I welcome from the Irish Cancer Society Professor Colm O'Morain, the well-known Ms Kathleen O'Meara, who is head of advocacy, and Mr. Roddy Carter. We look forward to hearing their presentation. We are aware they had some transport difficulties in getting here and we are glad to be able to facilitate them. I draw our guests' attention to the fact that members of the committee have absolute privilege but the same does not extend to witnesses. Members are reminded of the long-standing practice that they should not comment on, criticise or make charges against a person outside the House or an official by name or in such a way as to make him or her identifiable. Our normal procedure is to hear a presentation from our witnesses and then have questions and responses. Would Ms O'Meara like to start the ball rolling?
Bowel Cancer Awareness Month: Discussion with Irish Cancer Society.
Ms Kathleen O’Meara
Our apologies for being late. I speak on behalf of our chief executive officer, Mr. John McCormack, who is on his way here. I am accompanied by Professor Colm O'Morain and Roddy Carter. Thank you for the opportunity to make this presentation during Ireland's first ever bowel cancer awareness month, which is run by the Irish Cancer Society.
As our CEO has now arrived, I hand over to him.
Mr. John McCormack
Sorry I am late. My taxi turned up late due to the traffic. Thank you for inviting the Irish Cancer Society to the committee again. Ireland's first ever bowel cancer awareness month is an important expression of our commitment, as the national charity, to reduce cancer deaths through awareness and early detection.
The need to raise awareness of bowel cancer is clear. The Irish Cancer Society conducted a survey last summer to measure the levels of awareness among the general public of the early warning signs of bowel cancer. The findings show that there is much to be done to educate the public on how to act to both prevent bowel cancer, as well as to recognise possible early warning signs and take action.
More than 50% of people presenting with symptoms are in the later stages of bowel cancer. This informed the decision of the ICS to designate April as bowel cancer awareness month. We have organised a national and regional advertising and public relations campaign with Bill O'Herlihy and the Minister of State at the Department of Health and Children, Deputy Tony Killeen, as well as a bowel cancer literature drive in pharmacies and general practitioner surgeries. We were very pleased with the informative debate in the Seanad in early April. Our efforts this month are bearing fruit. There were over 1,000 calls to the ICS helpline and the traffic to our website has increased 15 fold.
I will outline our activities and objectives for the month,then Mr. Roddy Carter, who has very recently completed chemotherapy treatment for bowel cancer, has kindly agreed to talk about his experience. Professor Colm O'Morain, from Tallaght Hospital will talk about the pilot bowel screening programme which is currently operating in Tallaght Hospital.
There is no national colorectal cancer screening programme, in spite of the fact that 50% of individuals diagnosed with colorectal cancer in Ireland in 2005, the latest year for which we have figures, were diagnosed at stages three or four of the disease, where the five-year survival rates are 42% for stage three, and less than 5% for stage four. A survey commissioned by the Irish Cancer Society found that 70% of people would definitely attend screening for bowel cancer if the Government offered the service free of charge to all adults over the age of 50. As a crucial step towards more people being diagnosed earlier and surviving this disease, the Irish Cancer Society is seeking the implementation of a national bowel cancer screening programme by 2010 for everyone living in Ireland aged between 50 and 75.
The Irish Cancer Society understands that the National Cancer Screening Service, NCSS, was due to receive a budget allocation for 2009 of €1 million to prepare for the implementation of a screening programme. There is a need for clarity as to the allocation of these resources. We understand this funding has not, so far, been allocated. It is our understanding that the cost of rolling out a bowel cancer screening programme would be in the order of €15 million per annum. This compares with €42 million for cervical screening and €24 million for the breast screening programme, BreastCheck. Deaths from bowel cancer are 924 annually, compared with 674 from breast cancer and 80 deaths from cervical cancer. The Irish Cancer Society is asking the committee to support its call for a national bowel cancer screening programme, as the best and only way to tackle the major problem of preventable deaths from bowel cancer.
We understand that the health technology assessment for the bowel cancer screening programme is currently with the Minister for Health and Children and hope that it will be published soon. It makes a very strong case for screening and will show that in terms of investment, it would break even in a very short time. It is surely the impact of cutting deaths from bowel cancer that must be our priority and there is no doubt that screening works.
