Dáil Éireann díospóireacht -
Tuesday, 8 Sep 2020

Vol. 996 No. 6

Cancer Screening: Motion [Private Members]

Deputy David Cullinane

I move:

That Dáil Éireann:

notes that:

— this State has the third highest rate of cancer in the world with more than 43,000 cancers diagnosed on an annual basis;

— the importance of catching cancer early is indisputable;

— fewer than 100,000 people were screened in the first half of this year compared to 500,000 in all of 2019, with the National Screening Service saying that they are ‘unable to screen people at the same numbers’ as they did pre-Covid-19; and

— medical oncology services are operating at about 70 per cent with cancer surgeons treating a much-reduced number of patients than usual;

agrees that:

— before Covid-19, crucial targets in the National Cancer Strategy were missed relating to timely access to diagnostics, surgery, radiotherapy and screening;

— there have been significant delays in cancer screening at CervicalCheck, BreastCheck and BowelScreen with the phased resumption of services varying depending on the screening programme and capacity; and

— the postponement of screening and lack of clarity is causing huge additional anxiety for patients and their families while also contributing to growing waiting lists for cancer tests and treatment; and

calls for:

— an immediate review of the National Cancer Strategy to address capacity deficiencies and to lay out a timeline for catch-up on new and delayed cancer care with targets;

— the reversal of historic underinvestment in cancer care to meet targets set under the National Cancer Strategy; and

— additional funding to be made available for capacity protection measures to deliver cancer care in a Covid-19 environment.

Every time I stand up and wear this mask I must remind the Minister of the campaign for 24-7 cardiac care for Waterford. I will take every opportunity I can to raise the issue with him.

In tabling the motion, I recognise that those who are running our cancer treatment and screening services throughout the State are doing a first-class job. I also recognise we will have a very big challenge in the State in the weeks and months ahead in delivering Covid care and non-Covid care and attempting to catch up on all the missed care and missed screening services that have resulted from Covid-19.

Unfortunately, Ireland's cancer rates are the third highest in the world. On average, more than 43,000 cancers are diagnosed on an annual basis. Cancer related deaths account for almost one third of all deaths every year and one in nine people dies of cancer before the age of 75. This is a stark reality of cancer in Ireland. The importance of catching cancer early is indisputable and in the wake of the Covid-19 pandemic we all know there have been significant delays in cancer screening services and in treatment.

In 2019, 500,000 people were screened for cancer. We are on track to screen fewer than half of that number this year. According to the Irish Cancer Society, approximately 450 cancers and 1,600 pre-cancers would have been detected in a typical four month period if the screening services had been operating as normal. We are running the risk of denying hundreds of people the urgent care they need to have a good quality of life and, in some cases, to survive. This is not inevitable. I completely understand that screening is not a diagnosis but general population screening is a very important tool in fighting cancer. The pathway from screening to a diagnosis and services is critical.

To make matters worse, medical oncology services are operating at a reduced capacity, and some experts say it is as low as 70%, meaning cancer surgeons are treating a much reduced number of patients this year. We have to rapidly invest in cancer services and capacity to kick start the national cancer strategy and the national cancer control programme. These are historically underfunded, with the national cancer strategy receiving less than 4% of the necessary development funding in its first three years. When the Minister was an opposition health spokesperson he also raised the issue that we are not meeting the targets that have been set with regard to speedy access to treatment, radiotherapy, chemotherapy and screening. The reason we are not meeting the targets in the national cancer strategy is that we are not providing the funding. I read in the ministerial brief that the Department had asked for more than €40 million in recent years for the national cancer programme but received only €3 million or €4 million. We need to make the investments. Unfortunately, without immediate action, we will see avoidable cancer deaths.

We all accept and acknowledge the pandemic presented challenges that none of us could ever have envisaged. The public paused their daily lives and we stayed away from friends and loved ones while our State agencies and front-line healthcare workers worked around the clock to keep us safe. The efforts of everyone in the battle against this pandemic are to be lauded. It was, and continues to be, all hands on deck.

I lost my Mam to cancer in January last year, and I remember when she went for her scan she was not expecting to get the news that she did. She had no idea what was wrong with her. I remember very well the fear we had and the urgency we sensed was there to make sure she got the treatment she needed. I know first hand, as do many people in the Chamber as we all have loved ones who have suffered from cancer, that timely access is important.

We are looking for a number of things through the motion. These include the funding necessary to kick start the national cancer strategy. We have called for €20 million of additional funding for this. We also need additional funding of €10 million to provide cancer care in a Covid environment and another €10 million to provide screening services. If we have any chance to catch up and keep up, these investments must be made. We are being constructive in bringing forward the motion and we hope the Government is in a position to accept it.

Deputy Louise O'Reilly

During the course of Covid-19 and for a bit before it, my family had experience of cancer. My husband had to have surgery at the height of the pandemic and it was terrifying. Having surgery any time is not great but it was very scary because we were worried about how Covid would be dealt with. The staff were fantastic but we could tell that it was not an ideal environment. The capacity was not there. How many times did the Minister and I have conversations about the lack of capacity in the health service and the urgent need to build capacity? That was before a pandemic took away much of the capacity.

I am absolutely and forever grateful to the staff at Beaumont Hospital and my husband's GP for the vigilance, compassion and fantastic care they gave him, and he came through it. He would tell the Minister, and I can tell the Minister, they are operating in circumstances that are not just less than ideal but severely constrained. These are people who are at the absolute top of their game. Every single one of the healthcare workers in the cancer section in Beaumont Hospital is absolutely amazing but they feel they are constantly in a battle with the system. They feel they are constantly fighting because they are not getting the resources they need. On the one hand they get the plámás and are told they are fantastic, and they might get a round of applause every once in a while and everybody knows how important they are and how important the work they do is, but they do not feel they are being supported because they do not get the resources they need. The motion is about putting these resources to place and ensuring avoidable and preventable cancers are caught and treated. The person whose cancer is caught and treated goes back to work and does not have to go to the health service again, thankfully, and, touch wood, I hope not ever, and is back working and paying tax. This is what it should be about. This is what the motion is about. It is about ring-fencing the money.

I remember when the national cancer control programme was set up. There was much consternation at the time about how it would work if the money was moved out and was not centrally controlled, and whether it was a power grab by one doctor or another. The thinking in Government at the time was that the funding had to be ring-fenced because cancer was too important and we could not miss it. It was something we could actually beat and meet it head on with a screening programme and ensure people were caught, treated, turned around and put back in the system. That was the thinking at the time. All we are asking for now is cross-party support for the ring-fenced funding so the brilliant men and women in our cancer care services can get on with doing the work they do and cure people wherever it is possible, catch it quickly and get them back into work and into society.

Deputy Darren O'Rourke

I commend Deputy Cullinane on tabling the motion. It is timely and important. The CervicalCheck scandal and now Covid-19 with the suspension of screening programmes have brought cancer care in Ireland into focus again. I am sure others will address the important issues of delayed and missed diagnoses and the unnecessary pain and hurt this causes. Others will mention the poor outcomes we experience in Ireland. Five year survival rates for ovarian, colon and rectal cancers lag considerably behind other wealthy western countries.

I want to focus my comments on the essential role of medical scientists in cancer care, screening, diagnosis, treatment and monitoring.

As it applies to Covid-19 testing, a headline in a national newspaper two days ago read, "Overworked medical scientists warn of burnout as testing requirements increase." The same could be said at any stage in recent years of the general services that medical scientists are expected to perform, many of which relate to delivery of cancer care. This is a proud profession that feels underappreciated and undervalued. I know this myself because I worked as a medical scientist for a number of years, starting in 2003. The representative bodies - the Academy of Clinical Science and Laboratory Medicine and the profession's union, the Medical Laboratory Scientists Association - have, in my experience, stated their concerns loudly over two decades. We should be very proud of this profession, and I am sure the Minister is. We produce fantastic graduates, the best in Europe. There is a competition every year and we win it consistently. All those in the profession are educated to degree level, most have master's degrees, many have multiple master's degrees and many have PhDs. Increasingly, they are taking on FRCPath and MRCPath. We do not train enough medical scientists. Of those we train, 25% emigrate or go into industry. Those who stay to work in the Irish public health system are frustrated by the lack of recognition or of career progression opportunities. They have lived with pay inequality for decades, and that needs to be addressed.

The Minister and I have spoken privately about this before. I know he is interested in the opportunity there is available. I believe there is a clear win for the Government in this. I ask the Minister for Health and the Minister for Public Expenditure and Reform to take the opportunity to meet representatives of medical scientists. They have a great opportunity to contribute significantly more than they are being asked to contribute. I think there is a win there for the Government and I would appreciate it if the Minister took up that proposal.

Deputy Seán Crowe

For me this debate is very personal. In October 2014 I was told I had prostate cancer. Perhaps it would be relevant if I focused on this in the couple of minutes I have. At that time one got a biopsy up the back passage. When I was told I had the cancer, I was told they would probably monitor it for six months. I asked the doctor at the time whether it would be possible to get a transperineal biopsy, which is much more accurate. My cancer was at the top of the prostate and very difficult to get to. For years I had been getting different biopsies and they had come up negative. I was told then that I would have to go to see a radiotherapist and a surgeon. I thought the surgeon would basically say to go for surgery and the radiotherapist would say to go for radiotherapy. It worked out anyway. They said it was a fast-growing cancer and that the only option for me was surgery. I got the surgery. It did not work out. It was great in that they removed it, but a couple of days later I got sepsis, and a year after that I had to get another operation, another operation and so on. I was told after that that the prostate-specific antigen, PSA, was rising again. I had to get back into the system again.

