Tim O'Malley (Limerick East, Progressive Democrats)

I am pleased to have the opportunity to describe the substantial developments that have taken place in recent years in all aspects of cancer policy and, in particular, to outline for the House the main elements of the new national strategy for cancer control 2006, which the Tánaiste launched on 12 June last. Cancer is a major challenge to our health services. It is a major cause of morbidity in Ireland, with 20,000 people diagnosed each year. Effectively, tackling the problem of cancer means providing specialist services of a consistently high quality with sufficient capacity as well as appropriate support services for patients, their carers and their families.

Improving cancer care is a major priority of this Government. We have invested over €900 million in the development of cancer services since 1997. We have appointed over 100 additional consultants specialising in cancer. About 34,000 more people were treated for cancer in public hospitals in 2004 compared with 1998. That is a very significant increase of nearly 60%. The key goal of the 1996 national cancer strategy, which was to achieve a 15% decrease in mortality from cancer in the under 65 year age group in the ten-year period from 1994, was achieved in 2001, three years ahead of target.

Despite continuing improvement in mortality rates, the burden of cancer continues to rise mainly as a result of our growing and ageing population. The number of patients with cancer to be treated in 2020 is expected to be nearly 29,000, almost double the number in 2000, which stood at approximately 14,000 patients. A further significant issue is the variation in survival rates within Ireland and our relatively poorer cancer survival rates for many common cancers when compared with other European countries. In part, this is a result of our fragmented cancer services.

The central message of the new national strategy for cancer control is that the reorganisation of cancer care delivery is essential. There is clear evidence that people who have surgical treatment for many common cancers in centres with higher throughput experience better quality of care and better survival rates. The Tánaiste is especially concerned that many hospitals currently performing small volumes of cancer surgery do not meet international best practice. To ensure that patients receive the highest possible quality of care, we must develop a small number of cancer centres, which can pool together knowledge, expertise, experience, skills and the latest technology.

The development of managed networks around these cancer centres will allow for cancer care to be delivered in other hospitals within the network, with diagnosis and treatment planning directed and managed by multidisciplinary teams based at the centre. In such circumstances it is possible for much of the treatment to be delivered in local hospitals. It will be necessary to ensure that all cancer care is quality assured by the relevant cancer centre. This is the model which is operating successfully in paediatric oncology. Every child in Ireland who develops cancer has his or her diagnosis established and treatment planned at Our Lady's Hospital for Sick Children in Crumlin. For many children, significant components of their treatment are delivered in one of the networked hospitals under the supervision of and in accordance with the protocols of Crumlin.

As many as one third of cancers could be prevented by public policy initiatives and the promotion of healthy lifestyles. Cutting down on tobacco consumption and improving diet could help to save many lives. The adverse impact of tobacco consumption on human health is well documented. Over 7,000 deaths in Ireland each year are attributable to tobacco-related illness. Tobacco is a significant burden on individuals, family and society through death, illness and medical costs. Even a modest reduction in the huge burden of disease caused by tobacco consumption will result in significant health gains.

There have already been a number of positive steps to reduce the consumption of tobacco such as Ireland being smoke-free at work since 29 March 2004 and the availability of nicotine replacement therapy to medical card holders. The Tánaiste will explore with the Minister for Finance the scope for further fiscal measures to reduce the consumption of tobacco.

The Tánaiste is especially concerned that children are using sunbeds. This is a totally unacceptable practice which greatly increases the risk of melanoma cancer later in life. The Government has approved the Tanaiste's proposal to regulate the use of sunbeds, including prohibiting their use by those under 16 years and the placing of warning notices in sunbed salons and other places where sunbeds are available for use by the public.

Screening for certain types of cancer plays a crucial role in early detection, saving lives and reducing morbidity. BreastCheck, the national breast screening programme, is available to approximately 160,000 women in the 50 to 64 year age group in the former eastern, north-eastern, south-eastern and midland health board areas. Since the commencement of the programme in 2000, approximately 245,000 screening visits have taken place which is a massive endorsement of the programme by the women invited to attend.

The Tánaiste is most anxious that BreastCheck be rolled out to the remaining regions as quickly as possible. Revenue funding of €2.3 million has been made available to BreastCheck to meet the additional costs involved and an additional 69 posts have also been approved for this purpose. BreastCheck has selected two clinical directors to lead the roll-out and they are currently undergoing additional training for their new roles. BreastCheck will shortly begin recruiting consultant radiologists, consultant surgeons and consultant histopathologists.

