Cancer Vaccine: Statements.

In accordance with an order of the House today, we will deal with statements on the cancer vaccine. I will shortly call the Minister for Health and Children, Deputy Mary Harney, to make her statement under Standing Order 43 and, in accordance with an order of the House, I will call on the main spokespersons of Fine Gael, the Labour Party and Sinn Féin to make their statements for which the time allowed may not exceed 15 minutes and Members may share time. There will be a question and answer session at 1.30 p.m. for 30 minutes.

I am happy to have an opportunity to speak about this issue. In the context of the cancer programme on which the Government has embarked, there are a number of priorities from a clinical point of view. Clearly, the first priority is to ensure that we organise our cancer services to deliver better outcomes for patients. The manner in which our cancer services have been organised do not deliver good outcomes for patients, as we know, and do not compare very favourably to many other European countries in most cancers with the exception of children's cancer. It is centrally organised in Crumlin hospital and, therefore, we do extremely well compared to the experience in other countries not only in Europe, but elsewhere throughout the world. We do not do so well with other cancers. Our priority during the past 18 months has been to invest in putting in place eight designated centres with a multidisciplinary team of experts to be able to care for patients who are diagnosed with cancer.

A second priority is screening programmes. Many other European countries and countries beyond Europe have been involved in screening programmes for some considerable time. We are currently rolling out a breast screening programme, which will be completed during next year for those five counties to which it has not yet been rolled out.

We are also rolling out a cervical screening programme that began in September. Cervical screening has the capacity to prevent 80% to 90% of cervical cancers. Some 70 to 100 women present with cervical cancer each year. A national screening programme for women aged between 25 and 60 years of age has the capacity to eliminate the incidence of cervical cancer by 80% to 90%. Therefore, there was a choice presented with the roll-out of the cervical screening programme, which next year, in a full year, will cost €35 million. An extra €25 million will be allocated to that programme next year and an extra €15 million will be allocated to the cancer control programme to allow Professor Keane to continue to recruit the expertise we require in these eight centres to provide, in particular, multidisciplinary care. That €50 million funding has been identified for those two programmes.

In the summer of this year following a health technology assessment, I announced, based on the advice I received, that we wanted to introduce the vaccine from the school year beginning September 2009. The HSE believed at that time that this would be a challenge and in that context sought to defer it, as health services often do with computer systems and so on, but we believed it should be rolled out at the earliest opportunity. In a statement I made on 5 August, I said that it should be rolled out subject to two criteria, one being that it be cost-effective. Two companies supply the vaccine. One of the vaccines deals with four strains of HPV, of which there are 200 strains in all, while the other vaccine can eliminate two strains. I sought the introduction of the vaccine, subject to its cost-effective procurement and securing an 80% take-up of it. All the advice is that if we do not get an 80% take-up of it, we will not get the benefit of introducing it. Therefore, the permission of parents of 12 year old girls will be sought. It was subject to those two criteria that I sought Government funding in the context of the Estimates for 2009 to begin the roll-out of the vaccine next September.

Since then, as we know, there has been a considerable decline in our economic circumstances. Next year, for the first year in almost 11 years, health spending will not increase by 8%, 9% or 10% — the average annual increase has been 9% since 1997. Next year the increase will be just over 3%, which will present a challenge. As I said in the House during the debate on the medical card issue, when one has to find €700 million of planned expenditure for 2009 from the health Vote, it is a considerable challenge. There is no low-lying fruit in health — no easy pickings. Therefore, it was obvious that something that had not yet begun should not begin next year when we did not have the resources to do it. We must also consider this decision in the context of the pneumococcal vaccine, which has been rolled out to infants in respect of which there is a catch-up period of up to two years. That will cost €30 million next year to prevent certain meningitis strains. It is not a question that the decision on the vaccine was made in isolation, rather it was made in the context of many other big decisions that have been made.

I was asked parliamentary questions by Deputy Reilly and one of his colleagues on Tuesday and queries were also raised by a journalist. I gave the truthful answer that we would not be in a position to provide money for this during 2009. As the American presidential election took place the same day, I was accused of trying to go undercover and making the announcement on the day of that election. When parliamentary questions are asked, I believe they should be answered truthfully and people should not be misled into having a false view that sometime next year this vaccine would be introduced when I knew in my heart of hearts that I did not have money to do it.

When the HSE sent me its plan a few weeks ago and we discussed it with Department officials during the past two weeks, it was clear to me that we could not provide the additional resources without taking them either from Professor Keane's cancer control programme or scaling down the screening programme that has begun. I believe that when we begin something, we should do it well. Therefore, when it came to clinical choices, we had to continue with the decision that gives the best clinical return. The best clinical return is in regard to screening. That prevents 80% to 90% of cervical cancers, as we heard from Dr. Flannelly on the radio this morning. This vaccine has the potential to prevent 70% of cervical cancers, but the women to whom the vaccine would be administered would also have to be screened — it is not a question of either-or in this case.

Many other countries have introduced such a screening programme for cervical cancer. The UK introduced such a programme 20 years ago. We are only doing this now because, unfortunately, we had different priorities and did not have the resources of other countries to be able to introduce a cervical screening programmes 20 years ago. Our screening programme, as everybody here knows, only began this year in September. The announcement on Tuesday was not that we were scrapping the vaccine. What we said was that it is not being introduced from September next year.

There will be a challenge for the HSE in terms of when the programme can begin. One would hope it could begin as quickly as possible, but I cannot say that it will be introduced in 2010. I hope it can begin then, but I cannot give that guarantee now, unless the resources can be made available to do it. I hope we will able to introduce it as early as possible. Other European countries have not been in a position to introduce it either.

On the issue of the cost of the vaccine, it has been suggested that three doses of the vaccine would cost approximately €600 or €200 each. I do not know if that is the case. The HSE has estimated to me that for a full year it would cost approximately €16 million. The administrative cost of the vaccine is in the region of €6 million. As procurement of it has not taken place, I cannot say, with certainty, what the cost of vaccine would be, except I understand it has been suggested that if people can procure it privately, it would cost approximately €600.

When the HTA was done for me by HIQA, it said it would cost €390 for the vaccine. There are approximately 27,000 girls aged 12 in Ireland. We want to get an 80% take-up of the vaccine. On the assumption that we would, which was the only basis on which we were going to proceed with its introduction, it would cost in the region of €11 million for the vaccine alone and €6 million for the staff to administer it and for other non-pay and IT systems because we have to be able to track the people who are given the vaccine over a considerable period of time.

I am happy to explain the circumstances in which this decision was made. We wish we could make all the decisions that would benefit the health of our citizens all at once, but when it comes to priorities, clinical issues must come first. The clinical priority based on all the advice available to me as far as cancer is concerned is to continue with the reorganisation of services, which next year will require an additional €15 million for Professor Keane and to continue with the roll-out of the cervical screening programme to 1.1 million women, which next year will cost an additional €25 million over the €10 million that was provided for this year. That amounts to €50 million for those new cancer initiatives.