Much has changed since then. One can get a transperineal biopsy. I could not get robotic surgery at that time; it is now available in some areas. Again, I think a transperineal biopsy is much more accurate. What I am really arguing for tonight is that we give people a greater chance of going back to work. That was my priority. I wanted to get back to work. I wanted to get back to representing my constituency. Many people said I was mad and told me to think of my health and so on. There are many things we can do, though. According to the Irish Cancer Society, something like 3,357 people are diagnosed every year with prostate cancer. Of those people, 90% will survive, so the cancer has a high survival rate, but catching it early is so important. I recognise we are focused on Covid, but that is only one aspect of our health service and we need to focus on cancers and saving people's lives. That is my message tonight, including to those who are listening in at home. If you are worried, do not be worrying at home. Go get tested.

Deputy Pat Buckley

I welcome the opportunity to speak on the motion. I am always straight and to the point. This is about doing the right thing. It is about addressing the issues of major underinvestment in these vital services. Most of the speakers have mentioned the specifics of the cancers and so on. They are right when they say we have all lost family members and that families are decimated by cancer. I wish to address the underinvestment. It is probably the only opportunity I will get to put this on the Dáil record. I have been listening to some deeply disturbing stories coming out of the geriatric ward in Cork University Hospital, CUH, over the past two days on a radio station in Cork called RedFM, specifically on "The Neil Prendeville Show". I hope to send the Minister the podcast of it. It addresses duty of care and how patients have been treated.

This motion is all about doing the right thing. I have looked at the Government amendment to it. I am afraid it would result in something of a watering down of the motion and a return to the status quo. I do not want to go into the specifics of it. I am just appealing to the Minister. There are many more speakers here. The motion goes in the right direction to do the right things. We constantly come in here and debate underfunding. There is the line "where there is an action there is an instant reaction". We are always reactive instead of proactive. My wife is going to kill me for saying this in the Chamber, but I will say it: prevention is better than cure.

One of the speakers mentioned people going back to work. That would result in a better quality of life for people. What is affecting many people at the moment is the worry of getting an appointment and nothing happening for months. It has to be torture. I do not know whether it is a medical fact, but it has been said that extreme worry and stress can bring on cancer in the stomach, the bowel and so on, and here we are, our people stressed to their limit, waiting for appointments and waiting to see whether they can get positive or negative results. This puts indescribable pressure on all family members, and the knock-on effect of that is the kids going to school, mammy or daddy being unwell and elderly parents or grandparents being worried about it.

We know we can address this if we put the right protocols in place, so I appeal to the Minister to take stock and have a look at the motion. It is very simple, straightforward and black-and-white. It does what we should be doing, which is the right thing. We should invest in the services now and then, I hope, we will see the results of this in a number of years' time.

Deputy Violet-Anne Wynne

I welcome the motion and strongly urge all parties to support it. On the pandemic's arrival in Ireland we were faced with some very tough decisions which had to be made. We closed the schools and cancelled sporting and cultural events. Possibly one of the hardest calls that had to be made was the cancellation of medical appointments, cancer screening services, general check-ups and non-urgent procedures. While a tough one to comprehend, it was a decision that had to be made, and I accept that.

Here we are, however, six months on from the start of the pandemic and more than six weeks since the start of the easing of restrictions, and these screenings have not yet restarted and are not due to restart for at least four more weeks. We have seen figures that show there has been a drop of more than 50% in the number of BreastCheck screens carried out since the start of the year compared with the same period in 2019, equating to fewer than 100,000 tests, compared with 500,000 for all of 2019. If this is not a truly worrying number for some in the House, all I can say is that not much will phase them.

I have been contacted by a lady called Deirdre in my home county of Clare and she described the truly difficult situation she has been facing. Deirdre informed me that she had an important follow-up appointment with the colonoscopy clinic in UHL in April that was unfortunately cancelled. This appointment was vital as it would have enabled the medical team to check whether cells were redeveloping but also to ensure that the treatment received six months previously was actually successful. Deirdre has since April been left with so many questions, concerns and thoughts about what this delay may mean for herself, her family and all the other patients in this awful predicament. These patients are trying to stay positive, but receiving letters with the generic line "we apologise for any inconvenience caused" does little for the anxiety or the stress and absolutely nothing for the outright fear these people are enduring.

This burden is too much for any person to be saddled with, and it is not good enough. We need to get CervicalCheck, BreastCheck, BowelScreen and all the other cancer screening services up and running without delay. We need to get them back to full capacity and then some. We cannot begin to comprehend the long-term effects of people not being screened. We cannot allow this virus to stop vital screening and care for our people any longer. We keep hearing from the WHO, NPHET and the Government that we need to learn to live with this virus so let us do just that. Let us get our services reopened and funded as required to ensure they can clear any backlogs, especially dangerous backlogs.

Minister for Health (Deputy Stephen Donnelly)

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“notes:

— that the National Cancer Registry of Ireland records that over 23,000 people are diagnosed with cancer annually, with a further 20,000 people diagnosed with the common but rarely fatal non-melanoma skin cancer;

— the lack of clear comparable data on incidence across jurisdictions given variations in the nature of data collection and registration;

— that survival for Irish cancer patients continues to improve according to the National Cancer Registry’s Annual Report, with an estimated 180,000 people living after a diagnosis of invasive cancer other than non-melanoma skin cancer at the end of 2017;

— a 15 per cent improvement in breast cancer survival over the twenty years to 2015;

— that in a report by the International Agency for Research on Cancer (IARC) on cancer survival rates across seven high-income countries, Ireland showed the greatest improvement in survival for stomach and oesophageal cancers and the second highest improvement for rectal and ovarian cancers;

— the Government’s commitment to continued improvement in cancer outcomes, through research, prevention, early diagnosis and high-quality safe care;

— the progress made in implementation to date of the national cancer strategy

published in 2017 including:

— legislation on standardised retail packaging for tobacco;

— the passage of the Public Health (Alcohol) Act 2018 in October 2018;

— the development and launch of Ireland’s first National Skin Cancer Prevention Plan in 2019;

— the commencement of the roll-out of the National Cancer Information System which was launched in November 2019;

— the appointment of National Clinical Leads for Psycho-Oncology, cancer nursing, children, adolescents/young adults to provide leadership and focus on planning, development and implementation of key areas of the national cancer strategy;

— the publication and launch of the National Clinical Guidelines for Ovarian and Oesophageal Cancer in August 2019 to help healthcare professionals with the diagnosis, staging and treatment of patients and to standardise practice;

— the delivery and expansion of the Cancer Thriving and Surviving Programme in acute and community settings to provide patients with a programme to help with the transition from active treatment to living well with and beyond cancer;

— the publication of the National Cancer Survivorship Needs Assessment in August 2019, which will underpin improvements in meeting the needs of the increasing number of cancer survivors in Ireland;

— the establishment of a National Cancer Research Group in June 2019; and

— the construction and opening of a new radiation oncology facility in Cork in 2019, with work commencing on a new facility in Galway in 2020;

— the establishment and continued work of the Cancer Patient Advisory Committee, the role of which is to ensure the patient’s voice is heard, and to provide input into the development of programmes for patients with cancer;

— the introduction of the Human papillomavirus (HPV) vaccine for both boys and girls in their first year of secondary school, as a key element in prevention of cervical cancer and other related cancers;

— that Ireland has three advanced cancer screening programmes, namely BreastCheck, CervicalCheck and BowelScreen which have evolved and expanded over the years since their establishment, in line with international best practice; and

— that the CervicalCheck Screening Programme transitioned to HPV cervical screening on 30th March of this year which means that any test taken after this date is a HPV cervical screening test with follow-up cytology if required;

recognises:

— the unavoidable impact of the Covid-19 pandemic on cancer services, and the significant worry that it is causing cancer patients, their family and friends;

— that the National Action Plan on Covid-19, published on 16th March, identified the protection of cancer care as a key priority;

— the significant additional funding provided to the health services in 2020 to manage the response to Covid-19 and to maintain time-critical essential services including cancer services;

— that cancer services continued throughout recent months, albeit at reduced capacity, with the significant focus on maintaining these critical services through the use of:

— national agreed guidelines for the continued provision of cancer treatment during Covid-19;

— the use of private hospital facilities to maintain urgent cancer surgery and facilitate medical oncology in some instances;

— initiatives such as relocation of day wards as necessary for medical oncology;

— continuation of radiation oncology with provisions for physical distancing in place;

— recruitment of acute oncology clinical nurse specialists to facilitate hospital avoidance where appropriate and support timely, streamlined access for cancer patients to services;

— virtual/telephone clinics where possible; and

— provision of support to cancer patients and their families through the Together for Cancer Concern, a joint initiative between the Irish Cancer Society and the Health Service Executive (HSE) National Cancer Control Programme;

— the initial public reticence to attend for cancer services due to fear of infection and efforts to address this including through public advertising campaigns, and the collaborative approach taken between the National Cancer Control Programme (NCCP) and the Irish Cancer Society in that regard;

— that in light of the unprecedented public health challenges posed by the Covid-19 global pandemic in March 2020, the National Screening Service’s (NSS) four national screening programmes - BreastCheck, CervicalCheck, BowelScreen and Diabetic RetinaScreen were paused in March; and

— that during the pause clinical staff continued to work within the screening programmes and people who were in the system at the time of pause have continued to be treated as hospital resources allowed and women availing of BreastCheck screening services who had been screened continued to have their assessments completed and their treatment plans mapped out by the service, surgeries continued to be scheduled and completed, and with regard to CervicalCheck, colposcopy assessments and follow-up treatments continued for women who had been screened before the pause; and

supports:

— the restart of a phased reintroduction of screening services;

— the NSS to continue to prioritise the safe and effective resumption of the screening programmes, with regard to addressing the postponement of screening which has already occurred for people affected during 2020;

— the NSS in taking measures to protect both participants and staff and in monitoring the delivery of screening to ensure their continuing safety in order to ensure a safe resumption and delivery of screening services in the context of the Covid-19 pandemic;

— the priority focus now, in the context of the next phase of the pandemic, of facilitating cancer services to return to pre-Covid-19 levels, and in a safe and effective way in the context of overall HSE planning on increasing delivery of non-Covid-19 services; and

— the full implementation of the widely supported and evidence based national cancer strategy 2017 – 2026, as is committed to in the Programme for Government and in line with Sláintecare to underpin continued improvement in survival for cancer patients.

