I wish to share my time with the Fine Gael Party.
Private Members' Business. - Women's Health: Motion (Resumed).
The following motion was moved by Deputy Durkan on 27 April, 1994:
That Dáil Éireann, conscious of the concern about women's health as recently indicated by the high incidence of breast cancer in this country and the many women who have tested positive in the course of the current Anti D screening process, calls on the Minister for Health:
(1) to immediately set up a nationwide Breast Cancer Screening Programme under the GMS for women in the high risk age group in the first instance, and
(2) to provide the resources necessary for a comprehensive scheme to identify, counsel and treat all women and their families suffering from the hepatitis C virus and antibodies arising from Anti D immunoglobulin treatment from 1970 to 1994.
Debate resumed on the following amendment:
To delete all words after "That" and substitute the following:
"Dáil Éireann
—welcomes and supports the Minister for Health's proposals for the development of a comprehensive, integrated health care system as set out in the National Health Strategy,Shaping a Healthier Future,
—commends the proposals contained in the strategy regarding the development of a plan for women's health, including the proposal, in relation to screening for breast cancer, that a decision would be taken on the question of setting up a national screening service as soon as the findings of the present study at the Mater Hospital Foundation have been evaluated and
—commends the Minister for the action taken and proposed in relation to the identification, counselling and treatment of women and their families who have tested positive for hepatitis C arising from the National Screening Programme."
—(Minister for Health).
Is that satisfactory? Agreed.
I exhort the Minister to meet with representatives of the ICA and to agree a comprehensive programme of cancer prevention measures for all women, in particular breast screening combined with clinical examination for women over 50 years of age; clinical examination on a biennial basis for women under 50 years of age; a properly organised compaign of public education on the value of self-examination for all women. I advocate also the setting up of a national register to enumerate each member of the target population. This is essential to facilitate a systematic approach to the problem. Senator Mary Henry advocated this strongly last week in the Seanad. Will the Minister take this practical point on board? I urge him to put aside proper funding to intensify research on the causes of cancer. That is fundamentally important.
The motion deals also with the predicament of women who have tested positive for hepatitis C. I urge the Minister to direct the VHI to extend cover to their clients who have tested positive. I await the Minister's response. Information indicates that the services are not responding as speedily as they ought. I have been told as late as an hour ago that women have to wait for up to five weeks for a biopsy and a further four weeks for the results. That cannot be tolerated. It is not acceptable that women should have to wait for up to seven weeks for the result of the test. All women want is a straight answer to their question on the extent of their condition. Will the Minister take whatever steps are open to him to speed up the process?
Women with this condition ought to be issued with long term illness cards. I am aware that chemists have refused to supply other medication that women require in conjunction with interferon. The way to deal with this in a comprehensive way is to issue long term illness cards which would cover all their requirements. It would be a major step to ease the worries that women face.
Two vital healthcare issues have been raised by the motion. My party supports the motion fully and will be following the matter consistently in the months ahead to ensure the issues are tackled successfully.
I wish to share my time with Deputy Browne (Carlow-Kilkenny).
Is that agreed? Agreed.
I take this opportunity to congratulate my colleagues, Deputy Durkan, spokesperson on health, and Deputy Theresa Ahearn, Chairperson of the Women's Rights Committee for tabling this motion.
I agree with Deputy Quill that it is an extremely important issue. It is critically important that we discuss the availability of screening for breast cancer and the treatment needs of those women who have been diagnosed with hepatitis C. It is singularly appropriate to discuss the matter following the launch of the national health strategy. I applaud the Minister's efforts and focus on preventive care. It is appropriate to discuss it tonight as the proof of the health strategy will be seen by the quality of services provided to those suffering from illnesses.
The Minister has spoken at length on the importance of a comprehensive health strategy for women. As a former chairperson of the Council for the Status of Women it is very clear that women's health needs have not received the priority they deserve. The Commission on the Status of Women in its report stated this also. We should be very clear about this issue. As the Commission report said, women, especially those with dependent children, bear the major brunt of the effects of unemployment and poverty and responsibility for caring for the disabled and the elderly. Consequently women themselves are more likely to rank among the sick and in general to be more dependent on the health services. It is critical, therefore, that any health service should take into account women's specific needs. Women themselves are inclined to put their health second to that of their partner, spouse or family. There is silence on issues such as hysterectomies, breast cancer, miscarriage, still births, births of disabled children and gynaecological problems. I am delighted the silence has been broken and women are no longer silently coping with the effects of these illnesses. There is now more discussion. The right things are being said about women's health and the focus is on a national strategy for their health. Words and plans are one thing but delivery of the service is another. The delivery of breast cancer treatment is not satisfactory.
This motion calls for treatment and for cancer screening and for mammography to be available to women in a particular age group. I fully support that call. I noted that the Minister did not say he would prioritise the issue when the results of the pilot project become available. If I read it correctly, the Minister said he would see what action needed to be taken. Did the early results from the project indicate clearly that mammography screening services should be developed on a nationwide basis? If that is the case that is what should be delivered. Mammography developed to a high standard with staff appropriately trained and with the appropriate machinery is an essential part of providing appropriate healthcare for women. Breast cancer is a disease striking women out of the blue, and, despite the greater information available on the success of certain treatment arousing upset and fear in individuals and in families. Will the Minister prioritise within the health services any service that can identify the women at risk at an early stage in order to improve their chances of successful treatment. There is a danger that individual problems could get lost in the broadly based national health strategy. There is no doubt that the service for the treatment of breast cancer is disgracefully underfunded and appallingly under developed. Anyone who develops breast cancer needs to be diagnosed quickly with ready access to treatment and the availability of a multi-disciplinary team to treat the condition. The professionals say that the service is far from satisfactory. May I remind the Minister also that St. Vincent's Hospital, Dublin operates a breast cancer treatment clinic on Fridays only, at which 120 patients are seen each week and over 1,200 patients annually? The waiting time is far too long and capacity is exceeded. A senior surgeon has said that many women who are operated on receive little support from the services with which they come in contact because of lack of resources. This should not be allowed to continue and I ask the Minister to address it as a matter of urgency.
