Cancer Screening Programme: Motion.

I move:

That Seanad Éireann, recognising that Ireland has one of the highest death rates from breast cancer in Europe, condemns the failure to extend the operation of BreastCheck, the national breast screening programme, nationwide, as promised by the Government; and calls on the Government immediately to commit the funding necessary to ensure that women all over the country have access to free, regular breast screening in their own area within two years.

While it pleases me to move this motion and ask the House for its support, the issue under consideration is a matter of life and death. BreastCheck must extend urgently the national breast screening programme to women everywhere. Ireland has a very high mortality rate from breast cancer, which causes the death 650 women each year. An organised screening programme, such as the BreastCheck programme, can reduce the number of deaths by 20% to 30% among targeted groups. BreastCheck targets women in the 50 to 65 age group.

I congratulate the staff of BreastCheck on the excellent work they have done so far to produce a high quality screening programme run by the best of personnel. It is an excellent programme which provides very good feedback to those who avail of it. Last year, BreastCheck was commended for having one of the best such screening programmes in Europe. That is why everyone wants to benefit from it and it is also the reason everybody should have access to it.

I will cite some other figures for the benefit of the Minister, although I am sure he is already aware of them. Up to September 2002, BreastCheck had detected 634 early cancers and last year 30 early cancers per month were being detected by the programme. This represents a detection rate of 8.9 per 1,000 women screened, aged from 50 to 64.

I have held discussions with the BreastCheck organisation about rolling out the screening programme. In the context of those discussions we extrapolated figures showing that there are currently 45 undetected early cancers among the female population of north Tipperary aged beteen 50 and 64. The figure could possibly be higher because north Tipperary has one of the highest rates of breast cancer in the mid-west region and nationally. The failure to extend the breast screening programme has implications on that scale for that area alone. At the moment, therefore, there are 45 women in north Tipperary who have breast cancer but are unaware of it. The only way they will find out is if they are screened for early cancer diagnosis by a programme like BreastCheck. Indeed, it is the only programme that could detect such early cancers.

Last week's announcement that the programme is to be extended to a small number of additional counties caused widespread disappointment. Advertising and the feedback from the programme have created an expectation among women that not only are they entitled to such screening but that they will have it soon. The reality is very different, however. I have a simple question for the Minister – why is the programme not being extended?

From my discussions with BreastCheck I am aware that problems have arisen over the recruitment of radiographers and other specialist staff specifically for this programme. I appreciate that certain infrastructure is needed, as well as trained specialist staff. Despite that, however, the BreastCheck organisation has done the necessary groundwork and it could roll out its programme to the southern and western areas within 22 months of receipt of the required funding. Any delay in providing that funding means an inevitable delay in delivering the service to those who need it.

I estimate that women in north Tipperary and other areas will have to wait for many years before they can avail of such a screening programme, even though for many of them it could prove to be the difference between life and death. Is lack of money the reason? We can only assume that it is. Let us examine the costs. According to figures supplied as recently as last week to the Oireachtas Joint Committee on Health and Children, by the chief executive of BreastCheck, Mr. Tony O'Brien, the capital cost of extending the programme would be €13 million, rising to €21 million. That cost is not excessive, considering the excellent quality of the service and the implications of its availability for reducing deaths from breast cancer.

Let us examine the matter from a comparative point of view. How much are we currently spending on the national roads programme? I am not saying such spending should be reduced, but it runs into billions. I understand we are spending €60 million a year on animal disease eradication. Can we not afford €21 million to save the lives of women across the country? It seems that we either cannot or will not do so. I want to know who is responsible for that decision. Is it the Minister for Health and Children or the Minister for Finance? The women of Ireland demand to know who is behind this.

I want to discuss briefly the implications for people in areas where breast cancer screening services are not available. Last autumn, it emerged that the mammography unit at Nenagh General Hospital in north Tipperary was not being replaced by the Mid-Western Health Board, although this news did not come as a big surprise. There had been a breast and smear clinic in the hospital which was staffed entirely by female nurses. It was a popular local clinic run on an out-patient basis and it had a high reputation in the community.

The smear clinic closed down following the establishment of the national cervical smear testing programme. I commend that national programme and, as such programmes go, it is far easier to implement than the breast screening programme. There was much anger in the community, however, when it emerged that the mammography machine was not to be replaced. I had rarely experienced such a reaction to any issue in my work as a public representative.

In response, I organised a public meeting which was attended by a large number of women from the area. My colleague, Senator Noel Coonan, was present and he would probably agree that it was a very emotional event. Anger was expressed by those women who felt that issues affecting their personal health and that of their families were not being recognised or acknowledged. Arising from that meeting there was a demand for action. While it is understandable that the operation of a mammography unit in a hospital such as Nenagh General Hospital demands resources which might not be available at present, people could not understand why the services at Limerick Regional Hospital could not be linked to Nenagh by way of an outreach centre from the breast clinic and cancer centre in Limerick.

Following the meeting, we received an invitation from Limerick Regional Hospital to look at the cancer centre there, which is a symptomatic cancer treatment unit. We travelled to examine the unit which is impressive. Given its current staffing levels, it is very good. However, as has been pointed out quite rightly, women can only get access to that clinic if they are showing symptoms of breast cancer. In other words, it is no longer possible to obtain a routine mammogram in the north Tipperary area.

Interestingly, while it was decided not to replace the mammography machine at Nenagh General Hospital, it was decided last year to replace the mammography machine at Ennis General Hospital which, as the Minister knows, is in the same health board area. I have received two conflicting reports as to the reasons behind that decision. Perhaps the Minister would like to clarify this matter. One reason is that a directive was sent last year by the Minister to the health board to replace the machine at Ennis General Hospital. If that is the case, we in north Tipperary cannot understand why the machine in Nenagh hospital was not replaced. Ennis General Hospital is similar in status to Nenagh, although the population may be slightly higher. The reasons we were given for the non-replacement of the machine in Nenagh would appear to apply to Ennis also. There seems to be an inconsistency in the approach.

Routine mammograms are not now available at the hospitals in question. Women with a family history of breast cancer and whose sisters have died from the disease have been refused a mammogram at Limerick Regional Hospital because they were not considered to be at risk or did not have signs or symptoms of cancer. Naturally, this has been the cause of much anger and outrage. Such behaviour is not acceptable is not acceptable. The failure to extend the breast screening programme means that a woman with concerns about her health cannot have them assuaged.

I reiterate my case by saying that this is a matter of life and death. Lives are being saved thanks to the BreastCheck screening programme, where it is in operation. The women of Ireland cannot see what is preventing the extension of the programme. The Minister needs to make a decision now, particularly in view of the fact that it will take a minimum of 22 months to roll out the programme. He needs to find the money to extend the BreastCheck programme nationwide. Many lives will be saved as a result.

I second the motion. It is sad when the Upper House of the national Parliament has to debate an issue of this magnitude. The failure to extend the BreastCheck service nationwide, as per the commitments given at different stages by various Ministers, is a shocking indictment of how money is being expended by the Government. I am not being flippant about expenditure in essential areas, but the Government places greater emphasis on animal health than it does on women's health.

The Book of Estimates for 2003 states that €60 million will be spent on the eradication of bovine TB and that €70 million in total will be spent on the eradication of animal disease. It would only cost €25 million to extend the BreastCheck scheme nationwide and that could be achieved within a period of 22 months. I find it difficult to accept any excuse as to why this has not already been done.