Regarding other issues, like the pneumococcal vaccine, etc., it was not possible to make resources available to the HSE from the autumn of next year to begin a programme in either national or secondary schools. It costs approximately €500,000 less to provide it to secondary schools because there are fewer of them. However, in terms of getting the consent of parents, we know who the national school students are and my view was that it might have been easier to reach those parents and get their consent in advance, which is required to administer this vaccine because we are concerned here with minors. Regardless of whether it was available in national or secondary schools, we cannot begin the programme in September 2009 as envisaged. It needs to be postponed for that reason.

I wish to share time with Deputies Enright and Clune.

Is that agreed? Agreed.

On 5 August the Minister, Deputy Harney, announced that she had asked the HSE to prepare and submit a plan for the introduction of the HPV vaccination programme for 12 year old girls to commence in September 2009. She stated that she had considered all the advice available to her of the potential public health benefits of the HPV vaccination in the prevention of cervical cancer and the wider policy implications of its possible introduction into the national immunisation programme. She said:

I accept the expert advice that the introduction of a universal, high uptake, vaccination programme for young girls, in conjunction with population based cervical screening, could significantly reduce overall cervical cancer rates. I intend to seek Government approval for the programme and for the required funding in the autumn based on the implementation of a plan that can be shown to be cost-effective, in terms of delivery costs and uptake rates.

She went on to say "It is clear the main priority now is to move to the introduction of the vaccination programme for 12 year old girls to commence in Sept 2009". It is worth noting that this was only a month after the Taoiseach and the Minister for Finance had met in July and examined the financial situation in which the country had found itself.

Furthermore, the Minister has told the country that she circulated this news on the day that the country was consumed with events in America. I had tabled parliamentary question to her and I wish that all parliamentary questions I table were answered with such efficiency and speed.

However, given that the report on the deaths in the north east, which we had been promised would be published in July and was then held over until September, was released on the same day, no such excuse can be used. I am given to understand that report was available more than a month ago and was in the hands of several people but held back. I believe this represents cynical manipulation of the news.

The Minister mentioned the Health Information and Quality Authority. Its board considered the cost benefit analysis of the programme and recommended that the Minister institute it. The National Immunisation Advisory Committee also recommended the introduction of this vaccine programme. These are two organisations that are concerned with the public good and public health. I cannot understand why she has now chosen to ignore their advice.

I wish to put on the Dáil record the figures quoted by HIQA. It believes it would be possible to avert 2,244 cases of CIN1 based on the figures for cases that occurred in 2004. In the case of CIN2 and CIN3 — these are all pre-cancerous lesions — it would be possible to avert 1,435 of those. Of the 200 cases of cervical cancer in 2004, it estimates that 111 of these cases could be prevented. Of the 93 deaths that occurred in 2004 from this disease it would be possible to avert 52. These are stark figures. For the sake of €10 million are we going to expose our children of today and our women and mothers of tomorrow to the dangers of death, pain and suffering as well as the heartache to their families?

The Minister has talked about putting the patient first and not affecting front-line services. This is a crossroads for us. In response to parliamentary questions, Deputy Ring was able to ascertain that the Government is spending €10 million on press secretaries, press officers and constituency staff.

Some €1.4 million in bonuses to HSE senior staff.

Precisely. Why have we not touched the bonuses in the HSE? Why have we not addressed the issue the Minister, herself, has raised and I have raised numerous times with her, of redundancies in the HSE? Why has the issue of outside consultancies not been looked at?

I have only been in this House for a year and a half. Every time we have a problem the answer is to establish another committee, investigation, task force or commission, with money flying out the door. I remind Members of the Government's approach to money in the not so distant past when one Minister said of the €50 million spent on electronic voting machines: "What about €50 million in the overall scheme of things?" What about €10 million for the lives of children who may not get the opportunity to live to old age because of not having this vaccination programme? It has been recommended by two Government bodies. The Minister was congratulated when she announced it. I wanted to see it extended to 18 year olds as is done in the UK and in the North. Australia has had it since 2007 for women up to 26 years of age, but we cannot do it here. It is about priorities. The Minister is telling us that out of a €16 billion budget she cannot find €10 million to protect the future of children.

HIQA has stated this programme would cost €9.7 million. The Minister has given other figures here as to the cost of the vaccine. I would know from hearing on the grapevine that a hard deal done by the Government could result in no moneys being paid for the vaccine next year or the year after and that the suppliers might be prepared to wait until 2010 to receive their moneys given the economic climate in which we are all operating. While I agree the Minister is making hard decisions, it is with alarming frequency that those decisions are always hard on the patients and on front-line services and not hard where they need to be, on bureaucracy, waste and negotiations.

The Minister has her advisers with her today. We know that for every €1 spent on prevention it is possible to save €20 on treatment. I put it to her that this is penny wise and pound foolish. We are at a crossroads. This is a moral decision for the Minister. She should seek the money elsewhere from her €16 billion budget and protect those who need protection or else when she relinquishes responsibility in the area, she will leave behind her a heinous legacy.

The Minister opened her contribution by saying that her first priority was to have services that would result in better outcomes for patients. Nobody in the House could disagree. She said her second priority was the roll-out of the cancer-screening programme, which is a reasonable priority. I do not understand how she comes up with her priorities and how they can be so changeable or interchangeable depending on the situation. Deputy Reilly already quoted from the Minister's statement on 5 August, which is only three months ago. She stated: "It is clear the main priority now is to move to the introduction of the vaccination programme for 12 year old girls to commence in September 2009". I do not know whether her first or her main priority is more important, nor do I know what has changed since.

The Minister also stated that she was "having regard for the need to prioritise in relation to budget and competing demands of other service programmes". For this reason, she decided not to put in place the catch-up programme. It was because cost was a consideration that 13 to 15 year old girls were excluded.

The Minister did not raise this issue for the first time on 5 August. Although I was unable to find the date, I raised this issue in the Dáil before the summer recess. When I stated that the vaccination programme's introduction seemed positive, the Minister sat there and smiled. Obviously, some degree of forethought was given to the 5 August statement.

The outcomes cited by Deputy Reilly make understanding the Minister's decision more difficult. Most victims of cervical cancer tend to be young mothers. In addition to not vaccinating 12 year old girls, the Government is denying another group of children the opportunity to grow up with their mothers, given the chances of survival without vaccination.

For as long as I have been a Deputy, the Minister has been stating that she is rolling out breast cancer and cervical cancer screening, but they are still being rolled out. She is asking people to accept that the vaccination programme will not be available and to hope on the never-never that they will be able to avail of the screening programme. Given the circumstances, this is a sizable request. How do we know that, in a few months time, the Minister will not inform the House of delays in the programme or that it is no longer her main priority?

The Minister used the phrase "when choices came". There are always competing choices, but the Minister knew last August that the economy was in a difficult situation. Given the mini-budget in July, she knew the situation we were facing when she made her announcement. As the Government got its figures appallingly wrong, we must allow for the Minister not fully understanding the situation and relying on inaccurate figures while waiting for something more precise from the Minister for Finance. However, she was aware of the difficulties when she made her decision.

Will the Minister reconsider her decision and allow 12 year olds to avail of vaccinations? She should not blame the requirement for an IT system. We were vaccinated in school before there was an IT system. It would be a poor excuse to use in 2009.

