Brendan Ryan (Labour)

Debates such as this can sometimes be wasted by Government bashing, of which I propose to do a little, because there is much more to the issue. I wish the Government had made greater advances in many areas, some of which I will mention. Although there is no point in failing to acknowledge progress, a number of questions arise. I am not trying to diminish the significance of advances in service provision but the interventions which make it less likely that people will develop cancer in the first instance are also extremely important.

Our grandchildren will look back and wonder how we ever allowed a society to evolve in which everybody was forced to breathe vast quantities of smoke generated by other people. Having experienced smoke-free public places here, I recently visited a restaurant in Britain where a wall of smoke suddenly hit me. I recall the Irish hospitality industry claiming that tourists would stay away because of the smoking ban, but the reverse is the case. As more countries see the sense of it, countries that do not have a smoking ban equivalent or identical to ours, will discover that tourists will stay away from them.

A prominent American medical journal — I do not mean a popular journal, but a peer-reviewed one — published figures showing that in a large US city where a smoking ban equivalent to ours was introduced, the incidence of heart attacks dropped by one third in 18 months. This has nothing to do with cancer, but we will discover that as we restrict the situations in which people are exposed against their wishes to demonstrably carcinogenic materials, there is a decline in the incidence of related maladies. It will probably be far more significant in saving lives than if we even had the world's best oncology service.

In dealing with such services, we should not forget that we can do many things in various areas that will reduce the incidence of cancer. One such step is to fund increasingly aggressive research into environmental factors, such as workplace and domestic exposure to various chemicals. The last time I checked the statistics, I found that approximately 60,000 chemicals were known to exist, although the figure has probably risen to 70,000 now. Of all of those, not more than 400 or 500 have been thoroughly assessed. All we can say about the remainder is that we do not know because we have not proven that they are harmful. I teach this subject, so what that means is that we do not yet know whether those chemicals are good or bad. Every carcinogenic substance has been identified simply by the fact that people got cancer from it. We still have no way of examining a chemical and forecasting its hazardous nature. Western society must investigate further the potential carcinogenic effects of many things that we may currently take for granted.

In 50 or 60 years, we will no longer be willing to be exposed casually to God knows what sort of chemicals. I say that as a chemical engineer with considerable pride in my profession. I am not a guilt-ridden chemical engineer, but the sort of practices that my profession insists upon in dealing with the chemical industry should be the same for people outside that profession. Nobody working in a modern pharmaceutical plant would tolerate the levels of exposure to chemicals that people take for granted in their private lives. For instance, most people had ammonia around their houses for years, but the level of exposure to ammonia that a chemical plant would tolerate is much lower than what would be acceptable domestically.

It is a pity that we have not created a situation — some people love to say "incentivised" — whereby people are not put off by the cost of checking for and dealing with excessively high levels of radon gas, which is a proven carcinogen. It would be much cheaper for the State to fund such investigations and the remedial measures, rather than waiting for some people to contract lung cancer and then face the enormous cost of treating a potentially, and tragically often, fatal tumour.

There are so many gaps in our provision of oncology services, most notably for those women living outside the privileged BreastCheck areas. There is a continuing failure and delay in rolling out that service. Senator White is right about the limited age range within which the BreastCheck service is provided. The current limited BreastCheck service needs to be extended around the country, but there is no point in pretending that it is adequate. As Senator White said, women over 64 years of age cannot access the service. The cut-off point at 65 is one of the things that most upsets Age Action Ireland.

There is increasing evidence of a real threat to a significant number of younger woman from breast cancer. The capacity of mammograms to identify tumours in younger women is a real issue. We must deal with these matters not on the basis of prioritisation, but in terms of whether or not they work. Mammograms work for older women, but I am not sure they are so successful for younger women.

It is depressing to think that so many women die from cervical cancer when there is such a straightforward way of identifying it in time at a pre-cancerous stage and thus saving so many lives through proper screening. It seems that cervical cancer is even easier to pre-diagnose than breast cancer. I am bothered by phrases such as "the Department of Health and Children is discussing options with the Health Service Executive about a national cervical cancer screening service". We have had several reports, but we should be moving beyond discussing options.

This is not a huge country. In many other countries, an area the size of Ireland would constitute a single health service region and what they would call a pilot study we would see as a national programme. We should accept that not everything here has to be done on a micro-scale, although it is a small country. It is potentially possible to roll out matters nationally because this is not a big country, but we do not have to do things that may be necessary in a country the size of the United States. For example, we do not have the huge geographical and climate variations of larger countries.