I welcome the opportunity to address the House on cancer services. I thank Deputy Cullinane and his party colleagues for tabling the motion. I thank every Deputy this evening for offering ideas and solutions. I acknowledge that many Deputies have shared very personal experiences about how cancer has affected them and their loved ones. I do not imagine there is one of us here who has not been affected, either directly or indirectly.

I agree so far with pretty much everything I have heard. Deputy Cullinane and I can debate what should be €5 million, what should be €10 million and what should be €20 million and the best way to deploy the money but he is right that the funding for the cancer strategy has not materialised at the rate it needs to. He is right also that we need more funding in a time of Covid. The cancer services and services across the system are operating at reduced capacity. Some are only a little reduced but some quite a lot. I agree the screening services need to be up and running. I am not sure they need additional funding but if they do, I will provide it. We can debate the details about how money is allocated and how much is required but I agree we need to do more, to fund more, to target and to address the issues raised here this evening on behalf of every single family in our country.

Almost every family has been touched by cancer and the Irish Cancer Society pointed out that one in two people in Ireland will be diagnosed with cancer at some point in his or her life. Thanks to the works of doctors, nurses, medical scientists and many others around the country, the outcomes have improved enormously. We need to keep improving and ensure that those who receive a cancer diagnosis get the best care and that they get the diagnosis as early as possible. The countermotion I have tabled this evening provides a firm commitment to that and to the national cancer strategy and a focus on maintaining critical cancer services throughout the pandemic.

Covid-19 has had a significant impact on our health services, including cancer services, as Deputy Cullinane said. Understandably, this has caused much anxiety and concern among patients and their loved ones. Our doctors, nurses and healthcare professionals have done incredible work over the past few months and this has ensured that cancer services have been maintained to the greatest degree possible while keeping patients and healthcare professionals safe.

The national action plan on Covid-19 identified the continued provision of cancer care as an absolute priority and it remains an absolute priority. Symptomatic breast disease clinics and rapid access lung and prostate clinics have continued to operate while prioritising urgent cases. Fewer referrals were made to symptomatic clinics, which is an issue I raised not too long ago in opposition. Fewer people have presented to their GP with symptoms. That is a worry. I am happy to report that these clinics are now returning to normal levels of referrals but we must be cognisant of the dip between March, when Covid arrived here, and now. Urgent cancer treatment, including surgical oncology, radiation oncology and medical oncology, has continued. Private hospital facilities were used in some cases to maintain urgent cancer surgery services. Some day wards were relocated to ensure the ongoing provision of medical oncology treatment. In order to ensure the continuation of radiation oncology, measures to ensure physical distancing were put in place and a return to surgical and medical oncology services is now under way in many centres. Virtual and telephone clinics are being used where possible. The national cancer control programme, the Irish Cancer Society and Cancer Care West deserve great credit for the work they have done since March. They have provided a virtual community of care for people who are struggling with the emotional and psychological effects of living with cancer. I acknowledge the incredible work those three groups have done this year.

In light of the unprecedented public health challenges posed by Covid-19, the national screening service's four national screening programmes were paused in March. A similar pausing of population screening programmes has occurred elsewhere, including in Northern Ireland, Scotland, England and Wales. A recent WHO survey found that, across the world, it was quite regular to see governments pausing their national screening programmes. Critically, treatment did not stop. Clinical staff continued to work within the screening programmes and people who were in the system at the time of the pause have continued to be treated in hospitals, not as they were before but insofar as resources have allowed in an extremely challenging time. Women availing of BreastCheck screening services who had been screened prior to the pause had their assessments completed and treatment plans mapped out. Surgeries continued. Colposcopy assessments for CervicalCheck and follow-up treatments continued for women who were screened before services were paused.

Three of the four screening services, I am happy to report to colleagues, have now commenced a phased reintroduction of services. CervicalCheck recommenced at the beginning of July. BowelScreen resumed the issue of new invitations for screening on a phased basis from the 4 August. It is projected that BreastCheck will resume in the coming weeks, again on a phased basis.

I have been assured that the national screening service has a plan in place for the safe and effective resumption of screening. With regard to addressing the postponement of screening for those due to be screened in 2020, something we need to look at very carefully, CervicalCheck aims to have issued all invitations by spring 2021, which would deal with the very substantial backlog - if I may use that word - from 2020. BowelScreen's endoscopy units have already increased their operating capacity now to more than 50%. The programme aims to invite new participants for colonoscopy by December 2020.

The CervicalCheck screening programme transitioned to HPV screening on 30 March, which was fantastic to see. Any test taken after this date is a HPV test with follow-up cytology, if required. We should be proud of our screening services and our healthcare system. We join a small group of countries, including Australia, England, the Netherlands and Wales, that employ this best-in-class screening for cervical cancer. This improved testing methodology, along with the continued roll-out of HPV vaccine, will mean that in Ireland over the next ten to 20 years we can look forward to a very significant and very welcome reduction in the incidence of cervical cancer cases, something we should be proud of.

The national cancer strategy was published in July 2017 and provides a comprehensive ten-year roadmap for cancer services. The most recent annual report by the National Cancer Registry provides evidence that survival rates for Irish cancer patients continue to improve. The figures are impressive. In the late 1990s, the average five-year survival rate for men, excluding non-melanoma skin cancers, was 39%. It is now 63%. That is impressive. For women, it went from 39% to 60%.

My Department, in conjunction with the national cancer control programme, has overseen significant progress towards the implementation of the national cancer strategy since its launch in 2017. Achievements include: the development and launch of Ireland's first national skin cancer prevention plan; the construction and opening of a new radiation oncology facility in Cork; the appointment of national clinical leads for psycho-oncology, for cancer nursing and for children, adolescents and young adults; the establishment of the cancer patient advisory committee; and the establishment of a national cancer research group. As part of the service planning for 2020, an additional €3.5 million in development funding was provided.

Implementation of the national cancer strategy forms a part of the programme for Government and is in line with the objectives of Sláintecare. In that context, implementation of the strategy will be a priority for me and for the Government.

The past six months have been incredibly stressful and traumatic for cancer patients, their families and the amazing men and women who treat them. Our immediate focus is to restore cancer services to pre-Covid-19 levels while keeping patients and healthcare staff safe. The Government's priority is to implement the national cancer strategy. This strategy will save many lives and prevent large numbers of people, including family members, friends, neighbours and colleagues, from becoming seriously ill. We have a plan and it is saving lives already. We will implement it and it will save many more.

An Leas-Cheann Comhairle

I call Deputy Cronin of Sinn Féin.

Deputy Alan Kelly

I want to raise a point of clarification.

An Leas-Cheann Comhairle

Deputy Kelly is next on the list to answer that point of clarification.

Deputy Alan Kelly

That is wrong.

An Leas-Cheann Comhairle

It may well be wrong but that is what is before me. Deputy Kelly is next.

Deputy Alan Kelly

The Leas-Cheann Comhairle should rule on it. She knows the rules.

An Leas-Cheann Comhairle

I know the rules but that is what is set out before me.

Deputy Alan Kelly

That does not matter. The Leas-Cheann Comhairle knows the rules. The Standing Orders are the Standing Orders and we agree them.

Deputy David Cullinane

I want to offer some clarification that might be helpful. We are proposing the motion and then the speaking order kicks in, which would be Sinn Féin and then Labour. I imagine that is what it is.

Deputy Alan Kelly

I have never seen this before.

Deputy Thomas Pringle

For information, this is a new agenda that has been worked out and imposed by the Business Committee. It relegates all of us parties to a lower standing in respect of both Private Members' business and general business. These are the new rules.

Deputy Réada Cronin

I commend my comrade, Teachta Cullinane, on bringing forward this important motion. For many of us, time is of the essence in catching and treating cancer. Medicine is so advanced that a person has the opportunity to become cancer-free if a diagnosis is made and treatment is begun as soon as possible. Since the Covid-19 crisis, I have been contacted by people and families all across north Kildare who are anxious about their screenings for cancer being delayed. For too many people, early diagnosis and treatment are being denied. It is imperative that additional funds for screening be invested immediately so that more lives can be saved and better quality of life for a longer period can be enjoyed. For the sake of patients and their families, we simply cannot delay another minute.

Sinn Féin is proposing to provide lifesaving treatment. We are saying that we should get this investment into both screening and the implementation of the national cancer strategy, particularly in the Covid-19 environment, which as resulted in so many delays already. We know for sure that cancer does not social distance, it does not wash its hands of us and it will not put on a mask to protect us or the people we love from its effects. A a result, we must hit it hard and we must do so immediately, starting with the screening we are proposing. That will lead to speedy diagnosis, treatment and, for many, a future that is cancer-free. As has been said already, we all have loved ones who have died from cancer but thank God now we all know survivors as well. Let us keep it that way.

Deputy Donnchadh Ó Laoghaire

The word "cancer" strikes fear into many people. Cancer is not just a single illness; it is a series of illnesses. Sometimes our understanding of these illnesses can be simplified by treating them all as one. Nonetheless, cancer is a series of illnesses that has affected so many people. I would say almost everyone in this Chamber has had a loved one or relative who has died as a result of or is currently suffering from cancer. I acknowledge that there is a Deputy present who has recently had a diagnosis and I am delighted to see him here and looking well. It is something that affects so many people.

Prevention is better than a cure, which is one of those clichés, and screening is not prevention but it is the next best thing. It gives us the opportunity to ensure that people are treated in a way that is timely and effective and allows us to ensure that the greatest possible number of individuals who potentially have an illness are treated. It is so important and it is one of the best things this Dáil can do for public health.