The Irish Cancer Society has played an important role in drawing attention to the issue of waiting lists and highlighting to patients around the country that the National Treatment Purchase Fund, NTPF, is a self-referring body. The Irish Cancer Society is committed to ensuring that patients referred for colonoscopies are seen as quickly as possible, as early detection is key to survival. In November, the society expressed serious concern at the length of time many patients were waiting for a colonoscopy and had highlighted the fact that patients should have a colonoscopy within six weeks of being referred by their GP. At the time there were some 1,636 people waiting more than three months for a colonoscopy and 900 waiting more than six months for it.
Since then the ICS has monitored progress and issued bi-monthly updates on the matter. We are happy to see that since the Irish Cancer Society drew attention to the grave issue, the number of patients waiting more than three months has been reduced by more than half and those waiting six months have seen a reduction of nearly 80%. We are heartened at the progress that has been made in just four months; however, we are still behind best practice standards. The Minister for Health and Children stated that all patients referred for colonoscopy should be seen within four weeks of referral. The ICS is disappointed that just 18 hospitals meet the recommended waiting time, and 16 hospitals have waiting lists of longer than one month.
The ICS wishes to express concern at the expenses being incurred by referring patients to the NTPF for colonscopies. The budget for the NTPF increased from €5 million to €100 million in a span of six years which, while clearly meeting a demand, highlights that something is missing in the system of waiting list provision.
That concludes my opening remarks and Mr. Roddy Carter will tell his story.
Mr. Roddy Carter
Last week I had my final session of chemotherapy for advanced bowel cancer in St. Luke's Hospital in Dublin. I was diagnosed with late-stage bowel cancer after presenting with pains at St. Vincent's Hospital accident and emergency department several months ago.
I was on the waiting list at Tallaght Hospital for a colonoscopy for a year. Each time I inquired about the procedure, I was told I would have to wait. Such was the seriousness of my condition that I was operated on within three days of my visit to St. Vincent's University Hospital. I needed radical surgery and received chemotherapy as follow-up. If I had not taken the initiative and gone to St. Vincent's University Hospital, I would probably be still waiting for a colonoscopy at Tallaght Hospital.
My story is not an isolated one. There is clear evidence that in spite of the significant investment in cancer services and the massive improvements in infrastructure and staffing, patients with potentially serious cancers are not being diagnosed on time due to the lack of surgery on the part of hospitals and the failure to extend opening times to clear waiting lists.
Some 950 people die each year from bowel cancer in Ireland, the second highest rate of cancer-related deaths after lung cancer. Ireland has the highest rate of bowel cancer in western Europe.
Professor Colm O’Morain
In my professional career working as a gastroenterologist it has always struck me that patients presented late, usually with advanced cancer at stages three and four. It has already been illustrated that these patients need very expensive treatment and quite often the survival rates are poor. The trend throughout Europe is that bowel cancer screening is a right for most European citizens and it has been declared by the Council of Europe that there should be a screening programme for everyone over the age of 50 up to 74.
The whole point of screening is that it is done before people get symptoms. Instead of waiting and looking for encouragement from the National Cancer Screening Service and the HSE, which is difficult in times of financial stress, it was decided to start the service in Tallaght Hospital alone. With help from HIQA, the Meath Foundation and Olympus, the company that makes the endoscopes, we took an initiative to screen people between the ages of 50 and 74. We approached the GPs in the area, and as members know Tallaght would not be very affluent area, but they willingly collaborated with us and gave us access to the patients between 50 and 74 years. We wrote to patients directly telling them that they would be getting a very important test in the post to do in the following week. The simple test checks for the presence of blood in the bowel motion. We proved in Tallaght Hospital that the currently available test that is being used throughout Europe is unreliable. We have developed a more reliable test that detects cancer earlier than the treatment currently utilised in our near neighbour the United Kingdom, shortly to be rolled out to our nearer neighbours in Northern Ireland. We issued the test through the post. There was no coercion for patients to use it. It was totally free and 44% responded. This is an excellent reply rate when compared with the international experience. As usual, females respond better than males, but there was not that much disparity between males and females. There was some disparity in social class, as the more affluent reply at a higher rate than those less privileged. The response rate was gratifyingly high. We sent out 5,000 invitations, of which 10% turned out to be positive. We offered colonoscopies to those people and have carried out almost 200 colonoscopies. I must admit the service is overburdened. We avoid impeding the already overburdened service by conducting screening out of hours on Saturday mornings. Of the 10% who tested positive, approximately 10%, or 20 people, had cancer. These people were walking around without symptoms. A further 30% had polyps which were already large enough to be considered cancerous. It is gratifying that people are willing to participate. The increased detection rate probably reflects the fact that Ireland has one of the highest incidences of this cancer in the world.
