centres under Professor Tom Keane; when she will announce funding plans for developing capacity in the designated centres; and if she will make a statement on the matter. [29959/07]
I refer the Deputy to my reply to Question No. 44 of today.
Does the Minister agree the units which are to become centres of excellence do not have adequate resources to treat their current patients and that their waiting times fail to meet best practice guidelines? For example, Professor Gupta, who practises in my own area, has publicly stated that he needs additional resources in order to meet best practice requirements.
The Minister indicated that money would be available in the budget. Will that include provision for needs such as transport and accommodation and will the homework be completed in that regard before the budget is announced?
If resources are being moved, most of the locations due for closure could experience a surge in different types of cancer treatment. Certain staff are not easily relocated because they are already doing work that does not relate to cancer. Are these issues being taken into consideration and will adequate funding will be provided to implement the cancer strategy?
A lot of work remains to be done. Professor Keane has set targets of completing 50% of the transition by the end of next year and 90% by the following year. That is an ambitious programme but I believe he will have buy-in from the clinical community. Those who have chosen to be specialists in cancer care want to work in centres where they can pursue their clinical passions with like-minded colleagues. In the area of breast cancer, for example, I understand 70 surgeons currently performbreast cancer operations whereas we probably only need 12. Clearly, most of the surgeons who are generalists rather than breast cancer specialists will transfer to general surgery.
They will remain where they are.
Yes. We would like the specialist breast cancer surgeons to move to the centres and Professor Keane will be engaging them in dialogue in that regard. I understand that significant enthusiasm and interest have been expressed. We want activity to move from the centres to the hospitals where cancer surgery comes into the centre. Many people in these eight hospitals could have their surgery facilitated in different hospitals if the capacity was in place. It is a matter of moving some stuff out and other stuff in. The 13 places that have already closed dealt with in the order of 55 surgeries last year, or one per week.
An additional €1 billion has been spent on cancer treatment over the past ten years. Professor Keane will have control of that budget and of course more money will be available for cancer. Additional funds will be allocated for every speciality but cancer will receive special attention because of the aging of the population. However, to place all the emphasis on additional funding rather than what is already in place would be a mistake.
The transport issue is being reviewed by the HSE not only for cancer but also in respect of health services generally. The accommodation issue is also very important. I was impressed by the accommodation provisions made in British Columbia, which reported great patient satisfaction.
It would be erroneous of the Minister to place all her emphasis on existing resources instead of discussing additional funding. Has she not placed Professor Keane in an invidious situation? He has just arrived, yet decisions have already been made about where the centres will be located and the number to be established. He will have to unravel those arrangements if he does not agree. People certainly find it bizarre to see nothing north of a line between Galway and Dublin. Will he encounter the same problems as Professor Drumm in terms of trying to reorganise something that is already half-organised? Why will four centres be located in Dublin when only one third of the population reside in the greater Dublin area?
Glib references have been made to transport, which will be a massive issue. Someone dear to me just completed radiotherapy and, even though he did not have to travel far, he was shattered each day. Making somebody travel two or three hours by train and then face the same journey in reverse is not a prospect we can relish with any degree of humanity.
The Minister spoke about the services she closed down. Some services will clearly have to be discontinued but to close them before the new centres are up and running and seen to deliver is not acceptable. This is like Hanly all over again. It is no use to say that we will close the local accident and emergency unit and send patients up the road to Limerick but we will fix up the services in Limerick at some point in the future. The people who need services need them today or next week. We can see what happened subsequent to the closure of Ennis hospital, which required patients to travel to Galway. The following week, the regional hospital in Galway raised the prospect of reducing breast cancer services from five to three days per week because of cutbacks.
The Minister indicated to the House that she would discuss the budget with the Minister for Finance. I hope she will find the additional funds necessary to make this plan successful so that it does not become, like cervical screening, a mere aspiration.
