I thank the Chairman for the invitation to appear before the committee. I am a consultant in public health medicine with the National Cancer Screening Service. Earlier in my career I trained as a general practitioner. It is with that background in primary care that I have contributed to this submission to the committee. On behalf of the National Cancer Screening Service I extend my thanks for the invitation.
We are tasked, as the committee is aware, with the provision of population-based cancer screening programmes, including BreastCheck and CervicalCheck. We were keen to take up the invitation to appear before the committee so that our work could be seen against the wider health care context of disease prevention and health promotion in the community. There are many elements that contribute to the success of a population cancer screening programme but none more so than maximising coverage among the target population. The National Cancer Screening Service utilises screening promotion methodologies to inform and target populations about BreastCheck and CervicalCheck and to encourage attendance by developing and implementing effective promotion strategies. The evidence base suggested a multi-strategy approach to promoting screening and encouraging attendance is effective. Essentially this means there is nobody we will not talk to and no place we will not visit in terms of conferences or community groups if it can improve awareness and uptake of our screening programmes.
NCSS screening promotion officers are the individuals who implement these strategies. That includes working with GPs, practice nurses, public health nurses, community networks and specific groups linked to Traveller, disability and women from socially disadvantaged areas. The success of such an approach as that undertaken for BreastCheck in Dublin's north inner city — a traditionally low uptake area — is clear from the 40% average acceptance of invitation to screening. Following an intensive targeted screening promotion campaign in the area in late 2007, the uptake rate to screening reached 71%, which was a significant improvement. This is the highest acceptance rate ever achieved by BreastCheck in such a disadvantaged area. This would not be possible without our strong working relationship with primary care professionals and community groups.
The primary medical care setting is one of the key aspects to CervicalCheck, the cervical screening programme, as it is in these areas where 1.1 million women can avail of a free cervical smear with a smear taker of their choice. This has been achieved by the development of a national contract for the provision of these services between NCSS and registered smear takers in a primary care setting. At present there are just under 4,000 smear takers in GP practices, women's health, family planning, and Well Woman clinics nationwide. CervicalCheck also facilitates the development and delivery of accredited training programmes and education in primary care settings. In partnership with the Irish College of General Practitioners, the National University of Ireland Galway and the Royal College of Surgeons in Ireland, CervicalCheck delivers these accredited programmes of smear taker training throughout Ireland.
Although not yet a screening programme in terms of colorectal or bowel cancer, it is the opinion of the NCSS expert advisory group on colorectal screening, who compiled the expert report submitted to the Department, that primary care will play a critically important role, similar to its role for BreastCheck, in promoting any future screening programme and improving participation rates. It is noteworthy that this will be the first population screening programme that will involve men, which will bring unique challenges in getting their participation.
Worldwide we have also entered the era of HPV vaccination. The opportunity is here now to adopt a primary and secondary prevention model for cervical cancer control. What do I mean by that? Primary prevention is vaccination, secondary prevention is screening. They are complementary approaches to cervical cancer control. In that context, linkages and co-operation between primary care settings and the NCSS will be essential not only in evaluating the effectiveness of a HPV vaccine in the years ahead but also in informing changes to the operational structure of the cervical screening programme in the future.
I hope this brief summary of our interaction with primary care professionals and our community groups will prove useful to the committee today and tomorrow as it listens to the submissions from the professional bodies. They will, I am sure, outline in detail the many challenges that face primary health care professionals as we move the focus of our health care system away from a hospital-based system to that of primary-based care. There is no doubt in my mind that the development of a properly integrated primary care service can lead to better health outcomes for patients, improve their overall health status and result in the most appropriate and efficient use of what are limited resources.
To maximise health gain, as a public health doctor and someone who sees medical care from a population point of view, it is an absolute necessity that the planning of primary medical care services is based on evidence of need and service provision on the basis of equity, quality assurance and comprehensiveness.