I was struck by the Minister's opening statement to the effect that her objective is to deliver better outcomes for patients. The Health Information and Quality Authority, HIQA, has produced stark figures on how many deaths this vaccination would prevent, as well as on how many people and their families need not experience trauma, pain and anguish. The Minister's decision, which is based on minor economic reasons given her Department's overall budget, flies in the face of her opening statement in respect of the patients and young women whose long-term health would benefit measurably from the vaccination. It does not make sense.

When the Minister made her announcement three months ago, she knew the budgetary situation. From feasibility studies and investigations, she would have been aware of the programme's cost, but now the HSE's figures have put the programme out of reach. It cites a cost of €16 million, but HIQA cites €9.72 million. The latter also documents the savings achievable in terms of treatment costs per year, €2.7 million, and annual incremental costs, some €6.9 million. In overall terms, the total amount is small and would have a considerable effect on young people's long-term health.

The Dublin Well Woman Centre has condemned the move to scrap the vaccination programme, stating: "While short-term budget savings may be made by not proceeding with the vaccination programme, the reality is that unnecessary deaths will arise among the cohort of girls who were to be targeted". While there will be a gain in the short term, we will pay a long-term price in terms of health and economics. It is well known that €1 spent on disease prevention saves €20 on treatment. It always pays to invest in preventative programmes. I appeal to the Minister to find the money elsewhere in the overall budget.

With the permission of the House, I would like to share time with Deputies Kathleen Lynch, McManus and Burton.

Is that agreed? Agreed.

I thank the Minister and the Whips for the opportunity to discuss this matter. I call on the Minister, Deputy Harney, to reverse her decision immediately. It would not be described as a U-turn and there would be no criticism. Rather, it would be described as a humane, caring and life-saving measure.

Only three short months have passed since the August announcement, which was made despite what we already knew of difficulties in the public finances. Presumably, the manner of funding was discussed with the HSE. This morning, it was suggested on radio that the HSE does not have money to fund the programme. I urge the Minister to reconsider, as the programme would save 50 lives. We are a developed country and can surely introduce long-term preventative measures such as this to save lives.

Within the overall budget, the amount of money in question is small. I dispute the Minister's figure, but I will revert to this matter shortly. It is closer to €10 million. Deputies have suggested other ways to find the money. For example, we do not need so many Ministers of State. This immediate saving would be a considerable contribution. Regarding the variety of consultancies used by the HSE, it has farmed out a number of jobs that it could do, including the writing of letters to all of the unfortunate patients in the north east who needed X-ray reviews. Using a private company to administer the nursing home repayment scheme costs €15 million. There are many ways to find the money.

How does the Minister prioritise if this life-saving preventative measure, which would lead to greater health outcomes for women, is not a priority? Not for a minute would I suggest that the money be taken from the cancer control programme or the roll-out of cervical screening or BreastCheck, the latter of which has not been completed. These are not the type of programmes from which money should be taken. Rather, it should be taken from areas such as consultancies, bonuses, extra Ministers or farming out to the private sector work that could be done by the large number of people employed by the Health Service Executive and the Department of Health and Children, which has lost only a handful of employees since the HSE was established. With a little will and imagination, it will be possible to find the money needed to re-introduce this programme.

I want now to speak briefly about the cost of this programme. The Minister suggested this morning it will cost €14 million to implement it. She arrived at this figure by multiplying 24,000 by 600. The Health Information and Quality Authority document published in February this year, suggests it would cost €100 per dose of vaccine and that if a school-based programme were introduced, which is what the Minister is suggesting, the administrative fee would be €30. This amounts to closer to €10 million than €14 million. I ask that the Minister revisit this issue in that context. Also, given there is competition between the companies that produce the vaccine, it should be possible to negotiate a price that is lower than the €100 quoted.

I am afraid that what is lacking is the political will to address this issue. With political will, savings could be made in a variety of areas to enable this vaccination programme to be implemented at reasonable cost. Following announcement of the vaccination programme, I spoke to a mother of a young girl who is approaching 12 years. She had already explained to her daughter that she was going to get this vaccine. She, and other mothers, now have to explain to their daughters that while they had told them they were going to get a vaccine which would prevent them getting cervical cancer in the future — a difficult enough issue to explain to a 12 year old — they may well be 12, 13 or 15 years old before the programme is introduced and as such they may not get the vaccination.

I urge the Minister, given the relatively small cost involved and the value of this programme, to reconsider her decision. Despite the fact that we are in recessionary times, we are a relatively rich and developed country and we should be able to find the wherewithal to introduce programmes that will have positive results for future generations.

Information about this programme is in the public domain. While children may not know about it, their mothers do. Mothers are the greatest pursuers of all that is good for their children and they will pursue this issue and will want to know why their children cannot get this vaccination. There is not one person in this House, or outside it, that has not been affected by cancer diagnoses or by the death of someone from cancer. We all know, including those who have been caught in time or cured, the stress of living in a house with a person who receives a cancer diagnosis. We know the outcomes could be so much better.

Mothers know this vaccine is available and that it could prevent their children going through the trauma of a cervical cancer diagnosis, treatment and, hopefully, cure. It will, in the event of a cure not being possible, prevent their children dying from cervical cancer. We are all aware there are other cancers, the outcomes of which are not great and the treatment for which is harrowing, but there is no vaccine to prevent them. There is available, however, a vaccine which will prevent cervical cancer and provide our children with hope of a better future.

I plead with the Minister to reverse this decision. The cost of implementing this programme will not be €14 million. My information is that doctors who administer the vaccine in a private capacity will do so for €115 per dose. The Minister and I know that families who have the wherewithal and the resources will ensure their children get this vaccination. This will create a two-tier system. We will have a cohort of young women who will be vaccinated because their parents can afford it and another cohort of young women whose parents cannot afford it. We should not allow this to happen. These children may encounter similar problems later in life when it comes to housing, third level education and employment. We should not allow this to happen when we can prevent it. It is our job to ensure all children are treated equally.

I believe this particular scheme could be introduced at a far lower cost than that stated by the Health Service Executive. I do not blame the HSE for saying it will cost more than we can afford. At the end of the day, the €16 million saved as a result of not implementing this programme can be spent by it somewhere else and we will have no control over this. It is what the HSE did in the disability and mental health areas. It will spend that money wherever it sees fit and neither the Minister nor I will have control over it.

What we do have control over is whether this programme is introduced. It is a programme that will benefit all of us. This is not only about death but about harrowing experiences.

While this issue is about protecting women's health it is also a class issue in that women living in areas of disadvantage will now be three times more likely to get cervical cancer than the average person. These are the young women who will lose out because of this decision. People who can afford to pay will be able to access the vaccination and people who cannot pay will suffer, which is unacceptable. I do not think even the Minister believes this is acceptable. It is disappointing the Minister has not prioritised this issue.

