Feicim cuairteoirí anseo sa Dáil. Cuirim céad míle fáilte rompu. Is deas cuairteoirí a fheiceáil sa Dáil arís. Is tuar dóchais é sin.
Cancer Care: Motion [Private Members]
I move:
That Dáil Éireann:
notes:
— that, on average, 45,753 cancers or related tumours were diagnosed each year during 2018-2020;
— that there are currently approximately 200,000 cancer patients or former cancer patients alive in Ireland;
— that inpatient charges are incurred by cancer patients without a medical card or private health insurance at a cost of €80 per visit, or up to €800 per year;
— that most courses of chemotherapy and radiotherapy require more than ten visits a year, meaning most patients will pay the maximum charge for inpatient treatment;
— that a significant proportion of cancer patients have neither a medical card nor private health insurance; and
— the lack of clear guidelines for hospitals for waiving inpatient fees in cases of excessive hardship;
acknowledges:
— the report entitled "The Real Cost of Cancer" published by the Irish Cancer Society in 2019;
— that the average cost to someone diagnosed with cancer is €756 a month; in some cases this can rise to over €1,000; with increased cost of living and energy expenditure this cost is rising; and at the same time, people are faced with an income loss of over €1,500 a month on average;
— the expenses around hospital visits - petrol, parking and eating at the hospital - come to an average of €291 a month, more than the average cost of medicines, which is an average of €261 a month;
— that, should patients not pay their charges within 47 days, many hospitals contract debt collection agencies to call upon patients to seek payment for basic cancer treatment; and
— that the Health Service Executive (HSE) spent more than €4.377 million on debt collection agencies in the period between 2013 and 2020; and
calls on the Government to:
— abolish the €80 inpatient charge for those who are receiving cancer treatment;
— direct the HSE to end the practice of using debt collectors to collect hospital charges from cancer patients; and
— honour its commitment in the Programme for Government: Our Shared Future to "introduce a cap on the maximum daily charge for car parking for patients and visitors at all public hospitals, where possible" and "introduce flexible passes in all public hospitals for patients and their families".
It is disappointing that the Minister for Health is not here to listen to this debate. Cancer care is a very significant element of the health service. It is really disappointing that the Minister is not present. He is not in the country. He is off at some business event. That is a pity. With the agreement of the House, I will share my time with Deputies Whitmore and Gannon.
Every three minutes in Ireland, someone receives a cancer diagnosis. Sitting in doctors' offices throughout the country, across every village, town and city, it is a largely indiscriminate disease. Many patients say the minute they hear the word "cancer" it feels like the whole world has been turned upside down - like they are losing control. Most of us at one point or another have thought about and worried about receiving this life-changing diagnosis, but most people have not thought about the cost associated with that diagnosis and the reason for that is that they should not need to.
However, a cancer diagnosis comes with a hefty bill with some patients facing financial crisis alongside their treatment. In a 2019 Irish Cancer Society survey into the experiences of cancer patients and survivors, one participant said, "It was like a bomb went off. It cost a lot of money and has left me weak and in need of financial assistance." Another said, "I am just 17 days into being diagnosed. It is complete turmoil. As it goes on the financial burden is sinking in." This survey is filled with harrowing testimonies which paint a shameful picture, leaving no doubt that the State is failing cancer patients in many ways.
The myriad of expenses, which are often unexpected, can at times feel endless - medication, GP visits, specialist dressings, travel, wigs and additional dental care to name but a few. For the patients who do not meet the strict medical card income limits or cannot afford private health insurance, the financial strain is even greater. They are essentially left adrift with no financial support at a time when their physical and psychological energy reserves are low. As a 2018 report into health inequality in Europe put it, these patients are stuck in the twilight zone of the Irish health service. They are at the sharp end of a two-tier system, incurring €80 inpatient charges per hospital visit. While this is capped at a maximum of €800 per year, it should be noted that a high proportion of patients end up paying the maximum rate as their course of chemotherapy or radiotherapy requires more than ten visits a year.
For many patients their first introduction to these inpatient charges is often upon receipt of an invoice. Understandably, some newly diagnosed patients are not even aware that these charges exist. They assume that their treatment is free, particularly the day services. Last year one woman told the Irish Cancer Society that she found out about the inpatient charge the morning of her first chemotherapy session. Imagine a patient learning about this unexpected cost just before their first chemotherapy session, as if they would not be frightened and stressed enough already.
However, for many people it is the speed with which bills, reminders and even debt collector letters are issued that really distresses them. Invoices often come through the door while patients are still recovering from the treatment they are being billed for. In one case a patient received 19 separate correspondences from the hospital and debt collection agency. It is quite remarkable how efficient the health service can be when it is owed money.
The practice of hiring debt collectors is especially disgraceful in my view. It is meant to intimidate patients who with everything else going on in their lives during treatment may just not have got around to paying, maybe they just do not have the money or maybe they are waiting for the outcome of their medical card application. Frankly, the reason does not really matter. What matters is the absolute lack of sensitivity and understanding being shown to cancer patients. One cancer patient described the debt collector's relentless pursuit as bullying. She was told that if she did not pay up, her name would be blacklisted with things like car loans, home loans or even mobile phone contracts. Instead of winding down this deplorable practice, it appears that the HSE has actually intensified its pursuit of patients and spent more than €4 million on debt collection agencies.
On top of this, many HSE-run hospitals are still charging exorbitant fees for their car parks, with the average cost for car parking for cancer patients at around €62 per week. Despite a programme for Government commitment to introduce a cap on hospital car parking charges and to introduce flexible passes where possible, nothing has really changed. The Department of Health has failed to grasp this nettle after years of empty promises. Following a 2018 review of car parking charges, the HSE signed off on a plan to cap car parking charges at €10. The plan was signed off by the HSE directorate in January 2019 and yet many hospitals are still not complying.
For example, Our Lady of Lourdes Hospital in Drogheda charges up to €25 a day and there are many others doing likewise. In total this blatant moneymaking exercise amounts to around €12 million a year in income at HSE-run hospitals. These car parking charges are especially high in urban areas where our eight designated cancer centres for individual cancer types are located. The centres are in Dublin, Cork, Waterford, Galway and Limerick. Many of these hospitals, of course, are known as voluntary hospitals. They are public hospitals but they have the title of voluntary hospitals. They have commercial private car parks which they operate as substantial money-spinners and which place a heavy financial burden on patients.
Of course, for those living outside these counties, the costs associated with their appointments are even more substantial. When travel, parking, food, accommodation and items such as tolls and car servicing are included, the average cost is €989 per year. For many people this is the final straw. Instead of focusing on their well-being, treatment and recovery, patients are worried about money; they should not be. These extra and unnecessary charges are taking a considerable toll on cancer patients and their families. We cannot stand by and allow them to continue any longer.
While this motion is not a silver bullet, it is an important start. We all know that abolishing inpatient charges for cancer patients and placing a cap on car parking charges is the very minimum that must be done. Of course, the only way to fundamentally tackle the considerable financial challenges faced by cancer patients and indeed all patients is a system of universal healthcare, based on need and not ability to pay. However, without real political leadership and a commitment to radically scaling up implementation of Sláintecare, we will need to continue to plaster over the cracks of our health service.
With the stroke of a pen, the Minister could change that, allowing cancer patients the opportunity to focus on their health and not on the mounting debts. It is time to accelerate reform of our health service, to view it as an essential public service and to remove the cost barriers for patients. The Social Democrats believe this motion would be a good place to start, to make our health service more conscious of and more sensitive to the difficult circumstances that patients are in and to make it more empathetic. Therefore, by removing inpatient charges for cancer patients, by ending the practice of hiring debt collectors and by capping car parking charges, cancer patients can be relieved of some of the financial worries and concentrate their energies on getting well. It is the least they deserve and the very least that the Government should do. I ask Government Members to support this motion.
Every family in this country has been touched in one way or another by cancer. It is a diagnosis that can send a person and their family into a state of shock, grief and despair. It is often the start of a very long and difficult journey for everybody involved. However, there is a second shock which people never expect and which comes as a complete bombshell to them and that is the shock of the cost of their cancer care.
The people I speak to about this assume their care will be covered. They never expect to be hit with these bills. The fact that they are does our country and State a disservice. In Ireland those who do not have medical cards or private health insurance have these costs to cover. When they are not capable of covering them the debt collectors can come in. I do not know whether the Minister of State listened to the coverage this week on Newstalk. There was quite a bit of it. People rang in with stories of debt collectors knocking on their doors, putting horrible stress on them and their families at a time they are also trying to deal with their diagnosis.
It is not just limited to adults getting a diagnosis of cancer. Each year many children in our country are diagnosed with cancer. When a child faces cancer there is a huge cost for the family. The Irish Cancer Society estimates it can cost up to €15,500 in hidden costs for a child with cancer. This covers issues such as parking permits in hospitals, utility bills and services such as play therapy and counselling. I have spoken to a few charities in my local area, including the Gavin Glynn Foundation which helps the families of children who travel overseas. It has stated that when a child has cancer the average monthly cost is approximately €1,300. This is a lot to add on in hidden costs.
There is also the loss of income. In many cases carers have to give up their work in order to look after the children. The costs associated with this range from education supports to one-off costs such as wigs and hair pieces. Parents face additional day-to-day expenses such as food, clothing and mobile data. When parents bring their children overseas the HSE covers the cost of the care of the child but the costs of accommodation and all of the add-ons are not covered by the HSE. This can cost approximately €15,000 per child, which is a huge amount of money. This forces families to fundraise and set up GoFundMe accounts and put their energy into getting this money when it should be solely focused on the sick children and ensuring those children are getting the care and love they want to give them.
