Dáil Éireann díospóireacht -
Tuesday, 11 May 2010

Vol. 708 No. 3

Adjournment Debate

Cancer Screening Programme

Deputy Timmy Dooley

I welcome the opportunity to discuss a matter of significant importance to the lives of the women in my constituency in County Clare. I have put a considerable amount of effort and time into the issue over the years, including during my time in the Seanad. My Seanad colleagues and I sought to have the BreastCheck service rolled out along the western seaboard. For some time prior to that, it had been available on the east coast. A number of colleagues, including former Senator Margaret Cox, championed that cause to ensure that women in the west of Ireland would have the same access to the same level of cancer prevention screening as those on the east coast.

As the Minister is aware, the breast cancer screening programme under the auspices of BreastCheck was set up for the west of Ireland, to be headquartered at University College Hospital , Galway. It was proposed that it would have a number of static units — one in Galway and one in Cork — and a number of mobile units carrying sophisticated equipment. Those would visit the various counties, of which Clare would be one, on a frequent basis to carry out breast screening among the identified target group of women aged 50 to 64. At that time it was estimated the service would be available to approximately 8,000 women in that target group in County Clare.

In 2007, significant advances were made when almost €27 million of capital funding was provided to construct the clinical units at Galway and Cork, and to procure the eight mobile units and the associated state-of-the-art digital screening equipment. That came on-stream, with a major announcement by the Minister in December 2007, in a 12-month period. It was expected at that time that the service was to be rolled out in County Clare in the following ten months. At the same time, €15 million of additional revenue funding was provided to cater for the national roll-out of the entire programme.

Unfortunately, the roll-out of this vital service throughout County Clare has not yet taken place. I accept that a small number of women from the north Clare area have been called to the static unit at University College Hospital in Galway. However, the rest of the county is still waiting. The area with the greatest density of population is not covered.

I urge the Minister to tackle the problem with the agency that has been tasked with rolling out the service at the earliest possible opportunity. Women from the north of County Clare to south-east Clare — from Meelick to Miltown Malbay and back to Doonbeg, and from Whitegate to Loop Head — have the same entitlement to the service as women throughout the country.

I recognise that BreastCheck does some good work, but that is cold comfort to the vast majority of women in County Clare to whom the service is not available. There have been changes in the way in which the health service has been configured in County Clare. The mammography unit at Ennis was closed and, despite some initial protest, it was accepted that the national cancer control strategy, which included the development of centres of excellence at Galway and Limerick together with the roll-out of the BreastCheck programme, gave the best possible outcome for patients. The women of the county accepted that, but they are left waiting for that third component, which must be part of an integrated strategy for the control of cancer in our society.

A number of women in the north Clare area have had the use of facilities since August 2009. It was suggested that during the preceding ten months, there would be a complete roll-out of the service for the rest of the 8,000 women in the county. That has not happened, and I understand that even at this stage a site has not been identified for the location of the mobile unit. I look forward to what the Minister has to say, and I urge her and her Department to put a bit of pressure on our friends in BreastCheck. The organisation has, as I said, done some good work, but that is cold comfort to the lives of so many people who await that vitalservice.

Minister of State at the Department of Health and Children (Deputy Áine Brady)

I will take the Adjournment on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

I welcome the opportunity to set out the position on breast cancer screening services in County Clare. BreastCheck, the national breast screening programme, provides free breast screening to women aged 50 to 64 area by area. BreastCheck operates from four clinical units based beside hospitals — two in Dublin and one each in Cork and Galway — and a fleet of 15 mobile digital screening units that provide screening to women locally.

The majority of women are offered their mammogram at a BreastCheck mobile digital screening unit to make the service as close, convenient and accessible as possible for women. Factors that influence the choice of a site for a mobile digital screening unit include the capacity of the site to provide necessary utilities, including electricity, plumbing, access to toilet facilities and adequate space. It is preferable that a site can accommodate the unit for the length of time it takes to screen all eligible women in the area, which can be considerable.

