Tim O'Malley (Limerick East, Progressive Democrats)

My colleague the Minister for Health and Children has set out very clearly the significant achievements of this Government in cancer control. We have invested in all elements of cancer care and in all regions. These achievements have benefited patients throughout the country.

The Minister referred to the independent analysis of our progress in improving cancer survival undertaken by the National Cancer Registry. This Government is not complacent over its successes in this area. A recent report, published in June 2006 by the registry, predicts that cancer numbers in Ireland will have increased from 22,000 a year at present to 43,000 by 2020. The number of potentially fatal cancers will more than double, from 13,800 to 28,800, in the same period. Approximately two thirds of this increase is expected to be due to the increasing number of elderly people in the population and the remainder to upward trends in the incidence of some of the common cancers.

This anticipated increase in cancer numbers will place a major additional burden on cancer services and must be considered in current planning for cancer control. The Minister and the Government are committed to significant additional investment based on an integrated strategy that seeks to improve prevention, early detection, treatment and support services for cancer.

We have in place a national cancer control strategy, which the Minister launched last June. The aim of the strategy is to reduce our cancer incidence, morbidity and mortality rates relative to other EU countries by 2015.

The HSE is establishing a national cancer control programme to manage, organise and deliver cancer control on a whole population basis. The programme will have a strong emphasis on prevention and early detection, integrated across primary, hospital, supportive and palliative care. The service plan of the HSE for this year sets out the detailed deliverables of the programme. They include the establishment of the leadership team to implement the programme, including the director of the programme and key medical leaders at network level. The Minister referred to an overall investment for cancer of €20.5 million in 2007. This funding will also improve access to diagnostic services, support additional medical oncology and improve transport services for cancer patients.

Many cancers and cancer deaths are preventable. As many as one third of cancers could be prevented by public policy initiatives and the promotion of healthy lifestyles. Early intervention can make the difference. Cutting down on tobacco consumption and improving diet could help to save many lives. The Government has decided that it needs to put renewed emphasis on prevention as well as treatment. We cannot accept the future predictions for cancer incidence without redoubling our efforts to prevent as many cancer cases and cancer deaths as possible.

Ireland has led the way in Europe and beyond in implementing legislation to address the tobacco epidemic. There is widespread agreement that the smoke-free at work legislation has been hugely successful. From 31 May 2007 it will no longer be legal to sell cigarettes in packs of less than 20. The Minister for Finance decided to increase the tax on a packet of 20 cigarettes by 50 cent in the context of budget 2007. This increase was coupled with a decision to plan for further increases in tobacco excises for a period ahead, so as to keep the level of tax increasing in real terms and with a call on the social partners to discount some or all of the effect of such price increases in fixing on the relevant inflation benchmark. The HSE has also announced it is to step up enforcement activity on sales to minors.

The national survey of lifestyle, attitudes and nutrition, SLÁN, carried out every four years, is one of the most comprehensive pieces of research undertaken in this country into health and lifestyle. It has provided the Department with invaluable data for priority setting in health promotion initiatives and programmes which inform the Department's future policy and programme planning. The 2006 survey is at data collection stage and consists of face-to-face interviews with a randomly selected 10,000 participants. The Departments of Health and Children and Education and Science have established the social, personal and health education support service, SPHE. This is based on the importance of the school as a setting for promoting health. The SPHE curriculum is Ireland's most significant commitment to health promotion in schools. It is a broad-based health education programme that aims to enhance the self-esteem and decision-making skills of young people. All schools, both primary and post-primary, up to junior certificate level must make provision for the SPHE curriculum. A curriculum for senior cycle is being developed.

Screening for certain types of cancer plays a crucial role in the detection of pre-cancerous and early disease, saving lives and reducing morbidity. This year, we will have in place a national breast screening service and a national cervical screening service. I am aware of reports of delays in obtaining results of cervical smear tests. These delays have not arisen under the Irish cervical screening programme, but relate to smear tests referred by general practitioners to hospital laboratories, which are the responsibility of the HSE. The HSE has informed the Department that the majority of laboratories will process urgent requests for cervical smear tests in less than two weeks.

