While I welcome, at last, the opportunity to discuss this report, statements are a sterile method of debating the matter. I am glad of this opportunity, but it is long overdue. The report took far too long to complete and publish and it is taking too much time to act upon.
The report is absolutely damning. We have had many reports, but this is the most critical of the Government. It is littered with sentences which it makes one's blood run cold to read. For example, it states that given the magnitude of the service development which is needed in the immediate term, the number of radiation consultants per million of population is the lowest in western Europe. It continues:
The medical staffing norm is inappropriate. In the short term, the existing medical staffing levels cannot continue to provide modern radiation and oncology treatment services.
Reading it very carefully, the last line is the most damning of any report I have ever read. The deficiency is so great that the problem is not just one of capacity, it is a problem of quality.
It is difficult to be moderate in one's use of language in dealing with this report, but I will try. The report is an absolute indictment of the Government at the door of which blame lies. Fianna Fáil has been in Government for 20 of the last 27 years, while the current Minister has had a level of resources which no other holder of his office has ever been able to access to address this national scandal. That the treatment available is the best we can offer Irish people is a scandal. The report reads like one from a Third World country. It is an absolute outrage.
I cannot understand why the Minister is not dancing up and down in fury demanding funds from the Minister for Finance, Deputy McCreevy, and the Taoiseach to deal with the matter. It is up to the Minister for Health and Children, Deputy Martin, to communicate a sense of urgency, yet he has spent the last 12 months talking about a smoking ban while deficiencies of the kind outlined in the report exist in our health service. He sends docile and obedient backbenchers out to defend the health service when he knows the level of deficiency and they do not.
He knows there is a capacity problem. He knows radiation treatment is not available to many who require it while some of those who can access it may not get the best outcome from it. From now on, it will not be because the pressures are so great. The Minister knows what that means. He realises that while a lack of radiation treatment is negative, poor radiation treatment damages people's health rather than cures them. Given the caseloads consultants and technical staff carry, there are bound to be mistakes. A less than perfect quality of treatment will be delivered. That is the real scandal in cancer services.
Cancer is the greatest single killer in Ireland. Of every four deaths, one is due to cancer. Each year, approximately 20,000 new cases are reported. Despite these facts, the report under discussion paints a picture of cancer services would one expect of a developing country rather than of a modern State which is so often smug and self-congratulatory.
The first national cancer strategy was published in 1996 and its implementation stage was announced in 1997. That was a long time ago. It is a tragedy that the recommendations of the 1996 strategy are almost identical to the recommendations of the report before the House. There has been almost no progress in seven years. There continue to be major inadequacies and deficiencies in the service. Tragically, there is little prospect that things can be turned around in the short or even medium terms despite the fact that unprecedented resources have been available to the Government. At a time when it could have done a great deal in the area of cancer care, we have a radiotherapy service which fails to meet international standards at any level.
The most glaring example of shortfall is the lack of consultant radiation oncologists. If all of the approved posts were filled at this moment, we would have just 2.5 radiation oncologists per million of population. The international recommended standard is eight to ten per million. In effect, we have 20% to 30% of the staffing ratios currently accepted in most European countries. According to the review group, maintenance of existing radiation, oncology and medical staffing levels is not appropriate. It is very doubtful whether, even in the short term, it can continue to provide modern radiation oncology services.
The report deals with another major problem in the health service which is having an effect on delivery, recruitment of staff. Again, the Minister expresses no sense of urgency about it. The report highlights a case where two new consultants were approved by Comhairle na nOspidéal in 1999. However, by the middle of 2003 these posts were still not filled. It is unacceptable that it should take four years to fill a consultant post. At this pace the Minister must ask himself what is going on, why it is taking so long, what is wrong with the process. It is laughable to talk about doubling the number of consultants as recommended in the Hanly report if it takes four years to find two consultants.
