Adjournment Debate.

Cancer Screening Programme.

Mr. McGinley

I thank the Chair for affording me the opportunity once again to raise this important matter. The most important element in the successful treatment of cancer is early diagnosis. Unfortunately, early diagnosis and standards of treatment seem to depend on geographical location. Since 2000, BreastCheck screening has been available only in parts of the country. If one is aged 50 years or over and lives in Dublin or the eastern region, BreastCheck is automatically available. I am sure this programme has saved the lives of many women who are fortunate to be living in these areas. We all know and accept what a tragedy it can be for a family to have a member, particularly a mother, diagnosed with breast or cervical cancer, especially when it is at an advanced stage. Late diagnosis means more radical and severe treatment, often with limited success.

It is unbelievable that six years after its introduction, BreastCheck cancer screening is confined to so few counties. As usual, the west and the north west in particular are well and truly out of the loop. According to the latest information, places such as County Donegal cannot expect to benefit from a screening programme until 2008 at the earliest. This is completely unacceptable. Letterkenny General Hospital caters for a population of almost 140,000. In County Donegal, the country's most peripheral county, there are 50 new breast cancer cases, 70 new bowel cancer cases and 80 new prostate cancer cases annually. The medical board of Letterkenny General Hospital has taken the unprecedented decision that in the absence of an agreed permanent resolution to the issue of breast cancer services, no support services will be provided for new patients referred with systematic breast disease from 1 June next. Furthermore, all breast health clinics including review services will cease from 1 September. This is a serious development and illustrates the sheer frustration of the medical personnel attached to the hospital.

The new inpatient oncology unit in the hospital, which has been lying idle, will be used to increase medical capacity to address the current overcrowding crisis in the hospital, which is a daily occurrence. A total of 17 people were on trolleys in the hospital today. While any move that gets patients who are currently on trolleys into beds must be welcomed, it must be recognised that this is not the solution to the hospital's long-term problem or the improvement of cancer services in Donegal.

There are three main priorities in addressing the cancer treatment needs of County Donegal. It is absolutely essential to appoint a permanent breast surgeon for Letterkenny General Hospital, to ensure the roll out of BreastCheck and the designation of Letterkenny General Hospital as a satellite radiotherapy unit. In a shocking indictment of the health service, it has emerged that the absence of a radiation oncologist at Letterkenny General Hospital is resulting in unnecessary mastectomies in some cases and dangerous and lengthy delays in the treatment of certain cancers in others.

A group of medical professionals in the county maintain that many patients, in particular those receiving palliative care, are refusing radiation treatment because of the exhausting travel involved — anything up to six hours at a time to Dublin. Being a regular visitor to St. Luke's Hospital in Dublin, the number of Donegal patients journeying there for radiotherapy never ceases to amaze me. They are far removed from their families and natural environments for the duration of their treatment, which can often last up to seven or eight weeks. While many try to go home for the weekend, the Minister of State can imagine what a harrowing ordeal that long journey must be with their strength and resistance sapped by the severity of radiation treatment.

While I welcome plans to establish radiotherapy units in Limerick, Galway or even Waterford, these will be of no benefit to the north west. It is no easier to travel from west County Donegal or Malin Head to Galway than it is to Dublin. I am publicly calling for the provision of a radiotherapy unit in the north west, preferably in County Donegal, to serve the needs of cancer patients in that region. I am also calling for the appointment of a radiation oncologist, a permanent breast surgeon and a second bowel surgeon in Letterkenny General Hospital. If this does not happen, it is likely that the existing service, which caters for a population of almost 140,000 people, will diminish and ultimately disappear. There is a genuine fear among medical staff in the hospital that cancer services will disappear by a process of natural attrition rather than an act of commission. For example, if a permanent breast surgeon is not appointed, breast cancer services will go.

I am also suggesting that the Tánaiste should visit Letterkenny General Hospital to witness how inadequate and critical the situation is, not alone in the area of cancer treatment, but also the daily crisis throughout the hospital mainly due to inadequate accident and emergency facilities and a critical shortage of beds. Having been in charge of her Department for over a year, she is due a visit.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

Cuirim fáilte leis an rún seo ar Athló an Teach in ainm an Teachta McGinley, a bhaineann le forbairt na seirbhísí seo i dTír Chonaill. Thug an Teachta cuireadh don Tánaiste chun cuairt a dhéanamh ar an ospidéal sin.

Mr. McGinley

Beidh fáilte roimpi.

Mr. B. Lenihan

Tá a fhios agam ach tá fáilte roimpi in a lán áiteanna in Éireann sa lá atá inniu ann.