Although we hear a great deal about colonoscopy, the procedure is not acceptable to lay people because they think it is invasive and can give rise to complications. The man or woman in the street will not readily participate in a colonoscopy screening service. In the United States, where insurance often pays for the procedure, the acceptability rate is 10% to 15%. Acceptance in a relatively deprived area of Ireland was higher than 40% and 98% of the patients who test positive get colonoscopies. As the colonoscopist is attuned to finding pathologies, he or she does not become bored.
I can provide evidence for the life changing effects on patients. They do not require expensive chemotherapy, for example. Members will be aware that treating cancer can be expensive and advances in chemotherapy and surgery, even as far as removing part of the liver, put enormous strains on resources. We want to concentrate on individuals without symptoms, therefore, so that something can be done on time. The feasibility studies for which we have exact costings in an Irish situation indicate that rolling out screening throughout the country would only cost €15 million per year, which compares very favourably to breast or cervical cancer screening.
Ms Kathleen O’Meara
I welcome our colleague, Ms Joan Kelly, who is head of nursing services. As Ms Kelly has driven our awareness programme and manages a large element of our work in this area, she will also be available to answer members' questions.
I apologise for missing the beginning of the presentation but I have read the submission received by the committee. Professor O'Morain is correct in regard to the perceived invasiveness of colonoscopies. The level of take-up appears incredible but I suppose fear is a great driver. I was impressed by the campaign conducted in April. Several of my colleagues in the House, who I did not know were receiving treatment, spoke openly about the issue on television. That needs to happen on a regular basis. I am concerned that relatively young men comprise a large proportion of those who are late in seeking treatment and consequently do not survive. The Irish Cancer Society has done significant work in raising awareness and persuading men to speak about the issue. Women have always been good in this regard because we do not appear to have the same hang-ups about our bodies, apart from the fact that I would love to be size six.
It was pointed out to me yesterday that health resources tend to be deployed in areas which least need them. If the Tallaght experience is replicated elsewhere in the country, would the results be similar?
Professor Colm O’Morain
They would probably be even better because acceptability would increase as a result of public awareness. The results are already outstanding but they could improve even more if screening was rolled out nationally.
I have concerns about pilot schemes because they tend to be like prefabs in schools in that they are kept forever without ever progressing to permanent status. Does Professor O'Morain think a national pilot scheme over a specified period would be successful?
I thank the delegates for their presentations and Mr. Carter in particular for sharing his personal experience with the committee. They will be aware that we held a debate on bowel cancer in the Seanad on foot of their initiative on the April awareness campaign.
Mr. Carter was on a waiting list for one year but needed urgent treatment when he was finally seen. This highlights the difficulties that arise in deciding the urgency of cases, particularly in regard to the 182 people who have waited longer than six months for appointments and the 652 who have waited three months. What is the problem with these waiting lists? The Minister for Health and Children has announced that people should be seen within one month but this is clearly not the case. Do shortages in personnel or hospital facilities still exist? Professor O'Morain indicated that 18 hospitals are meeting the required targets. What is happening in the remaining 16 hospitals and is it likely that they will be able to reduce waiting times to four weeks?
It appears that screening is a victim of cutbacks. The national screening organisation is seeking €1 million to kickstart the project. Has the Government indicated whether this money will be made available to allow screening to proceed this year?