The success of the BreastCheck programme speaks for itself. By the end of August last year, over 91,000 women were invited for screening and 74% took up the offer. Up to June of last year, over 544 cancers were detected. That statistic, while in its way is sad, speaks volumes about the success of BreastCheck. The recent announcement that the scheme was to be extended to Carlow, Kilkenny and other places is welcome. Any assistance provided to women who may be carrying this deadly disease is a welcome development. However, the failure of the Government to extend this service to places such as Cork and Kerry and areas in Connacht is absolutely unforgivable. As already stated, the fact that the Government spends more on animal health is an affront to people's integrity and to democracy.

The Progressive Democrats stated in their manifesto that no person would have to travel 100 miles for radiotherapy treatment, but this aim has not yet been achieved. The Celtic tiger roared loud and often enough for many years and the Government should have been in a position to divert funding into this area and uphold commitments such as that made by the Progressive Democrats.

In west Cork, the reality is that many people have to travel over 100 miles to obtain this essential service. I cannot think of any credible reason that this service has not been extended nationwide and why it is not available to people in urban centres such as Cork. Is this because the Minister for Finance has refused to give him €22.5 million to extend the service? Is it because the Department of Health and Children, which has so much money in its budget, is unwilling to increase the funding for the service? Who really runs the Department of Health and Children or the Department of the Environment and Local Government?

In recent days it was indicated to the House that the Minister for the Environment and Local Government expects the ordinary Joe and Mary Soap to finance benchmarking in his Department by paying exorbitant increases in refuse collection charges. This is mainly due to the fact that the Minister for Finance, Deputy McCreevy, has refused to provide the necessary funding. Is the situation the same in the Department of Health and Children which requires €22.5 million to finance a service relating to such a serious and life-threatening disease? For some strange and obscene reason that money is not available or is not being given to the Department of Health and Children to allow it to extend this essential service. Who is running the country? Is it the apostle of fiscal rectitude in Kildare – the Minister for Finance – or is it the Taoiseach, the Tánaiste or the Cabinet? I can find no plausible, logical reason that €22.5 million cannot be spent on such an essential service. People's lives are at risk. I ask the Minister to answer the questions I have raised. I hope and pray that in the coming days and weeks the reality and seriousness of this situation will come home to some people who sit at the Cabinet table.

I move amendment No. 1:

To delete all words after "That" and substitute the following:

"Seanad Éireann commends the Government on the substantial investment in cancer services in recent years and, in particular, on the introduction of new screening services for cancers affecting women; and supports the Minister for Health and Children in his commitment to extend the BreastCheck Programme to women in the 50-64 year target group throughout the State."

It is true to say that women are a very important part of everyday life, particularly in the home and throughout the State.

The Senator only thinks they are important.

The Senator will discover the reason I believe they are so important in a moment. The Opposition had the opportunity to do something about this matter and I will also refer to that later.

BreastCheck, the national breast screening programme, commenced in March 2000 – the Senator knows who was in power at that time – with phase one covering the Eastern Regional Health Authority, Midland Health Board and North Eastern Health Board areas. Screening is being offered free of charge to all women in those areas in the target age group of 50 to 64 years of age.

The BreastCheck initiative has most certainly been a success since its commencement. By the end of August 2002, 91,906 women had been called for screening and 68,184 women have been screened. This represents an uptake of 74%. The Minister for Health and Children, Deputy Martin, recently announced that BreastCheck will begin the next stage of the national extension of the programme by rolling it out in Counties Carlow, Wexford and Kilkenny. Approximately 19,000 women in the 50 to 64 age bracket in these counties will be invited for screening. It is expected that approximately 60 additional cancers will be diagnosed and treated annually as a result.

The board of BreastCheck recently submitted a business plan to the Department of Health and Children for the national expansion of the programme. The Department is in discussions with the executive of BreastCheck in relation to the expansion of the programme and, in particular, the linkages with the existing symptomatic services. The Government is completely committed to the national extension of BreastCheck and has invested substantially in the development of symptomatic services. Further development is still required, but we will continue to commit our efforts to BreastCheck and we will ensure that the national extension programme will be completed as soon as is humanly possible. We must proceed on a phased basis in order to take into account the complexities involved in the screening process.

Cumulative additional investment in cancer services since 1997, when we took over the implementation of a national strategy, is in excess of €400 million which represents an average increase of almost €60 million annually well in excess of the £25 million initially envisaged in 1996 to implement the national cancer strategy when the Opposition was in power. An additional sum of €29 million has been allocated in 2003 for cancer services.

A research programme has been launched under the Ireland-Northern Ireland Institute cancer consortium which will allow hospitals throughout Ireland to participate in high quality clinical trials of new therapies for cancer, helping to ensure new and effective treatments are made available more quickly. The esteemed National Cancer Institute in the United States provides access to cutting edge research, prestigious clinical expertise and ground-breaking technologies. Our cancer services and cancer patients are the principal beneficiaries. Significant resources have been invested in the programme in order to establish an effective infrastructure for clinical cancer trials. To date, awards to the value of €3.5 million have been made available through the Health Research Board to allow hospitals to recruit and train staff, improve facilities and take part in world class clinical trials.

It is amusing that the motion was raised by the Labour Party because during the financial crisis of the 1980s and early 1990s Ireland did not have the funds to create the world class health service we all deserve. By the mid-1990s, however, the money was certainly available. The Labour Party was then in government but failed to put money into cutting waiting lists and providing new nurse training places or to provide the funding which the health service desperately needed. As everybody knows, there are necessary run-in times in the health sector. It takes years to train doctors and nurses, build wards and put programmes in place. Had Fine Gael and the Labour Party started the job of reforming the health service in the mid-1990s our problems today would be greatly reduced.

The Labour Party's record in government was disastrous. In the years 1995 to 1997 a Labour Party Minister for Finance, Deputy Quinn, raised the health spend by just £400 million. Two years ago he made the startling admission that his failure to heed concerns expressed regarding the future of our health service had led to many of the difficulties which we now face. Just over six years ago, when there was a different Government in office, concerns about the future of the medical professions, particularly nursing, were communicated to both the Government and the Opposition. Certain predictions were made about the changes that would occur, especially with regard to the number who would enter the nursing profession and the availability of well motivated and qualified people. A college of nursing was established in my health board area and I had the honour of presenting a second group of graduates with their certificates last Thursday. On 21 March 2001 Deputy Quinn said about the concerns expressed, "I confess I did not listen to those voices at the time as well as I might have, and the problems the Minister for Health and Children now has are, in part, related to that." He was not alone. His colleague in government, Deputy Noonan, then Minister for Health—

The Senator might talk about women for one minute instead of talking about the Labour Party. He should say something constructive.

Not alone do we talk about them, we look after them. The Opposition did nothing when in office. If it had, we would not have the problems we have today. We have done a lot and accept there is more to do, about which Senators will hear from the Minister.

The then Minister for Health, at a time of relative fiscal prosperity, cut the funding allocated for the reduction of waiting lists in 1997. This decision was taken at a time when the numbers on the lists had increased by 27 %. This bizarre reaction of addressing a 27% increase by cutting spending by 20% says it all.

The future plans for cancer services must be taken seriously. The national cancer forum, under the chairmanship of Professor Paul Redmond, is developing a new cancer strategy in conjunction with the Department of Health and Children. The national cancer strategy 2003 will set out the key areas to be targeted for investment in the coming years. As part of this work, the existing strategy is being evaluated to assess its success and the gaps in cancer services which need to be prioritised.