Part of the problem of attracting new consultants in this specialty is that the caseload the existing consultants are carrying is so stressful, which does not encourage anybody into the service. There is undoubtedly a trade-off between the quality of care people are receiving and the quantity of care that is available. There is huge pressure on resources at St. Luke's and other hospitals providing treatment. This is evidenced by the fact that in Ireland each year only 35% to 36% of cancer patients receive radiation therapy at any stage in their illness, with only 20% of new cancer patients receiving it in the primary stage of the management of their illness. This compares dramatically with statistics in other western countries where radiation therapy is part of cancer treatment for up to 50% to 60% of patients. The 20% rate of newly diagnosed cancer patients receiving radiotherapy in Ireland is also well below international recommendations. The World Health Organisation suggests that radiation therapy services in any country should be sufficient to treat 50% of new cases diagnosed in any year. The service here has a very long way to go to meet international standards for patients receiving and accessing radiation therapy.
Little has been done to increase the up-take of radiation therapy among patients. There is a variety of problems, including lack of capacity and lack of information among doctors about the benefits of referring patients for radiotherapy. Alternatively, perhaps they recognise that the capacity does not exist or that there is a problem of access, that people have to travel so far that they decide it would be kinder not to refer them for this kind of treatment. For whatever reason, the Government is responsible for the fact that people are not receiving treatment. Only 20% of cancer patients on primary treatment are receiving radiotherapy treatment compared to 50% or 60% in other European countries.
The Minister may not like to admit it but, as with many services in the health system, where one lives can often impact on the level and amount of service one receives. According to the report — these are inexplicable regional variations — 8% of patients receiving radiotherapy treatment for breast cancer had their first treatment within a month if they lived in the Mid-Western Health Board area, compared with only 3% who lived in the Midland Health Board or Western Health Board areas. In the case of lung cancer, 43% in the eastern region received treatment whereas only 16% in the Western Health Board area received treatment. That is inexplicable. Why there is not a revolution when people realise what is going on in the health service in this regard is a mystery.
We talk glibly of matters of life and death, but this is a matter of life and death, and such variations are a hugely serious matter. The Minister must find out why these variations exist and tell us what he is doing to deal with them. It may be that the problem is lack of data and that if we had the data we might be able to explain it. I suspect it has much to do with waiting lists not just in terms of obtaining treatment but of getting a diagnosis, seeing a consultant and getting a referral to a hospital for further diagnostic work before treatment can be recommended. That may be the problem and it is another very serious deficiency in the health service. However, we will never know because we do not have the kind of data we need.
The report reveals the pressures on the radiation service in Cork and particularly Dublin. On a national basis 76% of all patients receive their treatment in Dublin, with 23% receiving treatment in Cork. Some, as we know, go abroad and pay for their treatment, giving up on this modern economy. Nevertheless, most of the patients receiving treatment receive it in Dublin. This means that an enormous number of people are travelling very long distances to receive treatment. We have had long debates inside and outside the House about the unfairness of people having to travel long distances, the lack of organisation in terms of making it easy for them to travel, the stress it puts on them and on their families and, ultimately, the inequity which results when doctors decide not to refer their patients because of the pain, stress and inconvenience it causes to families where somebody has been diagnosed with cancer.
It is indefensible that people living in Kerry or Donegal who need cancer treatment for palliative purposes, who are in pain and are in a critical condition, must travel long distances on bad roads to receive tumour reducing treatment in Dublin. That is outrageous. Many local groups were hugely disappointed by the location of the radiotherapy services recommended in the report. I hope a concerted effort will be made by the Department and the Minister to ensure at least while the services are being built up in the future that all patients can access these services with the minimum of discomfort.
The proposed second phase of the development of the radiotherapy service, where the provision of satellite treatment centres in Waterford, Limerick and the north-west are to be examined, sounds like a delaying tactic. However, I will not concentrate on that because I realise that if I go down that road it will be a distraction and will provide an excuse for the Minister to do nothing in the areas in which he has promised to do something immediately. That is not to suggest that the areas in question do not immediately merit treatment facilities. However, overall capacity must be the main concern. It is the lack of urgency to overcome capacity issues that is the most worrying aspect of the Minister's response to this report.