I wish the Minister, Deputy Donnelly, were here. He is very familiar with the many great charities we have in Wicklow that deal with cancer services. This is replicated throughout the country. When I spoke to them this week I was surprised at the stories I heard. In one instance someone undergoing chemotherapy was missing his appointments because he could not afford the inpatient costs. This should never happen. Finances should not be a barrier to someone getting life-saving medical services. I hope the Minister, Deputy Donnelly, reviews this debate, takes it on board and speaks to the particular services who will tell him the real-life situations being faced by families throughout Wicklow and the country.
The reality is this is not going to get better. We are seeing a huge increase in the number of cancer diagnoses since Covid. Many local supports are still closed or dealing with very high-risk patients. The new wave of cancer diagnosis has been described as another pandemic. Late diagnosis cancer patients will be dealing with even more expensive cancer costs. The State has a responsibility to pre-empt this pandemic wave of cancer diagnosis coming down the track. People are seeing huge increases in the cost of living. The State has a responsibility to pre-empt this and step in now to ensure those cancer patients and families who receive this devastating news are supported fully by the State and that hidden costs do not present barriers to them accessing care.
I welcome a number of advocacy champions for the Irish Cancer Society who are in the Public Gallery, including Katie Lally, Pat O’Gorman and Léa Hearst. I also welcome Maria Fleming, who has been a great advocate in Dublin Central and holds us all to account. I value the work they have done and I am proud to welcome them to the Dáil.
The Social Democrats are proud to table this motion to mark an important week for cancer action and awareness. This Friday is World Cancer Day. Cancer is inescapable. There is not one person in the House or country who has emerged unscathed from the disease and its reach is growing. By 2035 there is expected to be a doubling in the number of cancer cases. An estimated 40% of the European population will face cancer at some point in their lives. At the same time, the number of cancer survivors living through or after cancer treatment continues to increase year on year.
At the end of 2019 almost 200,000 patients in Ireland were living with a cancer diagnosis. I have not received a diagnosis of cancer. I do not think anyone knows what their own reaction will be until they find themselves in the situation. What struck me from reading the Irish Cancer Society's report on the cost of cancer and hearing from cancer patients, survivors and their advocates is how much financial concern immediately weighs on a person who receives a diagnosis. No one's first thought after finding out they have a cancer diagnosis should be how they can afford it. This is not mental arithmetic as a form of self-preservation or distraction. It is not a translation into something more tangible or mundane because the thought of having cancer is too great. It is because what we fail to speak about in society is that cancer comes at a great personal cost not only in terms of health, emotion and quality of life but also financial impact.
The financial impacts are as real as the diagnosis itself. The Irish Cancer Society's cost of cancer report clearly illustrates not only the new costs associated with cancer but the reduction in income that hits simultaneously. I will read some direct quotes from cancer patients and survivors that highlight the devastating impact of the financial burden of cancer. One said it was like "a bomb went off". Another said "It's caused severe stress on us daily. Going from two excellent long-term full-time careers to social welfare. We even lost our house to the bank and I have missed appointments as we had no petrol to go". Another patient said "but for the generosity of friends, family and neighbours, we would not have been able to provide food for our children. The financial impact after a cancer diagnosis is immediate and significant."
Last year, further research from the ESRI showed the main reason people return to work after a cancer diagnosis is out of financial necessity rather than feeling ready to return. Once again, the financial implications overshadow what should be decisions made for the benefit of health and well-being. Research published in 2018 specifically examining colorectal cancer survivors and associated financial hardship supports the Irish Cancer Society's research. Of 496 respondents, 30% had no savings at the time of diagnosis. Of those who did have savings almost 50% used some or all of their savings.
There is no one type of cancer patient. Cancer patients are young people with families, working professionals, people living in rural areas and people living in cities. Stories of survival are becoming more commonplace but we know survival is different to thriving. Our previous thinking and priorities when it comes to the cost of cancer, namely, dealing with treatment options, life expectancy and survival rates, need to change. We need to be as concerned with the quality of life and the well-being of cancer survivors and patients as we are with treatment and survival rates. Every aspect of navigating a cancer diagnosis in Ireland comes at a financial cost, including travelling to treatment. People opt for public transport when travelling to and from chemotherapy despite knowing the nausea they feel. This is because they cannot afford the exorbitant car parking fees and worry about how many hours are left on the meter when receiving their radiation therapy. A total of 83% of patients incurred average car parking costs of €64 per month. Inpatient charges for chemotherapy and radiotherapy are €80 per visit and capped at €800 per year. Not only is there a cost for these treatments but cancer patients will be chased if they fail or forget to make a payment. After only 47 days, and with no clear guidance, a hospital can refer the debt to a debt collection agency. This is a time when people are at their most vulnerable.
Our motion supports a call from the Irish Cancer Society seeking to abolish the €80 inpatient charge paid by patients at every chemotherapy or radiotherapy appointment. It also seeks to stop the indignity of debt collectors being permitted to chase payments from cancer patients. It seeks to make the Government honour its commitment in the programme for Government to introduce a cap to the maximum daily charge for car parking for patients and visitors at all public hospitals where possible and introduce flexible passes in all public hospitals for patients and their families.
Last May, in response to a parliamentary question, the Tánaiste said with regard to using debt collectors for unmet hospital payments that people have a social obligation to pay their bills and taxes and settle their debts because if they do not do so they pass those debts, bills and costs onto society and other people. This is a Government that recognises a moral obligation for people to pay but not a moral obligation to provide affordable and accessible services. Politics is about choices. We can choose to be on the side of people who have experienced sickness and illness, who had no choice in getting ill, or we can choose to be on the side of those who believe people have to pay their debts regardless. The Social Democrats stand for our society where people who get sick are cared for.
I thank Deputies Shortall and Murphy and their colleagues for tabling the motion.
It is a welcome opportunity to discuss what is set out in it. The Deputy is quite right that every three minutes somebody gets that call. Unfortunately, mine was one of the families that got the call 15 months ago when my husband was diagnosed with cancer. Thankfully, he has come through it so far. I understand the issues the Deputies have raised and, to be honest, I am surprised we are here alone discussing this. I lost my father in 1995 to cancer and I have an uncle who is getting radiotherapy today. There is not a family in Ireland that has not been closely affected. Some families seem to travel that road a lot, but I doubt that any family will ever escape it. Therefore, I welcome this debate.
The Minister for Health, Deputy Stephen Donnelly, has asked me to express his thanks to the Irish Cancer Society, which, through its tireless work, has played such a vital role in helping to transform the experiences and outcomes of people affected by cancer. That includes research such as the Real Cost of Cancer report. This is something on which the House can agree. The Minister looks forward to continuing to work closely with the society to further develop cancer care services and supports in the years ahead.
The opening line of the motion is sobering and highlights the challenges we face today. It is true that approximately 24,000 people are diagnosed with invasive cancer in Ireland each year, excluding the common but rarely fatal non-melanoma skin cancer. The reality is that the overall number of cancers diagnosed has continued to increase due to our increasing and ageing population. This underlines the importance of delivering on the National Cancer Strategy 2017-2026 with its focus on cancer prevention, diagnosis, treatment and patient supports. The vision of the strategy is: “Together we will strive to prevent cancer and work to improve the treatment, health and well-being, experiences and outcomes of those living with and beyond cancer". It is about preventing cancer across our population, diagnosing cancer early, providing optimal care to people and maximising their quality of life. The strategy provides a comprehensive ten-year roadmap for cancer services, and there has been significant progress on its implementation over the past four years. Clear, evidence-based policy direction from the Department of Health and strong implementation by the HSE of its national cancer control programme have resulted in real improvements across all stages of the cancer continuum.
We have the evidence to show that this approach is working. The most recent annual report published by the national cancer registry shows that the incidence of cancer per 100,000 people has fallen or at least stabilised in recent years and that survival rates for Irish cancer patients are continuing to improve. Five-year net survival for patients diagnosed from 2014 to 2018 averaged 65%, up from 42% for those diagnosed from 1994 to 1999. As the Deputies note in the motion, an estimated 200,000 people are living with and beyond cancer in Ireland today thanks to continued improvements in medical oncology, radiation oncology and surgical oncology services.
However, we must recognise that the national cancer strategy is not concerned solely with advances in treatment but also with improving the quality of life for those living with cancer. This is why the establishment and ongoing work of the cancer patient advisory committee is so important and why there is also a focus on providing grant funding and best practice guidelines for community cancer support centres and developing survivorship services, to support those living with and beyond cancer. I am reminded of the Solas Cancer Support Centre in Waterford, with which Deputy Cullinane will be familiar. It offers great support and services to people living with cancer and going through treatment.
Such progress has only been possible due to the significant Government investment in cancer services in recent years. Over budgets 2021 and 2022, some €97 million in additional funding was allocated to cancer services, of which €40 million was allocated specifically for the continued implementation of the national cancer strategy, building on the progress and momentum to date. A further €30 million was provided for new cancer drugs while €12 million was set aside for screening services. The remainder was used to ensure that cancer services continued to recover from the disruption caused by Covid-19. It is important to set out for the House the extent of the Government’s investment in cancer services in both financial and policy terms to clearly demonstrate our deep commitment to supporting the many thousands of people, and their families and carers, who are living with cancer in Ireland today.
Nonetheless, despite the investments in cancer services, the Minister for Health is acutely aware of the financial difficulties that people can face following a cancer diagnosis. It is true that cancer can place a financial burden on some individuals and their families through the combined impact of loss of income and additional costs associated with their treatment. This issue is not confined to cancer patients. Individuals diagnosed with other long-term illnesses may also have to cope with financial stresses as a result of being unwell. It is for this reason that supports to ameliorate the costs of illness should be available to all rather than focused on those with particular conditions. This is the principle behind the transition to universal healthcare envisaged by Sláintecare, where people access the right services based on need and not ability to pay.