BreastCheck uses a range of sites nationwide such as hospital or clinic car parks, civic centres, shopping centre car parks and the grounds of schools or colleges. Screening schedules involve months of careful planning and preparation to ensure women are screened in an organised and efficient manner, and BreastCheck has a duty to fully utilise its available resources at all times.

When BreastCheck was seeking an appropriate location for a mobile site to offer screening to women living in County Clare, it was advised by Clare County Council that planning permission would be required. No other city or county council has ever required planning permission for the temporary location of a mobile breast screening unit. Months of extensive negotiation between Clare County Council and BreastCheck followed.

To commence screening of women in County Clare while negotiations with the council continued, BreastCheck invited more than 300 women living in areas in north County Clare, including Abbey, Boston, Carran, Castletown, Cloghaun, Derreen, Drumcreehy, Gleninagh, Glenroe, Lisdoonvarna, Mountelva and Rathborney, for screening at the BreastCheck western unit in Galway.

Clare County Council has recently waived its requirement for planning permission. That means that BreastCheck can now commence the necessary preparations required to locate a mobile unit in the county. A suitable site has now been selected in the grounds of the county council offices in Ennis. During the coming months, BreastCheck will proceed with the necessary preparations to make the site suitable for delivery of a mobile unit to provide quality-assured screening to women in the county. Screening of women is expected to commence in autumn this year.

It is BreastCheck's policy to publicly announce a screening schedule no more than three months in advance, as there is evidence that some women experiencing symptoms of breast cancer are likely to defer seeking a symptomatic referral from their GP and choose to wait for the routine screening.

However, any woman, irrespective of age, who has immediate concerns or symptoms should contact her GP who will where appropriate refer her to the symptomatic services.

I am pleased that arrangements are now being made for the continued screening of eligible women in Clare, and that screening is expected to commence by autumn.

Mental Health Services

Deputy Dan Neville

I thank the Ceann Comhairle for letting me raise again the issue of regulation of the professions of psychotherapy and counselling. At present, they are not regulated. There are no criteria by which one may gauge the standard of psychotherapy and counselling services. Anybody can set up a counselling or psychotherapy service without qualifications and charge a fee to vulnerable people whose lives may be in danger from suicide.

I will give two examples of short courses that allow, facilitate or encourage people to do that. The first is a course to gain a diploma in skills for counselling eating disorders, which is granted to people after fewer than 50 hours' tuition. One could do eight modules over eight weekends and obtain a diploma in counselling for eating disorders. There is no basic qualification required to enter this course. Eating disorders are extremely complex and have emotional, psychological, psychiatric and physical health implications. They have the highest mortality rate of any mental health condition. A counsellor with training of less than 50 hours does not have the range of skills to even understand the issues involved and is not qualified to probe the unconscious. He or she is dealing with human vulnerability and serious damage can be done to very delicate people

The second example I have concerns an advanced diploma in suicide studies that consists of less than 100 hours of tuition. This is marketed as providing people with skills to counsel people at risk of suicide and the bereaved of suicide. Modules include suicide prevention, suicide intervention and suicide postvention, each of which is completed in just two weekends, yet one receives an advanced diploma in suicide studies.

Those who are at risk of suicide, attempted suicide and self-harming require detailed psychiatric diagnosis. This cannot be done with training over three weekends. Some 80% of those who take their lives are suffering from a psychiatric disorder. A bereavement by suicide falls outside the normal range of human experience. It is an overwhelming loss that leaves the bereaved confused and helpless, overwhelmed by many emotions and many unanswered questions.

The two examples show the need to fully regulate the professions of psychotherapy and counselling, which are so essential to dealing with all areas of mental health and emotional difficulties and assisting in many varied areas of counselling, including marriage counselling, family counselling, sex and sexuality counselling, sexual abuse counselling, occupational counselling, bereavement counselling, addiction counselling, long-term illness counselling, and post-traumatic stress counselling. These involve very delicate areas of human vulnerability requiring the highest level of professional assistance. They should be included under the Health and Social Care Professionals Act 2005, which was introduced to regulate 12 professions. The areas to which I refer are not regulated under it because of issues that arose at the time regarding agreement between various groups. Disagreement has now featured for two years.