We need to be much more proactive with regard to prostate and testicular cancers. Prostate cancer is a long-standing issue that Senator Glynn has raised and I am glad he has done so. It needs to be addressed because it is a major threat to men's health. Testicular cancer is a problem for younger men in particular. It is an issue on which one will encounter giggling and discomfort, but young men need to be reminded that self examination is by far the best way of identifying testicular cancer at an early stage when it can be dealt with. I admire one young sportsman in particular, from my own county, who had the courage to say he had been diagnosed with testicular cancer. Hopefully his action will help to blow away the taboos surrounding testicular cancer. Although it kills young men, that cancer is eminently treatable if it is diagnosed in time. There is, however, a fear factor as well as a quasi-sexual factor related to machismo. Hard-hitting public information campaigns could help enormously in this respect.

Irish people are particularly susceptible to skin cancer. I have never fully figured out in terms of evolution and genetic mutations how we ended up being susceptible to it in our climate, but we cannot do much about that. The checking and treatment procedures for skin cancer need to be reiterated. It is difficult to get people to accept that skin cancer can kill, but it does. Among others, it killed Dr. Michael Smith, an eminent former Labour Party colleague of mine from north-west Cork.

Each of the cancers to which I have referred, requires a different national response. For example, I do not want to hear that we will have a pilot programme to educate men about testicular cancer. We are a small country so we can do it nationally and we should do it now. Genuine concerns need to be highlighted. It is a spooky fact — I do not wish to identify any of the people involved — but at one stage, of the 60 Members of this House, 54 of them men, three had partners being treated for breast cancer. Those are the sorts of figures that bring home to one just how extensive breast cancer is. Our mortality rates are still higher than those of other countries. I am glad to read in the Minister's script that they are going down, and I compliment the health services and the Government on that, although a good deal of it may be connected with such simple things as people stopping smoking. However, I am glad, although our mortality rates for those diagnosed with cancer are still unacceptably high by international standards, a theme to which I will return.

Regarding service provision, we must balance two things, the first being the undoubted fact that one cannot disperse every single oncology service to every single part of the country. One will not achieve an optimal service in that manner. The corollary is that if one says that certain people will have to travel long distances, one must incorporate travel into the service. One cannot have it as an addendum, as Senator Henry described. I found her comment hair-raising that one sees notices on a board in a radiotherapy unit asking whether anyone can provide a lift home to Sneem or wherever. That should not happen.

We can integrate services and make it no more difficult for a woman with breast cancer in Donegal than the time involved, but there should not be a great gap so that people worry about how they get there or back. If they are suffering from nausea, there is no reason not to have accommodation for them if they wish. I cannot accept that, since it does not constitute a service. As long as one has such hair-raising, heart-rending stories, one will have continual demands for the dispersal of services everywhere. I understand that the much-trailed provision of services in Belfast to people in Donegal is conditional on the availability of beds and not guaranteed. That is not adequate, and it is the sort of thing that gives people nightmares.

I want a technical answer to this question, which I am trying to depoliticise. The Government has taken a decision on private provision in the health service. We have been told that one needs a range of expertise to achieve optimum outcomes in service provision, including a minimum caseload. In the first instance, even in the best possible model, if one has two parallel services, dividing patients between them, one ends up with two small groups, therefore reducing the possibility of achieving the minimum caseload that we are told is necessary to guarantee a high level of expertise.

Second, one ends up with parallel services providing those ranges of expertise, one has people who spend half their time in one and half in the other, or, more likely, one has two parallel services, neither of which is complete. That is a characteristic of countries such as the US, where one has many hospitals trying to provide all the services and competing against each other. The upshot is that the US spends 15% of its GDP on an inadequate health service. It has a lower life expectancy than most European countries and a higher level of infant mortality.

I appreciate the Acting Chairman's indulgence. When we plan for the provision of a new health service by a consultant oncologist, let us incorporate non-consultant hospital doctors, nursing and secretarial services so that the expertise and time of the consultant oncologist go on treating people with cancer and not on paperwork, diary-keeping, appointment-making or telephone-answering. It is a terrible waste of high-level expertise if one does not plan such a service as a unit and integrate it with the various back-up services.