Northern Ireland Assembly Flax Flower Logo

Northern Ireland Assembly

Tuesday 27 June 2000 (continued)

Mrs Carson:

Some words strike terror in people's hearts and none more so than the word cancer. It is one of the most dreaded words in our language and is on a par with what tuberculosis was in the 1930s, '40s and '50s. Cancer engenders a fear of the unknown, a fear of the treatment involved, a fear of surgery, of chemotherapy, of radiotherapy - and perhaps of the possibility that there might be no cure. Tuberculosis was eliminated by penicillin and people hope for a similar cure for cancer. Cancer is the second largest cause of death in Northern Ireland, cardiac problems being the first. It accounts for 26% of all deaths. Statistics show that this disease is on the increase. It shows no sign of decreasing, mostly due to the ageing population and our lifestyles. Northern Ireland is an example in Europe of poor health and under-resourced services. I wonder if the underresourcing is a consequence of direct rule and the lack of funding for research a result of no direction from locally elected people. It might be the case.

Assembly Members must take responsibility to ensure that adequate funds are found to deliver the necessary service. At the moment, there are only 10 oncologists in Northern Ireland and we are told that we require 30 to provide effective treatment. To have more oncologists we need more money. At the moment there are only 10 oncologists in Northern Ireland, but we are told that 30 are required to ensure effective treatment of the community.

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Expenditure is currently £13 million, but we should be spending £24 million. Every area of the Health Service is competing for funding, but it is clear from what we have heard that more money is needed for cancer services. In Northern Ireland we are privileged to have a centre of excellence for cancer research in Belfast City Hospital. The excellent pioneering research of its staff must be commended. If, however, they are to continue the work of finding a cure for this dreaded disease, they will require additional funding. I am encouraged by yesterday's news, which Ms Morrice mentioned, that the Genome Project has successfully mapped the human genetic code. It is to be hoped that this will provide an important step forward in the search for an eventual cure for cancer.

Any advance in medicine has a financial cost, and it is clear that the projected figures for the financing of Northern Ireland's cancer services fall short of what is necessary. As our population lives longer it is clear that our lifestyles must change. Public education is required on an ongoing and urgent basis, especially with regard to smoking, sunbathing and our national food habits. A change of habit may help reduce the incidence of cancer, but this is not enough. A concerted effort must be made by the Department of Health, Social Services and Public Safety and by all agencies to eradicate this disease. This requires extra financial input for all cancer services - education, research, staffing, training, and modern facilities. We must see that this is available. I support the motion.

Mr Boyd:

Regrettably, due to poor diet and under resourcing of services, Northern Ireland has the worst cancer survival rates in Western Europe. One in three people will develop cancer in their lifetime, and one in four people will die from it. Sadly, both old and young have lost their lives through cancer. It can strike anyone at anytime. The worst survival rates are for Ulster men - just over half with the most serious cancers are still alive after one year, and 80% of our lung cancer patients die after a year. These are the worst figures in Europe.

In a recent report the Chief Medical Officer, Dr Henrietta Campbell, said that most cancers were preventable because lifestyle factors played an important part in their development. Tobacco-smoking and an unhealthy diet are responsible for two thirds of all cancer deaths. In Northern Ireland smoking claims 3,000 lives every year and causes illness, suffering and hardship to thousands more families. It is the single greatest preventable cause of ill health in Northern Ireland. Ulster people spend a staggering 55% more on cigarettes than the average for the United Kingdom as a whole. A 1998 survey revealed that households in Northern Ireland spend £8.50 a week on smoking, a massive £3 more than the UK average. Sadly, more children and young people are starting to smoke every year; recent research for Northern Ireland shows that 18% of teenage boys and 34% of teenage girls now smoke.

There is a responsibility, particularly for elected representatives, to reduce smoking and save lives. Smokers also have responsibilities to people who do not smoke. There are a small number of people who smoke in the corridors of this very Building which has a non-smoking policy. More funding must be made available to help educate the public, particularly young people, about the dangers of smoking. Such measures include controls on tobacco advertising, tough enforcement on under-age sales and changing attitudes to smoking through a major campaign. Attitudes and behaviour need to change to encourage a healthier lifestyle. In addition, increased funding is clearly required as a matter of urgency to combat cancer as a whole.

Four key steps need to be taken in order to tackle the disease. We need to put in place the best preventative measures; we need to provide the best treatments available; we need to ensure that people with cancer are given the highest standard of care and attention at all stages of their illness; and we need to invest in high quality research and development.

In Northern Ireland approximately 8,700 people develop cancer each year, and around 3,700 deaths from cancer occur each year. Cancer currently accounts for approximately 26% of all deaths in Northern Ireland, and this trend is increasing. It is projected that in the next five to seven years cancer will be the biggest killer in our society. By 2007 it is likely that cancer will overtake heart disease as Northern Ireland's number one killer. This is as a result of our ageing society as well as improving outcomes for people with cardio-vascular disease. Therefore cancer and its treatment will become a major burden on society for the foreseeable future.

We need an extra 140 specialist nursing staff plus a range of new screening and education programmes. We already have some of the best clinicians, surgeons and oncologists, but they need resources and finances to carry out the necessary treatment. Prof Patrick Johnston, Head of Oncology at Belfast City Hospital, has stated that we need to increase the number of oncologists from 10 to 30. The current spending for cancer services in Northern Ireland is approximately £13·9 million per annum. However, in order to provide the type of service that is required, funding of approximately £24 million per year is needed. That is almost double the amount currently allocated.

