Dáil Éireann - Volume 630 - 01 February, 2007
Private Members’ Business. - Cancer Services: Motion (Resumed).
The following motion was moved by Deputy Joe Higgins on Wednesday, 31 January 2007:
That Dáil Éireann,
conscious of the fact that 20,000 new cases of cancer are diagnosed in the State each year with 7,500 dying from the disease:—
calls on the Minister for Health and Children to make a clear and comprehensive statement on current services for cancer patients in this State and to clarify in detail the position on the implementation of the national plan for radiation oncology;
notes with alarm the recently highlighted situation of a Kilkenny mother, “Rosie”, with an aggressive cancer of the colon, who, being a public patient, had to wait eight months for a colonoscopy with the most serious and tragic consequences for her health and life;
condemns the fact that after ten years in power the Fianna Fáil-Progressive Democrats Government has failed to put in place a comprehensive national cervical cancer screening programme, 11 years after this was announced, while the waiting time for test results can be six months;
 further condemns the fact that a comprehensive national breast screening programme is not yet in place;
vigorous programmes for cancer prevention including education of children in schools from a young age;
urgency and added resources to put in place a comprehensive programme for the earliest possible detection, and the best possible treatment of cancer;
the immediate extension of cervical and breast screening to all areas of the country;
appropriate national screening programmes for other cancers such as colorectal and prostate cancer;
the provision of 3,000 acute hospital beds that are urgently needed to ensure cancer sufferers are not prevented from immediate admission to hospital when necessary;
the scrapping of the Government bias toward privatisation of health care through fostering tax incentivised private hospitals in the grounds of public hospitals;
regional radiotherapy centres providing access for cancer patients throughout the island of Ireland and to meet the concerns of communities in the north west and south east at the failure to provide radiation therapy for public patients;
a review of the decision to close St. Luke’s Hospital in Dublin in view of the testimony of former and current patients about its contribution to cancer care; and
a fully resourced public health service with immediate access to services by all, based on medical needs.
Debate resumed on amendment No. 1:
To delete all words after “Dáil Éireann” and substitute the following:
commends the Government for the unprecedented investment in cancer control, including prevention, screening, treatment services and supportive care;
supports the Minister for Health and Children in her commitment to ensuring equitable access to high quality cancer services for patients throughout the country; and
 recognises with approval:
that cancer survival is improving in Ireland for all of the major cancers;
that since the implementation of the first National Cancer Strategy in 1997, approximately €1 billion has been invested in cancer services nationally;
the additional revenue investment of €20.5 million in cancer control for 2007 and the establishment by the Health Service Executive of a National Cancer Control Programme to implement the New National Strategy for Cancer Control;
that the National Development Plan 2007-2013 includes major investment in the implementation of the Cancer Control Strategy, including modern diagnostic and treatment facilities;
the Government’s continued support for health promotion programmes, including health education programmes being delivered through schools nationally;
the recent establishment by the Minister for Health and Children of a National Cancer Screening Service Board which will roll out BreastCheck to the south and west commencing in spring of this year and the Irish Cervical Screening Programme commencing late 2007, and also advise on a colorectal cancer screening programme;
the progress that has been achieved to date on the implementation of the National Plan for Radiation Oncology; the commitment of all necessary capital funding for the plan through Public Private Partnership and Exchequer sources; and the commitment of the Government and the Health Service Executive to achieve full implementation in a timeframe that accords with the Government’s policies and priorities; and
progress being made in the procurement process for the initiative to develop private hospitals on the campuses of public hospitals in order that up to 1,000 beds currently reserved for private patients may be redesignated for use by public patients.
—(Minister for Health and Children).
Dr. Devins Dr. Devins
Dr. Devins: I wish to share time with Deputies Cooper-Flynn, O’Connor, Keaveney and McGuinness, if that is agreeable.
An Ceann Comhairle An Ceann Comhairle
 An Ceann Comhairle: Ciúnas.
Dr. Devins Dr. Devins
Dr. Devins: I am delighted to have the opportunity to speak on this Private Members’ motion on cancer services. I congratulate the Government on the proactive approach it has taken over the past ten years in the fight against cancer. We must deal in facts on this issue. It is a fact that more than €1 billion has been invested in the battle against cancer since the first national cancer strategy was established in 1997. It is also worth remembering that more than 100 consultants have been appointed in the three key areas of cancer care, namely, oncology, radiotherapy and surgery. These are the three pillars of cancer fighting and each must be developed to the maximum.
However, there is another aspect of the fight against cancer that I would like to focus on, namely, the early detection of this malignant disease. This is best achieved by screening. The implementation of effective, fully evaluated and cost analysed methods of screening is essential if the ravages of cancer are to be overcome. BreastCheck uses a proven method of screening for breast disease in women. I am delighted that the roll-out of this essential service in the south and west will commence in a few months. I welcome the €8 million which the Government has allocated for this. Construction of the two regional units, in Cork and Galway, is under way. The Galway unit will cover the west and north west, and construction commenced last year. This is the physical manifestation of the fact that the roll-out is on target. The purchase of five additional mobile units will ensure that those areas of the country outside the range of the regional centres will have the full benefits of BreastCheck. Women living in areas such as Sligo-Leitrim will be able to avail of this service from the start of the national roll-out this summer.
I want to refer to screening for cancer of the cervix. As we all know, cervical cancer is on the increase. An effective screening procedure is available and a pilot screening project has been available for women in the mid-west area during the period January 2001 to December 2006. This pilot project is currently being evaluated and I understand the results are encouraging. It is essential that the expansion of this much needed programme to the rest of the country is commenced as soon as possible. I ask the Minister to ensure that the full national cervical screening programme is in place by the end of 2007. I warmly welcome the €5 million provided by the Government to facilitate this roll-out.
However, it is important that this is not a partial roll-out, as occurred under the BreastCheck programme. All women in the country, irrespective of where they live, are entitled, and demand, this essential cancer screening service. It must be available to all women at the same time. We have seen in the past the geographic inequalities that  resulted from a partial roll-out of BreastCheck. After the strong case made by various public representatives from the west and south, including me, I am delighted that this inequality is about to be corrected with the commencement of BreastCheck in these areas. From repeated representations made to me, I know how much the women in Sligo and Leitrim, as in other areas, need this essential service.
I warmly welcome the commencement of BreastCheck in the summer. I urge that the commencement of the national screening programme for cervical cancer be commenced in 2007.
Ms Cooper-Flynn Ms Cooper-Flynn
Ms Cooper-Flynn: I welcome the opportunity to speak on the issue of cancer services, which are of huge importance throughout the country, particularly in the west where I am based.
I compliment the Minister for Health and Children and her Department on the significant improvements in funding for cancer services. However, having acknowledged this, we must examine the serious issues that still face us such as the inadequacy of the services and areas where I feel discrimination has taken place, particularly with regard to the roll-out of certain services to the disadvantage and detriment of women in the west. It is unacceptable that there are waiting lists of up to 14 weeks for radiotherapy and that people have to travel extremely long distances. People with prostate and lung cancer, for example, are on unacceptably long waiting lists. Everyone has acknowledged that this is against best clinical practice.