Mr. McGinley

Tá an t-ádh léi.

Mr. B. Lenihan

Since 1997, cumulative funding totalling more than €47 million has been allocated to the Health Service Executive north western area for the development of appropriate treatment and care services for persons with cancer. Cancer services in the north west are provided in Letterkenny General Hospital and Sligo General Hospital. In the former, cancer services are provided by a team of consultants comprising four consultant surgeons, one consultant medical oncologist, one consultant haematologist, one palliative care consultant, three consultant pathologists, six consultant radiologists, two senior pharmacists who specialise in oncology drugs preparation, a range of specialist nursing staff and one consultant radiotherapist three days per month.

An 11-bed oncology ward was recently completed, which is supported by an oncology day case area, breast care suite and clean air pharmaceutical preparation room.

A formal multidisciplinary breast care team meets and reviews all breast patients each week. Other teams meet to discuss cases as required.

Sligo General Hospital has a dedicated inpatient oncology unit, comprising 15 beds. The hospital also has a dedicated day services unit, with an oncology day services area comprising eight beds. A consultant haematologist was appointed in 2004. In addition, the hospital manufactures its own cytotoxic oncology drugs in a state-of-the-art clean room facility. The hospital has a full range of diagnostic tools including a CAT scan and a magnetic resonance imaging, MRI facility.

The HSE north western area has a regional consultant in palliative medicine, with a second post recently approved by Comhairle na nOspidéal. This second post will cover Sligo, Leitrim and south Donegal while the existing consultant in palliative medicine will cover Donegal.

Last year, the Tánaiste announced the Government's approval for a national network for radiation oncology services to be put in place by 2011, which will commence in 2008. The network will deliver a substantial increase in current radiation oncology capacity by providing additional capacity to the equivalent of 23 linear accelerators nationally. The network will consist of four large centres in Dublin, Cork and Galway and two integrated satellite centres in Waterford and Limerick, conditional on their adherence to certain quality assurance measures.

Patients in the north west are currently being referred for radiation oncology treatment to the radiation oncology department at University College Hospital, Galway, and to St. Luke's Hospital, Dublin. A consultant radiation oncologist from St. Luke's Hospital, Dublin, visits Letterkenny General Hospital three times per month as part of the multidisciplinary care of cancer patients. A consultant radiation oncologist with significant sessional commitments to Sligo General Hospital has recently been appointed to University College Hospital, Galway, which also provides radiation oncology services to patients in the north west, mainly to Sligo, Leitrim and south Donegal.

The Government considers that in the short term, the best option in terms of improving geographic access for patients in the north west is to facilitate access for those patients to radiation oncology services as part of North-South co-operation on cancer. The Tánaiste has agreed with the Minister for Health for Northern Ireland, Mr. Shaun Woodward, MP, that the new Belfast cancer centre will treat patients from Donegal. The option for people in Donegal. to attend for radiotherapy treatment at either Galway or Dublin will continue to be available.

In respect of the Belfast development, a number of discussions have taken place at official level involving both Departments, most recently on 20 February. Both Departments have requested the co-operation and working together initiative, CAWT, to ensure the timely and effective delivery of the ministerial agreement. There is a considerable political, departmental and service commitment to delivering on this agreement. It is important that this initiative succeeds as it will support further co-operation in health care, including cancer care. To ensure effective delivery, it is essential to have the support of medical consultants, patients and representative groups locally. I know how passionately the people of Donegal feel about this issue. The Tánaiste has worked extremely hard in this regard.

As for furthering the consideration of a satellite in the north west, the first priority is to deliver access for cancer patients in the north west to Belfast City Hospital as early as possible and thereafter to build on positive working relationships to deliver on this commitment. The issue of a satellite centre in the north west will continue to be furthered as a joint initiative involving bilateral discussions at departmental and political levels.

BreastCheck is preparing for the expansion of its screening programme for women aged 50 to 64 years in the south and west. Some €28 million in capital funding has been made available to provide static screening units and five mobile units. Screening for the western region will be provided at the static unit in Galway and by two mobile units. There is a screening population of 58,000 women in the west, including 10,500 in County Donegal.

The Tánaiste recently met representatives of BreastCheck. They are fully aware of her wish to have the programme rolled out nationally as quickly as possible. For this to happen, essential elements of the roll-out must be in place, including adequate staffing, effective training and quality assurance programmes. Additional funding has been made available this year for early recruitment and training of staff.

