Liz McManus (Wicklow, Labour)
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Question 52: To ask the Minister for Health and Children when bowel cancer screening will commence; if it is intended that the hospital personnel who currently carry out symptomatic screening will implement the screening programme; if so, the way she will ensure that symptomatic screening waiting times are not affected; and if she will make a statement on the matter. [10446/10]

Andrew Doyle (Wicklow, Fine Gael)
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Question 74: To ask the Minister for Health and Children the details on the roll-out of the national colorectal screening programme; when screening will commence; and if she will make a statement on the matter. [10489/10]

Mary Harney (Dublin Mid West, Independent)
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I propose to take Questions Nos. 52 and 74 together.

I am pleased to confirm that work has already begun on putting a national colorectal screening programme in place. The programme will initially be offered to men and women aged between 60 and 69 years. Screening will commence in early 2012 following an intensive period of preparation.

Colorectal cancer is the second most commonly diagnosed cancer among men and women in Ireland. Approximately 2,200 new cases are diagnosed and approximately 1,000 people die from the disease each year. A successful national screening programme has the potential to reduce mortality from this cancer significantly.

The programme will be provided by the National Cancer Screening Service. The immediate focus in preparing the programme is on colonoscopy capacity, accreditation and training. Based on expected uptake and incidence rates, it is estimated that approximately 6,000 colonoscopies will take place each year within the screening programme. Approximately 59,000 colonoscopies are performed in the public hospital system annually.

Last December the National Cancer Screening Service invited 37 publicly funded hospitals, which provide endoscopy services, to submit expressions of interest to be considered as a screening centre. Between ten and 12 screening centres will be required by the programme. Some 28 hospitals have now expressed an interest in participating in a national programme. One of the criteria for hospitals wishing to participate in the programme is that they reduce waiting times for urgent colonoscopies to fewer than four weeks prior to the initiation of the screening programme.

The National Cancer Screening Service is now preparing to undertake a baseline analysis of each hospital endoscopy unit. The outcome of the baseline analysis visits will identify potential areas for improvement and additional investment and staffing requirements. The National Cancer Screening Service will report these findings to my Department. It has already been decided that additional advanced nurse practitioners will be trained to provide additional capacity in the colonoscopy screening centres.

The screening programme will not be allowed to adversely affect waiting times for urgent colonoscopies in the symptomatic services. The need to comply with the four week time limit for urgent colonoscopies has been emphasised to the National Cancer Screening Service and the HSE and I am satisfied that there has been an enormous improvement in the capacity to deliver on this commitment.

Jan O'Sullivan (Limerick East, Labour)
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It is often pointed out to us that it is difficult for GPs, for example, to say whether a colonoscopy is urgent. The Minister should not just concentrate on urgent colonoscopies and the need to reach the target of four weeks. As I said, it is very hard to know whether a colonoscopy is urgent and all colonoscopies need to be carried out within a safe period of time. Will the Minister address that issue?

Is it intended that advanced nurse practitioners will do the screening? Will gastroenterologists be involved as well? There is a concern that the capacity will need to be increased considerably if the screening is not to affect the regular symptomatic colonoscopies required.

Mary Harney (Dublin Mid West, Independent)
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All cancer experts would say one must distinguish between urgent and non-urgent, not only in this area but in regard to symptomatic breast disease. Professor Keane has worked with the College of General Practitioners on referral protocols for doctors.

Professor O'Donoghue has been appointed as the lead for the roll-out of the colorectal screening and he is probably well known to most people in this area. The breakdown between consultants, doctors and nurses involved has yet to be determined but we want to empower nurses as much as possible. In many other countries, this service is provided by advanced nurse practitioners.

In regard to the hospitals that will be selected, a group which advised in the UK will be part of the advisory team visiting the 28 hospitals which have expressed an interest. There is no question of the screening programme being done at the expense of the day-to-day service and that must be factored in.

James Reilly (Dublin North, Fine Gael)
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Will the colonoscopy service be expanded by 2012? I make the observation that this will all be hospital-based. Surely we are missing a golden opportunity to implement this as a community-based service which would achieve two things, namely, it would bring the service closer to patients and it would not allow for the possibility of interference with the symptomatic service because it would be community-based and a separate service. There is absolutely no reason colonoscopies cannot be done in the community.

I understand from speaking to several surgeons that suspected cases of breast cancer receive preferential treatment, in terms of being brought in to be operated on, over established cancers of the bowel and lung and other cancers in women and men. We do not want the same thing to happen with the colonoscopy. Perhaps the Minister will comment on that and on why the screening programme will not be community-based.

Mary Harney (Dublin Mid West, Independent)
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We are effectively going to provide a home screening service. The kits will be sent to people and, to a large extent, they will be providing the service for themselves. Some 6% will require follow up by way of a colonoscopy, so that is a relatively small number out of the 200,000 who will be screened every year.

It is not envisaged that we would extend it beyond 60 to 69 years of age in the initial phase. Every new programme must be phased in, as was done in Sweden, Finland and the UK.

It would not make sense to duplicate a service in the community which we currently have at hospital level. We want ten or a maximum of 12 centres nationally. All the advice from both the Health Information and Quality Authority and the National Cancer Screening Service was that for many reasons, these colonoscopies should be done at hospital level.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Given that bowel cancer is the second most commonly diagnosed cancer in men and women, that its incidence increases with age and that it is projected that the population for the 60 to 69 age group in 2012 will be in excess of 278,000, can the Minister guarantee that she will have the necessary roll-out to ensure a comprehensive screening of that population? Following on from that, will she have in situ the required treatments and supports for those who have been diagnosed with bowel cancer as a consequence of that screening exercise?

Mary Harney (Dublin Mid West, Independent)
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Where somebody requires follow up, either a colonoscopy or treatment, that will be integrated as part of the service as it is with the breast screening service or the cervical cancer screening programme.

On the population to be screened, initially we are talking about people from 60 to 69 years of age. Half of the cancers occur in that age group. The resources will be made available and I acknowledge the support of the Irish Cancer Society which is providing resources towards the implementation of this programme, which is very helpful.

We have learned from other countries that we need to invest hugely in advance publicity and information because it is a very different screening programme. It will be the first screening programme involving men and the first screening programme where much of the screening will be self-screening using the kit that will be sent out. We need to be involved in advance publicity and information campaigns and they are currently being devised.