Mary Harney (Dublin Mid West, Progressive Democrats)

I move 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.

I wish to record the significant achievements of the health services in our country regarding cancer care and control, and the plans we have which will achieve the services we all want. We have to catch up after many years where failed economic policies led to enormous problems for health and social services. The successful economic policies of the Government have meant that the people of our country have generated the substantial resources to start catching up.

Since 1996, approximately €1 billion has been invested in cancer services nationally. We have made progress to date and are determined to make more. That is why our response now is to invest, as never before, to build up all aspects of cancer care and cancer control until we get our cancer services to world class standards. We are making patient safety and quality outcomes the drivers of all decisions on cancer care. That programme of investment in cancer care will be pursued relentlessly.

The finance for radiotherapy is already committed by the Government beyond any doubt. A new cancer director is to be appointed by international competition in the coming months. Good things are happening each day in cancer care. For example, the first prostate brachytherapy cases in the public health system were performed in University College Hospital Galway, UCHG, last Friday and the two patients were back at work on Monday. This is now one of the accepted forms of curative treatment for men with early staged prostate cancer. The team performing this procedure at UCHG has more than a decade experience with the technique during which it has treated more than 700 patients internationally. They are now bringing that expertise to Galway.

It is only fair to all those working hard in cancer care to record the improvements that they have made and are continuing to make. It is important that patients should have reasons for hope and optimism about cancer care. 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% on 1997. Approximately 58,000 people were treated for cancer as day cases in 2005, an increase of 130% on 1997. In 1997, there was no cancer screening programme anywhere in the country. This year we are beginning the full national roll-out of BreastCheck to the south and west and I decided also that we would commence a cervical screening programme later this year. Additional funding of €20.5 million has been allocated in 2007 for cancer control, an increase of 74% on the comparable 2006 investment.

Cancer survival is improving in Ireland for all the major cancers. I know that the statistics show that too many people still die prematurely from cancer in our country. For some cancers, such as breast cancer and cervical cancer, approximately the same numbers of deaths have occurred in each of the years between 2000 and 2005. However, that is not the valid and effective measure of overall survival rates in a growing and aging population. We currently have approximately 120,000 survivors, 3.3% of the population. The National Cancer Registry compared cancer survival data between 1995 and 1997 with data between 1998 and 2000. Our overall relative survival from cancer increased from 48% to 50% for women and from 38% to 44% for men. Both of these increases are statistically significant. For women, there were increases in survival in the four commonest cancers, namely, breast, lung, colorectal and lymphoma. Survival improved for almost all cancers for men.

Today I announced the appointment of the first board of the National Cancer Screening Service. We are going to develop totally integrated national cancer screening programmes in areas where the clinical evidence shows that cancer screening works reliably and delivers real results for patients. The new board will maximise the expertise in BreastCheck and the cervical screening programme. It will ensure improved efficiency and develop a single governance model for cancer screening. The total allocation to the new service is €33 million which is a 71% increase in the 2006 allocation to the programmes.

I am committed to ensuring that BreastCheck is rolled out to the remaining regions in the country as quickly as possible this year. I have allocated additional revenue funding of €8 million for this year to meet the additional costs involved. I have also made available an additional €26.7 million in capital funding for the construction of two new clinical units, five additional mobile units and the provision of state-of-the-art digital equipment. Construction commenced on both sites in Cork and Galway in early November last year.

Some 60,000 women were screened by BreastCheck in 2005, which represents a 19% increase over 2004. I expect 70,000 women to be screened this year. Of those screened in 2005, 318 cancers were detected. From the commencement of screening in February 2000 to August 2006, BreastCheck diagnosed and arranged treatment for 1,867 women with breast cancer. The first round of screening will commence in the south and west in the spring.

An effective national cervical screening programme will result in a substantial reduction in the incidence of cervical cancer. It is my objective to have such a programme rolled out, beginning late this year, based on an affordable model. From January 2001 to the end of December 2006, approximately 57,000 women attended for screening in the pilot screening programme in the mid-west. I have allocated additional revenue funding of €5 million in 2007 to facilitate the national roll-out of this programme. Significant preparatory work is well under way. It involves the introduction of new and improved cervical tests, improved quality assurance training and the preparation of a national population register. I have included a requirement in the legislation establishing the new board to implement special measures to promote participation in its programmes by disadvantaged persons and difficult to reach groups. This is of particular relevance in preventing and controlling cervical cancer.

