Dáil debates

Tuesday, 25 June 2019

Saincheisteanna Tráthúla - Topical Issue Debate

Patient Transport Provision

6:20 pm

Photo of Eamon ScanlonEamon Scanlon (Sligo-Leitrim, Fianna Fail)
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Transport to and from treatment is a significant problem for cancer patients and their families who already are dealing with physical and emotional strains of cancer diagnosis. I have met many cancer patients and their families, which has given me a profound appreciation of how difficult and varied the effect of cancer diagnosis can be.

The provision of funding for transport is a common-sense provision. A cancer diagnosis can be a very difficult time for cancer patients and their families and can often involve considerable travel for patients. Radiotherapy can involve the patient going to hospital for a series of daily treatments over a number of days or weeks. On average they receive 25 sessions.

For cancer patients in the north west, treatment involves a very long road trip. Some will travel 600 km in a week to get to the nearest cancer centre and back home again. Most patients travel to University Hospital Galway but others need to travel to Dublin. Cancer patients need transport to be provided for many reasons. Their doctors may have advised them not to drive due to the aggressive nature of the treatment. The patient may have no family in the immediate vicinity or family and friends may be unable to take time off work to transport them to weekly or fortnightly treatments which can last many months. They may need specialised or extra treatment.

I sent an email to the office of the Minister, Deputy Harris, highlighting the case of one such person who requires transport from Sligo to receive his chemotherapy and radiotherapy in St. Vincent's hospital in Dublin. To date this young man has been supported with transport to and from Dublin through the goodwill of many people. Many people on the ground have worked extremely hard in ensuring this happens, like the many individuals around the country who go above and beyond the call of duty for the needs of others.

Existing support services offer as much help as they can to cancer patients and their families. However, transport is not normally one of them. In my experience more and more charitable organisations and volunteer associations have been approached for support to help with transport problems. In recent weeks the young man I mentioned has been told that he needs extra chemotherapy and radiotherapy, which puts an extra burden on all services to try to get this person to Dublin on various dates between now and September. The gentleman has no transport of his own and has a young family.

While the Irish Cancer Society offers the care to drive scheme, this only operates within a 50 km radius. It is important to acknowledge the benefits of the care to drive scheme nationwide with volunteers collecting patients from their homes and driving them to their hospital treatments and back home again from those appointments. By removing the burden of continually having to organise transport, the scheme has transformed people's lives. Life would be very complicated for those people without that service. It has removed some of the barriers associated with accessing care. We must acknowledge the generosity and goodwill of the 12,000-plus volunteers. Those involved often have a family member who is unwell or had previously used the service themselves. Unfortunately the care to drive scheme offers little advantage to people from Sligo who have to travel to Dublin, a round trip of 420 km.

Patients undergoing chemotherapy and radiotherapy treatment are often exhausted. Someone who is ill and has had treatment will be feeling very vulnerable and having to hang around waiting for and being dependent on taxis or public transport is not good for the patient.

It is not uncommon for cancer patients who cannot afford to travel or cannot access transport to Dublin hospitals for vital radiotherapy to be directed to charity organisations such as the Irish Cancer Society, the Friends of St. Luke's and the Marie Keating Foundation to apply for financial assistance, but these agencies are already struggling with the limited funds available.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I thank Deputy Scanlon for raising this issue. I acknowledge that a cancer diagnosis is a difficult time for patients and for their families. There are also costs associated with a cancer diagnosis, as with any serious illness.

The Department of Health and the HSE’s national cancer control programme have worked together to improve the quality of cancer services through reorganisation and expansion. We have moved from a fragmented system of care to one that consolidates cancer treatment in larger centres, with multidisciplinary care and decision making.

Cancer care in Ireland is provided across the continuum of primary care, acute hospitals and social services. In line with international best practice, acute hospital cancer care is centred in eight designated centres. There is clear evidence that patients who receive treatment in hospitals with a high patient volume, from doctors who themselves see a high volume of cases, have better outcomes.

At the same time, care is delivered to patients as close to their homes as possible. For example, medical oncology is delivered in 26 hospitals under the direction of the designated cancer centres.

