Dáil Éireann debate -
Tuesday, 27 May 2008

Vol. 655 No. 3

Adjournment Debate.

Cancer Treatment Services.

Deputy Frank Feighan

I seek the Minister's immediate intervention in the case of Kerry Anne McLoughlin of Glenballythomas, Tulsk, County Roscommon, a 17 year old girl who has been attending UCHG for the past seven years with a thyroid problem and who is still awaiting an appointment for treatment in St. Luke's following the removal of a malignant tumour last July. I have tried to raise this matter on the Adjournment on several occasions and I am delighted it is being heard tonight. It is a frustrating and serious matter which should have been dealt with long before now.

In 2004 a scan showed a growth on Kerry Anne's thyroid gland and a repeat scan in 2006 showed the growth had doubled in size. Surgery was eventually arranged for July 2007, when one part of the thyroid was removed. Unfortunately, the result showed there was a malignant tumour on the thyroid gland and the patient received an urgent phone call from UCHG to say more surgery was necessary. Further surgery was carried out and it showed there was cancer of the thyroid gland with total invasion. Radio iodine ablation treatment was necessary.

This young girl was put on the waiting list for St. Luke's Hospital in Dublin and for St. Bartholomew's Hospital in London. In November 2007, UCHG told the family Kerry Anne would receive treatment in St. Bartholomew's Hospital in eight weeks' time. The family was delighted with this breakthrough and waited patiently for two months for the call. The then worried and concerned parents rang the hospital to inquire about the commencement date of the treatment, but were told her name had been removed from the list. Some weeks later the family contacted St. Luke's only to be told her name was not on the waiting list there. When they contacted UCHG, they were told her name had been removed from the St. Luke's list because she was supposed to go to St. Bartholomew's Hospital. This situation is the worst cock-up I have seen in my time in political office.

Following this, Mrs. McLoughlin made a phone call to UCHG in which she could not hide her anger and frustration at the way she and her daughter had been treated by hospital authorities, particularly by someone whom I will not mention but who is on the Minister's list and who was responsible for handling this case following surgery by Mr. Quill. Following her cry for help to St. Luke's, an appointment for Kerry Anne was arranged the following day. However, she was informed that owing to the long waiting list in St. Luke's, she will not be reached until after September, but before the end of the year.

The distraught family has contacted a hospital in Belfast in desperation. The head of department there listened to the nightmare story of how this 17 year old girl's life has been put at risk owing to the lack of services. A shocked consultant has promised to intervene and, hopefully, provide help. However, he is not able to provide the family with a definite appointment date at such short notice.

This girl has lost a serious amount of weight, suffers from anaemia and lies in bed most of the day with no energy. She is unable to attend school and mix with her friends and feels that nobody cares about her. So much for our cancer strategy of early detection and treatment and our promise that cancer prevention is of utmost importance. This girl was told in UCHG that if one was to get cancer, her type of cancer is the best type to get. This is not a great consolation for a 17 year old girl.

The family has decided to make one last plea for help. Before they go public with the heart-breaking story of this 17 year teenager, I implore the Minister to make an early and positive intervention in this sad case.

Minister of State at the Department of Health and Children (Deputy John Moloney)

I am taking this matter on behalf of the Minister for Health and Children, Deputy Mary Harney.

As the Deputy will be aware, the organisation and management of the health services is the responsibility of the Health Service Executive. The HSE has advised the Department of Health and Children that in November 2007 the individual was referred to St. Luke's Hospital, Dublin. Owing to the substantial waiting list for specialist radio iodine ablation treatment at that time, the medical team in University College Hospital Galway, UCHG, cancelled the appointment with a view to referring the individual to St. Bartholomew's Hospital, London. The HSE has further advised the Department that this referral was not followed through by staff in UCHG due to an administrative error.

The individual was again referred by her consultant to St. Luke's Hospital on 11 March 2008. Scans have been arranged for 28 and 31 July and the individual will be admitted for treatment during the week of 10 August. The HSE would like to apologise to the individual and her family for the distress caused by the prolonged delay in her treatment as a result of a breakdown in the referral process. The HSE will also make every effort to get an earlier appointment for the individual with the consent of her referring clinician.

