Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

I thank Sinn Féin for bringing forward this motion. It is important that we are honest about the failings of this Government on cancer care. I had hoped that the Minister, Deputy Donnelly, perhaps on Daffodil Day on 22 March or as part of, or instead of, a countermotion, would have announced a commitment to funding a national cancer strategy in the upcoming budget. It would not have been seen as flying a kite or a cynical act. It would have been broadly welcomed, given the debacle we had last year and in previous years, and the desperate need we have for funding of our national cancer strategy. Alas, it does not seem that the Minister is minded to do that at this point. The closer we get to the budget without such a commitment, the more we all fear a repeat of last year and the year before.

In budget 2024, funding was not allocated. Since the national cancer strategy was most recently updated in 2017, it has received just €40 million in new developmental funding when we know it requires €20 million annually. It is not penny-wise and pound-stupid but penny-stupid and pound-stupid. In fact, it is penny-pinching of the highest order for a disease that has touched, either directly or indirectly, the lives of everybody in this country.

The reality is that this Government has only properly funded the national cancer strategy in two of the past seven years. As the motion rightly points out, it has not revised the funding requirements in light of inflation, demographic changes that were not predicted or the impact of the Covid-19 pandemic. In fact, if we were to put a report card against this Government on cancer care, it would make for shocking reading. On the national cancer strategy, it would have to be granted a failing grade. We have only achieved one of the 23 objectives of the strategy according to the latest progress report. That also would require a failing grade. Ireland performs poorly in comparison with our western European peers in the uptake of cancer screening programmes. It is failing in that regard. Waiting times for certain treatments, such as radiotherapy and colonoscopies, are increasing. We are failing in that regard as well. It is absolutely unacceptable that the Government has gotten cancer care so wrong, particularly with so much money in its coffers and those of the Minister for Health.

Earlier this year, I asked him about the impact on a number of cancer care programmes of the decision not to award any new development funding to the national cancer strategy in the most recent budget. I was told that cancer services are a top priority for this Government. We are more than four years into the life of this Government - in fact, it is entering its final few months - and seven years have passed since the most recent update of the national cancer strategy, but we have seen no evidence or particular action to show it is a top priority for this Government or Minister.

Last month, I asked the Tánaiste to commit to multi-annual, ring-fenced funding for a national cancer strategy. To his credit, he said in his response it was something we had to do and see but, unfortunately, we have not yet seen that commitment. He spoke of the importance of the introduction of national cancer strategies and the impact they had in the 1990s and 2000s. He is correct that those strategies played a significant role in lowering mortality rates and progressing care. Between 1998 and 2018, when the first two national cancer strategies were completed, five-year cancer survival rates increased from 44% to 65%, as the Minister of State mentioned. That makes it all the more confusing that this Government's commitment to these strategies is faltering in respect of funding.

When representatives of the Irish Cancer Society were before the Joint Committee on Health last week, their call was crystal clear. There is a need for a commitment to multi-annual funding. The problem with the way we are operating at the moment is that we simply cannot plan for workforce, capital or anything else without a multi-annual funding model. These services are being asked to work with one hand tied behind their backs and with resources that pale in comparison with what they need. It is not the way a modern health service should operate. The inefficiencies this causes were laid bare to the committee last week. Life-saving equipment is being left idle across hospitals and there is a real shortage of radiation therapists in our health service. The reasons are simple: poor planning and underfunding. As noted by the chair of the national cancer strategy steering group, Professor John Kennedy, we are not training enough radiotherapists because we have not reacted to the increase requirement in recent years. Across the St. Luke's radiation oncology network, there is one linear accelerator, which is shut, and a skin cancer machine that is only operating part time. Cork University Hospital has one linear accelerator and one CT scanner that have never been used. Both have been sitting idle for three years.

At University Hospital Galway, a second scanner has been delivered in the past week but there is uncertainty as to whether it will be operational due to staff shortages. We know that radiotherapists are stepping up to plug gaps that they should not be expected to, having now agreed to facilitate longer working days to make up for staff shortages. In some instances, they are working in excess of ten hours per day in order to facilitate and work through the ever-growing cancer waiting list.

