Mr. Steve Dempsey:

I thank the committee for its time this morning. It is very much appreciated. One of the most important functions of the Irish Cancer Society is amplifying the voice of cancer patients for politicians. I want to start by giving the committee a flavour of some of the things we hear from our support line and in our daffodil centres. One patient asked for advice in relation to a suspicious lump noted during an endoscopy and they were told they would be waiting around one year for a biopsy. Another told us their scheduled surgery was cancelled due to overcrowding. They are still awaiting a new date nearly three months later. Another patient was waiting 18 weeks after surgery to commence radiotherapy. They had been given no date for planning an appointment and were really concerned. One 34-year-old patient had been informed they had a platelet count so low they were referred to haematology in their local hospital, and they got an email from the hospital to say they would not be seen for three months. Finally, a Ukrainian living in Ireland told us that they had bowel cancer symptoms. Due to long delays in waiting time for colonoscopies, however, they returned to Ukraine for a colonoscopy and subsequent surgery for bowel cancer.

In 2024, our nurses had 28,000 interactions like these with members of the public. It is no surprise given that one in two of us will get cancer in our lifetimes. Cancer is the leading cause of death in Ireland, and while our mortality rate is 13th out of 27 EU countries, we have the third highest mortality rate in western Europe. By 2045, twice as many people will have a cancer diagnosis compared with 2015. Survivorship is on the rise, which is great news, but it is rising further and faster in other countries.

The Irish Cancer Society feels that a complacent notion that we are doing very well has crept into the dialogue around cancer, and while cancer outcomes have improved in the past 30 years, we do regularly hear about delays, issues with staffing and other critical concerns. To give a flavour of those - these numbers relate to January to July of this year - more than 4,100 people were waiting more than the recommended 28 days for urgent colonoscopies, 5,800 women were not seen within the recommended ten working days at urgent symptomatic breast disease clinics, some 880 people did not start radiation therapy within the recommended 15 days, and not enough patients with pancreatic, prostate, breast or lung cancer were getting their cancer surgery within recommended timeframes.

These issues, while startling, are a direct result of the lack of consistent ring-fenced funding for our national cancer services. They indicate a dire failing, and it is not a failing of the strategy itself, the HSE or the national cancer control programme but, rather, a political failure of successive Governments which have not adequately funded the national cancer strategy. Given the complexity of funding streams and the cost of medicines, it is very hard, from our perspective, to say what adequate funding should have been for the current strategy that runs out next year. Our understanding is that over its lifetime the projections for the strategy should have resulted in incremental increases in funding year on year, and this would have allowed it to scale up and facilitate long-term planning in relation to staffing, infrastructure, capital expenditure and other things. The strategy received incremental funding in fewer than half of the past nine budgets, and this year we are told the funding will be allocated directly to REOs via a letter of determination outside of the budget. Weeks after the budget, we have no notion of the funding for next year’s cancer services and we may never get that detail. This is due to a new budgetary process in health which we are told is designed to empower the REOs. We have received reassurances from the Department that it is committed to a review of the current national cancer strategy and that there will be a follow-on cancer strategy after this one. It has also stated there is no desire to undermine the role of the NCCP in the next strategy, which is really good to hear. However, we do have a real concern that the good work that has been done to centralise cancer services in previous cancer strategies will be undermined in a push for regional subsidiarity.

It is worth reminding ourselves that the cancer strategies to date have worked. It is important to note that between 1994 and 1998 only 44% of Irish people were alive five years after a cancer diagnosis, but by 2018, after our first two national cancer strategies, that percentage had reached 65%. One of our messages is that centralisation has really worked. Patients have benefited from multidisciplinary services in one location, where cancer is treated in all its complexity with surgery, radiation therapy and medical oncology. For example, breast cancer surgery, which used to happen across 32 hospitals, is now centralised to eight cancer centres. That sort of specialisation really makes a difference in outcomes.

We also wish to point out a similarity, and some of the differences and divergence, with Denmark, which seems to be doing this quite well. We were in a similar position in the year 2000. In 2000, one in two people survived cancer in both Ireland and Denmark. Cancer survival rates in Denmark are now at 71%, and ours, while increasing, lag behind the Danes, at 65%. We have similar populations and healthcare expenditure relative to population. What has Denmark done differently? It has invested heavily in scanner systems. It has double the computed tomography, CT, scanners and more than five times the positron emission tomography, PET, scanners of Ireland. In the past few years, it has launched three times as many clinical trials as we have annually, and it offers quicker access to new medicines. Some 69% of new cancer medicines for breast and lung cancer are reimbursed in Denmark, compared with 39% in Ireland. Earlier this year, it launched its fifth initiative in the state's cancer plan. Critically, from our perspective, this included commitments to ring-fence the plan with €80 million in funding. Underpinning all this success is political consensus, and this is really where the battle with cancer is going to be won or lost in Ireland. From the 1990s onwards in Denmark, all major parties agreed that cancer should be a priority. The chief executive of the Danish Cancer Society stated, "Politicians must promise each other there is going to be a long, lasting partnership. And health leaders need to operate on a 10, 15, 20 year basis.”

What we want to discuss with the committee, and what we really want its help with, is to get an understanding of how funding will be allocated for cancer services in 2026, and what the role of the NCCP is in relation to the letter of determination to the REOs that will be sent out in due course by the Minister. We do not have a timeline yet. In the longer term, we want to build a political consensus to set up the next cancer strategy for success and that would include multi-annual ring-fenced funding to allow for long-term planning, staffing and capital expenditure. In particular, given there is a new role for the REOs in the budget process, it is critical that we get an understanding of the status of the NCCP going forward. It needs to be more than an advisory body floating somewhere between the HSE and the REOs. It has the expertise and knowledge to improve cancer outcomes in Ireland and we need to ensure it has the reach, resources and muscle to do that.