The Government's record in regard to early detection and diagnosis of cancer is abysmal. BreastCheck has not as yet been fully rolled out. Our extraordinary limited roll-out in terms of cervical cancer screening dates back to the Rainbow Coalition and the cancer strategy. There has not been, up to now, a commitment in regard to the roll-out of the screening programme. In this instance, however, we have a vaccination programme that will prevent rather than detect cervical cancer. Our record, even in tough times, has been good in terms of vaccination programmes for children. One need only recall in this regard Dr. Kathleen Lynn of St. Ultan's Hospital. During the 1930s and 1940s, a time when there was no money in this country, children were given the BCG vaccination. We are now saying, in 2008, that young women cannot be vaccinated because the Government has too many Ministers of State. We have 21 Ministers of State costing, salaries aside, €500,000. Yet, we cannot find the €10 million required to implement this programme which will prevent young women from getting cervical cancer. This is not acceptable.

I urge the Minister to reconsider her announcement in this regard. I do not believe anyone would blame her if she were to say she was sorry and admit that she got it wrong; they would applaud her for it. We all appreciate the difficult economic times in which we now live but to deny young women and children this opportunity to protect themselves is wrong. We often speak of death by a thousand cuts, this is death by one cut, one cutback that will affect the lives of many women. These women's lives could be saved if the Minister reverses this appalling decision.

The €600 cost per child of the vaccination referred to by the Minister this morning on "Morning Ireland" is dishonest. That the Minister and the Health Service Executive are seriously considering a cost of €600 per girl for the three-stage vaccine is not only dishonest, it is incompetent. The Minister's figure is approximately €115 and 21% VAT per vaccine shot, with three shots of the vaccine, amounting to approximately €400. There are then costs of administration by doctors and HSE overheads of another €200 approximately per girl.

The Minister must know that for these sorts of costs, she could offer every girl a medical card for the year. This is meant to be a national vaccination programme and is actually only deliverable as such. The only way to implement a national vaccination programme is through a school or health clinic structure on a mass basis.

If the Minister was to roll out a national scheme, the two vaccine suppliers could be negotiated with and the costs would be significantly less. I understand that in other countries it is about a third of the Minister's indicative costs. The programme and vaccine doses would be supervised by doctors but more likely administered by nursing practitioners. Is the Minister seriously suggesting GPs should be paid for three visits at approximately €50 per time? That is crazy. No wonder the HSE is in a financial black hole if this is the kind of health economics which the Minister has come up with.

Given her long experience as a Minister, I am surprised Deputy Harney has so comprehensively had the wool pulled over her eyes. The Minister delayed this programme for a year to allow a cost-benefit analysis to be done by HIQA. If these are the figures produced by the authority, somebody there should stand down. If the Minister is attempting to stand over these figures, she should consider standing down herself. I know at the weekend the Progressive Democrats are likely to be stood down and her mandate in this Government will be at an end.

Some 70 women a year die, usually in great pain, from different types of cervical cancer. Many of us know friends or family who have died from this disease. The young girls relevant to this scheme would get the disease years to come; I hope it will be long after our time. There is a thought that 70, 80 or 100 of today's girls, along with their future families and children, will go through suffering for absolutely rubbish economics. If the Minister has come up with these economics, perhaps the whole Government should resign.

I welcome the opportunity to address the cancer issue today. The decision by the Minister for Health and Children to cancel the cervical cancer vaccination programme is an absolute disgrace. The Minister announced the programme only three months ago but it has now been axed. The manner of the announcement was also a disgrace as the news was sneaked out under the door on the day of the US presidential election. The press release was apparently timed to go out after the Order of Business concluded in the Dáil, and as usual, it was late in the day, which made it difficult for Opposition spokespersons to respond.

The programme was designed to prevent the development of cancer in women and the Minister's hatchet job is another attack on public health by a Minister and Government whose stewardship of our health system has been disastrous. This public health programme is among the first to go on grounds of cost yet the budget left intact the tax breaks for developers of private hospitals. Estimates for the cost of the vaccination programme vary between €10 million and €14 million, yet in 2006 — the latest year for which figures are available — this Government gave tax breaks worth €10.6 million to the developers of private and for-profit hospitals.

In a budget that has slashed public services, those tax breaks were untouched, although they could have paid for this vaccination programme. Also untouched in this budget was the Minister's and Government's totally discredited private hospital co-location scheme. The Progressive Democrats may be about to disappear, as the previous speaker said, but its Thatcherite policies are alive and well in this Government.

Savings could and should have been made on the tax breaks for the private health industry and not on programmes which will enhance the health of women and prevent much greater cost in future, both in terms of the well-being of individuals and the cost to the health service of treatment.

Irish Cancer Society chief executive John McCormack said the Minister's decision to cancel the vaccination programme is "very disappointing". He stated: "If this is going to be the beginning of a pattern around hard-fought decisions being reversed, the Irish Cancer Society would be awfully concerned about it". This is a cancer prevention measure and €1 towards prevention is as good as €2 towards a cure. The Dublin Well Woman Centre has indicated the Minister's decision is both shortsighted and dangerous. The CEO of the centre, Alison Begas, said it was an illogical move that will cost even more in the long term. These are the voices the Minister should be listening to. We should not forget that we are talking about preventing cancer and saving the lives of women.

Cervical cancer is the second most common cancer in women under 45 and the third most common cancer in Ireland's women. Almost 200 women in the State, on average, develop the disease every year. In contrast to most other cancers, this type affects mainly younger women, with 60% of cases occurring in women aged 50 or younger. Approximately 70 women in the Twenty-six Counties die from cervical cancer each year.

A survey last year showed that only 29% of Irish women are aware that a vaccine for cervical cancer exists. Despite cervical cancer being the second most common cancer for women under 45, three out of four women did not know what caused the disease. It must be known as widely as possible that this cancer can be prevented by means of a simple test — the cervical smear test. It is a scandal and disgrace that successive Governments failed to roll out a national testing programme and that only this year is progress being made in this regard.

On 24 February 2005 there was a unanimous call from the Irish Cancer Society and 24 other organisations, including trade unions, professional bodies and women's networks, for a State-wide pre-cancer screening programme. Comprehensive screening, leading to early detection and treatment, can and will dramatically reduce the incidence and development of cervical cancer and the resulting all too terrible death toll.

There is still far too little information to show women that screening can save lives. Information and screening must be as widely available as possible and there must be quick progress in moving the screening programme forward. We have heard much from this Government recently about the excellent cancer service being developed across this State. We have heard about centres of excellence and I have seen a move in my own constituency, for example, where much of the Dóchas breast unit is being moved to Dublin.

I will relate an incident which happened recently. One of my constituents went to her GP four weeks ago with a concern about a breast issue. The GP shared her concern and referred her to the Dóchas centre as normal, and the doctor had not been advised of anything different. Over three weeks passed and she heard no word about an appointment so she phoned the centre in Drogheda to find out the date of her appointment. She was told that the Government had told the HSE to close the service, which is to be transferred to Beaumont in Dublin, and she had to contact that hospital because appointments were no longer being made in the Dóchas centre.

When she contacted the Beaumont breast clinic for the date of her appointment, she was told it was not making appointments. The clerk told her a pile of referrals was sitting on a desk but nobody had been put in place to arrange the appointments. In other words, this Government has begun closing services again on the pretext it is introducing better services, although this is not the case. No preparation has been made in that respect.

Is the Government not giving any consideration in such decisions to the stress and trauma suffered by the women involved and their families? Is there any appreciation in the health service or at Government level of the sheer worry, sleeplessness and torment brought about by these cases? This is what is happening.