While there are a number of other matters with which I wish to deal, my time is short. In respect of breast disease services, the Department has been advised by the Health Service Executive that agreement in principle has been reached between Letterkenny General Hospital and Altnagelvin Hospital on a model of co-operation in the provision of breast cancer services.

In addition, my colleagues, the Minister of State at the Department of Transport, Deputy Gallagher, the Minister for Agriculture and Food, Deputy Coughlan, as well as Deputies McDaid and Keaveney have met the Tánaiste recently to further these issues.

When this takes place, it is good for the Chamber, the House and for democracy.

Ms Burton

As for resolving some of the issues that arose, most issues with the Department of Communications, Marine and Natural Resources were dealt with directly, as were some issues with Bord Iascaigh Mhara, BIM.

As for the response, a total of 184 jobs have been earmarked for Clonakilty under the Government's decentralisation programme, with 91 from the Department of Communications, Marine and Natural Resources and 93 from BIM. The Office of Public Works has purchased a three-acre site in the town and tenders have been invited for the design and construction of the new permanent offices. The tenders were due back to my office on 31 March. We have to allow a certain period for tenders as we are obliged to be totally transparent in all our dealings. The successful tenderer will lodge a planning application later this year and construction should commence in early 2007, assuming the planning process is not delayed.

Given the high level of interest from civil servants to relocate to Clonakilty, the Department of Communications, Marine and Natural Resources has asked the OPW to source temporary offices to accommodate an advance party of staff until the permanent building is completed. The Public Appointments Service has indicated that a total of 176 expressions of interest from across the public service have been received for the posts in Clonakilty, 140 for the Department and 36 for the BIM positions. Following an extensive search for temporary office space in the town, the OPW has identified offices in the Clonakilty area that can accommodate up to 50 staff immediately and further suitable office space that could be acquired later in the year for an additional 50 to 60 staff.

The Department of Communications, Marine and Natural Resources has indicated its approval for the identified temporary accommodation and the proposal has been considered by the decentralisation group. The matter has been referred to the Department of Finance for sanction to acquire the space. This evening I checked with senior officials in the Department, who said the Minister has not yet given his sanction. They expect he will but that is a matter for the Minister.

When the business case for the interim accommodation has been evaluated and agreed by the Department of Finance, the OPW will proceed with the negotiations to lease the required space.

School Accommodation.

Ms Burton

Hundreds of children in Dublin 15 have no school place for this coming September and the reason is simple. Thousands of houses have been built in the Littlepace and Castleknock areas in the past five years but no provision has been made for school places for all the new families moving into the area.

Now we face another Groundhog Day, another round of crisis meetings to secure places for around 200 children who could not be accommodated in the first round of offers.

I want to take a positive approach in addressing this crisis as I am interested only in resolving this issue for once and for all. Next year's parents cannot be put through the same distress and upset that parents have experienced recently, year on year, in Dublin 15, indeed for the full tenure of this Government, nine years. There is a clear and pressing need to commit to a full new primary school in the Ongar-Littlepace area over and above the two schools already established, to complete the permanent buildings for the Castaheaney Educate Together primary school currently based in prefabs and facing another year in them, to build an extra primary school in Castleknock and to provide a new secondary school in the Castaheaney-Clonee area to cater for families in houses built ten years ago in the area.

To resolve this crisis I am calling for a round table conference of all school principals with county council and education officials. It is not good enough to have a conference with selected principals from the Minister of State's office in Marlborough Street. That does not impress me, particularly when the people in Tullamore cannot give answers.

I am also calling for a proper assessment of needs for the next five to ten years in line with expected new housing and the immediate purchase of sites for the new schools that will be required in Castaheaney. The Minister of State should tell us now how many sites and which sites have been acquired. I have received replies from the Minister for the past four years and she is still shilly-shallying about acquiring the sites.

Last year a quick-fix solution was found when the Minister was faced with a full-scale revolt from parents and the whole community. This year, in response to my recent parliamentary questions, the Minister acknowledged the extent of the crisis, referring yesterday to "the unabating increase in demand for pupil places" in Dublin 15. The poor woman sounds surprised. Extending existing schools, while welcome, is not enough. The Minister plans for Dublin West to have many primary schools of 1,000 pupils. With class sizes among the highest in the country, at more than 30 pupils, this is a shamefully inadequate response from a rich Government. We need more schools, particularly as new communities of 2,000 plus houses and apartments are being regularly built and more are planned. The interests of developers and their land deals cannot come before the interests of our children.