These workers need to be provided with support, which can come in a variety of ways. First, we need to see an increase in graduate places. In 1998, the number of college places for radiotherapists in Trinity College Dublin and nationally was 12. In 2024, it has grown to 42 nationally. Training more workers needs to be a priority moving forward. That should include starting a second postgraduate programme in the west that would have a meaningful impact in tackling the increased levels of burnout we are seeing in this area. According to a survey of radiotherapists carried out last year, 60% said they will not be working in the profession or do not see themselves working in the profession in the next five years. This has to be addressed or the waiting lists that these overstretched workers are working so hard to bring down and manage will increase further.

We also know that the inequality between public and private patients is growing, particularly in respect of access to new medicines. While funding for new medicines is vital and we should be ring-fencing funding rather than having a situation similar to budget 2024 when there was no committed funding and the Minister told us funding would instead be found in savings, we also need to look at how long it is taking to get these new medicines into the hands of the people who need them. In Ireland, it takes on average two years from the date of application to patient availability. When it comes to oncology drugs, the time to availability is longer, with a median of 704 days, and we rank 32nd out of 37 countries in a survey published by the European Federation of Pharmaceutical Industries and Associations in 2023. We are lagging so far behind.

The pressure on emergency departments, which we know is at astounding levels, is also having a serious impact on the care that those with cancer are receiving. We usually talk about a winter surge but now we know we have a year-round surge and pressure on our emergency departments. This is because our health service is not getting the necessary funding or resources, and nothing encapsulates this as much as the current recruitment freeze in the HSE, which needs to end. We also need to see some honesty from the Government on this being a recruitment freeze. Every time the freeze has been raised by members of the Opposition, we have seen members of the Government, particularly the previous Taoiseach, deflecting and trying to wave away concerns by saying it is not actually a recruitment freeze and more people have been hired than were planned or needed. We know that is not the case.

Despite the Government's claim to the contrary, the ball has been dropped on cancer. It is time to get down to brass tacks. The Government will say that mortality rates for all cancers have dropped by 11% in Ireland in the past ten years. While that statement is true, it ignores that the latest survival data we have, from 2019, shows that Ireland has the third highest mortality rate in western Europe. That was pre-Covid, and the related impact on cancer services, which the Government has acknowledged, has been significant. The Government will also say that cancer survival rates are steadily increasing but Ireland still ranks 13th out of the EU-27 in terms of survival. I certainly do not feel, and I do not think the Minister of State or anyone in this House feels, that we should be settling for a mid-table ranking for cancer survival.

The significant advancement in treatments for cancer that the Government has touted since taking office ignores the idle machines I referred to and the evidence that some care is going backwards, including statistics that show that in 2023 more than three in five people accessed their radiation therapy within 15 days, which is vitally important for fast-growing tumours, according to the HSE national service plan. This is in stark contrast to 2018, when it was four in five people who were being seen in that time. Again, we are going backwards.

There has not been a recognition from the Government that screening has not been expanded as planned. Target waiting times for cancer tests are not being met. Cancer surgeries are frequently delayed due to shortages in staffing, beds and theatre space. Investment in infrastructure has been lacking despite increased infection control issues and rising cancer incidence.

With regard to what we need to see now, I echo the calls made in the motion and by the Irish Cancer Society for a sustained, predictable, multi-year funding model. This is vital to ensuring the full implementation of the national cancer strategy, while also determining the level of resource required over an appropriate timeframe to fully implement the recommendations in the national cancer strategy and ensure the key performance indicators, KPIs, are being achieved.

Alongside this, we need to see infrastructural investment in combination with an audit of our current cancer infrastructure; ring-fenced capacity for cancer diagnostics and treatment away from acute and emergency care; increased staff in parallel with increased college places; dedicated theatre time for genetic services; an assessment of the feasibility of other methods of investigating risk; and an urgent examination due to the unacceptable colonoscopy waiting list, including the use of fit tests for people on routine waiting lists.

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