In Great Britain just 95p per person is spent on anti-cancer drugs. In Germany it is £6·24. The critical issue of funding for cancer services highlights graphically the current folly of public funds being used foolishly by the Department. I refer to the United Kingdom taxpayers' money being wasted by the Sinn Féin Health Minister. Much needed health funding is being spent unnecessarily on the Irish language. It must also be highlighted publicly that the amount of resources which are being used up due to paramilitary beatings and shootings could otherwise be directed to cancer and other much needed services if these illegal activities did not occur. We heard pleas for public funding in the debate on transport, which is a very worthy case. However, there is no greater case for increased public funding than that of cancer treatment.

I want to publicly thank the various cancer charities for their tremendous fundraising work and for the help that they provide to those who suffer from the effects of cancer or whose families are affected. Society owes them a great debt and we, as elected representatives, must continue to support them in every way possible.

Mr Shannon:

I support the motion. It says that the Assembly welcomes the Ulster Cancer Foundation's document 'Cancer Services - Invest Now' and urges the Minister of Health, Social Services and Public Safety to implement, as a matter of urgency, the recommendations contained in the report. That is a recommendation that we can all support. Indeed, Members have unanimously supported the motion and the call for a substantial and significant financial contribution to cancer services in the Province.

Cancer will touch most of us, if not all of us, at some time in our lives. Some Members mentioned that their families have been affected by it. Indeed, my family has been touched by it too. If we do not develop some form of cancer it is highly likely that a loved one or a close relative will. Some of us have watched family or friends suffer and perhaps even die from this illness. Consequently most of us are only too well aware of the traumatising nature of this disease.

The Ulster Cancer Foundation's report 'Cancer Services - Invest Now' is welcomed by everyone in the House. It is sad that there is an ever growing need for such services. Sadder still is the fact that the Ulster Cancer Foundation had to produce this document calling for adequate funding. It felt it had to because it is impossible to provide an efficient and effective service with the present inadequate funding.

The fact that the Ulster Cancer Foundation felt constrained to produce this report is an indication of its concerns. Cancer is a disease which crosses the boundaries of class, colour, race or creed. Young and old can all be affected by it. The document outlines the very frightening statistic that there are 8,700 new patients every year and that 41% of males and 36% of females will develop some form of cancer at some stage in their lives.

There are about 20 people in this Chamber at present, and if one in four were to die from cancer, then there would be five people who would not be in this Chamber in one year's time. These are startling statistics, but they bring home how cancer will affect us. As other Members have pointed out, there could be 35 to 40 Assembly Members who could pass away from cancer, but that does not mean that they will. Rawls' theory of justice states that the only fair way to make a decision or choice is to do so in the "original position" where we know nothing about our status or abilities. The layman's interpretation is that those who participate in this debate may not necessarily get cancer, but there are those in this Chamber who will.

We should put ourselves in the position of the people who will, or could, be cancer sufferers, and, if we do that, then we will hit upon what this debate is all about. It is essential that we do so and then ask ourselves how we would like to be treated. What drugs would we like to be made available? What standard of care and research would we expect or want to have been done? If we were to place ourselves in this position, I believe that we would all reach a similar conclusion - that we would want the maximum standard of care, the maximum standard of drugs, the maximum standard of research and the full implementation of Henrietta Campbell's report entitled 'Cancer Services - Investing for the Future'.

The motion is explicit and refers to a matter of urgency. I hope that all Members have either read, or have some knowledge of, the document and will be well aware of its recommendations. The Ulster Cancer Foundation calls for the full implementation of the 'Cancer Services - Investing for the Future' report, which is concerned with the reorganisation and improvement of services. There is no doubt that the Minister, the Department, and all of the elected representatives support the ethos of the report, but we need more than words, we need urgent action, and we need money - the words that were used earlier during the transport debate.

The document states that the current spend for cancer services in Northern Ireland is approximately £13·9 million. This is grossly inadequate to provide the type of service required. The foundation suggests that in order to have an effective and adequate service, at least £24 million a year is needed, but the Government's allocated funding falls well short of that.

The foundation also highlights the fact that as treatments become more complex, the required spend will most likely need to be significantly increased. In just a few years, it is likely that cancer will become the major killer in Northern Ireland - overtaking heart disease.

The concluding statement of this document is particularly significant, and I reiterate it and firmly support it. Its ethos is that it is entirely unacceptable that we, as a society, must accept such grossly inadequate resources to combat cancer.

The United Kingdom has long prided itself on its western civilised status, and yet statistics reveal that the survival rate in Northern Ireland over the past five years was approximately 20% to 30% worse than that of Holland or France. Cancer survival rates for the UK have been consistently low and are comparable to countries in the previous eastern European block. When we consider those figures, it gives us an idea of how bad the incidences of cancer are in Northern Ireland.

Unfortunately, statistics tell us that the problem will only get worse. Now is the time for action to reform and improve cancer services in Northern Ireland. Inadequate funding will be the direct cause of death of the many patients who, with improved facilities - doctors, drugs and research - may have survived their illness.