With regard to inpatient health charges, under the Health Act 1970, as amended, all persons, irrespective of illness or condition, accessing public inpatient, including day-case, services in a public hospital are liable for the statutory inpatient daily charge, which is capped at a maximum of €800 in any period of 12 consecutive months. However, there are exemptions from these charges for identified groups of people, including, but not limited to, people with full eligibility, that is, medical card holders. As is the case for all patients, cancer patients can apply for a range of supports, including medical cards, and they are assessed under the criteria applying to all applicants. Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. Indeed, the Irish Cancer Society found that more than 80% of those diagnosed with cancer who apply for a medical card are successful, while medical cards are awarded without a financial assessment to all children under 18 years of age with a diagnosis of cancer, for a period of five years. Individuals with a terminal illness who have been certified by their treating consultant as having a prognosis of 24 months or less to live are also now eligible for a medical card without a means assessment. Everybody has welcomed that. Beyond this, the HSE has discretion to reduce or waive inpatient charges in cases of excessive hardship while, in certain circumstances, the HSE may grant a medical card even though an applicant exceeds the income threshold, where the applicant faces difficult financial circumstances, such as extra costs arising from an illness. Further supports are available to individuals, including those provided by the Department of Social Protection.
All patients require a responsive and compassionate health system to meet their medical needs. I believe that is the underlying intent of the Deputies' motion, and it is what the Government is continuing to work towards in terms of delivering an affordable, accessible and quality health service for all. As such, the Government does not intend to table a countermotion. My colleague, the Minister of State, Deputy Rabbitte, will discuss progress being made on affordability later in the debate, as well as addressing some of the other issues raised by the Deputies in the motion.
I thank my colleagues for bringing forward this motion. I also thank the Irish Cancer Society for all the work it has done advocating on and highlighting this issue. It is welcome that the Government is not tabling a countermotion and will support our motion. However, simply supporting it and not tabling a countermotion is not enough. There must be action on the motion, and I have not heard from the Minister of State that there will be any action. In fact, what I heard from the Minister of State's most recent comments is a defence of the status quo, which is simply not good enough. It is not listening to cancer patients and seeing the difficulties and stresses they are undergoing.
The motion calls for the abolition of the €80 inpatient charge for all those receiving cancer treatment. What is the Government's position on that? If it is supporting the motion, when will it abolish the €80 inpatient charge? The motion specifically calls for the HSE to be directed to end the practice of using debt collectors. There was no comment at all from the Minister of State on that unacceptable practice. We have not received a commitment from the Minister of State regarding the car parking charges, which put a massive burden on people at the very time they do not need it. It is welcome that the Government is not opposing the motion, but for that to mean anything there must be action from the Government.
We need commitments from the Government and timescales on this issue, not a simple defence of the status quo. That will not cut it.
The motion is about recognising people and the stress or trauma they go through when they receive a diagnosis. It is about seeing the significant burden these financial charges place on such people at the very time they do not need them, while they are trying to deal with their diagnosis and treatment. I appreciate there is empathy on this issue, but I do not think that point has been heard fully by the Government because, if it had been, we would be hearing about the actions it is going to take to address this issue, when it will abolish the charges and when it will call off the debt collectors.
We should pause and ask ourselves how we got to a situation, as a country and a people, where debt collectors are being sent after people with a cancer diagnosis at the very time they are at their most vulnerable and when they need the most support from the State. That is the way in which they are being treated. I do not believe that any Deputy supports that. I do not think anyone in the country supports it. That is not enough, however. We have to change it into action and stop this terrible and inhumane practice. We need to stop this brutal treatment of people that cannot be defended and was not defended in the comments of the Minister of State. We have to act to make a change on that.
The Irish Cancer Society states:
When thinking about cancer, people tend to focus on the treatment options and chances of surviving the disease. Not the families right across the country crushed by debt, struggling to make ends meet and facing an uncertain financial future. Not a parent having to make the choice between paying for medication for themselves and putting food on the table for their children. Not the debt collectors working on behalf of hospitals, chasing cancer patients at their lowest physical and emotional point. Not those sitting in a cold house during chemo because the heating bills are just too high.
That is the reality into which people are being placed by the State and the lack of action on this issue.
Hospital parking charges, to which reference was made, are a significant extra cost and burden. A cancer patient stated:
I stayed in hospital for 115 days and during that time, my wife Trish came to visit me five days a week. It cost her almost €1,200 in parking charges alone in that time. ... If she was able to get free parking, or even a reduced rate, it would have been a great help to us.
A wife visiting her husband who was in hospital with cancer was charged €1,200. That is inhumane. It needs to change and we need action from the Government on it.
One in two people will develop cancer during his or her lifetime. Getting a cancer diagnosis is overwhelming and terrifying. Many or most, if not all, of us have lost loved ones to cancer but we also know many people who have survived. Screenings, improved treatment and excellent care are all increasing survival rates. However, this comes at a deep physical, emotional and, disgracefully, financial cost. This financial cost is callous and uncaring. Not only are cancer patients charged for their care but hospitals use debt collectors to pursue individuals and families dealing with the turmoil and toll of cancer. Patients without a medical card or private health insurance are charged for inpatient treatment, including life-saving chemotherapy and radiotherapy, at a cost of €80 per visit. There are numerous other costs, such as medication, counselling, childcare, wigs, heating and outrageous parking fees in hospitals. The Irish Cancer Society estimates the average cost to a person diagnosed with cancer is €756 a month but can be over €1,000 in some cases. At the same time, people are faced with a loss in income of more than €1,500 a month on average. The Minister and the HSE know all of this. The inadequacy of the response to the lived reality of cancer patients and survivors is truly staggering.
This awful and terrifying disease is made even worse by Government health policy. This has to stop and it can stop today. In the words of a constituent who contacted me on Monday, "The cost of cancer is a disgrace when people are at their most vulnerable." The Government should support our motion to provide relief and support for the thousands of people who are currently undergoing treatment and the thousands more who will do so in future. It should abolish the €80 inpatient charge, direct the HSE to end the practice of using debt collectors and honour the programme for Government commitment to cap daily charges for car parking at public hospitals and introduce flexible passes for patients and their families. The constituent who described to me the impact of the cost of cancer care outlined how his medical bills skyrocketed as he had to pay for medicines, pain relief, GP bills and much more. He eventually got a medical card after months of wrangling and, as he described it, fighting with the HSE. The State does not need to make cancer even more difficult for people and their families.
Cancer support services are also desperately underfunded. I recently visited Cork ARC house in Bantry which provides a range of support and care for people diagnosed with cancer and their families, from vital information and advice to counselling, wigs, art therapy for children and practical supports. In 2021, it had more than 1,500 active users, up from 1,200 in 2020, and it provided more than 10,000 services. Truly disgracefully, Cork ARC Cancer Support House receives only €45,000 annually in HSE funding towards the centres in Cork city and west Cork. That represents just 5% of its overall income, the remainder of which is fundraised. This is an incredible service that makes an immeasurable difference in the lives of cancer patients and their families during and after treatment, yet it receives only 5% of its income from the HSE. It is rightly seeking an increase in funding to ensure its services can expand and continue to meet the ever-increasing demand.
Cancer can have long-term costs and life-altering impacts for which patients too often have to pay. This week, I was contacted by a young person who had to have a hand amputated due to cancer. She quickly realised that public-funded healthcare and support falls so far short of what is required. She does not qualify for a primary medical certificate to allow her to purchase and adapt a car as she had one hand amputated, rather than the criteria of two hands. She is forced into getting and adapting a car herself to allow her return to work and care for her child. In addition, the public cover of prosthetics in Ireland is the worst in Europe. She will need three prostheses in the first year but the public system only covers one. The cost is shocking for this woman who wants to recover, get back to work and live a full life.
The cost of cancer care, however, is a Government choice. There is not a person in Ireland who is not affected by cancer. There is not a person in Ireland who opposes reducing the cost of care, so why would the Government do so? I sincerely hope the Government will go further than not proposing a countermotion today.
I am sharing time with several of my colleagues. I thank the Social Democrats and An Teachta Shortall for bringing forward this important motion. Obviously, Sinn Féin will be supporting it and we will continue to advocate for the removal of hospital inpatient charges, car parking charges and other taxes on being sick on a phased basis, balancing medical and financial need. My party believes in a single-tier universal healthcare system that delivers care when and where it is needed on the basis of need and not the ability to pay.
I will deal with the substantial issues raised in the motion in a moment. It is important to reflect on the wider context of where we are in our healthcare system and fundamental promises that were made by the political system to which all parties signed up in the form of Sláintecare.
We have not addressed the issue of reducing the cost of healthcare to any great satisfaction. We have not moved in any great regard on delivering universal primary care, starting with universal GP care, which is moving at a snail's pace. What was provided for in the budget for six- and seven-year-olds is still not in place because of ongoing talks with the Irish Medical Organisation and GPs. We have a real crisis with GP capacity. The Government has not even started to address many issues that need to be sorted, including looking at demographics and demand in the context of capacity. We have not moved on decoupling private medicine from public hospitals and we have not moved substantially on waiting lists, which are going up. Despite the big promise made to all patients, including cancer patients, that we would deliver a better healthcare system, we have not made the strides forward that we need to make, although I am aware that we have been through a pandemic in recent years. This is without getting into regionalisation and other issues that are important to the delivery of the necessary reforms.