It is critical that there should be teams of specially trained staff at a number of centres throughout the country to deal with breast cancer patients. If we are to develop a screening programme it should not be based on the provision of mammograms alone which can miss up to 10 per cent of tumours; high quality clinical services should also be available to women. I have outlined already the preventive measures that must be taken. There is also a need for extensive research into women's health.
It is worth repeating that this is the most critical disease affecting women in Europe. More than 250,000 European women are diagnosed with breast cancer each year and in the European Union alone more than 52,000 women die from the disease. One out of every 12 European women will be diagnosed with breast cancer during their lifetime. These are startling statistics and there should be an appropriate response. Europa Donna, the European women's movement against breast cancer, states that all health authorities should promote targeted screening programmes for breast cancer, ensure that adequate mammogram facilities are available to minimise waiting time and active breast treatment centres of excellence in areas where facilities do not exist.
The second part of this motion calls for a comprehensive scheme to identify, counsel and treat all women and their families suffering from the hepatitis C virus and the antibodies arising from the Anti D immunoglobulin treatment from 1970 to 1994. This is probably the most serious health problem to face hundreds of Irish women. It is important that they should have access to information and treatment and receive the response they need for the health service. I call on the Minister to finance the groups which are trying to develop a self-help network for women. My colleagues have highlighted the problems which many of these women are experiencing in obtaining information.
(Carlow-Kilkenny): I appeal to the Minister to allay the fears of those women who have tested positive to hepatitis C. Less than 15 minutes ago I spoke to a woman who has a fear of the unknown. While Pelican House is providing a marvellous service there is a lack of counselling services throughout the country. This woman informed me, like the meitheal of long ago, that women are now advising others in groups. This could be dangerous because they are at different stages. I appeal to the Minister to help these women who are living in fear and need advice and counselling. They should not have to come to Dublin to avail of these services.
I wish to share my time with Deputies Shortall, de Valera and Lawlor.
Is that satisfactory? Agreed.
I congratulate the Minister for tabling an amendment to this motion. He has set the standard for the health service for the foreseeable future by his commitment to provide a comprehensive health service. We in Ireland demand and expect a service that is second to none. It is only when we go abroad that we appreciate what we have got.
In the strategy he launched recently the Minister laid down guidelines, which many members of this House have called for, on important matters such as education, health and infrastructure. It has often been said that if we do not have our health, we have nothing. In many households women have put their own welfare at risk in favour of other members of the family, usually children who are given priority. It is time that these women put their needs to the forefront and the Minister gave them the status they deserve.
The provision of the new Tallaght hospital will enable us to provide a more comprehensive service in an area in which a large number of young women reside. As the Minister indicated in launching his comprehensive plan, it is far more important to prevent disease. While it is important to provide essential services, we must shift resources to teach people how to remain healthy rather than spend large sums on curing them.
It is noticeable, unfortunately, that more women are now smoking. Whereas in the past men were the greatest offenders, it is strange to see so many young women smoking knowing the effect that this may have on their health. A no-smoking campaign should form part of a major plan with a screening programme for breast cancer.
The Minister indicated that the purpose of the strategy he has launched is to ensure that women's health needs are identified and planned for in a comprehensive way; to ensure that women receive the health and welfare services they need at the right time and in a way which respects their dignity and individuality, with ease of access and continuity of care; to promote greater consultation with women about their health and welfare needs at national, regional and local levels. I congratulate the Minister for making provision for further health centres in my constituency which will enable women to gain access to the information and services they need. The Minister also said that there was a need to promote within the health service greater participation by women both in senior positions and at the representative level.
I congratulate the Minister for the way he handled the hepatitis C scare. He deserves to be congratulated, especially by Deputies in Dublin and particularly in Dublin South-West in which a large number of young women reside. Anyone I spoke to was extremely complementary about the efficiency with which the Blood Tranfusion Service Board dealt with this matter. Women were faced with great uncertainty and worry, but the manner in which the Minister put the plan into operation ensured the speediest possible response and assurances at an early stage that, in many cases, people had nothing to fear.
I will now turn to the area of preventive medicine. Often information does not filter down to where it is most needed, particularly in poorer communities. What we need is people who are available during the day at as local level as possible, including community centre, to speak to people about their difficulties. Access to information will give people what is their right, the right to information and a decent health service. I am certain the Minister will do this in his comprehensive plans for the health service and I wish him well.
Shortly after taking office the Minister for Health set himself the task of drawing up a comprehensive health strategy. He assured us that it would have a clearly stated philosophy and unequivocal objectives and targets, including the necessary legislative measures to back these up. The Minister has now produced a health strategy which has been warmly received by all those delivering the health service, by the consumer, the public and commentators.
This document sets out three clear principles which underpin the strategy. They are equity, quality of service and accountability. The strategy also sets out explicit objective targets, particularly in the areas of health promotion and prevention. The document also has a section dealing specifically with women's health in which the Government undertakes to publish a plan for women's health to be implemented over the next four years.