We all welcome the roll-out of the cervical screening programme. However, the availability of BreastCheck has been a serious issue in the west. Breast screening has been in place in Northern Ireland for more than ten years. It has been available in most parts of Ireland for the past four to five years. However, breast screening will not be up and running in the west until the end of this year. The Minister has been serious about making this happen and I welcome the fact that this deadline will be met. I welcome the additional investment of funds the Minister has put in place to make it a reality. However, it is important that we are not left to the end in the roll-out of the national cervical screening programme. The people of the west cannot be treated in this discriminatory manner. Sadly, there are women being diagnosed with breast cancer today who could have been alerted earlier if this service had been available to them.
A partial roll-out of any service of this type is unacceptable. I accept that a pilot scheme for cervical screening has been running and we all recognise that the number of women getting cervical cancer is increasing. Cervical cancer is a killer and must be addressed with the utmost seriousness. I note that from January 2001 until the end of December 2006 approximately 50,700 women attended for screening under this pilot programme in the mid-west. I welcome the decision to  expand the programme nationally. It is important that this is done throughout the country by the end of 2007. I welcome the provision by the Department of an additional €5 million to facilitate the rolling out of this service.
It is important to recognise that there is a definite national plan in place for radiotherapy and the Minister is to be commended on this. The deadline for the roll-out of this service throughout the country is 2011. The Minister maintains that much of this will be done through public private partnership. It will be difficult to meet this deadline, but all the resources possible need to be put into this area to ensure the deadline is met. It is critical to the public that this is taken seriously. I welcome the fact that the new national development plan includes a major investment for the cancer control strategy. This is an indication of how serious the Government is taking the whole issue of cancer services.
I welcome the improvements that have been made. It would be remiss of anyone not to acknowledge the very significant investment that has been made in cancer services. However, there are still huge gaps in the service and we must do everything we can to address them. I ask the Minister that fairness and equity be applied across the country and that the west not be discriminated against in the future as, unfortunately, it was in the past.
Mr. O’Connor Mr. O’Connor
Mr. O’Connor: I welcome the opportunity of speaking on this motion. I compliment the Independent group on the manner in which it tabled it.
The Joint Committee on Health and Children had a meeting yesterday with an SDLP group. It might encourage the Minister to know that the group paid much tribute to the work she is doing. Carmel Hanna, the SDLP spokesperson on health, said they are impressed by the efforts of the Minister. Perhaps the Minister of State will convey those views to the Minister.
I note that the Minister of State, Deputy Brian Lenihan, is in the House. As a Tallaght-based Fianna Fáil Deputy, I am particularly pleased that this week he confirmed that major funding is to be made available to the childhood development initiative in Jobstown. The news has been warmly welcomed in Tallaght and I thank the Minister of State for his efforts in that regard.
One would expect that in a debate such as this I would mention Tallaght at least once. There is a group from the VTOS in Tallaght in the Visitors Gallery and it has taken a particular interest in the debate so far. I know they would want me to speak up for Tallaght, which I always want to do. The Ceann Comhairle has taken a particular interest in Tallaght Hospital since it was founded and was kind enough to place me on its board more than 20 years ago. That was a significant act at a time when we needed community voices on Tallaght Hospital.
 When the hospital was set up in 1998 it was keen to develop its cancer services. Cancer care has become one of the major pillars of health care provision in the past few years at the Adelaide, Meath and National Children’s Hospital in Tallaght. While most of the specialties involved in cancer care were represented from the opening of the hospital in summer 1998, some key disciplines were missing. The advent of a medical oncology unit and the appointment of specialists in the fields of palliative care, radiation oncology and other disciplines have introduced a holistic approach to the care of the cancer patient. Against the background of the existing strength in the field of surgical oncology, Tallaght Hospital has now evolved into a centre providing all aspects of cancer care.
Over 1,300 new cancers are seen annually at Tallaght Hospital. Solid tumours including prostate, renal, cell, lung and others all have dedicated high-volume units. A strong unit oversees the research board and there is a clinics trial unit whose aim, I understand, is to conduct research into cancer. There has been a huge investment in cancer audit in the past two years which has resulted in the purchase of a dendrite system and the appointment of audit managers for all major disciplines in cancer care. The national institute of preventive health will play an important role in the range of cancer services provided at Tallaght, particularly relating to colon, breast, cervical and prostate cancer screening.
The recent publication of the National Cancer Forum recommended that there be four cancer networks and approximately eight cancer centres in Ireland. This is a much needed opportunity to enhance existing services. All site-specific groups mentioned want to consolidate and expand in line with the large increase in cancer numbers outlined in the report of the National Cancer Registry and in keeping with the increase in our elderly population. The volume of cancer numbers and range of cancers seen, the availability of the full range of necessary disciplines, its formal audit and quality assurance programmes all point to Tallaght Hospital as being more than qualified to be one of the national cancer centres. This is an essential ingredient for the future of the Adelaide, Meath and National Children’s Hospital and the population it serves. I remind Members that Tallaght Hospital, situated as it is in the third largest population centre in the country, also caters for a wider catchment, extending through parts of Wicklow and Kildare and as far as the Wexford border.
At a time when health care is on everybody’s mind and the subject of much discussion it is important we speak up for our local hospitals. I am happy to do so in the case of Tallaght Hospital. As a local Deputy for the Tallaght area, I believe that, as evidence of the Government’s commitment, it will be expected that the Adelaide, Meath and National Children’s  Hospital in Tallaght be designated as one of the eight major cancer centres when the report is finalised. I stress that point to the Minister of State and hope, taking an interest in Tallaght and in my work as he does, he conveys that to the Minister at the earliest opportunity.
This has been a valuable debate. The rota of Government speakers shows we have come from north, south, east and west, which highlights how important this issue is to people. At a time when there is unprecedented wealth in the country all of us have a role to play in ensuring health services continue to serve the people. We should not be ashamed to make that point at every opportunity where cancer services are concerned.
Cecilia Keaveney Cecilia Keaveney
Cecilia Keaveney: I will declare an interest. My father died of cancer so it is of personal interest to me as much as it is to anybody in this Chamber. Former Deputies, some good friends, have also died of cancer. People outside may think we are a different beast but we are also touched by this serious disease. One in four will get cancer and one in three will die from it.
I have spent some time dealing with the issue of cancer. A number of years ago I and the then Senator Mary Jackman spoke with people in England in various cancer hospitals. We were asked by one specialist not to politicise cancer nor to call for services in every single hospital just because we might represent the area in which one was situated. The specialist urged that we put the patient first and ensure the patient had the best opportunity to survive. That advice has had a deep impact on my work since. I am lucky that my local hospital in Letterkenny has the potential and ability to deliver a good quality cancer service. That service was fought for and has relied very heavily on one factor, namely the delivery of a permanent breast surgeon to link with a bigger centre, avoiding the situation where surgeons work on a small number of cases widely dispersed around the countryside. If I, God forbid, had to go under the knife at any point I would like to think the surgeon dealing with me dealt with cancer surgery day in and day out, week in and week out, so that his eyes were as sharp as his knife.
