Colm Burke (Cork North Central, Fine Gael) | Oireachtas source

I thank Senators Kyne and Conway for bringing forward this motion. Twelve Senators contributed to the debate and I thank each and every one of them for detailing their concerns and setting out how we need to roll out and improve our current cancer care plan. I will touch on some of the points raised because it is important that I deal with them as they arose. I may not be able to get through all of them but I have no difficulty with anyone emailing me if there are issues people wish to raise with me.

My understanding is that a proposal has been received for the development of cancer services and a new unit in Galway. A significant and ambitious proposal for a new cancer centre in University Hospital Galway has been developed by the hospital group outside of normal HSE capital development processes and the Department of Public Expenditure, NDP Delivery and Reform's infrastructure guidelines, previously known as the public spending code. Delivery of any cancer centre proposal will also depend on the completion of a number of enabling projects to decant and relocate existing services, including laboratory facilities. Currently, at appraisal stage in the capital plan for 2024, the Department is engaging with the HSE and the hospital to proceed with it. Progress is being made on that issue.

One of the other issues raised was the need for a screening programme for lung cancer. The group which oversees the screening programmes is giving consideration to introducing an additional programme. One of those being considered is a screening programme for lung cancer.

Another issue raised is around the sale of tobacco and tobacco products. We are currently drafting legislation so that shops will not be able to sell cigarettes to anyone under the age of 21. That legislation will be coming forward in the not-too-distant future. The Department is currently working on that.

The Department of children is dealing with amending legislation on the maternity leave issue which was raised by one Senator. That is being looked at. The issue of radiation therapists was also raised. I arranged for representatives from Trinity College Dublin and UCC to meet with the then Minister for higher education, the current Taoiseach, in October of last year. Proposals were made whereby the number of places in Trinity College would be increased from 30 students per year to 50 and the proposal in Cork was to increase the number from 12 students per year to 24. The course in Cork is a masters degree. A person on the radiation training course in Cork will already have a primary degree and would do this as a masters degree. My understanding is that it is currently with the Department and we are hoping to progress the issue. It is an important issue because we need radiation therapists. We do not have enough of them qualifying every year and we need to improve the situation. All of those issues are being dealt with.

The prosthesis issue arose previously in 2016, when there was a proposal to regularise it across the entire country because of the different arrangements in place in different parts of the country. As a result, areas that were really ahead of the curve were going to end up with what they were providing being reduced and other areas would be improved. Then it happened a second time and it has happened a third time. So far we have left it as is. I think we should now go back and re-examine it and try to come up with an overall proposal for the entire country so that the same level of services and supports is available right across the country rather than the mix we have at the moment. We need to work on that and come up with a solution. This has been going on since 2016, more than eight years ago. In fairness to the Department, it is working on the matter.

Successive national cancer strategies have shown the benefit of continued investment in national cancer services. The benefits for Irish cancer patients come from earlier diagnosis, better treatment and improved rates of survival. The Government's commitment to the implementation of the national cancer strategy is evidenced by significant investment in recent years. We have seen good progress on the implementation of the strategy through the past seven years. This progress has been driven by clear, evidence-based policy direction from the Department and strong implementation by the HSE's national cancer control programme, NCCP. At this time, 40 of the 52 recommendations have been implemented and work is progressing on the remaining recommendations.

Since 2017, there has been an additional investment of €456 million in cancer services, including €81 million on cancer prevention, screening and treatment. A total of €316 million has been spent on cancer medicines and €59 million on cancer research grants through the Health Research Board. The Government has allocated substantial funding of €50 million for national cancer treatment and screening services over the years 2021 to 2023. In the same period, the Government has allocated additional €98 million for new medicines, facilitating the introduction of 61 new cancer medicines .

Capital funding of more than €120 million has provided state-of-the-art radiation oncology facilities in Galway and Cork and updated cancer infrastructure in chemotherapy wards and lab facilities for the benefit of patients. A further €20 million has been invested in the new national cervical screening laboratory. The funding since 2017 has enabled the recruitment of more than 670 staff to our national cancer services. This includes an additional 200 nursing staff, 100 consultants and 180 health and social care professionals in designated cancer centres. Taken as a whole, this represents a significant investment in the implementation of the aims of the national cancer strategy and providing improved access to cancer care for patients in Ireland.