I am not dealing with aspirations but with change and reform, which are what the transformation programme is about. When I hear Deputy Reilly's questions, I sometimes wonder if he favours or opposes reform or whether he sits on both sides of the fence.
I am not in favour of removing services until their replacements have been established. I and members of the public will be pleased when the new services are up and running.
The transport and accommodation issues are central to making this plan a reality. Appropriate accommodation is needed for those who must travel long distances from home for radiotherapy whereas surgery is a once-off experience. The idea is that both developments will take place at the same time. As the centres are built up, they will have considerable capacity and expertise. We are not starting on greenfield sites. Some of the top clinicians in the world, both doctors and nurses, are working in the cancer area and their number has increased significantly in recent years. We want to organise within these centres and, in particular, retain all cancer functions in one place. As a result of the manner in which some of our hospitals are managed, cancer patients in some hospitals are located on every ward or floor, which is inappropriate. We want dedicated beds ring-fenced for cancer patients. Professor Keane and the medical colleagues he will bring on board to assist him will have responsibility for implementing the plan. It will be realised.
In her initial response, the Minister referred to moving "some stuff out" and other "stuff" in. Does she agree that this is a wholly inappropriate use of language to describe issues which directly impinge on people's lives? Does she understand that the decisions she takes affect the prospects of survival of people around the country?
The Minister is proceeding with the closure of hospital services without the so-called centres of excellence first being in place. How many centres of excellence for cancer care does she envisage will be rolled out? Is she aware that today a large body of people from Sligo gathered outside the House in protest at the prospect of the closure of a centre of excellence at Sligo General Hospital? What does she say to them? Does she have any assurance for the people of the north west regarding the provision of cancer care services at Sligo General Hospital? Is she aware that all shades of elected opinion in this House clearly indicated to the people who gathered outside the gates their support for the retention and development of the cancer service at the hospital? Will the Minister outline precisely what are the plans in this regard and give an assurance to the people of the north west that the services at Sligo General Hospital will be retained and developed?
I welcome the designation of Beaumont Hospital as one of the centres of excellence. When is it envisaged that the developed services in Beaumont Hospital will become available? Will they commence in early 2008 or at a later date?
I welcome the appointment of Professor Keane and ask the Minister to encourage all her ministerial colleagues to support his efforts to reform the health service. When is it envisaged that we will see the impact of the reforms he will roll out?
The more appropriate term for the new centres is "specialist centres" because the use of the word "excellence" implies we do not have excellence. We have an excellent breast surgeon — Dr. O'Hanrahan — in Sligo General Hospital. All our national experts, from Professor Niall O'Higgins down, as well as a large body of international evidence — I understand 250 medical journals are published on cancer — suggest that volume equals quality. It is not simply a matter of a single physician, whether a surgeon, a pathologist who has a specialty or a radiologist, but of numbers of people working together. All the evidence suggests that one's chances improve by more than 20% when one is treated in these centres.
A comprehensive team is in place in Sligo General Hospital.
I did not choose the locations for the centres. They were selected by experts, including the Irish Cancer Society, Europa Donna and a patient advocacy group active in this area.
On Deputy Finian McGrath's question, the changes will begin to take effect at an early date. I hope, in the first instance, that we secure buy-in from the clinical community. While this will not be forthcoming from everybody, the feedback I have received suggests many clinicians are excited about what is happening. We will get considerable buy-in from the clinical community early next year.
Professor Keane has done this work before and is immensely qualified. My colleague, the Minister of State, Deputy Jimmy Devins, will meet him shortly to discuss issues of concern to him. Professor Keane, who is very supportive of the centres, does not come new to Ireland. We have received assistance from British Columbia since I visited the province nearly two years ago. The individuals concerned did not arrive on Monday as we have already taken a great deal of advice from them. I was highly impressed during my visit to British Columbia where one will hardly find a person who does not praise the province's cancer services even though many people must travel long distances to access them.
The issue we must address is in Ireland.
I agree.
Written Answers follow Adjournment Debate.
