Before I call the next Member, I advise Members that, given that three hours have been allocated for the debate, they should limit their speeches to 10 minutes.

In bringing forward this report, the Committee realised the importance of cancer services in our community. When we found out that, as it says in the report, cancer will affect one in three of the population, we began to grasp the importance of the issue. When we consider that 6,500 people will be diagnosed with cancer in the near future, and that 3,500 people die from cancer here each year, we are immediately conscious that we are not dealing with some unimportant, short- term strategy. If we are to provide a service that will not only relieve the pain of cancer sufferers but also help their families, the report must be taken most seriously, not only by the Minister, the Department and the Assembly, but by everyone in our community.

The number of people who are diagnosed with cancer and the number of cancer deaths are only the beginning. Cancer casts a feeling of dread over everyone because there is a sense in which we all wonder whether we shall be the one in three to receive the death sentence. That is why we must inform the population that cancer need not be a death sentence. There are cures and effective ways to overcome cancer. We need not necessarily despair, and our families need not sink into a morass of hopelessness. By trusting and depending on the Health Service and its staff's expertise, we can have hope where before there was only despair. But - and this "but" is important - the waiting times and the number of people who are left without treatment for far too long are causing not only those who suffer, but the entire community, to lose confidence in the ability of the Health Service to address a situation that is of vital importance to one in three of the population and their families.

As we consider the report, we must address several issues. I compliment the Committee Chairperson on covering so much ground; indeed, he has covered so much that he has left very little for the rest of us to say.

I am amazed that the only guidance circular that the Department issues on waiting times for cancer treatment relates solely to breast cancer referrals. I ask the Minister to take the matter back to the Department; there are so many other forms of cancer. Without being facetious, that circular cuts out the male half of the population. Half of the population does not receive any guidance on waiting times for cancer treatment.

A short-term strategy must be devised to improve communication between acute hospitals and GPs. There is far too much isolation. The them-and-us mentality is much too prevalent in the Health Service. Services remain isolated from one another, and people are too often concerned with their own sections. We need a fully integrated service, especially where cancer services are concerned, so that patients are looked after by the whole service - from the GPs, to acute hospital attention and subsequent community care.

We can deal with the situation in two ways - through short-term or long-term strategies. In the short term, decisions must be made immediately. Hospitals are crying out because of lack of beds, staff and capacity, and we must address those issues. Different sections must not only be brought together in a multidisciplinary team, but we must examine the financing of cancer services. There is no point in having a cancer centre that will be the best in the world in four or five years' time. Such a long-term strategy would be of no benefit to the many patients who are waiting for treatment.

As regards finance, the community is prepared to play its part. A team effort will be required to overcome financial problems. When the Department says that it does not have funds, we must consider other ways of raising money. Some years ago, we came up against funding problems for the cardiac unit at the Waveney hospital in Ballymena. We brought the community together, and a great deal of money was raised. I ask the Minister and the Department, if the community were to raise hundreds of thousands of pounds, would they be prepared to match the amount pound for pound? In that way, the entire community would become involved - people would be interested in what they were doing and they could see that something was being done.

Our party's slogan with regard to the delivery of health services is "Putting Patients First". If the Department and the Health Service were to take that on board, a service could be delivered in which the whole community could have confidence.

I support the efforts of the Minister and the Department. I recognise that there have been shortfalls in investment, but immediate action must be taken on our cancer centre. We must have decisions, not more consultations. Let us move forward, and take our people with us, so that we can provide them with a Health Service in which they can have confidence.

In 1996, Henrietta Campbell produced a report on cancer services called 'Cancer Services - Investing for the Future'. That was a ground-breaking report; it was radical and pioneering, and one which has become the benchmark and framework for cancer service development in Northern Ireland.

The framework is that in its recommendations lies the goal of a proper cancer service. The benchmark is that we only have to compare what we have with what we should have.

In a sense, our report looks at both those aspects. Good points are clearly indicated, but sadly there are serious shortcomings that need to be addressed without delay. Our cancer services are a story of fortitude in the face of discouragement and valour in the face of limitations. The minutes of evidence that we have published contain several strong indictments about the range of measures that are lacking simply because there is no proper strategy.

