Phil Prendergast (Labour)

I wish to share time with Senator Norris, by agreement. I thank the Minister for coming to the Chamber where I see her frequently.

What is the current investment in cancer control services? In response to a parliamentary question last year, the Minister said that an additional €20.5 million had been identified to implement the new cancer strategy. How much in total has been spent to date on that strategy and how was that broken down between administration and frontline services? When will the BreastCheck roll-out be completed? How many additional radiographers are employed to provide the service and are there enough of them? If not this may be a factor in the delay. Is there a blueprint and who are the advisers on this roll-out?

Are the 23 oncologists working here sufficient to provide the service required? I suspect we need three times that number but am open to correction. There are 140 general surgeons who provide an excellent service dealing with the many cancers they encounter, from diagnosis to treatment and management. Without wishing to be too parochial, will Mr. Courtney, an expert in gastroenterology in Kilkenny be required to travel to Waterford to operate on a patient from Kilkenny? Will surgeons who are experts in their fields spend time travelling between their local hospitals and others to provide a service to their patients in a theatre in another hospital at great inconvenience to many? It is no joke to travel home after having any of the interventions needed to deal with the complex problem of cancer.

Over 80% of cancers are treated surgically. For 2,700 cancers diagnosed and treated there were 14,000 episodes and clinical encounters. Where will these encounters, such as outpatient appointments, tests, scans, radiological, GP and ancillary services occur?

What percentage of the €12 billion budget is pay? Are there plans to introduce an immunisation programme with the cervical cancer vaccine which has proved effective and is produced in my region? I am pleased that the vaccine is available but we should have access to it. Could this be costed and a timeframe identified for when it might be implemented?

If cancer is the vehicle this week for centralising hospital services, will obstetrics and gynaecology be next? While rationalisation and specialisation are welcome, decentralisation of specialist services may not provide the best outcomes. Can all the proposals in the national cancer control strategy be achieved and be budget-neutral and if so, how? I look forward to seeing how Professor Tom Keane, the radiation oncologist, progresses in restructuring the provision of services and I await the Minister's reply to issues raised. Who will audit this process?

Some 2,000 breast cancer cases are managed surgically in the country's public hospital system but the BreastCheck screening programme will reduce the number of symptomatic presentations by between 33% and 50%. The programme is limited to women between 50 and 65 years of age but breast cancer does not stop at 65. Despite the fact that BreastCheck is still being rolled out it should be extended to women over 65 because around 67% of cancers occur in such women. It is not proper that there should be inequalities in access to services and it is not right that women of a certain age should be denied this vital service. I welcome the many positive aspects of this strategy and the initiatives that are to be taken but I foresee great difficulties.

Some 90% of testicular cancer cases are treatable yet it seems there is a need for four testicular cancer centres, one in each network. I am not complaining about this but colorectal cancer, for example, is very common and will also be treated in only four centres. How were the criteria relating to the number of centres treating different forms of cancer reached?

I realise I have asked many questions in my short presentation and I am very pleased the Minister is here. I await her reply with interest.