I thank the committee for the important opportunity to address it on the recently completed expert report on the development of radiation oncology services in Ireland. I thank and commend the other 22 members of the group for their significant contributions to the many discussions and challenges that presented to us in addressing our remit. I am confident the detailed proposals outlined in the expert report will provide the significant first phase of development of a national clinical network of radiation oncology services. This will, to the greatest degree possible, guarantee patients access to the highest level of care that is being developed or is envisaged in other western countries. Fundamentally, the report recognises and endorses the right of all cancer patients in Ireland to access the highest quality radiation oncology service.
In regard to the proposed development of radiation oncology services within Europe, Ireland stands at a unique crossroads of opportunities. We are in the unenviable position of having the weakest radiation oncology service in the European Union. This, nevertheless, presents us with a unique opportunity to learn from other jurisdictions and to develop what is best. At its simplest, we have the critical opportunity to get this right and we have an equal opportunity to get it wrong.
The committee should be aware the report, with its recommendations, has been subject to significant national and international scrutiny and has been endorsed subsequent to its publication by international and national authorities, which are outlined in the information pack. Unequivocal endorsements of the report have been provided by Professor Norman Coleman, director of the radiation oncology branch, National Cancer Institute, Washington, the largest cancer care agency in the world; Dr. Martin J. Murphy, Jr., a trustee of the American Cancer Society Foundation and director of the American Cancer Society; Professor Michael Baumann, president elect of the European Society for Therapeutic Radiology and Oncology and chairman of the European education and training committee, which speaks on behalf of more than 6,000 radiation oncologists in Europe; and Professor Tom Keane, provincial radiation therapy program leader, British Columbia Cancer Agency and professor, chair and head of the division of radiation oncology, University of British Columbia. Nationally, the report has been endorsed and supported by the board of the faculty of radiologists of the Royal College of Surgeons in Ireland and, importantly, by the medical board of St Luke's Hospital.
It is important to realise both the magnitude of the clinical problem that the expert group has addressed and, equally, the potential benefit to our patients of correctly structured radiation oncology services. The burden of cancer on our society and the need for modern state-of-the-art centres of excellence is abundantly clear when one considers our present position. One in three individuals in Ireland will develop cancer during their lifetime. With present treatments, one in four of the Irish population will die from cancer. There is significant evidence, from both north America and Europe, that this burden can be reduced by the delivery of multidisciplinary care, including radiation oncology, in the context of specialist comprehensive cancer centres. Ireland lies 13th of the 15 EU member states in terms of cancer mortality rates. Although the cause of this is multifactorial, it is highly likely that the existing underdevelopment of radiation oncology services contributes to this excess and early mortality. The most modern estimates suggest that between 55% and 60% of patients will require access to radiation oncology services during their cancer illness. In contrast, approximately 20% of cancer patients in Ireland have radiation therapy as part of their primary treatment.
The report recognises and details the profound underprovision of services currently. It provides a solution where the issue of patient access is not dominated by the present limitations of profound treatment undercapacity. The proposed model of care will provide a 150% increase in treatment capacity by 2008 and full capacity within a decade.
It is equally critical that we recognise and acknowledge the importance of the quality of radiation treatment delivered to patients and its impact on patient outcome. Unlike other forms of human illness and treatment, the initial quality of treatment is of paramount importance in maximising the chances of cure. The quality of the first course of treatment has a profound influence on the chances of cancer control and patient survival. This outcome cannot be corrected by a second opportunity or attempt to get it right. If the initial treatment is sub-optimal, the chance of cure for patients is invariably reduced.
It is implicit, therefore, that future service must guarantee excellence of care at the point of service delivery. The overwhelming majority of the expert group believes the recommendations set out in the report, developed in the first phase around the four centre model, will deliver this potential. It is equally important to acknowledge the report's recommendations will deliver on the expectations of patients who have recently had the unique experience of receiving radiation therapy. These include in order of patient priority the unequivocal provision of the highest level of patient care; the guarantee that patients be given information on their condition; the need to reduce waiting times for radiation treatment; and the improvement of communication between medical and other health care staff and between all health care staff and patients.
The expert group has recognised the potential problems associated with travelling to centres of excellence, and has provided detailed recommendations on facilitating prompt and appropriate access, particularly through dedicated accommodation for patients and families, innovative fast track transport arrangements for patients and extended working days at the treatment centres. It is the expert group's view and my own passionate belief that the initial service development of a backbone of four large clinical radiation oncology centres will fulfil this expectation and, equally, the cancer care requirements of this and future generations.
I reiterate in the last decade our colleagues in Northern Ireland have undertaken a similar process of radiation oncology service review. Through their independent analysis of the Calman-Hine report, the NHS cancer plan and the Campbell report, the Northern Ireland authorities have opted for the development of a single large radiation oncology centre located in Belfast. This centre will have ten linear accelerator treatment units and a full complement of multidisciplinary teams. This single centre will serve the entire Northern Ireland population of 1.7 million.
The report defines a realisable and cost effective implementation plan that will address the following deficits: first, the unenviable position, where Ireland has the lowest number of clinical specialists per million population in both the EU and all western countries examined and, second, it will rapidly address the fact that Ireland has the lowest provision of treatment equipment per head of population in the European Union.
The proposed model will also provide a framework that meets the following national and international standards: it will adhere most closely to the World Health Organisation, and US National Institutes of Health concept and "gold standard" of cancer treatment being delivered within the context of a comprehensive cancer centre model; it will enable the development of specialist clinical teams with both tumour-specific and technology specific expertise; it mandates the development of more extensive and integrated multidisciplinary care; it meets the stated and expected medical and para-medical training programmes and their associated national and international accreditation mechanisms; it facilitates the most rapid implementation of new radiation technologies particularly those with significant complexity, and expense; and, fundamentally, it will address the issue of access where a profound shortage of national treatment capacity no longer becomes the dominant limiting factor.
For those who remain uncertain about the issues, the need for quality that the report identifies and the proposed solution of rapidly developing large comprehensive cancer centres, it is worth noting the following: without exception, every western country has an existing national framework and backbone of large treatment centres and all consultant radiation oncologists and medical oncologists in Ireland have trained at equivalent large institutions in Europe and the US before returning to Ireland. Each one of us, in our professional capacity, has recognised that these centres provide the best training and the best care for patients. Why should we suggest anything different for our own patients?
The report's recommendations are based on a comprehensive analysis of authoritative national reports, the existing international models of care and a detailed study of the anticipated evolution of care pathways in radiation oncology. I would like to acknowledge the immensely valuable input from the independent patient study undertaken on behalf of the group by the
IPA/RCSI. Some of these patients were receiving end of life care at the time of the study and their conviction and contribution to our thoughts and decisions were irreplaceable.
I acknowledge the commitment of the Minister to deliver the implementation programme endorsed within the report. This decision is courageous and correct.
The expert report enshrines excellence and the belief that equity of access to the highest quality radiation oncology treatment is a right of all cancer patients in this country. Within the discipline of radiation oncology, highest quality care means the greatest chance of patient cure. The report equally endorses the need for a continued and informed review of future service development. At its heart the report identifies an immediate timetable and realisable investment programme that will deliver this excellence.
The report has the overwhelming support of the majority of members of the expert group and the independent authoritative endorsements from national, European, Canadian and US authorities. We stand at a crossroads in the provision of new radiation oncology services. The report endorses excellence of clinical care, not compromise or mediocrity. Our patients expect excellence. To deliver otherwise is indefensible.