When I sought facilities for Letterkenny General Hospital a number of years ago I was told by the health board that it needed to link up with a bigger centre first, with the development of its services coming further down the line. Thankfully, many years later, it has moved on significantly. I acknowledge the tremendous role the Donegal Action for Cancer Care group played. Public recognition of and mobilisation towards what was needed were also important and we are now in a position where the job of permanent breast surgeon will soon be advertised. We have a link with Galway Regional Hospital, as a result of which the potential for our patients has improved dramatically. It has taken some time but surgery has been maintained in the interim so  I am pleased about the agreement to link up with Galway. Many people suggested we link up with Derry but that was discussed and we have moved on.
BreastCheck is the second of three major aspects of cancer delivery and I am delighted it is still on target for roll-out later this year. As with other Deputies from the west and north west I would have been delighted for our areas to have been part of the first roll-out. We look forward to being pilots for all sorts of schemes but we often seem to be the last to have them delivered.
The third aspect of cancer care is radio-oncology. The fact that there were links with Dublin and Galway meant people received a service and the idea of linking up with Belfast offers a third option. Some 50 spaces have been reserved for patients who want to choose that option. Given the level of new investment in the service, which is one of the best in Europe, if not the world, such cross-Border co-operation is welcome. Co-operation is not specific to cancer, because we interact with our neighbours in respect of NoWDOC initiatives, ENT, dermatology and other areas. It is a matter of critical mass and best patient outcomes, which I hope will continue to be the case.
The number of beds must increase to facilitate new specialties. Letterkenny General Hospital has a new oncology ward. My uncle was one of the first to use it, but it is unfortunate that he has since died. With an increase in specialties, there are other pressures in hospitals and I welcome the fact that more beds are entering the system at Letterkenny.
I do not know why people should have to wait unduly for operations. The statistics for the National Treatment Purchase Fund given to us in September showed that 3,125 people were awaiting surgery in Letterkenny and only 300 had been referred to the fund. A clear message must go to patients, general practitioners and consultants that the fund represents a major investment by the Government and a significant opportunity to reduce waiting lists. It might not be in the interests of private practice, but it is in the interests of patients, which is what a health service is supposed to be about. It is in everyone’s interest to keep people as healthy as possible. The Government is moving in the proper direction. While more remains to be done, I am clear on the need for the people to have a good health service with patients at its core.
Mr. McGuinness Mr. McGuinness
Mr. McGuinness: As I did last week, I welcome this debate on health matters. I hope that we will have ongoing debates on developments within the Health Service Executive, focusing on the current spend provided by the Department of Health and Children to the HSE, how it is being used and how services are being delivered. By way of debate, we should continue to ensure that the patient is at the centre of our health service  and that spending is directed to the service’s front line to bring about improvements in the regions.
During the course of this debate, reference was made to the case of Rosie in St. Luke’s Hospital, Kilkenny. As someone who represents Kilkenny, I want to say that everyone sympathises with the case. The hospital recognised its error, which highlighted an issue in the hospital that must be dealt with. St. Luke’s Hospital delivers a fine all-round service and has been recognised nationally as a model of best practice. As a result of the unfortunate incident, the hospital has reviewed its services and I am glad to say that it has identified the need for a day care unit, which has been funded to the tune of €300,000 by the HSE.
Hospitals that take initiatives in which patients are at the centre should be rewarded quickly. I consider the grant of €300,000 to be a reward and I hope that the patient, Rosie, will agree that something good for patients in general has come from the case. I encourage the Minister to continue to examine St. Luke’s and to conduct the hospital reward scheme around the country so that consultants and hospital managers can see a way to improve their services, take initiatives, be rewarded and benefit patients.
Like other speakers, I acknowledge the amount invested in cancer care since 1997, that is, more than €1 billion, but more needs to be done. I appreciate that 110 consultants are being appointed and that not only has the number of cancer patients increased, but they are being seen more efficiently. However, a number of issues are of concern to cancer patients in the south east, where more remains to be done. The commitment to provide a cancer care unit at a site co-located with a private hospital was given, but there seems to be back-tracking on that project in that it will be delivered by conventional means. People at the coalface of cancer care in the south east and those who have been campaigning for many years for an improvement in the centre are concerned that the HSE is not as clear on the development as it was.
The Minister has stated her case, but will the HSE come clean on what it intends to do and state whether it will provide a service within the timeframe specified, namely, two years? To know where we are going in terms of the campaign on improvements in services, we need to know what is happening. I appeal to the Minister of State to establish the up-to-date position and ensure that the HSE follows through on its political commitment, which can be delivered on. I do not mind that it will be delivered in the conventional way rather than through a public private partnership or co-location. All that concerns us is whether the service will be delivered. Will the Minister of State take this information on board and bring clarity to the debate?
Some €6.5 million is needed in terms of capital and required positions to bring the palliative care service in the south east to a minimum level. I understand that the project received €1.2 million  in 2006, but that the HSE did not spend the money. There is no clarity on how the money was spent. Why was it not spent on palliative care, what does the HSE intend to do about the issue and why did it not fulfil part of its agenda? In the south east, there are two palliative care consultants who do not work at weekends. The HSE has not succeeded in making a deal with them in terms of a weekend service. As home care teams are active on a 24-7 basis, I ask that the situation be reviewed and resolved.
Regarding dialysis, public patients are being referred to a private clinic in Kilkenny. At the Whitfield Clinic in County Waterford, a radiation oncologist must visit patients, examine their condition, decide on their standards of care and have them referred to the private facility. At a similar project handling dialysis cases in Kilkenny, the HSE was reluctant to put in place efficiently a service contract that would enable public patients to be referred. The debate is ongoing.
The bureaucracy and red tape should be removed from the system and the Minister should intervene to ensure that this type of service is established at the Whitfield Clinic as soon as possible and that public patients are referred to the centre immediately. Without political intervention, the matter will drag on for months on end, as has been the case at the Kilkenny dialysis unit. Kilkenny patients are being referred to Dublin and vice versa. It is hardship for the patients and it must be corrected.
The position of cancer patients is worse because they must travel all over the country. Regarding patients who must travel to Limerick or Dublin, CERT, a charitable organisation, arranges transport for cancer patients in the south east. It is poorly funded and cannot be advertised because it would be overcome by the numbers who would want to use the service. The HSE has a role to play in that it must ensure sufficient funds to transport patients in an appropriate mode to get them to their appointments in comfort and without stress, which is not the case currently. The promise in the Hollywood report of innovative transport measures has not been fulfilled. If the HSE, which is aware of this report, has not returned the €1.2 million it must put it to work to transport patients effectively and efficiently in a way that is available to all. While we are waiting for services to be provided in Waterford for those cancer patients, we should have a transport system in place.
Much needs to be done in the context of the management of the HSE and I ask that we continue to debate these issues until management is made more efficient and made to deliver. With the money it is getting, it should be able to fulfil some of the basic needs of these patients.
Ms McManus Ms McManus
Ms McManus: I wish to share time with Deputies O’Shea, Wall and Breda Moynihan-Cronin. I welcome the opportunity to speak on  this motion on cancer services and I thank the Members of the Technical Group for tabling it.
On World Cancer Day 2006, the Irish Cancer Society highlighted predictions that cancer numbers will increase from 22,000 a year at present to 43,000 by 2020 and that the number of potentially fatal cancers will more than double from 13,800 to 28,800. The Government’s policy documents acknowledge the need for comprehensive cancer services.
