asked the Minister for Health if he is aware of a leaflet circulating in the constituency of Dún Laoghaire from his Department and in his name which states that the cervical smear test is available in all health clinics throughout the country free of charge; and if he will name the clinics in the Dún Laoghaire area, the rest of the country of Dublin and the city of Dublin, where these facilities are available.
Ceisteanna—Questions. Oral Answers. - Cervical Smear Test.
1.
I am aware that the Department's leaflet "Summary of Health Services" was circulated in the Dún Laoghaire area. The Deputy will also be aware of a new report which I have just completed entitled "Report: Health Services 1983-1986".
I would like to confirm that cervical smear tests are available nationally through health centres, maternity hospitals on an out-patient's basis and through general practitioners. The level of demand for this service varies significantly from area to area; in areas where demand is low the service is organised on a regular review basis, while in areas with a high demand, a more structured approach is taken.
At present the demand on the Dún Laoghaire health centres for cervical smear testing is, I am advised by the local health board manager, too small to warrant the making of formal arrangements in the health centres. Accordingly, when women present at their local health centre they are referred either to their family doctor, to a hospital out-patient department, or to a health centre where the demand is sufficiently high to warrant the organising of special cytology clinics.
In the case of any individual difficulty being faced by any women in the area my Department will immediately consult with the Director of Community Care to ensure the full delivery of this service.
In the Dublin area cervical smear testing clinics are operating in the following health centres: Rathcoole, Lucan, Clondalkin, North Strand, Ballymun, Coolock, Kilbarrack and Edenmore. In addition, the service is available through general practitioners and at all the Dublin maternity hospitals on an out-patient basis.
The Minister will be aware that a number of constituents brought this circular to my attention. It appears that the information contained in the circular is misleading because it says cervical smear tests are available at all health clinics throughout the country free of charge. I would have thought that would have included the Dún Laoghaire area. Can the Minister now confirm that is not the case, that the information contained in the circular sent out in his name was misleading and confusing to say the least? Can the Minister say what was the cost of publication and distribution of this circular?
The "Summary of Health Services" is the general leaflet of the Department of Health. It is readily available to anybody who wants copies; there is no charge for its supply. It forms part of the general information services of the Department of Health. It indicates that the service is available in all health centres throughout the country. In simple terms, if a woman wants to avail of the service, she goes to the health centre and some centres have formal facilities located in the centres. She notifies them that she wishes to avail of the service, which is free of charge, when arrangements will be made by the staff of the health centre for a referral. In the case of some health centres in a large catchment area — where a large number of women frequently present themselves — formal full service is made available at the centre itself. Otherwise, as is the case in Dún Laoghaire — where women present themselves occasionally, a small number each week at the different centres — the demand would not warrant having health staff waiting for, say, six to ten women a week, perhaps one or two every second or third day. Such persons presenting themselves are referred immediately either to a maternity hospital or to a GP locally who provides the service. I stress that I have not had any individual complaint. I have had many inquiries from women's organisations and so on but no woman in Dublin has come to me or to my Department saying: "I cannot get a cervical smear test done as a matter of urgency".
The ladies I have in mind brought the Minister's circular to a health clinic in the Dún Laoghaire area, and the staff at the clinic could not help them. I do not want to embarrass the Minister — it is not my form having regard to the fact that we share the same constituency — but it smacks somewhat of electioneering, the Minister having issued the circular in his name, the women going to the clinic and discovering that the staff there were unable to assist them. In those circumstances the Minister might examine that type of circular in the future.
The Minister indicated that women going to clinics seeking this test would be referred to a local general practitioner. Would he say whether the service would be free from the local general practitioner in the same way as it might be free, if it was available, through a clinic?
The introduction of the service on a national basis is free of charge and the facility is available. The normal point of inquiry for the delivery of the service is a health centre. We try to build it up on the basis of a community health service rather than referring women directly to hospitals. In Dublin we have a substantial number now in operation. While appreciating Deputy Andrews' point, I do not accept at all that it is a local matter in so far as our constituency is concerned. I emphasise that my discussions in the Department of Health and with the Director of Community Care indicate that the service is readily available, that there have been some backlogs at the hospitals undertaking the actual assessment. That is something that was occasioned by disputes about overtime and so on, most of which have been resolved. We had continual difficulty in relation to St. Luke's Hospital, for example, but that was resolved last year. Overall, the service is available and Deputy De Rossa made that point. Since the previous parliamentary question came up in the House, I had the service extended to the health centre in Ballymun.
If there are sufficient women in Dún Laoghaire presenting themselves on a regular basis, say in Patrick Street in Our Lady's Clinic, service will be provided, or one in another major health centre in Loughlinstown. There is there a very new, large health centre with a catchment area of about 50,000 people. One might in that area have sufficient women who would present themselves. It could be operated on that basis. However, as of now my information is that the service provided is adequate.
The question on the Order Paper is confined to Dún Laoghaire. I appreciate that the Minister broadened the scope of the question a little, but that does not give rise to a national discussion on the subject.
I want some clarification on the matter of a woman going to some clinic and being referred to a GP because the service is not yet available in the local clinic.
The debate should be confined to the Dún Laoghaire area, Deputy.
This arose from what the Minister said. He said that she would be referred to a GP. I simply want to know if she can get that service from the GP free of charge, if she is referred to that GP by the clinic?
The answer is no.
The service is free of charge and is organised by the health boards. It is available on three bases, health centres, maternity hospitals on an outpatient basis and through general practitioners on referred lists.
Would the Minister not agree, now that it has been raised particularly with regard to the Dún Laoghaire area in which there are nine local health centres, none of which offers this service, that that catchment area is not being serviced? If we wish to make it a positive programme, not only on a national but on a regional basis, a catchment area of that size and with that population of young married women deserves some centres to be set up without the women involved having to signal individually that such a need arises, particularly if it is advertised that the service is already available.
The service is available but it is not a walk-in service.
That is what the leaflet appeared to promise.
It was never intended to be a walk-in service. It is quite impossible to organise such a service in most areas. One would have to have a medical practitioner in an area awaiting patients for protracted periods. For example, we have a maternity hospital in the constituency in question in Loughlinstown and nearby many other facilities where this service can be provided without any difficulty whatsoever to women concerned. In the Department of Health I have not had a single complaint from any woman who has had difficulty in obtaining the service. That is the reality.
That might be a sign of the times.
Local organisations, particularly political ones, decided that this was a useful thing with which to hit the Minister for Health over the head because he does not provide it on the sidewalk on a walk-in basis. I cannot do everything.
I am sorry, Deputy Barnes——
I just wish to say that I have evidence from that area which I shall give to the Minister.