At this juncture I will highlight the wider issues involved when Ministers take decisions about life and death, and it is important to bear in mind the human rights and European context. The impending implementation of the Human Rights Bill and its effect will mean that we must consider the convention rights when passing any Bill or making any decision. Possible litigation could arise out of a Minister's decision if it were allowed, or if adequate funds were not provided, that would be a violation of Article 2 of the Convention - the right to life.

In a recent case the European Court of Human Rights held that Governments have a positive duty to protect life and a duty not to make decisions that will cost the lives of those that they have a duty to protect.

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There is no direct analogy to illustrate the problem of inadequate funding, but many human rights experts feel that it is only a matter of time, and considering the state our health service is going through, the scale of potential litigation would be wide and far reaching. That aspect should be considered carefully when any decision is made.

In conclusion, I call for all Members to support the motion and I would urge the need for increased funding. I would remind Members that this issue potentially affects approximately 40% of our constituents. Consequently, we have a duty to use our position to urge the Department to make the only realistic option available and implement, as a matter of urgency, the recommendations contained in the report.

Mr McCarthy:

I support the motion brought forward by my Colleague, Mrs Bell. I pay tribute to all the organisations in Northern Ireland that have been working tirelessly for many years to combat this most terrible of diseases.

It is extremely sad to remark that with so much time, effort and money being utilised in research, treatment and provision, Northern Ireland still has an unacceptably high incidence of cancer.

I have said, on many occasions that the incidence of cancer in people living on the east coast has been higher than the national average. Some people might attribute this to the radioactive material that has been, and still is, discharged into the Irish Sea by the British Nuclear Fuels Ltd at Sellafield. If those discharges are causing, or partly causing, the unnaturally high level of cancer in this region, that dangerous operation should cease immediately. The concerns of my constituents in Strangford must be addressed now, as this problem has been ignored by the authorities for far too long. People have a right to know what is causing the appalling increase in the number of cancer incidents in Northern Ireland.

A recent report shows that Northern Ireland has the worse cancer survival rates in western Europe. That is totally unacceptable, but genuine efforts are being made to redress the situation. The Chief Medical Officer has stated - and this has been said already - that most cancers are preventable. Tobacco smoking and an unhealthy diet are responsible for two thirds of all cancer deaths. Surely, with regard to those two particular areas, much more should be done through education and by cutting back consumption of tobacco products. Efforts have been made, and are continuing to be made, to reduce the level of tobacco advertising, but we must go much further. Tobacco is a deadly drug. How does the Government deal with other deadly drugs? The answer may lie there.

The Minister, in her recent reply to my request to fully implement the Ulster Cancer Foundation document, stated her Department's commitment to the Campbell Report. She also informed me of the provision of a further £8 million for the improvement of cancer research and treatment services in addition to an extra £7 million provided last year. The money is most welcome, but more is needed. The Minister also said that she wished to see more specialist staff, oncologists and nurses being introduced into this branch of the health service. I reiterate the urgent need for the authorities to face this disturbing problem, but at the same time recognise the strain currently placed on the Health Service. The people of Northern Ireland must receive the best cancer services possible and we in the Assembly must not fail to provide them. I appeal to the Minister to adopt the Ulster Cancer Foundation document. I support the motion.

Mr J Kelly:

A LeasCheann Comhairle, I support the motion. I should like to say at the outset that I congratulate and thank Eileen Bell and Paul Berry for bringing this motion before the House. We must also congratulate Michael Wood, who is in the Gallery, for the tremendous work he and his colleagues have done in promoting the Ulster Cancer Foundation, and of course, Prof Roy Spence and Prof Patrick Johnston.

A LeasCheann Comhairle, I have been in a cancer hospital both as patient and visitor, and it would be remiss not to pay tribute to those in the medical profession - nurses and doctors - who service that most sensitive area of hospitalisation. At this juncture we should also pay tribute to the hospices for their tremendous work in caring for people in the last weeks, days or hours of their lives.

I was not here yesterday, a LeasCheann Comhairle I was at a funeral. A young woman of 55 died on Saturday after battling cancer for a year. It occurred to me that, within the last 18 months, I have been at 11 such funerals of young women within a 20-mile radius who have been afflicted by the dreadful disease, cancer, and who have died from their affliction.

One cannot help but notice the sorrow and hardship that the loss of a mother brings to her young family and husband, and the community in general. Echoing what other Members have said, there is no doubt in my mind that cancer is a growing killer in society. Cancer literally eats away at lives throughout the community. It eats away at those upon whom the community depends so much - young mothers who, perhaps having reared their children to school-going or university age, are taken away from them by this disease.

Jane Morrice has mentioned the genetic breakthrough we read about this morning, which was compared to man's landing on the moon for the first time. Yet already controversy is arising from the billions spent on coming to what we hope will be an extremely worthwhile genetic breakthrough. Indeed, other medical people question the wisdom of this expenditure when we do not yet have a solution to simple problems like the pollution of water.

However, we cannot be begrudgers, and we must welcome this breakthrough and hope that it will not be misdirected for commercial reasons or at disadvantaged people perhaps found to be genetically imperfect. I felt we might put down a marker on that. As I said, we support the Ulster Cancer Foundation report, and we are convinced by the argument that cancer is the greatest killer in society.

We have a number of concerns about the approach taken in the document. Our first relates to the somewhat narrow focus on the requirements for the curative service, and while we do not wish to downplay the importance of these services, we should all remember that most cancers are preventable diseases, resulting from the material, environmental and lifestyle factors already referred to. We do not believe it is enough simply to note the rising number of cancer cases and then to ask for adequate curative services in response. A more long-term but effective approach would be to concentrate on the question of why the rates are rising, and what society can do to halt, then reverse this trend.