There were good reasons for the decisions which meant that the entire health service had to concentrate on what was the most urgent matter before us at a particular moment earlier in the year but time has moved on and, unfortunately, we have been too slow to restore screening programmes. There is an awful lot of concern out there. Many people, women in particular but also men, are worried and feel that there is a great deal of focus on other activities and that other things are being opened up at the expense of screening programmes. The numbers that are before us are concerning. Fewer than 100,000 screenings were carried out in the first half of the year compared with 500,000 in all of 2019. There is huge work to be done - whether it can be done at all - during the remainder of the year. We urgently need to scale this up. It can help so many people.

Deputy Imelda Munster

It is hard to even imagine what it is like to learn that one has cancer and how devastating the impact of a cancer diagnosis can be on a person. It is a difficult diagnosis for anyone to accept, regardless of age or circumstances. It is difficult enough in normal times but life for people living with cancer has been unimaginably hard since the onset of the Covid-19 crisis.

It is understandable that screening and other cancer services were paused during the lockdown period but the break in services has led to a serious and significant backlog. Only 100,000 people underwent screening in the first half of this year. Last year, 500,000 people were screened. Hundreds of thousands of people who should have undergone screening tests have not done so. It is imperative, therefore, that the backlog be cleared as soon as possible. In order to do that, we need to increase screening capacity and this must be backed by increased funding. The Irish Cancer Society has estimated that 450 cancer and 1,600 pre-cancer diagnoses may have been missed this year. That is hundreds of people who could face devastating consequences as a result of not undergoing screening. The Irish Cancer Society has also said that other countries show clear indications that Covid-19 has led to significant reductions in cancer survival rates due to reduced capacity in cancer care services. The consequences of this could be dire if we do not act now. There is a serious onus on the Government to prioritise this issue.

Sinn Féin's policy document, to which my colleague, Deputy Cullinane, referred earlier - A Fresh Start for Cancer Care - lays out a timeline on how this can be achieved. In order to minimise the potential disastrous outcomes for patients, we have to ensure that we can provide full cancer services in a Covid-19 environment. In the short-term, we need increased capacity in order to deal with the backlogs. I hope the Government will consider this motion because it is important that we get the cancer screening and cancer services up and running in order to clear this backlog. There is an onus on the Minister to ensure that this is done by supporting the motion.

Deputy Brian Stanley

I welcome the opportunity to speak on the motion brought forward by my colleague, Deputy Cullinane. For people who may have symptoms of cancer, it has been a stressful time waiting to be screened. The Minister acknowledged that it is a traumatic time for people who are receiving treatment as well. We all acknowledge that. I welcome the fact that we will soon have BreastCheck, CervicalCheck and BowelScreen services all open this month. That is important.

In the first six months of 2019, some 248,223 people were screened for cancer. The figure for the same period in 2020 was just 99,000, or 40% of what was done the previous year. It shows that we are trying to play catch up here. We know the health services have gone through a difficult time and I want to acknowledge the work of the staff in the health services and of everybody who has put his or her shoulder to the wheel.

What we need now, following the reopening, is a plan to catch up quickly and reduce the waiting list. This will need to be adequately funded. Our calculation is that an additional €10 million will be needed from the Department of Health. We need to assess each cancer screening facility in the State and see what extra capacity might be possible in order to meet demand. Such capacity cannot be pulled out of the sky and, as a result, that work will need to get under way. We must make cancer care a key priority in the coming months.

I also note how important it is to monitor prostate cancer. This is a real issue. Some 3,665 men were diagnosed with this cancer last year. It is the second most common male cancer. If it is not diagnosed in time, that leads to further problems, such as people needing to have their bowels removed and other serious surgeries because treatment was not provided early enough. Men are also sometimes slow to go for screening. I take this opportunity to encourage men to have screening for prostate cancer performed every year. That is very important. If prostate cancer is detected early, more than 93% of men will survive and go on to live normal lives. However, we must have screening in place and available, as well as speedy diagnosis. People have been slow to go to their GPs, who do this screening. It is important to encourage them to go. It is also important that consultants diagnose the disease quickly and that treatment is carried out.

I wish to address the backlog in cancer treatment services, the figure relating to which is down 30% on last year. Those diagnosed with cancer need quick access to diagnostic systems and cancer treatment. In the medium to long term, this will ease the burden on the health service. That will be one of the positive outcomes of this approach, because treating people in time will ease the burden later. Most importantly, however, if we can put the correct system and adequate capacity in place, early diagnosis and treatment will improve healthcare for thousands of patients and their quality of life and future prospects. I urge people to support this motion. Time is of the essence in dealing with cancer. Having cancer is an awful worry for anyone diagnosed with it. In that context, I urge the Minister to use every effort possible to have cancer treatment services fast-tracked.

Deputy Alan Kelly

I thank Sinn Féin for bringing forward this motion, which we will be wholeheartedly supporting. This is a topic about which I have probably spoken more than most in this Chamber and about which I am very passionate. I will divide my contribution into two parts. I do not want to repeat the proposals put forward by others, which I support. As a result, I will just focus on the matters I feel should be concentrated upon. I will then deal with the civil liability (amendment) Bill, which is our priority in light of the judgment in the Ruth Morrissey case and the appeal to the Supreme Court, which she won. I was in a lonely place in this Chamber, with only a few others on my side. There were those who believed that the original judgment should not have been appealed. The Minister believed that it should have been appealed, as did what is now the main Opposition party. The Chief Justice has informed us that we, the Legislature, must deal with this matter. I will address that aspect as well.

I begin by welcoming the appointment of Fiona Murphy as head of screening services in the HSE. It is appropriate to welcome her, particularly as we are having this debate. I wish her the best. I thank the Minister for meeting online with the 221+ group during the week. I received a full report on the meeting, so, in the context of what he said, I would like to see the Minister's commitments honoured.

Turning to the Minister's contribution, I would have preferred it if he had provided some insights into where he is going with this matter rather than a commentary. This is about actions and measuring the data, as the Minister stated often when he was in opposition. What is he going to do? We all know about the issues. I want to know what the Minister is going to do, when he is going to do it and how he is going to spend the money.

The drop in the number of cancer screening tests since March will have a profound effect. We all know that screening is not diagnostic, but it can result in women and men needing different types of treatment, including more aggressive treatments. That is never a good thing. Regarding CervicalCheck, some 6,000 letters have gone out and there has not been enough of an uptake. This is a real concern. The low level of uptake needs to be tackled because otherwise there will be consequences down the line. Turning to BreastCheck, we also know that services are not resuming in the way that it was indicated they would. I also asked a question - but I did not get the answer - about the decision to move from an interval of two years to three years in the context of mammograms. If two years was the standard, show me the new medical evidence which states that three years should be the standard and please do not just use Covid-19 as a reason. I want to know why that interval between screenings has changed. Nobody has explained that yet or why we were using an interval of two years in the first place. I would like the Minister to outline the position in this regard in this reply.

I am glad that we have Ms Murphy in place because communication needs to be dramatically improved, especially now. I will make six points before I turn to the civil liability (amendment) Bill. Regarding BreastCheck screening, the status report on its resumption needs to come before us, and the same needs to happen with BowelScreen. We also need a plan, which I will not stick the Minister with, to bring screening home. We all agree that many of the issues which arose historically did so because we outsourced screening.

Turning to the CervicalCheck tribunal, I will give the Minister some space, not very long, to consider where he is going with that issue. It is going nowhere at present and, in light of the changes brought about by the Morrissey judgment, it will not go anywhere. I have many detailed thoughts on this issue, but I am not going to share them here. I want to give the Minister some space to consider what he heard last week.

I am delighted that arrangements for the administration of the HPV vaccine to girls and boys are in place. We have a good standard regarding HPV. I was pushing in the previous Dáil to bring vaccination forward for boys, so I am delighted that is happening. Given the circumstances we are in, however, it is important that there is no slippage in this happening. What is the plan to ensure that there will be no slippage? I ask that because we are protecting our future, and I know the Minister understands that.

I support the need for more funding. I have many reasons for doing so. The Covid-19 pandemic has given rise to practical reasons, but I also support the Irish Cancer Society's plan for the implementation of its strategy. I would like the Minister to break down what funding he thinks is required in order that we can support him with its prioritisation in this Chamber.

Finally, before I get to the other matter, I turn to the issue of auditing, which has stopped. We do not audit any more. That is unacceptable, particularly as auditing is good. When is it going to recommence? We cannot have a situation where there is no auditing. The Minister said the same thing when he was in opposition.

I turn now to the civil liability (amendment) Bill, a copy of which I sent to the Minister. I am raising this matter because his legislative programme will be outlined next week. I want to see this proposed legislation included in that programme. I do not care if the Minister amends my Bill. I want to do whatever is the right thing in the context of drafting, because this is not about egos. The Chief Justice stated that this legislation is necessary. Several cases, three of which I know well, are now before the High Court and those involved could really do with this Bill being passed.

I attended the hearing when the Morrissey case was appealed to the Supreme Court. There were many issues with the Civil Liability Act 1961, and related legislation, prior to that case but they were all swept beneath the carpet. People were left in a difficult situation. They were faced with having to seek all their damages in the context of one case, with the woman or man - with cervical cancer it is always women obviously - then, hopefully, taking the €500,000 for loss of earnings and loss of free services. When negligence was found, the quantum was calculated out of that. Under section 48 of the Civil Liability Act 1961, only one case can be brought in respect of a fatal injury. As a result, if a deceased person brings and settles a case for losses prior to his or her death, it is not then possible to seek damages for his or her children and provide for them to be cared for.

In other words, women who are affected in that way are left in the difficult situation that either they take a case or wait for their children to do so. Timing is an issue because the women involved obviously do not know how long they will live. We cannot have a situation in which the children of someone with a fatal injury in a case where negligence has been proven cannot continue the case. The Chief Justice has said that we cannot deal with this situation through case law. He has pointedly said that we must deal with it from a legislative position and it is the Oireachtas that has to deal with it. He has also asked for that to be done in a timely fashion. The Bill I have put forward does that. I am asking the Minister to deal with it.