The Department has sought and received assurances from Professor Tom Keane, director of the HSE national cancer control programme, that efforts are being made to ensure acceptable clinical waiting times for patients requiring radio isotope treatment. Professor Keane has already made significant progress in delivery of the programme to ensure equity of access to services and equality of outcome irrespective of geography.

Hospital Services.

Deputy Ciarán Lynch

I wish to share time with Deputy Kathleen Lynch.

Acting Chairman

Is that agreed? Agreed.

Deputy Ciarán Lynch

Last February, we raised this issue of gynaecological services in Cork. On that occasion, the Minister of State, Deputy Hoctor, was acting on behalf of the Minister, who incidentally is not in the House this evening. She stated in her response that it was planned that some minor surgical procedures would be carried out at the Cork University Hospital on a trial basis on Thursday, 27 March, with the aim of expanding the gynaecology service from the first week in April. She stated the ultimate aim was to have the gynaecological theatre open on a five-day per week basis. She claimed these developments indicated that gynaecological services continued to be improved in Cork University Hospital.

That was three months ago, but no improvement has taken place. Waiting times for Cork women in need of urgent gynaecological investigations are set to remain as health officials continue to renege on promised services and the Minister fails to deliver on her commitment. This is despite the warning from general practitioners in Cork that women's lives are being put at risk by the wholly inadequate gynaecological service based at a maternity facility that cost €75 million.

The doctors, members of the Cork city branch of the Irish College of General Practitioners, have described the situation as a disaster waiting to happen. Cork women over the age of 50 with suspected cancer of the womb have been forced to wait for months for crucial investigations, due to what has been described as underfunding in the service. These are women who could be treated in a morning. Two of the three operating theatres are closed and women with cancer will be told they cannot be examined. This is a diabolical state of affairs. A hospital in which €75 million has been spent on developing state-of-the-art gynaecological facilities has two of these facilities closed. This is because the HSE has failed to put staff in place due to a recruitment embargo by the Minister for Health and Children. I would like the Minister of State to inform the House this evening when the doors to these facilities will open and services will be put in place.

Deputy Kathleen Lynch

I thank Deputy Ciarán Lynch for sharing time. When this matter was first raised, certain commitments were made. One commitment was that from September 2007 two of these theatres in Cork University Hospital would be opened on a part-time basis, leading in time to full-time occupancy. This has not happened.

There are four operating lists for gynaecology for Cork University Hospital. A list comprises a half-day of operating. Of those four lists, two are taken up by two gynaecologists while ten consultants must compete for time in the other two lists. There is one gynaecologist who specialises in investigation but has a list only every two weeks.

The lives of women diagnosed with cancer are being put at risk. The necessary procedures could be carried out immediately. However, there is no space available at the theatres because the management at Cork University Hospital and HSE South have decided the money is not available to open them. One theatre could be opened for two days a week but this cannot be done because there are not enough staff to carry out the necessary sterilisation procedures for the theatre.

I am sure Deputy Harney is still the Minister for Health and Children, despite the fact we have not seen her for some time. However, she takes no responsibility for this situation. I am not blaming the Minister of State at the Department of Health and Children, Deputy Moloney, as he is only here to do a job tonight. Someone, however, must be responsible. This is a disaster waiting to happen. Consultants in Cork University Hospital, dedicated professionals, are in such a plight they are fast becoming disillusioned. We all buy into the notion that more consultants are needed. With no operating theatres and no time available, they can only sit around drinking coffee. If this is what the consultants will have to do, why are we employing more? The Minister is responsible, despite the fact that she wants to keep the health service at arm's length. She will eventually be made to confront the women in Cork whose treatment will be protracted. She is putting women's health and their lives in danger because of these delays. She should face up to her responsibility and deal with the matter.

Deputy John Moloney

I am taking this matter on behalf of the Minister for Health and Children, Deputy Harney, as she is at another engagement. In fairness, last week she spent three hours in the House dealing with the cancer strategy on Private Members' business.