First, there is the missing link - the new cancer centre. The vision of the "hub and spokes" has not been achieved. The spokes are being developed thanks to the clinicians, the trusts and voluntary organisations, but there is no hub. The ministerial delay and inactivity is apparent to all, but especially to those who suffer. Instead of pursuit, authorisation and implementation, all we have are delays and excuses. The central recommendation of the Campbell Report has not even materialised after five years, and there is no excuse for that. The new cancer centre is not merely an aspiration, but the crucial element of our cancer services, and its ongoing absence is a disgrace. A commitment that is not actively pursued towards achievement is but a mockery. As the report states, it is symptomatic of much that is happening in the Health Service when it comes to spending money - namely there is a lack of clearly defined objectives and goals. However, here is one goal that can, with active pursuit, be achieved. As Mr Coulter said, the reality of more than 6,000 cancer cases a year, with 3,500 deaths, is sufficient to show the need for the new centre.

Secondly, there is piecemeal implementation. Progress has been made since 1996, and all progress is welcome. The report clearly acknowledges each and every step taken, and tribute must be paid to those directly involved in delivering cancer services. However, no proper timetable exists for implementing all the recommendations of the Campbell Report. The Campbell Commissioning Project said that we are around 50% down the road - that is disappointing and is not helped by the glaring absence of service development money specifically for cancer services in the Budget. How that was overlooked needs to be explained, and to be told that any extra money that may become available will be used for cancer services is hardly reassuring.

Our report makes it clear that each part of the framework must be developed in parallel, not in isolation. The Ulster Cancer Foundation stated in its submission that "much remains to be done." We need a cancer plan, as Mr Gibson of Macmillan Cancer Relief pointed out when he said that

In other words, like the rest of the Health Service, it is plagued by a short-term approach and no long-term plan. We really need an independent audit of the resources provided and the services delivered. There are so many layers that it is all getting out of control.

Thirdly, there are serious trends. Although improvements have been made in particular areas such as the area of consultants, the Committee is concerned about what the Campbell Commissioning Project termed as the haemorrhaging of skilled staff from Northern Ireland. Given the time and investment in training, this is a significant matter.

Given the Department's staffing plans, there is considerable concern as to whether these targets can be met and sustained in the long term. Without crucial commitments and clear objectives, what is currently a trend will, in time, become a major crisis.

Another trend that causes concern is the increasing workload on GPs. Since 1996 their workload has increased to such a degree that they have less time to spend with patients, and because of that the detection of cancer may be seriously hampered. I trust that that will be addressed in the near future.

Our report also highlights the need to improve GPs' ability to diagnose cancer in the first place. That is not helped by the increased workload, part of which is due to the mass of guidelines sent to them every week. Little wonder that Mr Quigley, the chief executive of Action Cancer, is concerned about the ability of the Health Service to hold on to GPs and good medical staff. Our expertise is at risk, because they are attracted to other places.

Dr Patterson from the General Practitioners' Committee said that for GPs the biggest obstacle is coping with demand, which in turn is hampered by the backlog of work and the extra workload created by those who have difficulty getting treatment. Those delays have become familiar in our Health Service. We should read the submission by the General Practitioners' Committee to realise GPs' concerns.

The Committee Chairperson has regularly talked about a trend that must be radically reversed: the tendency to allow equipment to get out of date. There is evidence of piecemeal replacement and repair. It is incomprehensible that cancer patients are subjected to treatment with equipment that, in some cases, is a decade out of date. Up-to-date equipment is vital. At other times, patients have to wait while equipment is repaired. Given that any financial announcement about new equipment, while welcome, occurs a considerable time before the actual purchase, there should be a rolling programme of replacement for vital equipment. That is possible, given the millions that are wasted elsewhere.

There are also some general needs. The variation in delivery causes great concern. Patients may or may not receive treatment, depending on where they live. Many of the submissions, including those of the Ulster Cancer Foundation and Macmillan Cancer Relief, drew our attention to the variation in delivery experienced across Northern Ireland, where services and treatment are available in some areas but not in others. The Department must give genuine consideration to that matter and ensure that such variations are removed, because it is a matter of severe concern.