No patient, but especially someone with a terminal cancer diagnosis, should be hounded, threatened and terrified by debt collectors. I am sure the Minister of State, Deputy Butler, and other colleagues in the House have seen some of the letters sent to patients by debt collectors. They are nothing short of intimidation and they put additional stress on patients who may already have financial difficulties and are already dealing with the stress of cancer. The HSE spends nearly €4.5 million on debt collectors each year. This sounds like the furthest thing from a health system that is supposed to be moving to a universal healthcare model. We have to end this practice, particularly for patients with cancer and chronic conditions.
A cancer diagnosis is a life-altering event. Nearly one in two people will develop cancer during his or her life. The rate of cancer is equivalent to someone being diagnosed in the State every three minutes. Every hour, a person dies from cancer. Cancers are the leading cause of death, with nearly one in three deaths linked to cancer each year. Cancer is a massive burden on the individual, his or her family, the wider community and society. We experience it collectively and either personally or through someone we love.
As the Minister of State will be aware, a cancer diagnosis can be devastating physically, mentally and emotionally but also financially for the person who has cancer and his or her wider family. Thousands of cancer patients face into a financial burden in the region of €700 to €800 per month, which is nearly €10,000 a year. At the same time, many are left out of work or on reduced hours. The average household can lose out on €18,000 per year, which can devastate any household at the wrong moment. Obviously, low-income households are particularly vulnerable. Consider any family dealing with a cancer diagnosis and the additional stress of associated financial costs. How could the Minister of State justify setting a debt collector on them and tolerate the sending of threatening letters in an attempt to recoup a small amount of money, at most a couple of hundred euro, from a family that is already struggling with so much? Given its prevalence and potential severity, it is only right that beating cancer and supporting people with cancer is a top priority for us individually, the political system and the wider community health system.
I appreciate that in the past couple of budgets additional funding was made available for the national cancer strategy. I commended the Minister for Health on putting forward additional spend. However, many of the key performance indicators in the national cancer strategy have still not been met or have not been implemented. These will require further resourcing and support over the next years. There is a lot more work to do, in particular to catch up on the pandemic backlog and the cancers missed over the past two years, but also to deliver the top-class cancer treatments that are available to private patients in the State to public patients through a model similar to the National Health Service in Britain.
While cancer services in the State remain one of the better performing parts of the healthcare service, thanks to the efforts of the medical and healthcare professionals in that field, unfortunately a lot of progress remains to be made. In particular, access to innovative new treatments must be expanded, as well as access to therapeutic clinical trials. The cancer strategy set a target that 6% of patients would have access to clinical trials but only 3% of cancer patients have access to such trials. In a recent meeting I had with the working group for an all-island cancer research institute, cancer researchers stressed the need to reach and beat that target. Medics want it, patients want it and research needs it. I was told by this group that up to one in five cancer patients in England have access to all clinical trials. Denmark provides access to trials at a rate three times higher than we do. For all patients, particularly those with severe and complex cancers, we must do better at attracting clinical trials and enabling patients to access them. This can be done on an all-island basis to maximise access and trial availability. Patient advocates on both sides of the Border have been calling for this.
Wealth should not determine a cancer outcome, or any health outcome for that matter, but we know it does. Despite the investments in other cancer strategies to date, access to life-changing treatment for some severe cancers remains restricted and only accessible to private patients. A public patient seeking access to immunotherapy to prevent the recurrence of melanoma, for example, with the same condition as a private patient, faces a constrained system where the first option is often restricted to "watch and wait".
We also have a huge problem in the public system with diagnostics. Rather than more outsourcing and giving more money to the private sector to do more diagnostics, we need more investment in community diagnostics to properly equip GPs to improve their access to diagnostics. Perhaps because of the ideology of the parties in government, we have got into the habit of outsourcing everything. We outsource diagnostics and treatment to the private sector and we outsource the hiring of staff rather than properly investing in the public system, as we need to do.
I thank my colleagues in the Social Democrats for tabling this motion and again putting the very important issue of cancer on the political agenda.
The Minister of State is probably familiar with the TV programme "Breaking Bad". The Minister of State may recall that around the time it was first broadcast, a meme was doing the rounds known as "Breaking Bad UK edition". It showed the character Walter, having been diagnosed with incurable lung cancer, asking "This will bankrupt me, how will I pay my bills?" The doctor replied, "The government will pay your bills; what kind of barbaric society would allow a person's health to hinge on their wealth?" While we may not have a system that is quite as invidious, inequitable and, in some respects, vicious as the American healthcare system, which deprives people of their livelihoods and prosperity, our system is not too hot either.
I welcome the motion proposed by the Social Democrats. It clearly reflects that there is a huge impact on people's income when they have a diagnosis of cancer. This is completely wrong. This is one of the most stressful, worrying and frightening times of a person's life. Very often the person is out of work and his or her income is hugely affected. Quality of life, including that of the person's family, is hugely affected. At the same time, the person must deal with the impact of all the additional costs and if the person cannot afford to pay those costs, the prospect of debt collectors coming to pursue those costs. That is absolutely unacceptable and in some ways it may not be so far from the invidious US model.
Cancer patients are charged €80 per inpatient visit. Many of them have to attend hospital ten times or more per year, meaning charges of €800, with some as high as €1,000. This motion seeks to abolish this €80 charge. Sinn Féin agrees with this proposal. On top of those costs, we could throw in the costs of parking, food and all the rest of it.
Another issue that we encounter in our office concerns primary medical certificates for cancer patients. The radical decision by the board involved in this area, which recently came to light, clearly illustrated the frustration its members felt. A constituent who contacted our office had to have her arm amputated because she was diagnosed with clear cell sarcoma. She needs to adapt her car to maintain her independence, which is vital to her quality of life. The woman does not qualify for the primary medical certificate because she has only had one arm amputated rather than both arms. That is absurd and disgusting.
Ireland is the only country in Europe that does not cover the costs of prosthetics for people who require them.
This woman will require three prostheses in the shape of her arm during the year. She is covered for one prosthetic from Cork University Hospital and her health insurance covers her for up to €2,000 per annum. That will not come near the cost of one, let alone two, prostheses. That is another example of the impact our healthcare system has.
Returning to the example I gave and that meme, the NHS is not perfect but it is a system based on the public good. That is what we need to work towards. We need an Irish national healthcare service that is available free at the point of access so people are not deprived of care, delayed care or broken financially because they fall sick. As the meme indicated, what kind of barbaric society would allow a person's healthcare to hinge on their wealth? We are not in the same position as the United States - there is no question about that - but we have a long way to go if we are to have a healthcare system that is fair, humane and does not ensure that wealth is the key determinant of how healthy one is.
Like the rest of the Sinn Féin speakers, I thank the Social Democrats for bringing forward this important motion. Diagnosis of cancer is devastating for an individual and his or her family. It is a shock to the system. It is unacceptable that in the midst of this upset, fear, anger and sickness, the HSE is sending debt collectors' letters to people. The HSE has spent over €4 million on these debt collecting agencies for cancer patients since 2013. That is a shameful indictment of the treatment of cancer patients in this State.
We often look to America and its healthcare system. Obviously, our system is better in caring than that but for these cancer patients, it is not. That these patients receive debt collection agencies' letters while in the midst of chemotherapy is unacceptable. The HSE gives people 37 days before the debt collectors contact them. That means they have less than six weeks from admission to hospital before these debt collecting agencies knock on their doors.
For some people, €800 is not small money. There are so many hidden costs to a cancer diagnosis. There is time off work for the patient and family members, the costs of transport, medicine and, for some people, wigs because of the effects of chemotherapy. For some people, a bill of €800 arriving to the door is not affordable and it is like a dagger, on top of everything else when they are struggling and at their most vulnerable, to have debt collection agencies at their door. It undermines these individuals that, on top of this terrible illness, they and their families have this cost. There is a human side to this. This practice is wrong and it must stop.
I raise the delay in care in cancer treatments during Covid-19. A neighbour and friend of mine's wife contacted me last week to say her husband was sick last August and September and had to wait two months for a scan, which revealed a tumour in his brain requiring an emergency operation. Up to the weekend, the couple were waiting for contact for the operation to be done. It is a tumour on the brain. There was a delay because of Covid-19 for access to scanning and another delay for access to emergency surgery.
The Opposition has highlighted since the start of the pandemic the importance of cancer patients and other seriously ill people not falling through the cracks because of Covid. My thoughts and prayers go out to this man, Tom, and his family for what they are going through. Coupled with this weight on the family, families receive bills and have debt collectors chasing them down.
The requirement to pay car parking charges when going into hospital for chemotherapy, surgery or clinics has to change. That has to stop.
I also thank the Social Democrats for bringing forward this motion. I think every Member of the House agrees, from a human point of view, on where we need to get to and that we are not starting from where we want to be. Plenty has been said about the need to move properly to Sláintecare and a universal healthcare system that is free at the point of entry and provides care from cradle to grave. All those statements we make from time to time can seem somewhat trite but it is about a decent health system that works for our people.
On the medical card, we have all engaged on cases where somebody did not get a medical card as of right while suffering from cancer. We play the game, make the effort, try to get the card one way or another and eventually end up in that position because it is hard to refuse someone in those circumstances. However, it is a whole rigmarole that is not necessary, does not make sense and creates further hassle and effort for a family going through something difficult. The focus of patients should be on protecting their health and getting through an incredibly difficult process, such as radiation treatment or chemotherapy.
I think everybody is in agreement that the debt collection stuff has to stop. It is wrong for people under pressure to have this kind of communication or interaction for small money. Some of these debts should not accrue in any case. We need to get to that point.