The Government is committed to the provision of high quality gynaecological services across the country, including the Cork region. There are currently five gynaecology theatre slots per week in Cork University Hospital, amounting to the equivalent of two and a half day's service. Approximately 1,152 elective gynaecology procedures were carried out there in 2007. In addition, approximately 17 emergency gynaecological procedures are carried out each month.

There are three operating theatres in Cork University Maternity Hospital, CUMH, one obstetric and two gynaecological theatres. The HSE has indicated that the obstetric theatre is fully staffed and the hospital has recently completed the recruitment process for several senior nursing staff for the gynaecology theatres. In addition, a consultant anaesthetist is being recruited to facilitate the commencement of a gynaecology service in CUMH. In the interim, gynaecology procedures continue to be carried out in Cork University Hospital.

In March 2008 several minor surgical procedures were carried out in Cork University Maternity Hospital, on a trial basis. The ultimate aim is to have the gynaecology service operational on a full five-day per week basis. These developments illustrate that the gynaecological services continue to be improved in Cork University Hospital.

The HSE has designated Cork University Hospital as one of two cancer centres in the managed cancer control network for the HSE South. The decision by the HSE to have four managed cancer control networks and eight cancer centres will be implemented on a managed and phased basis. The delivery of cancer services on a programmatic basis will serve to ensure equity of access to services and equality of patient outcome irrespective of geography. Professor Tom Keane took up his position as interim director of the national cancer control programme in November 2007. Professor Keane will engage in detailed planning to facilitate the progressive, gradual and carefully managed transfer of services between locations over the next two years. A decision on the location of gynaecological cancer services for the HSE South cancer control network will be made by Professor Keane and the national cancer control programme.

The development of cancer services and the continuing emphasis on improving cancer care underline the Government's commitment to providing safe and accessible services for patients in the southern region.

Proposed Legislation.

Deputy Ulick Burke

The matter I raise was referred to me recently by a concerned constituent. While he was attending a food and drinks fair in England, he was given a sample of what is termed a "shot pack". As a father and family man, it would frighten him, and likewise me, if this product were allowed into Ireland without strict controls.

The shot products are advertised as "shots without glass". The manner in which the product is promoted indicates it is intended for the teenage market. The product's brochure claims it has revolutionised the single serve alcohol category by introducing a single shot of premium liquor in a lightweight, durable plastic pouch. The 50 ml shot comes in a safe, break-resistant plastic pouch which makes it safer than a glass and has built-in spout making it easy to pour no matter where it is taken. The stand-up pouch, which is sustainable and earth-friendly compared to rigid containers, has a tear feature for an immediate, ready-to-drink shot anywhere. The brochure claims these shots are perfect for concerts, sporting events, holidays, cruise ships and planes. It boasts, "You name it, you can take it anywhere" and "No glass to break, no liquor to spill".

This product of Canadian whiskey has an alcohol proof of 80%. It can be hidden easily on one's person and brought into a nightclub without observation. The Minister of State as a publican knows that all liquor sales in the State must be licensed. I shudder to think what could happen if these products are allowed into this country. They originate in the United States, Mexico and the Virgin Islands. They are promoted by an English company. When I challenged the managing director of the company today, he said they had no products of 80% proof, despite the fact that I had one of them in my hands and he only admitted the fact then. They are out to increase the vulnerability of young people in this country. We decry the binge drinking of some teenagers but if this product is allowed in, where will it be sold? It certainly will not be sold in the usual outlets but rather in the forecourts of petrol stations and other places where there is easy access for young people on their way to the disco.

The Minister of State has an ideal opportunity to include an amendment in the forthcoming legislation to prevent the sale of these products in Ireland. The manager of this company said that he is in active and forward negotiations to find an agency for the sale and distribution of this product in Ireland.

I refer to the report by Dr. Ann Hope on alcohol-related harm in Ireland. It lists about 60 instances of the damage done by alcohol. The report highlights research which found that alcohol affects an adolescent brain differently from the adult brain. The damage from alcohol used during adolescence can have long-term, irreversible effects.