The HSE wrote to GPs in the Dóchas catchment area on 23 October advising them they should make their referrals directly to Beaumont Hospital. However, that was a little late. It suggests the HSE was transferring patients to Beaumont at least two weeks before it informed the GPs what was going on, thus causing referrals to be processed by the Dóchas centre and sent on to Beaumont, which constituted a significant waste of time.

The Minister should comment on this development and whether she considers such treatment to be appropriate. Moreover, my constituent involved in this case received a letter from the HSE advising her that she had an appointment with Beaumont. It states, "we are writing to inform you that an alternative appointment has been made for you at the breast unit at Beaumont Hospital in Dublin". This was sent to her in writing but when she telephoned the hospital to ask when was her appointment, she was told that no appointments can be made because no one has been assigned there to arrange such additional appointments. She was also informed that because arrangements had not yet been concluded for the transfer of the consultants from the Dóchas centre to Beaumont, no one would be available to deal with her appointment in any event. The Minister should comment on this because some accountability in this regard would be timely.

The letter to my constituent also stated, "Many of the staff who have worked at the Dóchas centre will be moving to Beaumont Hospital to provide the new improved centralised service and we will continue to put you, the patient, first and ensure your health and safety are our primary concern". Nothing in this story demonstrates the Minister has patients at the centre or that they are her primary concern. Everything pertaining to this matter suggests this is another hatchet job designed to slash a service available to women in the north east and to centralise it into a service that is not ready to receive them and which will cause additional travel, pain and suffering to the patients involved. The Minister should comment on this scandal.

This week the HSE produced another review about the north east, the so-called look-back review of cancer patients. It demonstrated that of those concerned, at least one woman had a 60% chance of survival. Unfortunately she did not get that chance and has died. This is merely one of a litany of events in the north east. I will share some of them with the Minister, who may be divorced from some of it. The most recent event is the review of the X-ray scandal that was published on the day of the US presidential election. Second, I raised today the scandal in respect of the Dóchas breast unit. Third, there are issues regarding the report of Ms Justice Maureen Harding Clark into the Michael Neary episode — I refuse to call him "Doctor" — as well as the lack of an appointment of a clinical auditor. This still has not happened and therefore the possibility that abuses of that nature will recur is wide open.

Fourth, grave concern has been expressed pertaining to issues regarding the Rape Crisis Centre and the services provided to women in the north east. A significant number of representations have been made to me in that regard. Fifth, the ongoing scandal of the symphisiotomies never has been dealt with or cleared up. Although an external review was promised, nothing has happened in this regard. More than 400 such symphisiotomies were performed in Our Lady of Lourdes Hospital, Drogheda. In conclusion——

The Deputy should focus on the issue. The motion pertains to cancer vaccination.

While I am dealing with cancer, I am setting out the context in the north east.

I am anxious to give plenty of scope to the Deputy.

Very well. I will continue to raise the important issues associated with the deaths of Tania McCabe and her son Zach, again at Our Lady of Lourdes Hospital, Drogheda.

The Minister should address some of the issues I have raised because the crisis appears to be worsening. Statistics show the incidence of cancer is increasing throughout the State. Unfortunately, it continues to increase in my constituency and adjoining areas and many believe this is due to the toxic fall-out from the nuclear reprocessing plant at Sellafield. No inquiry, study, or survey has been carried out or set up in the area to try to establish the reason the incidence of cancer in the north-east region, and in County Louth in particular, is constantly between 12% and 13% above the national average. Why has the Minister for Health and Children not sought to deal with the high incidence of cancer in the area? Why, in common with her predecessors, is the Minister not concerned about this matter, despite calls from me and others to deal with it once and for all? No benchmarking has been put in place in respect of the incidence of cancer and it appears an approach akin to sleepwalking has been taken without any consideration for the seriousness of the issues involved.

I will revert to the central point regarding cervical cancer. As I pointed out in the earlier part of my contribution, great savings could have been made in other areas. While €10.6 million in tax breaks has been provided for the developers of private hospitals and private health care, the Minister is slashing this scheme for women that will cost between €10 million and €14 million. Surely an accounting exercise on the costing of such services would indicate clearly that, as one of the people to whom I referred observed, €1 spent on prevention is worth at least €2 spent on cure. Does the Minister accept the logic of this argument? The Minister should comment on this because it would be worth hearing her response.

Whatever the outcome of next Saturday's events outside this House will be, I hope the consequences will be that a different Minister for Health and Children will be in place thereafter. In particular, whatever about the Minister, a different policy should be in place in order that the people in this State will begin to get the public health service they deserve. Such a service has not been evident today.

We now will move on to questions. I call Deputy Reilly.

As I asked some questions during my original contribution, I will be brief. This is a political decision that only the Minister can reverse. A good manager or leader decides where savings can be made. This is a direct judgment on where the Minister's values lie. Does she make savings in administration, bonuses for the bosses, bureaucracy and through redundancies or does she do so at the expense of the future prospects and lives of young women?

I have never tabled a motion regarding the Minister's resignation before the House. However, unless she reverses this immoral decision, she should consider her position because if she does not, I will.

I will not respond to the political charges that Deputy Reilly continually makes. I do not need a lecture from him about moral responsibilities and will not take one. However, one must make choices based on clinical advice. Ireland only began a cervical screening programme last September, which will save 80% to 90% of cervical deaths. Were we in a position also to introduce the vaccine, up to 70% would be saved ten years on. This would be a belt and braces approach.

As I explained earlier, the cost of the screening programme next year will be an additional €25 million. The cost of Professor Keane's cancer control programme is an additional €15 million. In other words, an additional €50 million is going into cancer prevention and cancer control next year to achieve better results. Ireland still does not have a colorectal screening programme and there are many areas in which our programmes fall short. Ireland is not unique as many other European countries have not yet decided to introduce this vaccine. I understand that seven or eight other European countries have not done so and we are not alone. I would love to have been able to do it because it would be a belt and braces approach.

The Minister can do it.

However, Deputy Kenny should be aware the screening programme must take priority. It will cost an additional €25 million next year. It will detect women that have cancerous cells at present. That must be the priority, together with cancer treatments.

With respect, there is no other cancer——

I call Deputy O'Sullivan.

May I raise a point of information?

There is no such thing as a point of information.

There is no other cancer that we know of——

However, I will call——

——for which there is a vaccine and that can be prevented. That is the scandal of the decision made by the Minister.

Deputy Reilly is aware that screening will prevent 80% to 90% of cancers.

I am anxious to try to facilitate questions and replies as best I can. I call Deputy O'Sullivan to ask a question.

What exactly changed the Minister's mind between August and now? Did she seek to make the saving anywhere else before she changed her mind, or did she take comfort in the fact that — as she rightly said — she is spending money on the cervical screening programme and on the cancer control programme? Did the Minister try to find the money somewhere else?

What would the Minister say to a parent who cannot afford the fee but who feels his or her child should have the vaccination? Would she suggest that he or she would borrow the money to have it done?

