Seanad debates
Thursday, 17 October 2002
Adjournment Matters. - Cancer Screening Services.
10:30 am
Noel Coonan (Fine Gael)
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I welcome the Minister of State to the House and congratulate him on his appointment. I am pleased he has come to the House to outline the reasons that the national breast screening programme is currently unavailable to women in the Mid-Western Health Board region and other areas. Following the publication of a report on the development of services for symptomatic breast disease, in March 2000, the Mid-Western Health Board established a symptomatic breast clinic in December 2000. At the same meeting the board requested BreastCheck and the Department of Health and Children to set up a breast screening service simultaneously with the symptomatic clinic. That has not happened. I ask why the board is still awaiting a decision from the Department regarding the roll-out of the national screening programme and when it will happen.
I note that for administrative purposes the chosen centres are in Cork and Galway and I ask why Limerick has been overlooked. Failure to roll out the national scheme means that a large area of the mid-west, including my own area of Tipperary North, has no service. The mammography machine which was purchased some 12 years ago by the Irish Countrywomen's Association and the Friends of Nenagh Hospital, at no expense to the Government, is now defunct. It has outlived its usefulness and is no longer safe to use.
The women of that area have no service. That is putting unbearable pressure on people who must travel to out centres like Cork, Limerick or Dublin. The Minister of State might not realise it but parts of north Tipperary are 60 miles from Limerick. Further pressure is put on them because they must seek child care facilities, take time off work and travel but, above all, they have to queue and wait a long time, often six months or more, before they can have a mammograph. This is unacceptable.
Recently, the director of cancer services for the mid-west region stated that health services in the mid-west are 20 years behind the times. That is a damning indictment of this and the previous Government which allowed such a situation to develop. The Minister of State may say extra money has been invested in the health services and I accept that, but the service is not being delivered to the people when and where it is needed.
In this the month of breast cancer awareness, the advertising campaign which has been launched is false and misleading in that it urges women to avail of a service which is not being provided. I have been reliably informed today that those advertisements are being withdrawn. I urge the Minister of State to take action without further delay, to stop ignoring the people of the mid-west and provide them with the medical service deserve and to which they are entitled.
Ivor Callely (Dublin North Central, Fianna Fail)
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I congratulate Senator Coonan and wish him success in the Upper House. I thank the Senator for raising this matter on the Adjournment and for giving me an opportunity to set out the position in relation to the development of breast cancer services generally and in the Mid-Western Health Board area. It is an issue I raised on many occasions in the past when we had no services whatsoever in place.
I am pleased the National Breast Screening Programme was established in 1998 with the aim of reducing mortality from breast cancer by 20% by screening women in the age group of 50 to 64 years of age. BreastCheck commenced screening in March 2000 with phase one of the programme covering the area of the Eastern Regional Health Authority, in which I was happy to be involved as I was chairman of the ERHA, the Midland Health Board and the North Eastern Health Board areas. The decision to proceed on a phased basis is a reflection of the complexities involved in the screening process and it is essential that the programme is driven by international quality assurance criteria and best practice with which, I presume, everybody agrees. The experience gained in phase one will facilitate the process of planning and organising the roll-out of the programme nationwide.
To end of August 2002, almost 92,000 women had been called for screening and over 68,000 women have been screened representing an uptake of 74%. I understand BreastCheck is on target to complete phase one of the programme by December 2002. I take this opportunity to congratulate all those involved in phase one and in the success of the programme, including those involved in the administration and the practice and those who participated.
My Department's commitment to BreastCheck is evidenced by significant funding which has been provided for the programme. This year additional funding of €1.5 million was provided to BreastCheck for the continued development of the programme, bringing the total allocation to €8.7 million. In addition, the Minister has allocated approximately €6 million for the construction of a new state-of-the-art screening unit at St. Vincent's Hospital and work is expected to commence shortly.
The Minister, the Department and I are fully committed to the development of quality services to achieve best health outcomes. In relation to the development of cancer services generally, this commitment can be seen in the level of funding provided. Since 1997 over €103 million has been invested in the development of services – well in excess of the £25 million initially envisaged in the cancer strategy. Prior to that, there was no such investment by successive Governments. This is a tremendous new development with real commitment, a strategy in place and the appropriate funding being made available.
This investment has enabled the funding of 76 additional consultant posts. This includes approval for nine new consultant posts with a special interest in breast disease. This investment is a major element of the implementation of the recommendations of the report of the subgroup on the development of services for symptomatic breast disease. Professor Niall O'Higgins was the principal architect of this report and he is also a member of the board of BreastCheck. The Minister has invested considerably in this programme for the provision of services for symptomatic breast disease in recent years and further investment is required.
I realise that while much has been achieved in recent years in relation to the development of the health services, there is still much to be done. In recognition of the need to further develop cancer services, the national health strategy has identified the need for the preparation by end of 2002 of a revised implementation plan for the national cancer strategy.
The National Cancer Strategy 2003-10 is currently being prepared by the National Cancer Forum under the chairmanship of Professor Paul Redmond of Cork University Hospital in conjunction with my Department. The new strategy will set out the key areas to be targeted for the development of cancer services over the next seven years. This will have regard to existing policies in the areas of symptomatic breast disease and palliative care and the forthcoming recommendations of the Expert Group on Radiotherapy Services.
The board of BreastCheck has submitted a business plan for the national expansion of BreastCheck to the remaining counties, including the mid-western region, which Senator Coonan will be pleased to note. The total cost of the extension, as calculated by BreastCheck, is approximately €27 million, including capital costs estimated to be in excess of €13 million. The annual cost of the current programme is €8.7 million.
The Department of Health and Children is in discussions with the executive of BreastCheck in relation to the expansion and especially the linkages with the existing symptomatic services. I am committed to the national expansion of BreastCheck and a decision in relation to this issue will be considered in the context of the overall investment programme in cancer services for 2003.
As regards breast cancer services generally, the Mid-Western Health Board formally adopted a report on the development of symptomatic breast disease services for the region on 8 December 2000. The Mid-Western Health Board has agreed to develop its symptomatic service at Limerick Regional Hospital. The breast clinic at Limerick Regional Hospital opened in October 1998. Referral to the clinic allows rapid access to a consultant surgeon, mammography and rapid processing of results. A weekly multi-disciplinary meeting commenced in June 2001 and is attended by all relevant members of the team. Two breast care nurses have been appointed to Limerick Regional Hospital.
Out patient clinics for the assessment of patients with symptomatic breast disease are available at Ennis General Hospital, Naas General Hospital and St. John's Hospital as part of general surgical clinics. Mammography is currently available at Ennis, Nenagh and the Mid-Western Regional Hospital. Surgery is currently undertaken at all sites. Any woman, irrespective of her age or residence, who has immediate concerns or symptoms should contact her GP who, where appropriate, will refer her to the symptomatic service in her area.
Noel Coonan (Fine Gael)
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Mammography is not available in Nenagh.
Noel Coonan (Fine Gael)
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The Minister said that mammography services are currently available at Ennis, Nenagh and the Mid-Western Regional Hospital, but they are not available at Nenagh General Hospital. Perhaps the Minister, through his Department, could ensure that mammography services are made available at the hospital.
Ivor Callely (Dublin North Central, Fianna Fail)
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I understand from the information available to me that mammography services are available at Ennis, Nenagh and the Mid-Western Regional Hospital. I will bring this to the attention of the Department and I will have somebody make contact with the Senator later today or early tomorrow to clarify the situation.