Of equal importance is a directory of specialists involved in cancer services. This was recommended by the Campbell Commissioning Group, but so far it has not materialised. There have been promises, but no product. I urge every Member to read the report in order to get a full picture of the current situation in cancer services. The second volume of submissions, in particular, reveals the real problems that people who are actively involved in the delivery of cancer services face.

Finally, I join with the Members who have commended the Health Service staff who are working at the coalface on a daily basis, dealing with cancer patients. We salute these people, who are doing wonderful work, as well as the cancer organisations who work continually, not only with us, but most of all with cancer patients. I also commend the Committee Clerk and staff for their dedication and commitment. I trust that everybody will support this important motion.

Go raibh maith agat, a LeasCheann Comhairle. I commend the Business Committee for allowing three hours for this debate. During recent health debates we have all complained that we have been involved in writing up reports and then an hour or an hour and a half has been allocated for debate, so maybe they are taking our complaints on board.

As a member of the Committee for Health, Social Services and Public Safety I support the motion and commend the report.

I want to take the opportunity to thank the Committee Clerks and the support staff for their help and support over the past few months. Some of them worked hard over the Christmas recess. We appreciate all that work in providing the Committee with the relevant information and documentation in order to finalise the report.

As several Members have said, the Committee received detailed written submissions and took oral evidence from several organisations and individuals with an interest in cancer and cancer services. I thank them for their efforts and their excellent presentations.

Nearly 10 months ago, the Committee agreed to investigate the position of cancer and cancer services and, where possible, make recommendations to the Minister that might improve services. From the report, the Committee has made 41 recommendations, which I hope the Minister will examine. I thank the Minister for her attendance at the debate. This is an issue for the Executive, and I raise it at nearly every debate. The Executive have stated time and again that health is a priority in the Programme for Government. If that is the case, the Executive must provide proper long-term funding so that problems in the Health Service can be tackled and, more specifically, cancer services can be dealt with.

Our communities have one of the highest levels of deprivation. We also have one of the highest smoking rates as well as a poor diet. All those factors are associated with increased rates of cancer. As several Members have said, cancer will affect one in three of the population, and one in four will develop cancer before the age of 75. Mr Coulter pointed out that referrals to oncologists have risen from 3,400 in 1996 to 4,000 in 2000; approximately 6,300 people have been diagnosed with cancer, and 3,500 have died. Cancer is expected to be the number one killer in the next five years. That is the stark reality.

Measures such as screening, education and raising awareness must be increased and made more effective. I welcome the advertisements currently running on television, and I support the need for more of those advertisements. I also welcome the initiatives taken by groups such as Action Cancer and others in raising the awareness of some cancers. The levels of uptake of screening programmes in socially disadvantaged areas are poor. Education is a key factor in that. Last year, over 31% of women had not had a cervical screening test in the previous five years, and 28% of women aged 50 to 64 had not had breast screening in three years. That is again a stark statistic that we must try to tackle.

There is also a commitment to providing services in the medical and professional field. Prof Paddy Johnston pointed out to the Committee that in the five years since the Campbell Report was published there have been some significant improvements and patients are beginning to experience benefits in cancer services. He said that there is more specialist focus on cancer care, and multidisciplinary teams are making valuable developments in most areas of cancer care. He also stated that there is better access to investigation and treatment for some cancers. Chemotherapy now has a consultant-led presence, and the quality and profile of cancer research has improved. That has led to the development of clinical trials research that allows patients access to new therapies as they develop.

In the report the Committee took on board not only the negative side of cancer services and what cancer patients are experiencing but also the positive work that is being conducted, both in the community sector and the voluntary sector. Action Cancer pointed out that services should seek to address the needs of patients from the start. Nobody would argue with that. There is concern with regard to referrals from GPs to hospitals, and back again.

Action Cancer said that services should take a holistic view of patients and should help to address their physical, emotional, social and spiritual needs. Nobody would argue against that. We cannot look at cancer in isolation; we need to take on board the social, emotional and physical effects that it has on people. Action Cancer also said that each patient's needs differ and that services must be flexible to meet those needs. The Committee took both statements on board and made suitable recommendations. Evidence has shown that the transition from GP to hospital and back has not been smooth - and that alarmed the Committee.

