Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I move:

To delete all words after “Dáil Éireann” and substitute the following: “notes:

— that the National Cancer Registry of Ireland records that over 23,000 people are diagnosed with cancer annually, with a further 20,000 people diagnosed with the common but rarely fatal non-melanoma skin cancer;

— the lack of clear comparable data on incidence across jurisdictions given variations in the nature of data collection and registration;

— that survival for Irish cancer patients continues to improve according to the National Cancer Registry’s Annual Report, with an estimated 180,000 people living after a diagnosis of invasive cancer other than non-melanoma skin cancer at the end of 2017;

— a 15 per cent improvement in breast cancer survival over the twenty years to 2015;

— that in a report by the International Agency for Research on Cancer (IARC) on cancer survival rates across seven high-income countries, Ireland showed the greatest improvement in survival for stomach and oesophageal cancers and the second highest improvement for rectal and ovarian cancers;

— the Government’s commitment to continued improvement in cancer outcomes, through research, prevention, early diagnosis and high-quality safe care;

— the progress made in implementation to date of the national cancer strategy

published in 2017 including:

— legislation on standardised retail packaging for tobacco;

— the passage of the Public Health (Alcohol) Act 2018 in October 2018;

— the development and launch of Ireland’s first National Skin Cancer Prevention Plan in 2019;

— the commencement of the roll-out of the National Cancer Information System which was launched in November 2019;

— the appointment of National Clinical Leads for Psycho-Oncology, cancer nursing, children, adolescents/young adults to provide leadership and focus on planning, development and implementation of key areas of the national cancer strategy;

— the publication and launch of the National Clinical Guidelines for Ovarian and Oesophageal Cancer in August 2019 to help healthcare professionals with the diagnosis, staging and treatment of patients and to standardise practice;

— the delivery and expansion of the Cancer Thriving and Surviving Programme in acute and community settings to provide patients with a programme to help with the transition from active treatment to living well with and beyond cancer;

— the publication of the National Cancer Survivorship Needs Assessment in August 2019, which will underpin improvements in meeting the needs of the increasing number of cancer survivors in Ireland;

— the establishment of a National Cancer Research Group in June 2019; and

— the construction and opening of a new radiation oncology facility in Cork in 2019, with work commencing on a new facility in Galway in 2020;

— the establishment and continued work of the Cancer Patient Advisory Committee, the role of which is to ensure the patient’s voice is heard, and to provide input into the development of programmes for patients with cancer;

— the introduction of the Human papillomavirus (HPV) vaccine for both boys and girls in their first year of secondary school, as a key element in prevention of cervical cancer and other related cancers;

— that Ireland has three advanced cancer screening programmes, namely BreastCheck, CervicalCheck and BowelScreen which have evolved and expanded over the years since their establishment, in line with international best practice; and

— that the CervicalCheck Screening Programme transitioned to HPV cervical screening on 30th March of this year which means that any test taken after this date is a HPV cervical screening test with follow-up cytology if required;

recognises:

— the unavoidable impact of the Covid-19 pandemic on cancer services, and the significant worry that it is causing cancer patients, their family and friends;

— that the National Action Plan on Covid-19, published on 16th March, identified the protection of cancer care as a key priority;

— the significant additional funding provided to the health services in 2020 to manage the response to Covid-19 and to maintain time-critical essential services including cancer services;

— that cancer services continued throughout recent months, albeit at reduced capacity, with the significant focus on maintaining these critical services through the use of:

— national agreed guidelines for the continued provision of cancer treatment during Covid-19;

— the use of private hospital facilities to maintain urgent cancer surgery and facilitate medical oncology in some instances;

— initiatives such as relocation of day wards as necessary for medical oncology;

— continuation of radiation oncology with provisions for physical distancing in place;

— recruitment of acute oncology clinical nurse specialists to facilitate hospital avoidance where appropriate and support timely, streamlined access for cancer patients to services;

— virtual/telephone clinics where possible; and

— provision of support to cancer patients and their families through the Together for Cancer Concern, a joint initiative between the Irish Cancer Society and the Health Service Executive (HSE) National Cancer Control Programme;