Resources will need to be divided evenly between curative and preventative services. Moreover, we do not believe that responsibility for tackling cancer and other health issues should be confined to the Health Service. All Government agencies should be required to take responsibility for the health impact of their policies, and that goes back to the argument on the environment.

We also note that the report, whilst it takes note of Campbell's recommendation to develop multi-disciplinary teams, emphasises the number of consultants, oncologists and surgeons required. So, we are saying to the Minister, and to you, a LeasCheann Comhairle, that the response to the cancer service is to "invest now."

The Assembly lacks fiscal autonomy, and we depend on the block grant allocated by the British State to the Assembly and subsequently to the Department of Health, Social Services and Public Safety. We believe that it is only by instituting democratically controlled tax-raising powers that services such as this will be provided with the financial resources required. Nevertheless, we hope that this report will provide further pressure for the provisions of adequate funds to invest in services essential to our community's well-being.

A LeasCheann Comhairle, I hope my comments will be taken in the spirit in which they are meant, and that is with the desire to do everything possible to rid society of the scourge of cancer. We applaud the Ulster Cancer Foundation again for putting its case so clearly and we earnestly hope that this document will have the desired effect of leading to improved cancer services in the area. Thank you a LeasCheann Comhairle.

Rev Dr William McCrea:

I believe that this subject deserves the support of every Member of the Assembly. I appreciate that the Chamber is not full because of the staggered lunch arrangements, meetings, and Members attending different functions. However, I genuinely believe that there is unanimous support for action to be taken as suggested by the Ulster Cancer Foundation.

I would like to express my appreciation to Michael Wood, Director General of Ulster Cancer Foundation and the other members of that organisation for their presentation and the copy of the report given to each Member. I trust that Michael knows that his excellent service has been deeply appreciated and will be appreciated in the coming years.

I would also like to thank Mrs Bell and Mr Berry for bringing forward the motion because it is important that we discuss a matter that is causing great concern. Many people fear even the mention of the word, and when they feel ill and go to the doctor, one of their fears, if they cannot attribute the pain or the sickness to any other disease or sickness, is that the doctor will say it is cancer.

Many people fear the mention of the name, and many fear even to talk about the disease because they want to close their eyes, somehow, to the reality of their sickness, or to the pain that it will cause to their family circles. However, I believe that whenever the doctor does diagnose cancer that does not necessarily mean that the next word is death.

It is right to say that, because of the excellent scientific advances, many cancers can be cured and we would urge people to help doctors in the early diagnosis of the disease. This is one very important point: we should urge people to get tests done rather than carry a cross on their shoulders about what it might be. They should get treatment as quickly as possible.

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There are alarming statistics in the report, but statistics do not do justice to the individual stories of pain and suffering behind them, and I say that as someone whose father-in-law and mother-in-law were both diagnosed as having cancer inside a matter of days. My wife and our family circle nursed them as best we could, ensuring that they spent the rest of their days comfortable, and with a meaningful life until it was in the purpose and plan of God to call and take them home.

We are talking here about something that affects every grouping. The age or the sex of a person means nothing. Every group in society, and nearly every family in society, can, at some time, put a hand out and touch someone, among their loved ones, who has suffered from cancer, and sitting here today, not one of us knows exactly what that word might mean to us or what such an experience might mean to our families.

We are talking about something that is very real, not something imaginary. We are facing a great reality. The other reality is that we need resources to fight this disease, to get the necessary research done that will enable scientific and medical progress. Some people do not have access to particular drugs because they are very costly. People have come to me about the drugs they need, or believe would help. Some are told that in their cases, they might not be of great help, or because of uncertainties some are denied them. If cancer comes to our homes or family circles, we will want to ensure that everything humanly possible is done to save the life or lives of our loved ones.

I thank my Colleagues and Friends in the Assembly for moving this motion. I trust that we have highlighted a very human problem today and, indeed, that action will be taken and the financial resources made available to let our people live.

Mr Hussey:

I congratulate those who have brought this to the attention of the House. The motion has been well and widely debated. We are talking about 'Cancer Services - Invest Now'. We can all concur with the remarks made by Dr McCrea that cancer does not necessarily mean death, though too often it does. Through the provision of services we may be able to ensure a higher survival rate, and that is vital. If one life can be saved, a good job will have been done today by this Body.

I do not want to broaden the issue too much, but I do want to move to one small area of prevention. Causes have been mentioned such as smoking and radon gas et cetera. A small reference was made to the large amount of money that was brought in by the sale of mobile telephone licences while there is concern about the possible effects of mobile phones. I request that the Minister, in addition to this motion, take serious note of the House of Commons Science and Technology Committee's Report of 22 September 1999. It was the 'Scientific Advisory System: Mobile Phones and Health'. If there is a means of prevention, that report should be taken into account in the considerations that the Minister will be making.

I refer to one of its recommendations:

"We recommend that the Government ensures that a higher priority is given to a research programme into the health impacts of mobile phones".

One does not want to scaremonger, but it is highlighted that much research is needed in that area. I do not want such research to detract from the immediate investment in cancer services to prevent deaths, if possible. I support the motion.

