Tuesday, 12 November 2002
Adjournment Matters. - Hospital Services.
About 12 years ago a number of formidable ladies in an ICA guild – the Leader of the House will know the type of person I mean – formed a group to fund raise for the establishment of a mammography service in Nenagh General Hospital. One of the group's members had developed breast cancer and, arising from their concern about this issue, the group started its fund raising campaign. As a result of the successful campaign a group called the Friends of Nenagh Hospital was established. This group is still in existence. It is a powerful lobby group on behalf of the hospital and has worked extremely hard to ensure that equipment is kept updated and that the staff and infrastructure of the hospital are supported. The group has been most successful in this.
It was a matter of grave concern and huge disappointment to learn about eight weeks ago that the mammograph machine had come to the end of its natural life but that the Mid-Western Health Board had no intention of replacing it. Eighteen months ago the same series of events occurred in Ennis General Hospital. The mammograph machine there had come to the end of its life but the health board took the view that it should be replaced. The decision regarding Nenagh General Hospital, however, was negative. No consultation took place with the local community or the Friends of Nenagh Hospital. The news was released via the local media. This happened at about the beginning of October.
Being a public representative and a woman, I received a huge number of calls, letters and personal representations about it. As a result I organised a public meeting which was held about four weeks ago. There was a huge attendance, about 98% of whom were women. That reflects the major concern in the community about not only the loss of the service but also the fact that there is no interim service to replace it.
Until about a year ago Nenagh General Hospital provided a fine breast and smear clinic. It was run within the hospital and was available to anybody who sought it. The mammograph machine was an important element of the service. The smear clinic was replaced by the national screening programme. It is a good programme although I do not approve of some elements of it. The screening programme has been implemented nationwide and is being provided through general practitioners. Hopefully, it will be an effective service.
The BreastCheck programme is not available in the Mid-Western Health Board area. I have been in contact with the BreastCheck service and have been told that from the date the service receives funding, it will take a further two years for the roll out of the service to reach north Tipperary. There is a minimum wait, therefore, of two years for a breast screening service.
North Tipperary has no breast screening service at present. This is an issue of great concern to many women. Yesterday a petition was launched to seek a restoration of the breast screening service in Nenagh hospital. It is extremely important that there be an interim arrangement based in Nenagh until the national programme is implemented.
The Minister of State will probably refer to the centre of excellence based in Limerick Regional Hospital. We welcome that development but it is not yet a centre of excellence and it will not be until it is given full funding. There are concerns about the availability of funding, particularly in the coming year or so. We do not, therefore, have a centre of excellence and there is no screening service. It should not be too much to ask that an interim arrangement be established in Nenagh General Hospital to provide a service to women in the north Tipperary area.
I have seen a number of letters on this matter which were brought to me by women in the area. One woman showed me a letter in which her GP had asked, on her behalf, for a mammograph in Limerick. The reply said she was not to get a mammograph because she did not display any signs or symptoms. She is hugely upset by the letter, as any woman would be. It is unacceptable.
The experts tell us that requests for mammographs in Limerick are being screened, in other words, the letters being sent to Limerick are being sifted and decisions are made on them. That is unacceptable. This is happening against a background of high public awareness about breast cancer, as there should be, and a high level of public attention to the issue. There is also a high level of public concern and disquiet, particularly in north Tipperary, that the health needs of women are not being met by the service.
I appeal to the Minister to ensure that some type of interim arrangement is put in place. I will be part of a delegation which will go to the December meeting of the Mid-Western Health Board. This is the argument we will make. We will also put forward more points which I do not have the time to put forward now. We will not stand idly by and allow this situation to continue. It is not acceptable. Women's health is in danger and there is much public disquiet about it. I ask for a positive response.
I thank the Senator for raising this matter on the Adjournment and for giving me this opportunity to set out the current position in relation to the development of breast cancer services generally and in the Mid-Western Health Board in particular. I also thank the Senator for outlining the background to this matter.
The national breast screening programme was established only as late as 1998, under the last Fianna Fáil led Administration, 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 Eastern Regional Health Authority, 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. It is essential that the programme be driven by international quality assurance criteria and best practice.
Successive Governments had the opportunity to put in place some type of breast screening programme but failed to do so. It only commenced, therefore, in March 2000 on a phased basis. The experience gained in phase one will facilitate the process of planning and organising the roll out of the programme nationwide. We have to start somewhere and we have to accept that there must be a phase one. From that phase we will gain the experience that is required to roll out a national programme. To the end of August this year, almost 92,000 women had been called for screening and over 68,000 women had been screened, representing an uptake of 74%. That will assist in ensuring the active rolling out of the nationwide programme.
My commitment and that of the Department of Health and Children to BreastCheck is evident from the 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. I am 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 national cancer strategy. This investment has enabled the funding of 76 additional consultant posts in key areas such as medical oncology, radiology, palliative care, histopathology and haematology. This includes approval which has been given for nine new consultant posts with a special interest in breast disease.
The investment is a major element of the implementation of the recommendations of the report of the sub-group on the development of services for symptomatic breast disease. Professor Niall O'Higgins was the principal architect of this report and is also a member of the board of BreastCheck. My Department has invested considerably in this programme for the provision of services for symptomatic breast disease in recent years and it is acknowledged that 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 much still 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 the end of 2002 of a revised implementation plan for the national cancer strategy.
The national cancer strategy, 2003-10, is 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-west region. The total cost of the extension as calculated by BreastCheck is approximately €27 million, including capital costs 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 of the programme and especially the linkages with the existing symptomatic services. The Minister is committed to the national expansion of BreastCheck at the earliest possible date.
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 board has agreed to develop its symptomatic services at Limerick Regional Hospital. Referral to the breast clinic at the hospital allows rapid access to a consultant surgeon, mammography and rapid processing of results. I see that the Senator is nodding, in disagreement with me.
I note the Senator's concern that there will be a minimum wait in excess of two years. If that is so, she should please let me know because that is not my understanding. The service provider in the area is the Mid-Western Health Board which has provided us with this information. I have been advised that there is rapid access to a consultant surgeon. If that is not the position, the Senator should write a note to me and I will be happy to revert to her positively about it. The delay should not be two years. I will not preside over such a delay.
I will not preside over unacceptable delays. A weekly multidisciplinary meeting commenced in June 2001 and is attended by all relevant members of the team. Financial approval has recently issued to the Mid-Western Health Board for the appointment of a general surgeon with a special interest in breast surgery. In addition, two breast-care nurses have been appointed to Limerick Regional hospital.
In relation to mammography services available to women in North Tipperary, the Mid-Western Health Board has informed me that patients are now being referred to the centre of excellence at Limerick Regional Hospital. Any woman, irrespective of her age or residence, who has immediate concerns or symptoms, should contact her general practitioner who, where appropriate, will refer her to the symptomatic service in her area for immediate attention.