Far from delivering a world class cancer service, however, a confidential Health Service Executive document exposed last month that the cancer treatment plan launched by the Minister for Health and Children 18 months ago is in total disarray. It is beset by a catalogue of errors, delays, and what the report describes as “lingering complexities” over cost. In short, the cancer plan is a shambles. Despite the commitment to spend €400 million on 36 centres by 2007, the report makes it clear that none of this is going to happen on time. Moreover, the interim plan to increase capacity in Dublin at St. James’s and Beaumont Hospitals by 2008 will also not be achieved by that date.
Yesterday, we were alerted to the news that St. James’s Hospital in Dublin was forced to postpone 20 surgical operations because of a lack of intensive care beds. St. James’s is one of Ireland’s best run, best managed and best operated hospitals but even it cannot perform vital, potentially life-saving operations because of insufficient numbers of intensive care beds. This has a direct impact on the survival chances of patients. I note that in another major Dublin teaching hospital there are intensive care beds that have not been commissioned because of staffing issues. On one hand there is a hospital that cannot keep up with demand while on the other, another hospital cannot provide for demand because the Government has not put the resources in place.
Site identification issues are creating problems in Limerick and Waterford, despite the fact there are private facilities available for public patients. In the north west, the plan to allow patients to access services in Belfast cannot be realised, meaning very sick patients must still endure a ten hour round trip to Dublin for treatment.
The radiotherapy plan was designed to alleviate the distress of those who are extremely sick. It was roundly welcomed and supported by this side of the House. Tragically, it has fallen victim to the Minister’s unfortunate habit of announcing grandiose plans for the health service without adequate consultation, advance planning or any idea of what the final costs will be.
Among the Minister’s cancer strategy goals was an aspiration to have a national cervical screening programme yet at present the results of smear tests are taking over six months to process. These delays are causing real risks where no risk should pertain because the treatment is so simple. It is about time the Minister dealt with the existing  inequity and shortcomings before making further grandiose unfulfilled promises.
Figures for cancer in this country show mortality rates from cancer are often determined by socio-economic background and geographic location. For years, activists campaigning for improved cancer services have argued the obvious, that patient outcomes are reflected in access to quality treatment. A report by the National Cancer Registry, however, two years ago confirmed the geographical discrimination that exists in Ireland is “striking”. Ireland’s incidence of breast cancer is below the EU15 average but the rate of death from breast cancer in 2001 was the highest reported in the EU15. The Institute of Public Health in Ireland in its report entitled “Inequalities in Mortality” found that all the rates of mortality for cancers in the lowest occupational class were 100% higher than the rate in the highest occupational class.
Most of us are no doubt familiar with the tragic circumstances of Rosie who spoke out on “Liveline” in January. The day before she appeared on “Liveline”, she was getting chemotherapy alongside a man with the same diagnosis. He too had bowel cancer but had got his colonoscopy within three days of seeing his GP. He was a private patient but, like half of the Irish population, Rosie does not have private health insurance.
The HSE has radio advertisements directed at alerting people to the early signs of colon cancer. “Early diagnosis can save lives”, the radio advertisement says. Early diagnosis can only save lives if the services are there to diagnose those using them. Rosie, along with 2 million other Irish people, is treated as a public patient in the bottom half of a two-tier health system where the delays in accessing treatment can cut a person’s life short.
A further inequality is geographic. BreastCheck was introduced seven years ago but it is still not available nationwide, access to a lifesaving screening programme depends on a person’s address. It has been estimated that 65 women a year are dying in Ireland for the simple reason that breast cancer screening is lacking in the west and south of the country. “Early diagnosis can save lives”, that is the slogan but there are parts of the country that have four times more cancer specialists than other parts.
The lack of cancer services imposes horrific travel journeys on people at the most vulnerable time of their lives. Journeys from Donegal to St. Luke’s for essential radiotherapy can take up to ten hours, hours which are gruelling and difficult for people who are so sick.
It is now clear that the Government has broken its promise to patients requiring radiotherapy treatment. The most tragic aspect of this is that there are cancer patients who have simply given up any hope and do not expect to receive this vital and life-saving treatment in their community, allowing them to access it while dealing with the other demands on their daily lives.
 After 12 years of prosperity, we have failed to capitalise on our economic well-being to improve our social well-being. Nowhere is that more manifest than in the health sector. A fairer society is a healthier society. In developing our thinking on health, Labour has committed itself to a number of simple principles: quality, fairness and value for money. It is important that it is recognised that there are inequalities as we speak in cancer services, geographically, particularly with BreastCheck, but also in class and socio-economic terms when it comes to cervical cancer screening. These issues could and should have been addressed by the Minister but instead there is deep disappointment after such hope being generated by the Minister’s pronouncements.
Ms B. Moynihan-Cronin Ms B. Moynihan-Cronin
Ms B. Moynihan-Cronin: I welcome the opportunity to speak on this vital issue and commend the technical group for bringing it to the floor of the House.
On a daily basis we hear horror story after horror story about the deficiencies in our cancer services. Those services are staffed by incredibly dedicated and caring personnel and I feel for those personnel when I hear complaints about cancer services. In many cases, they are under-resourced, over-worked and at the end of their tether.
When it emerged recently that women in Kerry and Cork are waiting six months for the results of cervical smear tests, there was justifiable anger. The Minister for Health and Children and the Health Service Executive encourage women to go for tests but then ask them to wait agonisingly long periods for the results. I was speaking to a woman in my constituency before Christmas who waited for nine months for the results of a smear test and, as a result, she must undergo intensive treatment.
She should have received her results within three weeks. I questioned the HSE about this and I was informed there was a shortage of trained staff in Ireland to carry out the tests. However, when the Taoiseach was questioned on the Order of Business yesterday about the health service, he stated there was no shortage of staff and that it was not the issue. I remind him that the women of Kerry are suffering because of a staff shortage in Cork University Hospital.
Ireland has experienced a steady increase in the number of deaths from cervical cancer at a rate of 1.5 each year since the late 1970s. In England and Wales a screening programme was introduced in 1988 and the rate of cervical cancer deaths reduced noticeably. Research on cervical cancer in Britain and Ireland published in the British Journal of Cancer two years ago found the death rate was higher in Ireland because of the absence of a proper screening programme. When will a cervical screening programme, similar to BreastCheck, be put in place? A total of 70 women die a painful and needless death annually from cervical cancer in Ireland and each death  would be preventible if a national screening programme was in place, which should be accompanied by a public information and awareness campaign to alert women to cervical cancer and the benefits of screening.
However, I am surprised by the delay on the part of the Government in providing cervical screening. We only have to consider the shameful situation regarding the roll-out of the BreastCheck programme in the south and west, to which Deputy McManus referred. The programme was due to be delivered in the south and west in 2002. It was then deferred to 2005 and now it has been deferred to the end of this year. Two years ago I instigated a widespread campaign in Kerry to lobby for the nationwide roll-out of BreastCheck. I and many women of my age were fed up and appalled because we were being denied a service other women of our age were being provided with because we had the wrong address.
