I want to set out the current position in respect of national oncology services. Cancer is one of the most common causes of morbidity and mortality today, with more than 10 million new cases and more than 6 million deaths each year worldwide. More than 21,000 people in this country develop cancer each year and approximately one third of the population will suffer some form of cancer in the course of their lives. Cancer numbers are increasing by approximately 1.5% every year, mainly due to the growth of our population. While cancer can affect all ages, it is most prevalent in the over-65 age group. The significance of this is heightened by the fact that our population is ageing. The disease can have a devastating effect on patients, their families and the wider community. The impact of the disease on our society is substantial and provides a major challenge to our health service.
There is an awareness of the need to develop cancer services nationally in tandem with best international practice. The Government constantly strives to improve the quality of care and the outcome for cancer patients. Since 1997, additional cumulative funding of more than €720 million has been made available for the development of appropriate treatment and care services for people with cancer. This includes the sum of €23.5 million which was provided in 2005 to ensure that we continue to address increasing demands for cancer services throughout the country. This substantial investment has enabled the funding of approximately 110 additional consultant posts in key areas of cancer care and an additional 327 clinical nurse specialists in the cancer services. The investment in cancer services has also led to increased activity, with the number of patients discharged from hospital with a diagnosis of cancer increasing by 100% in the period 1994 to 2003. Moreover, the number of day cases increased by 225% during the same period. The 2006 Estimates include an additional €9 million for the Health Service Executive to continue to meet the additional service pressures in cancer care, to improve the quality of care, to facilitate better access to radiation oncology services and to continue the preparation for a national cervical screening programme.
The development of breast disease services is a major priority in the development of cancer services. Breast cancers make up a high proportion of all cancer in younger women and the majority of women will be treated by the symptomatic breast disease services. Each year approximately 2,000 women are diagnosed with breast cancer in this country and in the region of 650 women die from the disease. The O'Higgins report on the development of services for symptomatic breast disease recommended the development of a new organisational structure for the provision of breast disease services. The report recommended the development of 14 specialist breast units throughout the country with a minimum case load to improve the quality of care for those women suffering from breast disease. Funding in the region of €60 million has been made available to support the development of symptomatic breast disease services since 2001. Six of the units recommended in the report are now fully operational and the remainder are at advanced stages of development.
To ensure that the women suffering from breast disease receive the highest standard of care, it is important that quality assurance structures are put in place. Last July, the Tánaiste established a national quality assurance group for symptomatic breast disease services under the chairmanship of Professor Niall O'Higgins, president of the Royal College of Surgeons in Ireland. The work of this group will be a key element in developing an improved national approach to quality assurance in the management of breast disease and an important initial step in improving and assuring quality in cancer care generally.
BreastCheck, the national breast screening programme, was introduced in 2000 and screening is being offered every two years, free of charge, to approximately 160,000 women in the 50-64 year age group in the eastern, midland, north-eastern and parts of the south-eastern areas. Since the introduction of BreastCheck, cumulative revenue funding of more than €60 million has been allocated to support the programme and €12 million capital funding has been made available to provide for the necessary infrastructure.
There are approximately 130,000 women in the target age group in the remaining regions of the country. The national roll out of the screening programme is therefore a major priority. A capital investment of approximately €21 million has been approved for the construction of two new BreastCheck clinical units at Cork and Galway. BreastCheck recently advertised for key lead consultant radiologists and radiographers for the expansion of the programme and the recruitment of other key clinical posts will commence early in 2006. A design team has been appointed to work up detailed plans for two new clinical units and BreastCheck expects that, subject to obtaining satisfactory planning approval, the design process, including the preparation of the tender documentation, will be completed by mid-2006. BreastCheck is confident that the target date of 2007 for commencement of the national roll out will be met.
A pilot cervical screening programme was introduced in the mid-western region in 2000. Under the programme screening is being offered free of charge to approximately 74,000 women in the 25-60 year age group at five year intervals. The Department requested the former Health Board Executive to commission a report on the feasibility and implications of a national roll out of a cervical screening programme. The report, by an international expert, was published in 2004 and, following its publication, the Department consulted with relevant professional representative and advocacy groups as part of its considerations on a national programme. The Department will discuss options for a national programme with the Health Service Executive.
