Dáil Éireann díospóireacht -
Thursday, 29 Mar 2007

Vol. 634 No. 6

Adjournment Debate.

Cancer Incidence.

Ms Harkin

I wish to raise the matter of the report on cancer statistics published this week. Our cancer survival rate does not compare favourably with many countries in the EU 15. Cancer survival rates are linked to European geography but we learned that this is also the case on a national basis. This makes grim reading for the Minister but does not come as a surprise. Two years ago, a report compared cancer survival rates in Northern Ireland with the Republic. The figures showed that, for breast cancer in particular, a greater percentage of women died in the Republic than in Northern Ireland. This week we learn that women in four different regions, the midlands, the south east, the south west and the west, have a higher risk of death from breast cancer than in other regions.

Irish women have poorer survival rates from breast cancer than many of our sisters in Europe and Northern Ireland. Women in four regions, including the midlands and the west, have significantly higher rates of death than our sisters in other regions. This is a stark statistic. These are not minor variations. The risk of death from breast cancer is 28% higher if one lives in the midlands and 26% higher in the west. The poorer survival rates also apply to colorectal and prostate cancer.

The Taoiseach accepted the fact of significant regional variations in survival from those suffering from a number of cancers. As always, the Government states that matters are improving and will get better. There may be truth in this. Who takes responsibility for the failure of the past ten years? Who takes responsibility for the fact that BreastCheck is not available in the north west? Who takes responsibility for the fact that we are 40 years behind our European counterparts because we have no cervical screening programme? Who takes responsibility for the deficit of 18 urologists to treat prostate cancer in Ireland?

Who takes responsibility for the fact that, as the second richest country in Europe, people in the north west do not have reasonable access to a radiotherapy service? There is no promise of a service other than that in Belfast which can barely cope with demand in Northern Ireland. It has committed to take one patient per month. Is that good enough for those living in the north west?

Who takes responsibility for those who need palliative therapy in the north west? This will give them some quality of life as the illness progresses. They are too sick to travel long distances on inadequate public transport. Will anyone take responsibility for the poorer access to chemotherapy and radiotherapy in many regions? This leads to poorer chances of survival. Will the Government state that things are getting better? That is not good enough and does not represent being accountable in the way Ministers and the Government should be. Responsibility lies squarely on the shoulders of one Minister for Health and Children after another.

Will the Minister examine regional services in the context of best practice? Bigger is good, certainly, but it is not always better. Will the Minister ensure multidisciplinary teams are in place and that hospital networks share data with satellite units so that those who live in the regions, especially the west and north west, can have reasonable access to the very best services? This model is in place in a number of countries and it works well. I am asking that whatever new regime the Minister is putting in place, she will guarantee better service, better medical outcomes and geographical access for those in the regions.

Minister of State at the Department of Community, Rural and Gaeltacht Affairs (Mr. N. Ahern)

I am taking the Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

The Government welcomes the report on patterns of care and survival of cancer patients in Ireland between 1994 and 2001 which was published this week. This report, funded by the Department of Health and Children, adds significantly to our understanding of survival patterns of care for four major causes of cancer, namely, breast, colorectal, lung and prostate. This Government is making the full range of cancer services available to cancer patients throughout the country. Since 1997, approximately €1 billion has been invested in cancer services nationally. More than 100 additional consultants have been appointed in key areas of care such as medical oncology, radiology, palliative care and histopathology. An additional 343 clinical nurse specialists have been appointed in the cancer services area. Almost 94,000 patients were discharged from hospital following a diagnosis of cancer in 2005, an increase of 70% over 1997.

We have invested substantially in all regions to improve cancer survival. The improvements are evidenced in the report. It shows improvements nationally in survival rates for breast, colorectal and prostate cancers, but not lung cancers. There were improvements in all regions for breast and prostate cancers and in most areas for colorectal and lung cancers. For example, in the period 1994 to 1997, 73% of women with breast cancer survived at least five years. This figure had increased to more than 78% in the period 1998 to 2001. For colorectal cancer, the five-year survival rate for the period 1998 to 2001 in the north west increased to 53.5%, which is in excess of the national average of 51%.

