Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Deputies Shortall and Murphy and their colleagues for tabling the motion.

It is a welcome opportunity to discuss what is set out in it. The Deputy is quite right that every three minutes somebody gets that call. Unfortunately, mine was one of the families that got the call 15 months ago when my husband was diagnosed with cancer. Thankfully, he has come through it so far. I understand the issues the Deputies have raised and, to be honest, I am surprised we are here alone discussing this. I lost my father in 1995 to cancer and I have an uncle who is getting radiotherapy today. There is not a family in Ireland that has not been closely affected. Some families seem to travel that road a lot, but I doubt that any family will ever escape it. Therefore, I welcome this debate.

The Minister for Health, Deputy Stephen Donnelly, has asked me to express his thanks to the Irish Cancer Society, which, through its tireless work, has played such a vital role in helping to transform the experiences and outcomes of people affected by cancer. That includes research such as the Real Cost of Cancer report. This is something on which the House can agree. The Minister looks forward to continuing to work closely with the society to further develop cancer care services and supports in the years ahead.

The opening line of the motion is sobering and highlights the challenges we face today. It is true that approximately 24,000 people are diagnosed with invasive cancer in Ireland each year, excluding the common but rarely fatal non-melanoma skin cancer. The reality is that the overall number of cancers diagnosed has continued to increase due to our increasing and ageing population. This underlines the importance of delivering on the National Cancer Strategy 2017-2026 with its focus on cancer prevention, diagnosis, treatment and patient supports. The vision of the strategy is: “Together we will strive to prevent cancer and work to improve the treatment, health and well-being, experiences and outcomes of those living with and beyond cancer". It is about preventing cancer across our population, diagnosing cancer early, providing optimal care to people and maximising their quality of life. The strategy provides a comprehensive ten-year roadmap for cancer services, and there has been significant progress on its implementation over the past four years. Clear, evidence-based policy direction from the Department of Health and strong implementation by the HSE of its national cancer control programme have resulted in real improvements across all stages of the cancer continuum.

We have the evidence to show that this approach is working. The most recent annual report published by the national cancer registry shows that the incidence of cancer per 100,000 people has fallen or at least stabilised in recent years and that survival rates for Irish cancer patients are continuing to improve. Five-year net survival for patients diagnosed from 2014 to 2018 averaged 65%, up from 42% for those diagnosed from 1994 to 1999. As the Deputies note in the motion, an estimated 200,000 people are living with and beyond cancer in Ireland today thanks to continued improvements in medical oncology, radiation oncology and surgical oncology services.

However, we must recognise that the national cancer strategy is not concerned solely with advances in treatment but also with improving the quality of life for those living with cancer. This is why the establishment and ongoing work of the cancer patient advisory committee is so important and why there is also a focus on providing grant funding and best practice guidelines for community cancer support centres and developing survivorship services, to support those living with and beyond cancer. I am reminded of the Solas Cancer Support Centre in Waterford, with which Deputy Cullinane will be familiar. It offers great support and services to people living with cancer and going through treatment.

Such progress has only been possible due to the significant Government investment in cancer services in recent years. Over budgets 2021 and 2022, some €97 million in additional funding was allocated to cancer services, of which €40 million was allocated specifically for the continued implementation of the national cancer strategy, building on the progress and momentum to date. A further €30 million was provided for new cancer drugs while €12 million was set aside for screening services. The remainder was used to ensure that cancer services continued to recover from the disruption caused by Covid-19. It is important to set out for the House the extent of the Government’s investment in cancer services in both financial and policy terms to clearly demonstrate our deep commitment to supporting the many thousands of people, and their families and carers, who are living with cancer in Ireland today.

Nonetheless, despite the investments in cancer services, the Minister for Health is acutely aware of the financial difficulties that people can face following a cancer diagnosis. It is true that cancer can place a financial burden on some individuals and their families through the combined impact of loss of income and additional costs associated with their treatment. This issue is not confined to cancer patients. Individuals diagnosed with other long-term illnesses may also have to cope with financial stresses as a result of being unwell. It is for this reason that supports to ameliorate the costs of illness should be available to all rather than focused on those with particular conditions. This is the principle behind the transition to universal healthcare envisaged by Sláintecare, where people access the right services based on need and not ability to pay.

With regard to inpatient health charges, under the Health Act 1970, as amended, all persons, irrespective of illness or condition, accessing public inpatient, including day-case, services in a public hospital are liable for the statutory inpatient daily charge, which is capped at a maximum of €800 in any period of 12 consecutive months. However, there are exemptions from these charges for identified groups of people, including, but not limited to, people with full eligibility, that is, medical card holders. As is the case for all patients, cancer patients can apply for a range of supports, including medical cards, and they are assessed under the criteria applying to all applicants. Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. Indeed, the Irish Cancer Society found that more than 80% of those diagnosed with cancer who apply for a medical card are successful, while medical cards are awarded without a financial assessment to all children under 18 years of age with a diagnosis of cancer, for a period of five years. Individuals with a terminal illness who have been certified by their treating consultant as having a prognosis of 24 months or less to live are also now eligible for a medical card without a means assessment. Everybody has welcomed that. Beyond this, the HSE has discretion to reduce or waive inpatient charges in cases of excessive hardship while, in certain circumstances, the HSE may grant a medical card even though an applicant exceeds the income threshold, where the applicant faces difficult financial circumstances, such as extra costs arising from an illness. Further supports are available to individuals, including those provided by the Department of Social Protection.

All patients require a responsive and compassionate health system to meet their medical needs. I believe that is the underlying intent of the Deputies' motion, and it is what the Government is continuing to work towards in terms of delivering an affordable, accessible and quality health service for all. As such, the Government does not intend to table a counter-motion. My colleague, the Minister of State, Deputy Rabbitte, will discuss progress being made on affordability later in the debate, as well as addressing some of the other issues raised by the Deputies in the motion.

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