Deputy Gould was trying to get onto the issue of car parking. That goes without saying. For many of us, it is a nuisance to land at the hospital and have to find change, a card or whatever. It can be relatively expensive but people will live with it if it is a once-off charge. However, for people going through constant day-by-day or week-by-week treatment, it is not okay to put this extra cost on them. There is the added issue that some of these are private car parks. It is not beyond the ability of the Government to find a solution to this problem. Rather than us making political points in relation to this matter, it would be far better if it were taken off the agenda and delivered on.
We all know of people suffering from cancer. I have been dealing with friends of mine recently and some, unfortunately, have passed since. They got the best of care but there are difficulties. We need to look at the systems we operate. Sometimes the family arranges to bring the person to hospital for treatment and then all of a sudden it is cancelled. Communication is imperfect and some of that is because the database systems and systems between doctor, patient and administrator are not perfect. There are difficulties but the matter needs to be rectified as soon as possible because it is costing time, causing pain and, in some cases, probably having bad ripple effects that need to be taken into account.
There are a number of simple steps that just need to be take so we have better cancer care for our people.
I thank Deputy Shortall and the Social Democrats for bringing this excellent motion, which crystallises clearly the problems with the cost of cancer care. We have been speaking a great deal in this country in recent months about the cost of living. This motion speaks dramatically to the cost of trying to stay alive.
When people are diagnosed with cancer, their first thoughts should be about their treatment, the impact on themselves, their families, loved ones and friends and the journey ahead. However, for many one of the first thoughts is about whether they can afford the treatment.
The majority of people suffering from cancer are going through the public system. That is where these costs are being incurred, not through elective treatment options. The Irish Cancer Society's research is excellent and clear and paints a vivid picture of the challenges that these people and their families face.
I will speak about the costs in a moment because they have been well laid out by others. People who are facing into cancer are not incurring those costs with their pre-diagnosis incomes remaining static. According to a survey by the Irish Cancer Society, the average drop in income for cancer patients is €1,500 per month, which is €18,000 per year. Not only are they facing increased expenses, but also a dramatic decrease in their incomes due to an inability to work or other reasons related to cancer. Having to pay for vital treatment and meet other costs while their incomes are decimated is a double whammy for people at their most vulnerable time.
The debt collection situation has to change. The Government has to be unequivocal on this. I received a response to a parliamentary question that set out the amount spent on debt collectors year on year up to 2020. Starting at €439,000 in 2013, it increased to €532,000, €567,000 and then €585,000. In 2017, it was €603,000. It then decreased to €573,000 but was €687,000 in 2019. The spend in the year to date was €386,000 by September 2020, which is the latest figure I have, but in 2020 it was on course to being well over €500,000. Some €4.3 million of HSE money went to debt collectors. The HSE is invoking its national financial regulation NFR-25, which sets out that, if a patient has not paid an invoice within 40 days of it being issued, the patient will get a notice to refer to a debt collection agency within a week. Someone's debt is being sent to a debt collection agency six to seven weeks following an unpaid invoice relating to cancer treatment or another health treatment. We have dealt with constituents with unpaid utility bills, Sky Sports subscriptions and the like that have taken longer to get to debt collection stage. What is happening is immoral and has to stop.
As I stated the week before last when the Government did not oppose an Independents 4 Change motion, not opposing a motion or not tabling an amendment to it is not the same as supporting it or acting on any of its recommendations. The proposers of this motion would accept progress being made on even one, two or three of its requests, but what we got from the Minister of State was just a setting out of the status quo. That is not good enough. Tea and sympathy are not required; we are talking about real costs. The €80 inpatient charge has to end. The car parking charges have to end. Some hospitals have reduced their car parking charges or provide parking for free, but they are the exception to the rule. Hospitals are operating without a national policy on this matter. In 2018, the then Minister for Health, Deputy Harris, commissioned a report on parking charges. It was finalised in 2018 but has not yet been published. There is no excuse for that except an intransigence to tackle what many would consider to be reasonably low-hanging fruit in terms of reducing costs for people undergoing cancer care. Some of the car parks are private, which creates complications, but those are not insurmountable. The outsourcing of car park provision to private companies over the years is another example of the privatisation by creep of our health service. Once they are privatised, we say that we do not have responsibility for parking, but we should. It is vital. Deputy Cian O'Callaghan articulated the case of a wife visiting her husband while he was getting cancer treatment and incurring over €1,000 in car parking charges. We cannot stand over that. Nor can our health service.
The figures have been well laid out, including the inpatient charge and the additional home bills. There are additional home heating, electricity and telecom bills for people undergoing or recovering from therapies. We do not need to discuss current gas and electricity bills again. They are outrageous. The Opposition has made practical proposals to reduce them. When someone's income has been reduced by €1,500 per month on average and his or her costs are increasing across a range of areas just because he or she has been among the unlucky one in two people to be impacted by a cancer diagnosis, these are the issues that we need to tackle quickly if we are to have a health service of which we are proud.
The motion is wonderful and makes clear requests. Even if all of them cannot be delivered as soon as possible, the Government could at least make a contribution by achieving progress in respect of one or two of them. Unfortunately, we have not got that. We will get tea and sympathy from the Government rather than real change, and that is disappointing.
Next is Deputy Gino Kenny, who I understand is sharing time with Deputy Paul Murphy.
I commend the Social Democrats on this very good motion. It breaks down the stealth charges that people are incurring during one of the most traumatic times in their lives.
It is good to see people in the Public Gallery for the first time in a long while. It warms every Deputy's heart.
The charges are stark. I am unsure as to whether any member of the Government could justify such costs for someone with a cancer diagnosis. The list goes on: day charges, car park charges and so forth. I received a letter from a constituent recently. I will refer to some of it. It was from a lady who was going through chemotherapy at the time. During the chemotherapy, she got a letter from a debt collector telling her that she owed a certain amount of money and the collector wanted it as soon as possible. A country cannot call itself civilised if it is chasing down people in the middle of chemotherapy over charges for a public service. It is ludicrous. I do not know who makes this stuff up.
I try not to personalise issues in politics or anywhere else but Mr. Paul Reid earns €420,000 per year. That is ten times what a nurse earns. That cannot be justified. I do not care if Mr. Reid can speak 20 languages. He does not justify that incredible amount of money while nurses, the lady in Dublin Mid-West and other people who are going through similar situations have to pay these costs.
Let us break it down. We are talking about someone who is in the middle of a diagnosis and going through a very stressful time, who cannot work because of the diagnosis and who is now incurring extra costs. If someone can justify that, I would like to hear it. The Minister of State, Deputy Rabbitte, could not justify it. I am curious as to what her response would be to someone in that situation.
I thank the Social Democrat Party for bringing forward this motion, which highlights aspects of a dysfunctional two-tier health system that exists in a permanent state of crisis. The problems in healthcare on this island are not accidental. They are not to do with personnel; they are structural in nature. They are the consequence of years of underfunding of our public health system, cuts, privatisation from below and neoliberal management. That neoliberal management seeks at every opportunity, which is demonstrated by the debate today, to extract money from people, even for things as essential as healthcare needs, through the application of charges for treatment and parking in hospitals. To add insult to injury, debt collectors are brought in on the act to extract their cut from ordinary people's requirement for healthcare.
In our budget statement, we called for the abolition of all inpatient and emergency department charges for public patients. According to a reply to a parliamentary question in respect of the matter, the cost involved would be €20 million. This was part of our proposals for a universal single-tier national health service free at the point of use and funded by means of progressive taxation. The removal of charges is also a Sláintecare recommendation. Nonetheless, those charges remain. This is deeply regressive and morally bankrupt; the charges should go.
The HSE doubles down on the inequity of these charges by using debt collectors to pursue patients in respect of those that remain unpaid. Rachel Morrogh, director of advocacy and external affairs at the Irish Cancer Society recently stated:
The Irish Cancer Society has heard from patients about the distress and anxiety that contact from a debt-collection agency chasing payment for hospital charges brings [and understandably so].
The worries and fears that are naturally brought on by cancer diagnosis are compounded by this practice and we want it to end.
An Irish Examiner report in December told of a Ms Cogavin who was diagnosed at 48 with breast cancer. She said that a debt letter followed her out of the hospital after her surgery to remove a tumour. She said:
As soon as I went home, the bill followed you out from the hospital, whatever it was, two, three nights I stayed. They billed me up to €240 in inpatient charges.
As a newly diagnosed cancer patient, you're so angry and your entire existence is all over the place, and you have people chasing you for money.
This is scandalous. We also learned from the Irish Independent recently that the HSE spent more than €568,000 on debt collectors to pursue patients for unpaid hospital bills during the pandemic. Charges for hospital care are regressive and immoral, and the HSE must immediately end the use of debt collection agencies to pursue outstanding charges and all related debts should be cancelled.
I also want to refer to the issue of-----
I am sorry to interrupt, but can I ask the Members who are speaking to either go outside to have their conversation or to be quiet. There is a Deputy in possession and they are interrupting him. Please continue, Deputy Murphy.
I thank the Acting Chairman. I also want to refer to the issue of parking charges. It is more than three years since a €10-per-day cap on parking at hospitals was promised. Fianna Fáil went further and promised free parking, but this regressive tax on sick people and their relatives and friends who are faced with inadequate public transport infrastructure remains in place. According to the Irish Independent in early January, the HSE generates €12 million per annum from car parking charges. It can cost €15 a day to park in St James’s Hospital and the Mater hospital and €14.50 at St. Vincent’s University Hospital. Hospital parking charges were abolished in recent years in Scotland and Wales and they should be abolished here.
It is time for the Government to stop charging for essential healthcare and for transport to allow people to access it. It is also time to stop harassing cancer patients and others with debt collectors, particularly as these patients have more than enough to be dealing with. We support the motion and thank the Social Democrats for bringing it forward.
I now call the Regional Group. Deputies Tóibín and Canney are sharing an eight-minute slot equally.