— the initial public reticence to attend for cancer services due to fear of infection and efforts to address this including through public advertising campaigns, and the collaborative approach taken between the National Cancer Control Programme (NCCP) and the Irish Cancer Society in that regard;

— that in light of the unprecedented public health challenges posed by the Covid-19 global pandemic in March 2020, the National Screening Service’s (NSS) four national screening programmes - BreastCheck, CervicalCheck, BowelScreen and Diabetic RetinaScreen were paused in March; and

— that during the pause clinical staff continued to work within the screening programmes and people who were in the system at the time of pause have continued to be treated as hospital resources allowed and women availing of BreastCheck screening services who had been screened continued to have their assessments completed and their treatment plans mapped out by the service, surgeries continued to be scheduled and completed, and with regard to CervicalCheck, colposcopy assessments and follow-up treatments continued for women who had been screened before the pause; and

supports:

— the restart of a phased reintroduction of screening services;

— the NSS to continue to prioritise the safe and effective resumption of the screening programmes, with regard to addressing the postponement of screening which has already occurred for people affected during 2020;

— the NSS in taking measures to protect both participants and staff and in monitoring the delivery of screening to ensure their continuing safety in order to ensure a safe resumption and delivery of screening services in the context of the Covid-19 pandemic;

— the priority focus now, in the context of the next phase of the pandemic, of facilitating cancer services to return to pre-Covid-19 levels, and in a safe and effective way in the context of overall HSE planning on increasing delivery of non-Covid-19 services; and

— the full implementation of the widely supported and evidence based national cancer strategy 2017 – 2026, as is committed to in the Programme for Government and in line with Sláintecare to underpin continued improvement in survival for cancer patients.

I welcome the opportunity to address the House on cancer services. I thank Deputy Cullinane and his party colleagues for tabling the motion. I thank every Deputy this evening for offering ideas and solutions. I acknowledge that many Deputies have shared very personal experiences about how cancer has affected them and their loved ones. I do not imagine there is one of us here who has not been affected, either directly or indirectly.

I agree so far with pretty much everything I have heard. Deputy Cullinane and I can debate what should be €5 million, what should be €10 million and what should be €20 million and the best way to deploy the money but he is right that the funding for the cancer strategy has not materialised at the rate it needs to. He is right also that we need more funding in a time of Covid. The cancer services and services across the system are operating at reduced capacity. Some are only a little reduced but some quite a lot. I agree the screening services need to be up and running. I am not sure they need additional funding but if they do, I will provide it. We can debate the details about how money is allocated and how much is required but I agree we need to do more, to fund more, to target and to address the issues raised here this evening on behalf of every single family in our country.

Almost every family has been touched by cancer and the Irish Cancer Society pointed out that one in two people in Ireland will be diagnosed with cancer at some point in his or her life. Thanks to the works of doctors, nurses, medical scientists and many others around the country, the outcomes have improved enormously. We need to keep improving and ensure that those who receive a cancer diagnosis get the best care and that they get the diagnosis as early as possible. The countermotion I have tabled this evening provides a firm commitment to that and to the national cancer strategy and a focus on maintaining critical cancer services throughout the pandemic.

Covid-19 has had a significant impact on our health services, including cancer services, as Deputy Cullinane said. Understandably, this has caused much anxiety and concern among patients and their loved ones. Our doctors, nurses and healthcare professionals have done incredible work over the past few months and this has ensured that cancer services have been maintained to the greatest degree possible while keeping patients and healthcare professionals safe.

The national action plan on Covid-19 identified the continued provision of cancer care as an absolute priority and it remains an absolute priority. Symptomatic breast disease clinics and rapid access lung and prostate clinics have continued to operate while prioritising urgent cases. Fewer referrals were made to symptomatic clinics, which is an issue I raised not too long ago in opposition. Fewer people have presented to their GP with symptoms. That is a worry. I am happy to report that these clinics are now returning to normal levels of referrals but we must be cognisant of the dip between March, when Covid arrived here, and now. Urgent cancer treatment, including surgical oncology, radiation oncology and medical oncology has continued. Private hospital facilities were used in some cases to maintain urgent cancer surgery services. Some day wards were relocated to ensure the ongoing provision of medical oncology treatment. In order to ensure the continuation of radiation oncology, measures to ensure physical distancing were put in place and a return to surgical and medical oncology services is now under way in many centres. Virtual and telephone clinics are being used where possible. The national cancer control programme, the Irish Cancer Society and Cancer Care West deserve great credit for the work they have done since March. They have provided a virtual community of care for people who are struggling with the emotional and psychological effects of living with cancer. I acknowledge the incredible work those three groups have done this year.

