Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Senators O'Reilly and Garvey for tabling the motion. I have to say I was very interested in it when I saw it. I was not familiar with the therapy and took the opportunity to look into it. It is impressive; there is no question about that. The unfortunate reality for all of us is that an awful lot of people in our country will interact with our cancer services, either directly as a patient or as a friend or family. We are blessed with very good cancer services in this country and I will speak about them shortly.

The reality that many people will interact directly or indirectly with cancer services is one of the reasons I have fought very hard, along with colleagues in Government and in the Government parties, to increase significantly funding for cancer patients. Our healthcare workers have done a fine job in turning this additional resource into better services for patients, better access for patients and better outcomes for patients.

I acknowledge the distress that can be experienced in receiving a cancer diagnosis and the related treatments, and the negative impact on the patient of hair loss and chemotherapy-induced alopecia. As outlined by Senators O'Reilly and Garvey in the motion, a scalp-cooling service is offered to patients undergoing chemotherapy in seven of the 26 hospitals that provide systemic anti-cancer therapies, including chemotherapy and immunotherapy. This service can be of use to some patients. As the Senators pointed out, it is not suitable for everybody but it is suitable for some.

The scalp-cooling machines cost approximately €216,000 to install in the centres that do not have them. There are also associated costs and impacts on services that we would also need to consider. The machines are generally operated by healthcare assistants. The additional roles in the hospitals would cost approximately €600,000. Providing the service also requires additional capacity in oncology day wards. We do not want it to have an impact on the number of patients who can receive chemotherapy. There are the machines, the staff to run the machines and the physical space required.

Provision of a scalp-cooling service in the remaining hospitals needs to be considered in the context of growing demand for cancer services across the board. We have a proposal to expand the oncology day ward in Kerry University Hospital, which would cost approximately €10 million. For next year, the focus will be on improving performance in cancer services within existing services. As colleagues are aware, new development funding for healthcare for next year has been tight. The additional allocation for the national strategies, unfortunately, is quite constrained for next year.

We have seen significant improvements and expansion in cancer services. In 2021 and 2022, we allocated approximately €70 million in additional funding for cancer patients. This included approximately €40 million in services and new development funding and another €30 million in new cancer medicines. This has had a real impact on access to diagnostics, treatments and supports. We continue to work closely with the national cancer control programme to help and support the implementation of the national cancer strategy.

In recent years, we have recruited an extra approximately 400 staff into our cancer services, mainly consultants, nurses and health and social care professionals.What this means is that the waiting times are down, thankfully. The waiting times for patients are down by 46 to 72% across rapid access clinics for breast, lung and prostate cancer. The clinics have seen in excess of 43,000 people this year, 800 more than they would have seen in 2019. More than 10,000 cancer surgeries have been performed so far this year, which is extraordinary. That is approximately 700 more than in 2019. Approximately 75,000 chemotherapy and other anti-cancer therapies have been administered, and some of those patients are exactly the ones who might benefit from this motion. Over the past two years, 50 new drugs have been approved for cancer patients and total funding allocated for new drugs since 2021 is nearly €100 million, supporting 129 new drugs.

There have also been some important advances in new cancer treatments and models of care. One of the ones I have spoken about in the Seanad previously, which blew me away, is CAR T-cell therapy, a form of immunotherapy. It is being offered to children and adults in St. James's Hospital and CHI. There are others treatments, like peptide receptor radionuclide therapy, PRRT. That is a treatment for neuroendocrine tumours and it is in St. Vincent's. We recently opened a new €70 million radiation oncology centre in University Hospital Galway, which is state-of-the-art. Fantastic new services are being provided with better outcomes for patients. There is less sickness, illness and associated challenges with the therapy. There are a lot of patients who would have previously had to come to Dublin from the west but who will now be treated there. I say all of this by way of acknowledging that while we will continue to invest in them, our cancer services are getting better. The types of therapies are getting better and we are creating more college places for the likes of radiation therapy and other posts that are important.

The motion speaks to psycho-oncology. We are rightly investing a lot more money in new cancer drugs for patients and in cancer diagnosis, screening and treatment in the hospitals. As a result of this, we are seeing better outcomes but that is not enough. We are investing in psycho-oncology supports. I had the great honour of launching the youth and adolescent psycho-oncology framework last year. We are rolling out new services. We have provided funding this year, for the first time at this level, to the community cancer support groups. We have provided €3 million in one-off funding for them, which is a fivefold or sixfold increase in State funding for the hugely important work they do.

The type of proposal before us this evening, caps for scalp cooling, is important. I get it and I understand why it is important. I fully accept the feedback from patients. It is the patients who are saying that this is one of the biggest stresses they have while going through everything they are going through. As the Minister of State, Senator Hackett, said, many do not only have to mind their care but they have to think about their kids, protect them and manage all of that as well. I fully support the idea and it is only a question of funding. The funding for this year was tight for new development and then we have to make calls on whether we spend the money on this, a new cancer drug, more chemotherapy chairs or the new day oncology service in University Hospital Kerry. These are the tough decisions we all have to make. The proposal fits well with the new philosophy that is being introduced in cancer care in Ireland, which is a focus on screening, acute treatment and psycho-oncology. That is the mental and emotional well-being of the patient and the patient's family as they are going through treatment. It fits well within that context.

The good news is we have seen a dramatic improvement in survivorship for people going through cancer treatment. The five-year survivorship rate is a standard one that is used. Over the past 20 years, the rates have gone up from approximately 44% to approximately 65% for the period from 2014 to 2018. We fully expect that the rates are much higher now. We have had improvements in symptom recognition, access to screening and treatments. We are seeing that the five-year survival rates for some common cancers, such as breast and prostate cancer, have increased to 88% and 93%, respectively. That is a great testament to all of the healthcare workers working on this. Improvements in the five-year survivorship rates over the past two decades present additional challenges for those living with and beyond cancer. Believe it or not, there are approximately 215,000 people in Ireland living with and beyond a diagnosis of cancer. That is one in every 25 people in the country. When we go home tonight and walk down the street, one in every 25 people we see, on average, has survived five years with cancer. That is a positive thing and we need to keep investing in it.

The alliance of community cancer support centres and services was set up by the national cancer control programme, NCCP, with the aim of delivering a collaborative framework for the community-based centres. The alliance promotes participation in capacity building activities, communication, networking forums and others. The NCCP is acting as a roadmap for these centres, and as I have said, we have invested €3 million in community support.

I know there are calls on me to come in here and announce the funding but, as Senators will be aware, that is not how funding allocations work. They work through the budgetary process and new development funding in the budget. There is no new development funding allocated for this into 2024. However, we know there are individual hospitals that have invested in it and that have made the decision. We know this is important for patients. It is important to have it debated in the Seanad because it increases awareness and the likelihood of future investment. It has stimulated a debate here and within the Department of Health. I commit to Senators that we will keep this in mind. For the first time, we have a business case developed for roll-out across the entire country. I support it and it is an important thing to do. We will keep it in mind as we continue to invest in cancer services, and critically, in the psycho-oncology aspects of those services.