Many more cases are coming through. We must consider how to deal with the legacy of the achievements of Ruth Morrissey, Vicky Phelan and all the other women. The Bill I am proposing would be a legacy to all of their efforts. Ruth Morrissey should never have been put through what she was, especially after what the Taoiseach said on "Six-One". The law was written so there could not be double jeopardy but it did not anticipate the case pathway that has now developed. The children of the affected women now cannot take on cases after their death and that cannot be allowed to continue.

There is also a problem with the timelines in that regard. The women affected in these cases, and men affected by other forms of cancer, almost need to time their deaths because the statute of limitations can kick in. We have that extra problem.

I am asking the Minister to bring forward this legislation as a part of the legislative programme. The Minister should put it on the programme for next week. I will work with him to bring in the Bill. We can to and fro about how it will be drafted. We can meet and debate the Bill. It would be an absolute travesty if the Bill is not on the legislative programme because it would undermine everything that Ruth Morrissey did for this State. She should never have gone through what she did. She should never have had to go through the Supreme Court because that case should never have been appealed. The standard of absolute confidence existed in the UK. I ask the Minister to do her memory justice by ensuring that we bring in this Bill.

I looked at some of the messages that Ruth Morrissey sent me before she passed away. She really wanted this legislation to be her legacy. She wants us to work through this legislation in a timely manner to serve the many women whose cases are coming down the road. I ask the Minister to please do as I ask.

Deputy Róisín Shortall

I commend Sinn Féin and Deputy Cullinane on bringing forward this important motion. It must be said that we could be here every night for the next fortnight talking about what amounts to neglect of different aspects of the health service and the storing up of significant problems for the future. That could apply to the lack of speech and language therapy for children, the absence of audiology services which is damaging to the children concerned, or a whole range of different areas of healthcare that have been put on ice for the past six months or so. We are storing up big problems down the line.

Cancer services stand out because cancer can, unfortunately, be life-threatening in many cases and is life-altering in all cases. Cancer is set apart in many ways by the importance which we should attach to it and cancer services need to be protected to the greatest possible extent. We have not seen that happening in the past six months.

Over the years, cancer strategies have been very hit and miss. New strategies have been introduced every ten years or so since the first launch of the cancer strategy in 1996. It was followed, ten years later, by the strategy for cancer control. The current national cancer strategy came in more than ten years after that. The thinking behind those strategies was that cancer had to be treated as a different, more important area of medicine. It is only right for that to be the case for the reasons I have already mentioned. Priority was to be given to this area of healthcare through a stand-alone service based on centres of excellence. Prior to that, as befits the strange nature of the Irish healthcare system, small hospitals in every corner of the country were trying to provide cancer services. That was not the way to go and, for that reason, the idea of centres of excellence was identified and proved to be the right kind of approach, in the main.

The adherence to, and funding for, those cancer strategies has been hit and miss over the past 20 years or more. Energy and attention would be focused at the launch of a strategy but would inevitably wane. It is true to say that too often in the past, people with private health insurance or those who could afford to pay for private healthcare had priority. Obviously, the resultant recovery rates were substantially better for people who could get quick access to treatment and pay their way. The fundamental unfairness was identified in each of those three strategies and could have been addressed if successive Ministers and Governments had ensured that all of the other elements of the health system were properly resourced and in place. Unfortunately, over the years, attempts have been made to implement cancer strategies while, at the same time, there have been problems in the adequacy of diagnostics, bed and staff capacity. Those shortages have dogged cancer services as well as many other aspects of the health service.

Of course, all of those were identified within Sláintecare as issues that had to be addressed if we were to bring our health service up to a modern standard that could provide a public healthcare system on a timely and equitable basis. If we had started implementing Sláintecare in 2017, we would be nearly halfway down the road to a modern, responsive and timely healthcare system. It is unfortunate that has not happened. Three years have been lost and the Minister's partners in government, Fine Gael, are largely responsible for that but his own party must also accept responsibility for not making the implementation of Sláintecare a priority over the past three years, especially when it came to budget negotiations and commentary. The Minister seems to be quite content to go off on tangents, looking for money to be put into the National Treatment Purchase Fund and other attention grabbing things like that, without giving a commitment to funding the Sláintecare programme, to which we are all supposed to be committed. There has, unfortunately, been a lot of slippage on that.

It is important to bear in mind that there were serious problems in the implementation of the cancer strategy before the Covid-19 crisis. The Minister has quoted figures, which is fine, but, on a European scale, we are still quite a bit down the list.

While we made progress on our previous performance relative to other European countries, it has not been great.

The implications of Covid have been pretty devastating for cancer services. Obviously, initially and understandably everything was put on hold in regard to cancer and other services. After a few months, a number of critical cancer services resumed, including oncology surgery and radiation.

An awful lot more could have been done in terms of utilising the capacity in private hospitals. Many of us, including the Minister, followed the use of private hospitals and it was very poor during a large part of that period. We were paying very substantially for what amounted to spare capacity. I could never understand the argument put forward that the capacity needed to be protected and saved. A lot more people could have been treated while at the same time keeping capacity to free up more beds in the event of an early second wave. That was disappointing.

It was also a mistake to delay the screening of people who were in treatment, which has resumed. I am glad we are now finally getting to the point of resuming regular screening services. CervicalCheck, BreastCheck and bowel screening are critically important. Prostate screening needs to resume.

A couple of things are now happening, apart from the failure to completely utilise the private hospital capacity. I am concerned about staff that have been diverted from core health services into testing and tracing. In my view, that is unforgivable. Those dedicated staff should have been recruited during the lull in the summer months and we should not be diverting staff from other important services. It is also really important that the workload for GPs is lifted to enable them to start providing their regular services. I wonder why we are requiring anybody looking for a test to go to a GP first. Why not go directly to a test centre? I cannot understand that. Why are we diverting so many people to GPs for the flu vaccine rather than having school-based programmes or extending pharmacy programmes?

The Minister will be tested on the extent to which he succeeds in making the case for and achieving considerable budgetary allocations. Cancer services must be a priority and he must make that case very clearly to his colleagues.

Deputy Bríd Smith

On behalf of Solidarity-People Before Profit, I welcome the Sinn Féin motion and give it our full support. I want to ask the Minister why, given the experience he had in opposition, he needs to amend the motion so significantly. Had he been sitting on the Opposition benches he probably would have agreed with every word of the motion rather than amending it in the way he proposed. Perhaps he could address that when he returns to the House.

The motion is important for all of the reasons other Deputies have said and which I will not repeat. There is another reason the kind of approaches we need at this point in the Covid crisis are absolutely vital. It is because we are facing into a period where a tug-of-war is taking place between the absolute need to protect public health and the need to return to economic activity. It is extraordinary that we have seen more emphasis put on the reopening of pubs, which I am not opposed to per se, than on the reopening of our health services to the degree that we need them to be reopened. This motion is important because there is a vacuum in our society which represents the frustration of tens of thousands of people who are anxious about the continued lockdown and restrictions of Covid-19, and are also vulnerable to the anti-science logic that is being put about by many organised groups throughout Irish society. There is anti-science logic that says that the Government is over egging the pudding, that there is no danger, that people are not dying from this disease and that we should not mask up or socially distance. There is also a campaign in schools whereby legal letters are being sent to principals and teachers warning them not to take children out of a class if they have a temperature.

These are dangerous times for ordinary people whose ideas, frustration and values may be vulnerable to this kind of exploitation. It is thoroughly and absolutely anti-science. Not only is it anti-science, it is anti-worker and, specifically, anti-health worker. Not to mask up and take precautions on public health grounds is very dangerous.

Although the motion does not necessarily address that, it helps to shift the emphasis of the political class to where it should be. How are we going to address the balance and tension between our economic survival and health services? This motion goes a long way towards pulling towards the latter, which is necessary.

It is vital that we protect ourselves and, particularly, our health workers. It is also vital that we signal to the population that they are not going to be neglected if they need a mammogram. I am of an age where I know many women whose mammograms have been cancelled. They are worried sick that, in the long run, this may endanger their lives because, as has been said over and over during this debate, cancer can be life threatening and life taking. The same is true of CervicalCheck, bowel screening, etc. The thrust of the motion is to insist that we begin to find ways to return to full, normal and proper screening services.

The denial of screening services is dangerous for women, in particular, but we also know that women have been put through significant danger because of our approach to healthcare, including outsourcing some of the best services we could have given them such as CervicalCheck and other types of screening. That outsourcing has led to the tragedies we have seen involving the 221+ women, some of whom have become household names and whose faces we all know from our screens because they have experienced the tragedy of being victims of a service that let them down.

To that end, I want to spend a couple of minutes talking about the CervicalCheck scandal because it is not over. It was stated earlier that legislation needs to be put in place to deal with this. Next Tuesday, women who belong to the 221+ group will be outside the gates of this House to protest. I hope the Minister, Deputy Donnelly, who has left the Chamber, will go out to meet them because when he was an Opposition Deputy he met women who protested in this manner.

I know of a very tragic case where a family is still being brought through the courts. That has to end. The State cannot treat women in this way. As has been said, do we not think that the legacy of Ruth Morrissey matters? Do we not see the necessity to undo the harm that was done by the cervical screening scandal? We need a faster turnaround of services once they are reinstated, which implies that we need more investment. We also need more trained staff and, ultimately, we need clinicians and technicians trained in our very fine colleges who can do the job at home. We should never again rely on sending our services out of this country. Full repatriation of all screening services is required.

The kind of protests that we are seeing on our streets, where people insist they will not wear masks or socially distance, is not acceptable because it is anti-worker. This Saturday, I will be on the streets with a small group of socially distanced, fully masked up protesters to say that very thing, namely, that to be anti-mask is to be anti-health worker. We have to put an end to that sort of rhetoric, which is why the positive nature of this motion is important in the midst of this pandemic. I fully support Sinn Féin for putting it forward.

