Marian Harkin (Sligo-Leitrim, Independent)
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Question 53: To ask the Tánaiste and Minister for Health and Children if, in view of the fact that breast cancer is a terrible killer, health care apartheid exists here and that 260 more women will die needlessly in the west and south before BreastCheck is up and running; if she will take up the offer made by the Galway Clinic on 11 February 2003 to provide a BreastCheck service until a unit is built in Galway; if she cannot fast-track BreastCheck before 2007, will she allow the Galway Clinic to provide a breast screening service in the meantime to save these 260 women's valuable lives; and if she will make a statement on the matter. [15108/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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BreastCheck, the national breast screening programme, commenced in 2000 with the programme covering the former Eastern, North Eastern and Midland Health Board regions. In 2003 the extension of the programme to counties Carlow, Kilkenny and Wexford and its national expansion to the rest of the country was announced. Screening commenced in Wexford in March 2004, in Carlow in April 2005 and in Kilkenny in March this year.

I informed the Deputy last month of my meeting with representatives of BreastCheck and of my wish to have the programme rolled out to the remaining regions of the country as quickly as possible. Some €2.3 million was made available to BreastCheck this year to provide among other things for the early recruitment and training of staff. The interview process for the posts of clinical directors is now completed and BreastCheck has also commenced the recruitment process for other essential staff. The notice for the procurement of a construction company for the new clinical units in Cork and Galway has been published in the EU Journal and the design team is in the process of short listing applicants. Following the selection of the contractor, construction of the units will commence. BreastCheck is confident that the target date of next year for the commencement of the national roll out will be met. On full roll out, all women in the target age group in every county will have access to breast screening and follow up treatment where appropriate.

As I previously informed the Deputy, any proposal received by BreastCheck to support the roll out of its screening programme is carefully examined to assess the extent to which it complies with existing standards. BreastCheck has advised my Department that it has engaged in extensive discussions with the Galway Clinic. BreastCheck conducted an evaluation of this proposal and has concluded that the clinic in question would not be in a position to provide a population based screening programme in line with its requirements.

Jerry Cowley (Mayo, Independent)
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I thank the Tánaiste for that reply. As she knows this is something that I am particularly anxious about. When it was introduced in 2000 BreastCheck covered half the population. It is now 2006, however, and it will be 2009 before the full roll-out is completed, according to BreastCheck. There is no other term for this but cancer care apartheid. I have calculated that at least 200 women have died in the south and west since BreastCheck was rolled out for half the population. That is a disgrace, considering the position in other countries. This is not rocket science, as the Tánaiste has conceded. This information has been available for 20 years and it is a terrible disgrace that BreastCheck was allowed to cover half the country and not the other half. On my calculations more than 200 more women will have died by 2009, who need not have. I know the Tánaiste says the Department has talked to the Galway Clinic, which offered to intervene in 2003. If that offer had been taken up, at least 150 more women would be alive today. The excuse then was that BreastCheck was an analog service and the Galway Clinic's service was digital. BreastCheck has upgraded its service to Galway Clinic level, however, and is now digital. I am asking the Tánaiste how she can let those 200 women die who need not. It is a question of money. Money was available for all sorts of matters, the wasteful PPARS system, the horse racing industry and all types of stupid things. We are talking about real lives here.

It is not Galway Clinic that is saying this, but the Department of Health and Children. This is the same Department that said that this must be done on a phased basis, as it was so complicated. The complication is how the service is available to half the population and not the other half. I ask the Tánaiste to please save the lives of those 250 women. She has the power to intervene. Has she the will to do it? It can be done.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have looked at population screening as regards another area in which I am interested in pursuing when we can. Any population screening is always done on a gradual basis for a host of reasons. One cannot move from a situation where there is no population screening for a particular type of cancer to one where the entire population is covered in a short period of time. That is not to say that perhaps things could not be done quicker. However, this is the reality.

BreastCheck did not get subsumed into the HSE. It is an autonomous body with a board of directors. I asked it to look at the proposal from the Galway Clinic which had been sent to me and the Department has discussed matters with BreastCheck. It is a matter for BreastCheck to assess whether the proposal meets its requirements and it has concluded that it does not. I have to accept that.

I was criticised earlier for encouraging the private sector. Here I am being criticised because we are not giving business to a private independent operator. I want to see it rolled out as quickly as possible. That is why we made the funding available. We also need to see cervical screening rolled out. That is in only one pilot project at present and I hope it will form part of the new contract with general practitioners since it clearly can be done at primary care level. Again, this is an area where early detection can bring about fantastic results, which Deputy Cowley knows, as a doctor. I am committed to ensuring that we put the resources in place to do that as part of the new contract of employment.