At present women's health services are not delivered in a co-ordinated way. There are separate maternity and gynaecology services, separate family planning services, mammography, cervical screening and welfare services. There is no framework to provide a unified service to women. What is required is a policy based on a comprehensive view of women and on the issues that affect their health. To this end the Department of Health is preparing a discussion document on women's health and the Minister has undertaken to publish this document during the current year. Comments will be invited from all interested parties and it will take account of the recommendations made by the Second Commission on the Status of Women.
In advance of the plan, some of the major elements underlying Government policy on women's health services have been set out in the health strategy. The objectives will include ensuring that women's health needs are identified and planned in a comprehensive way; ensuring that women receive the health and welfare services they need at the right time and in a way that respects their dignity and individuality; promoting greater consultation with women about their health and welfare needs — this must be done at national, regional and local levels; and promoting within the health services a greater participation by women both in the more senior positions and at the representatives levels.
The document also sets out details of the cervical smear testing which is currently taking place. In regard to screening for breast cancer, the Government has undertaken to make a decision on the setting up of a national screening service as soon as the findings from the present study of the Mater Hospital Foundation have been evaluated. Screening for breast cancer has been a much debated and controversial issue in Ireland for some years now. Although there has been pressure to institute a national breast screening programme, there has also been vigorous criticism of mammographic screening in both the medical and lay press. In 1988 the Mater Hospital Foundation, assisted by European funding, set up the first breast screening clinic. During the setting up of this clinic a number of areas were identified as needing specific attention and much valuable experience was gained in different areas. The main organisational problems that had to be tackled before screening could begin were the appointment and training of staff, the construction of a custom-built mobile screening unit, the equipping of both static and mobile units and the compilation of a population register.
A major question relating to screening for breast cancer is the feasibility of developing a national programme. This is primarily a political issue and I believe the current Minister will not be found wanting in this respect. Such a screening programme cannot proceed without evidence regarding the effectiveness of screening or information about the logistics of mounting such a programme. The Eccles programme has been set up to address both these issues. The definitive answer to the former will only become available after many years of follow up. Meanwhile, valuable information is being gathered on the latter. Overall, the performance of the Eccles breast screening programme has been satisfactory. Technical excellence has been achieved and provides the standard for an extended programme. A higher compliance might have been achieved with a more comprehensive population register. An extension of this programme should, therefore, first address the issue of improved demographic information for the targeted population.
The Minister should be commended for the speed with which he introduced the Anti D screening programme. Everything possible is being done to ensure that adequate screening, counselling and treatment is made available to all women who received the Anti D product between 1970 and 1994. Arrangements have been made so that women can attend either their own general practitioners, who will send on the blood samples to be tested, or specially designated clinics. Three tests are carried out on all samples of blood. They are the Elisa test done by the Blood Transfusion Service Board Board, the RIBA test which is done by the Virus Reference Laboratory at UCD and the PCR test — although technology is not available here to carry out the volume of tests involved, these are sent to an accredited laboratory in Edinburgh.
If diagnosed positive after all three tests the patient is sent to hospital, and there are four named hospitals for them to attend in Dublin, one in Galway and one in Cork, each with special consultant-staffed clinics. The Blood Transfusion Service Board estimate that 60,000 women received the Anti D product. To date 50,000 have been screened. Around 900 have tested positive on the second test but could well be negative on the third test. These results take longer because they re-test to make sure that people get the right result first time. Counselling by medical counsellors is provided by the Blood Transfusion Service Board at a number of centres throughout the country and further counselling is provided if tests are confirmed positive.
The Minister's commitment to providing an equitable and efficient health service is clearly shown in his health strategy. The issue of breast screening is most certainly being taken seriously and, in regard to the Anti D problem the Minister has behaved in a commendable way. I commend the motion, as amended, to the House.
As I am sharing my time with Deputy Lawlor I will refer only to the breast screening service and the position in regard to the incidence of hepatitis C. I thank both Labour Party speakers for sharing their time with me.
I am sure all Deputies received correspondence from ICA guilds throughout the country outlining that organisation's concern for a national screening service for breast cancer. According to that organisation — members of which have told me its statistics are based on Eurostat information — a total of 660 women died here last year from breast cancer, more than in any other EU country. While there is much more awareness about the need for early diagnosis of breast cancer and the positive results which can be achieved even following radical surgery, some experts in the medical field in the United States believe that ageism has crept into information programmes and that people could be forgiven for believing that breast cancer is something which is more likely to affect young women. It is chilling to note that the most common form of cancer among women between the ages of 50 and 64 years is breast cancer.
In a recent speech the EU Commissioner for Social Affairs, Pádraig Flynn, predicted that cancer deaths could rise dramatically — perhaps up to 15 per cent — in the next number of years. The Joint Committee on Women's Rights recently devoted an entire meeting — which was attended by experts in the field, including Professor O'Higgins — to the high incidence of breast cancer here. I urge the Minister and his Department to capitalise on available medical information by setting up an appropriate health programme for women in this regard. I understand that is the Minister's intention.
While commending the Blood Transfusion Service Board and the Minister for their calm approach in addressing the current Anti D screening process, I must point out that many women in that risk category are extremely concerned. Women in my constituency have voiced their fears which they readily admit are due to a lack of knowledge on the subject and they underline the fact that they are unable to get further information about hepatitis C either from their doctors or counsellors in their areas.
I acknowledge that this virus was identified only in 1989 and that very little is known about the natural history of the condition. I also recognise and accept that the medical profession does not wish to be rushed into giving erroneous information as to what we can expect from the virus. Delays, however, in testing and disseminating information is causing a great deal of psychological distress. Providing a telephone help line is not enough to allay anxiety. I understand from professionals in this area that some women have telephoned up to 20 times each seeking assurances and that out of the number already tested, 893 have either proved positive or indeterminate.
