Fergal Browne (Fine Gael)

I welcome the Minister of State and his officials to the House. He is a frequent visitor and is due back this afternoon. I compliment the former Minister for Health and Children, Deputy Martin. Although I have disagreed with him on many issues, his contribution to future cancer reduction through the ban on smoking in the workplace will be seen as a turning point. From that episode we learned that Ireland, a tiny country on the periphery of the EU, could lead the way. Other countries now follow our example. We must take that tough line and put pressure on cigarette companies as we have done. There is a direct link between smoking and cancer and future generations will see a reduced rate of cancer, which will save families trauma. We should build on that, take it a stage further and move forward. The plastic bag tax was another great idea by the previous Government and, along with the smoking ban, was a great success. It is great for a change to see England following our example instead of us following them and that is the way forward.

I am disappointed that yesterday's budget did not increase cigarette tax, which it should have done. We should do everything possible to deter people, especially young people, from smoking. The British Secretary of State for Health plans to increase the legal age for smoking from 16 to 18 years. I am not sure how it will be implemented, perhaps the same way the alcohol age limit is implemented. We should monitor that situation and if it works in England mirror it here. I am always bemused when I meet my ex-students who are now in secondary school and see them smoking and thinking they are cool, particularly girls. I have seen few boys smoking. For some reason secondary school female students think it is cool to smoke. Perhaps it is related to weight control and image. Unfortunately it leads to serious problems. A friend of mine who is in his 40s had throat cancer recently and I saw the devastating effect it had. Although he made a full recovery the treatment was very severe. We need to highlight the risks of smoking.

The Joint Committee on Health and Children has received correspondence from a recently formed alliance about the dangers of food and the link with cancer in later life. Manufacturers are disingenuous when they talk about the contents of food and do not give the consumer the full facts. Much education needs to take place in that area and we have a role as a Legislature to ensure that people are told the fat and salt content, etc., of products they buy. Many young children's lunches are loaded in the wrong way in terms of food content. If they start life on a bad note there is no doubt that they will end up with severe medical problems. Senator Glynn continually raises the issue of diabetes and obesity. There is a link with cancer and we need to play our part in that area.

We should look at raising the age limit for buying cigarettes from 16 to 18. The idea of banning packs of ten cigarettes was mentioned before. I do not know what stage that is at but it would be a concrete example of how we could eliminate the attractiveness of cigarette smoking for young people in particular, which would have an effect in the future.

While the Minister's speech contained much good news, and much good work is happening, there is confusion in the area of cancer services. Phrases he used in his speech say it all. The Minister mentioned funding to "continue the preparation for a national cervical screening programme". That is vague and contains no definite commitment. We recently received correspondence from the Irish Cancer Society pointing out that while a full-scale national programme for cervical cancer screening was promised nine years ago, the Government is no nearer to implementing it now than it was then. The number of cases is frightening. In 2000, there were 1,090 new cases of cervical pre-cancer, 193 cases of cervical cancer and 65 deaths from cervical cancer. Ireland still has no nationwide cervical cancer screening programme. The Irish Cancer Society points out that such a screening programme could reduce the number of cases and deaths from cervical cancer by up to 80%. Cancer can be treated and people can recover fully but that is not happening. An inconsistent approach is adopted in different parts of the country. In the mid-western region free cervical screening is available to 71,000 elderly women but it is not available in the rest of the country where women are forced to pay for the screening. That is unsatisfactory.

I am bemused by the number of announcements by Ministers over the past years that BreastCheck has been fully rolled out to the whole country and yet we discover today that almost half of women are not getting the service they should be getting. The Minister's speech states, "160,000 women in the 50-64 year age group in the eastern, midland, north-eastern and parts of the south-eastern areas", are entitled to a free breast check but then mentions that approximately 130,000 women are not availing of it. Almost half the women in the country entitled to be screened under the BreastCheck programme are not receiving the examination. The programme has been announced time and again by successive Ministers. I am confused that money is not a problem with the programme, but staffing is. I am encouraged to hear the Minister of State talk of increased staffing in his speech, but he might clarify the problem. Is the problem with cervical screening due to funding and is the problem with breast cancer screening caused by staffing? Surely these obstacles can be overcome.

I will discuss the issue of travelling for treatment. Many people from Carlow who develop cancer can travel to Dublin to receive treatment, as we are quite lucky to have a train service. Such a service is particularly important for patients undergoing cancer treatment, who may be incontinent or nauseous after treatment. Travel in a car or bus may not be suitable, and a train has toilet facilities and is therefore more comfortable. I sympathise with people from Donegal who have no train service and must go long distances for treatment. The announcement today of co-operation with Belfast hospitals will be well received by these people.

