Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I commend Sinn Féin and Deputy Cullinane for bringing forward this important motion. It must be said that we could be here every night for the next fortnight talking about what amounts to neglect of different aspects of the health service and the storing up of significant problems for the future. That could apply to the lack of speech and language therapy for children, the absence of audiology services which is damaging to the children concerned, or a whole range of different areas of healthcare that have been put on ice for the past six months or so. We are storing up big problems down the line.

Cancer services stand out because cancer can, unfortunately, be life-threatening in many cases and is life-altering in all cases. Cancer is set apart in many ways by the importance which we should attach to it and cancer services need to be protected to the greatest possible extent. We have not seen that happening in the past six months.

Over the years, cancer strategies have been very hit and miss. New strategies have been introduced every ten years or so since the first launch of the cancer strategy in 1996. It was followed, ten years later, by the strategy for cancer control. The current national cancer strategy came in more than ten years after that. The thinking behind those strategies was that cancer had to be treated as a different, more important area of medicine. It is only right for that to be the case for the reasons I have already mentioned. Priority was to be given to this area of healthcare through a stand-alone service based on centres of excellence. Prior to that, as befits the strange nature of the Irish healthcare system, small hospitals in every corner of the country were trying to provide cancer services. That was not the way to go and, for that reason, the idea of centres of excellence was identified and proved to be the right kind of approach, in the main.

The adherence to, and funding for, those cancer strategies has been hit and miss over the past 20 years or more. Energy and attention would be focused at the launch of a strategy but would inevitably wane. It is true to say that too often in the past, people with private health insurance or those who could afford to pay for private healthcare had priority. Obviously, the resultant recovery rates were substantially better for people who could get quick access to treatment and pay their way. The fundamental unfairness was identified in each of those three strategies and could have been addressed if successive Ministers and Governments had ensured that all of the other elements of the health system were properly resourced and in place. Unfortunately, over the years, attempts have been made to implement cancer strategies while, at the same time, there have been problems in the adequacy of diagnostics, bed and staff capacity. Those shortages have dogged cancer services as well as many other aspects of the health service.

Of course, all of those were identified within Sláintecare as issues that had to be addressed if we were to bring our health service up to a modern standard that could provide a public healthcare system on a timely and equitable basis. If we had started implementing Sláintecare in 2017, we would be nearly halfway down to the road to a modern, responsive and timely healthcare system. It is unfortunate that has not happened. Three years has been lost and the Minister's partners in government, Fine Gael, are largely responsible for that but his own party must also accept responsibility for not making the implementation of Sláintecare a priority over the past three years, especially when it came to budget negotiations and commentary. The Minister seems to be quite content to go off on tangents, looking for money to be put into the National Treatment Purchase Fund and other attention grabbing things like that, without giving a commitment to funding the Sláintecare programme, to which we are all supposed to be committed. There has, unfortunately, been a lot of slippage on that.

It is important to bear in mind that there were serious problems in the implementation of the cancer strategy before the Covid-19 crisis. The Minister has quoted figures, which is fine, but, on a European scale, we are still quite a bit down the list.

While we made progress on our previous performance relative to other European countries, it has not been great.

The implications of Covid have been pretty devastating for cancer services. Obviously, initially and understandably everything was put on hold in regard to cancer and other services. After a few months, a number of critical cancer services resumed, including oncology surgery and radiation.

An awful lot more could have been done in terms of utilising the capacity in private hospitals. Many of us, including the Minister, followed the use of private hospitals and it was very poor during a large part of that period. We were paying very substantially for what amounted to spare capacity. I could never understand the argument put forward that the capacity needed to be protected and saved. A lot more people could have been treated while at the same time keeping capacity to free up more beds in the event of an early second wave. That was disappointing.

It was also a mistake to delay the screening of people who were in treatment, which has resumed. I am glad we are now finally getting to the point of resuming regular screening services. CervicalCheck, BreastCheck and bowel screening are critically important. Prostate screening needs to resume.

A couple of things are now happening, apart from the failure to completely utilise the private hospital capacity. I am concerned about staff that have been diverted from core health services into testing and tracing. In my view, that is unforgivable. Those dedicated staff should have been recruited during the lull in the summer months and we should not be diverting staff from other important services. It is also really important that the workload for GPs is lifted to enable them to start providing their regular services.

I wonder why we are requiring anybody looking for a test to go to a GP first. Why not go directly to a test centre? I cannot understand that. Why are we diverting so many people to GPs for the flu vaccine rather than having school-based programmes or extending pharmacy programmes?

The Minister will be tested on the extent to which he succeeds in making the case for and achieving considerable budgetary allocations. Cancer services must be a priority and he must make that case very clearly to his colleagues.

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