Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)

I thank Senator Craughwell very much. I welcome his daughter here today. Since I became Minister of State with responsibility for health, cancer has come up so much. So many families are affected by cancer. It is not only the Senator's daughter but he, his wife and all of them together who are affected. As he said, they are a unit working within the hospital. I want to say well done. It was very emotional today. It is great to see the Senator's daughter here. As Senator McDowell said, timing is of the essence, and it is important. Senator Craughwell spoke about the €500,000 that has been cut. He can be assured that I will definitely convey that message to the Department. Officials from the Department are here taking notes and, as he knows, I am representing the Minister, Jennifer Carroll MacNeill, who cannot be here today. He can be assured that I will go back and highlight the issues.

I am delighted to take this debate on behalf of the Minister. We will not be opposing the motion. That is important. All of us working together is going to be really important now. I thank the Senator for tabling the motion and giving us the opportunity to discuss oncology-related dental services and head and neck cancer. This is an opportunity to listen to and acknowledge the very real challenges faced today, to set out some of the progress made to date and to inform the Seanad of the ongoing work in both the critical prevention side and the necessary improvements nationally for head and neck cancer services. Central to this is the need for the development of a clear patient journey for head and neck cancer patients. The delivery of a national head and neck cancer oral health pathway is a priority under the national oral health policy and will be included in phase 1 of the implementation plan, which is expected to be published shortly. I will try to find out more on that for the Senator. It is important to know when it will be published. I will make sure the Department comes back to him on this.

The HSE national cancer control programme, NCCP, is responsible for implementing and overseeing cancer services in Ireland. The NCCP is progressing the development of a pathway for head and neck cancer patients. The NCCP, the dental hospitals and Department of Health and HSE stakeholders, that is, the national oral heath office, the access and integration team and regional services including the integrated health area, IHA, manager, for Dublin Dental University Hospital under the service level agreement, are collaborating to improve head and neck cancer services nationally, including better oncology-related dental services. This group aims to define the optimal dental oncology pathway and is actively progressing this work. The group is meeting again this month to continue its efforts to improve head and neck cancer dental services nationwide.

Head and neck cancers encompass a broad variety of anatomical sites, including the oral cavity. Over the past few years, the incidence of head and neck cancer has increased in Ireland. Demographic changes may be causing a growing number of younger people to be affected by the disease. The NCCP has indicated that this trend could be due to the increasing prevalence of HPV, about which both Senators have spoken. Primary prevention of cancer associated with HPV infection can be achieved through vaccination. The HPV vaccine has been provided to secondary school children to help prevent HPV. One of the Senators said it is important that we highlight the necessity of this and look at the information and awareness and get that into schools and to parents. That is also something we also really need to look at. One of the programme for Government commitments is to extend the HPV vaccination to anyone under 25 who may have missed it. As an initial step, the Minister for Health has committed to the introduction of a school-based HPV catch-up programme. This will be put in place in 2026. It will provide students who have previously been offered a HPV vaccine another opportunity to receive it. From our point of view, we need to better explain the dangers and how important it is to get this vaccine. We definitely need to look at that.

The Government is committed to the continued implementation of the national cancer strategy. To date, more than €105 million has been allocated to cancer control under the strategy. This includes funding to support and expand population-based cancer screening programmes. It also includes funding to bring new treatments to Ireland and supports for community organisations supporting the growing number of people living with and beyond cancer. Additionally, capital investment of more than €140 million has been made, which has delivered new lab facilities, day wards and new radiation oncology facilities. Since 2020, the Health Research Board has awarded €43.7 million in cancer research funding. This includes €21.6 million for clinical trials infrastructure.

Today, over 220,000 people are living after receiving a cancer diagnosis, up from 150,000 in 2017. That is a 32% increase. This includes nearly 5,800 head and neck cancer survivors. The national cancer registry of Ireland reports an average of 786 head and neck cancer patients each year and this is projected to increase by 66% in the next 20 years to reach over 1,000 cases by 2045. Some of this increase arises from our growing and ageing population, improvements in our diagnostic services and the growing awareness of cancer among our population, which leads to more people seeking help.