We know there are regional variations in cancer survival rates, and Deputy Harkin has outlined some of those. The Government's national cancer control strategy, published last year and welcomed by stakeholders, is designed to change this fundamentally to improve outcomes for cancer patients in each region of the country. We are committed to investing significantly in the implementation of the strategy. The National Development Plan 2007-2013 includes major investment in the cancer area. We have made available an additional €20.5 million this year for cancer control, covering screening, acute services and research. This is an increase of 74% on the comparable 2006 investment and includes €3.5 million to support the initial implementation of the HSE's national cancer control programme.

The registry report confirms the importance of a national approach to improvements in cancer control. It is the intention of the Minister and the HSE to ensure patients, regardless of location, have timely access to high quality, specialised care that will lead to further improvements in cancer mortality rates. The HSE cancer control programme will manage, organise and deliver quality assured cancer services on a whole population basis, regardless of geography. The service plan for the HSE for this year sets out the detailed deliverables of the programme.

Evidence-based population screening programmes are an essential element of the strategy. On 1 January this year, the Minister established a National Cancer Screening Service Board. This amalgamated BreastCheck and the Irish Cervical Screening Programme, ICSP. Both BreastCheck and the ICSP will be rolled out nationally this year. The total allocation to the new service is €33 million, a 71% increase on the 2006 allocation to the programmes. The service will also advise on the implementation of a national colorectal screening programme. The findings contained in the registry report provide an essential benchmark against which we can monitor the provision of equitable cancer services. The Government is committed to continuing investment in cancer care. We will ensure that the full range of cancer services is available and accessible to cancer patients in all regions.

Pension Provisions.

Mr. O’Shea

I raise the issue of a social welfare case that appears blatantly unfair, discriminatory and anomalous concerning the pension entitlements of a woman in my constituency who is 66 years of age. This woman lives in west County Waterford, has virtually no vision in her right eye and very little in her left. Since 1999, she has been in receipt of widow's pension and was further granted the blind pension in 2000. However, since turning 66. last November and consequently receiving old age contributory pension, she has found that she has lost a considerable amount of her income.

Before reaching 66, the two pensions combined had given her €340.10 per week, with fuel and living alone allowances in addition. However, on turning 66 she lost the entitlement to the blind pension and now receives only €209.30 in basic pension plus fuel and living alone allowances. As one may imagine, she is quite distressed about this. She believes it is very unfair to take away one of her social welfare payments simply because she has turned 66. As a result of this development, she has become quite depressed and feels a large amount of her independence has been taken away from her.

She has written a number of letters to the Minister for Social and Family Affairs, Deputy Brennan, about her case, to no avail. In each instance she has pointed out the contrast with those receiving carer's allowance. They will be able to claim half a carer's allowance as well as another social welfare payment from September. Why should people with visual impairment not be treated in the same way? It is disgraceful that Celtic tiger Ireland treats older people in such a miserly and skinflint manner. This woman has done nothing wrong. All that has happened to her is that she has aged one more year, yet she finds herself significantly penalised financially for doing so. I am calling on the Minister to explain why this anomaly is allowed to exist, whether he agrees with it and if not, how he intends to clear it up.

Mr. N. Ahern

I am taking this issue on behalf of the Minister for Social and Family Affairs, Deputy Brennan. The social welfare code provides for the avoidance of multiple payments. That is, where a person is entitled to more than one income maintenance payment at any time, only one such payment can be made. However, there are a number of exceptions to this principle provided for in regulations, including the payment of blind pension for persons who have sufficient PRSI contributions concurrent with any of the short-term social insurance payments, including illness, occupational injuries, job seeker's, maternity, adoptive, health and safety benefits or, alternatively, one-parent family and analogous payments or widow's-widower's under 66 contributory or non-contributory payments, all of which relate to working age. Once a person reaches the age of 66 years, only one payment can be made.