The strategy recognises the positive impact of early detection on patient prognoses and the importance of preventing cancer, where possible. Current estimates show that four out of ten cancer cases can be prevented by a change in lifestyle or environment. Since the beginning of 2020, the Government has spent more than €60 million on measures to assist people to quit smoking. This funding has allowed people to receive smoking-cessation medications, access to the national quit line and provided staffing and other programmes. In 2022 the NCCP launched the Early Diagnosis of Symptomatic Cancer Plan 2022-2025. The plan focuses on raising awareness of the signs of cancer among health professionals and the general public, with a particular emphasis on marginalised groups. I note that some Senators raised that issue earlier on. Nine out of ten cancers are diagnosed when individuals present to their GP with symptoms. This highlights the importance of those worried about any health symptoms attending a GP.

For healthy people without symptoms, population-based screening programmes are in place. I am pleased to advise that the national screening advisory committee has commissioned the Health Information and Quality Authority to review and assess the evidence for potential expansion of the age-range eligibility for the bowel screening and breast check programmes. This important work is currently in the planning stages, and will soon be under way.

The national cancer strategy sets out a vision for continuous improvement of cancer services, following on from the progress under the two previous cancer strategies. A particular focus is the centralisation of cancer surgery, which is now 85% complete. This means that expertise and resources are concentrated in designated centres, ensuring that patients have the best care available for cancer surgery. It goes back to the issue that if consultants are doing a particular procedure, the more procedures they do, the more expertise they acquire. That is the whole point about centralisation and it has worked very well.

Since 2020, new cancer treatments and models of care have been lodged in Ireland thanks to the increased funding from the national cancer care strategy. Among these are specialised treatments, such as CAR T cell therapy, radioligand therapy and advances in radiotherapy treatment. This is on top of the funding for cancer medicines. As I mentioned, 61 new medicines are now available.

Since 2020, more than 1,200 additional acute inpatient beds have been opened as of March 2024. This represents the largest expansion of public acute hospital capacity in the history of the health service. As well as an increase in bed capacity, hospitals have received an unprecedented uplift in funding and workforce since 2020. The figure for the HSE has gone from 103,000 in 2014 to more than 145,000 whole-time equivalents in 2023. That is an increase of almost 45,000.

Even with this support for additional acute inpatient capacity alongside investment in community care, reform and innovation, the health service is experiencing an increase, year-on-year, in demand for acute hospital care. The Minister for Health recently published the acute inpatient hospital bed expansion plan, which aims to deliver more than 3,300 acute inpatient hospital beds by 2031. The plan recognises capacity already delivered and committed to by the Government while also addressing medium- to longer-term capacity needs. We recognise that our bed capacity needs to be increased to meet the healthcare needs of our growing and ageing population. Under this plan, in recognition of the role of single-occupancy rooms in infection prevention and control, it is intended that all new beds will be in single-occupancy rooms. There may be some instances where this is not possible and where some provision of multi-occupancy rooms is appropriate.

The role of palliative care in cancer care is highlighted in the national cancer strategy. People with cancer are considered to comprise the majority of palliative care patients. In 2010, a clinical programme office for palliative care was established within the HSE. The aim of the national clinical programme for palliative care is to ensure that patients with life-limiting conditions and their families can easily access a level of palliative care services that is appropriate to their needs, regardless of the care setting or diagnosis.I acknowledge the presence of Averil Power from the Irish Cancer Society and of those from the Irish Hospice Foundation. In partnership with the Irish Cancer Society, the HSE delivers night nursing care to patients receiving specialist palliative care to enable people to die at home. This invaluable service also provides respite to carers during end-of-life care.

The HSE has taken over a number of hospices previously run by independent organisations. That has happened over the past 12 months and is a welcome development under HSE management. When this strategy was brought to Government in 2017, 150,000 people were living after a cancer diagnosis. That number is now 215,000, a 43% increase under the strategy. This is a massive achievement, and it means that the aim in the strategy to increase patient involvement and maximise quality of life becomes even more important.