We have a caring and compassionate Minister. I assure the Opposition we will finish what we have started in regard to BreastCheck. While the job is well advanced, I accept there is more to do. I am not being patronising in saying I appreciate the women of this country to whom I pay tribute.

I support the Labour Party motion and congratulate BreastCheck on the excellence and high standard of its service and data. We were promised that the BreastCheck screening service would be available nationwide by 1999. That promise was then extended to 2002. Now we have to wait another 22 months before it will be extended to the south and west. That is unacceptable.

Women not covered by the BreastCheck programme are at risk and live in fear of breast cancer. A modest amount, just over €13 million, is all that is required for the roll-out of the service. This expenditure would represent good value. When I see how the Government throws money around, for example, €250,000 was spent yesterday on photographs, I know the money could be found. Some have said the problem is a shortage of radiographers but my belief is that it all comes down to money. The service is overdue. What drug could cut the cancer mortality rate by 20%? What we need is money and a dedicated plan to ensure the west and south get the same treatment as other parts of the country.

There is strong evidence for extending the programme to women aged between 65 and 70 years provided they have already attended. More cancers would be picked up and there would be a better chance of securing a reduction in mortality. In America some women avail of breast checks through an insurance based system. There is a cancer epidemic worldwide and in Ireland the situation seems to be particularly bad. The World Health Organisation has stated 80% of cancers are linked to environmental causes.

Mention was made of offering the service to women aged between 30 and 50 years. There is an alarming incidence of breast cancer among women in that age group. This needs to be investigated. I urge the Minister to commence a roll-out programme immediately. Why is the high detection rate related to the start-up of the programme? Why do 650 women die each year from breast cancer? If the mortality rate was cut by 20%, 130 women nationally would be saved.

Given that only half of the country is covered by BreastCheck and the screening programme has been in place since 2000, 195 women could be alive today if the service was extended to the west and south. It is unforgivable that those women might have been saved if breast screening had been introduced to these areas. There is a major disparity in the health provisions made for the east coast area in comparison with the south and west.

Last July the board of BreastCheck made its report to the Minister, yet he acknowledged receipt of it only in December. What happened to it in the intervening five months? I support the Labour Party motion.

I welcome the Minister to the House and thank him for giving us of his time. I think I am the first speaker to do so tonight.

I was outraged by the remarks of Senator McCarthy. It is an insult to women everywhere that he should suggest more is spent on animal welfare than on women's health. I suggest that the Senator does not hold women in high regard. Is the Labour Party trying to score a cheap point on the backs of sick and vulnerable women? Putting publicity before patients is not on. I wish to bring a sense of balance to the debate. Unlike the Labour Party, I think it is wonderful that we have the opportunity to debate the issue of breast cancer and its treatment services.

There are two levels of diagnosis available to women in detecting breast cancer; screening is one and symptomatic diagnosis is the other. Everyone knows that it is possible to detect a lump by self-examination. Nipple discharge is also an indicator that something is not quite right with one's breast and a woman should then go and have that checked.

We are all very familiar with the O'Higgins report on a cancer strategy. Professor O'Higgins promoted the idea of centres of excellence. Under the previous Government, which was also a Fianna Fáil-led administration, 13 such centres of excellence were set up. Three of these are based in Dublin; one in the Mater Hospital, one in St. Vincent's Hospital and one in St. James's Hospital; there are two in Cork and one each in Waterford, Portlaoise, Limerick, Galway, Drogheda and Letterkenny. These locations were chosen to provide optimal coverage throughout the country. Because of the nature of these centres, their staff is of the highest calibre. I take my hat off to the Minister for his decision in this regard.

We have the best oncologists, surgeons, radiologists, pathologists, haematologists and related medical support staff to go with the multidisciplinary teams. Heretofore, we never saw the like of this. General surgeons treated women who presented with lumps or breast cancer. We now have multidisciplinary teams delivering the appropriate treatment in these centres of excellence. It is an accepted principle that to sustain such a centre one must have adequate case volumes, that is, in excess of 100 individual cases presenting per year.

There is an enormous amount of research ongoing in this area. In preparation for this debate I took the trouble to ring two friends of mine who have both been unfortunate enough to develop breast cancer. One of them was picked up through the screening process, while the other detected a lump herself. Both said that, regardless of the method of diagnosis, the most important element was the service provided to them. Each of them spoke about how excellent the service was and the great care they received, particularly the lady who was picked up through screening who had a team of seven medical experts available to her and, at any time, two or three of them might be dealing with her problem. She did not particularly wish to know how advanced her case was and there is an argument both for and against having this knowledge. Ultimately she had to be told but she is delighted with all the care she is receiving.

I do not agree with Senator Feighan's allegation that women's lives are being put at risk. There is an alternative to breast screening, which I have outlined. However, there is a huge amount to be gained by screening. Even if the Minister had money at his disposal to extend the scheme, the medical expertise is not there to provide it. It is, therefore, virtually impossible for us to do that.

I commend the Minister for extending screening to the areas of Carlow, Wicklow and Kilkenny. Such places could almost be considered as outreach elements of the Dublin programmes as they are within easy reach of the capital. In commending the Minister, I should point out to the House that, to date, since 1997 some €400 million has been spent on cancer care, which is far in excess of what was envisaged at that time.

I also took the trouble to talk to some medical experts who are caring for women with breast cancer. They are some of the most highly qualified medical practitioners in the country. The Minster will be delighted to hear that they take their hats off to him also. They commend the way he is directing the Department, as well as his caring, understanding and approachable manner, in addition to his grasp of the problems that face the Department and his ability to move them on.

As a member of Fianna Fáil I am delighted the Minister is in the House to talk to us on the issue of screening for breast cancer. We must not forget that there are other ways of detecting breast cancer and it is wrong of the Opposition to hammer us on this one. It is an attempt to get cheap publicity.

I also welcome the Minister to the House. I am very glad he has been able to visit the Central Mental Hospital. I asked the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, to go there and the fact that the Minister also went is marvellous. I am quite sure he will have been as horrified as I was by the conditions there.

To return to the subject in hand, I speak as a satisfied customer of BreastCheck. I was called back at the right time and got reports very quickly. A friend of mine who was not so fortunate, in that her mammograms were not clear, was also very well treated when it was detected that she had early breast cancer and she has made a very successful recovery from operative treatment. However, it is the Minister for Finance who should be here tonight to hear what we are saying. I am quite sure that if the Minister for Health and Children had the money he would roll out the programme all over the country.

I know there have been staffing problems, particularly with radiographers, but they seem to have been solved. I particularly salute those radiographers who decided to come back for retraining so that the scheme could be expanded to other places.

Those who are getting involved in BreastCheck are receiving excellent treatment. What is distressing for women in the rest of the country is the fact that they know some of us have had excellent treatment and they are not getting it. BreastCheck had a radio advertisement in which women were encouraged to take up their appointment and told how much better the level of survival is if breast cancer is detected early on. All over the country people's expectations were raised, but they were then not offered the opportunity to come forward and be screened.

I take Senator Feeney's point that one can have a symptomatic diagnosis. However, the success rate of treatment is much lower then. The value of screening is that, if one manages to catch people very early, small tumours can be diagnosed before a lump appears. If the cancer has got to the stage of nipple discharge the success rate is not good.

