Kathleen O'Meara (Labour)

I will speak briefly on this important debate. I acknowledge that much has been done in respect of both the delivery of cancer services and in preventive care. It has already been observed that in the future, the smoking ban will be regarded as having been one of the most significant moves we could have actively taken in respect of a public health issue. While the campaign for the smoking ban was in full swing, I came across some figures which revealed the extent to which St. James's Hospital in Dublin was occupied by people suffering from smoking-related illnesses.

While the cost to the public purse is one matter, another issue concerns the extent of mortality arising from smoking, which is clearly preventable. In addition, we are now aware that some cancers may be linked to lifestyle issues and we have much more to do in terms of encouraging people to be more active, to consider what and how they eat and to look at their lifestyles generally as far as the incidence of cancer is concerned.

The second point I wish to discuss is the question of BreastCheck. It is the major reason I have chosen to speak in this debate. Recently, at my invitation, the chief executive of BreastCheck, Tony O'Brien, spoke in Nenagh to a group of women who came together — as similar groups have done elsewhere — to campaign and agitate for the rolling out of BreastCheck in our area. While people discuss this issue in respect of the west and the north, they may not be aware that the western region includes north Tipperary.

North Tipperary will be served by the Galway unit of the breast screening programme. I have always stated that it is an excellent, high-quality programme, which is why we want it extended to cover all areas. The delays in the roll out of BreastCheck have been scandalous. The will to have BreastCheck rolled out simply did not exist when it was needed. While it could be available now, in 2005, instead we are obliged to wait until 2007 at the earliest. As Mr. O'Brien spoke in Nenagh, it became clear to me that the programme's roll out will hopefully begin in 2007 in the western region. However, it will be rolled out over a period of two years. Hence, it will begin somewhere in the western region in 2007 and will continue until 2009. Therefore, north Tipperary may not be reached until 2009. That is the reality, even if the current best estimates and targets are met.

There are 45 undetected cancers in north Tipperary as we speak, based on screening figures from elsewhere in the country, for the population group consisting of 45 to 64 year olds. Hence, 45 women in north Tipperary are unaware that they have cancer and may not know for a number of years. This is the consequence of the delay in rolling out the screening programme. While I have no doubt that it will be magnificent when rolled out, as the standards of delivery elsewhere have been excellent, this is the reality we face.

The third point I wish to make is in respect of the current delivery of services. Clearly the issue of distance from a centre is highly significant. On occasion, although recently not as frequently as I would wish, I use the train to travel to Dublin. One meets an extraordinary number of people who travel to Dublin for cancer treatment on a day return basis. That is better, as other Members have noted, than being obliged to drive from northern Donegal or from Sneem in County Kerry to Dublin. Hence, it is extremely important that the delivery of cancer services be made accessible. It should be brought to people, rather than making it virtually impossible for people to access it.

My final point pertains to a subject raised by other Members, namely, the issue of public versus private health care. We are now witnessing the division between public and private care. I have considered the delivery of private care carefully and I believe we should be extremely careful in this respect. I do not support it for a number of reasons. One such reason is that it is extremely bad value for public money. Public money will leak into the private system, as it already does. However, one will not get good value from it, as private hospitals only deliver a narrow range of services. They do not contain accident and emergency units. For example, I was informed by a senior official from what was the Mid-Western Health Board region, now the HSE region for the mid-west, that the answer to the bed capacity problem in Limerick Regional Hospital was the building of a private hospital. However, a private hospital will take a minimal number of patients and will only accept those patients who are easily managed. If, for example, a person is coming out of a private hospital and slips and breaks his knee or leg, the private hospital will be unable to treat him. He will have to be brought by public ambulance to the public hospital which, of course, will have fewer resources allocated to it because of the existence of the private hospital.

This policy makes no sense. It is the worst possible policy decision to create a parallel private hospital system which is profit driven, not health driven. They are effectively hotels, not hospitals. When we look back on this we will see it as a great waste of public money. It will not deliver a quality health service and is a really bad idea.