The psychological forum has criteria setting out the skills required of staff working in these areas. One does not allow doctors and nurses the freedom to walk in and out of each other's profession but it is allowed in respect of psychotherapy and counselling. The forum recommends that the baseline academic qualification for entry to training is a degree or equivalent in human sciences, be it medical, psychological, social or educational. For registration as a psychotherapist, the forum specifies a minimum of four years' training in specific psychotherapy modality at Master's level, which involves 1,400 hours.

With regard to entry for training for counselling, the forum requires that one have a leaving certificate or equivalent qualification, or a relevant degree, while equivalent accredited prior learning is considered. An interview is required to enter training for both counselling and psychotherapy to determine whether one is suitable. The baseline qualification and experience for registration as a counsellor is a minimum of four years' training in specific counselling and psychotherapy modality, involving a minimum of 1,250 hours. This is what is required, not a few weekends of training.

I tabled a parliamentary question asking the professions that have completed registration on the Health and Social Care Professionals Council and the reply stated, "Arrangements for the establishment of the first of these registration boards are currently being finalised". Can I take it that none of the 12 grades has been regulated since 2005 despite the high profile of the Bill which was intended for this purpose? The Minister has informed me that it is not until the 12 grades are dealt with that the areas I am addressing will be considered.

Deputy Áine Brady

I am responding to this matter on behalf of the Minister for Health and Children, Deputy Harney. I thank the Deputy for raising this issue and for giving me the opportunity to update the House on the ongoing regulatory programme undertaken by the Department of Health and Children.

The Health and Social Care Professionals Act was passed by the Oireachtas in 2005. The Act provides for the establishment of a system of statutory registration for 12 health and social care professions. The 12 professions to be regulated under the Act are clinical biochemists, dieticians, medical scientists, occupational therapists, orthoptists, physiotherapists, podiatrists, psychologists, radiographers, social care workers, social workers, and speech and language therapists.

The structure of the system of statutory registration will comprise a registration board for each of the professions to be registered, a health and social care professionals council with overall responsibility for the regulatory system and a committee to deal with disciplinary matters.

As a first step in the implementation of the system of statutory registration, the Minister for Health and Children launched the Health and Social Care Professionals Council in March 2007. The chief executive officer of the council was appointed in 2008 and additional senior administrative staff took up duty with the council in late 2009. The council must establish a registration board for each of the 12 professions currently covered by the Act. These appointments, and further progress in the establishment of a suitable organisational structure, will greatly assist the council in its ongoing work in preparing for the establishment of the individual registration boards. Arrangements for the establishment of the first of these registration boards are currently being finalised. The council is currently working to put in place the necessary structures for registration, education and fitness to practise for the 12 health and social care professions designated in the Act and it is hoped to bring additional registration boards on stream in late 2010.

The Health & Social Care Professionals Council will enable health and social care professionals to practice in a regulated, controlled and safe environment and in a manner which will ensure the provision of high-quality interventions, meeting the challenges of increasingly complex and evolving care for service users. Health and social care professionals will be facilitated in ensuring responsible and accountable practices while providing the highest level of patient care and service.

While the proposed system of statutory registration applies, in the first instance, to 12 health and social care professions, the legislation empowers the Minister for Health and Children to include, on the basis of specific criteria, additional health and social care professions in the regulatory system over time, as appropriate.

A detailed examination is required of the degree to which such groups conform to the criteria included in section 4 of the 2005 Act governing the addition of further professions into the system, including the extent to which the profession has a defined scope of practice and applies a distinct body of knowledge; the extent to which the profession has established itself, including whether there is at least one professional body representing a significant proportion of the profession's practitioners; the existence of defined routes of entry into the profession and of independently assessed entry qualifications; the profession's commitment to continuous professional development; the degree of risk to the health, safety or welfare of the public from incompetent, unethical or impaired practice of the profession; and any other factors that the Minister for Health and Children considers relevant.

The priority for the Health & Social Care Professionals Council is to establish statutory registration for the 12 designated health and social care professions in the first instance. The issue of inclusion of other grades, such as psychotherapist and counsellor, within the scope of statutory registration will be considered after the initial designated 12 professional grades have been fully dealt with.

