Tim O'Malley (Limerick East, Progressive Democrats)

I have listened carefully to the views of Senators who have contributed to a good debate and I am pleased to have the opportunity to describe the substantial developments which have taken place in recent years in all of the main elements of a comprehensive cancer policy. Specifically, I propose to outline the substantial investment that has supported cancer services throughout the country; the progress to date on achieving the target of next year for commencement of the roll-out of BreastCheck nationally; the increased investment in the cervical screening programme and the recent decision of the Tánaiste and Minister for Health and Children to ask the HSE to prepare for national roll-out; the significant developments in oncology cytogenetic services and in laboratory and clinical genetic services for families at risk of hereditary cancer; and the unprecedented investment in radiation oncology services under the Government's national plan for radiation oncology services.

Improving cancer care is a major priority of this Government and there is broad recognition among health service providers of the significant changes that have taken place in recent years in oncology services. The key goal of the 1996 national cancer strategy was to achieve a 15% decrease in mortality from cancer in the under 65 age group in the ten-year period from 1994. An evaluation of the 1996 national cancer strategy demonstrated that this figure was achieved in 2001, which was three years ahead of target.

There is no doubt that cancer is a major challenge to our health services. It is a major cause of morbidity in Ireland, with 20,000 people diagnosed each year. There was little change in the number of cancer deaths between 1994 and 2001. The true risk of dying from cancer before age 75 — allowing for the effects of population change and aging — is decreasing by approximately 0.6% for women and 0.1% per year for men. Breast cancer remains the main cause of death for women but is decreasing in frequency.

Between 1991 and 1994, the five-year relative survival rate for women with all cancers was 47% in Ireland and 52% in Europe. The current five year survival rate for Ireland is 73% which is 4% below the EU average for breast cancer so we are not doing too badly but as all speakers have said, we must continue to progress.

Effectively, tackling the problem of cancer means providing specialist services of a consistently high quality with sufficient capacity as well as appropriate support services for patients, their carers and their families. This Government's focus is on ensuring there is access to services which deliver this experience for each person diagnosed with cancer. To this end, we have invested over €900 million in the development of cancer services since 1997. We have seen the appointment of over 100 additional consultants across the modalities of care. This investment has been reflected in the substantial increase in the level of activity, with the number of discharges from public hospitals with a diagnosis of cancer rising from 58,507 in 1998 to 92,508 in 2004 and the number of day cases in the same period increasing by 106%.

Population-based screening programmes for breast and cervical cancers have been proven to reduce mortality, with subsequent improvements in population health in terms of survival, morbidity and quality of life. The Tánaiste and Minister for Health and Children has publicly expressed her commitment to the extension of both programmes nationally.

BreastCheck, the national breast screening programme, is available to approximately 160,000 women in the 50 to 64 age group in the eastern, north-eastern, south-eastern and midland regions. Screening is offered free of charge to eligible women in these regions. Since the commencement of the screening programme in 2000, approximately €73 million cumulative funding has been provided to support it. Approximately 245,000 screening visits have taken place, a significant endorsement of the programme.

There are approximately 130,000 women in the target age group in the remaining regions. The Tánaiste recently met with representatives of BreastCheck and they are fully aware of her wish to have the programme rolled out nationally as quickly as possible.

Capital funding of €21 million for the development of the necessary infrastructure has been approved. The national rollout of the programme required detailed planning for the development of essential infrastructure to provide for two clinical units, one at the South Infirmary-Victoria Hospital in Cork and the other at University College Hospital, Galway. This detailed planning involved considerable work by BreastCheck, University College Hospital, Galway, the South Infirmary-Victoria Hospital, Cork, and the Department of Health and Children. Planning permission for both units has been granted and BreastCheck is now inviting tenders for construction.

BreastCheck requires highly-skilled specialists working together to ensure best outcomes for patients. A key requirement and dependency for the national rollout of the programme is the recruitment of a wide range of specialist staff. The largest single requirement in terms of staff numbers is for specially-trained radiographers who will provide screening services, both at the static centres and at mobile clinics. BreastCheck interviewed for lead consultant radiologists and radiographers in 2005 for the two new units and the recruitment of these and other key clinical staff is continuing. While the exact date of rollout will depend on the availability of adequately trained staff, BreastCheck is confident that the target date of next year for commencement of the national rollout will be met.

The majority of women diagnosed with breast cancer will be diagnosed and treated outside of the BreastCheck programme. It is necessary, therefore, that we support both the symptomatic breast disease services and the screening services to ensure that comprehensive breast cancer services are available for all women. Breast cancer is the individual site-specific cancer which has received the most investment in recent years and more than €60 million has been made available for development of symptomatic services since 2000. The benefit of this investment is reflected in the significant increase in activity which has occurred with inpatient breast cancer procedures increasing from 1,386 cases in 1997 to 1,812 in 2003, an increase of over 30%.

The Tánaiste recently requested the Health Service Executive to prepare a detailed implementation plan for a national rollout of the cervical screening programme via effective governance structures that provide overall leadership and direction in terms of quality assurance, accountability and value for money. A pilot cervical screening programme commenced in the mid-west region in 2000. Under the programme, cervical screening is being offered, free of charge, to approximately 74,000 women in counties Limerick, Clare and north Tipperary.