The Minister has made great efforts to get centres of excellence going, with little help from some members of my own profession. This is not to mention local politicians, who are sometimes not satisfied unless there is to be a centre of excellence at every corner. I have great sympathy for the Minister in this respect. Nevertheless, there are areas where women are significantly disadvantaged due to the lack of such services as radiotherapy. I do not blame the Minister for this problem. This is why I believe the Minister for Finance, Deputy McCreevy, should be taking this debate.

We must take seriously the need for a better spread of radiotherapy services around the country. Galway, Waterford and Limerick are the most obvious instances. The Minister already knows this to be the case and I am not telling him something he has not heard before. It is very difficult to get a centre of excellence with surgeons, oncologists, breast treatment nurses, psychologists and other professionals all working together if one knows that women in the west of Ireland will need more extensive operative treatment simply because there is not a radiotherapy unit nearby.

A friend of mine told me that one of the most distressing things she found about going to the unit in Cork was to hear people asking for a lift to Sneem or Dungarvan or some other place. Could we even try to make transport for patients a little easier? These are not necessarily the Minister's problems but there are very big problems of logistics, particularly for people getting radiotherapy services.

When are we going to get a national register for breast screening? I have been talking about this need for too long in this House. BreastCheck still gets its register from four different sources. This is a terrible waste of time and money. I believe we now have registration numbers for people up to the ages of four or five. However, we must extend them because we cannot wait another 45 years to call 50 year old women. At a meeting of the Joint Committee on Health and Children the other day I heard representatives of BreastCheck complain that one of their major problems is the lack of a national register. BreastCheck is having to bear the cost of this, which the Minister's Department should not be doing. The Minister should pass this problem to the Department of the Environment and Local Government and tell them to get on with it. It must be possible to extend the register more rapidly.

I am disappointed that we are falling behind in the testing of women who have a genetic predisposition towards breast cancer. That is very important because there are obviously some families where there is a greater hereditary predisposition towards breast and ovarian cancers, which are caused by the same gene. Ovarian cancer is even more difficult to diagnose early and is more deadly. It is important, therefore, that the national genetic centre in Crumlin gets proper funding. The centre never seems to know what its budget is. Professor Peter Harper's report, which was produced by the centre last year and was sent to the Minister's Department, referred to the importance of a clinic and laboratory genetic service for hereditary breast and ovarian cancer and stressed the value of the four year pilot scheme which the Department has funded through the health research board. However, the centre has been funded ever since in jumps of €80,000, which is not much good. The Department accepted the Harper report so the value of it is known. A huge amount of money is not involved but programmes of this sort cannot be run on a stop-go basis because clinical scientists must be employed to do this research. We know the value of these genetic tests regarding the programming of treatment and we must make progress in this area.

Within Europe there is huge resentment at the fact that patenting of human genes, particularly of the BRCA1 which is the most common human gene, has been granted to Myriad Genetics of the United States. Virtually every Government in Europe has made representations about this matter but Ireland has not. I raised this matter in the House on a previous occasion and I ask the Minister to request officials in his Department to look at this again. This will cost us a fortune because some of the best work in the development of these diagnostic tests is done in places like Ireland and we pay Myriad Genetics in Utah every time a test is done in this country. It is immoral that the human genetic profile should be patented. I am not the only one who thinks this. The Minister probably agrees.

I would like to see the Government supporting the other European Governments which have brought this matter before the European Parliament and the World Trade Organisation to say it is wrong. Our voice would matter in this and it is particularly important. It will cost us a fortune because we will be using quite a lot of tests.

I welcome the Minister and I am glad to endorse the amendment proposed by Senator Glynn commending the Government for its commitment to the national breast screening programme.

When I read the motion proposed by Senator O'Meara I looked back at how far we have come. Since 1997 the Government has committed a considerable amount of money, while very little was committed before that. The Government's commitment to breast screening began with phase one, which is in place in the east, the mid-east and the north-east areas.

The programme was to be completed in 2002.

This is an area where we must be clinically correct and absolutely accurate in our diagnosis and treatment and there must be accuracy. Phase one is very successful and there has been an uptake of 75%. The Minister is committed to introducing the second phase which will bring Carlow, Kilkenny and Wexford into the programme.

The Senator should talk about now.

Over the next three years we will have a national progamme in place.

What about the the Fianna Fáil manifesto?

The Minister's heart is in the right place, as everyone's heart is. There is no one in this Chamber who does not know colleagues and friends who have gone through the trauma of breast cancer, either personally or in their families. The Minister is aware that we must have access to screening and would like to see a screening unit in every health board area. That is the forward strategy and funding is being committed to that.

Let us take things one step at a time. We have got phase 1 which is very successful and are now on phase 2 in respect of counties Kilkenny, Carlow and Wexford. I have no doubt it will be up and running in a short period. I congratulate the Minister on taking a special interest in this area, providing €400 million since 1997 and having reports and research carried out to ensure we have the expertise available. We were short of radiographers and consultants in oncology whom we are now getting but it cannot happen over night. One cannot snap one's fingers and say everything is in place. It takes a while to get everything in motion. It is a serious matter. We are concerned about women who discover they have breast cancer. It is important that all backup supports are in place and that the women concerned have access to the nearest unit. The Minister is committed to this area and will do the right thing in the next few years. I have great faith in him. I am here to endorse what has been done and know the Minister has a programmein situ which will provide us with a national programme in the next three years.

My contribution will be brief. Much of what I wish to say has already been said by my colleagues in the Labour Party. I reiterate that the Minister failed to deliver on the Government's commitment in the Fianna Fáil manifesto to extend BreastCheck nationwide by 2002. That is disappointing. I welcomed the announcement in recent weeks that the programme would be extended to counties Carlow, Kilkenny and Wexford. The Government has made a promise, yet another was broken.

Was that promise made?

The Minister promised in his party's manifesto that the BreastCheck programme would be extended nationwide by 2002.

In the last one?

It was also contained in the Progressive Democrats manifesto, just in case the Minister cannot find it in his own. It has probably been put in the bin at this stage.

I can understand that certain services have to be delayed but when it comes to peoples' lives, the Government should introduce a service to ensure lives are saved. For example, Deputy Cowley who comes from County Mayo has said screening is known to reduce the number of deaths by 20% to 30%. Each year we fail to implement a nationwide screening programme lives will be lost that need not be lost. Will the Minister inform my colleagues and me when he intends to implement his party's policy? It is not a good enough excuse that the administration has to be put in place first. He should provide the necessary resources to put a nationwide programme in place as soon as possible.

I appreciate the opportunity to speak to the House on this important issue. I have listened very carefully to the views of Senators in relation to the extension of the BreastCheck screening programme. I hope to deal with some of the issues they have raised. I have no disagreement with the essential tenet of what is being said in relation to the need for an extension of the breast screening programme. I have publicly expressed my commitment to the extension of BreastCheck and did so at the launch of the BreastCheck annual report.

My commitment is based on principles of equity. Women in the 50-64 age group should have access to the same level and quality of service, regardless of geography. The BreastCheck programme is for women aged between 50 and 64 years. This applies equally to breast screening services, access to breast surgery and oncology drug therapies which combined are essential elements in an effective breast cancer programme. It is the combination of these modalities of care, with radiotherapy, which are required if we are to reduce mortality rates from breast cancer. That is the reason we take issue with the nature of the debate so far on BreastCheck in that there has been an attempt to almost isolate it from every other component part of a breast care programme. That is a huge mistake. Let us remember also that women who present with symptomatic breast disease are entitled to as rapid access to care as those who go through the BreastCheck programme. The combined nature of the different modalities of care coming together is the key point. I will flesh this out later.