In light of the unprecedented public health challenges posed by Covid-19, the national screening service's four national screening programmes were paused in March. A similar pausing of population screening programmes has occurred elsewhere, including in Northern Ireland, Scotland, England and Wales. A recent WHO survey found that, across the world, it was quite regular to see governments pausing their national screening programmes. Critically, treatment did not stop. Clinical staff continued to work within the screening programmes and people who were in the system at the time of the pause have continued to be treated in hospitals, not as they were before but insofar as resources have allowed in an extremely challenging time. Women availing of BreastCheck screening services who had been screened prior to the pause had their assessments completed and treatment plans mapped out. Surgeries continued. Colposcopy assessments for CervicalCheck and follow-up treatments continued for women who were screened before services were paused.

Three of the four screening services, I am happy to report to colleagues, have now commenced a phased reintroduction of services. CervicalCheck recommenced at the beginning of July. BowelScreen resumed the issue of new invitations for screening on a phased basis from the 4 August. It is projected that BreastCheck will resume in the coming weeks, again on a phased basis.

I have been assured that the national screening service has a plan in place for the safe and effective resumption of screening. With regard to addressing the postponement of screening for those due to be screened in 2020, something we need to look at very carefully, CervicalCheck aims to have issued all invitations by spring 2021, which would deal with the very substantial backlog - if I may use that word - from 2020. BowelScreen's endoscopy units have already increased their operating capacity now to more than 50%. The programme aims to invite new participants for colonoscopy by December 2020.

The CervicalCheck screening programme transitioned to HPV screening on 30 March, which was fantastic to see. Any test taken after this date is a HPV test with follow-up cytology, if required. We should be proud of our screening services and our healthcare system. We join a small group of countries, including Australia, England, the Netherlands and Wales, that employ this best-in-class screening for cervical cancer. This improved testing methodology, along with the continued roll-out of HPV vaccine, will mean that in Ireland over the next ten to 20 years we can look forward to a very significant and very welcome reduction in the incidence of cervical cancer cases, something we should be proud of.

The national cancer strategy was published in July 2017 and provides a comprehensive ten-year roadmap for cancer services. The most recent annual report by the National Cancer Registry provides evidence that survival rates for Irish cancer patients continue to improve. The figures are impressive. In the late 1990s, the average five-year survival rate for men, excluding non-melanoma skin cancers, was 39%. It is now 63%. That is impressive. For women, it went from 39% to 60%.

My Department, in conjunction with the national cancer control programme, has overseen significant progress towards the implementation of the national cancer strategy since its launch in 2017. Achievements include: the development and launch of Ireland's first national skin cancer prevention plan; the construction and opening of a new radiation oncology facility in Cork; the appointment of national clinical leads for psycho-oncology, for cancer nursing and for children, adolescents and young adults; the establishment of the cancer patient advisory committee; and the establishment of a national cancer research group. As part of the service planning for 2020, an additional €3.5 million in development funding was provided.

Implementation of the national cancer strategy forms a part of the programme for Government and is in line with the objectives of Sláintecare. In that context, implementation of the strategy will be a priority for me and for the Government.

The past six months have been incredibly stressful and traumatic for cancer patients, their families and the amazing men and women who treat them. Our immediate focus is to restore cancer services to pre-Covid-19 levels while keeping patients and healthcare staff safe. The Government's priority is to implement the national cancer strategy. This strategy will save many lives and prevent large numbers of people, including family members, friends, neighbours and colleagues, from becoming seriously ill. We have a plan and it is saving lives already. We will implement it and it will save many more.

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