We are pleased that there are six hospitals dealing specifically with the problem of hepatitis C, four in Dublin, one in Cork and one in Galway and that in each hospital specialist staff are providing a sensitive service. We also recognise the important role played by GPs in disseminating information and counselling patients in regard to hepatitis C. However, coming from a rural constituency I am aware of the great difficulties facing many women in isolated areas. They believe there is great need for counselling in rural areas and this is reflected in the large numbers who have contacted me. Obviously, the psychological effects of this are very pronounced.
I would like to hear the Minister's comments in regard to the financial aspects of the incidence of hepatitis C. Many women living in rural areas have to travel long distances to be tested. For example, concerned women in County Clare have to travel to Limerick or further afield for medical tests and counselling. I am also aware that in some instances there have been delays in carrying out biopsies which cause great stress not only for the woman involved but her family, especially children who may be at risk. Those at risk believe there is too much emphasis on the year 1977 and that information should be extended to 1994.
Hepatitis C is an infectious disease. This adds to the psychological concerns and implies a need for confidentiality and privacy. I hope home visits by nurses can be arranged to give the necessary treatment to those who test positive. I will be interested to hear the Minister's remarks in regard to medical insurance and whether he foresees any difficulties in obtaining such insurance in the future. What will be the position for women who prove positive with hepatitis C and wish to take out medical insurance with the VHI in the future?
The general consensus since the Minister, Deputy Howlin, took office is that he has been competent, effective and efficient in dealing with the complex and sensitive issues that arise in his Department. Many people look to the Minister for Health for reassurance that the health services will improve.
I wish to address some anomalies in regard to my constituency which is unique in some respects. I represent two new satellite towns on the outskirts of Dublin with a population approaching 100,000. The Tallaght hospital which is under construction will provide health care facilities for a large population and is a welcome step in the right direction. As the project is at the construction stage those services are still out of reach and many young housewives with young children living in north Clondalkin and west Blanchardstown who do not have their own transport must take a tortuous route to reach the services and facilities they require.
The Minister referred to the lack of clarity about the focus or direction of the services. I hope that will be addressed. It is relevant that in his speech he constructively criticised the lack of appropriate links. That matter needs positive and urgent attention from the Minister and the health boards to ensure that a comprehensive range of services is provided in a cost effective and efficient manner. That is a matter of serious concern in unemployment blackspots where there is a high level of crime and associated social problems. The capacity of the medical profession and the Eastern Health Board to support general medical practitioners is lacking because that area is not a lucrative or an attractive one in which to set up facilities. Special consideration should be given to providing facilities for young doctors to set up a comprehensive medical service under the GMS scheme, in areas such as north Clondalkin where the financial capacity of its population of 20,000 to 25,000 has been affected by unemployment, to allow those areas cope with severe growing pains and provide young housewives and mothers-to-be with easy access to regular GP services which most of us take for granted. I have met groups of doctors trying to provide a service in those areas who have highlighted this problem. The Minister referred to the issues of equity, quality, service and accountability but they are not adequately addressed in my constituency.
Consideration should be given to improving screening facilities and preventative medicine to facilitate early diagnosis of breast cancer and other complaints that may lead to serious illnesses or may be fatal. I listened to Senator Henry, an expert in that field, speak in the Seanad and she made positive recommendations for improvements in this area. No issue is more emotive or crucial in a community than the provision of a comprehensive range of health services.
Staff in the Eastern Health Board centres in parts of my consistuency have a heavy workload and consideration should be given to fine tuning resources. Services and facilities should be provided in areas of greatest need. While we can build a regional hospital in Tallaght to serve a catchment area of south west Dublin with a population of 0.5 million, small can be beautiful in that the local health clinics could provide many routine tests and services and would save young mothers with small children unnecessary journeys to a general hospital. Dublin, with a rapidly growing population, requires additional services. I urge the Minister to proceed with this work and ensure the sentiments he expressed are given practical effect and implemented in policy.
Last Wednesday the Minister referred to the national health strategy launched recently with a great fanfare. I am sure he will recall that the proposal for that strategy arose during discussions with Democratic Left before the formation of this Government when Deputy Rabbitte, Mr. Des Geraghty and the Minister for Health, Deputy Howlin, negotiated on a common platform. We urged that a national health strategy should be put in place underpinned by legislation, and we were pleased that the idea survived later negotiations with Fianna Fáil.
We in Democratic Left believed it was so important that we drew up our own national health strategy. At our conference last October a number of eminent speakers debated this topic and reached the conclusion that poverty and unemployment have a major impact on people's health status and that tackling those fundamental issues will bring about an improvement in the population's health status. Not only are the major killer diseases more commonly suffered by poorer people but in recent years the gap between the expectation of life of the rich and the poor has widened further. The most recent issue of the British Medical Times points that out in stark terms. It is not only the relative difference between rich and poor that affects mobidity and mortality. There is a fall in mortality rates among, in particular, poor males in the 40 to 65 age group, independent of factors such as AIDS or drug use, and this is related specifically to poverty and unemployment. That trend is significant. Although research in this area in Ireland is patchy, the trend of a fall in mortality rates among the poor in real rather than relative terms in Britain is reflected here because of the division and disparity of income. That trend is exacerbated here because those people in the greatest need of access to treatment are denied it because they are poor. An inverse care law exists, particularly in the area of hospital care.