Patients are also presenting younger. The median age of diagnosis is falling and there is a shift in demographics resulting in a growing number of younger people being affected by the disease. While this trend may be attributed to the increasing prevalence of HPV, we know for certain that these patients will be living with the after-effects of cancer and cancer treatment for longer. Using data from the national cancer registry, we also see differences in outcomes across different cancer types, socioeconomic status and geographical areas. Cancer incidence is higher and survival rates lower among the most disadvantaged quintile in Ireland. This inequity also applies to head and neck cancers. One of our key priorities is to promote equity in cancer care, ensuring patients receive high-quality care regardless of where they live, which hospital they attend or the doctors they see. We also know the dominant cause of mucosal head and neck cancers is nicotine inhalation. While smoking prevalence has come down from 27% in 2004, 18% of our population still smoke today. We know restrictions in this area can have positive long-term effects. As fewer people take up smoking, we are keen to build on our progress and are working to bring two important pieces of legislation into effect this year. This legislation will bring important changes to the licensing, sales and distribution of tobacco and nicotine-inhaling products, particularly to those under the age of 21.

Turning specifically to oncology-related dental services, the Government allocates more than €230 million towards the provision of oral healthcare every year. This shows our commitment to delivering oral healthcare services. There have been additional investments to oncology-related dental services due to the increasing demands of the service provided by Dublin Dental University Hospital, DDUH. This has resulted in increased funding being provided to DDUH since 2023. The HSE initially provided €311,000, which increased to €578,000 by the end of 2023. This excludes education funding of €189,000.

In 2024, over €900,000 was allocated to continue the development of head and neck cancer services for the treatment of patients. This funding is available to the HSE which engages with dental hospitals to ensure the use of the funding meets the needs of the patients. The Minister for Health wants to do much more to improve oncology-related dental services and work is ongoing with the HSE to improve these services.

There have been some recent developments in oncology-related dental services I would like to highlight today. Since March 2022, out-of-pocket expenditure for patients attending DDUH for head and neck cancer-related care has stopped. The appointment of a consultant for medically compromised patients, treating head and neck cancer, to DDUH in April 2023, and a dental consultant in St. James's Hospital in September 2023 has helped support the provision of reconstructive care to patients following head and neck cancer.

To enable the development of the patient care pathway for individuals with head and neck cancer, the NCCP team has been working with the Department of Health on issues of oncology-related dental services. To enable the development of these services for patients with head and neck cancer, the appropriate staffing and skill mix will need to be outlined which will require a clinically led focus that responds to patients' clinical needs.

In respect of dental services and supports more generally, a range of measures have been put in place since 2022 within the dental treatment service scheme for adult medical card holders. This introduced, and then reintroduced, elements of preventative care. The fees paid to contractors for most treatment items also increased by 40% to 60%. Those who have a medical card and are aged 16 and over can access a range of treatments under the DTSS free of charge for head and neck cancer patients. They are eligible for several dental treatments under the DTSS.

The dental hospitals provide a pathway for individuals to access dental treatments, but dental treatments can also be availed of through dentists who operate the DTSS. However, I acknowledge there are challenges with this scheme at present. Some of these challenges will be addressed through the implementation of the national oral health policy, Smile agus Sláinte. This policy aims to radically transform our current oral healthcare service, recognising we need an entirely new approach to oral healthcare to meet the needs of our population into the future. The policy provides a framework to transform oral healthcare services in Ireland, where prevention and promotion are an integral part of all service provision. Smile agus Sláinte is informed by and aligned with other relevant Government and health policies, including the primary healthcare approach, Sláintecare, our overall framework for better health in Ireland and a healthy Ireland. The implementation of the national oral health policy is a programme for Government commitment to support the focused and structured implementation of the policy. The Department of Health and the HSE are currently finalising an implementation plan for the first phase of the roll-out. This phase of implementation includes the development of a national head and neck cancer oral health pathway.

I assure Senators and thank them again. I have another meeting but the Minister of State, Deputy O'Donnell, will be coming in shortly. I thank the House. We will continue the ongoing work being delivered by the Department to address the current challenges faced with head and neck cancer nationally. We are grateful to Senator Craughwell for tabling this motion. While the ongoing investments being made are important, ultimately, the development of an optimal dental oncology pathway will better enable the provision of care to those patients with head and neck cancers.

I can only say I will go back and speak to the Minister, Deputy Carroll MacNeill, who apologises that she cannot be here. The seriousness of this is such that time is of the essence. With cancer patients, everything is about timing and how quickly you can access services and get your treatment. On an emotional point, I thank Senator Craughwell and say to his daughter and everyone who is here to support her and who gives her the services that I wish them well. As I said, we will not be going against this motion; we will be supporting it.