I am glad that the Minister of State is here to hear what I am going to say because it has all to do with her own part of the world and I know that I am speaking to the converted.
The probability of receiving a timely diagnosis of cancer and of surviving the disease differs substantially across Europe. Because of the major inequity in the access to cancer diagnostics and treatments, the chances of surviving cancer are reduced in the west of Ireland relative to the rest of the country and Europe. That is a fact.
The Saolta cancer centre, based in the model 4 hospital at University Hospital Galway, UHG, delivers a programme of cancer care to an overall catchment of approximately 1 million people across the area for which the Saolta University Health Care Group has responsibility. This includes Connacht and Donegal, with substantial numbers from Clare, Tipperary, Limerick and the midlands, including Longford, Offaly and Westmeath. The Saolta region consists of some of the most rural and deprived areas nationally. Those areas are associated with the western seaboard. Saolta has a larger, older population compared with the position nationally. Cancer is a leading cause of premature mortality in the region in which the Saolta University Health Care Group operates.
According to the National Cancer Registry Ireland, cancer patients from this region have the worst cancer outcomes in Ireland. In addition, with the impact of Covid-19, the mortality rate is estimated to increase by 20% due to delayed diagnosis and the lack of access. This implies that more patients will die from cancer than from Covid-19.
Cancer services in the Saolta group were working at full capacity and above, with no resilience within the cancer programme to deliver a safe staffed and sustainable service, prior to Covid-19. While Ireland introduced a national cancer control programme in 2006 and designated eight cancer centres, the cancer programme for the west has not received any infrastructural support over the past 12 years and has not been able to develop into a sustainable, staffed, secure programme. The lack of resilience within the cancer programme can be strongly linked to what is described as serial underinvestment in infrastructure for the development of cancer services at UHG and at the model 3 hospitals across the region.
A review of the national service plan of historical capital expenditure in the period 2017 to 2021 demonstrates that only 7% of the national infrastructural investment was allocated to Saolta.
The 2019 KPMG options appraisal for UHG highlighted serious deficits in cancer infrastructure at the hospital and specifically identified critical interim developments that need immediate investment because those buildings were classified as being unacceptable in their present condition. KPMG recommended that the ambulatory cancer care centre be progressed as a matter of urgency.
The case for investment in cancer infrastructure is self-evident and requires fast-tracking and urgent action in order that we might optimise and improve outcomes for our population. Such action will not be sufficient, however, because Covid-19 has exposed other infrastructural deficits at UHG in the context of a lack of inpatient beds, dedicated cancer theatres and ICU capacity and at the model 3 hospitals across the Saolta region.
A person with cancer in the west of Ireland should expect the same outcome as any other patient in Ireland or Europe. In the absence of the required infrastructure to develop the cancer care programme this is not possible, regardless of what efficiencies are put in place in the hospitals. We need to ensure that patients in the west of Ireland have an equitable chance of early diagnosis and appropriate and timely access to the comprehensive cancer care programme and the cancer centre for complex therapies, including surgery and radiotherapy. The national development plan contains this and its words needs to be actioned immediately.
"You have cancer" is probably one of the worst things that any person is going to hear from the health service. One of the next worst sentences that anybody will hear in the health service is being asked if one has private insurance or public insurance. If you have private insurance, you are likely to get an appointment in the next fortnight for your condition but if you just have public insurance, you are likely to be put into a lottery and will never know when you will be reached. Another aspect of this is that, typically, it is going to be the same doctor, hospital and treatment that is received by both patients. It is just that one is prioritised and the other is deprioritised.
A scandal emerged in 2019 when the VHI stated that it would be offering new drugs to its members for the treatment of advanced melanoma, breast cancer and lung cancer. Professor John Crown kicked up a serious fuss at the time.
This was the first time the State was going to allow private patients to receive a cancer drug but refuse access to it for public patients. Professor Crown quite poignantly and publicly asked the Government what he should say the following day in his clinic to breast cancer patients in the public system who could not have access to this particular drug. In the week the scandal broke, my office was contacted by a woman who was suffering from stage 3 breast cancer. She was receiving therapy and treatment in hospital. She developed an allergy to a particular drug and, as a result, she was left in limbo without treatment for some time. Her family was deeply upset by the news that the alternative drug was available in another hospital up the road but was not available to that young mother in the public hospital. We in Aontú fought hard for that woman. Thank God she is in remission now.
We need to know if that to which I refer has come to an end. Are treatments available to some citizens and not to others in the State? The facts of the matter are quite incredible. There is a 12% differential in the survival rates for breast cancer between the public and private systems. If 100 women are diagnosed with breast cancer while in private hospitals, seven of them will sadly die according to the statistics. If, however, 100 women are diagnosed in public hospitals, 19 of them will die. That is according to the most recent statistics from the Department of Health. That is incredibly wrong. It means that 12 women extra out of 100 will die because they are in the public system, which is absolutely criminal. We cannot persist with a situation that allows such an economic and life expectancy divide to exist in this country. According to the statistics from National Cancer Registry Ireland, lung cancer survival rates are also significantly worse in the most socioeconomically deprived groups compared to the least socioeconomically deprived groups. Again, there is a massive divide.
We in Aontú have introduced a Bill that will be debated on 17 February. I hope the Government will support it. If passed, it will mean that there will no longer be parking costs for patients in hospitals. This will relieve some of the economic pressure that is currently faced by patients. We do not have a cure for cancer, but we should be doing the best we can to reduce the fatalities caused by cancer. If a woman in Sweden is diagnosed with breast cancer, she is 7% more likely to survive for five years than a woman diagnosed with breast cancer in Ireland. In Britain, someone diagnosed with cancer is 5% more likely to survive for five years than someone diagnosed in Ireland. We need an all-Ireland approach to this matter. Currently, some Covid-19 antivirals are available in the North but not in the South. This is of particular concern to some haemato-oncology patients who are particularly vulnerable to Covid. I call on the Government to address this.
I am sharing time with Deputy Danny Healy-Rae. I want to begin by commending the Irish Cancer Society on the fantastic work it does all year round, every year. I deal with many families whose loved ones have received a shock diagnosis. I commend the Irish Cancer Society on the information it provides and on the dedicated nurse line which deserves a special mention this morning. It is very professional. Without it, we would be at a loss in our constituency offices regarding where to direct patients and families.
Cancer always comes with a cost, be it emotional, psychological or financial. The degree of that cost and the impact it has on individuals and families is something we in this House can all do something about. I have been raising the issue of eliminating hospital car parking fees for cancer patients for a number of years. Last September, I engaged with the Ministers for Health and Public Expenditure and Reform as part of my efforts to have public hospital car parking charges for cancer patients abolished. This followed a meeting I had in my constituency with a representative of the Irish Cancer Society, Siobhan Hayes, who is based in County Laois. The society has been advocating for the provision of €5 million to public hospitals to reduce the cost of car parking charges for cancer patients. It is also calling for a reduction in the drugs payment scheme cap to a maximum payment of €100 a month, and a maximum payment of €72 a month for single-headed households. Those changes need to be taken on board. It was very clear to me following my meeting with the Irish Cancer Society that the stress and challenges created by car parking fees have to be tackled once and for all. It is very doable and we should all endeavour to resolve it.
I thank the Social Democrats for tabling this very worthy motion. I will be supporting it. I support everything that has been said so far. The family of Padraig and Elaine Clifford have paid a very high price, leaving four children behind them. This young couple died within four months of each other.
I wish to highlight the plight of Karin O'Shea, a 27-year-old girl from Kilgarvan who is a personal friend of our family and best friends with my daughter, Theresa. I even brought her to school. This girl has gone around with Lyme disease undiagnosed for more than 12 years. The problem is that the Department does not recognise Lyme disease and will not accept results of blood tests from Germany or other countries. Testing in Ireland is inaccurate. We have only one Lyme disease consultant here. That individual can only offer antibiotics. Irish patients have no other option but to seek treatment abroad. Such treatment is not covered by the cross-border treatment abroad scheme because general practitioners here are not allowed to sign off on it. There is not enough education about ticks in Ireland. Many people are going around with undiagnosed Lyme disease. Not everyone comes out in a bull's eye rash. More must be done to educate people about other symptoms, like muscle pain, tiredness and headaches, because early diagnosis can make a big difference in curing this terrible disease. This lovely girl's whole life is in turmoil. She had to give up her job teaching at St. Brendan's College in Killarney. The cost of four weeks' treatment in Germany is €35,000 and she has embarked on a GoFundMe campaign to help her access this treatment.
Higher numbers of late-stage cancers are being diagnosed because of screening delays caused by the Covid-19 pandemic according to the Irish Cancer Society. Screening was paused in 2020 and CervicalCheck, BowelScreen and BreastCheck did not get back into operation for some time. BreastCheck cancer screening is currently running one year behind. The Irish Cancer Society has stated that 250,000 fewer people were screened for cancer in 2020 compared with the previous year. We have a cancer crisis in Ireland.
My mother died from cancer in 1984. Hers was a late diagnosis. During the pandemic, we have lived with cancer in our house. I have seen first-hand and experienced watching a loved one going for their treatment. When I see that general practitioners cannot get appointments for people for cancer screening, it cuts straight through me. I have lived with it. My good friend went to three public hospitals for late diagnosis because she had no private insurance. She had to pay €1,000 for a private hospital to tell her she had cancer. As stated, she went to three public hospitals. That woman left a husband and two children behind her. I consider us to be the lucky ones in that we have received the treatment and are working with it. I hate to see people not getting diagnosed or not getting screened. It is not right.