Poor diet also causes death from cancer, and the Committee strongly advocates initiatives such as the five-a-day programme, which is designed to improve diet by increasing consumption of fruit and vegetables. I welcome and highlight that initiative taken by the Minister of Education and the Minister of Health, Social Services and Public Safety. I appeal to them to ensure that the programmes are not only carried out, but are seen to be carried out where they are most needed.

Interested groups are carrying out positive, ongoing work. Like other Members, I thank them for their hard work, dedication and commitment. Without such individuals and the voluntary and community sectors, services could be worse off. We must appreciate their hard work.

The Chairperson referred to the cancer action plan earlier, which is an all-Ireland report on cancer launched recently by the Minister of Health, Social Services and Public Safety and her counterpart in the 26 Counties. We must support that initiative. In a joint press release the Ministers said:

That is the vision we were seeking when we were examining cancer services.

The Committee makes 41 recommendations. Some Members reading the report or the executive summary may feel that some recommendations seem quite simple and ask why they were not implemented already. Others might feel that some recommendations seem quite silly, and if we are talking about lack of services, why are we making such recommendations.

The issue that struck me was the up-to-date information that many patient advocate groups are asking for. They want information on waiting times for the treatment of different cancers to be presented in an easily understood format on the Department's web site and other public information facilities. That issue kept coming up. I was struck that people were being diagnosed with some form of cancer but were being left waiting for months without relevant information. People were wondering whether they would have the energy to beat their diagnosed cancer.

I acknowledge the commitment from the Minister and her announcement of additional money to cancer services. However, the Health Service has been underfunded for years, and cancer services face extreme and complex problems. The Executive must accept that health has been underfunded. If health is a priority then the Executive should put their money where their mouth is.

I felt duty bound to be involved in this very important debate. I hope that progress will be made. Cancer is a scourge.

I wish to congratulate those who work so diligently in the Health Service to prevent this enemy of society. There are 8,700 new cancer patients a year and 3,800 deaths from cancer a year. Either sex has a one in three chance of developing cancer. To think of it in another way, of the 108 Members in the Assembly, 36 could be afflicted with cancer in their lifetime.

Cancer survival rates for the United Kingdom have been consistently poor and rank at the bottom of cancer survival rates in western Europe. We must improve access to high-level care, provide a patient-centred service, provide efficient and effective services to all and for all and provide services and facilities that are flexible and fulfil the requirements of the community.

A new case of cancer is diagnosed in Northern Ireland every 80 minutes. It is a shocking and a frightening thought. On 3 October 1999 a tripartite agreement was signed in Parliament Buildings between the USA, the Republic of Ireland and Northern Ireland to initiate a centre of excellence in Northern Ireland. It was to lead Europe in cancer services. I was pleased to be part of that as the UUP health spokesman, and I was accompanied by Dr Joe Hendron.

I would also like to pay tribute to the hard work of Prof Paddy Johnston and Prof Roy Spence. Dr Henrietta Campbell, the Chief Medical Officer, was also very supportive. There was a memorandum of understanding, of which I have a copy. What has happened to it? Where has it gone? Is it not time that we saw some movement to fulfil that magnanimous intent?

There are other needs to be fulfilled. I accept, having been in the Executive, that it is always easier to be an advocate than a doer. However, there is a real and presently unfulfilled need. The regional cancer centre is the missing link to a fully integrated cancer service for all the people of Northern Ireland.

We require more oncologists to service the need in the outpatient clinics of our major hospitals. At one time, we needed 30 oncologists to cater for our needs; today we have 10·5. The number of patients has increased by 54·4% in the past four years, while the number of oncologists has increased by 23·5%. That is not a good record.

Coming from a country area as I do, I find it a shame that people in rural areas are less likely to beat cancer. They are up to four times more likely to die before the disease is diagnosed. Weak and elderly patients have to endure very long journeys. Surely everyone is entitled to equality of treatment? I come from Enniskillen, which is very isolated. To reduce services in that part of the world would be lacking in compassion and totally unacceptable.