Deputy Peadar Tóibín

I welcome and fully support this motion. One of the biggest mistakes of this whole pandemic has been that so many key, life and death services have been stopped by the previous Government and have been kept closed by this Government. For the past number of months we in Aontú have consistently called for the reopening of the health services. We have said over and over again that these services must return.

Back in June I raised it with the then Minister, Deputy Harris, and when I asked him, he confirmed to me that he was aware of and supported the decision to cancel cancer screening services in March. This was not some kind of mistake or aberration. Cancer screening was cancelled under the authority and permission of the former Minister for Health.

Whenever I ask the Government about concerns over the present level of non-Covid-19 mortality rates, the response is always to go to the health service. What is the point in sending people to the health service when many of those services have either been paused or stopped? It was ludicrous that, right through the lockdown, we had a situation where the HSE continued to advertise cancer screening online even though those services were not in operation. Many people who were worried about cancer felt that they were being pushed down a cul-de-sac.

For months I have been asking the previous Government and the present one the cost in mortality and morbidity of the cancellation of services. For months the Government has been giving me the equivalent of a political shrug. Just a week ago the Taoiseach organised a meeting of party leaders, NPHET, and the CEO of the HSE. Again I put those questions to these individuals. I was told a week ago that I would have an answer, but there is no answer as of yet to those questions.

Will the Minister of State address why the Government has not sought to investigate the cost in terms of mortality and morbidity of the cancellation of services? In Britain it was estimated that 35,000 people would lose their lives to cancer due to the Covid-19 pandemic. Yet nobody in this Government has thought it worthy to carry out such an investigation here. The fact that mortality and morbidity associated with the closure of these services remains an enigma to this Government is a national disgrace. I regularly hear the HSE, NPHET and the Government say that they are making these decisions on the basis of scientific evidence and all of the information. If, however, a significant portion of the equation of the excess mortality that is happening now, which is the cancellation of these services, is ruled out, and if even investigating, analysing or understanding it is ruled out, then those decisions are simply not being made on the basis of all the facts and the science necessary at this time.

It is interesting that the current Minister for Health, Deputy Stephen Donnelly, was also asking these questions along with me when he was on this side of the Chamber. Unfortunately, the voice of the Minister has become silent on these issues.

According to the Central Statistics Office, CSO, in its latest report, Covid-19 has caused between 850 and 900 excess deaths in Ireland in the five months from the start of March to July. These are deaths that have occurred that would not have occurred in that period of time. This is a figure which is down from 1,072, which was the original reported excess deaths level and is obviously much lower than the 1,700 deaths that have been reported in the media every day.

Covid-19 is a serious threat which we have to take seriously. We must all do what we can to reduce the number of deaths that occur because of it. Cancer is a significant threat. Some 9,000 people die of cancer every year. We have to take it seriously and we need to do absolutely everything we can to ensure that we reduce and prevent those deaths.

As has been mentioned in the Chamber a number of times, there are very few people here who have not been touched either personally or indirectly by cancer. Just eight weeks ago I received one of those phone calls which people do not want to receive, which was to say that I had skin cancer. It said that I had a mid-sized melanoma tumour in my scalp and, luckily, or maybe unluckily, because of the severity of the issue that I had, I was lucky enough to get timely treatment by fantastic doctors and nurses. I owe them so much for that. Since then I have had two operations on my scalp and a big chunk has been taken out. My four-year-old son said to me that my head looks like it has caved in. I said that sometimes it feels that it has caved in, to be honest. We are on the road to recovery, thankfully, because of all of that treatment.

Not everybody in that situation is so lucky. I have been speaking to doctors throughout the country and many people who are cancer symptomatic are not getting the treatment that they need. Many are suffering significantly delayed diagnosis and treatment. The medics I have been speaking to are saying that some of their patients are simply not going to make it. That is a startling and shocking thing. They are also victims of this Covid-19 crisis and should be treated equally in this whole process to ensure that they have equal access to healthcare.

With cancer, timely treatment is of the essence. Nobody should be waiting months for chemotherapy. We should strive to abolish waiting lists altogether. Imagine the number of lives we would save in this country if we did that. Screening does save lives. Early detection and treatment does save lives. What I find mind-blowing at the moment is that in September 2020, a person can get a haircut but cannot get a BreastCheck screening or have a face-to-face consultation if he or she has a mental health issue. A person can be in the physical space of somebody to get his or her hair done but cannot be in the physical space of somebody to carry out something that is perhaps an existential threat to that person's life. That has to change. It shows the confusion of priorities of the Government currently when that happens.

A date for the budget has been set. This is a real opportunity for the Minister of State personally and for the senior Minister in this Department, since this is the first budget where he will be a Minister. It is a test as to whether all that he said in the years that he spent on this side of the Chamber have been talk or whether there is substance to it.

There are a couple of issues that are related that I wish to raise. The first concerns Mary Bartley Meehan. Mary is a constituent of mine in County Meath, and she tragically lost both her son and her husband to Covid-19 in a nursing home in my county just a number of months ago. I am slow even to discuss her particular case because it is so shocking but it is important to discuss it. Her husband had terminal cancer and his face became infested with maggots by the time he was brought to a hospital. I do not say that for shock tactics but because Mary, in the past couple of weeks, has looked at a video recording of that situation that her husband was in. The reason she looked at that video recording was because she said that she had to know the full information for her to be able to fight for her husband. She is fighting. "Golfgate" was serious, but nobody has resigned or lost his or her job nor has there been any investigation for Mary Bartley Meehan. It is just mind-blowing that this is what happens in Ireland. I ask the Minister of State, if he can, to take the bull by the horns on this issue to ensure that Mary is not pushed around from Billy to Jack any longer in this.

I also wish to raise the issue of CervicalCheck. In recent days it has emerged that the governor of Florida is ordering state agencies to break ties with Quest Diagnostics after that lab mistakenly delayed the reporting of results of nearly 75,000 Covid-19 tests. It sounds familiar - delays, mistakes, and IT glitches. I have spoken to Sharon Butler Hughes, the woman who triggered the MacCraith report last year, and she is calling for the reopening of testing. The MacCraith report recommended that we put women first. The outsourcing of cancer screening does not put women first.

We need to see funding used towards accrediting our laboratories here in Ireland so that we do not have to rely on laboratories abroad, which had the reputation of repeatedly making mistakes. This is another issue in the Minister of State's grasp. She should use the opportunity available to her.

Deputy Danny Healy-Rae

I am glad to get the opportunity to contribute. I thank Sinn Féin for bringing this very important topic to the floor of the Dáil, which gives us a chance to debate this very important issue. Cancer screening is so important and the fact that it was delayed or cancelled for so long means that there are people lining up for services. I understand it is the people who already have cancer who are being screened but we know the story. There is stage 1, stage 2, stage 3 and stage 4, and when a person arrives at stage 4, it is too late.

CervicalCheck is so important. As that has been cancelled also, there is an overloading in the system and a serious number of women who need attention. I am glad it is the Minister of State who is on the opposite side of the House because I know there is humanity in her as a result of the way she fought for the unborn child, like myself and others. I know that she is listening to me. I appeal to her and the HSE, with which she is involved, to ensure that everything is done for these people.

A cancer diagnosis can happen suddenly. I had a lady on to me yesterday looking for a medical card. She was only diagnosed yesterday. She was working last week and she went for a check. The result came back yesterday that she had cancer and would have to go for treatment and possibly an operation. She said, "Danny, I feel fine but this is what has turned up." If she had not been diagnosed she would have been working away and the cancer would have gone too far before anything could have been done to treat it.

Regarding medical cards, an emergency medical card can be had if the GP completes the special form he has. Many of them do not even know they have that facility and complete the ordinary medical card form. However, if the doctor completes the emergency medical card form, the person will get the card in a couple of days. That is very important and it needs to be given to people.

Deputy Michael Collins

I thank Sinn Féin for giving us the opportunity to speak on this motion. More than 9,000 people die from cancer every year in Ireland. Therefore, urgent action is needed to ensure that the national cancer strategy meets its targets of being in the top quarter for five-year survival rates among EU states.

There are major backlogs in cancer screening and treatment in Ireland due to Covid-19. The HSE has advised that the CervicalCheck screening service resumed on 20 July and that bowel screening services resumed at the beginning of August 2020. However, for many women, BreastCheck has yet to resume. The HSE has indicated that the service is expected to resume later this month, September, or next month. That is simply not good enough. Will the service be able to catch up on the cervical screening? It appears highly unlikely that the service will fully catch up in respect of the BreastCheck and bowel check programmes.

I and my colleagues in the Rural Independent Group are calling on the Government for an urgent and comprehensive audit of each cancer service in the country to be undertaken immediately, first, to determine capacity levels; second, to target additional capacity to areas which require it; and, third, to ensure that additional financial resources required are correctly ring-fenced and targeted to ensure value for money and the benefit of cancer patients.

Governments should not use Covid-19 as an excuse for slippage in the early diagnosis and treatment of cancer patients. These capacity issues were apparent before Covid-19. Now, additional financial resources will be needed just to tread water. This is an enormous challenge that requires an ambitious and immediate response from Government.

Another major concern I have for the people of Cork South-West is the reason we cannot have a full BreastCheck clinic in Bantry General Hospital, which, I may add, is a hospital of excellence. This hospital has the capability of looking after tens of thousands of people. While I have the floor I again ask the Minister of State who is now in the Chamber - the Minister was here earlier - to have the HSE appoint a full-time anaesthetist for Bantry General Hospital, something for which I have called time and again and which was promised by Fianna Fáil in writing to the people of Cork South West. My worry is that I am not getting answers to date and that this is all falling on deaf ears. A full-time anaesthetist for Bantry General Hospital is required immediately.