The Minister of Health, Social Services and Public Safety (Ms de Brún): Go raibh maith agat. Fáiltím roimh díospóireacht seo agus gabhaim buíochas leis na Teachtaí a bheartaigh ar an ábhar seo a thógáil. Tá mé sásta a fheiceáil go bhfuil an t-Uasal Michael Wood i láthair agus ba mhaith liom an deis seo a ghlacadh le buíochas a ghabháil leis agus le Fondúireacht Ailse Uladh agus leis na heagrais dheonacha eile a d'obair go crua thar na blianta in aghaidh na hailse.

I welcome today's debate, and I thank the Members who have raised the issue and brought it before the House. I am also glad to see that Mr Michael Wood is present, and I would like to take this opportunity to thank him, the Ulster Cancer Foundation and the many other charitable organisations that have worked throughout the years, with the services, in order to tackle this terrible disease.

I firmly believe that people here are entitled to internationally accepted standards of treatment and care. I welcome the report from the Ulster Cancer Foundation, an organisation which has provided much needed care and support for cancer patients for many years. It also provides resources for research and has funded the cancer registry. I am glad that the Ulster Cancer Foundation's report strongly supports, and endorses, the recommendation of the Campbell Report on the reorganisation of cancer services. These services have changed out of all recognition over recent years. Indeed, the Cancer Foundation notes, as have Members during the debate, that many aspects of the Campbell Report are being implemented. Cancer units have been developed in our area hospitals where patients with more common cancers are being treated by specialist multi-disciplinary cancer teams.

In addition, Belfast City Hospital and the Royal Victoria Hospital have been developed as a regional cancer centre. In line with the Campbell recommendations, radiotherapy and chemotherapy services, currently provided at Belvoir Park Hospital, will be relocated to the Belfast City Hospital. This will result in a state-of-the-art oncology centre, which will include the latest facilities and equipment. Work on this project is on course to be completed by 2003, and there is no doubt that this will be a world-class facility.

The new oncology centre is being developed as a public and private partnership, and we expect the preferred tender to be announced in the near future. In conjunction with this, a new day hospital for people with cancer will be established in the existing Tower Block, and it is expected that this will be funded by my Department on approval of the final business case.

During the course of the debate much mention has been made of the number of oncologists, and, indeed, there has been progress, and further progress remains to be made.

At the time of the Campbell Report there were only eight oncologists, and it was recommended, at that time, that this figure be increased to at least 13 by 2005. Currently there are 14 oncologists in post, with plans to increase this figure to 22 by 2005. However, there is a world-wide shortage of trained oncologists. These specialists take a number of years to train, and this raises difficulties in attaining the number we would wish. It is not simply a matter of resources.

Furthermore, while it is vital that we have a sufficient number of oncologists, a quality cancer service depends on having a wide range of other staff, including specialist surgeons, physicians, pathologists and nurses. In the debate questions have been asked as to why everything is in Belfast, but what I want to see is a network of care that ensures that people, no matter where they live, have access to good quality care and this network must encompass the cancer centre, cancer units and primary care. I recognise, as does my colleague Sam Foster, the pressure on the public purse and, obviously, any increase in the block fund would be very welcome indeed.

As many Members have indicated, there is no doubt that every one of us in this room felt a personal impact as a result of this terrible disease and the toll that it takes. I am very aware of the toll for cancer sufferers, their families, carers and those throughout the service who work closely with them. I also pay tribute to the courage shown by all of those people who are battling against cancer. We need to do all we can to provide the best possible level of support. We all know someone who has suffered from cancer, or who has died from cancer. I can attest to that as it has been the case in my own experience recently. People do survive this disease and go on to live meaningful lives. Again I can attest to this from my own family. The courage people show in coming through this acts as a beacon to others going through times of difficulty. I also hope that people realise that Irish speakers are not immune to cancer and that people from all parts of our society suffer equally from this disease.

There has been mention of the 'Eurocare Study'; this was an important study which revealed that there were great variations in outcomes from cancer treatment throughout Europe. What the study actually showed was that outcomes in England and Scotland were not significantly different from the European average. Irish cancer registries were not included in the study, however we have no reason to be complacent. I want to see cancer outcomes in our country being similar to those achieved in Switzerland, Holland and the USA. This will depend not only on having high-quality cancer hospital services but also on having excellent linkage and support for primary and palliative care. I fully support the work of the National Cancer Institute, the establishment of the important linkage between cancer specialists in Ireland and the USA. That is already bringing benefits to patients, as oncologists and specialist nurses on both sides of the Atlantic collaborate in caring for patients with cancer. It has also facilitated the collection of information on cancer incidences and outcomes on an all-Ireland basis through the cancer registries.

I also recognise that the death toll is rising, and this is why we must direct our energies to implementing preventative action as well as ensuring good quality primary, acute and palliative care. The percentage of funding going into the various sectors will, in many cases, depend on local need, and I think that this will be best determined at local level.

I am also fully aware of public concern about radioactive waste, leakage and pollution, and this is an issue that needs to be kept under close scrutiny.

I certainly support the focus on prevention and education, and I would like to see this kind of initiative developed on an all-Ireland basis. Indeed, I think there is a need for a greater focus on prevention, particularly on initiatives to reduce tobacco smoking - another point that Members frequently mentioned during the debate (including those who recognise they need to give up smoking). Last year, my Department provided £0·5 million for smoking cessation programmes, including a major publicity campaign. Programmes for this year are currently being evaluated, and this will inform a strategy and action plan on smoking, which we hope to publish in the autumn.