Judging by yesterday's reply, the Minister unfortunately continues to keep her head in the sand. Planning for these new schools has to start today. Our children want school places but they also need a quality education in permanent buildings with reasonable class sizes, not the vision of endless prefabs and over-full classrooms, which seems to represent what Fianna Fáil and the Progressive Democrats consider good enough for Dublin 15. Unless this is provided, the Government will continue to fail the new communities in Clonee, Littlepace, Ongar, Hansfield, Diswellstown, Luttrelstown, Tyrellstown and the many other growth areas in Dublin 15.

We have been blessed in Dublin 15 with a remarkable range of teachers, school principals and managers. Only they have been able to keep the show on the road, with dedicated parents. I have many expectations from the Minister for Education and Science, Deputy Hanafin, in her approach to education, but she has not delivered for Dublin 15.

Minister of State at the Department of Education and Science (Mr. B. Lenihan)

I thank the Deputy for raising this matter. It is an important subject and I share the concerns Deputy Burton has outlined to the House about the proper development of primary education in the area.

The Minister is conscious that the Dublin 15 area as a whole is one of the most rapidly developing areas in the country and that as a result there has been a marked increase in the demand for primary school places. I am conscious of that demand too and I assure the Deputy I have worked unceasingly in that regard with the planning unit in Tullamore and with the school principals, teachers and parents in the area. I join in the tribute the Deputy paid to them. They have gone a long way towards meeting the accommodation difficulties which the Deputy outlined to the House. To date, however, there has not been a Groundhog Day in Dublin West because the Minister, her officials, the school principals and parents have worked together to find solutions. That is what we must do this year too. I appreciate that Deputy Burton is committed to finding solutions in this area too.

The Department of Education and Science has taken a number of measures to increase the capacity of existing schools in the area concerned with the development of new schools to meet this growing demand. All building projects arising from these interventions are awarded a band one priority rating under the Department's prioritisation criteria for large-scale building projects to ensure they are delivered as expeditiously as possible. The allocation of financial resources is not the issue in the provision of primary education in Dublin 15.

Ms Burton

Has the Department bought the sites?

Mr. B. Lenihan

I will deal with sites shortly. In the Littlepace-Castaheaney area a new school building has recently been completed at Mary Mother of Hope national school and an additional project is under way with a target delivery date of September 2007. In addition, a 32-classroom campus is planned for a school site in Ongar. Under the arrangement between the Department and Fingal County Council the site at Ongar has been secured and transferred to the council. That happened last week. The project will provide a permanent accommodation solution for Castaheaney Educate Together national school. It also has a target completion date of September 2007. This area is also served by the Sacred Heart national school in Huntstown where an extension project to provide a 32-classroom school is nearing completion.

The accommodation needs will be addressed this year. A serious question the Deputy has raised is the need for additional school provision in the area. The Deputy must be aware that no patron tendered for any additional school in the last school application process last September. If necessary, the Minister will take all necessary steps to address the school needs of this area.

Mr. Bruton

I thank the Ceann Comhairle for the opportunity to raise this important issue. This matter concerns the provision of applied behavioural analysis schools for children on the northside with autistic spectrum disorders. The northside has a serious shortage of places for such children. There is one school in Kilbarrack, the only one on the northside. It has 30 places for which there is a waiting list of 48. ACORN, the school concerned, has offered 12 places but already 31 children are waiting for those places. It is the virtually uniform and strong belief of parents of children with autistic spectrum disorders that applied behavioural analysis is the preferred way to deal with children. They have provided an excellent document in support of this application which I hope the Minister of State has an opportunity to examine. It describes the particular disabilities of children with autism and the particular relevance of the applied behavioural approach to their needs. It goes on to cite international opinion which shows there is a consensus that the applied behavioural analysis is the most successful educational intervention. In the US that system is the automatic preference. The New York State Department of Health states: "Based upon strong scientific evidence, it is recommended that principles of applied behavioural analysis and behavioural intervention strategies be included as an important element of any intervention programme for young children with autism".

It is clear there is a strong desire among parents of children with autism that this is the best way for their children. There are many who are extremely passionate about this model. I am sure the Minister of State has had representations on the matter. It is extraordinary that our Department, despite having committed itself to the Education Disability Act which provides that the needs of the child must be paramount, continues to resist providing the applied behavioural analysis approach and to persist with the system that provides much less personal support to these children. There is a genuine fear that this is about economics and that the reason the Minister of State is not willing to commit to it is that by the standard approach it is a ratio of six children to one teacher, plus two special needs assistants while the applied behavioural analysis system is a one-to-one approach. There is no doubt it is more resource intensive. The Minister of State needs to respond not only to this crisis where there are 78 children waiting on the northside but also in the national context to recognise this system has an appropriate place. This application was first made nine months ago. It has been with the new special education council in Trim and is going to the National Educational Psychological Service for yet another loop. Instead of making parents go through loop after loop we need to recognise this is a core requirement. It is clear that children at a certain part of the spectrum who have severe difficulties need this system. There is a need to move forward and we need a proper policy statement.