In July this year, the Tánaiste announced the Government's approval for a national network of radiation oncology services, to be put in place by 2011, commencing in 2008. The plan will consist of four large radiotherapy centres in Dublin, Cork and Galway and two integrated satellite radiotherapy units in Limerick Regional Hospital and Waterford Regional Hospital, conditional on their conformity to certain quality assurance arrangements. These arrangements include the following conditions: satellites to be integrated with one of the four large centres to ensure maintenance of standards and adherence to protocols; radiation staff to be employed by large centres subject to agreement and arrangements where there are pre-existing employment contracts; and radiation staff to rotate in and out of large centres to maintain and develop their skills and knowledge.
The national plan will mean an investment in additional capacity to the equivalent of 23 additional linear accelerators. The capital investment involved will be approximately €480 million, with most of it funded through public-private partnership over the period to 2011. In this regard, the Tánaiste has asked the Health Service Executive and the National Development Finance Agency, as a matter of priority, to develop and progress public-private partnership arrangements to design, build, finance, maintain and partially operate the proposed services at Dublin, Cork and Galway, including the satellite centres at Waterford Regional Hospital and Limerick Regional Hospital, subject to discussions between the Limerick Hospital Trust and the Health Service Executive.
The Government considers that the best option in terms of improving geographic access for patients in the north west is to facilitate access for those patients to radiation oncology services as part of North-South co-operation on cancer. It was agreed that the issue of access in the short term to the radiation oncology centre at Belfast City Hospital for patients in the north west would be progressed and that consideration would be given to progressing a joint initiative for the provision of oncology services in the medium term to patients in the region from a satellite centre linked to Belfast City Hospital.
The Tánaiste met with the Minister for Health for Northern Ireland, Mr. Shaun Woodward, MP, and it has been agreed that the new Belfast Cancer Centre, which is due to open next March, will treat patients from Donegal. Details of the arrangements will be finalised in discussions involving the Health Service Executive, Belfast City Hospital and the respective Departments. This will involve assessment of the specific radiotherapy needs of cancer patients in Donegal and the development of clinical treatment protocols, including appropriate transport arrangements, to ensure best patient care. Discussions will also be necessary on the funding arrangements involving the hospital and the Health Service Executive. The issue of a satellite centre in the north west will continue to be progressed as a joint initiative involving bilateral discussions at departmental and political levels.
The national radiation oncology co-ordinating group provides advice to the Tánaiste and the Health Service Executive on radiation oncology. The group has just submitted quality standards for the provision of radiation oncology services for public patients to the Tánaiste. The Department has raised the issue of transport arrangements for patients requiring radiotherapy with the Health Service Executive to ensure that appropriate transport arrangements are put in place on a national basis for patients who are required to travel to obtain radiotherapy. Transport solutions are already a feature of the current provision of radiation oncology services and will form part of the planning and implementation of the new national plan given the significant increase in capacity involved.
The importance of cancer research and education in the delivery of high-quality cancer care is increasingly recognised. Most of the preventive, diagnostic and treatment methods available in cancer care have resulted from innovative research and clinical trials over many years. Following the Good Friday Agreement the Ireland-Northern Ireland national cancer consortium was launched as a trilateral partnership between the Governments of Ireland, Northern Ireland and the United States. One of the aims of the consortium is to provide an all-Ireland infrastructure to co-ordinate the clinical trials of hospitals on both sides of the Border. Awards to the value of €3.5 million have been made to the Health Research Board to support this initiative.
Cancer control policies must be patient-centred, quality-driven and evidence-based. The introduction of the ban on smoking in the workplace has been a significant milestone in our cancer prevention policy. Almost two years on the ban is working and Ireland has set a new health and legislative precedent. The National Cancer Forum has responded to the continued priority that needs to be given to the strengthening of cancer policy and its implementation by developing a second national cancer strategy. The key goal of the first national cancer strategy was to achieve a 15% decrease in mortality from cancer in the under 65 age group in the ten year period from 1994. An evaluation of the 1996 national cancer strategy demonstrated that this figure was achieved in 2001, three years ahead of the target date. The National Cancer Forum is finalising the new national cancer strategy, which will be published soon. The new strategy will have regard to the multifaceted aspects of cancer control. The key priority in the development of improved cancer care is the provision of multidisciplinary care. The strategy would set out key priorities for the development of cancer services over the coming years and will make recommendations on a balanced organisation of cancer services nationally with defined roles for hospitals in the delivery of cancer care.
This Government remains committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland in accordance with best international standards. We believe it is important to build teams of expert clinicians working together to deliver top quality cancer care to all our patients. To this end we will continue to provide considerable investment in oncology services in the coming years.