The Irish Cancer Society has done terrific work on public awareness, which is badly needed given that significant numbers are dying from this illness. We will do anything we can do to improve public awareness and I hope the society will be able to continue its own work in this regard.
Are all hospitals in Ireland making use of the new test that has been developed or is it confined to Tallaght at present? Professor O'Morain stated that international evidence suggests that the laboratory test is not as effective as the one in used in Tallaght.
I join my colleagues in warmly welcoming the delegates. While all their presentations were very interesting, I wish to single out Ms O'Meara because she has been very helpful in bringing us up-to-date on issues of concern. I told her recently that I am still receiving calls from constituents who do not wish the price of cigarettes to be increased. I have always taken a proactive attitude to health awareness. In regard to Deputy Kathleen Lynch's comments on men's health, I have no hang-ups about my body.
Does the Deputy wish to be size six?
I have never been afraid to speak about health challenges because I suffered a heart attack ten years ago. I was up-front and honest about it and I have survived very well. The cardiologist in my local hospital tells me that I will probably die from something else. I have known Professor O'Morain for a long time and he cured my ulcer, something people told me would never go away because of the stress levels politicians suffer.
I am positive about the project in Tallaght and I am glad the professor has taken this opportunity to highlight it. A few months ago he invited me to be briefed on the project and I was extremely impressed. It is very important that the professor stressed the way it was received and particularly the co-operation received from the GP network. It is important that it is a successful project. It deserves to be properly resourced and rolled out. This can lead to success in other communities around the country.
Everybody is concerned about cancer. While there have been developments in medical science, similar progress has not been made on cancer. Much progress has been made, but there clearly is a long way to go. We all know of family or friends suffering from cancer. This project is important, especially when we understand the ongoing challenges. I do not want to discuss centres of excellence and so on, but there are issues in Tallaght and elsewhere. I talked to Deputy Scanlon about Sligo and other colleagues will talk about their own regions and their own hospitals. There are issues about providing good services. The service should not be moved from Tallaght; the bowel cancer screening programme is showing the way and should be supported on that basis. I suspect everybody would agree that this project is well worth supporting. I hope the Irish Cancer Society succeeds in rolling it out.
Senator Fitzgerald made a few political points, and that is fine. The overall economic situation is difficult, but we are talking about small amounts of money to roll out the programme. There is a strong case for supporting it. This has been a very important presentation. All the groups that come in deserve our attention, but all of us are affected in some way by cancer over the years and it is important to support what is being done. I am particularly excited about the Tallaght project. It is important to support Professor O'Morain, and that he knows we support him.
I thank the guests for their presentation today. I extend a special welcome to Mr. Carter, who has been through so much. I am very lucky to be healthy, but over my career, I have seen people come into hospital and mention something in passing, and as they were in the system already, we refer them to our consultant physician. In the follow up, they would be found to have cancer in its early stages. I have also been occasionally relocated to the day care centre, due to the needs of the service, where there was up to 20 gastroscopies and colonoscopies carried out per day. It would be considered a great day if there was only one positive diagnosis. In Clonmel, where around 40 gastroscopies and slightly fewer colonoscopies are done per week, we would consider ourselves to be experts in this. I am not being political about it, but talking about a system that always worked for us where we had good consultants to carry out the surgery and which led to positive outcomes that we see before us today.
I feel very strongly about BreastCheck and the pulling of the HPV vaccine, which was a retrograde step. This should be revisited. We are talking about €80 million for all the important screening services. It is important that awareness is built up about this, and Irish people are particularly good at listening to messages. We require an NCT on a car every two years that is rigorously enforced by legislation. However, we seem to adopt a completely different attitude to people, where we decide that we will shelve such tests due to a lack of money. That is not good enough.
I am particularly delighted to see Ms O'Meara. Dedicating a month to bowel cancer awareness is a great idea. I cannot over-emphasise the value of having someone like Mr. Roddy Carter here. He is a real person who has been on a waiting list. Anybody on those waiting lists is there because they have symptoms of a possible or probable problem. They should be seen in a defined space of time. When someone at the top of the pile says we should do this within a period of four to six weeks, then we are abdicating responsibility by not following up on that. A position like that cannot be sustained. People worry when there is no follow through because they wonder whether they will be at the wrong end of the statistics and be at stage three or stage four or even too late. We all know that there are successes in late stage diagnosis, but the treatment must be far more radical, which is far more costly as it involves acute hospital stays, chemotherapy, radiotherapy, follow up outpatient visits and so on.