Does the Minister question the figures shown on page 38 of the HIQA report of 25 February 2008? A table shows the cost estimate for the school-based universal HPV vaccination programme. A three dose course is estimated at €300 for the vaccine and €90 for the administration fee, which comes to a total of €390. This morning on the radio the Minister referred to a cost of €600 per girl. How can she stand over the figures to which she referred this morning? Does she accept the figures on page 38 of the HIQA report?

I did not say the cost would be €600 this morning. I was responding to what Dr. Flannelly had said in an earlier part of the interview with Cathal MacCoille in which he expressed outrage that the cost of the vaccination to parents would be €600. Of course I accept the HIQA costs. The Health Service Executive recently made a submission to me that the cost would be of the order of €16 million. I never accepted that a computer system was needed. That is why I wanted the Health Service Executive to start the programme next year and not to wait for a further year for a computer system——

Why did the Minister insist it would start next year?

——that would cost a further €500,000. In response to Deputy Burton's question, the cost of vaccines here is approximately three times higher than in other countries in terms of GP charges. This vaccine would be administered by nurses and the Health Service Executive's estimate of that cost is approximately €5 million.

I accept the figures for costs outlined in the HIQA report. Deputy O'Sullivan asked me what changed my mind. When I made the announcement in August after the health technology assessment I said the programme would be introduced subject to two things. The first was that we could get the vaccine on a cost-effective basis and the second was that we could get an 80% take-up from parents. The advice is that if one does not get a penetration level of approximately 80%, then it would not be effective to introduce the programme. Subject to those two caveats we were going to introduce the programme from 2009 if we could get the money in the context of the Estimates.

What has changed dramatically since August is that in the context of next year the Minister for Health and Children was required to take €700 million off planned expenditure for 2009. That is not easy to do. There is no low-lying fruit here; it is not easy pickings. The decision was to continue with the screening programme because that would save women who have cancerous cells and pick up women currently at risk. That must be the priority. That programme will cost an extra €25 million next year. We have to organise our services to get better outcomes and that requires €15 million to be given to Professor Keane to recruit the expertise to allow us to establish the eight designated centres. Treatment for people with cancer and picking up people who have cancer have to be the priority.

Of course I want to see the vaccine introduced as quickly as possible. In August, I accepted that we could not do the catch-up for cost reasons. We would love to do that too. Unfortunately, we cannot do everything unless we have the resources. Therefore, I had to make choices based on the clinical advice, which said that screening prevents 80% to 90% of cancers and picks up the women now who are at risk of cancer while treatment deals with people who have cancer.

It should not have been a choice between those two things. The Minister should have chosen to make cuts in other spending areas.

Dramatic cuts have been made to consultancies and other such areas of expenditure for next year. I would like to see the Health Service Executive service plan for 2009 debated in the House. It is clear that the public health service will be challenged financially next year to provide services in a range of areas because of the financial situation in which we find ourselves.

This is a morally reprehensible action by the Government and the Minister for Health and Children. She should not tell me she cannot find €10 million out of €16 billion expenditure. She proclaimed — as did the Government — that there would be no cutbacks in health in 2009. It was said there would be no cutbacks in health and education, but now we are talking about a cutback of €700 million.

In response to Deputy O'Sullivan, the Minister stated that of 60,000 births, 50% are female, which is in or about correct, giving a total of 30,000 girls. If we take 80% of the total that gives 24,000, which is probably high compared to most vaccination programmes. I understand the current cost of administering the vaccine to 12 year old girls is €115 per shot plus VAT. When that is multiplied by three, the total is €345. When that is multiplied by 24,000, one gets a total of €8 million — if one wishes to add VAT the total is approximately €10 million, not €14 million as the Minister indicated.

Deputy Kenny should not forget the cost of staff.

If the Minister is going to force parents to pay for this themselves, the very least the Government can do is not charge VAT on the product, which is a medicinal one. Is that the Government's intention?

A procurement agency operates within the Health Service Executive. How successful is it at getting value for money for this kind of product? Surely it should be able to secure savings of approximately 10%? That would be significant and might reduce the overall cost from €10 million to between €5.5 million and €7 million. Has the procurement agency provided value in this regard?

The situation may well arise where the Minister is challenged legally by virtue of the fact that she said she would introduce a programme but she did not do it. She backed off in a morally reprehensible way.

I noticed last week that the Taoiseach was in Carlow turning the sod at the Merck Sharp & Dohme plant, which will mean a major investment in the future. That is to be commended. I understand also that this plant was to manufacture the product and supply one product on a worldwide basis. That was like an invitation to the world to come to our country, invest in our infrastructure and give us jobs, yet a couple of days later the Minister for Health and Children announced she was getting rid of the programme announced in August for the product that is made by that company, which has such a bearing on the quality of life for young girls as they grow into adulthood.

To clarify, we are not cutting €700 million. I referred to planned expenditure. If we are to do all the things we would like to do next year, we require an extra €700 million. In fact, health spending is increasing by 3.1%.

The Minister could drop the bonuses.

In that context, many tough decisions have to be made. The priority in cancer, which is very important, has to be that we improve the quality of treatments by investing in the expertise we need in the eight designated centres. That was €15 million. That money had to be found. It is not easy to find such sums of money. If staff costs account for up to 80% of one's costs, one has to find savings from the remaining 20%. We also want to continue with cancer screening because it picks up women who currently have cancer and treats them. That saves 80% to 90% of women, which is a very high success rate. Many other countries have had screening programmes for 20 years. We have only been running one since September.

We are getting very good value since the central procurement agency was established across a host of areas in the Health Service Executive. On capital plans, for example, I am advised that it is getting reductions of 20% and 25% on what was envisaged. The HSE cannot go to procurement unless we give it the money to procure. As Deputy Kenny well knows, one cannot go into a tendering situation to procure unless one will be in a position to honour that procurement.

The agency could tell the Minister the figure if it could procure.

I have no doubt we can get good value. My statement in August included a reference to "subject to getting good value" because even if there are only two companies——

If the Minister examines the savings on 24,000 cases——

If one signs a blank cheque, one will not get good value. Subject to good value and subject to the agreement of 80% of parents——

——what would they get for 24,000 shots?

It will be a challenge to get 80% of parents to agree because other issues arise.

They will respond. What about the saving on the 24,000?

If I can answer the question, we would then seek the money in the context of next year. In the context of next year, it became a question of trying to continue with the programmes we put in place. I am sure Deputy Kenny would agree that there is no point starting something new if we cannot sustain it. The best thing to do——

There is no point in announcing it either.

It was announced in good faith subject to those two caveats. The best approach is to ensure the screening programme will be fully operational next year, which will be achieved through an extra €25 million and the treatment plans. Many other European countries have not introduced the vaccination programme, for very similar reasons. It is a question of making clinical choices based on the best outcome.

Deputy Kenny should note it is not that we have scrapped the programme or that it will never be put in place, but that we are saying we cannot start it next September. It was appropriate to make that clear.

The Minister is admitting defeat in respect of finding €10 million out of €16 billion.

The labour cost is €5 million. One must also consider the procurement stage for the vaccine. It costs a lot more in Ireland to have vaccines, as Deputy Reilly will be aware. Smear taking costs substantially more here than in the United Kingdom.

It is because of the cost of staff and the manner in which people are remunerated.