Many Opposition Deputies referred to St. Luke's Hospital, Kilkenny. It is regrettable that any patient referred to a hospital with possible symptoms of cancer would be subject to a delay in diagnosis. This is especially the case as the earlier a diagnosis of cancer is made the earlier treatment can commence and the prognosis is usually better. I have been assured by the Health Service Executive that a patient referred to St. Luke's for endoscopy and considered urgent will be given an immediate appointment and will be seen within one to two weeks. Urgent cases are forwarded directly to the medical consultant for prioritisation. General practitioners are encouraged to make contact directly with the medical consultant. The HSE has made available capital funding of €300,000 to build a new modular endoscopy unit at the hospital and is referring patients to the National Treatment Purchase Fund to reduce waiting times for non-urgent cases.

Real progress is now being made in implementing the national plan for radiation oncology. We already see the return on the substantial investments in Cork and Galway. In Cork University Hospital 1,845 new patients were treated over the four linear accelerators in 2006. This constituted 35,302 treatments, an increase of almost 5,800 treatments over the previous year. The waiting time for patients to receive treatment has halved from eight to ten weeks to three to four weeks. In University College Hospital Galway, almost 1,000 patients were treated in 2006, representing a 76% increase over the previous year. The number of treatments increased from 10,500 in 2005 to 18,500 in 2006. University College Hospital Galway expects treatments provided to increase by 7% this year.

In December last year I met with the chairman and chief executive officer of the HSE and I agreed the executive should examine options to speed up the pace of the plan. I reiterate that the funding for this plan is totally secured by the Government's decision of July 2005. This is the first time a major capital project for cancer care has been fully funded years in advance. The job now is implementation without delay.

It is my objective and that of the HSE to see the earliest delivery of the plan in the best interests of cancer patients throughout the country. I am determined the HSE will deliver on this plan in 2011 as originally scheduled. It is a challenging timetable and I will provide the HSE with the necessary support and approvals to deliver on it.

The main developments to date include the procurement of additional capacity in the shape of two linear accelerators for St. Luke's Hospital, Rathgar, which are scheduled to be delivered around the end of 2007. They also include the provision of interim facilities at Beaumont Hospital and St. James's Hospital, which will be delivered by early 2009. The capital requirements amount to €45 million. Four leading international experts have been appointed to validate the population needs assessments, technical specifications, process mapping and other outputs. Additional revenue funding of €3.25 million has been provided in 2007 to support the implementation of the national plan. This funding will support the appointment of five additional consultant radiation oncologists, seven specialist registrars and five support staff.

Patients are now being referred to the radiation centre at Limerick Regional Hospital. The operators at Limerick are fully signed up to integrating their service delivery within the radiation oncology department at University College Hospital Galway. A service level agreement is being finalised at present between the HSE and the private Whitfield Clinic in County Waterford. It is a good example of the public and private sectors working together for an immediate solution. This will support the referral of public patients for radiation oncology treatment while we build the public radiation oncology facility at Waterford Regional Hospital. The NDP will also support a new day ward with 20 treatment places at Waterford Regional Hospital. Planning of this facility is under way and construction is scheduled to commence next year.

As regards patients in the north west, a service level agreement is now in place for the referral of approximately 50 radiation oncology patients annually from Donegal to Belfast City Hospital and a number of patients have already been referred for treatment.

The decision to transfer St. Luke's Hospital to St. James's was taken by the Government in the context of its consideration of the national plan. The board of St. Luke's Hospital and its executive management team are fully committed to supporting the Government's decision. We value and will build on the expertise and ethos of St. Luke's in this transfer. A transfer along similar lines took place last year in Northern Ireland when radiation oncology services transferred to Belfast City Hospital, a major academic teaching hospital.

In conclusion, I am glad to put on the record of the House the substantial developments that are taking place in cancer control and my determination, as well as that of the Government, to ensure cancer care is brought up to a top class standard in our country. With focus, determination and persistence, this goal will be achieved.

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