The qualifying criteria for entitlement to blind pension states that a person must be over 18 years of age, satisfy a means test and be so blind that he or she cannot perform any work for which eyesight is essential or cannot continue his or her ordinary occupation. It has always been regarded as a scheme providing income maintenance for persons of working age, that is, up to 66 years. Prior to the introduction of the State non-contributory pension, a person receiving blind pension who reached 66 years was allowed to continue on it instead of being transferred to the old age non-contributory pension. This was because the structures of the former old age non-contributory pension and blind pension payments were similar with only marginal differences in terms of the means assessments. This approach was changed with the introduction of the State non-contributory pension as part of a move towards the rationalisation of social assistance payments, with as far as possible one more favourable means test for all recipients aged 66 years or over, including blind persons over that age.

In February 2006, the Government decided that income support and maintenance schemes, together with associated resources, should be transferred from the Health Service Executive to the Department of Social and Family Affairs. An interdepartmental implementation group was established, under the chairmanship of the Department of Health and Children, with representation from the Department for Social and Family Affairs and the HSE, to progress this issue. The blind welfare allowance is one scheme administered by the HSE which will transfer to the Department of Social and Family Affairs.

Blind welfare allowance is a supplementary payment in addition to an existing social welfare payment which is paid to eligible persons over 16 years who are blind or visually impaired or to eligible persons whose income is below the combined rate of blind pension and blind welfare allowance rate. A person in receipt of blind pension and who qualifies for blind welfare allowance will continue their entitlement past 66 years.

A policy review of blind welfare allowance and the other HSE schemes designated for transfer is being conducted. It is expected the social welfare Bill 2008 will provide the necessary legislative framework for the transfer. This policy review will examine the scope for rationalisation of the HSE schemes within existing social welfare schemes and the scope for development of these schemes in the context of progressing issues around the additional costs of disability. Any changes to the blind pension will be considered within the wider context of this policy review and of the transfer of the blind welfare allowance scheme from the HSE to the Department of Social and Family Affairs.

Parking Regulations.

Mr. Costello

The Minister of State will have some experience of the lack of residents-only parking in the vicinity of Croke Park. It is an issue of concern to the local residents who suffer on big event days. Croke Park's capacity stands at 82,500 and it is open not just to Gaelic games but to international rugby and football matches. Last night, Croke Park was at full capacity for an international floodlit football game. Cleaning did not take place until 3 a.m., causing much grief to residents in the vicinity of the facility. While there has been a large increase in the use of Croke Park, mainly for international games, nothing has been done to make life easier for the residents in the vicinity.

Initially when the plans for the expansion of Croke Park were put in place in 1994, it was intended that a one-mile radius around Croke Park would be free from vehicles of fans attending games. That has not transpired and local residents experience vehicles parked on grass margins, blocking driveways and double yellow lines. It is especially difficult in the Dublin Central constituency. Many teams in the latter stages of the all-Ireland championships are from Northern Ireland. Many fans travel from counties Derry, Donegal, Armagh, Tyrone and the central Dublin area near the Drumcondra Road has seen a proliferation of parking that gives rise to numerous problems for local residents.

Since I tabled this matter, I am glad the Minister for Transport has taken on board my proposal. He has tabled an amendment to the Roads Bill 2007 which is seven pages long and comprises a third of the entire Bill. It does not, however, address all the issues. What provision will be made for park-and-ride facilities? How will the proposed permit system be implemented? By-laws will be granted to local authorities but will require individual applications when residents-only parking is required. This will be a nuisance when a generic approach is much preferable. I am glad a move has been made in the right direction. It seems there will, however, be teething problems in getting the system right. When that happens, it will be to the benefit of many people living on the north side of Dublin.

Mr. N. Ahern

I am replying to this matter on behalf of the Minister for Transport.