The national rollout of the cervical screening programme is a major undertaking with significant logistical and resource implications. The Tánaiste has specifically requested that the general practitioner elements of a national cervical screening programme be tabled at the review of the contractual arrangements for the provision by general practitioners of publicly-funded primary care services being conducted at present under the auspices of the Labour Relations Commission. Any remuneration arrangements agreed must be capable of delivering a high uptake among women and payments must be primarily based on reaching acceptable targets.

The Tánaiste is convinced that we must also have in place tailored initiatives to encourage take up among disadvantaged and difficult to reach groups. She wishes to see the programme rolled out as quickly as possible but only when the essential infrastructure, organisation and services are in place that are quality assured and meet international standards.

Outside the programme, many women present for opportunistic smear tests and the number of these tests has increased substantially in recent years. Overall, in the region of 230,000 smear tests are carried out in laboratories throughout the country each year. To meet this increased demand, additional cumulative funding of approximately €14.5 million has been provided by the Department of Health and Children since 2002 to enhance laboratory and colposcopy services. This funding has enabled the laboratories to employ additional personnel and to purchase new equipment, thereby increasing the volume of activity. These initiatives have resulted in a reduction in the waiting times for smear test results.

Additional revenue funding of €1.1 million was allocated to the programme on an ongoing basis to support the introduction of liquid-based technology in laboratories where the technology is not available and to support the development of quality assurance and training programmes. The introduction of this technology will result in fewer unsatisfactory slides that require women to return for repeat smears. It substantially improves throughput in the laboratories.

Senators referred to the failure to introduce a national colorectal screening programme. National population-based screening programmes for cancers are considered where clear evidence exists of benefit to the health of the whole population to be screened. There is evidence in some specific cancers which shows that population-based screening can improve population health in terms of survival, morbidity and quality of life. As part of the National Cancer Forum's work in preparing a new national cancer control strategy, the forum developed a framework for evidence-based decision making on the introduction of population-based screening programmes, including colorectal screening.

In July 2005, the Tánaiste announced the Government's approval for a national network for radiation oncology services to be put in place by 2011, commencing in 2008. The Department is working closely with the HSE in implementing this national plan and the Tánaiste has asked the HSE and the National Development Finance Agency, as a matter of priority, to develop and progress public private partnership arrangements to design, build, finance, maintain and partially operate the proposed services. The plan consists of four large radiation oncology centres in Dublin, Cork and Galway and two integrated satellite radiation oncology units in Limerick Regional Hospital and Waterford Regional Hospital, conditional on their conforming to certain quality assurance arrangements.

The Tánaiste has agreed with the Minister for Health for Northern Ireland, Mr. Shaun Woodward, that the new Belfast cancer centre, which is due to open this month, will treat patients from Donegal. Details of the arrangements for access for patients in Donegal to Belfast City Hospital will be developed as a matter of priority at the request of both Departments. For this purpose, an assessment of the specific radiotherapy needs of cancer patients in Donegal is being developed by the HSE at present. These developments will result in a significant increase in the numbers of patients receiving radiation oncology treatment throughout the country over the coming years.

The National Centre for Medical Genetics is located at Our Lady's children's hospital, Crumlin, and currently runs clinics in Dublin, Cork and Galway for familial cancer. The unit has received funding in excess of €2.3 million over the past number of years to extend the oncology cytogenetic service nationwide and to provide laboratory and clinical genetics services for families at risk of hereditary cancer.

Four cytogenetic staff were appointed in 2004 to take on the additional workload to provide a national service and since mid-2005 the centre has taken samples for oncology cytogenetic analysis from the whole country. There has been a resultant doubling in sample numbers to about 1,700 samples annually and there is now a staff of nine in the oncology cytogenetic section, headed by a principal clinical cytogeneticist.

In 2005, the National Centre for Medical Genetics appointed five laboratory staff for the laboratory and clinical genetics services for families at risk of hereditary cancer. Two genetics counsellor posts were also filled; the first person is in place and the second is due to start this June. The additional genetic counsellor post has reduced the clinic waiting time significantly and the aim is to reduce it further by the end of 2006. Families are seen in clinics in Dublin, Cork and Galway. In 2005, the number of patients seen for clinical suspicion of hereditary cancer doubled in comparison with 2004, there was a growth of 30% in laboratory activity for molecular cancer genetics and a growth of 86% in laboratory activity for oncology cytogenetics.

In January of this year, the National Cancer Forum submitted a new national strategy for cancer control to the Tánaiste. The forum consulted widely on the strategy during 2005 and received significant endorsement and support for its recommendations. The strategy makes recommendations on organisation, governance, quality assurance and accreditation across the continuum of cancer care from prevention and health promotion through ten treatment services, palliative care and research. There is a strong emphasis in the strategy on health promotion, addressing inequalities and quality assurance. It is a policy document which aims to take Ireland up the international league table in terms of cancer control. The Tánaiste is examining this strategy prior to bringing it to Government and it will be published shortly.

The developments in cancer services I have outlined are a clear indication of the considerable progress which has been made in addressing the burden of cancer. These developments reflect the priority given to cancer care by the Government. It is, therefore, appropriate that the House should commend the Government on its positive and demonstrable commitment to cancer services, especially cancer affecting women.