Vol. 557 No. 6
5 Ms McManus asked the Minister for Health and Children the steps being taken to implement the commitment given in An Agreed Programme for Government, that people in all parts of the country will have reasonable access to cancer services; the additional resources being allocated to ensure this objective is met, having regard to the number of people suffering from or at risk of cancer; and if he will make a statement on the matter. [23109/02]
One of the key goals of the health strategy entitled Quality and Fairness – A Health System for You, is to make sure that equal access for equal need is a core value for the delivery of publicly funded services. Access in terms of timing and geographical location is also encompassed by this goal. Since the implementation of the national cancer strategy in 1997, more than €103 million has been invested in the development of appropriate treatment and care services for people with cancer. Cancer services throughout the country have benefited from this investment, which far exceeds the £25 million requirement initially envisaged under the national cancer strategy.
Among a range of other initiatives, this investment has enabled the funding of 80 additional consultant posts in key areas, such as medical oncology, radiology, symptomatic breast disease, palliative care, histopathology and haematology, together with support staff.
This year a total of €27.3 million was provided for the maintenance and development of cancer services, some €23.55 million of which was allocated between all the health boards. An additional sum of €29 million is being allocated in 2003 for cancer services. This investment will ensure that next year we continue to address increasing demands in cancer services throughout the country in such areas as oncology/ haematology services, oncology drug treatments and symptomatic breast disease services.
In recognition of the need to develop cancer services further, the national health strategy has identified the need for the preparation of a new national cancer strategy. The national cancer strategy 2003 is being developed by the national cancer forum in conjunction with the Department of Health and Children. This strategy will set out the key investment areas to be targeted for the development of cancer services in the coming years, and will make recommendations in relation to the organisation and structure of cancer services nationally. This will have regard to existing policies in the areas of symptomatic breast disease and palliative care, and the forthcoming recommendations of the expert review group on radiotherapy services. The forum is currently consulting with the ERHA and all health boards, as well as professional bodies, voluntary agencies, patient groups and members of the public, in relation to the future development of cancer services, including how best to organise these services.
The report on breast cancer strategy, which designated 13 treatment centres, was published some time ago. When will the strategy be carried out and completed? As regards breast cancer screening, when does the Minister intend to extend BreastCheck to the next phase across the country? To reassure patients, will the Minister assure the House that there will be no attempt to refuse cancer treatment, including medication, to public patients, as was mentioned in The Sunday Tribune newspaper? Many cancer patients are now desperately worried that they may be denied high-cost treatments.
I also wish to ask about the radiotherapy unit in Waterford. The Minister should not refer the matter to the radiotherapy task force because the Minister has ultimate responsibility to deal with this serious lacuna. Will he define what is meant by reasonable access, which is the term used in the Government's programme?
The Minister referred to election promises and during the election campaign he made a commitment, on behalf of Fianna Fáil, to eliminate hospital waiting lists by 2004. Will he explain exactly how he intends to do that?
The Deputy has raised about eight questions relating to cancer services and I will try to deal with them first. The Deputy referred to the establishment of symptomatic breast disease treatment centres, and progress has been made in that regard across the country. Consultants have been appointed to all health boards to work in areas such as oncology, breast surgery, histopathology and haematology. I have details of the progress that has been made in each health board area. In the Eastern Regional Health Authority—
Can the Minister provide me with that information?
I can forward the information to the Deputy but it might be no harm to put some of it on the record of the House.
There were other questions.
The Deputy does not want the good news.
I would like to have it in writing.
Obviously, the Deputy does not want me to put on the record the fact that we have made some progress on breast disease. I am anxious to see breast disease centres established in all health board areas, including the BreastCheck service. I have received the report from the BreastCheck board, but one important issue needs to be resolved. The BreastCheck board has indicated to the Department that, irrespective of the establishment of the symptomatic breast disease centres, if a patient is screened, for example, in Donegal – where there is an excellent breast disease treatment centre – they would have to travel to Dublin or elsewhere to avail of the BreastCheck facilities. That issue has to be resolved between the Department and the BreastCheck board. Lines have been drawn on the issue and people have strong views about it. I do not see the logic of the Department establishing teams in centres of excellence across the country, thus having an alternative treatment system linked to the BreastCheck screening programme. The obvious thing to do from a policy viewpoint is to merge both services. We will have to resolve that matter prior to the expansion of BreastCheck nationwide. We hope to be in a position to expand BreastCheck in 2003. The BreastCheck board has told us that it will take about two years from commencement to get everything in place to expand the service to the remaining half of the country.
As regards oncology drugs, there is an onus on us not to hype this matter, which was mentioned in The Sunday Tribune, out of all proportion. There was a memo, apparently relating to a remark made by one—
We must proceed to the next question.
This is an important issue, a Leas Cheann Comhairle, if I may continue. Members of the House would wish me to put on the record the fact that no cap will be placed on any oncology drugs. At present, we operate by clinical autonomy and we have attracted top-class consultants back to this country. We have more oncology consultants now than ever before and because more such people are practising at the coalface, the bill for drugs is going through the roof. I would like to establish a body, such as the national information on quality authority, to ultimately evaluate for the State what new drug therapies should be applied, and when, on the basis of best medical evidence and in accordance with international protocols. This should also be the case concerning emerging new health technologies. The country is lacking such a facility at present but my policy is clear – if patients require oncology drugs as prescribed by their clinician, they will have them.
We will now proceed to Question No. 6, as we have gone way over the time limit.
Will the Minister answer the other points I raised, including the radiotherapy unit in Waterford and the definition of reasonable access?
I am somewhat surprised that the Deputy seems to be imploring me to disregard completely any expert view that will come my way via the radiotherapy group.
I asked a question.
I find that a new departure.
The Minister can make a commitment.
A very dangerous departure, if I may say so. In proceeding, we must be guided by best medical practice regarding the best outcomes for patients. We need a genuine national debate about this but I am not pre-empting what will happen when we get the report in January. I am not making any decisions prior to receiving the expert review group's publication in January but I appeal to all sides of the House to ensure we have a reasonable, rational debate on this issue. We must strike a balance between convenience and access, which are important to patients, and how we can guarantee the best outcomes for patients in terms of treatment.
We must move on.
Ultimately, this is what we want. We want to improve cancer survival rates and to enhance the facilities we have, which are not where we want them to be now. We must take on board the expert international clinical protocols coming our way. The outcomes in America and elsewhere are indisputable; the incomes there are better than they are here. It is easy to go down the political route and we are all susceptible to it, no matter what party we are from, but we have a responsibility to inform the public of the choices that have to be made.
There are 30 minutes allowed for Priority Questions and we have now spent almost 42 minutes on them. We now come to other questions. and I remind Deputies that supplementary questions and their replies are subject to a one minute limit.