Deputy Richard O'Donoghue

I welcome this timely motion. Well done to Sinn Féin for bringing it forward. I acknowledge 100% the priority given to the most urgent cases of cancer during the pandemic and the efforts that were made by the health services throughout the country. At the end of February this year, cancer hit our family. I cannot thank the HSE and all the people in the cancer services enough for what they have done for my family. I thank not only the people who helped our family through this time but also the people who surrounded my family and gave us support to allow me to come here and allow our family to function the way it did previously. They were hard times. People could not get to see their loved ones during treatment because of Covid-19, but the service my family got was second to none, and I thank everyone for that.

My concerns now are the huge waiting lists for colon cancer screening. At the end of February, in terms of non-urgent cases identified, 11,000 people had been waiting for appointments for at least three months. It is a fact that 15,780 people were waiting in August for a colonoscopy. Of that number, 11,780 were waiting for longer than three months. A total of 1,500 of that group were waiting for more than a year. That is outside the emergency group with symptoms that were being seen during the pandemic. What do we say to the 450 cancer patients who would have been diagnosed during the four-month period of the pandemic?

I am calling for a rapid access clinic and diagnostic services to ensure that people are diagnosed as early as possible, particularly in the so-called non-urgent cases. We were one of the lucky ones but there are many people who are waiting for screening and treatment now to help their case.

Deputy Michael Healy-Rae

I thank Deputy Cullinane very much, and Sinn Féin, for bringing this terribly important motion before the House. There is not a person in this room, in this county or in this country who has not been affected by the horrible disease that is cancer. It is a major fight for everybody who gets cancer to survive, do their best to try to prolong life and beat it, unless it beats them. Tragically, many people lose that battle, but at the same time we have to work with our healthcare professionals who do so much to try to save lives. Over recent years, the methods of fighting this awful disease have improved and the outcome for many people is far more positive now than it was in the past. People are surviving cancers that were unsurvivable in the past.

I compliment a number of people, for instance, the Irish Cancer Society in County Kerry; the Kerry Cancer Society; all the people in the group that organises fundraising, whether that is Daffodil Day or other events; my very close friend in Killarney, Eugene O'Sullivan, and the great team of people who work with him every year in organising Daffodil Day in the town of Killarney; and all of the outreach people throughout the county. They are in Kenmare and all around the Ring of Kerry. Every one of them put their shoulder to the wheel on Daffodil Day to raise much-needed funds. That funding is used, first, for the Kerry to Cork Link bus. I thank the organisers of that who provide an invaluable service to people in the county I represent. They take sick people from their own communities on that journey to Cork for treatment.

The screening programme is so important.

With regard to the cancer link bus, if I were here for the rest of the night I could not compliment enough the people who drive it, organise it, seek sponsorship for it and fundraise for it because it makes a very tough and intolerable time tolerable. People make friends on that bus. It is an unusual thing to say but people going for cancer treatment enjoy the journey to Cork if at all possible because on that journey they meet friends in the same position as themselves. They are all in the same fight; they are all in it together. There are people who are so kind to them. I thank the healthcare professionals, the people who organise the bus and the fundraisers. Theirs is such an important job of work. I thank and compliment each and every one of them. Again, I thank Deputy Cullinane for his work and for bringing this most important topic before the House.

An Leas-Cheann Comhairle

I am moving on to the Independent Group. Deputy Pringle is the first of three speakers.

Deputy Thomas Pringle

I hope the Leas-Cheann Comhairle will be speaking at some stage.

I congratulate Deputy Cullinane of Sinn Féin on the motion. It is very timely and it is important that it has been moved here tonight. The most interesting remark made on the Government side was made by the Minister, who said funding has not materialised and that this needs to change. It is interesting that he said that in his speech, yet the Government's counter-motion on the Order Paper makes no mention of it and lauds the great job the Government is doing.

When one reads the language in the counter-motion, one wonders what is happening. There is a reference to cancer services having continued at reduced capacity. The public is blamed for the decrease, the reason given being the "initial public reticence to attend for cancer services". The amendment states services were paused in March and also that programmes continued as hospital resources allowed. The effective resumption of services is to be at some ill-defined stage in the future. That is the problem. The Government is not accepting responsibility for making the services available again. We all know that services had to be curtailed initially because of Covid but they have to be got going again. For the Minister to say there will be a return to pre-Covid levels is pie in the sky. To get to pre-Covid levels, there is a need to increase greatly the number of people going through the hospitals. This will not be attempted. That is really the problem. Unless this is addressed, unless required staff are recruited and unless the way in which hospitals work and provide services is altered, we will not get to the stage where we can allow an increase in the numbers going through the hospitals. There needs to be immediate recruitment and a reorganisation of outpatient and inpatient systems within hospitals to increase the number of patients seen in order to get back to levels close to those before the Covid pandemic. The HSE and healthcare system have to accept that there has been a change. It has to be funded and managed. First, one has to make the funds available.

The one thing Covid has shown is that we can have a health service that responds to the people and provides for them but it has to be funded. If the Government continues to deny this, we will continue to have a system in crisis. That will be the real problem in the future. This can be resolved by providing funding. I doubt very much that the Government is going to do so. It is, however, the only way the issue can be resolved.

Deputy Catherine Connolly

I thank Sinn Féin for introducing this motion. I fully support it. I am a little disappointed in the Minister, not because he has just left but because he stood up and said he agreed with practically everything said and then proceeded with an amendment to the motion. For the life of me, I do not understand that. I cannot understand what the Minister would disagree with in the motion. Sinn Féin has been extremely reasonable. It has simply asked for a review of the national cancer strategy to address capacity deficiencies and to lay out a timeline for catch-up. The Minister has said he agrees with that so I am not sure what is occurring.

The motion calls for the reversal of historic underinvestment in cancer care. I believe the Minister agrees with that also. The motion calls for additional funding to be made available. The Minister agrees with that also. It would be a measure of his bona fides if he agreed with the motion and let us get on with the business of implementing the national cancer care strategy. Unfortunately, we are certainly not implementing it. When the Minister said he wants to go back to pre-Covid arrangements, I tremble. I certainly do not want to go back to pre-Covid treatment regarding the cancer strategy because its roll-out is utterly deficient. This is my interpretation but it is backed up by an analysis of the key performance indicators in the National Cancer Strategy 2017-2026. Time prevents me from going through them. I have put red question marks beside nearly all of the 23 indicators because we have failed to achieve the targets set.

On private hospitals, I have asked repeatedly for the service level agreements but I never got them. I would like them.

Deputy Marian Harkin

I fully support this Sinn Féin motion. If we implement its recommendations, we will save lives. Like many Deputies, I have received correspondence, particularly from women who are most anxious about the delay in BreastCheck and cervical screening. I accept that, because of Covid-19, we have major challenges but we need to strike a balance and respond in an equitable and efficient way to the health needs of all our population, Covid patients and non-Covid patients alike. In that context, I would like to emphasise the absolute need to restart BreastCheck as soon as possible, or immediately, and to ensure all screening programmes return to their pre-Covid levels. How often have we heard that screening saves lives? It does. We know that any delay in restarting BreastCheck, cervical cancer screening and colon cancer screening, which are still limited, will cost lives. I am not attributing blame for that but saying it because detecting cancer at an early stage ensures shorter and less invasive treatment, fewer days in acute hospitals and, critically, better outcomes for patients and fewer deaths.

Bowel screening is carried out at home, and further consultation can be carried out online or by telephone. The Minister, in his response, was not sure about the need for further resources but surely putting further resources towards bowel screening would make a difference.

Has any thought been given to mobile units for BreastCheck or cervical cancer screening? I can remember attending a mobile unit. It might be unprecedented but we have to have an unprecedented response.

We heard many statistics here tonight regarding cancer. I would like to cite one or two figures from the European Cancer Information System. These are projections but they are accurate forecasts. The organisation estimates that, in 2020 in Ireland, over 3,400 women will develop breast cancer. Over 1,300 women will develop colorectal cancer, and over 1,850 men will develop colorectal cancer. The question we have to answer this evening is how many of those cases, if they go undetected, will lead to death.

I am particularly concerned about BreastCheck. Back in 2016, its then clinical director stated: "BreastCheck can only be effective in achieving its goal of reducing the number of mortalities from breast cancer in the population if at least 70 per cent of eligible women attend for screening." Will the number this year be even half that?

On 17 June in this House, the then Minister for Health, Deputy Harris, said the four screening programmes were finalising their plans for a phased reintroduction of screening. What has happened to BreastCheck? We are now just one week short of three months since the then Minister told us they are finalising their plans. He also said he was 100% committed on that day to a catch-up campaign and an information campaign. All l can say is that we still await evidence of this.

I am aware the Minister of State does not have a magic wand but the ask in this motion is perfectly reasonable and I believe it will make a positive difference to outcomes. I have not seen the Minister of State's counter-motion but I ask that she and the Government make that difference.

Minister of State at the Department of Health (Deputy Mary Butler)

It is clear from the debate this evening that right across this House, Members share a commitment and determination to ensure that patients with cancer receive the best care possible and that they and their families are supported to live well with and beyond cancer. I thank all those who have contributed here tonight and those who shared personal stories. I heard Deputy Cullinane from my office when he spoke at the start about his beloved mother whom he lost last year. My own father died 25 years ago from cancer. His anniversary was last Sunday and I have to say that 25 years on it is still difficult, as it is for everyone who shared personal stories here tonight. There is not a family in Ireland that has not been affected by cancer and it is a timely debate.

We want to support families to live well with and beyond cancer. In a nutshell, this is what the national cancer strategy aims to achieve. The vision set out in the national cancer strategy is that, "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".

This vision is one in which all aspects of cancer control, from the promotion of healthy living, more specific prevention measures, optimum treatment and quality of life measures across the patient's cancer journey and beyond are addressed, backed up by solid governance, workforce planning and research. The strategy sets out a ten-year roadmap towards the achievement of this vision.

Central to the achievement of this vision is the prevention of cancer wherever possible through the implementation of prevention programmes to reduce the incidence of cancer, an increase in symptom awareness and an increase in the number of cancers diagnosed at an early stage. We all know early intervention is crucial when one is dealing with any type of disease but especially with cancer because the outcomes can be so much more positive if one has early intervention.