Under the Road Traffic Act 1994 responsibility for traffic management was devolved to individual road authorities. Responsibility for the implementation of traffic management measures and the application of road traffic regulatory provisions in the Dublin city area is therefore a matter that falls to Dublin City Council in the first instance.

The issue of parking has been the focus of the traffic management issues that have been raised with the Minister for Transport. Representations have been made to the Minister about parking problems that arise on the roads in the environs of Croke Park and other stadia on match and other event days when a large influx of motorists from outside the area park on residential roads for the duration of the events.

On match and event days, the Garda authorities put in place extensive traffic management plans. This includes a Garda cordon area for crowd safety controls and to regulate access. This has been in place for many years in respect of the streets in the immediate vicinity of Croke Park and Lansdowne Road when matches or other major events are held there. Divisional traffic corps units also patrol the outlying areas prior to and subsequent to any event ensuring the traffic flow is maintained.

Vehicle owners who reside within the Garda cordon area may apply for an annual permit to allow that vehicle to enter and exit through the cordon barriers. The regulation of access and residents permits measures are implemented and administered by the Garda as are other traffic management and parking prohibitions that are applied in the greater stadium area on event dates.

The matter being raised now is that parking be reserved on a residents only basis on match and event days to facilitate people living in the Croke Park area. This proposal would effectively prohibit or exclude the public from parking on a public road. An important point to bear in mind is that road traffic regulations have national application and the issue of reserving parking on public roads to local residents is very complex and is much broader than in the context of match days at Croke Park.

Discussions on this issue have also drawn attention to the fact that inconvenience can also be experienced by residents where parking congestion can arise on a daily basis on public roads in residential areas in other circumstances in other parts of Dublin and countrywide. At some locations throughout the country, parking on residential roads is now taken up on a daily basis, not just on periodic match or event days, by motorists, who use the location to park if working nearby or to use the location as a park and ride facility while they commute onwards by bus or rail to work or walk to work and collect their vehicle later that day on return.

Provisions in regard to the regulation of road traffic and parking on public roads are contained in the Road Traffic Acts and in the Road Traffic (Traffic and Parking) Regulations 1997 to 2005 and supported by road traffic signs. Responsibility for traffic management, including the implementation of parking controls such as prohibitions and restrictions, was devolved to individual road authorities under the Road Traffic Act 1994. An examination of this issue was carried out in the Department of the existing road traffic legislative provisions to ascertain if new measures to reserve parking to local residents in any circumstances would be appropriate or feasible. This examination indicated that there is no existing legislative provision to exclusively reserve parking on a specified public road on specified dates to the persons who reside in premises on that road.

The matter was then referred to the Office of the Attorney General for advice to establish whether it would be appropriate or feasible to provide for parking restrictions of this nature on a public road at specified times on specified days to cover matches and other events. On the basis of the advice received, the Minister has included a comprehensive provision, as Deputy Costello mentioned, in the Roads Bill 2007, which is going through the House, to provide a by-law making power for road authorities for restriction or prohibition of parking at specified events.

The Deputy referred to other matters, park and ride facilities and so on. If the Roads Bill is dealt with in this House next week, he might have another opportunity to tease them out. I am aware of the problem. My constituency at one stage extended nearer to Croke Park and to the North Circular Road. The northerners, to whom the Deputy referred, do not all park in the environs of Dublin Central.

Mr. Costello

The Deputy finds that a few of them park in his constituency as well.

Mr. N. Ahern

I assure the Deputy that a number of them park in Griffith Avenue, Whitehall and Santry. Something is being done about it.

Mr. Costello

It might be beneficial to both our constituencies.

Mr. N. Ahern

It may not be a total solution to this issue. Such motorists can be restricted from parking in one area or street and they might then park in my constituency. It is a case of addressing this issue in a number of ways. I recommend that the Deputy tease this out with the Minister, Deputy Cullen, during the debate on the Roads Bill next week.

The Dáil adjourned at 7.25 p.m. until 2.30 p.m. on Tuesday, 3 April 2007.