Jimmy Deenihan (Kerry North, Fine Gael)

This Bill provides for the dissolution of the board of St. Luke's Hospital and the transfer of its employees, assets and liabilities to the Health Service Executive. The dissolution arises from the national plan for radiation oncology under which there are to be four radiation oncology centres, two in Dublin, one in Cork and one in Galway, and two satellite centres in Waterford and Limerick. The Bill affords us an opportunity to discuss not only the dissolution of St. Luke's Hospital board but also to examine services throughout the State, including in Members' own areas.

I join with previous speakers in recognising the work that was carried out in St. Luke's Hospital over the years. We have all had occasion to visit patients there - in some cases, family members - and we all found it an example of how hospitals should be run. Patients suffering from cancer experience various stages of trauma during their treatment and these are trying times for them and their families. St. Luke's Hospital catered for such patients in a sensitive way. The dietetics department in the hospital has built up expertise in the area of diet and its relation to cancer treatment. I acknowledge in particular the work of Eimear Finn, head of the dietetics department, as well as the senior dietician, Catherine O'Connor, who is from north Kerry and over whom I had some influence in directing her towards dietetics through Listowel food fair. They have built up an excellent department and I hope their expertise will be utilised in Beaumont and St. James's hospitals. As I understand it, services will remain at St. Luke's Hospital until 2011, while phase two will be confined to Beaumont and St. James's hospitals.

In the debate pack supplied by the Oireachtas Library & Research Service, reference is made to a report on the development of radiation oncology services. In referring to the existing and short-term plan, it is noted that the increase in treatment capacity within the State is "significantly below" the equivalent guidelines recommended by international agencies and authorities in other western countries. It goes on to say that during the late 1990s and early 2000s, major investment in new and replacement clinical treatment services took place in Dublin and Galway while, during the same period, a more limited investment programme in replacement equipment took place in Cork. The service may have improved since that report was published. It is also noted in the information pack that the current utilisation of radiation therapy for various common adult cancers, as indicated by comparable data, appears "considerably less" than in several European Union countries and in North America. As regards patient case load analysis and projections to 2015, we are told that the total number of new cancer cases is increasing annually, with some of that increase a consequence of growth in the population and a significant element of it attributable to our aging population. I will come back to that later.

We have seen, therefore, that while our services have improved considerably, they are not comparable to those of our neighbours in Northern Ireland, the rest of Europe and elsewhere in the developed world, including North America and Canada. Nevertheless, according to data from the national cancer control programme, published this year, survival rates for almost all types of cancer improved for people diagnosed between 2000 and 2004 compared with those diagnosed between 1994 and 1999. We all know of people who have survived cancer following treatment. It is critical that once people are diagnosed, they receive treatment without delay. Unfortunately, however, that is not the case even for patients with private health insurance. Lives have been lost because people have not been diagnosed and treated in time. The value of screening and early detection is that they help to save lives. As other Deputies said, it is vital that people are encouraged to monitor their health on an ongoing basis and to have check-ups on an annual or six-monthly basis. Sometimes people do not recognise or act upon symptoms of cancer, diabetes or other diseases. Early detection is vital in all such cases.

Ireland is on a par with Europe and the United States in terms of survival rates for children diagnosed with cancer. We have made remarkable progress in this area and young children's lives have been saved as a consequence of early intervention and treatment. Approximately 22,500 new cases of invasive cancer are diagnosed every year. The current trend indicates that the number of cancers diagnosed each year is likely to double in the next 20 years. This will impose a significant burden on our health budget which currently is 12% of GNP and is primarily funded by the taxpayer. The financing of services will be a major challenge in the future, as we will have an ageing population and there will be more detection of cancers.

I commend the excellent cancer screening programme in Kerry General Hospital. However, people bought into the centre of excellence in Cork on the promise that services would be provided locally. These are being put in place, albeit rather behind schedule. Politicians should support these services. I hope that women in Kerry will not be disadvantaged because of the change in services which means they will have to travel to Cork for major surgery with follow-up chemotherapy treatment in Tralee. The jury is still out and some people are rather concerned, including doctors, that this system may not work. However, we must ensure it will work.