To reduce the backlog of cervical smears awaiting testing, the HSE is referring approximately 25,000 smear tests to a laboratory in the US. The HSE has sent samples from Cork University Hospital to the US and results were returned last week. CUH is preparing to send a further 2,000 smear tests to the US on 7 February. The HSE has commenced discussions with the other testing centres and the Royal College of Surgeons is working closely with the HSE to transfer tests to the US.

The HSE is also making arrangements to ensure proper follow-up of women with abnormal smears. The HSE has reviewed hospital services, including cytology, and is planning on the basis of a four-week turnaround time in reporting. The roll out of a national cervical screening programme planned for later this year is the most efficient population approach to prevent and control cervical cancer.

Colorectal cancer is the second most common cancer in Ireland and is a significant public health problem. The National Cancer Forum has monitored emerging evidence and trends in other countries in respect of colorectal cancer screening. The forum has advised that substantial work is required to address a range of issues as a prerequisite for the development of a screening programme.

The national cancer screening service, established by the Minister on 1 January, has an advisory function in respect of screening for cancers generally. The Minister will ask the service to advise on the implementation of a national colorectal cancer screening programme, specifically on the population to be screened, at what intervals screening should take place and the requirements for a quality assured and well organised cost-effective symptomatic service.

Deputies referred to the need for prostate cancer screening. Prostate cancer is the second most common cause of cancer deaths in men. There are approximately 11,150 new invasive prostate cancer cases annually. It is predominantly a disease experienced by older men, with the majority of cases occurring in the 70-74 year age group and the majority of deaths in the 80-84 year age group.

The National Cancer Forum has concluded that there is insufficient evidence to recommend the introduction of a population-based prostate cancer screening programme in this country. The forum has recommended that this issue should be reassessed when results are available from randomised control trials being conducted internationally. This position is consistent with the recommendations adopted by the European Union, which advocate the introduction of cancer screening programmes that have demonstrated their efficacy having regard to professional expertise and priority setting for health care resources.

I am supportive of the Irish Cancer Society's Action Prostate Cancer campaign, which was launched in April last year by the Minister for Health and Children. Information on the signs and symptoms of prostate cancer is essential in the early detection of the disease.

The National Development Plan 2007-13 includes major investment in the implementation of the national cancer control strategy. This will involve significant investment and development of facilities to treat people affected by cancer. Infrastructural investment will include state-of-the-art diagnostic and treatment facilities, including day and outpatient facilities and facilities for the administration and preparation of cytotoxic drugs.

The national plan for radiation oncology will be funded under the NDP. Rapid developments are taking place in terms of diagnostic imaging, which provides a better biological molecular understanding of cancer. New technologies support better and more accurate diagnoses and, hence, more effective treatments. Funding will also be made available for these technologies.

Patients are being referred to the radiation centre at Limerick Regional Hospital. The operators at Limerick are fully signed up to integrating their service delivery with the radiation oncology department at University College Hospital Galway. This is an important element of the implementation of the Government's national plan for radiation oncology.

The service level agreement is being finalised between the HSE and the University of Pittsburgh Medical Centre Whitfield Clinic in County Waterford. This will support the referral of public patients for radiation oncology treatment pending the commissioning of the radiation oncology centre at Waterford Regional Hospital as an integral part of the national plan for radiation oncology. 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.

I wish to refer to the position at St. James's Hospital and the deferral of some cancer operations. There are significant pressures on intensive care unit and high dependency unit beds. This is due to a large number of medical emergencies presenting and inpatients whose conditions have deteriorated during treatment. This has affected the hospital's capacity to carry out some operations on patients who are in need of intensive care nursing after their operations. Based on an assessment of medical need, some operations needed to be deferred.

I acknowledge that this is an unsatisfactory situation causing patients and their families stress. The HSE has advised that these patients are given high priority and it is hoped to accommodate them within a week. The HSE has offered full support to the hospital in terms of assistance to fast-track patients to other settings to free up intensive care unit beds. ICU capacity at the hospital has been increased by more than 50% in the past three years. The HSE is in discussion with the hospital with a view to further increasing high dependency capacity at the hospital.

The developments I and the Minister have outlined are a clear indication of the progress that has been made in addressing the burden of cancer in our community and demonstrate the Government's commitment to the provision of quality cancer care nationally.

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