The spend in Northern Ireland is approximately £15 million a year. We need about £25 million a year in order to cope. New money is essential. It is the duty of Government to invest in the vital quest to arrest the scourge of cancer, because there is no wealth but health, and hence, life.

I support the report. Ilka thrid bodie in the Unitit Kingrik taks sum kin cancer - a fair scunnersum stateistic. Oot the 108 LMFs here theday, 36 wul maist lyke tak the cancer for sum pairt o thair lyfes. That feigur's a quare gunk, but whit begeks us mair is that monie o thaim waitin on treatment coud hae sae lang as nyne month ti byde, on ower thae months the cancer could get that ill the wad be nocht coud be duin for it. We cannae hauld wi sicna seituation, an we maun luik at it nou. It is aw weill an guid allouin that our Halth Service is crummlin doun around our lugs and that we'r needin ti dae sumthin anent it, but fowk as coud mend an gae on ti hae fu an blyth lyfes is leiterallie diein, thai'r efter bydin that lang. A'm o the opeinion the recommends wul hae fowk waitin ower lang on trysts wi specialists, but gif this pairt o't is juist a preliminary bydin tyme wi the inlat for lowdenin the tyme tint on waitin leits in the twa-thrie yeir cumin, A'm for uphauldin it an grie it soud be putten forrit.

One in three people in Britain are diagnosed with cancer. That is a scary statistic. Out of 108 Members, 36 will be diagnosed with cancer at some stage in their lives. The figure is astounding, but what is more astounding is that many of those people have to wait for up to nine months for treatment. During those months the cancer can become terminal and, perhaps, untreatable. This is an untenable situation, and it must be addressed immediately. It is all very well to say that the Health Service is crumbling around us and we need to do something about it, but people who could be cured and go on to lead full and happy lives are dying while waiting for treatment.

The waiting time recommendations for appointments to meet with specialists are still too long. If this is just a preliminary waiting time with the prospect of reducing waiting lists in the next couple of years, I will be in support of it, and I will agree that it should be recommended. My constituency of Strangford, along with the rest of the Antrim coast, has a high frequency of cancer. I agree with the implementation of a comprehensive regional cancer plan. That would enable each region in Northern Ireland to address particular needs such as bowel cancer and children's cancers. It is imperative, however, that the Minister and the Department of Health, Social Services and Public Safety listen to those people who work with cancer patients. They must listen to patients to gain an extensive understanding of the problems that they face when they are trying to fight this debilitating and exhausting disease. We must give every patient the full opportunity to survive cancer, as opposed to living with it.

As a matter of extreme urgency the communications system between hospitals must be not only instigated, but safeguarded. General practitioners, consultants, Macmillan nurses, hospices and laboratories must be connected to a central network that allows patients' records to be updated immediately, to prevent the duplication of tests and, in some cases, of drugs prescribed. Nothing can be more disheartening than having to describe one's ailment over and again to uniformed personnel simply to gain some relief from the constant pain and discomfort. We must remove some of the lengthy and frustrating red tape for the 8,500 people who are diagnosed with cancer every year and who have a real battle to fight.

Those frustrations come across to the nurses, doctors and patients as stress, creating a working environment that is unhelpful to the healing process. The communication system will be a useful tool for examining areas, such as Strangford, which have concentrations of certain cancers. The cause can then be investigated in the light of those findings.

Ensuring that only the medical staff is privy to information is difficult. Many members of the security forces have been diagnosed with cancer. Members of the Special Branch allege a link between 10 deaths from cancer and the radios that they use while on duty. Their families would not like it if those patient details got into the wrong hands. If there is a way of safeguarding the information system from subversive intrusion, I will fully support its immediate implementation.

It is often through cancer charities that patients find the most helpful, patient replies to the never-ending questions about their condition. One patient told me that he was given answers from the hospice nurse only because members of hospital staff were so rushed off their feet that they came to regard his constant questioning of his treatment and his bodily changes as a nuisance or a psychological problem. He told me that he was not an angry young man; he simply wanted to know what to expect so that he could prepare himself for the next stages of the disease.