Road Network

Deputy Simon Coveney

I thank the Office of the Ceann Comhairle for allowing me to raise this matter and the Minister of State for being present.

I speak for the 15,000 people who live in Carrigaline, one of Ireland's largest commuter towns. It was the case some years ago that more people drove to work alone in their cars from Carrigaline than from any other town in the country. When I was a member of Cork County Council for three or four years, I worked on the planning of a western relief road for the town. Much of the zoning and planning permission for the many houses that have been built in Carrigaline, like other parts of the country, was agreed in anticipation of the construction of a western relief road to try to relieve the intense traffic on Main Street in the town. The street in question, which is no more than 8 m wide, was built for a town of 500 or 600 people but now has to cater for a town of 15,000 people. The eastern relief road in the town has worked reasonably well, especially in allowing traffic to flow from Crosshaven to Cork city, but the western side of the town still has no relief road. All the traffic is driven through Main Street, which simply cannot handle it.

A detailed study of the town, which was undertaken in 2006 so that a western relief road could be designed, has been in place for some time. Cork County Council received planning permission from An Bord Pleanála in 2006 to proceed with the road. At the time, the board said that this most important infrastructural development would allow the town to continue to grow and breathe. We had planned to make progress with the project on a public private partnership basis so that a new town centre could be developed for a large urban area outside Cork city, but that project has been halted. As recently as this week the county manager said he was very anxious to move ahead with this road but simply does not have the money to do so. That is why I am raising the issue in the national Parliament. Funding needs to be allocated by the Department of the Environment, Heritage and Local Government or the Department of Transport to allow this crucial infrastructure to be built. A partnership between local authority and national funding is required so that the crucial bottleneck in the town of Carrigaline can be alleviated.

I am conscious that I am calling for funds at a time when the Government has none. I do not make that call lightly. This project would pay for itself, however. I live in Carrigaline. My office is on Main Street. More than 30 businesses on the street have gone out of business over the past 18 months. This town needs help. One of the ways the Government can make a significant contribution to the business community and the residents of the town is to provide a share of the funds needed to allow the western relief road to be developed. That will allow the town to grow and breathe and enable businesses to start flourishing again. That, in turn, will produce revenue and jobs for the State. The borrowing of this money can be justified, in my view. It is capital rather than current expenditure. I ask the Minister of State to pass on my appeal to the appropriate senior Minister. We need to make progress by providing funding or allowing Cork County Council to increase its borrowing capacity, so that this infrastructural project can take place. Everything is in place to make it happen, with the exception of the funding.

Deputy Áine Brady

I am responding to the Deputy on behalf of the Minister for Transport, Deputy Noel Dempsey. I thank Deputy Coveney for giving me an opportunity to address this issue in the House. The improvement and maintenance of regional and local roads is the statutory responsibility of each local authority in accordance with the provisions of section 13 of the Roads Act 1993. Works on such roads are funded from the resources of local authorities, supplemented by State road grants paid by the Department of Transport. The initial selection and prioritisation of works to be funded is also a matter for the local authority.

On 22 February last, the Minister, Deputy Dempsey, announced the regional and local road grant allocations for 2010. A total of €411.409 million is being provided to local authorities this year for the maintenance and improvement of regional and local roads. In deciding on allocations for this year, the first priority was to ensure the protection of the existing road network, particularly the massive Exchequer investment of €6 billion which this Government has made through the provision of regional and local road grants since 1997. It is important that resources are targeted to address on a priority basis the most urgently required repairs resulting from the extensive damage caused by the prolonged severe weather. Local authorities should carefully reassess their planned road programmes for 2010 with regard to these priorities.

In August 2009, Cork County Council submitted a proposal for funding the land acquisition and construction of this project in 2010 and beyond. The estimated cost of this project is approximately €18.5 million. The Minister recently wrote to Cork County Council on this matter. He is awaiting its response.

The Dáil adjourned at 8.55 p.m. until 10.30 a.m. on Wednesday, 12 May 2010.