That is the key issue facing the Minister for Health. He referred to the central issue of equality in the national health strategy, but the document he produced is a great disappointment as it does not contain the radical shift in health provisions necessary to deal with these major inequities. It includes slavish concessions to private health care which will only serve to bolster the division in the future. It simply does not do the business. It does not deal with the issue of access to treatment in a realistic way or tackle the inequalities inherent in our health service but slides over them. It is full of clichés, aspirations and feel good statements that do not provide a framework for altering the inherently unjust basis of much of our health care provision. Some aspects of the provision address the issue of inequality, particularly at primary care level, but that is not the case throughout the system. The fact that the health strategy document did not upset anybody should sound alarm bells as it is an indication that the real issues have been circumvented rather than tackled head on.
I carried out a survey of hospitals in regard to an appointment for a child to see an ENT specialist. The earliest an appointment could be secured for a child whose parents were medical card holders from a poor background or unemployed was 12 months unless in the case of an emergency. An appointment can be secured in the Blackrock Clinic in two weeks for a child born to rich parents. That example highlights the disparity which has not been tackled in this strategy. It could be dealt with in a comprehensive strategy.
There are other issues relating to the strategy that were avoided. For example, no account was taken of the number of consultants, of whom there are too few. The Tierney report investigated this area of health care and put forward sound proposals about maximising the number of consultants so that we would have a consultant-provided service rather than a consultant-driven service. That matter will have to be dealt with. Separate waiting lists must also be considered if people are to have access to the care they need.
Local accountability is referred to in the strategy, but to whom will there be accountability? If health boards are to be truly reflective of people's needs — the population at large must have an input into the way we devise our health programme — they must be directly and locally elected. Changing the name of the Eastern Health Board will not necessarily result in an authority that is open to people's needs. It is not fair to expect that because that board covers such a huge population.
I do not wish to dwell too long on the strategy because the issues under discussion relate to breast cancer and hepatitis C, but I am putting it in context, as does the Minister in his amendment. I do not agree with the comfortable consensus that the strategy holds the solution or is the way forward in meeting the aspirations outlined. The strategy is full of aspirations. It will certainly ensure that many managers in the health system sleep easier in their beds because it is about managerial reform. I have no problem with that, but it is not really a strategy. The Minister misunderstands the purpose of a health strategy if he thinks managerial reform will make a fundamental difference. I would have expected more from a Minister for Health who would describe himself as a social democrat.
The impact of poverty and unemployment on health is very severe. At the end of this Government's term of office those issues will be the yardstick by which its record will be judged. The Minister for Health's record will stand or fall on those measures, not on the aspirations set out in the health strategy but on how those aspirations were met, how the mortality rates for the rich and the poor compare and whether the strategy has improved the lives of those at present denied an equal chance.
A report in the British Medical Journal clearly states that not just in relative terms but in certain categories in the poorest wards the level of mortality in Britain was reduced. The authors of various studies conclude that public health is strongly linked with material conditions rather than individual behaviour. However, those conditions are not centre stage in this strategy. It is all very well to talk about individual behaviour, but we all know that it is the better off who have their children vaccinated, who give up smoking, keep fit and can afford to do all the things to help you live longer and feel better. We must focus on the poor and target resources in their direction to ensure equity. It takes more muscle and nerve to take on that challenge than is evident in the health strategy.
On cardiovascular disease, the report states that an unemployed middle aged man is twice as likely to get a heart attack than is a middle class middle aged man. There is no point lecturing about improving your diet if you have not the means to pay for better quality food.
I had to closely examine the strategy to find any mention of suicide. Suicide is directly related to class. Nobody can deny that suicide is on the increase in Ireland. The level of suicide can be reduced and the strategy should set a target in this area. It should also set a target for reducing the number of teenage pregnancies.
There is a weak response to breast cancer and breast cancer screening. There is no perfect system of treating any disease, but there are measures that make a difference. There is sufficient clinical evidence to confirm that breast cancer screening for women over 50 years and under 69 years is a worthwhile exercise and can save lives. Breast cancer kills more Irish women every year than car accidents. Every year of inaction by the Minister means the deaths of more Irish women which is a great loss to individual families and to communities. In south Wicklow there was a tragic litany of deaths from breast cancer: in one small area eight women died of breast cancer. This has a very damaging effect on a community. That trend is evident across the country where women, many of whose lives could be saved, are dying. We have an option to combat this disease and the Minister is responsible in this regard. The director of the National Breast Cancer Research Institute recently stated that between 200 and 300 lives per year could be saved with a proper national screening programme. A population register would be required, as would high quality technology, but are women's lives not important enough to provide such a system?
The Minister is dragging out this issue by stating that he is waiting for the Eccles programme. Meanwhile women are dying while the need for services is increasing. One only has to talk to a daffodil nurse to realise the enormity of their task and the increase in their workload. There is a huge demand on the services of St. Vincent's Hospital dedicated breast unit. Perhaps the publicity surrounding breast cancer has resulted in more women coming forward, and if that is so it is a very welcome development. There has been a tendency for Irish women who suspect they have breast cancer to present themselves to their doctors when it is too late.
I commend the ICA on its national campaign in this regard. Like other Deputies, I received much correspondence from that association. These ordinary women are making breast cancer a political issue. We are not alone in this movement; there is a movement across Europe to make breast cancer a political issue. Too many women have died in the shadows and it is unacceptable for us to simply say that we will wait. A start must be made on the national screening programme for women over 50 years of age. There must also be additional funding and staffing for dedicated units around the country. This will cost money; nobody is saying otherwise but we are talking about a major disease that is spreading. The figures indicate a steady increase in the rate of breast cancer and that is most worrying. We are not even at the stage where the disease has reached a plateau. Professor O'Higgins of St. Vincent's Hospital stated in a newspaper article:
It is not just about women getting access to mammograms but about any woman who has a breast condition getting access to a clinic where they can have appropriate examination, support and counselling. There should be a proper and respectful service of care for women in this country and we are very short of that at the moment.