Cancer screening for women in Kerry commenced in April 2009, in the grounds of Kerry community services headquarters in Rathass. Women living in the greater south Kerry area, including Tralee, Ventry, Dingle and Listowel, were invited for screening in Tralee. The initial take-up was low because, for whatever reason, women were not encouraged or were discouraged to avail of the service. However, the numbers have increased considerably.

The statistics on cancer screening should be readily available, such as the numbers of women availing of the service, but, apparently, this is not the case. In preparation for this debate, I looked for statistics on the number of women who availed of the BreastCheck service in Tralee. This information was not available. The free mammogram service for women aged between 50 and 64 years, will be carried out every two years on an area basis. I suggest this service should be expanded. Cancers can be detected by screening in GP surgeries and in hospitals such as the Bon Secours Hospital in Kerry. However, it is crucial that all women carry out a personal breast check on a regular basis to ensure they have not developed cancer. Lumps in the breast are common and they may not always be cancerous but it is very important to have these diagnostic services available and women should be encouraged to use them. Approximately 13,000 women between 50 and 64 years live in County Kerry and these will be invited to avail of BreastCheck which will remain in County Kerry until all eligible women have been offered an appointment.

The most recent statistics available for 2008 and early 2009 show that 92,061 people were screened by BreastCheck and 672 cancers were detected. This means a large number of people were saved. Screening for cervical cancer seems to be working very well. This is available for women between the ages of 25 and 44.

I have an interest in screening for colorectal cancer. Anyone whose parents died from colorectal cancer or stomach or bowel cancer, should be screened regularly. It is obvious that this cancer is genetically transmitted from one generation to another.

The Minister announced last December the NCSS would proceed with preparations for the national colorectal cancer screening programme for men and women aged 55 to 74 years and that preparatory work is well under way. However, this will not happen until 2012. Deputy James Reilly referred to this programme in his contribution. It is hoped this programme will not be postponed beyond 2012 but there is no reason it could not have been put in place in 2011. The earlier, the better as more lives will be saved.

Colonoscopy can be carried out as an outpatient service and people should be encouraged to avail of this service. Early detection can save lives. We all know of people who went in for a routine check-up and discovered they were in the early stages of cancer of the bowel. Procedures and treatment can commence immediately and this means a colostomy bag is not required afterwards. Early intervention means that people can live for years.

I refer to the National Cancer Registry of Ireland which last 23 December published an atlas of cancer incidence. This was not a very auspicious publication date for receiving publicity. It outlined the geographical status of cancer sufferers across the country. It showed that poorer areas are more likely to record higher incidences of the disease than other areas. For example, poorer rural and urban areas have higher incidences than other areas. This is a very important fact. A Combat Poverty report showed the two counties with the least income per capita were Donegal and Kerry. A National Cancer Registry report mapped where the sufferers of specific cancers were located across the country and those diagnosed with the disease between 1994 to 2003. It found that socio-economic factors such as high deprivation levels as well as population density often correlated with higher levels of particular cancer diagnoses.

The report also claimed:

Some geographical variation in cancer incidence may be due to differences in health awareness, in participation in screening, or in access to cancer services. However, it is generally accepted that it is predominantly the result of differences in well-known risk factors such as tobacco smoking, alcohol drinking, obesity, diet and sexual behaviour.

The report provided a breakdown of where particular forms of the disease are found across the country. Breast cancer, for example, showed little variation in the location of sufferers across Ireland but the highest density cases were found in west Cork, north Kerry and the east midlands. This is why north Kerry should be singled out for special treatment with more awareness campaigns for breast cancer screening.

When general cancer treatment services were moved from Kerry General Hospital, Tralee, a commitment was made for a digital mammography unit to be established there. While it took some time for the unit to be provided, it will be opened on 14 June and will allow follow-up treatment for treatment done in Cork.

Every year 200 people die from cancer caused by radon gas. This is an area that must be examined more seriously.

The country faces major challenges in the delivery of health services, particularly cancer treatment. The annual health care budget is €19 billion of which the Government contributes €14 billion and the outstanding €5 billion has to be borrowed. Prevention of ill health will become an important element of health strategy. Between now and 2033, the overall number of invasive cancers is projected to increase annually by 6% for females and 8% for males. Early intervention, improved diagnostics and immediate treatment will reduce the cancer casualty rate. However, we must be far more aware of ways of preventing the disease too.

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