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Cancer treatment waiting times are an issue of great concern. I am determined to reduce the length of time cancer patients have to wait for outpatient appointments. I am pleased to announce that a target of two weeks will be introduced for breast cancer patients from 1 August. I intend to extend this target to other cancers within 18-24 months. Tackling our waiting list problem is a priority issue. There can be no overnight solutions. Long-term strategies are required. The same applies to in-patient waiting times. I intend to bring forward in the near future a regional waiting list action plan, which will put in place the necessary strategies to reduce unacceptably long waits for all treatments, including cancer treatment.

I note the important point that early diagnosis is essential. To ensure that, public and professional education is vital. The new breast cancer waiting time target, which I have just announced, will be accompanied by guidance on early diagnosis of this disease. Further guidance will follow in the next 18-24 months.

We all welcome the success of the human genome project. I have no doubt that, within our lifetime, this will result in the development of completely new ways of preventing and treating cancer.

To come back to the question of funding, we need to ensure that allocations are such that the general health of our population is improved and, specifically, that we have funding to tackle this particularly terrible disease. I support the Ulster Cancer Foundation's wish for an adequately resourced cancer service, as do we all. Many of the required changes will take time to implement, because of the need to have adequately-trained and skilled staff in place. This year, an additional £8 million has been provided for cancer services, on top of the additional £7 million last year. That shows the priority that we attach to this vital question. I am confident that the new funding will make a substantial contribution to the continuing development of our cancer services. I want to ensure that, in the years ahead, cancer services have and retain a high priority within my Department.

Mr Deputy Speaker:

Everyone will be very pleased - although, as I am in the Chair, perhaps this should be regarded as being off the record - to hear your announcement of a two-week target for breast cancer, and also the considerable increase in the number of oncology specialists, which should be a tremendous improvement.

Mr Berry:

I thank Members for their kind words about Eileen Bell and myself. While we accept those kind words, I feel strongly that it was our duty to bring forward this motion and back the Ulster Cancer Foundation document. At the outset, I commend the tremendous work carried out by Mr Michael Wood and his staff at the foundation. There is no doubt that they have carried out tremendous work, over a number of years, in an effort to defeat this serious disease.

Few issues in modern society are as emotive as cancer. The very word provokes fear and worry on a considerable scale. Such statistics, if they are to be believed, do not present a very encouraging picture. It is clear from what has been said that Members have studied the Ulster Cancer Foundation's report, and I want to make some further points with regard to that.

We all have a one in three chance of getting cancer. One in four will die from cancer. About one in nine are diagnosed with cancer before the age of 45. Men are more likely to die from cancer than women, and men are more likely than women to develop invasive cancer. Jim Shannon, Rev William McCrea and Derek Hussey have all made it very clear that cancer does not just affect the elderly. It happens to young people, to the middle aged and to many other people. When I went on a tour of Belfast City Hospital this really hit me. There is a perception in Northern Ireland that it is mainly women who get cancer. From the evidence in this book, it is quite clear that cancer affects, not only women, but men and young people. When I visited Belfast City Hospital I looked at one ward in the cancer unit, and I saw in front of me only young fellows, around my own age, who were all being treated for that terrible illness.

It is extremely important that cancer is diagnosed early. This point has been raised several times. While recognising that there are many problems with data - in terms of determining if there is a real increase or simply better quality data - the figures present adequate evidence of a major health problem in this country. Perhaps what is most alarming is that the survival rate in Northern Ireland is not only very low in comparison to other countries, but also in comparison to the United Kingdom as a whole. While recognising that there are heavy demands on the taxpayer's money across all levels of the Health Service and that we will never eliminate this terrible disease, or deaths from it, we should not be deterred from making a case for proper investment in this particular area.

Now is the time for us, as elected representatives, to lay down some markers as to where money should be directed in this country. We should not be deterred when we are confronted with the reality that efforts to prevent and cure cancer have been intensified as well as increased. There is a very real success story and many people, who in the past would have died sooner, are now able to live longer. Others whose quality of life would have been very much poorer now have an enhanced quality of life, thankfully. Research into both diagnosis and the forms of treatment has greatly improved. Today we aim to demonstrate to the Assembly that it is essential that the 'Cancer Services - Invest Now' is not merely heeded but, more importantly, becomes part of the planning within the Health Service and that it is catered for within the allocation of resources.

However, having laid down the foundation, there has been very little progress towards getting the structure in place. That failure has been due to the lack of resources. Some may be tempted to think that this report does not matter too much since cancer treatment is ongoing. Others may be tempted to think that this is simply another reminder of the importance of the Health Service to all of us. This is not the case. The reality is illustrated in the following ways. First, cancer patients are being denied access to the very drugs required for their treatment. This is the equivalent of having a car without wheels. Secondly, there is a shortage of specialists to treat cancer patients.

That shortage is directly attributed to the lack of funds to employ specialists' time. An injection of resources would increase the number of cancer specialists. That is necessary to meet current demand. Cancer patients are being denied access to high quality treatment when they need it because there are not enough specialists to deal with them. Thirdly, there is a very real need to ensure that the Campbell report is fully implemented. Until that is done, we will continue to have a less than adequate health quality cancer service. I have listened very closely to Members today. I listened closely to my Colleague Mr Roger Hutchinson as he enquired about where the money would be allocated. Only the Ulster Cancer Foundation can lay that out, as it has specific areas to allocate to. I have no doubt that the points that the Member raised will be taken on board by the Ulster Cancer Foundation when it goes to lobby the Health Department. The Member made very good points about primary care, palliative care, the shortage of specialist medical and nursing staff, and the need to reduce waiting times for patients. These, and many other issues, need to be addressed in the field of cancer services.

