Fergal Browne (Fine Gael)

I welcome the Minister of State to the House. His speech was good but it reminded me of someone about to paint a room, it filled a lot of cracks.

The opening paragraph of the report states that 20,000 Irish people develop cancer every year and 7,500 die from the disease. One in four people will die from cancer and 60% of cancer patients die within five years of diagnosis. Cancer incidence appears to be falling but because we are aging and living longer, the chances of developing the disease are expected to increase. The number of new cases by 2020 will have increased by almost 107% of the number dealt with in 2007. There are now 120,000 cancer survivors. Such figures are startling and give an outline of the work ahead for any future Government in the area.

Much work is being done. Fine Gael welcomes the report and acknowledges the huge amount of work put into it by those involved. We are concerned, however, that a person's address can have a major impact on his or her treatment and survival rate. That should not be the case for a small country. We are told every day that we are one of the richest countries in the world but this stark fact confronts us.

We welcome the national cancer strategy but are disappointed that the Tánaiste did not publish an implementation plan outlining where cancer services will be located, the funding that will be given to the strategy and the timeframe for implementation, although the HSE is due to announce such a plan in seven weeks. We admire the research and work the National Cancer Forum put into the strategy and we hope its work is not let down by the Government, which has not yet published its policy.

The Government's record is worrying. In 2001, the national health strategy promised a revised implementation plan for the 1996 national cancer strategy by the end of 2002. Here we are four years later and the Government is late publishing the strategy, never mind implementing it. The HSE will be obviously responsible for implementing the strategy and will devise an action plan within the next few weeks. It will decide which hospitals retain services and will appoint a national director to oversee implementation of the plan. Cancer care will be delivered at eight centres across the State, in four regional networks each serving a population of approximately 1 million. The Government has launched the strategy, yet has not told us where these cancer centres will be based or what areas will be covered by the four networks. If the Minister had done so, perhaps the strategy would have had more credence.

The Minister of State in his speech spoke about key areas, which to my mind are the easy topics. Immediate action was taken on sun beds, for example. While the Minister of State also mentioned tobacco control, as far as I recall in the two most recent budgets the Government did not increase VAT or excise duty on tobacco, which seems to send out the wrong signal. While the Minister of State stated in his speech that the Tánaiste would consult with the Minister for Finance on this issue in the run-up to the next budget which indicates there will be an increase in tax, we must do everything in our power to deter people from smoking. Certainly, it is quite worrying to see young women smoking now. Whereas it does not seem to be as big a problem among young men, for some reason young women seem to think it is fashionable and "cool" to smoke when the opposite is the case.

As I stated earlier, there is a significant variation in the level of service meted out around the country. For example, Professor Paul Redmond, who is chairman of the National Cancer Forum, told us that there are major variations in treatment of cancer between the regions; there is inconsistency in treatment of cancers at the same stage; there are major variations in survival rates between the regions in Ireland; and our pattern of care and survival are generally poorer than those of the other EU countries.

Prostate cancer is the most common cancer, after skin cancer, among men in the Republic yet there is no mention of a national screening programme for prostate cancer in this strategy. I accept that the best international medical advice is that there should not be one, although I am totally baffled by it. In every debate on health, Senators, in particular Senator Glynn, correctly point out that we should be doing everything in our power to encourage citizens, in particular men, to get regular health screenings. I cannot understand why one cannot get one's blood tested for PSA. I availed of such a test myself recently in the Houses under a health screening programme. My father had prostate cancer and my uncle died from it. Lately, the former Taoiseach, Charles J. Haughey, died from prostate cancer and the cancer was much publicised as a result. I do not understand why we cannot put in place a scheme that would raise awareness of prostate cancer or even an advertising campaign to encourage men to go to their doctor to be tested. I am totally baffled by this. I accept that the Department is being told it is not best international practice, but Ireland could take a lead on this. If the Department does not implement a strategy on it, perhaps they should at least undertake an aggressive advertising campaign or take some initiative on the issue.

Despite nine years of reports and promises, a nationwide free cervical screening programme has not yet been rolled out. Only 30% to 40% of the population is being screened opportunistically and only 9% of the population is covered by the pilot national cervical screening programme, whereas a screening programme would cover between 80% and 90% of the population. Approximately 150,000 smear tests are being done each year and this number could double under a screening programme. It is worth noting that such a programme would only cost an additional €10 million, which is a drop in the ocean. A while ago when the PPARS system failure came to light the Minister for Communications, Marine and Natural Resources described €150 million as a small amount of money. It is a pity that for want of such a small amount of money the Department cannot implement a full national screening programme for cervical cancer. The Minister of State, Deputy Tim O'Malley, in his speech accepted that there are considerable economic and social implications for the family of a person dying from cancer.

The number of women diagnosed with breast cancer has increased by 25% since 1994 and a comprehensive national screening programme is still not available to facilitate prevention and early detection. Next year Fianna Fáil and the Progressive Democrats will have been in power for almost ten years but there is still no nationwide breast cancer screening programme. It is six years since phase 1 of the service commenced in the eastern region and five years since publication of the national health strategy, which promised that breast and cervical cancer screening would be extended nationwide. In the intervening period there has been a litany of announcements that have come to nothing and women must wait until 2007 or 2008, according to the latest announcement. It is particularly upsetting for people in the south and west who were led to believe in 2003 that a service would be rolled out nationally in 2005.

I was shocked to learn lately that in 2008, women in Northern Ireland will be celebrating 15 years of breast cancer screening and a reduction of one fifth in deaths from the disease. By that time in the Republic of Ireland hundreds of women will have lost their battle with breast cancer and hundreds more will have endured devastating radical surgery. I accept that much good work has been done but, on behalf of the Opposition and of many people in Ireland, I must express frustration that the national screening programmes have not been rolled out as promised and ask why this is so.

The Minister of State spoke about the radiation unit for Waterford Regional Hospital and I hope that will be announced in six or seven weeks time. It is vital that the south east would have a centre in which people could receive radiation therapy as part of their cancer treatment. On the last occasion the Minister of State was in the Seanad, he raised the issue of people in Donegal receiving radiotherapy services in Belfast. I was not familiar with the case and thought that was quite good news until I checked it out. What appears to be happening is far different from the picture he painted on that occasion. I noted he referred to it in his speech again today. Although I am open to correction, the service is only available to people in Donegal if there are treatment spaces available which is not as satisfactory as we would wish. Senator McHugh spoke on the matter on the day in question. The Minister of State, in his concluding comments, might outline exactly what is the position on the treatment of people in Donegal through the services in Belfast.

While I have no difficulty with the report, it is a question of implementation and setting deadlines. I hope that the Tánaiste and Minister for Health and Children, in conjunction with the HSE when it announces the next phase of centres in eight weeks time, will clearly indicate achievable targets. It should not be the case in 2006 that where one lives could have a major impact on one's survival rate and treatment rate.