I thank the Social Democrats for tabling this excellent motion, which deserves all our support - 100%. I thank the Irish Cancer Society for the excellent work it has been doing. I thank all the Kerry branches of the society, including in Kenmare and the excellent group in Killarney. One of my close friends, Eugene O'Sullivan, has worked so hard. I thank other people like Brendan Ferris in Beaufort, who organises the Threshing Cancer event every year. It was affected by Covid in the past couple of years but, hopefully, it will be back again. I thank people like Jay Galvin and all those who operate the Kerry link bus. It is so important for carrying cancer patients to Cork.
This vital service is run on the basis of volunteerism and fundraising. It is such an important service to provide. I wish to thank the drivers, the helpers and everybody involved in the Kerry link bus service. I could not praise it enough if I lived forever.
I must say that whether you are in Ballinskelligs, Ballyferriter, Ballyduff or Ballsbrige, if you get the diagnosis of cancer, you should have excellent treatment. You should be taken care of at a centre of excellence and have the best of what is available in order to get the most positive outcome.
I thank our doctors, nurses and other specialists who deal with cancer patients on a daily basis. I humbly mean that. When it comes to us as legislators supporting people who have cancer, we must ensure that the simple things, including adequate healthcare, are provided. Last week, I asked the Taoiseach to give people who have a diagnosis of cancer an automatic right to medical cards for a period of three months in order to let them get started with their medical treatment. There are also issues with car parking charges. Of course, any person who is parking a car while they go into hospital to get cancer treatment should not have to pay for it. This is not a luxury; it is an absolute necessity. I thank everybody who is involved in caring for people who have cancer.
I wholeheartedly welcome and support this motion. What is proposed in the motion should have really gone without saying. The fact that people who are diagnosed with cancer are not only faced with monetary hurdles but are actively hindered and hounded by their own Government is a resounding disgrace. Surely, the €4.3 million that has been thrown into debt collection could have been the subject of a more humane, not to mention a more efficient and effective, purpose. Perhaps I am misled in thinking the HSE has no other areas that require funding. The very idea of a debt collector in any instance would be more than enough to scare, intimidate and stress any regular person. I ask the Minister of State to imagine that level of fear and upset being laid on the shoulders of a person who is in the midst of battling one of life's most physically and emotionally draining challenges. In fact, the horrendous thing is that it affects not only individuals, although that is bad enough, but also their families.
A recent report by the Irish Cancer Society, The Real Cost of Cancer, notes the disastrous lived impact that a cancer diagnosis has on a person, their family and their income and finances. If the cancer patient is an adult, they are often unable to work or have to reduce their hours significantly. Understandably, this is due to feeling unwell and to the impact of treatments. The Irish Cancer Society has also reported increasing problems for cancer patients applying for discretionary medical cards. This is completely unacceptable. The medical system is clearly not serving the people it was set up to serve and needs a complete overhaul. It is based on an antiquated 1970s piece of legislation that is just not fit for purpose. It should be the objective of every Government to have it repealed and removed.
In the unthinkable situations faced by so many Irish families where a child has been diagnosed with cancer, more often than not, one parent will cease work in order to be able to care for their child. For those fortunate enough to be unaware of the realities of cancer treatment and care, it does not limit itself to check-ups and a day in hospital to receive the treatment in question. For many, particularly in rural areas in counties such as Donegal, even just receiving treatment means travelling to a larger hospital located hours away. This undoubtedly gives rise to parking fees and food, drink and often accommodation costs. There are voluntary transport providers who provide the transport for patients from County Donegal to Galway on the aptly named cancer bus. It is a vitally important and a very good service that the patients rely on. The service relies on fundraising. In this day and age, it does not bear thinking about.
In the children's hospitals, limited parental accommodation is offered. While the organisations that fund and run these accommodations are providing hugely important support to families desperately in need, there are still ancillary costs involved. When the illness and treatment is ongoing, these costs accrue. The report of the Irish Cancer Society notes that monthly costs can run up to beyond €1,000. Even without the additional costs involved, the Irish Cancer Society notes that cancer patients face a loss of €1,500 per month on average. That means that people facing one of life's toughest battles are already feeling financial strain before additional costs even begin to add up.
At present, the supports that help in the everyday reality of those in the midst of cancer treatment, are offered by NGOs. I applaud the volunteer driver service and the NGOs that provide night nurse care when a patient is terminal and care has reached the end-of-life stage. These are all exceptionally helpful. However, it saddens and angers me that while we have charities and NGOs providing empathetic support, the Government is not only failing to do likewise, but it is actively adding to the huge burden that cancer patients and their families face. Is it not enough to hear the dreaded words "It is cancer", and the emotional toll that takes on a person and their loved ones? Is it not enough that the harsh reality is that when people face cancer, not only do their finances cease to improve but they are reduced considerably?
I support this motion and call on the Government to: abolish parking rates or, at the very least, implement the promised cap on parking payments; ensure a complete overhaul of the medical card system; put an end to debt collections; and scrap the ridiculous €80 inpatient charge for cancer patients.
Gabhaim buíochas leis na Daonlathaithe Sóisialta as ucht an rún seo a chur os comhair na Dála agus deis a thabhairt dúinn, mar Theachtaí, páirt a ghlacadh sa díospóireacht. I welcome the motion. It is a very basic and modest motion. It calls for the abolition of the €80 inpatient car parking charge, for a stop to be put to the abominable practice of using debt collectors and for a follow-up in respect of the commitment in the programme for Government to introduce a cap on car parking charges. I note that the Minister of State is nodding. She has been put in the position in which she finds herself because the senior Minister is absent. I might come back in a moment and comment on why he is in Dubai and on the privatisation of the health service and the marketisation of it and of medicinal products. If I have an opportunity, I will come back to that matter.
It is interesting that what this motion highlights is the inequity in our health system, and not just, unfortunately, for people who are suffering from cancer. As with all Deputies, I have somebody in my mind who is very close to me and is suffering from cancer. I am also thinking of a member of my family who died. All of this is irrelevant because, in a sense, all of us could offer similar anecdotes. The reason we have a national cancer strategy is to avoid that. All the inequities have been highlighted repeatedly. That is what Sláintecare was about. The board was established to deliver a health service that was fit for service. I emphasise that I am using the word "service". I am not referring to a product or a company, but a health service to serve everybody equally, because that is what we deserve as human beings and citizens.
It is significant that we are doing this debate today, especially as this Friday, 4 February, is World Cancer Day, which is an annual event led by the Union for International Cancer Control, of which the National Cancer Control Programme and the Irish Cancer Society are members. Objective No. 23 of the national cancer care strategy, which is underfunded and which is not being implemented properly, is to "Reduce inequalities in five year survival for: - all cancers combined ...". The cancers are then listed out. The target for the objective is to have no greater than a 3% difference in the survival rate between those who are most seriously disadvantaged in society and those who are not, thereby reducing the distinction in survival rates. I will not use the word "deprived" because I do not like it.
In 2019 and 2020, the official position was that survival is 11.4% lower in among disadvantaged communities and patients than it is among those who are not disadvantaged. We could use this benchmark for everything that we talk about in terms of health. It was already mentioned by Deputy Gino Kenny in the context of the geographical differences throughout the country and survival rates. I come from Galway, which is supposedly a city that has a hospital that is a centre of excellence, where somebody very close to me could not get an MRI scan even though they had stage 4 cancer.
I will not go on, because I would not be able to. I will stick to the issue, namely, that this motion focuses and puts a spotlight on the much bigger issue that we are commodifying and making products of our health system. The senior Minister is off in Dubai at an expo, where, I understand, the difficulty is that companies are upset because they do not have enough access to the HSE in the context of selling their products. The Minister should be at home here talking about the importance of universal healthcare service for all, including patients who have cancer that we all know about, and not off in Dubai. It is simply unacceptable. We have been through all of this and the criticisms and limitations of health service before. That is why we brought in Sláintecare. Deputy Shortall did a great job as chairperson, as did the relevant committee, in producing the action plan. They did so in order that we could avoid these type of excuses for debates in which we share anecdotes about who has suffered in our families. It is important to share those stories; I am not belittling it at all. However, we should be beyond that in terms of strategy and implementation of it. That is why the Minister should be here to be held to account.
I wish to thank the Social Democrats and all the Deputies who have contributed to this debate on the financial challenges facing those diagnosed with cancer.
I am not unique or different from Deputy Connolly or anyone else in this House. We all understand the traumatic events that ensue when a family member is ill. Therefore, I am not unique in this experience. The sad case referred to by Deputy Danny Healy-Rae, where two members of one family were struck by cancer within a short time, must also be recognised. I acknowledge a former colleague of mine as well, former Deputy Noel Treacy, who passed away this morning from cancer.
I am taking this motion on behalf of the Minister for Health, so I will keep to the script from the Department, because I get in the most trouble when I do not.
Please do not keep to the script.
Go ahead.
Feel free.
The Minister of State will get into no trouble here.
I concur with Deputy Nolan in commending the Irish Cancer Society and the nurse line for all the wonderful work it does. It is greatly appreciated. We all have cancer care groups in our communities. I could talk about Gort and Ballinasloe and all the Deputies have them in their constituencies as well. That relief valve is important in our communities, especially for those of us who live in rural areas. We depend on those groups because they are a means of supporting people in the community and act as the access point to information and understanding in this regard. We talk about the local bus link and those people who volunteer to drive cars as well. We cannot have a motion like this and not acknowledge their existence and what those people do to support families.
As we have already heard, this Government has prioritised the delivery of the national cancer strategy and invested significantly in improved services and supports for cancer patients, including the provision of almost €100 million in new development funding in the last two years alone. This funding has enabled improvements such as the development and launch of Ireland’s first national skin cancer prevention plan; new referral pathways for patients with suspected cancer; the appointment of national clinical leads in psycho-oncology, cancer nursing and children, adolescents and young adults; the opening of a new radiation oncology facility in Cork and the construction of a new facility in Galway; further centralisation of cancer surgery in the eight designated centres; the repatriation of the CAR-T targeted immunotherapy services to Ireland; and increased use of previously approved cancer drugs with increased patient numbers.