Thousands of people were involved in the campaign and BreastCheck would not be rolled out in the south and west next September were it not for that campaign. I am delighted that Fianna Fáil took an interest in the campaign recently when its members took credit for the roll-out. When the campaign was under way, I did not see a sign of a Fianna Fáil member at a public meeting, rally or collecting signatures but, because the programme is about to be delivered, they are taking credit for it. People will see through that.
Cervical screening is very necessary. Staff should be put in place in Cork University Hospital because I do not want to see any more of my constituents and friends die of cervical cancer.
Mr. B. O’Shea Mr. B. O’Shea
Mr. B. O’Shea: I am pleased to have the opportunity to contribute to the debate. The Minister for Health and Children stated in regard to radiation oncology in the Waterford area that “A service level agreement is being finalised at present between the HSE and the private Whitfield Clinic in County Waterford”. The service will be provided by the University of Pittsburgh medical centre, which is located in the clinic and which is a not-for-profit organisation. My problem is the agreement could have been in place many months ago if the HSE and the Minister had the mind to develop the service in the area. However, the Minister’s statement is not definitive.
She did not state when the agreement would be finalised or signed and, therefore, the issue is still up in the air. The Minister further stated, “This will support the referral of public patients for radiation oncology treatment while we build the public radiation oncology centre at Waterford Regional Hospital”. This statement also results in more questions than answers. My understanding is the centre is to be provided through a public private partnership and that 11 of the 12 PPP con tracts on hospital grounds were to be signed last month. What is the current position regarding the building at WRH? Is there another delay?
The Minister concluded that “The NDP will support a new ward with 20 treatment places at Waterford Regional Hospital”. This is very welcome because the chemotherapy facilities for patients leave much to be desired but it is ominous that she made no reference to the dedicated oncology unit. Has this been abandoned by the Government? Will such a unit be provided during the lifetime of the national development plan? While the Minister has indicated action is being taken, nothing definite has been provided. My colleague, Deputy Moynihan-Cronin, referred to the roll-out of BreastCheck. According to the Minister, the first round of screening in the south and west will commence in the spring. Today is the first day of spring and it is extraordinary that she could not be more explicit regarding the commencement of the service. Does this mean women in the Waterford constituency will be screened this spring? What does this vague statement convey?
The issue of palliative care has also been raised. Last year €1.2 million was provided for the development of such services in the south east but the money was not spent, which is appalling in the context of planning and the provision of services. Annually, 1,000 patients in the south east must travel to other centres for radiotherapy treatment. For example, a lady in her late 20s had to travel for such treatment three days before she passed away. While there are indications such cases will become a thing of the past and palliative services will be provided, insufficient beds are available. What is happening in this regard?
How many of the 1,000 patients from the south east who must travel for treatment every year will be treated at the University of Pittsburgh medical centre? What cancers will be treated? I acknowledge a number of complicated cancers can only be treated in an integrated manner in a designated hospital but the Minister’s comments regarding the south east are too vague. She did not indicate when the service level agreement would be in operation, what it will cater for and so on.
I understand a medical treatment is now available which can prevent the onset of cervical cancer, to which Deputy Moynihan-Cronin referred. In light of that amazing and welcome breakthrough, does the State have any proposals for introducing the treatment here? I am not sure of the technical aspects but if it is possible to eliminate cervical cancer, money should be no object and any technical or other obstacles to introducing the treatment should be addressed immediately.
We want clarity and answers to the mystery which surrounds the status of the public private partnership developments at 12 hospital sites. Some positive indications have been made but the situation remains vague, which is typical of  this Government. As the Government approaches its dying days, it is hoping that the vague undertakings it is giving will pull it through the next general election.
Mr. Gormley Mr. Gormley
Mr. Gormley: I wish to share time with Deputies Ferris and Morgan.
A statistic which stands out with regard to cancer is that we are going to see a 90% increase in cancer rates over the next 15 years. That amounts to a cancer epidemic but we should not be surprised to hear that one in three people will have cancer or that the rate is rising continuously. It is no longer a case of saying that when people died in the past we did not know what killed them because we now have statistics dating back to the 1960s. It is clear from statistics published by the WHO that 80% of cancers are environmentally linked. That is a telling statistic. Sandra Steingraber wrote a seminal book on cancer, Living Downstream, in which she demonstrated clearly that our rising rates of cancer are linked to the increasing numbers of chemicals we are inhaling and using in our households. It is time we returned to first principles because cancer care is extremely expensive and it would make much more sense to address the root causes of this problem by studying factors such as our lifestyles, air pollution, the quality of our water, the food we eat and the household pollution which arises from the types of furniture and paint we use. The evidence leaves me in no doubt these factors are resulting in an increase in cancer rates. This Government will have to do a bit more joined up thinking on this issue.
We also should pay closer attention to the influence of the tobacco, alcohol and food industries instead of allowing reports to gather dust on shelves, such as those by the task forces on alcohol and obesity. These reports have not been implemented and it is unlikely they ever will because no concerted action is being taken by this Government. The Minister of State can shake his head but the consequences of alcohol consumption in this country cost us €2.65 billion per annum. With regard to health consequences, cancer and a wide range of other illnesses result from alcohol abuse. This Government kowtowed to the alcohol industry.
Mr. S. Power Mr. S. Power
Mr. S. Power: We did not kowtow to them at all.
Mr. Gormley Mr. Gormley
Mr. Gormley: The Government got rid of the legislation it promised on alcohol products.
Mr. S. Power Mr. S. Power
Mr. S. Power: When Deputy Gormley has a good story, he has no regard for the truth.
Mr. Gormley Mr. Gormley
Mr. Gormley: The alcohol products Bill was shelved because the Government opted for a voluntary code. It is not dealing with the root causes of the problem, as usual.
 We know from the Irish Cancer Society that when the Government was devising its cancer strategy, it did not budget properly for the significant increase in cancer cases we are now experiencing. No mention is made in the strategy of how cancer services will cater for an increased capacity or budgets for the maintenance and development of cancer care services. According to the society, the annual budget for cancer services, which currently stands at €25.5 million, will be totally inadequate to meet increasing demands and the need for health promotion, cancer prevention and screening programmes.
It is important that we invest in the early detection of cancer. Given the slow roll-out of screening services, many people are dying unnecessarily. Statistics compiled by Maev-Ann Wren and Dale Tussing indicate that, even though Ireland’s incidence of breast cancer is below the EU average, the death rate from breast cancer in 2001 was the highest reported within the EU 15. This combination suggests that early detection and treatment are inferior in Ireland. When BreastCheck is finally introduced nationwide, the death rate should fall. Now that we are approaching an election, the Government is only too happy to announce screening programmes but we will wait to see what happens.
The Irish Cancer Society states that we have reached a crisis point in terms of accident and emergency care due to a lack of bed capacity. We have also reached a crisis point with regard to intensive care beds. The society warns that unless the Government takes action immediately, we will face a serious crisis in cancer care. Unfortunately, those realities have been ignored. The society is calling for equity in the availability, access and performance of cancer services throughout the country and the establishment of four cancer care networks to cater for a population of 1 million people each and incorporating eight licensed cancer care hospitals. It is also demanding the provision of integrated primary care, which the Green Party advocates in the primary care document we published last Friday, along with better hospital care, palliative care and psychology and support services.