There are various transport options available for patients travelling for medical care. These include HSE directly funded transport, voluntary schemes and community transport, as well as specific cancer-related services supported by the National Cancer Control Programme, NCCP. Travel2Care is a transportation assistance fund which has been made available by the National Cancer Control Programme to patients travelling to a designated cancer centre, approved centres or an approved children's hospital for assessment, diagnosis, surgery or active treatment. It is administered by the Irish Cancer Society. This nationwide transportation assistance fund is specifically aimed at supporting people who have a financial difficulty in meeting some of the costs of travelling to appointments.

Some 13 hospitals across the country are covered by the service, including Beaumont Hospital in my constituency, Mater Misericordiae University Hospital, St. James's Hospital, St. Vincent's University Hospital, Cork University Hospital, University Hospital Waterford, Galway University Hospital, University Hospital Limerick, Letterkenny General Hospital, Our Lady's Children's Hospital in Crumlin, St. Luke's Hospital in Dublin, the Whitfield Clinic in Waterford and Altnagelvin Area Hospital. The NCCP makes a specific grant of €0.35 million annually to the Irish Cancer Society to assist with the cost incurred by the Travel2Care programme and such funding will continue this year.

Separately, the Irish Cancer Society operates a volunteer driver service, which provides transport for cancer patients to and from their hospital chemotherapy treatments. Nationwide, 21 hospitals participate in this programme, to which patients are referred by hospital voluntary cancer support centres.

The focus of the Department of Health and the National Cancer Control Programme is on the provision of health services, including cancer services, and this is in line with the approach across Europe. The national cancer strategy for 2017 to 2026 sets out a roadmap for the continued development of cancer services over the ten years of the strategy. Patient involvement was a key feature in the development of the strategy, in line with the increasing emphasis on understanding the patient perspective. This has been continued through the establishment of the Cancer Patient Advisory Committee, which comprises 15 people who have been affected by a cancer diagnosis directly or through a family member. The committee has already provided a valuable contribution to initiatives related to the implementation of the cancer strategy.

The Department will continue to work with the National Cancer Control Programme and with voluntary organisations such as the Irish Cancer Society to address the needs of cancer patients in a holistic manner.

6:30 pm

Photo of Eamon ScanlonEamon Scanlon (Sligo-Leitrim, Fianna Fail)
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I thank the Minister of State for his response.

This issue cannot be ignored. There is no doubt that cancer patients are receiving excellent medical care in our hospitals and more patients than ever are surviving cancer. I was very much aware of the excellent transport schemes provided by volunteers, but I was not aware of the Travel2Care scheme, and some of the organisations I have dealt with recently are not aware of it either, under which funding can be applied for to take patients from anywhere in the country to the hospitals listed by the Minister. Quite a number of organisations are not aware of the scheme and I was not aware of it. It would certainly alleviate a lot of difficulty. Two weeks ago, a group rang me to see whether I knew anybody coming from Dublin on a Wednesday night who could take a patient down, or anybody who might be travelling back to Sligo. That should not be happening.

People in the north-west have to go to Galway or sometimes Dublin for radiotherapy services. Technology is now in place which was not there ten years ago whereby radiotherapy services can be provided in outreach centres. Is the Government looking at that? I am talking about Sligo and the north-west, where people have to travel to either Galway or Dublin. I have discussed this with consultants who provide cancer treatment and the technology is there. Is the Government looking at this possibility to save people the hardship of having to travel all those miles?

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I agree with Deputy Eamon Scanlon that this issue cannot be ignored. I appreciate his contribution and the discussion on this important issue. The focus of the Department of Health and the HSE's National Cancer Control Programme is the provision of cancer services and specifically the implementation of the national cancer strategy.

I take the Deputy's point on the Travel2Care transportation assistance fund. It has been made available by the National Cancer Control Programme to patients travelling to a designated centre, approved centres or an approved children's hospital for assessment, diagnosis, surgery and active treatment. It is administered by the Irish Cancer Society, and if enough of the public do not know about this service, we absolutely have to deal with that.

The focus is on centres of excellence. I am open to correction on this, but as far as I know the nearest hospitals for those in the north-west are Altnagelvin Area Hospital and Galway University Hospital. Those are the designated centres of excellence. The Deputy makes a valid point about travel costs. It is a difficult time for families, and perhaps we will have to look again at whether the annual €0.35 million in assistance to the Irish Cancer Society is enough to support cancer patients.

I will bring back all the issues raised today to the Minister, Deputy Harris, and get a more detailed response.