We are also continuing to develop survivorship services, including psycho-oncology services, to improve the quality of life of those living with and beyond cancer. Patients consistently identified the psychological impact of cancer as one of the most enduring challenges of a cancer diagnosis, which can occur at any point in the cancer experience. I do not want to labour the point about progress being made and I understand that this debate is focused on the financial challenges facing some people with cancer. It is important, however, that the House does not lose sight of the improvements in cancer care made in recent years, even as Deputies rightly seek to identify areas where we can improve further.
One of the areas of improvement identified by Deputies is hospital car parking charges. These charges are often highlighted as an additional burden on cancer patients and others who must attend hospitals frequently. That is why the programme for Government commits to introducing a cap on the maximum daily charge for car parking for patients and visitors to all public hospitals, where possible, as well as to the introduction of flexible passes for patients and their families. This subject arose when I met with the local patient advocate from the Irish Cancer Society. In my experience, it was a burden, as was even trying to find a space in the local hospital car park. Designated spaces should be provided to ensure ease of access, because we are talking about very frail people who need to move from the car to the oncology unit. Therefore, not only should parking charges be capped, but parking should also be designated and in a more appropriate setting. Spaces should not be at the back of the car park which can mean patients might have to walk 300 m when they do not have the strength to do so.
How this commitment can best be addressed is being considered, taking into account existing arrangements. While this process is ongoing, the HSE has advised that hospitals which currently charge car parking fees are cognisant of the financial implications of parking costs. Many hospitals have introduced maximum daily fixed parking charges and have reduced parking rates for long-term patients and visitors where the full rate would cause hardship. Having said that, it is only as good as it is communicated at local level. There must be better and clearer communication from local hospitals regarding how people can access those supports. That would be a help in itself. The use of debt collection services has also been referred to. Debt collection is managed at a local hospital level and the Minister has been assured by the HSE that any such activity is managed in a socially responsible, ethical, efficient and cost-efficient way.
This debate has highlighted the financial burden that long-term illnesses, such as cancer, can place on individuals and their families. It has also shown that help is available and we must ensure that people know how to access those supports, whether applying for a medical card or seeking other assistance. The Government is taking steps to address long-standing issues of affordability in access to healthcare. Budget 2022 again provided significant funding towards achieving universal healthcare and its three pillars of affordability, quality and accessibility, as envisaged by the programme for Government. Specific affordability measures being advanced under budget 2022 include the extension of GP care without charges to children aged six and seven; the abolition of inpatient charges for children aged 16 or less; dedicated funding of €30 million to ensure access for patients to new innovative medicines; a reduction in the drugs payment scheme, DPS, threshold to €100 per month from 1 January; and the provision of additional funding to enable progress to be made in addressing issues around access to community dental health services for medical card patients in 2022. The reduction in the DPS threshold and funding for innovative medicines may benefit cancer patients more directly, but the other measures will also ease the financial pressure on individuals with cancer and their families, depending on their circumstances. Moreover, in line with commitments made in the Department of Health’s statement of strategy, a review of the eligibility and charges system is planned. This reflects the fact that eligibility and some charges have been highlighted as a potential obstacle to patient access to healthcare.
Our current system successfully protects many people from financial hardship due to illness, but clearly there are gaps that we must address. The Minister for Health is committed to addressing those eligibility anomalies or barriers to ensure the health system cares for those in greatest need first. In line with the Sláintecare policy, however, the Minister believes that this aim is best achieved through a systemic and strategic approach to universal healthcare. It is generally acknowledged that Ireland has an unusually complex system of entitlements to publicly financed health services. A focus on waiving fees or charges for individuals based on a particular medical condition would only increase that complexity, while potentially also creating issues of equity and, indeed, feasibility. The Government is instead committed to continuing to make progressive steps towards the provision of universal healthcare in the months and years ahead.
We have shown what is possible in our response to Covid-19 by providing universal access to testing, diagnosis and treatment for Covid-19 without charge and extending free teleconsultations for all Covid-related symptoms to the whole population. It is incumbent on us to learn from that experience and to develop services so that people with cancer, or indeed other illnesses, can access the right services based on need and not on the ability to pay. The Government will continue to invest in our health service and will work to improve protection and supports for those on lower incomes, while continuing to expand capacity and service provision. The implementation of the structural reforms we are progressing will ensure that all patients, including those with cancer, will get faster and more efficient treatment, regardless of means.
I thank all the Deputies for their contributions on and support for this motion. I also welcome the return of people to the Gallery who have a particular interest in this area. I acknowledge Erica Tierney. She is the patient advocate in my area and we chat regularly.
We purposely kept this motion narrow and focused because we think this is something that can be done. The Minister of State said she would have liked to have deviated from the script and I wish that she had.
I did not hear the opposition to debt collectors or immediacy regarding scrapping the inpatient charge. The Minister of State said that will come within the context of a review. There is no amendment opposing the motion, but neither am I hearing that the Government is going to do something in the immediate term, in particular regarding debt collectors and inpatient charges.
I wish the Minister of State, Deputy Butler, and her family well. I had a very similar experience on a couple of occasions in our household and I know what it is like when it comes. It is a bolt out of the blue because we all assume good health and this comes as a complete shock. When somebody gets a diagnosis, there is very often surgery, chemotherapy and radiotherapy. People think about things like their own survival. The last thing they think about is the financial implication, until they are forced to. The last thing people expect is a bill. I could not get over actually seeing such a bill. I am sure that is how others feel. I do not think people expect to see a debt collector at their door. It is inhumane and has to stop.
There is a reality facing cancer patients. When we talk about medical cards, we need to ask who is being impacted by what we are trying to do here. There are people who do not have health insurance and do not qualify for a medical card. I accept that there are fully discretionary medical cards, but they take quite a bit of time to get and are not always granted. We are discussing the group in the middle, which is very often looking at their household income and wondering what they can cut out, because of housing costs, the increase in the cost of living and all of that. Very often, health insurance is not an option for people in that group. The qualifying criterion for a medical card for a single person living alone is €184. That is below the minimum social welfare rate. The qualifying criterion for a medical card for a household with two adults and two children is €342. The qualifying criteria for medical cards involve very low levels of income.
Last year I received a response on the take from parking charges in hospitals. In University Hospital Galway, the take in 2019 was €1.4 million. The following year, the take was €630,000. The difference was that visitors were not allowed visit the hospital because of Covid. Those figures show these charges affect patients. In Waterford, the take went from €1.2 million in 2019 to €469,000 in 2020. Covid has given us that piece of data. This is not exclusive to cancer care, but it gives us a picture of the kind of money involved. I was told there are no parking charges in ten hospitals and charges can vary considerably depending on the hospitals. Some hospitals have introduced a cap, and I want to acknowledge that.
Cancer is very stressful and stress does not help health outcomes. We need to consider what it is like for a person facing that financial burden. When Sláintecare was introduced, it was expected this would be one of the things that would be dealt with in year one, but we are still not hearing when inpatient charges will be dispensed with. We want people to focus on their recovery when they get a diagnosis.
A study by the ESRI found that almost half of all cancer patients found their cancer prospects were negatively impacted by their work environment, with the highest negative impacts reported by women, younger workers, the self-employed and those in the public service, which is of concern. We need to examine what exactly that involves. The same study found that the financial impact of cancer was driving cancer patients back to the workforce long before they were ready, which is not good for healthcare outcomes.
A survey by the Marie Keating Foundation found that more than half of patients focus more on financial difficulties than their own treatment, recovery and well-being. I understand the conference in Dubai is about wellness and well-being. We would like to introduce a bit of that into the care of our cancer patients. I find the facts as odds with why the conference was prioritised in the way it was. I thank both Ministers of State for being here.
The Society of St. Vincent de Paul told us it has received 1,400 requests for assistance since 2019 from people who are struggling financially with a cancer diagnosis. It told us it recently began supporting a one-parent family with three children, the second youngest of whom is being treated for cancer and is required to attend weekly appointments in Dublin. The parent had no childcare so all three children had to travel to hospital, costing about €90 in petrol, tolls, parking and specialist snacks for the child that is ill, before the family car broke down and the parent had to take out a loan. That is the kind of thing that completely throws a family. When people have to give up work because they are caring for a family member, we can see the kind of costs that are involved.
Our motion is not so wide that what is proposed is not achievable. It looks for a very deliberate and limited changes to ensure that people will not have debt collectors on their doorsteps and inpatient charges are dispensed with. I do not think people expect to see that kind of bill coming to the door, in addition to their diagnosis. I would also like to acknowledge the work done by the Irish Examiner in a series which described people's personal experiences. People understand things better when they hear about the personal experiences of others, but it should not come to that.
The past two years of the pandemic have been incredible, and we all know that. We know there will be late diagnoses and the number of people who are impacted by cancer will escalate rather than reduce. The last thing we want to do is have people miss care and appointments because the financial burden does not allow them to do that.
The €80 inpatient charge needs to go and parking charges, at the very minimum, need to be reduced. I accept that ownership is not straightforward, and the nature of our health service means the system is quite fragmented, there are voluntary hospitals which are not under the HSE and so on. If there is a will there is a way to deal with this and reduce the burden. Car parking charges are a significant burden on households and individuals. I would like to have heard something very focused from the Minister of State and for her to provide timelines. I did not hear that today. That aspect is very disappointing. We will follow up on this.
Question put and agreed to.