I accept that Irish mortality rates are out of line with European data and need to be reduced. It is important to state the vast majority of women with breast cancer will be diagnosed and treated outside the national screening programme. Judging from the debate in recent weeks one would imagine BreastCheck was the be all and end all of saving lives. It is not. I argue that prior to 1997 – I do not mean this in any political sense – we were not treating cancer properly and not responding to it in any sophisticated focused programme in line with international best practice which would guarantee better survival rates and a better outcome.

While incidences of breast cancer rise dramatically in older women, breast cancers still make up a high proportion of all cancers in younger women. National Cancer Registry data show that 35% of breast cancer cases occur in women in the 50-64 year age group. Because the screening programme deals only with women in the 50 to 64 year old age range and only those who have no symptoms, the great majority of women with breast cancer will continue to be diagnosed and treated outside the screening programme. For this reason and because of the need to investigate and treat the large and increasing number of women with breast symptoms due to benign conditions, it is necessary to develop and support both the symptomatic and screening services to ensure a comprehensive cancer service for women.

I am pleased to have an opportunity to speak on the Government motion which concerns a broadly based cancer programme within which breast and cervical screening are important components. The significant progress made in terms of the growth in funding available for the sector in recent years is indicative of the Government commitment and mine, as Minister for Health and Children, to the ongoing development of cancer services.

Since 1997 there has been an unprecedented level of investment in cancer services. Since the implementation of the national cancer strategy a cumulative figure of approximately €400 million has been invested in the development of cancer services. That represents an average increase of almost €60 million annually, well in excess of the £25 million initially envisaged in 1996 when the national cancer strategy was devised. It was thought that £25 million per year would cover the strategy but that would have gone nowhere near meeting the issue.

This investment has enabled the funding of 80 additional consultant posts, with support staff, in key areas such as medical oncology, radiology, palliative care, histopathology and haematology. Up to quite recently in many cities outside Dublin there were no oncologists. In the major urban centres there were no oncologists. Senator McCarthy spoke about how the people had to travel from west Cork. There was no oncologist in what was meant to be a super regional hospital, Cork University Hospital, up to two years ago. I was in Waterford last Friday where a third oncologist post will be approved shortly. Up to three years ago there were no oncologists in Waterford. This is all about care for women with breast and other forms of cancer.

I acknowledge the sincere commitment to try to expand the service. Let us acknowledge what has happened which represents a sea-change and a transformation in the quality of care for those with cancer. While we have a long way to go, we have achieved a significant amount. It is important to work collectively to get home the concept of combined modalities of care in centres of excellence. I accept Senator O'Meara's genuine concern about the issue of the mammography machine in Nenagh or Ennis but we have got to tell people that a comprehensive cancer programme is not light years away and is ahead of a mammography machine. Some still hold the view that if we have a mammography machine, we have a cancer service. We do not. Keeping in line with best international practice will give us the outcomes we desire and which we envy the capacity of countries such as the United States and others to achieve. This is emanating from people who have been abroad, worked in other centres and who have returned and want the best configuration of services, etc., for Ireland.

The most recent report of the National Cancer Registry, Cancer in Ireland 1994-1998 – Incidence, Mortality, Treatment and Survival, indicates that there is a significant upward trend in breast cancer incidence in women under 65 years. Importantly, there is also a downward trend in mortality rates in all age groups combined, reflecting the fact that survival from breast cancer is good. We are currently carrying out an evaluation of the national cancer strategy. The initial finding is that the original objective of reducing mortality rates is well on target. It is gratifying to see that because we would not like see services and facilities being provided if we were not getting some results in terms of better survival rates and reduced mortality rates. That is the key issue. These trends were evident prior to the initiation of the breast screening programme and I expect them to continue as a result of the continued improvements in treatments and also as a result of the national breast screening programme.

Breast cancer is the individual site specific cancer which has received the most investment in recent years. Since the implementation of the strategy, approval has been granted for an additional 39 consultant posts with a special interest in breast disease. That is a phenomenal increase by any standards in any specialty or area at consultant level.

All women with symptomatic breast disease should have prompt access to high quality multidisciplinary care. Although services should be delivered as close to the patient's home as is feasible, the overriding priority should be to provide the best, safest and most effective treatment for women and in so doing, provide the best opportunity for long-term survival to those who are found to have breast cancer.

The report of the subgroup on the development of services for symptomatic breast disease contains recommendations for the establishment of a network of specialist breast units throughout the country and the appropriate infrastructure, personnel and equipment needed for such specialist units. The report also makes recommendations regarding the siting of such units in each health board area.

The report recommends that specialist breast units should be based on a population of 250,000 to 300,000 from which it is expected that there will be a minimum of 100 new primary breast cancers per annum. The modern management of breast cancer entails triple assessment, a concept which those expert in the field constantly assert as being the key. It involves the surgeon, pathologist and radiologist working as an integrated team.

Since the publication of the O'Higgins report, my Department has been in consultation with the health boards in relation to the development of services for symptomatic breast disease in their respective regions. Since 2001 there has been a cumulative investment of approximately €30 million in these services. The benefit of this investment is reflected in the significant increase in activity which has occurred with in-patient breast cancer procedures increasing from 1,336 in 1997 to 1,839 in 2001. This is an increase of 37% nationally.

BreastCheck currently provides breast screening services to women in the 50 to 64 age group in the Eastern Regional Health Authority, North Eastern Health Board and Midland Health Board areas. It has proved extremely successful in identifying breast cancer among women in this age group and it also provides for the necessary surgical care of women who require breast surgery. To the end of November last year, the programme had invited over 100,000 eligible women for screening and screened nearly 80,000, with an uptake rate of 75%.

Since the pilot phase commenced in 1989, quality assurance has been an integral feature of the design and implementation of BreastCheck. An effective multidisciplinary structure is in place to advise on quality and ensure that it is sustained at the key interface with women presenting for screening or who require treatment.

BreastCheck has ensured that its programme is externally reviewed and validated. Last year a team from the European Reference Centre for Quality visited the programme. The key strengths of the programme identified by the reference centre are: outstandingly high levels of professional expertise; team working; and commitment to the programme with all disciplines working to an internationally recognised standard. The report also congratulates the programme on its investment in high quality and internationally recognised professional staff. This is high praise from an international visiting team and, at the launch of its annual report last October, I congratulated the board of BreastCheck and its staff, who have contributed at all levels to such an impressive result.

My commitment and that of my Department is evidenced by the significant funding that has been provided. There has been cumulative investment of €40 million to date in this programme. In addition, I have also made available approximately €6 million for the construction of a new state-of-the-art screening unit at St. Vincent's Hospital to replace the current Merrion unit. In 2000 we had problems getting enough radiographers and that slowed up phase one to a certain degree. We had to go overseas and do our own in-house education to try to increase the number of radiographers as quickly as possible for the service.

The board of BreastCheck has submitted a business plan and there are three geographic elements to the expansion in that plan. Three further counties – Carlow, Wexford and Kilkenny – are part of the eastern region. Women from those counties who require treatment will be referred to the static units in Dublin, which are already in place. In regard to the west and south, we have selected where the static units will go – the South Infirmary in Cork and UCH in Galway. We must build those static units before anything can happen in those counties. I recently announced that, as part of the next stage of the programme, BreastCheck will roll out the programme in Carlow, Wexford and Kilkenny. Approximately 19,000 women will be covered and about 60 additional cancers will be diagnosed.