It is great that there is a one month awareness campaign. I cannot overstate the importance of it. I will do anything I can to highlight and help develop the case for colorectal screening and other screenings.
I welcome the delegation here. I apologise because as soon as I finish here I must go to meet another group waiting to see me. I congratulate the delegation on the bowel cancer awareness month. The importance of the message requires us to repeat it.
Men's health was mentioned. None of us likes to attend the doctor, nor do we like dealing with personal health issues. However, if somebody is referred to a hospital for investigation, he or she is not referred for the fun of it. A query will have been made by the person's GP, or the person will present with symptoms that warrant further investigation. As human beings, we deserve to be seen as quickly as possible. We have all heard the horror stories of people who presented and got appointments ten or 12 months down the line, and God knows what the story would have been but for what happened to Mr. Carter. If some hospitals can do it, I cannot see why all hospitals cannot. People talk about more for less, and Mr. Carter made an important point when he spoke about the lack of urgency on the part of hospitals. Some hospitals treat these things more urgently than others. There is a failure to extend opening times to clear waiting lists. There must be a focus on how we can get greater productivity and end up with better outcomes for the patients presenting.
For my part, I will support the delegation's call for the full roll out of the bowel cancer screening programme. This week, as we come to the end of bowel cancer awareness month, I have placed an article in the local newspaper to highlight the need for people to become more aware. I applaud the Irish Cancer Society for what it is doing and urge it to keep up the good work because people need to hear the message and become aware of the symptoms. Many people do not realise what the symptoms are until something hits them. People need to know what to do and where to go for help. I will support the society and do everything I can in conjunction with my colleagues to ensure that happens.
Would Mr. McCormack like to farm out those questions or deal with them himself?
Mr. John McCormack
I will deal with some of them. I thank the Chairman and members for their contributions. We are putting in place a new national cancer control programme headed up by Professor Tom Keane. He would say that no matter how good a cancer service is in terms of diagnosis and treatment of cancer, when somebody presents late it makes it harder for doctors to succeed. There is no substitute for early detection. One of the two ways to achieve early detection of bowel cancer is through a screening programme.
To answer Senator Fitzgerald's question, we are not aware of whether the €1 million has been allocated for the screening programme this year. In Ireland we are fortunate that we have a national entity that looks after cancer screening. I refer to the National Cancer Screening Service. The screening service is ready to go once it gets the nod. It has the experience of rolling out BreastCheck and the cervical screening programme. If it gets the go-ahead we can have confidence that it will succeed based on the quality of its work. It has a blueprint for a screening programme. What Deputy Conlon said about early detection is most important. People like to be reminded of the early signs and symptoms of various cancers. We find that they do not tire of being reminded. I will ask Ms Kelly to deal with that issue in greater detail.
Does Mr. McCormack know what is causing the delay in the allocation of the €1 million or is he concerned?
Ms Kathleen O’Meara
Our understanding is that the health technology assessment has only recently gone from HIQA to the Department of Health and Children and it will take several weeks at the very least before it is dispensed with there. HIQA will publish the health technology assessment and that provides the basis for the value for money assessment of the cost. All the issues of that nature are discussed in the health technology assessment and that forms the basis for a decision by the Department in conjunction with the Department of Finance on whether to roll out the screening programme.
We had anticipated that if €1 million was allocated to the national cancer screening service this year it could start that two-year process. If €1 million was invested this year, €6 million next year and €15 million the following year the necessary funding would be in place to roll out the full programme. As of now we are not aware that the €1 million has been made available to the cancer screening service. It appears that a policy decision has not been made as yet on whether to go ahead with the screening programme.
I have a brief question. When Professor Keane came before the committee he insisted he was not talking about centres of excellence but a cancer control programme. What is his position on the screening programme? Is it part of his agenda?