I ask the Minister of State to bring to this matter to the attention of the Minister for Justice, Equality and Law Reform, to ensure that something provision will be included in the forthcoming legislation to prevent added misery being heaped on the teenage population of Ireland, as demonstrated by the ease with which these products can be hidden on the person. Anywhere one goes, these products can go. We must prevent this situation.

Deputy John Moloney

I thank Deputy Ulick Burke for bringing this information to the House and for his proactive involvement in researching the case.

I welcome this discussion of the alcohol-related harm which is so prevalent in our society and, in particular, the opportunity to mention the decisive action which the Government is taking to address the problem. Last year, the Health Research Board published its overview of health-related consequences of problem alcohol use in which it drew attention to the fact that alcohol consumption in Ireland has increased significantly over recent decades. We have one of the highest levels of alcohol consumption in the European Union. In 2006, alcohol consumption levels in this country were about 30% higher than the EU average. Moreover, we have a particular problem with binge drinking which is far more common here than in other EU countries. The 2007 Eurobarometer survey found that 34% of Irish drinkers consumed five or more alcoholic drinks in one sitting compared with the EU average of 10%. When asked about the frequency of consuming five or more drinks on one occasion, 54% of respondents in Ireland stated that they did so at least one a week. This was the highest figure recorded for any of the countries in the survey. Ireland emerges with the highest level of binge drinking.

The health-related consequences of excessive alcohol consumption are by now well known. They include an increased incidence of accidents, injuries, domestic violence and suicide. Adverse social and economic consequences include absenteeism and loss of productivity. I do not need to spell out the impact of excessive alcohol consumption on levels of crime, public disorder and anti-social behaviour.

I wish to detail the decisive action which the Government is taking to combat alcohol-related harm. The Government alcohol advisory group was established last January last to conduct an urgent examination of the public order aspects of the sale and consumption of alcohol. It submitted its report on 31 March 2008 which contains 31 recommendations for legislative and other reforms in areas covered by its terms of reference. On 22 April, the Government approved the drafting of the Intoxicating Liquor Bill 2008 which contains proposals for urgent reforms to licensing law and public order legislation in response to certain recommendations in the report. Both the report and details of the proposed legislation were subsequently published.

Drafting of the Intoxicating Liquor Bill 2008 is at an advanced stage and the Minister for Justice, Equality and law Reform intends to present it to the Dáil in the very near future. With the support of both Houses, he is confident that this legislation can be enacted before the summer recess.

On the specific subject matter of this discussion, the product in question appears to be a distilled spirit-based drink, originating in Mexico, Canada and other countries and marketed in lightweight plastic containers. Each container holds a single serving. These products have high alcohol content, typically of 35% to 40%, although Deputy Burke said it is close to 80%, which is alarming. While it is not clear at this stage that they are being promoted specifically with young people in mind, the fact that the containers are light, portable and easy to conceal means that they could be attractive to persons under the age of 18.

The Department of Justice, Equality and Law Reform is currently in contact with the Department of Health and Children about this product and both Departments will explore the possibility of a statutory prohibition or controls on its marketing. However, where any product is in free circulation within the EU internal market, difficulties arise in prohibiting its circulation and consumption within a single country. The introduction of specific national controls or regulations is also problematic.

Some Members may recall that a similar problem arose in 2004 with regard to plastic sachets of vodka, known as Bullseye Baggies, which had been placed on the market and which appeared to be directed at young people. The then Minister for Justice, Equality and Law Reform sought and obtained the co-operation and agreement of the licensed trade, both the on-trade and off-trade, not to market the product and this strategy proved effective and successful.

The Minister would ask the drinks industry and the licensed trade for their support and co-operation in refusing to market and supply the product. There now is a high level of awareness of the extent of alcohol-related harm in our society and anything that is likely to exacerbate or add to existing problems should be avoided. I thank Deputy Burke for raising this issue and for providing the opportunity for this discussion.