Martin Daly: Pushes EU Cancer Network to Fix Irish Access

Thank you to the witnesses who have come this morning, Professor David Fenley, Dr Thomas Hoffmarcher and Nicky Gallagher from the Cancer Society, and thank you for your statements. I'm looking at the, firstly I just want to reflect, I suppose we had successive National Cancer Strategies, I'm not so sure they were dueling the crown, but I would certainly say that they were the first attempt at a serious, mature reconfiguration and consolidation of cancer services based on evidence. And considerable political capital was expended, including deputies in this Parliament losing their seats because they lost a cancer service in their local hospital. In order to maintain the confidence of the public in the consolidation of cancer services, we really do need to deliver for them. I looked at the cancer dashboard, we have done well in certain areas, but research deficient, prevention deficient, which I'm really surprised at, alcohol consumption and tobacco public health programmes deficient, I'm really interested in the tobacco one, because we pride ourselves on being one of the first countries in the world to ban tobacco smoking in the workplace by Micheál Martin. We're behind in colorectal screening, our digitalisation is really stone age compared to the rest of Europe. Access to radiotherapy, we've had witnesses in here before, poor access and less than timely access to chemotherapy for breast cancer patients and for all patients of other cancers as well. So I just want to dive straight into it. I'm really interested in the European Union's target of having 90% of the population having access to a comprehensive cancer care centre by 2030, and Professor Fennelly, you're part of that pilot, and really explain to us maybe around the whole network model, because I think the only way we're going to get access to protocol driven, internationally benchmarked care and to people in Ireland, and access to early access to new medications and to trials, will be through this model. Perhaps you could explain to the committee what it entails. Thank you for your question. I'm immensely proud of the progress that we've made in Ireland in terms of cancer care, and I do think that we are, as I said, at a pivotal moment. The network model of care is key, and Ireland is ideally suited with a population of approximately five million people. The purpose of a network, essentially, from a patient perspective, is to put the patient at the centre of the process. What we want to do when we consider the important aspects of cancer care, important aspects revolve around timely surgery, timely chemotherapy interventions, radiation therapy as well. Surgical centralisation is key, so there are centres that will be designated for specialist surgery. We know surgical outcomes are dictated by volumes, and therefore we must focus on surgical centralisation. However, what a network will do is it will take those OECI benchmarked standards, treatment pathways out to the community, throughout the network, so that the patient can access state of the art cancer care in their local hospital. They can access that care in the knowledge that it is OECI approved and dictated and directed by the regional cancer centre. They will also have access, and very importantly, will have access to clinical trial participation. Any clinical trial that is activated within the cancer centre hub will be exported throughout the network, and therefore a patient can participate in a clinical trial in their local hospital. This is well demonstrated throughout Europe, and I'm sure Thomas can speak to it in more detail in Europe as well, but this is a model of care that is well practised in Europe, and I do feel it is a key part of the next cancer strategy, and it is the way we can ensure ongoing progress for our patients. So it's almost a reversal of what we had 20 years ago, where there was this drive to centralise everything, and rightly so, it was based on evidence and time, and outcomes have improved. But as our population grows older, and our capacity to deliver at those centres diminishes at the moment, this is really bringing people back to, okay, we accept that surgical volume has to be centralised, and that's accepted. But in terms of protocol-driven chemotherapy and radiotherapy, that can be done, but certainly chemotherapy can be done in local hospitals, maybe level 3 hospitals. Absolutely. The treatment pathways will be directed by the local cancer centre. They will be OECI-approved, benchmarked against OECI European standards. If I look at the South East Network, for example, I work closely with my colleagues in Waterford, in Wexford, Kilkenny, South Tipperary, and the intention would be that the network would link all of those hospitals, and ensuring not only OECI-standardised treatments throughout the network, but a key part of it is if we come back to KPIs, access to treatment, there's two parts of access to treatment, there's access and there's capacity. What a network will do is it will ensure rapid access to the specialist unit. Capacity remains a challenge, nationally we're particularly challenged from a radiology point of view, from a radiation oncology point of view, from a pathology point of view, there are clear challenges. But what I really want to do is I want to ensure that patients nationally, wherever they live, have rapid access to a specialist centre. Once they have access to the specialist centre, their treatment can very readily and should be delivered locally, coordinated by their regional cancer centre, which is done under the auspices of the NCCP, and ensuring standardised OECI-approved treatment pathways throughout. So we're taking a small country like Ireland, because we're literally the size of a city population-wise in a major European city or an American, North American city, and we're taking that, we're going to put that, we'll have our national cancer network, but we're part of a European Union cancer network. So the benchmarking comes from a population of 500 million people, with all the research, early access, the leverage to get access to early treatments maybe, early access schemes, so it puts us into that network, so it strengthens everything from the top down. So that person who needs that protocol-driven chemotherapy can be delivered in their level three hospital, but at a standard delivered for 500 million people in the European Union. Is that...? That's exactly the idea. And I think, to add to that, if we take, for a second, our poor prognosis cancers, and we're the national centre for pancreas cancer, a key strength of a national network that's linked with a European network is that our patients now are part of a large-scale European network of care. So the ability to perform clinical trials, the ability to gain data and develop new treatments quickly is far, far stronger as part of a European network.