Dáil Éireann debate -
Wednesday, 16 Feb 2000

Vol. 514 No. 4

Adjournment Debate. - Cancer Treatment Services.

Mrs. B. Moynihan-Cronin

I thank the Minister for coming to the House for this matter. This is the first opportunity I have had to wish him well publicly in his new position. I am delighted that the Southern Health Board can look forward to bigger and better things.

Yesterday, at the launch of Daffodil Day, Dr. Michael Moriarty, who is consultant radiotherapist at St. Luke's Hospital, painted a grim picture regarding the availability of radiotherapy services in Ireland. During his presentation he said that on average only 16% of cancer patients are receiving radiotherapy, despite the fact that up to 50% of patients could benefit from it.

This is not the first time in recent months that the inadequacy of our radiotherapy facilities has been raised. The consultant radiotherapist at Cork University Hospital, Seamus Cathil, also recently drew attention to inadequate treatment facilities. He went so far as to state that up to 1,000 people are dying because of inadequate treatment.

While I accept that considerable progress has been made since 1996 with the launch of the national cancer strategy, the issues that have been raised by these eminent consultants who work specifically in the areas of cancer treatment should be taken seriously. Compared with the 16% of Irish cancer patients who receive radiotherapy, an average of 66% of patients receive such treatment in the EU. This gulf is an indication of the long way we have to go before we even approach the EU treatment average.

In raising the inadequacy of radiotherapy services in Ireland, I do not wish to cause alarm. Indeed, Dr. Moriarty acknowledged that plans to develop radiotherapy services in Cork, Galway and Dublin are welcome. Nevertheless, he warned that there is a need for better planning in the provision of radiological services to ensure that treatments are not disrupted because of machine depreciation or breakdowns. Not alone would better planning contribute to an increase in capacity of existing facilities, but disruptions in treatment can be extremely distressful for patients.

Right across our health services there are inadequacies and shortcomings. Hospital waiting lists for vital operations are now at crisis levels. However, most patients with cancer simply cannot wait. The stress and worry which is brought on by a cancer diagnostic must be minimised at every level. Waiting lists for cancer treatments in the Southern Health Board are now down to six weeks, but six weeks is too long for a cancer patient. Our objective in developing our cancer services should be zero waiting times. We should be in a position to offer cancer patients all treatment options which may benefit them in the shortest possible timeframe.

I wish to refer in general to the other cancer treatments on which Dr. Moriarty commented yesterday. For example, let us take bowel cancer. Irish men have the highest rate of bowel cancer in the EU, yet we do not operate a structured screening programme to ensure early detection and treatment. Screening is a vital process in tackling cancer. Early detection results in better treatments and this message must be brought home to every member of our adult population. However, until we offer nationwide screening services which are accessible to everyone, the importance of screening will continue to be over looked. While I welcome the commencement of the national breast screening programme in the Eastern, Midland and North Eastern Health Board areas, I believe it should be mainstreamed and extended to all health boards.

I take this opportunity to pay tribute everyone working in the delivery of cancer treatments and support services. In particular, Dr. Moriarty at St. Luke's has a tremendous record of patient care and the inadequacies he highlighted in our cancer care services should be taken very seriously. I also take this opportunity to wish the Irish Cancer Society every success with Daffodil Day on 24 March. The quality and availability of the services established under the Daffodil Day initiative are greatly valuable and have provided great comfort and relief to those who have used them.

Minister for Health and Children (Mr. Martin)

I thank the Deputy for raising this matter. I spoke with Dr. Moriarty yesterday at the press launch for Daffodil Day and we had a good discussion in respect of the progress that has been made and in terms of our future plans.

This debate affords me an opportunity to outline the major investment the Government is making in the development of radiotherapy services in the context of an agreed strategy based on a firm assessment of need. Against the background of some recent critical comment, it is important to reassure patients, potential patients and their families of the capacity of radiotherapy services here to respond to their needs and of the Government's continuing efforts to ensure that the development of services keeps pace with demand.

I wish to make a number of important points regarding cancer treatment services in this country. The national cancer strategy, which was published in November 1996 and followed in March 1997 by a three year action plan for its implementation, identified two principle objectives – to take all measures possible to reduce rates of illness and death from cancer in line with the targets established in the health strategy "Shaping a Healthier Future" and to ensure that those who develop cancer receive the most effective care and treatment and that their quality of life is enhanced to the greatest extent possible. Underlying these objectives is the need for a high quality, patient-focused service. One of the specific objectives of the strategy is to ensure that all patients have access to an equitable effective service with a uniformly high quality of care wherever they live.

Since the commencement of the implementation of the strategy in 1997, £40 million of dedicated funding has been allocated to the development of cancer services nationally. This investment has resulted in additional consultant appointments in the areas of medical oncology, haematology, histopathology and palliative care.

Radiotherapy is a highly specialised and capital intensive service requiring specialist personnel, including, for example, therapeutic radiogra phers, nurses with training in oncology and technical and engineering support staff. A minimum throughput of patients is required in order to maintain and develop the specialist skills required for the service. Because of these considerations and the complexity of radiotherapy services, the national cancer strategy recommended that radiotherapy services should be provided from two supra-regional centres. The two centres currently providing radiotherapy services to cancer patients are St. Luke's Hospital, Dublin, and Cork University Hospital. The strategy recommended that the case for providing a radiotherapy service from a third supra-regional centre at Galway should be kept under review. I am pleased to report that the Government acted quickly in accessing that case and took the decision to provide the service at Galway at an estimated cost of £10 million. The radiotherapy services in Galway will be provided as part of the overall phase two development at the hospital. This is currently out to tender with a view to construction work commencing in a matter of weeks.

In addition to this major investment in new radiotherapy facilities, existing services have also been benefiting from a major injection of resources. I recently announced an important investment in radiotherapy and other cancer services in Cork University Hospital with the allocation of £12.5 million for this purpose. The development will include a chemotherapy day unit, two state of the art linear accelerators and advanced CT simulation facilities. Together with approval for the appointment of two consultant medical oncologists, the improvements will ensure that the service for cancer patients in this area is in line with the best available internationally.

The State's largest radiotherapy centre at St. Luke's and St. Anne's hospital opened in June 1998 having undergone a major redevelopment funded by capital investment of over £20 million. Last year two additional consultant radiotherapists were appointed to the hospital as part of the ongoing process of developing services.

I am aware of the need for further investment in cancer services and will continue to identify this as a priority for my tenure in office. To date the national cancer strategy has achieved the widespread enhancement of the range and quality of cancer services available, and a major improvement in equity of access to these services. We must continue to look ahead and to examine ways of building on the success to date by continual improvement and investment. In this regard I have received a proposal from the National Cancer Forum to establish an expert review group to examine the appropriate further development of radiotherapy services. It is my intention to act on this proposal and to quickly put arrangements in place for the establishment of such an expert group.

I cannot over-emphasise my commitment to the further development of cancer services. Cancer is a scourge on this society as on all others. While it must be recognised that significant pro gress has been made in the development of our infrastructure and services for the treatment and prevention of the disease, I am equally aware of the need for a continued concerted effort in this area. It is my intention to work with the National Cancer Forum which is the correct vehicle to further develop cancer services. A structure is in place to deal with the assessment of need and the proper logical development of facilities, infrastructures and services. Great progress has been made and we will continue to ensure that people requiring cancer treatment services will have a high quality, equitable service available to them which matches the best available anywhere in the world.