I am fully committed to the further extension of the programme to the remaining counties in the west and the south. I will meet representatives of BreastCheck shortly in this regard. The objective is to prepare an effective and cohesive model which is in the best interest of the women concerned and which builds on the quality standards applied by BreastCheck and by the symptomatic services. Any woman with concerns, regardless of age, should attend her GP who will, where appropriate, refer her to the symptomatic services.

Senator O'Meara and others asked about the rollout and why we are meeting representatives of BreastCheck in advance. When I launched BreastCheck in 2000 I did not say it would be available throughout the country in two years. I know this because I re-read the speech I made in Dublin Castle on the evening in question. We said phase one would inform the rollout of phase two because it was very much a learning experience in terms of getting the external evaluation from Europe to make sure the quality assurance was right and so on.

When BreastCheck was launched in 2000 we did not have the Niall O'Higgins report on symptomatic services and the centres of excellence had not been developed. That is important for the following reason. It is the considered opinion of the BreastCheck board that we should roll out BreastCheck in accordance with phase one. Cork will be the static centre for the south and Galway for the west. We have funded and approved 13 centres of excellence and we believe there should be a synergy between the centres of excellence and the BreastCheck model. BreastCheck does not accept that, although it is prepared to discuss it with us and I am prepared to listen to the views of its representatives on this issue.

The practical implication of this is that we could roll out two different strands of a service. We would have 13 centres of excellence with teams of surgeons, radiologists and pathologists while the BreastCheck model would be in these areas as well with separate teams of surgeons and so on. There is an important issue here in terms of the rollout. If a woman from Letterkenny was attending the BreastCheck programme in the east, even though we had developed a centre of excellence in Letterkenny, would she have to travel to Dublin for surgery and for post-diagnostic care if she was diagnosed through breast screening? BreastCheck states that she would have to do so.

We are investing in centres of excellence in Limerick and Waterford, but BreastCheck has said that if women between the ages of 50 and 64 in those regions are identified in Cork, they will continue their treatment in Cork. We have, however, built centres of excellence and employed people in those regions. This is an issue we need to address before the service is rolled out. Funding will then be an issue, but we must resolve the matter to which I refer in the first instance.

Medical professionals have different perspectives on this. I will meet the BreastCheck board, particularly the medical people thereon, because I want to hear why they believe, despite the fact that we have centres of excellence, there should be a ring-fenced continuum in regard to BreastCheck. One would expect that the centres of excellence should be capable of doing some of the work and that those presenting would be given a choice. From BreastCheck's perspective, I can see that there is an issue of quality assurance involved and that it must see matters through to the end of the process. Most people looking at this objectively would say that if we have centres of excellence around the country and have provided significant funding and investment and recruited top class people, surely there should be some synergy between the two, particularly at the treatment phase. That is an issue which is up for discussion.

The cost is approximately €26 million over a two year period. It takes approximately two years to roll out a programme in terms of recruiting specialist staff for a multidisciplinary team and the building and equipping of units. The roll-out will happen on a phased basis in terms of the mobile units which must be put in place. This is a very exact and high quality service. The BreastCheck board received tremendous recognition and validation at a European level and is very anxious that the level of quality is maintained and continued.

The cervical screening programme is a valuable preventive health measure when delivered as an organised programme. Phase 1 commenced in the Mid-Western Health Board area in October 2000. Approximately 67,000 women in the 25 to 60 year age group will be screened at five yearly intervals free of charge. Funding allocated to the board to cover the annual cost of running phase 1 is in the region of almost €4 million. As part of an examination of the feasibility and implications of a roll-out of the national programme, the chief executive officers of the health boards are making arrangements to have an external review of phase 1 carried out during 2003. Other issues relating to the management of the national programme, in particular in the sphere of governance, are also being examined by them.

To meet the additional demand for cervical cytology laboratory services, additional resources have been made available in recent years to develop both laboratory and colposcopy services. These resources have resulted in the employment of additional staff, the purchase of new equipment and the introduction of new technology. In 2002 additional ongoing funding in the region of €2.5 million was provided. This year a further €1.4 million has been allocated to health boards for ongoing development of the services.

The developments I have outlined describe an overall framework through which cancer services can be developed and provided in the most co-ordinated and effective manner. I am pleased I had the opportunity to outline the substantial developments that have taken place in cancer services in respect of which we have made substantial progress across a broad range. We are evaluating the national cancer strategy with a view to formulating a new strategy for the next five years which the national cancer forum is undertaking in consultation with the Department. It is important to bring all services along together to make sure women who present with symptomatic breast cancer have as rapid access to quality of care as those involved in the screening programme. That is the reason we have put so much emphasis, particularly in the last two years, on investment in symptomatic breast cancer facilities and appointed the relevant consultants and so on.

I thank the Minister for coming and his presentation. The screening programme for breast cancer provides diagnosis and primary treatment for women between the ages of 50 and 64 years. I have benefited from such screening and have an appointment shortly for a second screening. While I appreciate what has been done and do not want to criticise Fianna Fáil and the Government, I fully support the Labour Party motion. I would like more co-operation from the Minister's side of the House because we are trying to impress on him how seriously we take the BreastCheck programme.

While I accept much has been done in recent years in regard to the treatment of cancer, more can be done. International studies show that an organised screening programme can result in a 20% to 30% reduction in mortality rates. The Minister said that by rolling out the programme to counties Carlow, Kilkenny and Wexford he expects approximately 60 detections. If it was not rolled out, what would happen to the 60 women concerned? The fact that he is not rolling out the programme to other areas means cases will not be detected, and people may die. What is the cost of a life? The Minister should make rolling out the programme to the rest of the country a priority. I hope he has got a flavour of what we are saying – that this is an urgent matter. He can point to the money spent during the years but we expect that and more. This is about women's lives and the cost of a life.

I am in a privileged position because I live in Dublin. Senator O'Meara, who lives in County Tipperary, does not have access to that level of service. How can we deny women this? Why should women living in Dublin be in a privileged position? Women living in counties Carlow, Kilkenny and Wexford will now be lucky to have access to the service. The Minister said it takes 22 months to roll out the programme. Therefore, when will the rest of the country have access to it? Is he now beginning to establish units in the BMW region and the south? We are afraid it could take up to five years before the other units are in place. How many lives will be lost in the meantime? We cannot afford to wait.

We must ensure the necessary clinicians are in place to provide the service, including radiographers, surgeons and pathologists. The fact that they were not available was a problem in recent years. We must ensure they are trained and appointed in the next couple of years.

I support the motion and ask the Government parties to do likewise. We want to extend the service to every woman in the country. I do not understand the reason the Government parties will not support and work with us on the motion.

I am pleased to have an opportunity to speak in this debate. I welcome the Minister of State and thank the Minister for being here earlier.

It is good to have an opportunity to debate this Labour Party motion. I was very interested in the earlier contributions, including that of the Minister. I would like to disabuse anyone of the idea that there are women in other parties and none in Fianna Fáil.

I did not say that.

I know that. However, I got the impression that other parties were peopled with caring women and that Fianna Fáil had uncaring men and no caring women.