Only after visiting the hospice nurse, and sitting with him for over two hours, over several cups of coffee, did he get the answers to his questions - the answers that he had been looking for. Hospice nurses and Macmillan nurses should be drafted into the equation at a much earlier phase, and they should be accessible to the patients - located on the wards instead of being restricted to their own buildings. After all, the word "cancer" strikes fear into the hearts of any man or woman, be they as strong as Hercules or as intelligent as Prof Stephen Hawking.

Smoking, as the main cause of cancer, should be actively discouraged. We need to see more advertisements such as the recent one that featured the aorta of a 32-year-old smoker. If you have seen that television advert you will have been impressed. However, if you like mayonnaise, you may never eat it again. It caught my attention, but one such advert is not enough. We need more hard-hitting advertisements. I agree with the Committee's recommendation that there should be a Province-wide ban on cigarette advertising. That needs to happen soon. Nearly every advertising hoarding in Ards has a cigarette advertisement at one point in the year, and some of those are near schools. Perhaps the national scheme, which recognises those who have given up smoking or rewards those who have given up, could encourage more smokers to give up. However, do they have the right incentive?

Something needs to be done, as I have noticed that smoking has become glamorous again, probably due to the film industry and television. It is certainly rubbing off on our children. There are figures to suggest that 25,000 teenagers will die from smoking-related diseases in middle age, and that gives a perspective of what could happen. Yesterday I met with teenagers from Donaghadee High School who are investigating what we, as MLAs, are proactively doing in the Assembly to combat smoking. It would be fantastic for them to see that the Assembly is making moves to do something specific, targeted and focused.

At this stage I want to mark up the issue - and I have asked the Minister a question about it - of teenagers and their rehabilitation in hospital. Teenagers need to have their own rehabilitation unit when they are having treatment, rather than being alongside smaller children. Teenagers are growing up; they need somewhere for themselves, and I hope that we can get the answers that we need on that.

Research shows that cancer can be genetic, but are there outside influences that can predetermine which person out of three will get cancer? I want to see schemes set up whereby family members of those with cancer are screened, so that we can prevent cancer starting, and subsequently, painful and radical treatment being used. It should be the Government that starts those schemes and not the family members. In the United States of America, a news anchorwoman started a campaign for the relatives of victims of bowel cancer. She encouraged them to contact the cancer centres in their towns that were organising countrywide research into the disease from which her husband had died the year before. It was a personal initiative, yet it started a movement. That one brave woman wanted to help others.

It is the responsibility of the Government and the Department of Health in the Province to help the people, whom they are supposed to represent, by organising that sort of scheme. It can be done, and it should be considered. It would provide families with education about the disease, such as symptoms, eating habits that can combat cancer and other invaluable information. Cancer - the scourge of modern society - needs to be addressed. I commend the report, and I hope that the Minister and her Department can respond in a positive manner.

Go raibh maith agat, a LeasCheann Comhairle. I too welcome the report. Prof Paddy Johnston has played a Herculean role in the fight against cancer. In speaking about the report 'Cancer Services - Invest Now', he said to society here:

At the other end of the spectrum, a cancer patient said:

Cancer is a frightening disease, and we have all been affected by it in some way, through our families or our extended families. It is frightening to think that approximately 8,000 new cases of cancer occur each year in this part of Ireland, mainly among the elderly.

The key to the problem facing not just our cancer services but the entire Health Service is contained in the first paragraph on resources in the executive summary of the Committee's report.

That is an example of the ground that we need to make up - a total of £435 million.

Cancer will affect one in three people, and the impact is massive. The emotional cost of cancer, the stress and the need for real, extra care cannot be underestimated. I welcome the progress made in bringing resources closer to the patients. We need a vision for health, and it must be patient-centred. We need diagnosis and review facilities close at hand, and I welcome the Minister's response to the Campbell Report. The four cancer units are now providing 50% of all-day patient chemotherapy, and that is the way to go.