All Members taking part raised very important points. Can we expect the taxpayer to keep on picking up the tab for providing medical services for those who show no interest in their own lives and who do not look after themselves? Members have mentioned the problems of smoking and alcohol abuse, and how people should try to help themselves more. They are very valid points and are very controversial matters in themselves. However, there is a need to remind people that certain activities can increase the likelihood of developing cancer. It is important that the message "Look after your health before you have to be looked after" continues to go out.

There are many areas where the people of Northern Ireland can help themselves, but we must also commend the work of other cancer organisations across Northern Ireland and, indeed, the UK. We welcome this report, and it has been an honour to bring it forward today with Eileen Bell, but I must also pay tribute to Macmillan Cancer Relief. It has also contributed to the cancer services and in the effort to defeat this terrible disease over the years. It must be brought to Members' attention that Macmillan Cancer Relief has invested £5 million across the four board areas in recent years. That includes specialist cancer and palliative care nurses. That is a great grant scheme available to cancer patients, which must also be supported. Members, and the Department of Health, must look carefully at, and listen clearly to, what has been said today. Waiting times must be dealt with, and proper information must be supplied to support cancer patients. Support, with the opportunity to talk to cancer patients, is another important issue.

I have no doubt that every Member in the Chamber has had loved ones and relatives who have died because of this terrible disease. There are also Members who have had family members who, thankfully, have been successfully treated because of early diagnosis. We do not want to be scaremongers, but I believe that supporting this motion welcoming the Ulster Cancer Foundation's document 'Cancer Services - Invest Now' will go a long way in defeating this terrible disease. £13.9 million is currently spent on cancer services. There is a need for £24 million to bring services up to proper standards, and I believe that the Health Department must find that money urgently. Then, there will be light at the end of the tunnel for the people of Northern Ireland who are suffering because of the terrible disease of cancer, and also for their families.

2.45 pm

It has been an honour to bring this motion forward, and I ask the Assembly for its support.

Question put and agreed to.


That this Assembly welcomes the Ulster Cancer Foundation's document 'Cancer Services - Invest Now' and urges the Minister of Health, Social Services and Public Safety to implement, as a matter of urgency, the recommendations contained in the report.

Mr Deputy Speaker:

I was delighted to hear my friend Michael Wood being commended by so many people, including the Minister. I have known him for many years. He was a distinguished and active member of the Institute of Directors when I was director of that body, and I have no doubt that his advice and example have kept many people alive.

The sitting was suspended at 2.47 pm.

On resuming -

Private-notice Questions


3.00 pm

Mr Deputy Speaker:

I have received notice of a private notice question to the Minister of Enterprise, Trade and Investment under Standing Order 20. Before I call the Minister I would like to explain how private notice questions, PNQs, are to be handled, since it is the first time that this matter has been dealt with in the House.

A PNQ must be tabled in the Business Office before 10.30 am on a Monday in the week during which an answer is sought. In accepting the question, the Business Office will consider three important issues: the urgency of the subject in question; the scale of importance to the public in having an answer; and whether sufficient notice has been given to the Minister to enable him or her to respond.

The question will be taken immediately before the start of the adjournment debate on Tuesday of that week. At that time I will call on the Minister to provide an answer. At the end of the answer I will call the questioner to pose any supplementary, and other Members may also indicate their intention to pose supplementary questions. However, given the limited notice of these questions I will be paying close attention to the relevance of any supplementary to the subject matter of the initial question. I will stick very firmly to that. There will be no excursions into matters that do not relate to this question. I will rule out of order any question without a direct and clear relationship to the original question.

In total I would expect to dispose of these matters in 15 to 20 minutes, although in future it might not be unusual to take two or more PNQs together. In the case of the question before us, I am grateful to the Minister for agreeing to respond against quite tight time constraints and also given the lack of precedent for how these matters are to be handled.

Private Notice Question

Transtec Staff: Employment Prospects


Mrs Nelis asked the Minister for Enterprise, Trade and Investment to clarify the current position regarding the employment of staff at Transtec and its subsidiaries in Northern Ireland and to outline the steps being taken to safeguard the future employment of these workers.

The Minister of Enterprise, Trade and Investment (Sir Reg Empey):

The Transtec group, including its Campsie operation, has been in administrative receivership since December 1999. The employees at Campsie continue to be employed under the terms of their existing employment contracts. Intense discussions are currently ongoing regarding a significant investment proposal that could secure the majority of the jobs at Campsie.

Mrs Nelis:

Go raibh maith agat, a LeasCheann Comhairle. I wish to thank the Minister for his answer. Is the Minister aware, and he has touched on this in his answer, that there was to have been an announcement on 12 May on a possible takeover of Transtec by another company, and if that is the case, can he state that the jobs of the 300 workers employed in the Campsie factory will be safeguarded?

