I thank the Minister for taking this Adjournment matter at such a late hour. It is a sensitive and difficult issue for many women and must be raised given its significance. I refer to the provision of prostheses for those who suffer from breast cancer. Prostheses is a form of artificial breast that fits into a bra in order to replace the natural breast. According to the latest data from 2006, an estimated 16,000 women in Ireland have undergone breast surgery and require external breast prostheses. The provision of a well-fitting prostheses in a mastectomy bra is an essential aspect of the healing process. For a woman's body image, femininity and well-being following breast cancer surgery, it is a vital part of the recovery process.
There are many types of prostheses, including standard, partial, shell, light-weight, self-supporting, foam and temporary. At present there is a significant problem in certain parts of the country with the type of prostheses available to women. The service is patchy and ad hoc, and depends completely on the policy of the local hospital manager. The prostheses fitting service and the standards which should be applied for this extremely important aftercare are not being applied nationally. A good quality prostheses fitting service with equity in access, as well as consistently high standards of care, is vital for any women who needs it for her body image, femininity and psychological well-being.
There is a need for the Minister for Health and Children to indicate what is to be done to maximise the holistic approach to lifelong aftercare for breast cancer patients, particularly those who need prostheses. The Irish Cancer Society invited a number of us to a meeting recently to talk about this matter. The society considers, however, that nothing has happened since 2006. We have invested so much in creating world class standards of care so that no matter where one lives, once one walks through the doors of a designated cancer service one will have exactly the same high quality experience. However, cancer care does not stop at the hospital door, so we need to do better on after care. The standards for prostheses provision should be under the remit of Professor Tom Keane in the national cancer control programme. All suitable products should be available to all women in all parts of the country, and there should be equitable costs and expenses nationwide.
HIQA is currently developing quality safety standards that will cover all health care sectors and services. Part of the process will involve a review of the national quality assurance standards for symptomatic breast disease services. The Irish Cancer Society will be recommending the inclusion of standards of care for breast prostheses supply and fitting in the revised standards.
In 2006, the Irish Cancer Society conducted research in partnership with DCU, funded by the Health Research Board, to investigate the woman's experience in the provision, supply and fitting of breast prosthetics in Ireland. They talked to women with prostheses, with medical staff and prostheses suppliers. They broke it down into three different areas: the patient's viewpoint, the environment and the prostheses flitters. From the patient's viewpoint there was dissatisfaction with aspects of the prostheses — in particular, the wait. Some 24.4% had a problem with that, while 17.3% had an issue with comfort and 14% of people had a difficulty with body movement.
Almost half of the women had not received information on prostheses and nearly 70% said that a choice of centres was important. There was a need for the best possible fitting environment with a range of products and the space and privacy to try them on. There are no national or service guidelines for retail fitters. There is a need for a trained, competent, knowledgeable and sensitive female fitter.
In 2006, in response to the issues raised in the research, Action Breast Cancer, a programme of the Irish Cancer Society, developed the standards of care for prostheses. They are endorsed by the Irish Breast Care Nurses Association, Europa Donna Ireland and Reach to Recovery. These standards of care give women an understanding of what to look for from a prosthesis and bra-fitting service and provide useful guidelines for those providing the service.
I visited London some years ago with Europa Donna Ireland and saw the difficulties that arise in trying to provide an holistic cancer care service. The consultants there told me not to fight for services in my local hospital just because it is local. We have been lucky in the north west in that Letterkenny has been linked to Derry. There is a service there that will equal those of the other seven cancer care services.
I am not speaking today about the north west but about the national service. If someone has had a mastectomy, she must live with the consequences for the rest of her life unless she opts for breast reconstruction. It must be dealt with regularly as people grow older. It is an issue that is not known about as much as it should be and there is definitely not a nationwide service which should be in place. The service should be integrated into the cancer care service under the aegis of Professor Tom Keane. I hope the Minister will have some positive news for the 16,000 women with breast cancer and the others who will suffer from it in the coming years. There but for the grace of God go any of us. I look forward to the Minister's response.