The three national cancer screening programmes play a key part in the prevention and early detection of cancer. BreastCheck, CervicalCheck and BowelScreen have evolved and expanded over the years since their establishment, in line with international best practice. Since 2000, BreastCheck has provided more than 1.9 million mammograms to women and detected over 12,200 cancers, more than half of which were diagnosed at an early stage. I paused when I heard Deputy Tóibín compare a breast check mammogram to having one's hair done. For someone who has experienced both I do not think one could compare them.

Since its launch in 2008, CervicalCheck has provided almost 3.2 million cervical screening tests and detected more than 115,000 abnormalities, many of which could have developed into cervical cancer if not detected through screening. Furthermore, the CervicalCheck programme detected 1,500 cancers and detected and treated 64,000 precancerous cell changes between 2008 and 2018.

Since its launch in 2012, BowelScreen has detected 930 cancers and detected and removed 25,350 precancerous growths which if left untreated might have developed into bowel cancer. The resumption of these essential screening programmes is a key priority for me and for the Government. I know Members across this House all share this view because we have heard it here all night.

In the context of the next phase of the pandemic, our priority focus now is to facilitate the return of all cancer services to pre-Covid levels. However, it is important that in resuming services we ensure this happens in a safe and effective way, and in line with overall HSE planning to increase delivery of non-Covid services. CervicalCheck recommenced screening services at the beginning of July with invites being issued in line with programme prioritisation. BowelScreen resumed the issue of new invitations for screening on a phased basis from 4 August. It is projected that BreastCheck will resume within the coming weeks. In the first instance, invitations will issue to those women who were due to be screened during the paused period, beginning with those who have been waiting the longest. The Department has been assured that the national screening service has a plan in place for the safe and effective resumption of the screening programmes.

We are living in unprecedented times. The last six months have been challenging, but notwithstanding those challenges, cancer services have, insofar as possible, been maintained. Covid-19 has forced us to change the way our health services operate, and the way patients interact with our health services. Cancer services have adapted and continue to adapt. Through the extraordinary efforts on the part of our healthcare staff and the national cancer control programme, we have ensured that patients continued to receive essential care.

It is important to add at this point for those who are waiting to be called for screening that if a person feels he or she may have an issue, it is important not to stand back and wait but to contact a GP. Obviously, the GP is the first line of defence and can refer a person on so it is important people realise that.

Despite the changed landscape, the vision of the national cancer strategy holds strong, as does our firm commitment to its implementation. The Minister, Deputy Donnelly, and I urge all Members of the House to recognise the good work being carried out in this area and to support the ongoing implementation of the national cancer strategy.

Deputy Johnny Mythen

I am happy to support the motion put before this House and I commend my colleague, Deputy Cullinane, for bringing it forward. We all agree cancer screening is the main tool we have in the diagnosis and treatment of this destructive, invasive and malignant disease. For instance, breast cancer screening is associated with a 40% reduction in cancer mortality. Colorectal cancer screening is associated with a 22% to 32% reduction in cancer mortality with a follow-up of 53% success rate.

Each of us in this House has lost relatives or dear friends or know someone in our communities who has died because of this disease. A collective approach is needed in the challenges ahead. Therefore, a collective duty of care to our citizens must be our first and foremost priority. The only way we can seriously do this is by prioritising cancer screening. The national cancer strategy is operating under stress and strain. Cancer screening has dropped to a completely unacceptable and disproportionate level compared with this time last year. Medical oncology services are operating below 70% capacity. Studies have shown that more than 50% of women who have developed cervical cancer have not had appropriate screening. It was reported in January this year that less than 13% of women awaiting colposcopy services were seen at separate colposcopy clinics in counties Sligo and Wexford.

We need an organised system that can deliver appropriate risk assessments. We need a system that can ensure screening at recommended intervals, provide prompt diagnosis and treatment and that provides essential transport for cancer patients. The only way this can happen is to provide additional funding and an immediate review of the national cancer strategy. If we allow cancer screening to be tangled up and constrained under the current regimes of the Covid-19 pandemic then we have miserably failed our citizens. I ask for the Minister of State's full support for this motion.

Deputy Martin Browne

I also thank Deputy Cullinane for bringing this motion before the House. Every family in the country has been affected by cancer. We all know that early screening and diagnosis are crucial and can save lives. The current crisis has robbed us of time. For health reasons, services had to be reduced or cancelled. For people with a health condition they think might be cancer, this pandemic must have turned days into weeks and weeks into months. So far this year, fewer than 100,000 people have had cancer screening compared with over 500,000 last year. For this reason, it is vital that we do not delay in ensuring that the build-up in demand for screening and treatment be dealt with quickly and efficiently. Lives will be lost if addressing the backlog relating to screening and treatment is not made a priority.

Related procedures are already under great strain. For example, last month I was told that more than 1,000 people were awaiting various scope procedures at South Tipperary General Hospital alone. When it comes to the challenges relating to cancer screening and treatment, it is vital that our healthcare professionals have the resources to act quickly so that patients have the prospect of the best outcome, which is what this motion aims to do.

We are also asking for money to help in the context of what the Irish Cancer Society calls a chronic underfunding of the national cancer strategy. This has led to a lack of investment in innovation, new services and addressing the unmet needs of cancer patients. The historical underinvestment in health prior to the crisis to which Covid has given rise has made it harder to deal with the unexpected. Let us consider needs assessments in my constituency of Tipperary. Last month, 230 children in the mid-west area, including north Tipperary, had been awaiting needs assessments for over a year. A total of 106 children were overdue for the same service in south Tipperary. A total of 293 people had been awaiting occupational therapy appointments and 18 people had waited more than six months for child and adolescent mental health services in north Tipperary.

I am pointing out how historical underinvestment makes the system particularly vulnerable when a crisis is thrown into the mix. The Irish Cancer Society believes we are faced with a stark choice: either proper funding be provided or the pattern of underfunding will continue. The latter would see services and healthcare professionals remain overwhelmed, leading to the risk of worst outcomes for patients.

Sinn Féin calls for cancer care to be made a priority and that is why I am supporting the call for €20 million to meet the target set out in the national cancer strategy, €10 million to address missed cancer care caused by Covid-19, and a €10 million package to ensure that all screening services are restarted and all backlogs dealt with. I appeal to everyone in the Chamber to support the motion. It is too important to ignore.

Deputy David Cullinane

The Minister of State and I soldiered together and campaigned in respect of many local issues in Waterford. It is a bit surreal to see her sitting across the floor now and holding ministerial office. I take this, my first opportunity in the Chamber at least, to commend her on her appointment and to wish her well.

It is very telling that everybody who spoke tonight referred either to direct personal experience of cancer or to the experience of a family member. This shows the stark reality that cancer is a major scourge we all have to contend with and do our best to deal with. In crafting this motion and in my presentation to the media in recent days, I was very careful not to overstate the case. It is very important for us to be factual and to present the arguments in a very clear, intelligent and honest way. It is also important that we do not understate the case. Unfortunately, the reality is that cancer care has been chronically underfunded for far too long. I agree with what the Leas-Cheann Comhairle said earlier. I do not want to see a return to pre-Covid cancer levels. I want us to go beyond that and to get better and sharper at what we do.

I want to avail of this opportunity and commend a number of people and organisations. I commend the Irish Cancer Society. I commend to the Minister of State its pre-budget submission, which very clearly sets out the challenges and opportunities for cancer patients if we get it right. If we make the right investments, it sets out very clearly the improvements that can be made. I also commend the document I crafted on the investments which are necessary and the timeframes we need to adhere to if we are to give people the opportunities they need.

Furthermore, I wish to commend Mr. John Wall, a cancer patient and someone who is dealing with the disease. He has been a very strong advocate for screening services and for people to come forward and get tested. There are many people like him who have been campaigning to encourage people to go to their GPs and get tested. Screening plays a vital part in that. They are also calling for medical cards for all terminally ill patients. That issue should also be put on the floor of the Dáil today. It was a promise made by the Minister of State's party. There is some commitment in the programme for Government and we want to see it delivered.

I am a bit concerned about the Minister for Health's contribution to the debate. As previous speakers indicated, the Minister talked about the reopening of screening services. However, there is an incredible lack of detail about how this will happen. For example, the Minister stated, "It is projected that BreastCheck will resume in the coming weeks". He did not say which week, at what capacity or how many people will be screened. In talking about CervicalCheck he said, "CervicalCheck aims to have issued all invitations by spring 2021" to deal with the backlog. That is on the optimistic side. He also said that BowelScreen would operate at only 50% capacity, which is not acceptable. The Minister went on to say that we may not and we do not need any additional funding in respect of screening. I do not believe that for a second because if we have any chance of keeping up, never mind catching up, we will need to have more staffing, more physical space and more laboratory space. To say that is not a reality is accepting that we will have a greater build-up and more people waiting for screening and for treatment.

The Minister also talked about €3.5 million in new development funding. However, he failed to point out that €45 million is needed. He said that to me privately before making his contribution. He said he wants more money and cannot understand why it was not made available.

In his contribution, the Minister was actually talking about and giving a context to what the previous Government did. He was not even part of that Government. I would have preferred to hear about what he is going to do as the new Minister for Health and about his new ideas and the energy he wants to bring to dealing with this matter rather than getting a restatement of what we already know, namely, that the record of the previous Government reads like a litany of failure. I accept that there were successes in some areas but the fact is that the previous Government failed to meet almost all of its targets under the national cancer strategy. The bottom line is that we can, should and must do better to protect citizens from the scourge of cancer.

I commend the motion to the House. I hope the Government will have a rethink and support the motion rather than proceeding with its amendment.

Amendment put.

An Leas-Cheann Comhairle

In accordance with Standing Order 80(2), the division is postponed until the weekly division time on Thursday, 10 September 2020.

The Dáil adjourned at 10.20 p.m. until 10.30 a.m. on Wednesday, 9 September.