We should be aware of people in remote areas. For example, I am not sure what happens with people from west Cork, although I presume they go to Cork University Hospital for treatment. This is still quite a long distance on poor roads. Transport is a key aspect of cancer services of which we should be mindful. People may have to travel 100 miles for treatment, which may only last for five minutes, before returning home.

A private hospital being built in Carlow will have chalets around it. The idea is that people can have treatment and instead of being stuck in a hospital bed on their own and having too much time to think, which can be bad when one is ill, these people can bring their families with them and treat it as a type of holiday. They can have their short treatment and come back to be distracted in a good way by their family. I imagine if a person had to come to Dublin and stay in bed and breakfast accommodation alone for six or seven weeks while receiving treatment, it would be very lonely. This cannot be good for convalescence. People in Carlow are lucky enough that they can use the train every day and spend time with family. If a person is single or has no family, it would not be good to have to travel long distances.

What will the satellite centres mentioned by the Minister of State consist of? It is regrettable that the announcement made by the Tánaiste in July discusses the national network of radiation oncology services being put in place by 2011. That is almost six years away. These have been promised before, and I cannot understand the delay with these services, which are vital. Some 30% of Irish people will have some form of cancer in their life, and one would imagine the issue would get more priority. It is worrying that only 30% of Irish people who develop cancer receive radiography treatment. The normal global percentage is approximately 50%. This country has a high rate of people developing cancer, and not all those who develop the disease get the treatment they should be receiving. This impedes recovery and could contribute to a quicker death.

In Carlow and Waterford two private hospitals are being built. These may not initially provide radiography services, although such services may be included over time, along with more laboratories. Perhaps the Minister of State could expand on the plans for private hospitals around the country. Will these hospitals be allowed to develop their own services, perhaps in conjunction with major hospitals? This issue could be examined in tandem with my previous point of patients needing only a five-minute treatment rather than a process lasting an hour or more. It is a pity to force sick people to travel long distances when they are receiving a short treatment, especially when they may feel unwell afterwards. Outreach centres in the community, which could cut down travelling distances, should be facilitated.

Last night I browsed an American website with details of cancer facts and figures. The Government should take up this issue. The website has statistics on age-related cancer deaths, complete with the breakdown by ethnic groupings. Ireland is now a multicultural society, and similar information would be useful. The Government could work on developing a website providing all the information about cancer, and I compliment the Irish Cancer Society, which has an excellent website that provides people with such information. We must unearth statistics for cancer care, as some ethnic groups would have a higher rate of cancer than others, and age is also a significant factor. It would be useful if such information was given to the public, and we could then compare the information with that of other countries in an effort to improve services. The Irish Cancer Society has pointed out that if the national screening programme included cervical cancer, deaths could be reduced by 80%, which is startling.

In October 2003, the Government published the report on the development of radiation oncology services in Ireland. It recommended different radiotherapy services, and the Minister made further announcements in July. There is much confusion on the matter as we have heard many announcements in the past. We do not have any way to benchmark the services. The announcement that the services will be arriving so far in the future, such as 2011, makes it difficult for people to gauge the progress being made. I made a point earlier about 35% or 36% of cancer patients receiving radiation therapy at some stage in their illness, and 20% of new cancer cases receiving radiation therapy as part of the primary management of the disease. In Western countries, radiation therapy is part of the treatment for 50% to 60% of cancer patients.

The Tánaiste yesterday remarked to the Joint Committee on Health and Children that the treatment of cancer in Northern Ireland is better than here. Although this was a throw-away remark it is significant. She stated that care has been rationalised, featuring fewer surgeons and more concentration of services in a few units. This has led to improved cancer treatment and we should follow this example.

It is shocking that where one lives can have a significant impact on the chances of a person surviving cancer. As we live in a small country with a small population, this should not be the case. I visited Taiwan two weeks ago, which has 24 million people, and countries such as India and China have populations of over 1 billion people. In these countries which cover large areas one could understand such a correspondence between where a person lives and cancer survival rates. Ireland is a very developed and wealthy country. According to yesterday's budget, the coffers are quite full. In 2005 and 2006, where a person lives in Ireland should not dictate how quickly he or she recovers from cancer or if recovery actually happens. Facilities should be spread across the country on an even basis.

It is shocking that a quarter of all deaths in Ireland result from cancer. Another worrying trend is the prediction of a 41% increase in the number of cancers by 2015. This excludes non-melanoma skin cancer. A patient recently went to court to vindicate her right to essential life-saving hospital treatment and care. I hope we learn from that debacle.

The Tánaiste spoke of €400 million being used in the delivery of oncology services, mainly through public-private partnerships. I have concerns about the privatisation of the health service, although I am not a left-winger or a loony socialist.