Ms Rachel Morrogh:

In Ireland today, many cancer services are struggling to meet patient demand. At the Irish Cancer Society we see the impact of this every day. Through our support line, daffodil centres, night nurses, advocacy network, fundraisers and volunteers, patients share their experiences, and the human side of cancer care is revealed. Patients have told us about the layers of additional anxiety and distress of having cancer in a pandemic. As well as this, we have been struck by the overwhelming fear and loneliness felt by people who have received life-changing news alone and who have spent considerable periods of time cocooning since March. We thank every healthcare worker who has made this journey easier through his or her kindness, professional knowledge, understanding and empathy shown to the thousands of patients who are currently using Ireland's cancer services.

The Irish Cancer Society is in the business of hope. We know that cancer numbers are growing, but we believe things can and must get better. We point to the national cancer strategy and the incredible cancer workforce in Ireland and we say that the future is positive. Yet, the performance of some cancer services is getting worse, not better, due to historical underfunding, lack of capacity in the system and an under-resourced and incomplete workforce.

Thankfully, this has been recognised by the Minister for Health and cancer services received substantial funding in the budget this year. However, the scale of the challenge is immense. While increased funding is vital, money alone will not solve all the problems. Covid-19 has had a devastating effect on a system that for many years had insufficient capacity to be able to assure people that they would get diagnosed and treated for cancer as quickly as they should. Insufficient hospital capacity, inbuilt inefficiencies and too few healthcare professionals along with an increase in cancer cases of between 3% and 4% annually has led to lengthy and growing waiting lists. Longer waiting lists mean delays in diagnosis and treatment. Delayed diagnosis and treatment can mean worse patient outcomes. The truth is that, in Ireland, access to care is being rationed by waiting lists, and until these are eradicated, patient care and, sometimes, outcomes will be compromised.

I appeal to committee members to imagine being symptomatic but being unable to get timely access to a test to find out what is wrong. This is the reality for thousands of people waiting for a diagnosis in Ireland. For instance, we understand that there may be in excess of 100,000 people waiting for a radiology appointment. This includes urgent, semi-urgent and routine waiters for ultrasound, CT and MRI tests. The demand for radiology services is steadily rising at an annual increase of between 8% and 10%. In the national cancer strategy, the vital role of radiology in diagnosing cancer was called out and the strategy document outlined that there are substantial deficiencies in access to such services. In Ireland, recent reports have found that we have fewer radiologists and radiographers than is recommended by international best practice. This has led to high workloads compared with peers in other countries and correspondingly high waiting lists for patients.

Timely access to cancer treatment is vital. Yet, capital investment to expand capacity and infrastructure in many oncology day wards throughout the country was badly needed pre Covid. Medical oncology was routinely working above capacity. Now, the reduction in hospital occupancy capacity to 85% in line with clinical guidance on safe practice for patients and staff and the ongoing risk that staff will need to take Covid-19 leave puts further pressures on waiting lists. Even if capacity is expanded, we doubt that additional staff are available. In the case of surgical treatment, only seven in ten patients were able to get care within the appropriate timeframe up to the end of 2019. Covid-19 has made accessing operating theatres more difficult, and timeframes from diagnosis to surgery are of particular concern to us.

One of the most critical key performance indicators in the national cancer strategy, which relates to the centralisation of surgery, will be missed at the end of this year. Progress must be accelerated in this area. We have previously called for protected surgical time for oncology cases and we believe the national cancer control programme needs to consider how to improve diagnosis-to-treatment timeframes.

Another area I wish to draw to the attention of committee members is genetic services. Waiting lists exist at every point on the pathway for people who have or may have a genetic risk of cancer. Currently, genetic services and the downstream services that are needed by patients are underdeveloped and under-resourced. As well as the development of genetic services as envisioned in the national cancer strategy, we are keen to see the development of a dedicated pathway for breast cancer gene, BRCA, positive patients and an audited quality-assured screening programme for them. More capacity needs to be created in downstream services so that a dedicated group of physicians can follow these patients and discuss options and psycho-oncology support. Patients have told us that the lack of capacity is illustrated by the fact that if they choose to have risk-reducing surgery, some women cannot be given a date for when reconstruction can happen.

Lastly, great cancer care is intertwined with cancer research. Research is the driving force for ongoing improvement in cancer outcomes and motivates hope among patients and the world-class experts who give them care in this country. Yet, the metrics suggest that research activity is significantly declining rather than growing. Some of the issues I have illustrated are related to a lack of investment in capital infrastructure and service development. Equally, the challenges associated with the cancer workforce are a significant threat to the success of the national cancer strategy. The implementation of many recommendations is wholly reliant on having enough staff with the right skills and access to the best equipment to deliver cancer services. Healthcare professionals underpin the success of the entire strategy.

The Irish Cancer Society believes that there has never been a more urgent time to focus on cancer services. We are grateful for the funding injection into cancer services that the Minister for Health, Deputy Stephen Donnelly, announced as part of budget 2021. We believe it will be one element of the many that are needed to build a strong and resilient cancer service.

I thank committee members for remaining focused on the performance of cancer services and for acknowledging the major challenges that have built up over a considerable period. Committee members have refocused political attention so that cancer does not become the forgotten C during the pandemic. Covid-19 has had a devastating impact on all of our lives. When it comes to cancer, however, it is the things we do today and the measures we put in place here and now that will decide the ultimate impact of this pandemic on our cancer outcomes.

I said we are in the business of hope. Together all stakeholders - patients, healthcare professionals, representative groups, members of Government and Members of the Oireachtas - need to turn hope into action. We do this by demanding improvements, listening to and learning from experts, putting in place best practice and making sure we have efficient, well-funded and well-staffed cancer services. I firmly believe that everyone here today can play a role in achieving that.