The debate has been interesting because we all want the best of everything immediately, including in the health service. It would be ideal if every woman in the land could be screened immediately to the highest standard. However, we do not operate in an ideal world. We must work within a health budget which has doubled since 1987 and within resources which must be applied to various areas. I was amazed when I discovered how much was spent on cancer services since 1997 and how much continues to be spent. We must acknowledge this fact. BreastCheck is one of a range of services being provided. The Minister listed others which are very worthwhile. He is aiming towards the introduction of BreastCheck in different areas.

The fact that we cannot rub a magic lamp to make these services appear in every part of Ireland tomorrow does not mean that the Minister, Deputy Martin, is not concerned about the health of women, which is at the centre of this debate. What Minister for Health and Children – male or female – would deliberately withhold a cancer service if it could be made available? That is a stark way of putting it, but the motion tabled by the Labour Party leads one to believe that the Minister or the Government decided not to extend BreastCheck facilities, which is not the case.

The Government is committed to providing a comprehensive range of health services, including BreastCheck facilities, centres of excellence and GPs throughout the country available for consultation. I admit that the provision of health services is not ideal and that further facilities could be made available, but the Government's policy is to increase the level of service and expertise.

I welcome this debate. We may not have heard the facts given to us by the Minister if it had not been held. I appreciate that many of the statistics he detailed are available elsewhere, but it is good they have been correlated.

It was a concise presentation.

From where did that voice come?

Senator O'Rourke would never interrupt in such a manner.

Senator O'Rourke, without interruption, please.

It is my fault because, as Senator O'Toole said on a previous occasion, I am inviting interruptions.

The Minister said that although 13 centres of excellence exist, public representatives want one in their local areas. I want one in Athlone, where there is no hospital, and others want them in Tuam and Nenagh. Everybody is keen for their own area to be designated as a centre of excellence. It is to be hoped that the various health reports will be published soon so they can debated in the House. The leaks that have emerged from the reports make clear that we cannot have centres of excellence everywhere if we want better diagnosis, the latest technology and the best professionals to care for and cure those who present themselves at hospitals. I do not refer to the diagnosis of cancer in particular. We will face an enormous decision about that dilemma in five or ten years. Innovations in the health system lead to things that help to prolong and enhance life, such as better drugs, a superior quality of care and new technology.

We will invest in the highest quality facilities, but we cannot do so in every parish. No sudden shining light will cause Senators to agree that centres of excellence are needed and admit that the services provided by certain hospitals need to be curtailed, but such ideas will be gradually accepted. Patients are not being well served by demands that the highest levels of treatment should be available at every crossroads. People often say that they would be fine if there was an accident and emergency department in their local hospital. It would be fine until there was a severe accident and they realised that the hospital did not have the back-up expertise to deal with it.

I welcome the Labour Party's motion in so far as it has provided an occasion for debate, which is useful in itself. I commend the Minister, Deputy Martin, and the Minister of State, Deputy Tim O'Malley, for the proper steps they have taken to bring cancer care to men and women. I particularly welcome the Government's emphasis on the BreastCheck programme and I hope it will be continued and expanded in the years to come.

I welcome the Minister of State, Deputy Tim O'Malley. I acknowledge the fact that some progress is being made, that additional consultants have been recruited and that centres of excellence have been established.

Quick diagnosis and treatment is vital after a woman discovers a lump on her breast. I have heard women say that waiting for diagnosis is absolute hell and that waiting for treatment after detection is no better. Many speakers referred to the BreastCheck service, which exists in some parts of the country but not in others. The service was recently extended to three counties, but I do not understand why it was not extended to the entire health board area. It is ludicrous that we have moved from making progress in relation to BreastCheck on the basis of health boards, to doing so on the basis of individual counties. It should have been extended to the entire health board area in this instance.

The Minister for Health and Children mentioned that there are 13 centres of excellence and pointed out that the BreastCheck system is in operation. He suggested that there may be duplication and said that arrangements to remedy it would have to be arrived at. The Minister's job is to resolve these matters. We all know that there is a great deal of politics in the medical profession and that doctors are not averse to protecting their own patches. Patients – women in this instance – should be a priority, however. It has been proven that lives can be saved if there is early detection of breast cancer and that BreastCheck has a high success rate in this regard. Money should be found for these services, as lives are it risk if it is not provided. The statistics are there for everyone to see and they show that my argument is valid. Surely the money that is needed to save the lives of women can be found. It is of paramount importance that the Government should appreciate this.

Senator Henry mentioned the regionalisation of radiotherapy services. Recent leaks suggest that the facilities in Dublin, Cork and Galway will be extended and that services will be provided in those locations only. I hope these rumours are incorrect because every Fianna Fáil politician in Waterford and the south-east vowed during the general election campaign that a radiotherapy unit would be provided at Waterford Regional Hospital within three years. Movement is needed now if this promise is to be kept because it will take two or three years to put linear accelerators in place and to establish a full radiotherapy unit.

It is fine to make promises before an election, but it is wrong that people who are very ill should have to travel to Dublin from Waterford, south Kilkenny and the Minister of State's home city of Limerick, where people are pressing for radiotherapy facilities. Many difficulties are faced by the families of people who have to travel to and from Dublin, or pay to stay there, for two or three minutes' treatment per day. It is traumatic for all concerned that people who are ill have to travel great distances.

I understand that there are problems in relation to radiotherapy units, but I appeal that the BreastCheck service be extended to the entire country. I urge that radiotherapy units be delivered in Waterford Regional Hospital and regional centres of excellence. The promises made prior to the general election should be honoured as people voted for certain politicians because of the promises they made. Dealing with the sick and those with cancer should be above politics. I appeal to the Minister to deliver on the promises made.

I am glad the House is having this debate and that the Minister for Health and Children, Deputy Martin, was present to discuss the issue. I also welcome the Minister of State, Deputy Tim O'Malley.

Senator Terry made a very relevant point about screening services being available in Dublin only. It is a subject about which I have spoken when dealing with other issues with regard to the west. There has been a strong campaign to have cardiac and cancer services provided in the west and for the regionalisation of health services. The investment of £140 million by the Government in University College Hospital, Galway, showed the investment needed for cardiac and cancer treatment services. Senator Terry's point could also be made about other services. For example, neurological services are badly needed in the west as it is important to have a unit close by when serious injuries occur.

In addition to the services provided in Galway, the Minister provided £11 million to purchase Portiuncula Hospital, Ballinasloe, from the Franciscan Sisters. He gave over £3 million to the local health board to purchase the hospital from the Bon Secours order in Tuam where there are now plans submitted by the Western Health Board for a community hospital. I would like the Minister of State to look at this proposal.

I am concerned about recent leaks to the media. There was a typical leak toThe Sunday Tribune last Sunday regarding the closure of a number of hospitals, when Ballinasloe received particular mention with regard to the loss of maternity and accident and emergency services. It is hard to understand how that could be as the hospital has recently been purchased from the Franciscan Sisters and it would cost millions of euro to try to relocate services. Portiuncula Hospital, Ballinasloe, also provides cancer treatment services.

The Minister made an interesting point when he referred to the €400 million spent since 1997 on cancer services and the fact that 39 additional consultant posts had been approved in the context of breast screening. Three positions are to be made available in the Western Health Board region. There will be interviews for one position in March while advertisements are to be placed in the newspapers for the positions of breast radiologist and breast pathologist in Galway who will also serve Mayo County Hospital, which is important. Screening should be provided nationwide and the sooner the announcements are made, the better, because it takes time to provide a service. Buildings and personnel must be provided. It is important the matter is dealt with for each region.