If we can provide what Professor O'Higgins has described we will be taking a major step towards the improvement of women's health.
I appreciate that the Minister had a problem on his hands when the matter of hepatitis C arose. He had to make decisions swiftly and set up a programme that involved major screening around the country. I am not satisfied that his approach was fully correct. Engaging in a media campaign without providing proper notification to doctors around the country added to the anxiety and distress experienced by women. The Minister should have given the representative bodies such as the IMO and the Irish College of General Practitioners a warning about what was going to happen because some doctors were simply not equipped to deal with what was a bombshell landing in their surgeries. They had no details or information on a condition which was very new.
The second problem that has arisen from the particular strategy adopted by the Minister in relation to hepatitis C is that approximately 11,000 women have not yet come forward for screening. We must find those women although there is no clear indication how many of those women are easily found and how many have gone abroad or, perhaps, have died. A sizeable minority who have not yet come forward for screening should be brought into the net.
A huge question lies over the expansion of the scheme. I am aware of some men whose cases that have been highlighted by this testing and who never had the Anti D injection. I would like to know what expansion plans the Minister has to bring in those other people who may be at risk from hepatitis C. I appreciate they may be a minority but it is important to note that hepatitis C is more aggressive in men, and men who may have this latent condition should be screened in order to obtain treatment. They should also be advised about the dangers of alcohol intake. Those who had transfusions or other blood products should be easily traced through the Blood transfusion Service Board. This would ensure that everybody with hepatitis C — and we have already seen that there is quite a number of them — receives the appropriate treatment free. I have already received complaints from people who had to go to community welfare officers to obtain money to cover these costs. It is not satisfactory for women to have to go through community welfare officers to obtain money for ancillary costs that may arise.
A full report must be forthcoming as to why there were delays in setting up a screening programme and testing between the period when the Blood Transfusion Service Board first alerted the Minister in 1989 and the commencement of testing in 1991 and, indeed, the final introduction of proper testing procedures in 1994. I appreciate that this problem came out of the blue to some extent but it must be remembered that there were certain signals in this regard.
I look forward to a debate on the national health strategy. I realise such a debate is due to take place tomorrow in the Seanad but we in this House must seriously examine the optics of the health strategy and ensure that it meets the requirements of those most in need.
I wish to share my time with Deputy Flanagan.
Is that satisfactory? Agreed.
Over the past few weeks we have heard much about the Minister's programme for a healthier future. Much of the Minister's strategy for effective health care involved the clever pulling together of existing programmes with some new elements and, as Deputy McManus described, many aspirations. This is all very fine and I wish the Minister every success with this programme.
Over the past few weeks also we have had another suggested programme for shaping a healthier future. This came from the Irish Countrywomen's Association guilds in Sligo-Leitrim and around the country. By contrast with what the Minister has to offer this was something immediate and absolutely specific, a programme that would not just produce a healthier future but also save lives. The number of lives that might be saved could almost be quantified from existing statistics.
The ICA are seeking a national cancer screening programme for all women in the high risk group, namely, 50 to 64 years of age. The motion in the names of my colleagues, Deputy Durkan and Deputy Ahearn, requests that the programme be put into operation. I expected the Minister for Health to come into this House and announce that he would be accepting the demand for national screening of the high risk group that is being made by the ICA. This could be done almost immediately but instead of an undertaking or some sort of promise, all we heard from the Minister was waffle. He covered up the fact that he either could not or would not deliver the funds for this purpose. I accept his waffle was well worded but it contained no substance whatsoever. There was no acceptance of the central demand of this motion or of the demand of the ICA.
The Minister fobbed us off with the information that pilot schemes are being carried out at present. Pilot schemes are necessary, on occasion, but not in this case. In 1992, 650 women died of breast cancer, many of whom were in the high risk age group. The facts are there and, as Deputy McManus said, we cannot afford to wait. People are dying and we can almost quantify the number of lives that could be saved.
The Minister may well point out the facilities for screening that already exist but it is not simply a question of availability; there is much more to this problem than that. Leaving aside the question of costs, which is a consideration, the atmosphere must be created to encourage all women in the high risk group to be screened. This can best be done through a national screening programme where women, when they reach a particular age, are routinely screened for breast cancer. That should be the Minister's objective and he should provide the facilities for this as soon as possible.
The Minister has said in response to Dáil questions that studies carried out abroad suggest that well organised screening programmes can reduce death from breast cancer in women aged 50 years and over by 25 per cent to 30 per cent among the screened population.
In the face of such statistics, is it necessary to advance further arguments as to why national screening for breast cancer should be introduced immediately? I welcome the Minister's programme for a healthier future. However, this is something we could do immediately which will save lives and prevent tragedy in many families as well as reduce fear, anxiety and suffering. I find it difficult to understand how he could have a study for effective health care in the 1990s without introducing national screening for breast cancer. The Minister said that studies show deaths in women aged 50 years or over can be reduced by 25 to 30 per cent. There are few other health programmes about which any such claim could be made. Let us have national screening.
Up to 100 lives could be saved each year through the introduction of national screening. It is essential that support structures in the form of counselling for women undergoing examination for breast cancer should be provided. Almost every woman who shows symptoms of breast cancer fears she has contracted the disease. There is urgent need for clinics to deal efficiently and sympathetically with women who fear the worst.