Mr. John McCormack
Professor Keane reports to a Cabinet sub-committee and he has pointed out that a screening programme is urgent and needs to be addressed. As he travels around the country he is seeing the evidence of late presentation, which is a major problem in Ireland. The very best cancer service in the world cannot get around the problem of late presentation. That is why awareness and early detection is crucial.
Professor Colm O’Morain
I thank members for raising important issues during our discussion. I agree with the point made about the pilot study. It is a feasibility study. As the Deputy correctly said, a pilot study would confine it to a prefab. It is a feasibility study to learn the economic implications of rolling out the programme. In that way we have the full costings that are pertinent to the Irish situation.
It is important to emphasise that we should not limit screening to people aged between 60 and 65. We should screen people between the ages of 50 and 74 because quality of life for older people is just as good now as for younger people. From our study we have shown there is significant pathology of 50 to 55 year olds so we would not want the starting age to creep upwards. This is a small country and a feasibility study should be rolled out. So-called pilot studies in the United Kingdom cater for bigger populations than the whole of Ireland. We should consider a national programme.
Regarding centres of excellence, Senator Prendergast mentioned Clonmel. I was there last week for a study day. There are excellent facilities there and the hospital is perfectly equipped to carry out a screening programme. There is no reason that hospital should be excluded.
Senator Fitzgerald raised some important points about the test itself, the faecal occult blood test. We tried to validate that and we found it to be almost useless. We got stool samples and spiked them with blood and asked the people who tested them whether they could detect blood and, surprisingly, they found the samples to be negative because it is a qualitative analysis based on a colour, a grey colour. What colour to choose – grey or blue? The stability of the test is also quite low and if one is dependent on the postal service the sample could go off. The test that we use, which we validated, is a quantitative test so there is an actual value for the amount of blood in a stool. The test is automated and that is much better. Like most good things it is a Japanese invention, but it has been validated in Australia. We have validated it in our population and it is much more reliable than the test that is being used in the United Kingdom or for that matter in France or Germany. We have made some progress. If we get a national screening programme up and running we would be ahead of our near neighbours in Europe.
Waiting is a major issue. I hear about that every day. I am seeking a two-step phase for colonoscopy consisting of an intermediate test where one would get almost 100% acceptance. One of the problems with the waiting list is that some of the patients on the waiting list fail to turn up. Some people have been given three or four appointments and they are still on the waiting list and that skews the figures. I accept there is a problem. It was rightly pointed out that the demand for the test will increase according as people's awareness increases.
There is a problem with personnel. We are training people for it and I hope that when everything is settled with the new contract that we will be able to employ all of those superbly trained people in permanent, pensionable jobs. We have the manpower but we do not have the posts for them as yet. There is an increasing demand and we have to cater for that. There is a bigger demand for this specialty internationally than there was before we knew colon cancer could be prevented. The waiting list is an important point but the list includes 20-year olds who do not have cancer. Our worry is not detecting people with cancer.
We work on the issue every day. We take into account the national treatment purchase fund and see whether we can increase our throughput by utilising our facilities to an even greater extent and turning over greater numbers of patients by staying on for extra hours. Why not use this expensive equipment out of hours and on Saturdays and Sundays? We can make progress on the waiting list. We are taking important steps in that regard.
Ms Joan Kelly
I thank the Chairman. On Senator Fitzgerald's question on awareness, what prompted the Irish Cancer Society to address the issue is that we carried out a survey last year among members of the public and more than 35% of them could not name one symptom associated with bowel cancer. That was a worry for the society and we prioritised the area and considered what we could do. We did not want to confuse it with our screening work, which is very important and must continue, but we decided to tell people through the radio and multimedia outlets about the early warning signs of bowel cancer. There are seven and if people remembered even a couple of them, it would be very useful. That was the thrust of our campaign. As it is still in progress, I do not have absolute results. However, we have received more than 1,000 calls. Interestingly enough, more than half of them were from men which is very encouraging. Our specialist nurses have talked people through their concerns.
