David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I am sharing time with several of my colleagues. I thank the Social Democrats and An Teachta Shortall for bringing forward this important motion. Obviously, Sinn Féin will be supporting it and we will continue to advocate for the removal of hospital inpatient charges, car parking charges and other taxes on being sick on a phased basis, balancing medical and financial need. My party believes in a single-tier universal healthcare system that delivers care when and where it is needed on the basis of need and not the ability to pay.

I will deal with the substantial issues raised in the motion in a moment. It is important to reflect on the wider context of where we are in our healthcare system and fundamental promises that were made by the political system to which all parties signed up in the form of Sláintecare.

We have not addressed the issue of reducing the cost of healthcare to any great satisfaction. We have not moved in any great regard on delivering universal primary care, starting with universal GP care, which is moving at a snail's pace. What was provided for in the budget for six and seven year-olds is still not in place because of ongoing talks with the Irish Medical Organisation and GPs. We have real crisis with GP capacity. The Government has not even started to address many issues that need to be sorted, including looking at demographics and demand in the context of capacity. We have not moved on decoupling private medicine from public hospitals and we have not moved substantially on waiting lists, which are going up. Despite the big promise made to all patients, including cancer patients, that we would deliver a better healthcare system, we have not made the strides forward that we need to make, although I am aware that we have been through a pandemic in recent years. This is without getting into regionalisation and other issues that are important to the delivery of the necessary reforms.

No patient, but especially someone with a terminal cancer diagnosis, should be hounded, threatened and terrified by debt collectors. I am sure the Minister of State, Deputy Butler, and other colleagues in the House have seen some of the letters sent to patients by debt collectors. They are nothing short of intimidation and they put additional stress on patients who may already have financial difficulties and are already dealing with the stress of cancer. The HSE spends nearly €4.5 million on debt collectors each year. This sounds like the furthest thing from a health system that is supposed to be moving to a universal healthcare model. We have to end this practice, particularly for patients with cancer and chronic conditions.

A cancer diagnosis is a life-altering event. Nearly one in two people will develop cancer during his or her life. The rate of cancer is equivalent to someone being diagnosed in the State every three minutes. Every hour, a person dies from cancer. Cancers are the leading cause of death, with nearly one in three deaths linked to cancer each year. Cancer is a massive burden on the individual, his or her family, the wider community and society. We experience it collectively and either personally or through someone we love.

As the Minister of State will be aware, a cancer diagnosis can be devastating physically, mentally and emotionally but also financially for the person who has cancer and his or her wider family. Thousands of cancer patients face into a financial burden in the region of €700 to €800 per month, which is nearly €10,000 a year. At the same time, many are left out of work or on reduced hours. The average household can lose out on €18,000 per year, which can devastate any household at the wrong moment. Obviously, low-income households are particularly vulnerable. Consider any family dealing with a cancer diagnosis and the additional stress of associated financial costs. How could the Minister of State justify setting a debt collector on them and tolerate the sending of threatening letters in an attempt to recoup a small amount of money, at most a couple of hundred euro, from a family that is already struggling with so much? Given its prevalence and potential severity, it is only right that beating cancer and supporting people with cancer is a top priority for us individually, the political system and the wider community health system.

I appreciate that in the past couple of budgets additional funding was made available for the national cancer strategy. I commended the Minister for Health on putting forward additional spend. However, many of the key performance indicators in the national cancer strategy have still not been met or have not been implemented. These will require further resourcing and support over the next years. There is a lot more work to do, in particular to catch up on the pandemic backlog and the cancers missed over the past two years, but also to deliver the top-class cancer treatments that are available to private patients in the State to public patients through a model similar to the National Health Service in Britain.

While cancer services in the State remain one of the better performing parts of the healthcare service, thanks to the efforts of the medical and healthcare professionals in that field, unfortunately a lot of progress remains to be made. In particular, access to innovative new treatments must be expanded, as well as access to therapeutic clinical trials. The cancer strategy set a target that 6% of patients would have access to clinical trials but only 3% of cancer patients have access to such trials. In a recent meeting I had with the working group for an all-island cancer research institute, cancer researchers stressed the need to reach and beat that target. Medics want it, patients want it and research needs it. I was told by this group that up to one in five cancer patients in England have access to all clinical trials. Denmark provides access to trials at a rate three times higher than we do. For all patients, particularly those with severe and complex cancers, we must do better at attracting clinical trials and enabling patients to access them. This can be done on an all-island basis to access to maximise access and trial availability. Patient advocates on both sides of the Border have been calling for this.

Wealth should not determine a cancer outcome, or any health outcome for that matter, but we know it does. Despite the investments in other cancer strategies to date, access to life-changing treatment for some severe cancers remains restricted and only accessible to private patients. A public patient seeking access to immunotherapy to prevent the recurrence of melanoma, for example, with the same condition as a private patient, faces a constrained system where the first option is often restricted to "watch and wait".

We also have a huge problem in the public system with diagnostics. Rather than more outsourcing and giving more money to the private sector to do more diagnostics, we need more investment in community diagnostics to properly equip GPs to improve their access to diagnostics. Perhaps because of the ideology of the parties in government, we have got into the habit of outsourcing everything. We outsource diagnostics and treatment to the private sector and we outsource the hiring of staff rather than properly investing in the public system, as we need to do.

I thank my colleagues in the Social Democrats for tabling this motion and again putting the very important issue of cancer on the political agenda.

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