With regard to the money being allocated to palliative care, Jane Bailey, who lives in Deputy O’Shea’s constituency, has been in contact with the health spokespersons of the Opposition parties to complain that the amount allocated and the way it is spent are pitiful. The Government should take responsibility for that failure.
The Irish Cancer Society is calling for a comprehensive health promotion and cancer prevention plan which would incorporate nationwide screening for certain cancers, where appropriate. With regard to breast cancer screening, the society is adamant that the deadline of 2007 for the full national roll-out of BreastCheck should be met, so all women in the country have access to screening. The society supports the recommendation that a national screening programme  for colorectal cancer should be implemented. Cervical cancer screening is vital. On skin cancer, it recommends simple measures. Clearly children should not be allowed near sunbeds, which have become popular. It is ridiculous that some children use sunbeds to get a tan before their First Holy Communion. The Government has ignored measures that could and should be taken.
Let us get the early years right. Let us go back to first principles and then let us invest in screening and preventive measures.
Mr. Ferris Mr. Ferris
Mr. Ferris: Sinn Féin strongly supports the motion. In common with the experience of all other Deputies, there are numerous cases in my constituency that illustrate the problem people are having with services for cancer patients. All Deputies have met families affected in this regard. These families are under enormous pressure primarily because of the lack of proper facilities and care for their loved ones. In recent years we have highlighted, for example, the difficulties women have getting access to the BreastCheck programme. It is a disgrace that it required a public campaign in Kerry to push for such a service to be made available. The co-ordinated efforts of the public, Sinn Féin members and activists along with Deputy Moynihan-Cronin collected thousands of signatures to a petition urging the Minister for Health and Children to do something to deal with the issue.
It takes too long for people to be seen and get the results of their tests. Currently the average waiting time for women to get the results of cervical cancer tests is between four and nine months. In countries with national screening programmes, the average waiting time is just six weeks, which makes a significant difference in reducing their anxiety and allows them to access the necessary treatment if the test proves positive. It is evident that suffering anxiety or stress as a result of an ailment only accelerates the illness. It is vital that such a programme is made available here.
I recently encountered the case of an elderly married man in his 60s. He and his wife were on the minimum wage. He had worked all his life. He had cancer and needed to travel to and from Cork for chemotherapy. While their savings lasted, his wife was able to travel with him. Unfortunately, their savings ran out and he was then required to make the journey unaccompanied, although very weak, to and from Cork to get treatment. It took a public campaign backed by Sinn Féin for him to get funding to allow his wife to travel with him.
In Kerry South we had the disgraceful case of a mother of five, whose husband had died of cancer a few weeks earlier. On one occasion she had to be transported for treatment in the back of a Hiace van because no proper transport was available. These unfortunate medical card holders, who do not have the money to get the necessary treatment, find themselves discriminated  against, which is a disgrace and a total indictment of both partners in Government.
Mr. Morgan Mr. Morgan
Mr. Morgan: I fully support this motion on the vital issue of cancer services and I commend the Independent Deputies for tabling it. As the motion makes clear, we have a long way to go before cancer services are provided at the proper level in this State. Like the rest of the health system, cancer services suffered from historical neglect over decades by successive Governments. In 2001 the rate of death from breast cancer in Ireland was higher than in any of the 15 pre-enlargement EU states. There were 31 deaths per 100,000 Irish women compared with 24 for the EU 15. At the same time this country’s incidence of breast cancer is below the EU average. This clearly suggests that cancers are not being detected in time, are not being treated in time or are not being treated in an effective manner.
I wish to outline the case of a constituent, who like Deputy Ferris’s, had to endure very significant hardship in the course of suffering cancer. As with most people the complaint started with back pain and she attended her GP. A series of tests carried out locally, including blood tests and ultra-sound, failed to diagnose the problem. Finally, after the condition deteriorated — she was unable to eat and suffered significant weight loss and severe pain — she was admitted to Louth County Hospital and then transferred to Our Lady of Lourdes Hospital in Drogheda. Following further tests she was finally diagnosed with ovarian cancer.
Over the following months she attended the oncology department at Our Lady of Lourdes Hospital for a course of chemotherapy as an outpatient. In between treatment she regularly travelled from Dundalk to Our Lady of Lourdes Hospital for blood checks. She also attended the oncology clinic in Our Lady of Lourdes Hospital, which involved long waits in a draughty corridor. Considerable personal trauma was involved with many other patients and staff going past. In this long corridor very ill patients were queuing up for critical treatment in a very degrading way.
When the chemotherapy treatment was finished she was referred to St. Luke’s Hospital in Dublin for a course of radiotherapy. She was also referred to St. James’s Hospital, which she attended as an outpatient. As her condition deteriorated further she was attending three different hospitals, Our Lady of Lourdes Hospital in Drogheda, and St. Luke’s and St. James’s in Dublin. For some of these visits she left her home at 7 a.m. returning at 4 p.m. or later. This all happened over a period of 18 months from diagnosis. There did not appear to be a great deal of communication between the hospitals or the various doctors. There was no sign of a proper care plan. This is just one minor example of the trauma the people we represent must endure all too regularly. That woman’s husband died nine weeks before her death from cancer.
 This is not surprising given the constituency from which I come. Diagnostic procedures seem to take forever. Several hospitals are involved with fragmented and poor communication between many professionals and no sign of the problem being resolved. In my constituency some 25% of deaths result from cancer illness. We all wonder why that is the case. Unfortunately no effort has been made by officialdom to try to establish the cause. Many of us have formed voluntary groups and are pursuing the matter in whatever way we can. Unfortunately that will not get to the root of the problem. Meanwhile the 25% of people whose deaths result from cancer illness in County Louth invariably go through the type of hardship I have outlined. It is time the Government took the issue seriously. The people of the State are entitled to proper care. I will not try to put a political slant on the issue. The Minister of State knows what we are saying is right. He has heard of cases from all sides of the House. The issue has not been taken seriously by the Government thus far. It is overdue that it did. I commend the motion.
Mr. S. Power Mr. S. Power
Mr. S. Power: The Government’s amendment to the motion is based on recognition of achievements to date in cancer care, and the broad range of strategies we are implementing on health promotion, prevention, screening, treatment and supportive care. It is also based on the need to plan, reform and ensure we have sound, evidence-based policies for the short to medium term. This is especially needed, as we will see a doubling of cancer cases in the years ahead. My colleagues, the Minister for Health and Children, Deputy Harney, and the Minister of State at the Department of Health and Children, Deputy Tim O’Malley, have informed the House of the substantial increase in investment which has resulted in increased medical, nursing and support staffing. This investment has delivered real improvements in care.
There are approximately 120,000 survivors of cancer which reflects the improving diagnosis and more successful treatments for cancers generally. We have achieved the key goal of the 1996 national cancer strategy, which was to reduce the death rate from cancer in the under 65 age group by 15%. This was achieved three years ahead of target. More than 100 additional consultants have been appointed in key areas of cancer care. There were almost 94,000 admissions for cancer care in 2005, an increase of nearly 70% over 1997. Just fewer than 58,000 people were treated for cancer as day cases in 2005, an increase of 130% over 1997. We ask this House to recognise these achievements. This request is not based on complacency. It is founded on the reality that many more patients are being treated and our health system detects more cancers early.