I welcome the provision of more MRI scanners and in the interim the upgrading of equipment at Belvoir Park. However, that is not a long-term solution. The original plan for the regional cancer centre would have provided a facility with a certain level of services, but the £57 million plan will create a world-beater - a facility of international standard, and the international links fostered and deepened will ensure that we deliver a world- class service. That must be our vision, and people deserve nothing less. I recognise the urgent need to start building the regional cancer centre, but I am not convinced that private finance initiative (PFI) is the best route, either in cost or speed.

We have mentioned health and health promotion, and we need to consider the tobacco-smoking statistics and the number of young people whose health and lives are endangered from smoking. Smoking kills people - 3,000 people die prematurely because of smoking in this part of Ireland each year, with an annual in-patient care cost of £22 million. Smoking accounts for 30% of all cancers and 80% of lung cancers.

I welcome the Minister's and the Department's efforts to bring about a preventive process in the fight against cancer. It is important that we look not just at the statistics but at young women especially coming out of school. The first thing they do is light a cigarette. How to combat that and bring the message home that they are shortening their lives is of concern to us all. They are shortening lives that could play an important part in programmes and schemes for good health and in the future of this part of Ireland.

I congratulate the Minister on her Health Promotion Agency. We need more public health and prevention of illness campaigns. They should be central to our vision for health. I am pleased that the Executive last week endorsed the Investing for Health strategy.

I will return to the matter of resources. More people must be trained, and the Minister of the Department for Employment and Learning will support and facilitate that aim.

We must ask why there are not enough consultants and nurses. The origins of that problem extend back for 10 or 15 years. We must make changes to the training process, especially in specialist areas. I do not need to repeat - or perhaps I do - that the Health Service needs more money. I am sure that the Minister of Finance and Personnel will support this.

We must challenge the unfair Barnett formula, but not just for talk's sake. Either there is a case for challenging how the block grant is worked out, or there is not. We must challenge the British Exchequer, and the Executive, the First Minister, the Deputy First Minister, the Finance Minister and the Health Minister should all be engaged in that process. Most importantly, every party in the Executive, and every Department, must accept hard choices, because there will be hard choices in the battle against cancer.

As other Members have said, we must not forget those people who worked so hard to bring the report to the Assembly. It has been a massive piece of work for many people in the Committee, and we must thank all the people and organisations who made submissions. All those people expressed the same concerns about the underfunding of the Health Service and the way in which the whole foundation of cancer treatment is being run down, with staff having to use outdated machinery that breaks down. That is because we did not have the sort of funding required to give the Health Service the facilities to treat cancer patients.

I want to mention a few points from the executive summary of the report. The Committee recommends that:

That is where the primary care issue is coming into focus, because we are told that early detection of cancer is more than half the battle.

I want to quote also the recommendations that:

and

Education and training programmes play a vital role in the fight against cancer.

I thank again those who came to the Committee to give evidence and express the professional opinions that are contained in the report and its recommendations. Go raibh maith agat.

As a member of the Health Committee, I support the motion. I thank all the contributors who came from a wide range of interested groups concerned with cancer provision to give evidence and detailed accounts of their dealings with cancer services in Northern Ireland. It would be impossible to list them all, but they provided the Committee with a broad understanding of the entire cancer service provision in Northern Ireland. In particular, I commend Roy Spence and Patrick Johnston of Belfast City Hospital for their unstinting work in the cancer field. I thank the Committee Clerk for providing members with full briefings for each meeting of the Committee and for compiling the report. I also thank our Chairperson, Dr Hendron, for his detailed presentation, which left little more to be said.

The issue of cancer will, undoubtedly, touch every household in this country at some time. Cancer is set to become the biggest killer in Northern Ireland in the next few years. At current rates of incidence in the UK as a whole, one person in three will be afflicted before their seventy-fifth birthday.

In the UK, almost 250,000 new cancers are diagnosed every year, and there are over 140,000 deaths from the disease. In Northern Ireland, which is identified as having high levels of poverty and social deprivation and as lacking in health investment, it is unacceptable that cancer services do not enjoy a pro rata ring-fenced spending increase in line with the rest of the UK.

With that additional money, Northern Ireland's cancer services could support a strategic plan for improved staffing levels, facilities, equipment, drugs and information systems. Additional funding will be extremely difficult to acquire for Northern Ireland, such is the unfair and disproportionate level of funding it receives. For a country that is at the upper end of the socio-economic deprivation league compared with the rest of the UK, Northern Ireland has demonstrably lower funding allocations for health services.