Sir Reg Empey:

I cannot confirm that that announcement was due on 12 May but what I can say is that I am aware that intensive negotiations are currently ongoing with a very reputable automative industry company that would instil confidence in us that they are very significant players in their field. As you know, the Ford Motor Company is also the principal customer at Campsie and the receivers, Arthur Andersen together with the IDB, are rigorously pursuing the negotiations. These negotiations are at an advanced stage, but we cannot say for certain when there will be a result. Similarly, it would be wrong to go further than to say, as I did in my original answer, that, should the negotiations proceed well, there is certainly a possibility of retaining a majority of those jobs, but this is a private, commercial set of transactions.

The IDB could well be involved and stands ready to assist with the objective of ensuring that there is a viable manufacturing unit on that site. As Members are probably aware, the product made is cylinder heads for the Ford Motor Company, and the particular vehicle or engine for which these cylinder heads are being made is enjoying extremely buoyant market conditions at present. The potential exists therefore for a satisfactory outcome, but I would not wish to mislead the House by saying that we could guarantee that all the jobs would be secured. It is entirely a matter for the negotiations, but the IDB stands ready to assist in achieving the most positive outcome possible for that plant.

Mr Hay:

I thank the Minister for taking time out today to answer a number of our questions. There is deep uncertainty in the Londonderry area concerning the Campsie site and the employment of the 300 workers in that factory. I have two questions for the Minister, the first relating to the £7·5 million grant aid that the company has already received. Where has that money come from? The other issue is the £139 million the company currently owes to creditors. How much of that money is owed to creditors in Northern Ireland?

I thank the Minister, who has been very exact on the issue raised in the House today. I must remind him, however, that the sooner the uncertainty over the company in Campsie is brought to an end, the better for the workforce. I express my thanks to the Minister and his Department for the work they have done in attempting to salvage the company in some way.

Sir Reg Empey:

The hon Member for Foyle will be aware that the administrative receivers, Arthur Andersen, are in charge of the company. The question of its creditors and how much is owed in Northern Ireland are matters exclusively for the administrative receivers at this stage. As far as grant aid is concerned, quite obviously assistance was forthcoming from the Industrial Development Board in the form of selective financial assistance to provide for capital equipment and training when the subsidiary was established.

The Member will also be aware that, because of the high-tech nature of the processes and the significant quantity of automation installed at the time of the project's inception, a great deal of technical difficulties were encountered. The workforce was unused to these processes, and, indeed, litigation between the company and the suppliers of certain equipment is ongoing. The matter is currently before the courts, and it is not possible for me to elaborate on that, but that shows and demonstrates the depth of the difficulties surrounding this particular project. With regard to the total number of creditors, the Member will be aware that there is a subtext, in that a Department of Trade and Industry investigation is currently being conducted by independent inspectors into the affairs of Transtec plc, concentrating on the accounting treatment of a claim by the Ford Motor Company against Transtec.

I cannot prejudge the outcome of that investigation as it is sub judice, but Members will see at a glance that a significant number of complicated issues surround it. As to the need for a positive, satisfactory and early outcome, I fully appreciate the difficult situation in which the workforce finds itself. That having been said, there is a lot of work on the shop floor now. As I said in my original answer, the workforce is currently operating under the same terms of contract that it had when Transtec was in charge of its affairs. So the position of the workforce has not materially changed since the administrative receivers were appointed.

Mrs Nelis:

Can the Minister elaborate on that? This is not just about the future of the workforce. Because this company is in receivership, those working at the plant have been denied mortgages when they have given the address of their employer. They are also having other financial difficulties because of this.

Sir Reg Empey:

I can sympathise with the position in which many workers find themselves. This is not unique, I regret to say. I know from local government experience that when people are on temporary contracts, mortgage lenders and other finance houses take a very sceptical and jaundiced view of them, because, not having permanent, guaranteed employment, their income stream cannot be guaranteed.

The position is only resolvable with confirmation that agreement has been reached with a potential purchaser. Regrettably, as long as this company remains in administrative receivership, I do not see any solution to the problem. The basic problem is that mortgage lenders and finance houses do not regard people who may currently be earning satisfactory wages as being in long-term employment. They will not adjust their attitudes until the jobs are confirmed when the company passes back into private hands.

Mr Tierney:

I thank the Minister for his comments. Does he envisage a gap between Transtec and the new negotiations that he is involved in? Are the jobs that he has saved existing jobs, which will not be re-advertised? Will the owners employ the existing workforce if the negotiations are successful?

Sir Reg Empey:

I do not quite understand what the Member means by a gap. This is the subject of a private negotiation. Since the company went into receivership, those employed on that date have had their contracts of employment adopted, on behalf of the company, by the administrative receiver. Those who were previously working at Transtec have had their contracts adopted by the administrative receivers. They remain employees of the company and continue to be employed under the same terms as before. The administrative receiver is liable for post-employment wages and salaries.

The most likely outcome, though I can not guarantee it, is that a significant number of employees would be retained by the new purchaser, depending on the contract that that company may have with the Ford Motor company. This is a competitive industry, based on supply and demand, and with more than one supplier in the EU. It is most likely that the contracts of the existing workforce would be adopted, but I cannot give any guarantees as it is a private matter.

3.15 pm

Motion made

That the Assembly do now adjourn. - [Mr Deputy Speaker]

Mr Deputy Speaker:

The Business Committee has decided to allocate two hours to the question of the arts in Northern Ireland and one hour to the matter of the PFI scheme in Antrim.


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