I was alarmed to see among the correspondence I received that the Minister for Education and Science has consistently refused to meet Irish Autism Action, the national umbrella organisation for promoting this form of education. Scales need to fall from the eyes of the people within the Department of Education and Science who need to recognise this is not only the wish of parents but also internationally proven to be a preferred approach. If the Minister of State does not have a positive response I hope he will convey the strength of feeling of parents to the Minister.

Mr. B. Lenihan

I thank Deputy Bruton for raising this issue. It is an area in which I have taken a big interest as a Deputy and as a Minister of State. I agree this model deserves fair evaluation and consideration by the Minister. The one school in Kilbarrack was opened some years ago. The demand for this school is substantial. Like the Deputy I have the honour of representing the northside of the city and am well aware of the issues raised. The special facility operates the applied behavioural analysis method of teaching children with autism. I have met some of the groups involved and referred to by the Deputy. I understand the application is known as the ACORN proposal.

The Minister is most anxious that all children, including children with autistic spectrum disorders, receive an education appropriate to their needs. It is in recognition of this that the Department of Education and Science provides the following facilities for the education of children with autism: 159 special classes for children with autism, attached to special and mainstream schools; 15 pre-school classes; five special classes for children with Asperger's syndrome; and 12 stand alone facilities providing an ABA specific methodology.

Many of the children being proposed for the unit in question are in existing autism specific provision. The ABA method is one of a range of approaches to the education of children with autism. The approach is based on understanding a set of behaviours, breaking down the components of the tasks involved in learning and the application of consequences to either reduce-weaken or increase-strengthen a particular behaviour or set of behaviours.

Based on a detailed assessment of a child's current skills, numerous systematic instructional sequences are presented to the child. The child's response to each component of each task is closely monitored. Positive reinforcement is used. Progress is closely monitored through recording the child's reaction on each trial throughout the day. The results of each trial are recorded on detailed graphs and these form the basis of decisions as to when to move on to new tasks.

The past few years have seen the promotion of the ABA method in certain sectors as the most effective approach to the education of children with autism. Some parents believe the ABA method alone can effectively address their children's needs. Expert opinion varies on the success of the ABA approach. The view of the Department is that while the ABA method has a role to play, especially for younger children, it is not the only approach and is not necessarily appropriate for all children with autism. There is also concern that exclusive adherence to the ABA method to the exclusion of all other models is unduly one dimensional and not in the best interests of the overall long-term development of children.

The role of ABA was considered in detail by the task force on autism which concluded that ABA, in common with a range of other models, has a valuable contribution to make. The task force's view was that ABA and a range of other models should all be available within an eclectic approach where the precise model or models used and the extent of their use at any give time should be dictated by the professionally assessed and evolving needs of each individual child.

While the Department's preferred approach is to provide appropriate provision based on an eclectic model and delivered through the recognised primary and post-primary school network, it will continue, in conjunction with the National Council for Special Education, to consider applications which may be received for the establishment of further stand-alone facilities. The involvement of the NCSE also takes account of the role and responsibility of that organisation in identifying suitable educational placements for children with special needs. In examining all current and future applications for ABA specific units, the involvement of the NCSE, through its relevant special educational needs organisers, will enable the Department of Education and Science to consider the need for stand-alone units on a fully informed basis.

This participation will enable the Minister's officials to establish what provision, if any, is in place for the relevant children; where a child is not currently placed in any provision, to identify appropriate provision in that area, if it exists; to explore the potential of establishing new school-based provision; and at the end of this process to report back to the Department on the outcome of that process and provide an update on the position regarding each child.

The Department is considering a report from the National Council for Special Education on the application in question. Input has been requested from both the National Educational Psychological Service and the Department's inspectorate.

Mr. Bruton

It is nine months since an application was made for 12 places, for which 78 children are waiting. Surely the Department can act with greater urgency.

Mr. B. Lenihan

The information received is being considered and Department officials will revert to the relevant agencies if further information is required. The officials will notify all relevant parties when a decision on the application has been made.

The Dáil adjourned at 9.15 p.m. until 10.30 a.m. on Thursday, 6 April 2006.

Dáil Éireann díospóireacht - Wednesday, 5 Apr 2006