I am conscious as I quote these figures that they do not give the real picture because there is  a story behind each number, from the shock of discovery, the treatment and the disruption it can cause to families, to the hope of recovery which is realised for some. For other families, despite treatment and care there is devastation following a death. The “Big C” as it is often known as, is no longer seen as the inevitable end, as it once was. Survival rates for all the major cancers are improving in Ireland. It is important to make that point in discussing this sensitive issue.
Cancer patients and their families recognise the impressive services being provided by doctors, nurses and support staff. We often hear cancer patients lauding the professional standards of care they receive and the caring approach of health professionals. This is the case whether patients are at the curative stage of illness or when cure can no longer be achieved. It is important that this House recognises the cancer carers, whose numbers have increased substantially in recent years, a reflection of the priority and investment in cancer care.
The organisation and delivery of cancer care will be an integral element of the current reform agenda. The Health Service Executive is progressing the implementation of the national strategy for cancer control and establishing a national cancer control programme to manage and deliver cancer control. This will involve the integration of health promotion, screening, treatment and supportive and palliative care services within a single governance structure.
The programme will bring together major functions in planning, needs assessment, prioritisation, resource allocation, workforce planning, implementation of national guidelines and cancer care pathways. Patients interact with the cancer control system at various stages, from screening and treatment to supportive and palliative care. They require seamless transition between these stages, where services, regardless of setting, are organised and delivered around the patient. This is the basic organisational principle behind the HSE’s reform. We need to achieve equity in the delivery of cancer care, regardless of where and how the patient interacts with our health system.
Deputy Boyle mentioned the National Cancer Registry last night. The collection, evaluation and application of timely and comprehensive cancer control data is essential to support evidence-based planning and performance management. For these reasons, the Minister has concluded that it would be preferable for the functions of the National Cancer Registry to form part of the HSE’s national cancer control programme. The Minister has allocated additional revenue funding of €400,000 in 2007 to the National Cancer Registry, a 20% increase on last year’s allocation. This funding will be used to progress electronic data capture, geocoding, the completion of a patterns of care study and to expedite registration in the Dublin area.
Questions have been asked about future investment in cancer control. The Government has  invested heavily in cancer services and the House can be assured that we will invest substantially in cancer control in the coming years on the basis of the reform programme outlined.
The developments in cancer services which I have outlined today clearly indicate the considerable progress that has been made in addressing the burden of cancer in Ireland. I am glad of the opportunity to put on record the substantial developments that have taken place to ensure the availability of high quality cancer services nationally. That is what we all want.
Ms Harkin Ms Harkin
Ms Harkin: I wish to share time with Deputies Healy, Gregory, McHugh and Cowley.
Cancer screening saves lives. Cancer screening works. Cervical cancer is virtually 100% treatable if caught in time, yet all we have is a pilot programme that is now being evaluated. The only way forward is to roll out a national cervical screening programme now. Colorectal cancer screening is also effective. A total of 900 people die of that disease in Ireland each year. In the United Kingdom the National Health Service is rolling out a screening programme and we need to follow that lead.
The women of the north west are still waiting for BreastCheck. We were promised it in 2001, 2003 and 2005, and today BreastCheck says it will be delivered at the end of autumn 2007. We have waited too long.
There is a need for a regional radiotherapy service in the north west. The former North Western Health Board recommended that we move towards the provision of radiotherapy services, either within the board’s old area or a larger north-west catchment area. Why will the Minister not give fair and equitable treatment to patients who require radiotherapy in the north west? The combined population of Sligo, Leitrim, Donegal, Fermanagh, Tyrone and Derry is higher than the critical mass needed to provide these services with best practice.
The Government is spending billions of euro on cross-Border action so why will the Minister not include health infrastructure, particularly radiation services in that action? The Minister announced in July 2005 that she would set up arrangements for patients in the north west to travel to Belfast. Eighteen months later the reality is that most people cannot avail of this service. We know that Belfast can cope only with patients from Northern Ireland. It is unfair and indeed cruel to give hope to people about the provision of accessible radiation services and not to deliver.
While we in the north west are well used to not getting our fair share, there is something essentially wrong in a country where there is regional inequality in health provision. This is the second richest country in the European Union, with the highest growth rate, and we will not provide  equality of access to radiotherapy for those who live a distance from large population centres.
The leaked memorandum from the HSE in December on the national plan for radiation oncology states that neither the 2008 interim targets nor the 2011 overall targets will be met. Non-involvement of the HSE prior to announcement and difficulties with public private partnerships is the problem. The Minister disagrees but that is not good enough. We need a categoric assurance from her that neither of these issues will delay the programme and that a regional radiation oncology service for the north west will be part of the health plan.
Mr. Healy Mr. Healy
Mr. Healy: I strongly support this motion. It raises a sensitive issue which has touched most families and many Members of this House in the past few years. I was disappointed that the Government tabled an amendment to this motion. I ask the Minister of State to be magnanimous and not to divide the House on such a sensitive issue.
Early detection and treatment is the key to success in treating cancer. Unfortunately, many of our services are totally deficient in this area. There is a lack of cervical screening, breast screening has not been rolled out throughout the country, there is no colorectal or prostate screening and there are various other deficiencies in the service. We need someone of the calibre of the late Noel Browne to take this issue by the scruff of the neck and solve it by putting in place services and facilities to deal with it on a daily and professional basis.
I thank all the staff involved in this area, from hospitals to primary care and hospice care. They do an excellent job in difficult circumstances. There is also a major voluntary effort in this area for which many people are to be thanked. It is disgraceful that hospice home care nursing teams must be funded via voluntary efforts. Cancer sufferers need this basic service and it should be provided by the State. Any voluntary services should provide something that is over and above comfort for families and cancer sufferers. Basic services should be provided by the State.
Mr. Gregory Mr. Gregory
Mr. Gregory: This is an important motion, even if all we, as Independent Deputies, achieve is to help to ensure, as Mr. McCormack, chief executive of the Irish Cancer Society, stated, that a momentum is reached and that plans for delivery of services are achieved now. We cannot undo the neglect of successive Governments of this vital part of the health service. As Mr. McCormack also stated, cancer patients do not have a voice and have been badly let down for too long.
In a modern and extremely affluent society, it is unacceptable that people too vulnerable to highlight their own suffering are obliged to cope with waiting lists for radiotherapy and travel long distances for treatment. Waiting lists for prostate and lung cancer in particular are intolerably long  and must be addressed now. Equally intolerable is that women are dying because we do not have a nationwide cervical screening programme. These are not my words, they are the words of the chief executive of the Irish Cancer Society. With proper screening, the number of deaths and serious cancer conditions could be dramatically reduced. It is a scandal that this has not happened. Nationwide cervical screening has been in place in England since 1988 and in Canada since 1960. Despite its great affluence, Ireland is still nowhere near achieving that.
Equally important is the issue of inequality in our health services. The plight of public patients is highlighted by the plight of the Kilkenny mother, Rosie. How many others on waiting lists are suffering in the same way as the woman to whom I refer? This inequity permeates all sectors of the health service. The inequality of the two-tier health system is compounded by the fact that there is a far higher incidence of serious illnesses such as cancer in disadvantaged communities, most of the members of which are public patients. These people have no voice to demand equality of access to treatment. As long as the two-tier system exists, there will be tragedies such as that involving Rosie and so many others who have no voice.
