Maurice Hayes (Independent)

I congratulate the Minister of State on the frankness of his contribution. As Senator O' Meara has underlined, it is important that we have an open debate on this matter and that people begin to understand the nature of a strategy and its basis. I hope he will stick to his strategy. It is easy to respond to pressure and distribute money and resources in penny packages around the place but if one has a strategy which is being unrolled and will ultimately cover the whole country, it is preferable. People should reflect on the fact that it is not just a question of money, it is a question of getting people to work the system within a timescale. One cannot pluck oncologists from the trees. They are scarce.

There is a tremendous dilemma in this form of health care, almost more than any other, of balancing access with quality and correcting for equity. Most would go for quality but there is also a need to understand the problems of people at a distance and try to make services such as mobile screening as accessible as possible.

There is a need to maintain a concentration of intensive phases of treatment. It is well noted in international literature that the two year and five year survival rates are much better where there is a concentration of people. It is not just a question of maintaining skills or the volume of work; the interaction between people in different disciplines is important. People are coming across new things all the time. This is particularly important when dealing with some of the more obscure or less commonly met forms of cancer.

The Minister of State might find it useful to take a look at the provision in relation to cervical screening, in particular among young women. A connection has been made between the increase in sexual activity among young women and some forms of cervical cancer. Given their age and the possibility of longer survival periods, it might be worthwhile looking at that area. We should take a hard-nosed look at all screening programmes from a health economics point of view. Some of them are more valuable than others. One can spend a great deal on identifying one single case but that simply diverts resources from other areas.