The Minister is the final arbiter now. According to the Competition Authority, she is the final arbiter on all prices.

A number of Deputies indicated they want to contribute and Deputy Reilly has already asked his question.

As Deputy Reilly knows, smear taking was put to tender among his colleagues and the prices submitted were substantially higher than those elsewhere — that is a fact.

The Minister is the final arbiter.

I want to Minister to explain the breakdown that results in the figure of 12,000 girls per year at a cost of €600 each. I understand from a radio broadcast this morning that this is where the figure of €15 million is derived. The figure simply does not stand up to analysis. Although we have the tables from the Health Information and Quality Authority, HIQA, I rang a family planning clinic before I entered the House and was told it is €115 per dose plus 21% VAT and that three doses are required. This amounts to approximately €400. If doctors are being paid a full fee, depending on the location, the cost of each visit amounts to between €50 and €60. Are my statistics correct or not?

The HIQA tables indicate a cost of €390 for three shots of vaccine under a school-administered programme. I presume there is no VAT because the service is State provided. The doctor service costs €475. The Minister delayed the programme to have a cost-benefit analysis carried out. Why does she accept that the vaccine cost in Ireland should be exorbitant? This is Bush economics and a case of the private corporations commanding premium prices for public products because of the Minister's policy of privatising the health services. I am thankful the sun is setting on Bush economics in the United States and hope it is doing so here. How can Deputy Harney, who has been Minister for a significant period, stand over the economics of these costs? If she is seriously contemplating that family doctors or individual health clinics should charge the fees I mentioned, it is a resigning issue. The programme can be administered by nurse practitioners.

Does the Minister recall that one of her predecessors, Dr. Noel Browne, was able to eliminate TB at a time when the country did not have tuppence? Although our circumstances are not as favourable as they were, we are still very rich and cannot offer the comfort of positive programmes. In Africa, countries with very few resources have universal immunisation programmes for children in respect of a range of conditions. Children in Cork and other areas are not able to receive ordinary immunisation after birth because the system the Minister oversees is fundamentally broken. She should provide a breakdown of the figures. If she cannot do so now, will she do so later in tabular form?

The cost to which I refer concerns public sector workers. I am not talking about the cost in respect of drug companies but of the cost of the labour of public sector workers.

Is the cost of each shot of vaccine not €115 plus VAT at a rate of 21%? The vaccines are provided by private companies.

Allow the Minister to continue, without interruption.

Irrespective of whether the figure for next year is €10 million, as Deputy Burton states, or €16 million, as the HSE states, I will not have it to introduce the programme next year.

It is outrageous.

In respect of the following year, we cannot start a programme we cannot continue. We cannot give one shot of vaccine in 2009 and not give the two remaining shots in 2010. Everybody will agree that, if we start a programme, we should start it well and continue it. That is what we are doing with the screening programme and the cancer control programme. Deputy Perry should note the same issue will arise when we begin colorectal screening——

Where is all the money gone?

——which will be of equal merit in identifying those with cancers.

However, there is no vaccine.

The Government has ended programmes it started in education and agriculture.

We introduced the pneumococcal vaccine, which is to cost €30 million next year.

But not for cancer.

I know that. I wish we could do everything but we do not have the resources to do so.

A number of Deputies wish to contribute.

It is a bit late closing the stable door when the horse has bolted

The figures for 2006 alone are the latest figures available. The Government gave away €10.6 million in tax breaks for developers of for-profit hospitals. How can the Minister justify giving this away when a smaller sum would have provided a vaccination programme to prevent cancer in women? The Minister should go back to the drawing board, scrap the tax breaks and put the money where it should be, that is, into delivery. It should not be spent on private for-profit hospitals that enrich people when there are women crying out for the vaccine. What is being done is totally immoral and I ask the Minister to reconsider it.

We need infrastructure in the health service and capital allowances have proven to be a very cost-effective way of delivering infrastructure, particularly in the nursing home sector. Very many patients are in private nursing homes that probably would not have been built if it were not for encouragement through the tax system. It is not a question of "either-or".

We cannot introduce the vaccine in the school year beginning in September 2009. It is hoped and intended that, pending financial circumstances, we will be in a position to introduce it very quickly thereafter. It is a belt-and-braces operation to have a vaccine and screening programme. They complement each other. The vaccine prevents certain strains but not all types of cervical cancer. Therefore, we must have the two approaches. It is not the case that one can stop the screening if one has the vaccine, as Deputy Enright said.

I do not believe she said that.

We must do both. Screening must be the priority.

How can the Minister justify tax breaks when we cannot provide the vaccine?

The Minister stated screening should be the priority. Will she explain why only €750,000 has been allocated for centres of excellence. She has found ten reasons not to implement the vaccination programme and this is an appalling indictment of the Government. She cannot find €10 million out of €16 billion. As Deputy Reilly stated, 50 lives could be saved with this money. I am tired talking about value for money, audits and the assessment of costs; what is occurring is appalling when one considers the amount of money that has been wasted.

Will the Minister confirm that Professor Keane has made no contact whatsoever with the oncology team in Sligo? This is an appalling indictment of the Government. Although there is talk of transferring the screening service out of Sligo General Hospital, no contact whatsoever has been made with the hospital by Professor Keane. There is no BreastCheck service and this affects 4,000 women. The Minister is all over the shop on this. Although lives are at stake and the Minister stated screening is important, screening is not taking place. Two beds were to be allocated to Galway University Hospital for the whole north west and we are now told there is to be only one.

Deputy Reilly stated correctly that lives are at stake. The Minister is sacrificing the lives of 50 people to save €10 million — that is the kernel of the problem that arises today. If the Minister cannot find €10 million out of €16 billion, something has gone frightfully wrong. It is an appalling indictment of the system and points to ineptitude and bad management. It is a disgrace. I call on the Minister to reverse her decision.

The Deputy raised many issues. I am satisfied that Galway University Hospital will have the capacity to deal with the patients from the north west.

It has not to date.

It will when the transfer takes place.

The roll-out of BreastCheck will happen in the north west as quickly as possible——

It will be 2011.

The Deputy posed a question that is not germane to the statements.

It is germane——

I allowed it and I now ask the Deputy to allow the Minister to respond.

The Minister referred to centres of excellence and cancer care in my constituency. Nothing is happening.

If the Minister will allow me——

In my constituency——-

Deputy, this is a question and answer session. One poses questions and one allows the Minister to respond.

Why will the Minister not answer the question?

Will the Deputy take his seat and allow the Minister to answer?

Professor Keane has had no contact with Sligo.

The Deputy will resume his seat.

Regarding Professor Keane, his deputy, Dr. Hynes, has been to Sligo on many occasions and Professor Keane is more than happy to meet the clinicians, as the Deputy knows well.

I do not quite know it. The Minister will please tell me.

Deputy Perry knows this. I have told him so before in this Chamber. With regard to the saving of lives, ten or 20 years from now 50 lives will have been saved but 81 lives can be saved through the screening programme. I say to Deputy Perry that this must be the immediate priority, to pick up the women today——-

Where is all the money?