The roll-out will begin next year. Clearly it will take time before everybody in a given catchment area is called. I know the response rate to BreastCheck is about 70%, which by international standards is apparently very good. However, this means that about 30% of those called do not respond. We should all do everything we can to encourage people. I meet people from time to time who receive a letter and take the view that they prefer not to know. Yet we know there can be fantastic results if cancer is detected early. I would encourage everybody who is called to respond and to go for the mammogram. It is a wonderful service, and I hope we can have it in place everywhere before long.

Jerry Cowley (Mayo, Independent)
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The death rate in Scotland was cut by 30% in only five years.

Mary Harney (Dublin Mid West, Progressive Democrats)
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That is right.

Jerry Cowley (Mayo, Independent)
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This has been happening all over the world, in the USA, the UK and so on. There is no reason the service could not have been extended to the whole country in 2000. We are suffering the effects of this now. I know the Tánaiste argues that she is not an advocate of anything other than keeping people alive. If the Galway Clinic route is the way to go, then it should be let do it. I spoke to the clinic and was told it could do it. We keep getting the same answer as regards the intricacies. There is no intricacy here except the conundrum as regards how people in the west and south cannot have this service which is in the other half of the country. I just cannot understand it. It does not make sense. Why did those people die?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I assure the Deputy it is my intention and that of the Government to have it rolled out as well. That is why provision has been made by way of resources for that to happen and why we have gone to tender for procurement of a contractor to build the facility. However, it is not just about a building. It is also a question of highly qualified staff such as a radiologist, specially trained nurses and others. As I told the Deputy earlier, clinical directors and other key staff have been selected. In addition to the screening process and the 2% of the population that require follow-up, there is the question of the surgical team. In the case of the west there is the University College Hospital, Galway. Staff in the whole facility must work together and it is not just an issue of screening, as the Deputy is aware.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I welcome the Tánaiste's earlier response on the number of women who do not take up the opportunity, for the following reason. Does she recall that a mammography machine was located at Cavan General Hospital for several years, that it was never used and was then transferred to Our Lady of Lourdes Hospital, Drogheda? During its time at Cavan a number of radiographers were specially trained in England to use it, but never allowed to actually put the equipment into use at Cavan General Hospital. Does the Tánaiste not agree that this is yet another indication of the folly of over-centralisation and that the powers-that-be have decreed from on high that services as regards BreastCheck in the north east will be centred at Our Lady of Lourdes Hospital, Drogheda?

On the numbers of women to whom she refers as not taking up the opportunity — and some who require after-care referral — it is not always a question of preferring not to know. While I appreciate the importance of the roll-out throughout the rest of the State and fully concur with Deputy Cowley's points, nevertheless, where the service is in place it is not being taken up by all the women who should avail of it. Part of the reason is that we have a very serious transport problem. The Tánaiste should know that there is practically no public transport system in place in the north east. It is virtually non-existent. There is no regular service to Drogheda from any of the other key locations within the neighbouring counties, certainly not Cavan and Monaghan. Accepting that deficiency, will the Tánaiste outline steps she may be considering to help ensure all women have the opportunity to avail of the service already in existence and, in preparing for its roll-out throughout the rest of the State, will she build in to the plan transport arrangements because often women are left isolated and alone? There may be a vehicle at home that is used by another person in the home for work and other reasons. It is not always simple. I would like to know if any measures are being considered to address that deficiency.

Mary Harney (Dublin Mid West, Progressive Democrats)
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As the Deputy is aware, we have mobile units that go to more remote areas to do the screening. Not everybody has to come to the big centre. Among the people I referred to earlier, one person in particular whom I met last weekend lives within a mile and a half or two miles of St. Vincent's Hospital where BreastCheck is located in Dublin. There are different issues. I am not taking away from the transport issue but we do have mobile screening facilities and clearly they are of great use in the more peripheral areas of the country. Some 98% of people do not require any follow-up. Thankfully they get good news after being screened. Only 2% of people may come for follow-up treatment.

Breast surgery takes place in a large number of centres. All the evidence would suggest that a unit should carry out at least 100 operations a year and that it is not safe for the procedure to be carried out in a facility that is smaller. That is why I asked Professor Niall O'Higgins, the president of the Royal College of Surgeons, and a group of experts to make recommendations in regard to this area in particular. The Minister for Health and Children of the day and the Department should at least make sure that surgery takes place under safe conditions. We cannot stand over a situation where a patient's outcome is disimproved because an operation is not taking place in an appropriate setting.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What is the Minister doing about the transport needs?

Séamus Pattison (Carlow-Kilkenny, Labour)
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We must proceed with Question No. 54.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am not the Minister for Transport. My job is to try and provide health services and that, as the Deputy knows, is a challenge even with a budget of €13 billion.

Séamus Pattison (Carlow-Kilkenny, Labour)
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We must proceed with Question No. 54.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Transport is a matter for others.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is not a matter for others, it is a matter for the Tánaiste. She cannot wash her hands of this.