In running a campaign the Irish Cancer Society is very conscious of the need not to flood every GP's surgery with people who are well. Important elements of this campaign are the objectives of conveying some of the early warning signs and encouraging people to call our cancer information service, the national cancer helpline, and speak about their particular situation to an experienced specialist cancer nurse who will ask them questions about their family history or listen to what they have to say, talk to them about their symptoms, address their questions and direct them to their GP, if appropriate.
That is the campaign we have run and it is ongoing. We are very happy that we are reaching a lot of people. Unfortunately, we have not yet had a chance to evaluate it but, comparing it with other such campaigns, we are very happy with the response we have received and hope our message is getting through. We will evaluate it more fully in time.
Let me return to the question of waiting times. Mr. McCormack might give an overview. Professor O'Morain spoke about initiatives that might be taken to reduce waiting lists. How will the recruitment cap in place impact on reducing waiting times? Will it be necessary to have new people in position to do this? What will get us to a point where people will not have to wait longer than one month? Clearly, despite what has been said recently, people are waiting longer than one month in many instances. Mr. Carter told us he was on a waiting list for one year. Initiatives can be taken but, as Professor O'Morain said, with increased awareness, there will be more people waiting for a colonoscopy and more GPs referring patients. What resources will need to be put in place? Will waiting times be affected if there are no new personnel in place because of the recruitment cap? What is the reality?
Mr. O'Morain has mentioned how important it is to get the co-operation of GPs. He referred also to the promotion of the programmes. Not long ago the committee discussed at length the issue of primary care and how health centres could be used in that regard. If there is pressure on the system, is there not huge potential to carry on such activity in health centres and further increase the role of GPs? GPs will say they have a lot to do. However, I believe strongly in the importance of co-operation between hospitals and GPs because GPs have a role to play. Could Mr. McCormack elaborate on this a little?
Mr. John McCormack
To answer Senator Fitzgerald's question, there are two ways in which waiting times can be dealt with in the short term. The first is to maximise use of the National Treatment Purchase Fund because it is in a position to access colonoscopy resources in a variety of settings. What is important is that they are availed of and that hospitals with waiting lists point patients to it. Since we have monitored progress, the number of patients waiting for more than three months has been reduced by more than one half and the numbers waiting for six months have seen a reduction of nearly 80%.
Is that through the National Treatment Purchase Fund?
Mr. John McCormack
It is due to a combination of the National Treatment Purchase Fund and better working in some hospitals, a more intensive realisation by the people in power in hospitals that we need to deal with this issue.
I would like to ask a question about the cap on resources. Is it having an impact? Is it hoped to recruit more staff in hospitals? I do not know whether Professor O'Morain would like to comment on this. I am trying to find out how the waiting lists are to be dealt with in a timeframe of one month.
Professor Colm O’Morain
The NTPF is not the complete answer. In going for one procedure one does not deal with the whole patient. I have some reservations in that regard, as we are not talking about merely a colonoscopy. One must adopt a holistic approach to a patient. It is a whole service, about what one finds and what one does about it. It must be done as a package. I hate looking at international figures for gastroenterologists per head of population but the norm in Europe is one per 40,000. Here we have one per 150,000. I hope we will see an expansion in our numbers and that we will have more skilled people. That is important. Colonoscopy is only part of the service but it must be done as part of a quality assured programme.
The appointment of consultants is central to the process. Would somebody care to comment on the primary care process? There is a vote in the Dáil and we will have to adjourn in a few moments but I would like to hear a comment on the primary care aspect.
Mr. John McCormack
Primary care personnel have very important features. They have to be educated a little. It is very important that one takes the family history. GPs are so busy that they sometimes omit to do so. They must stress that this is not an optional test if a patient receives a letter in the post. At the beginning of our campaign people thought they did not have to have it done but now that we have seen the results they are much more proactive.
On behalf of the committee, I thank the Irish Cancer Society for its presentation and the invaluable work it is doing for society. We all support its campaign. We will lobby and speak with the Minister and the HSE to press for the funding stream identified. I am very conscious that achieving the targets set and honouring the commitments made are matters of life and death. We must work to that end.
I propose that we write to the Minister to express our support and ask him to ensure the necessary €1 million is provided.
We certainly will.