Dr. Jerome Coffey:

I agree entirely with the Deputy on palliative care. The hospice movement has been hugely successful here. One of its successes has been finding alternative sources of capital funding to build facilities that were not there beforehand. In terms of funding for the future, a couple of things need to happen. Without betraying confidences, in the cancer strategy there is a recommendation that the cancer control programme in the Department of Health integrate palliative care. There is a HSE palliative care programme and we work very closely with Dr. Karen Ryan, who is the lead physician on that. We need to have palliative care integrated with cancer control programmes in order that we are not neglecting that part of the service and there is no geographical neglect either. In terms of funding, I take the Deputy's point. More staff means more funding. Overall, though, the biggest driver of cost in cancer care is drugs. The cost of cancer drugs is massive. They are more effective than before and have fewer side effects and consequently we want to be able to fund them for our population but that is the biggest element in driving the total cost of cancer. The provision of personnel is important and will happen. It will not be as difficult to achieve as the funding of cancer drugs over the next 20 years.

On the vaccination point, it is very difficult when one is talking to parents whose child is ill and became so after vaccination. It is also important to say that potential side effects of vaccines are reportable events. There is a data collection process for that. At this point, the scientific evidence and guidelines coming from the European bodies do not link the two. If there was any evidence that added up to a note of caution or precaution, then the cost-benefit of vaccination would be entirely different. Were we to state it is very effective at reducing the risk of various sorts of cancers in the long term but there is a 5%, 10% or 15% chance of permanent side effects from a vaccine given at a very young age, the decision to be made by parents would be very different. Having put all that together, the scientific evidence and guidance is that vaccination is effective. The causative link between the vaccination and the side effect that some children are experiencing has not yet been proven. If that were to change there would be absolute urgency to change the policy. Until that point, the cost-benefit is still in favour of vaccination.