The Minister also made an interesting point regarding issues to be resolved between BreastCheck and the centres of excellence. He told the House he would be meeting with representatives of BreastCheck shortly and I wish him well in his discussions. Before funding, buildings and personnel are provided, what is to happen with regard to the centres of excellence? This must be sorted out. The Minister outlined what could be a difficult situation for women if they had to travel around the country, going from certain centres to BreastCheck. It is an important issue on which he must decide.

The health boards are under threat. As a member of a health board, I may be under threat also. However, the health boards have done a good job. I am concerned in regard to the closure of hospitals if the boards are abolished. Some new agency may undertake rationalisation. For the same reason, I ask what will happen with breast screening. The Minister got it right when he talked about phase 1 and the other phases he wants to put in place. While he said a lot more work would have to be done to bring breast screening to the remaining counties, he also announced that counties Carlow, Wexford and Kilkenny would get this service.

A serious attempt is being made by the Minister and the Department to deal with the symptoms of the disease. It is hoped he can provide a start-up date in order that, in years to come, the service will be put in place.

The motion gives us a great opportunity to discuss these issues and get the views of the Minister, especially on the relationship between the centres of excellence and BreastCheck, and his discussions to ensure the service is extended to the whole country. It is very unfair that services are concentrated in just one part of the country but this is true for many services. I hope this debate serves to ensure they will be provided throughout the country.

I call Senator Callanan.

I had no intention of speaking in this debate.

The Senator is not obliged to speak.

However, I have listened to the debate and the Minister, Deputy Martin. Cancer and I lived together for a while and I had three attacks. When I look back at my time as a patient and when I see the huge investment and strides made in general care for cancer, I acknowledge a number of facts. I am glad Senator Cummins said this issue was above politics because I commend Deputy Michael Noonan for setting up the health strategy and directing £25 million in that direction when Minister for Health. However, since 1997 in excess of €400 million has been spent by the Government. I welcome this and the advances made in the meantime.

No matter what is done or will be done, those who have been down this path will say not enough is done. That would be case with any medical problem. Those whose life is challenged will always say this, and that money should, ought and has to be found. However, the issue is not about money alone. There have been many developments to ensure experts are available.

Care, treatment and attention are hugely important in terms of overcoming the problem. I say this as one who was challenged and overcame. Funding for research should be provided. The incidence of cancer in this country is far greater today than it was ten or 20 years ago. I cannot even pretend to guess what has gone wrong. This week I attended the funeral of a friend six weeks after they were diagnosed and yesterday evening I received a telephone call from another friend who has also been diagnosed. We all attend funerals of friends who die of cancer and know people who have survived.

Research is needed because science has a role to play. God forgive the scientists who are engaged in cloning. They are not doing a service to natural law. We could overcome the scourge of cancer if we applied ourselves. I call on scientists to stop their extravagant thoughts and concentrate on what human beings require.

Most of this debate has been conducted in a reasonably constructive spirit. The voters of Westmeath decisively answered the Senator who commented on the role of the Labour Party by coming down on the side of my party chairman, particularly in Mullingar. That argument in Westmeath is over and it is time it ended here because we wish to engage in serious political debate.

Much of the time I disagree with the Minister, who is especially clever at casting clouds of obfuscation while leaving his listeners wondering what he is talking about. However, he at least addresses the issues. The opening words of the motion call on the House to recognise that Ireland has one of the highest death rates from breast cancer in Europe. In its amendment, Fianna Fáil has removed those words, yet the Minister indicated his acceptance that cancer mortality rates in this country are out of line with European data. That is why I and my colleagues on this side of the House have good reason to respect him. He is capable of addressing real arguments and he avoids play-acting about what the Labour Party or the rainbow coalition Government did five, six or seven years ago when the country was half as rich as it is now.

I want to address issues. When Senator O'Meara referred to the need for mammography services in Nenagh and elsewhere she did not advocate that every town in the country should be able to provide some kind of health service. We know that is not possible. Her point was that two towns of approximately the same size – Nenagh and Ennis – required the replacement of mammography equipment. The authorities in Nenagh were informed that this could not be done because of the dangers involved. There may be a technical argument in favour of that approach. By contrast, the authorities in Ennis were given a different answer, probably because the then Minister for Arts, Heritage, Gaeltacht and the Islands, Deputy de Valera, was considered to be a more dangerous adversary than the Minister for Defence.

What is wrong here is political play-acting dressed up behind objective scientific evidence. This debate is not served by that approach. I am glad Senator Feeney has returned to the House because it must be said that Senator McCarthy did not trivialise women.

He was referring to a situation where money is scarce. I do not accept that it is. The Government is constrained by ideology from using the funding at its disposal because it will not act in a sensible manner. That would require it to prioritise and borrow sensibly and intelligently for capital projects that are economic while using current resources to fund current problems, among them the inadequacies in the BreastCheck service.

This is a rich country and it is not short of resources; it is short of the political will to make choices and those that are made are conservative and backward looking. The greatest of all economists, John Maynard Keynes, observed that whenever he heard prominent people talk about life in simple terms, such as stating that money was short, they were inevitably harking back to some out of date economist. This is not the 1980s and Ireland is not a poor country. The question is one of choice.

The Government made choices about utilising our resources and one such choice was to slow down the implementation of the BreastCheck programme. The Minister outlined all the issues that needed to be addressed concerning the rollout of the programme. He is superb at that kind of presentation. However, he failed to tell us that when the decision was taken to extend the programme to three counties, those in BreastCheck, as the informed the Oireachtas Joint Committee on Health and Children last week, were the last to be informed. The Minister engaged in his usual nonsense of making a small gesture. The fundamental problem is that it will cost money to extend the BreastCheck programme. The Minister has failed to get the Government's sanction and he has dressed up this failure in a cloud of pseudo-scientific argument which is nonsense.

Amendment put.

Bohan, Eddie.Brady, Cyprian.Brennan, Michael.Callanan, Peter.Cox, Margaret.Dardis, John.Dooley, Timmy.Feeney, Geraldine.Glynn, Camillus.Kenneally, Brendan.Kett, Tony.Kitt, Michael P.Leyden, Terry.Lydon, Don.MacSharry, Marc.

Mansergh, Martin.Minihan, John.Mooney, Paschal C.Morrissey, Tom.Moylan, Pat.O'Brien, Francis.O'Rourke, Mary.Ó Murchú, Labhrás.Ormonde, Ann.Phelan, Kieran.Scanlon, Eamon.Walsh, Jim.Walsh, Kate.Wilson, Diarmuid.

Níl

Bradford, Paul.Browne, Fergal.Burke, Paddy.Burke, Ulick.Coghlan, Paul.Coonan, Noel.Cummins, Maurice.Feighan, Frank.Finucane, Michael.Hayes, Brian.Henry, Mary.

Higgins, Jim.McCarthy, Michael.McDowell, Derek.McHugh, Joe.O'Meara, Kathleen.Phelan, John.Ross, Shane.Ryan, Brendan.Terry, Sheila.Tuffy, Joanna.

Tellers: Tá, Senators Minihan and Moylan; Níl, Senators O'Meara and Ryan.
Amendment declared carried.
Motion, as amended, put and declared carried.

When is it proposed to sit again?

On Tuesday, 25 February 2003, at 2.30 p.m.