Breast cancer is the most common cause of death in young women aged between 25 and 34 years. It is a killer disease. In the context of the debate on the Minister's strategy, positive steps must be taken to initiative a campaign on the issue. Every year 1,250 new cases are diagnosed and 650 women die annually from the disease. The primary cause is unknown but in view of the high incidence in western countries people look to diet, environment, different child birth patterns and lifestyles as perhaps providing answers. In 1985 one woman in 11 in the Unites States contracted breast cancer. Within two years it was one in ten and in 1991 it was one in nine. The trend in this country is similar.
If we had a proper and effective screening programme up to 100 lives could be saved each year. We must at all times act in the belief that the earlier the disease is diagnosed the more likely it is that treatment can be effective. An educational campaign must be undertaken among women's groups and special interest groups as well as involving members of the public. A national programme of seminars, conferences, lectures, courses, booklets, displays and videos should be established with the cooperation and active participation of the Department of Health.
It is regrettable that in the course of this debate the Minister for Health, in the week in which his health strategy was related in expensive, glossy, snazzy documentation and distributed throughout the country, refused to sanction the introduction of a national breast screening service. That in the context of what Deputy Nealon stated about a reply to a Parliamentary Question is an indication of an element of hypocrisy that I would not like to attach to the Minister for Health. The Minister of State has an opportunity to rebut what I said. Since we are dealing with a killer disease and the saving of life the Government's response must be a little more positive. Time is not on our side. We are sitting on a time bomb. This matter appertains not only to women but to the nation as a whole and urgent action is required.
I thank my party colleagues for their constructive support for the motion and I thank all Members for their contributions. I pay tribute to the ICA who focused public attention on the issue of breast cancer in a real, progressive and incisive way. I thank those members of the association in my constituency, those who corresponded with my colleagues and others throughout the country. I acknowledge the assistance and support I received from the women and their spouses in my constituency who are potential hepatitis C patients and also others who contacted my colleagues.
I cannot describe my disappointment at the Minister's response to this motion last Wednesday. Deputy Nealon referred to it as a load of waffle. That was an understatement. It did not address the motion before the House. It showed scant regard for the concerns of women in relation to breast cancer or hepatitis C. The Minister was more concerned about furthering his health strategy programme which was published a few days beforehand. His reply to the debate was nothing more than what was contained in the document and, in relation to hepatitis C, was nothing more than the longwinded replies to parliamentary questions which he gave over the last month. I expected to hear something new.
Despite all the protestations, I have come to the conclusion that the Minister is more concerned about his own public image than about how quickly he can react to an emergency. I am worried about the number of times I heard members of the Government parties say tonight that he is the best Minister since the foundation of the State. It is a little too early in the day to hold such notions. I am sure former Ministers, including some from his own party, are not impressed.
On page 55 of the health strategy document it is stated that the Department of Health is preparing a discussion document on women's health which takes account of the recommendations of the Second Commission on the Status of Women. This discussion document will be published in 1994 and comments will be invited on it. The Government's plan for women's health will then be put in place. In advance of the plan some major elements underlying Government policy in women's health services are set out. The objectives include the following: to ensure that women's health needs are identified and planned in a comprehensive way; to ensure that women receive the health and welfare services they need at the right time and in a way which respects their dignity and individuality. They must have ease of access to and continuity of care. Another objective is to promote greater consultation with women about their health and welfare needs. This must be done at a national, regional and local level. I suggest that now is as good a time as any to put these proposals into operation. I expected further time to elapse before the Minister hedged on an issue such as this.
We are talking about two serious issues both of which need immediate attention. We are aware of the divided medical opinion on the mammography issue and have listened with great care and attention to the debate but women are concerned and have suggested a way of doing something about breast cancer. The Minister's response last Wednesday to the plea from the women of Ireland was a disgrace.
I am sure that all those affected by hepatitis C and those concerned about their future health would have welcomed information on the matter. All Members of this House, the infected women and the thousands of women who are more than a little concerned about their health would have liked the Minister to have given more information on the steps he proposes to take. There has been a veil of silence over the proposals. Responsibility for this problem was hived off into other areas as quickly as possible so that no one could point a finger at the Department or the Minister. This is not the type of response people want. The Minister should reassess the issue and recognise the concerns of women who have been — or are likely to be — infected with hepatitis C. The very least he should do is make a realistic response to this issue and get away from the nonsense of hoping that these unfortunate women will have the time and energy to travel to centres in the different areas referred to by him.
I thought at this stage that the Minister and his advisers, of whom he has plenty, would have copped on and recognised that counselling is an important element of the treatment required. There is no counselling available simply because counsellors do not have any information. Several people concerned about this issue have had to get information from other countries: people in my constituency have done this and I have had access to the information. Why has the same information not been made available here? Why has the Minister not accepted that these women are genuinely concerned about their health and that of their families?
I thought we might have heard more from the Government benches than a rehash of the contents of this famous yellow book and the points made by the Minister in the House over the past two months. This response does not satisfy Opposition Deputies or reflect the seriousness of the issue. At a time when so much emphasis is placed on health in general and on women's health in particular the Minister should have thought it worthwhile to work out the best way to deal with the problem from the point of view of the patients. One of the flaws is that the problem has been dealt with in the best way from the point of view of the Minister and his Department —"keep it as far away from us for as long as possible, pretend it does not exist and hopefully it will go away". Problems cannot be dealt with in this way.
I want to contrast the Minister's response to this problem with his record as an Opposition Deputy during the debate on haemophiliacs when he correctly laid responsibility for dealing with the matter at the door of the then Minister. It is amazing the changes a few years can bring. The Minister now seems to be adopting a much more laid back attitude to people's health, that this issue is not as important as he thought it was when in Opposition. The issue is every bit as important now as it was then.