Mr. McHugh Mr. McHugh
Mr. McHugh: I welcome the opportunity to speak on this important motion, which was tabled by the Independent members of the Technical Group. Much of the debate so far has been pessimistic and has highlighted the many needs that exist in the context of the provision of health care. There have, however, been some welcome developments. I refer to Galway as an example in this regard. Long overdue but nonetheless very welcome developments have taken place there and these will prove to be extremely beneficial for Galway and the west. For a long period, a vigorous campaign was waged to have a BreastCheck service established in the west. I welcome the fact that the construction of the BreastCheck building is under way. Again, this development is long overdue. I outline the situation in Galway not as a defender of Government policy but merely as a statement of fact.
I urge the Minister to extend BreastCheck to cover women over the age of 65. This motion puts forward the importance of education in preventing cancers. The Minister referred to the support the Government is providing in respect of education provision in this area. However, I cannot agree that the level of education is adequate or that information is delivered in a fashion that is sufficiently aggressive. For example, diet is important and a balanced diet can prevent many illnesses. However, the message in this regard is not being put across in an aggressive manner. We were promised a national diet and fitness programme specifically aimed at children. Again, however, this matter is not being treated as urgent.
 The motion refers to the public private debate that is under way at present. The motion is very specific in this regard but, from a personal point of view, I have no ideological hang-up, per se, regarding public and private health care. My judgment is based on what is best for patients. Ideology will not save people’s lives. However, good standards, professionalism and good health management will do so. We would be better served by focusing on this area.
There is a clear onus on the Minister to launch an examination of management and the efficiency thereof within the health service. Management throughout the services has a great responsibility for the weaknesses within the system. I put it to the Minister that an assessment should be carried out by an independent group to identify where the weaknesses in the management structure lie. It would not be beyond her capabilities to put such an examination in place. While I agree that situations differ, I am aware that, for example, a unit delivering a particular service in the east of the country will have its practices and procedures replicated in a similar unit in the west. Why is it not possible to develop a best practice method of delivery for all services irrespective of where they are delivered? It is, of course, possible to do so but it is not being done. Accordingly, no one can be held to account for the failures in the system, many of which have extremely serious consequences.
Dr. Cowley Dr. Cowley
Dr. Cowley: The Independent Members brought forward a motion on this issue in 2003. At that time, much reference was made to cancer care apartheid, which continues to exist in this country. I salute Rosie for her bravery in coming forward. Unfortunately, there are many others like her. The day must come when people receive equal access to services. The fact that they do not have such access is what is rotten about the health service and about cancer services in particular.
There is one certainty, namely, if one has money and health insurance one will have a better chance of survival. That is the reality with which we must deal. The situation will get much worse, with the number of cancer cases predicted to rise from 22,000 per year now to 43,000 by 2020.
There are those who accuse Independent Deputies of being parochial and state that we are single-issue candidates who do not take the national interest to heart. Our motion clearly shows that this is not the case. Our work on behalf of our constituents illustrates that we care and that we can make a difference for the betterment of society as a whole. I will provide a number of examples in this regard.
While I serve the people of Mayo, I have initiated campaigns with people such as Jane Bailey and some of my colleagues to ensure that public cancer patients in the south east are not obliged to make long journeys to access radiotherapy. The situation in the region to which I  refer has improved, thanks to the efforts of those such as Independent Members. The position is similar as regards radiotherapy centres in the mid-west region and Galway.
My Independent colleagues and I have worked hard on the Joint Committee on Health and Children to represent the needs of patients in the north west who need access to a cancer unit, not in Belfast but in Derry and Letterkenny. People are opting to have mastectomies carried out rather than make the long and horrendous journey to Belfast.
The Minister, Deputy Harney, made excuses in respect of our poor cancer services by stating that we are still playing catch-up as a result of the failed economic policies of the past, but there was sufficient money to ensure that BreastCheck services were rolled out to half of the population. However, enough money has not been invested in the national cancer strategy, which, like the health strategy, the primary care strategy and every other strategy that might make a difference in people’s lives, remains underfunded. As already stated, BreastCheck services were rolled out for half of the population following a decade of research which showed that such services could reduce the death rate by 20% to 30%. This is a small island, but those in the North have a better chance of survival than their counterparts in the South and that is a complete scandal.
What sort of a half-baked proposal did the Minister put forward in respect of cervical screening? She stated that it is based on an affordable model. What is meant by the term “affordable model”? Does it mean more of the same? BreastCheck was not rolled out to the entire country because the Government would not spend money on the half of the population that lives in the west and south. That is the reality.
Everyone who is diagnosed with cancer represents an emergency case. In Galway, it can take up to a month before beds can be acquired for elective cases. This compares with cases involving private patients, in respect of whom beds can be made available within a day or two. Public cancer patients are obliged to go through accident and emergency departments, even though they must be seen at least once by consultant oncologists. When they are seen, they must still queue for accident and emergency services. There are cancer patients spread throughout the accident and emergency departments of our hospitals. That is absolutely and utterly scandalous. People have been removed from trolleys and placed in  transit lounges similar to that set up in Mayo General Hospital. It is a case of their being out of sight, out of mind.
The Intensive Care Society of Ireland stated last night that there are not enough intensive care beds. A total of 3,000 beds were removed from the system. A similar number were promised, but not delivered, under the national health strategy. The Taoiseach stated last night that these beds are not needed. If that is the case, why the hell did he promise them in the health strategy?
Cancer care services have been massively underfunded. The position in respect of palliative care is disgraceful. Such care is left to charity. Across the country, service provision in this regard resembles a patchwork quilt. There are no dedicated services in this area, which is not acceptable.
The position is similar with regard to dedicated oncology services. To wait one month for a dedicated oncology bed is unacceptable. This year’s budget for cancer treatment, €3.5 million, is utterly disgraceful. Ireland is wallowing at the bottom of the European league for cancer treatment. The Independent Members introduced a motion on cancer treatment in 2003, yet the situation has not changed.
According to the Government’s amendment, “cancer survival is improving in Ireland for all of the major cancers”. What good is that to Rosie and the others who have died since then? What good is that to the 500 women from the west and south west who have died from breast cancer since 2000? These women died from Government neglect because it refused to provide the same money it was prepared to put into cancer treatments in the east.
The Independent Members have given leadership and made a difference on this issue. They represent the people and started the campaign for the national roll-out of BreastCheck. The Independent Members encouraged other parties to support this campaign and I am glad the Labour Party and other Opposition parties did so. The death rate from cancer is in the doldrums. The only way it will change is if the Government puts adequate funding in place. The Government pays lip-service to doctors and others in the health service treating cancer patients. It would be more in its line to give the moneys needed to allow those doctors and nurses to bring Ireland up to European standards. Why should Ireland, one of the richest countries in the world, be at the bottom of the league? It is simply unacceptable.
 The Dáil divided: Tá, 67; Níl, 54.
 Motion, as amended, put and declared carried.
Dáil Éireann 630 Private Members’ Business. Cancer Services: Motion (Resumed).