The Deputy wants to have an answer to his question or he does not. The priority is to pick up today, through screening, those women who are prone to cervical cancer and then to provide quality assured treatment. That is what we are doing and that is why an extra €50 million is going into cancer next year, notwithstanding the economic circumstances. That is a fact. We cannot do everything at the same time. I wish we could.

When the Minister announced this plan earlier this year, she said that this service would save lives. Is that true or false?

The Deputy must put his question.

She said it would save lives. This morning, or during the week, the Minister announced that she was cutting this service. Therefore, she is saying that she does not mind if people die of cancer. That is exactly what she is saying.

I had great admiration for the Minister——

The Deputy should——

Am I speaking to the Minister of State, Deputy Andrews? I am not.

He should really think about what he is saying.

I am not speaking to the Minister of State. The Minister is a person——

This is absolutely outrageous.

The Minister is a person for whom I had great admiration. Whenever I was asked, locally and nationally, who was the person outside my own party I most admired, I said the Minister was that person because of what she has done over the years, as a Minister and as a Member of this House. However, my respect for her as a Minister has definitely diminished this week.

This morning, I had a call from a constituent who told me she had e-mailed to the Minister for Health and Children a photograph of her 12-month-old baby daughter. In her e-mail she asked the Minister to choose whether she wanted the person in the photograph to be alive or dead in years to come.

That is the question I pose to the Minister and it is the one that people outside this House pose to us as public representatives. We are asked, as messengers of the people, to pose that question to the Minister. This is to save a measly €10 million. When one sees the wastage in the health service over the past number of years under the Minister's stewardship, it is shameful that the Minister comes into the House and gets rid of this service.

I return to my original point. The Minister said in her statement that this action would save lives. I ask her, as a public representative, to change her mind on this and to reverse what she has already done.

I have a number of comments to make. I will not respond to the question about whether I care that people die. If I did not care, I would not bother to organise these services. It would be much easier not to face as I do, in this House and around the country, any opposition to the re-organisation of services. This is being done for only one reason, namely, to deliver better treatments for cancer patients——

That is not happening.

——with better results. The second point concerns the screening programme. We know this programme will pick up women who have cancer and afford them the opportunity to be treated. If it is to be a choice between picking up those who actually have the cancer today and offering them treatment, or putting in place something that will prevent the cancer developing in ten or so years, I must make——

That is not the choice.

I am sorry but that is the choice. It is a choice that I face along with many of my ministerial colleagues throughout the rest of the world, including those in the European Union. Does Deputy Reilly believe that these Ministers spoke lightly when they said they would not introduce the vaccine this year? Of course they did not.

Third, I will address the question of the 12-month-old daughter of Deputy Kehoe's constituent. We have introduced a pneumococcal vaccine to prevent that child getting particular strains of meningitis, at a cost of €30 million next year. We do these things and we do them as fast as we can, within the resources we can make available, and we do them to a very high quality standard. The screening programme we have introduced is of a high standard and that is what is important. We are doing all these things.

We do not say that we will not introduce the vaccine. We are simply saying that we cannot do so in September 2009. We are not saying that we will abandon this programme or that we will scrap it. I accepted the advice that the vaccine is a good product that should be introduced and I want to see it introduced as quickly as possible.

The Minister should look somewhere else to save money.

I wish to take brief supplementary questions from Deputies Reilly and O'Sullivan.

The Minister has €16 billion in her budget. She can find €10 million. She can give us 20 reasons not to do something rather than find one way to make it happen. I already covered that with her.

The Minister made the argument that she has choices to make. The choices are not between cervical screening and cervical vaccination but between front line services and bureaucracy, taxis, meetings and bonuses for the bosses. Those are the choices. What about the 5,000 redundancies that we were supposed to see? We have not seen them.

The Minister says she cannot do this. I quote the President-elect of the United States: "Yes, we can." I say to the Minister that if she does not reverse this decision, and if the Minister of State beside her, Deputy Andrews, does not do so, she will be forced to vote on this matter, and on her future as Minister for Health and Children, on the floor of this House. This is a step too far. We are at a crossroads in this country where the choice is between Boston or Berlin. We know the Minister has gone to Boston in respect of health care but the country is not going with her. The people aged over 70 will not go with her because of the medical card issue; disabled children will not go there with her, children with special educational needs will not go with her and the children affected by today's decision will not go with her either.

I wish to take a brief supplementary question from Deputy O'Sullivan.

I apologise. I have a question. If the Minister——

Did the Deputy take a 5% pay cut?

VAT is to be applied to this vaccine programme. Will that be removed?

For the sake of the young women of Ireland, I wish to end this debate on a positive note. In August the Minister said, and has repeated as much today, that she would roll out this programme in September next year subject to cost and to a take-up of 80%. We already brought the cost down today. It appears from the debate today that the Minister accepts that the cost will be in the region of €10 million. I ask the Minister to do two things. Perhaps she cannot officially do them but unofficially somebody might talk to the pharmaceutical companies who supply the vaccine in order to investigate whether we might get it at a cheaper rate than the estimated €100 per vaccine. I believe we can.

Could we also check whether the schools are happy to administer the programme? The Minister's other proviso was for an 80% take-up. If the vaccination can be done through the schools, I am confident that she will get that percentage take-up. Might we then see if we can find the remainder of the money somewhere within the Health Service Executive budget or within some other aspect of Government? It is not a great sum of money. Might we leave this Chamber with some type of positive hope that we can actually bring in this programme next year? That is what the people want to hear. They know we have arguments in this House and that we shout at each other across the floor. What they want is a positive result.

If the Minister can turn around her decision she will be seen as humane, caring and life-saving. I put it to her that if she does these things, if she reduces the cost, gets the agreement of the schools and finds the money, that we will all have done a good day's work.

With regard to Deputy Reilly's point about Boston or Berlin, the Swedish Government has not introduced this vaccine and I do not believe it could be put into the Boston schools of economics or politics. Several other Ministries have not done so either, for the many reasons we face here. Clinical choices must be made based on the best clinical advice when there is public money to spend.

Concerning Deputy O'Sullivan's point about cost and take-up, I said earlier that I accepted the health technology assessment which advised that the introduction of this vaccine in Ireland would be a good thing. We want to have it as quickly as possible and I had hoped to introduce it for the school year beginning in September 2009, subject to 80% of parents agreeing that their daughters should receive the vaccine, and that it be cost-effective. That cannot happen next September but I hope it can happen soon thereafter.

Why can it not happen then?

The resources have not been provided for it for 2009, in respect of what was allocated in the recent budget and confirmed to the HSE. We have not provided new money for this programme because we do not have it.

It has been suggested that the Minister could find the funds elsewhere.

I could make choices and decide not to proceed with the €10 million for speech therapists for children who have terrible language problems.

I am not suggesting the Minister do so.

What about the €10 million for Government advisers?

The time for the debate has expired. I ask the Minister to conclude.

These are the type of choices one would have to make in health. While the cervical cancer vaccination programme cannot proceed in 2009, I hope it will proceed as soon as possible thereafter.

The Minister takes the soft option every time. She does not have to go to Sweden to find a comparison as she could find a better one 40 miles up the road in the neighbouring jurisdiction.

The Deputy's GP colleagues up there are paid much less than down here.

The Minister is the final arbiter.