It is important to re-emphasise that the hepatitis C problem arose because women followed an agreed and approved procedure. The Minister suggested that this procedure gave women an opportunity to have babies and that perhaps in some way this was the result. These women were following a fully approved procedure which went wrong despite repeated assurances.
Apart from a broad statement that the treatment would initially be paid for by the State, the Minister made little reference to the type of treatment necessary, the method of treatment and who would foot the bill. It is about time, some two and a half months later, that the Department re-examined the problem, ascertained whether the VHI would be willing to offer cover and the way in which patients will be affected if they seek insurance and outlined the extent of its involvement.
As Deputy McManus said, this matter came to light very suddenly in the media last February but the Department of Health and the Blood Transfusion Service Board had known for some years that a problem of this nature would arise; this was intimated to the Department of Health some years ago. It is not true that the Minister had to suddenly put in place procedures to deal with the problem. The Department had ample time to deal with the problem but no plans were put into operation.
It was insulting to Members of this House and women for the Minister to spend so much time eulogising his document when he should have been addressing the motion. The same applies to the other members of the Government who spoke. When Opposition Deputies have the tenacity to put down a motion of this kind then the Minister should at least have the courage to respond directly to it.
I have already outlined some of the measures which should be taken by the Minister. On the question of breast cancer, he should support the motion. Government backbenchers prepared to show initiative might be prepared to support this motion instead of the woolly Government amendment which congratulates the Minister for something he has not done. On the question of the treatment for hepatitis C, the Minister should, as a matter of urgency, put in place procedures which will reassure women about the method of treatment, the costs involved, the way in which insurance is likely to be dealt with in the future and the type of counselling to be made available. Notwithstanding all that has been said by Government Deputies, the level of counselling available at present is deplorable. The Minister should get off the fence, stop pretending that this problem does not exist and deal with it. If he does this he will be doing himself and everyone else a favour.
This motion was timely in the sense that it gave the Minister an opportunity to respond positively to this problem. The eyes of everyone were focused on the Minister following the publication of his health strategy policy. It is recognised that this is the ideal time for the Minister to take the initiative and reassure women who are concerned about this problem. However, he has failed to grasp this opportunity. Does he not attach sufficient importance to this issue or does he know that he does not have anything to fear from the Opposition because of the large Government majority? That may well be the case but I want to point out that those who sat on the Government benches during the past 75 years ultimately found their way to these benches.
And back.
The complacency of the Government on this issue will prove very costly in the future.
I commend the Fine Gael motion to the House and I call on the Minister to react before it is too late.
Question put: "That the amendment be made".
The Dáil divided: Tá, 63; Níl, 45.
CLASS="CP">Tellers: Tá, Deputies Dempsey and Shortall; Níl, Deputies E. Kenny and Boylan.
CLASS="CP">Níl
- Ahearn, Theresa.
- Barrett, Seán.
- Boylan, Andrew.
- Browne, John.
- (Carlow-Kilkenny).
- Bruton, Richard.
- Carey, Donal.
- Clohessy, Peadar.
- Connaughton, Paul.
- Connor, John.
- Crawford, Seymour.
- Creed, Michael.
- Crowley, Frank.
- Currie, Austin.
- Deenihan, Jimmy.
- De Rossa, Proinsias.
- Doyle, Avril.
- Dukes, Alan M.
- Durkan, Bernard J.
- Finucane, Michael.
- Fitzgerald, Frances.
- Flaherty, Mary.
- Flanagan, Charles.
- Foxe, Tom.
- Gilmore, Eamon.
- Harney, Mary.
- Higgins, Jim.
- Hogan, Philip.
- Kenny, Enda.
- Keogh, Helen.
- Lowry, Michael.
- McCormack, Pádraic.
- McDowell, Michael.
- McGahon, Brendan.
- McGinley, Dinny.
- McGrath, Paul.
- McManus, Liz.
- Mitchell, Gay.
- Nealon, Ted.
- Noonan, Michael.(Limerick East).
- Quill, Máirín.
- Rabbitte, Pat.
- Shatter, Alan.
- Sheehan, P.J.
- Timmins, Godfrey.
- Yates, Ivan.
Question declared carried.
|
Ahern, Michael.Ahern, Noel.Aylward, Liam. Bhreathnach, Niamh. Broughan, Tommy.Burton, Joan.Callely, Ivor.Connolly, Ger.Davern, Noel.Dempsey, Noel.de Valera, Síle.Doherty, Seán.Ellis, John.Fitzgerald, Brian.Fitzgerald, Eithne.Fitzgerald, Liam.Flood, Chris.Gallagher, Pat the Cope.Geoghegan-Quinn, Máire.Haughey, Seán.Howlin, Brendan.Jacob, Joe.Kenneally, Brendan.Kenny, Seán.Killeen, Tony.Kirk, Séamus.Lawlor, Liam.Leonard, Jimmy.Martin, Micheál.McDaid, James.Morley, P.J. |
Bree, Declan.Brennan, Matt.Brennan, Séamus. Briscoe, Ben. Moynihan, Donal.Nolan, M. J.Ó Cuív, Éamon.O'Dea, Willie.O'Donoghue, John.O'Hanlon, Rory.O'Keeffe, Batt.O'Leary, John.O'Rourke, Mary.O'Shea, Brian.O'Sullivan, Toddy.Penrose, William.Power, Seán.Quinn, Ruairí.Ryan, Eoin.Ryan, John.Ryan, Seán.Shortall, Róisín.Smith, Brendan.Smith, Michael.Stagg, Emmet.Taylor, Mervyn.Treacy, Noel.Upton, Pat.Wallace, Dan.Wallace, Mary.Walsh, Eamon.Woods, Michael. |
Motion, as amended, agreed to.