An additional €21 million capital funding has been made available to BreastCheck for the construction of two new clinical units and the provision of five additional mobile units and state-of-the-art digital equipment. BreastCheck is confident that the target date of next year for the commencement of roll-out to the rest of the country will be achieved. A pilot cervical screening programme commenced in the mid-west region in 2000. Screening is offered free of charge to approximately 74,000 women in counties Limerick, Clare and north Tipperary.

The Tánaiste wishes to see cervical screening rolled out nationally by 2008. Up to 200 lives a year could be saved by such a programme in Ireland. To progress this initiative, the Tánaiste has announced her intention to establish a national cancer screening board to manage both the BreastCheck and the cervical screening programmes. This will maximise the expertise in both programmes, ensure improved efficiency and develop a single governance model for cancer screening.

The new board will also advise on the implementation of a national colorectal cancer screening programme, specifically on the population to be screened, at what intervals screening should take place, the type of test required and the requirements for a quality assured, well organised and cost-effective symptomatic service.

The Department of Health and Children is working closely with the HSE and the National Development Finance Agency in implementing the national plan for radiation oncology. The plan consists of four large radiation oncology centres in Dublin, Cork and Galway, and two integrated satellite radiation oncology units in Limerick Regional Hospital and Waterford Regional Hospital. In addition arrangements for access for patients in Donegal to radiotherapy services at Belfast City Hospital are being progressed as part of North-South co-operation in the health sector. These developments will result in a significant increase in the numbers of patients receiving radiation oncology treatment throughout the country over the coming years.

I have already outlined the substantial investment that has taken place in cancer services since the publication of the first national cancer strategy, as well as the additional appointments and increased cancer services activity. We will continue to invest significant additional resources in cancer control. The Tánaiste asked the HSE to prepare a robust needs assessment for cancer control for the next five years that reflects the projected increase in cancer cases.

We need to make our health care system more accountable, more focused on outcome and more committed to quality care. Many of the services available for patients with cancer in this country are on a par with, if not better than, services in many other countries, but we need to tackle the problems identified by the National Cancer Forum in fragmentation of services and the variations in outcome experienced by those who use them.

We will address this by developing a framework for quality in cancer control. Through this framework we will be able to ensure that services perform to the highest standards in all parts of the country and that the interests of patients are protected. It will help to show where this is room for improvement so that we can ensure that people with cancer get a consistently high quality of service irrespective of where they are treated.

The work of the quality assurance group on symptomatic breast cancer services under the expert chairmanship of Professor Niall O'Higgins will point the way forward for quality assurance. This group is currently at an advanced stage of developing guidelines for the interdisciplinary management of breast cancer. On completion, the Tánaiste will ask the HSE to apply these guidelines in hospitals it funds and to monitor adherence to the guidelines as part of its performance management system.

An information model and infrastructure to address the information needs of patients, professionals, managers and policy makers is also essential. One of the functions of the Health Information and Quality Authority will be to evaluate and provide advice on the clinical effectiveness of health technologies, including drugs. The Tánaiste will be asking HIQA to establish a cancer health technology assessment process to facilitate speedy introduction of proven health technologies in the field of cancer.

Cancer research stands on the threshold of unprecedented opportunity. Recent developments in science and research hold out the potential for more effective, safer targeted treatments tailored to the specific characteristics of each individual patient's cancer. The Tánaiste considers that it is timely to ensure that cancer control research is better planned and integrated to ensure that Ireland can develop as a centre of excellence. Significant opportunities exist in cancer research given the commitment and investment of the Department, the HSE, the Health Research Board, Science Foundation Ireland and the Irish Cancer Society.

The Tánaiste is convinced that there is a need for a more identifiable national focus on research to harness the disparate financial and intellectual capital and thereby achieve a better return nationally. The aim is to ensure that current and future resources are invested to support an overarching national cancer control research plan. The Tánaiste will arrange for this to be scoped in consultation with the various stakeholders. We will seek to ensure that priority areas in cancer research are identified, that current gaps in cancer research are effectively addressed and that duplication of effort is reduced.

The developments which I outlined here today in cancer services are a clear indication of the considerable progress that has been made in addressing the burden of cancer in Ireland. I ask the House to commend the Government on its positive and demonstrable commitment to cancer services.