Over the lifetime of the strategy, the NCCP has developed models of care for psycho-oncology which incorporate best international practice and ensure psychosocial supports for cancer patients and their families are of a very high standard. This has included specific models of care for children, adolescents and young adults and recognises their needs differ from those of adults. These models of care have the aim of improving outcomes for cancer patients who face a heavy burden throughout their treatment and recovery.

The NCCP has also developed guidelines for community services which have been adopted by the NCCP alliance of community cancer support centres. The Minister for Health has allocated €3 million in funding to these centres for 2024, recognising the impact the centres have for cancer patients and their families in communities throughout Ireland. Senator Kyne referenced this.

The ongoing transformation of cancer services is a priority under the strategy. This is enabled by integrating research into cancer care where possible and making use of innovative methods to improve how our national cancer services provide care.

HRB investment in cancer research since 2020 represents almost 14% of its total health research investment. This funding has gone towards support for developing cancer clinical trials infrastructure to help achieve one of the aims of the strategy, which is to increase patient participation in clinical trials. The HRB has also provided funding towards a national cancer clinical trials network as well as research projects and programmes and clinical trials. In addition to this funding, this year the HRB announced a provision of €1.2 million for cancer research projects operating on a North-South basis as part of the Cancer Consortium, which is a co-operation between Ireland, Northern Ireland and the United States National Cancer Institute. The all-island approach is extremely important and we need more co-operation between both sides in developing additional services.

Ireland has made important developments in improving the clinical trials and health research landscape, including the development of a national health research data protection impact assessment template. This template is being rolled out in HSE sites. More recently, the HSE has agreed on a clinical trial contract template for commercial organisations, clinical research organisations and public healthcare providers.

The HSE commenced the development of a national strategy for radiology in January of this year. A national steering group and working group have been set up to develop this strategy. Its aim is to set the future direction of radiology in Ireland. This will be done through examining current radiology capacity and existing and forecasted demand, identifying strategic priorities and defining a future service delivery model to meet the needs of patients. I expect this to be delivered later this year.

Under the strategy, there has been an improvement in cancer survival rates. The five-year survival rate for patients diagnosed with cancer between 1994 and 1998 was 44%. This increased dramatically to 65% for people diagnosed with cancer between 2014 and 2018.

For 30 years, the National Cancer Registry has been helping us to better understand cancer. Since it started data collection in 1994, the registry has published annual reports on cancer incidence and epidemiology in Ireland. Extensive work is done across our hospital system in providing the information for these reports. These reports are an invaluable tool for policymakers because we can see what effect our actions have on cancer incidence and outcomes. The registry is also involved in benchmarking partnerships across Europe and internationally.

Ireland is performing strongly in the reduction of cancer mortality in comparison with other European countries. European comparisons for the period 2011 to 2019 found that Ireland reduced cancer mortality by 14% for men and 13% for women compared with the EU average of 10% for men and 5% for women. In addition, recent estimates by the European Cancer Inequalities Registry suggest that Irish cancer mortality rates have fallen below the EU 27 rate. This is proof of the benefits of our long-term strategic approach to cancer, with strong policy oversight from the Department of Health and a national cancer control approach led by the NCCP. With improvements in symptom recognition, access to screening programmes and improvements in treatment, five-year survival rates have increased for almost all cancers.

Stage at diagnosis plays a significant role in treatment and, ultimately, in survival rates. This is why early diagnosis is so important. The key message for anyone concerned about cancer is to discuss concerns with your GP in the first instance so that you can start on a patient pathway.

I thank Senators for their contributions. It is important we discuss this. Last week was men's health week. We need to highlight the need for people to go for regular health checks. Men are slower to go to their GP or look for healthcare. It is important we continue to raise the issue, give out more information about living healthily and well and ensure that, where people suspect they have a health problem, they do not delay it for two, three, four or five months, as happened in a number of cases I have come across recently. I look forward to working with Senators on continuing to deliver and improve the strategy and deliver the best possible healthcare for all diagnosed with cancer.