During the 1990s, when expenditure on health in Northern Ireland rose by 35% in real terms, the rise in England was 57%. Although the contrast in percentage is evident, the disparity becomes more obvious when the differential with England is applied pro rata to Northern Ireland's health budget. Had Northern Ireland matched the increases for England, health and personal social services would have gained an extra £83 million this year, £138 million for 2002-03 and £214 million for 2003-04. Several Colleagues referred to those figures earlier. However, I believe that it is important to emphasise those amazing figures. I would like someone to tell me that those figures are fair and reasonable. The people of Northern Ireland are treated in a second-class fashion in relation to the proper and proportionate allocation of health funding.

The Committee for Health, Social Services and Public Safety undertook the inquiry into cancer services for three reasons. First, there was consensus on the need for a strong focus on the disease that is set to become our biggest killer. Secondly, Committee members were aware of the public's concern with regard to the equality of, and access to, cancer treatment across Northern Ireland. Thirdly, an inquiry would provide the opportunity to review what progress, if any, had been made in Northern Ireland since the Campbell Report in 1996.

The Committee's investigative remit included, at its core, patients' needs, provision of services, staffing levels of doctors, nurses and ancillary staff, variations in services for different cancers and the structure of the cancer centre and the cancer units. As Members can see, the Committee carried out a full investigation. It found that, although some progress has been made, more work and, more importantly, more money is required.

Not all of the 41 recommendations in the report will cost more money. Many of the recommendations concern good practice and should already be receiving attention from the Department. However, many other recommendations will need extra cash to achieve a successful outcome. In order to raise the provision of cancer services in Northern Ireland, the inevitable requirement is funding. The ambitious National Health Service cancer plan for England and Wales, which aims to deliver the fastest-improving cancer services in Europe over the next five years, is something that we should also aim for. The plan will receive considerable additional resources: some £280 million in 2001-02, £407 million in 2002-03 and £570 million in 2003-04. What does Northern Ireland receive in comparison?

I want to draw Members' attention to a report in the 'Daily Express', which I was reading this morning on my way from London. It states:

I am not for one moment saying that this is the route that we should take, but it is an interesting approach. The newspaper report goes on to say that, rather than spending lots of money on a "one-size-fits-all" breast screening programme that examines some women too often and others not enough, screening could be planned according to a woman's risk. For women with a very high risk of getting the disease, drugs such as tamoxifen may be useful preventative agents.

Last night, experts predicted that, within five years, it would be possible to provide a national genetic screening programme. If we are to make strides towards a breakthrough in the treatment of breast cancer, it is important for the money to be in place to bring those benefits to women diagnosed with the disease.

In relation to cancers caused by smoking, a newspaper this morning stated that America is now banning the sale of cigarettes to people under the age of 21. I believe that the previous age was 18, but it has now been raised to 21. America leads the world in the banning of smoking in public places. It also has stringent laws deterring young people from being caught in the trap of beginning smoking. Can something akin to that not be pursued in Northern Ireland? Why are we always lagging behind? Think of the money that the National Health Service would save in treatment, and of the number of man- hours that would be saved in the workplace.

The Executive's Programme for Government sets out their aims to improve the quality of health treatment and care for the people of Northern Ireland. How will that be done without additional funding? Northern Ireland's cancer services are not on a par with those in the rest of the United Kingdom. It is vital that substantial investment in cancer services be achieved if we are to receive the quality and level of care that should be expected in a modern, patient-centred Health Service.

It is important that this report follows on from the initiative first begun by the Calman Hyne Report in 1995, and by the Campbell Report in 1996, which has helped to increase the provision of cancer services in Northern Ireland. I hope that the Committee's report will not be wasted or ignored but will, in fact, spur us all on to get the proper funding that cancer services require. There is no doubt - statistics clearly back up the argument - that we are unfairly treated in Northern Ireland. I urge Members to support the report and to join together to demand extra funding for this service, which desperately requires our immediate attention.

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