The number of people travelling — more than half the people seeking treatment travel very long distances — highlights the urgency to complete the radiotherapy treatment centre in Galway in particular and the expansion in Cork. The report stated that Galway's treatment centre was to be completed in 2003 or 2004. I understand that the Minister has indicated that the physical infrastructure will not be completed until 2005. Last spring the Minister sanctioned some of the staff to operate the linear accelerators in Galway. That was almost a year ago. Has there been any success in appointing that staff? One of the major problems is the difficulty and time it takes to accumulate the necessary level and range of expertise. Nobody knows better than the Minister just how technical and complex are the needs of a professional modern radiation service. It takes a very long time to gather that kind of expertise together. What progress has been made? Will the full range of staffing be available when the physical infrastructure is ready or will there be further delays?
There is a country-wide shortage of linear accelerators. There are eight, although the report recommends 25 to 29 to achieve the 50% take-up of radiation therapy. That means we have less than one third of the required number of linear accelerators compared with, for example, the Netherlands, which has a population only four times the size of Ireland's but the number of linear accelerators, at 82, is ten times that of Ireland.
The Minister indicated, arising from the report, that future services will be located in two locations in Dublin and one each in Cork and Galway. He did not make clear where the Dublin services will be located, however. The staff of St. Luke's Hospital in Dublin are uncertain about their future. I would like the Minister to clarify this matter. I understand he intends to announce the Dublin locations next month, but I am anxious to be informed about the future of St. Luke's Hospital. I ask the Minister to be cautious in making decisions about the hospital, where expertise has been accumulated over a long time. The hospital, which is the backbone of the service, constitutes a vital resource. Regardless of whether the service is moved at some future date, it is critical that it is not run down in the meantime. It should be strengthened rather than regarded as something to be cast aside in the future.
We need to deal with the immediate needs. There is an urgent need for action on the development of services. As this is being done, we should ensure that services are capable of addressing the new forms of treatment emerging from the technical progress that is being made. There are many challenges and pressures.
Although the Minister has announced the national roll-out of BreastCheck, very little action has taken place and very little funding has been provided. If BreastCheck is rolled out, it will detect further cases of cancer, thereby putting greater pressure on the need for radiation therapy services. The clinical director of BreastCheck has said that the greatest challenge will be to get staff in place to roll out the programme and to treat those whose cancer is detected.
It is clear that the number of cancer cases will increase by 41% by 2015. Such a figure should make our blood run cold. Given that we cannot cope now, how will we be able to deal with such an increase just over ten years from now? Some of the reasons for the predicted large increase are not clear, but some of the increase will result from an ageing population and, perhaps, environmental factors. It seems that some of the year-on-year increase in the incidence of cancer cannot be explained.
The report under discussion states that the shortfall of clinical radiation oncology services in the Republic of Ireland is of such a magnitude that a major programme is required to rapidly develop treatment services to acceptable standards. The Minister should act on this statement and all the other recommendations in the report. He knows how long it takes to build up a body of expertise to provide a service and he should start to build it now. There should be a sense of urgency in this regard.
Issues relating to manpower, training and retention must be addressed. There should be a significant increase in radiation oncologists, radiation therapists, physicists, oncology nurses and other staff. The Minister knows that all aspects of radiation oncology, including imaging and simulated treatment, are vitally important. Every element of the team needs to be in place, of the highest quality and performing at peak. One cannot perform at one's peak if one is carrying a caseload which is four times greater than that which is recommended.
I could speak at length about various aspects of the service. Members often speak of life and death issues. Perhaps we use the term "life and death" rather loosely and glibly from time to time, but this is an issue of life and death. I ask the Minister not to procrastinate or to obfuscate on this issue but to act on this report. It is more important that action is taken in respect of this report than any of the other reports. Given that it will take a long time to deliver the type of service that Irish people deserve, we must start to put it in place now.
