Martin Daly questions cancer-service planning amid population growth

Thank you again all for coming in and appreciate it. Taking into what has been said in the previous meeting and what you've outlined in your statement, has there been actuarial modelling on the needs going forward based on age profile, growing population and the increasing burden of cancer? And in some respects because people are surviving longer now with cancers we're going to have to provide more services and there are more layers of treatment. And I suppose that's the first question. And I might ask Trona maybe to take that in terms of our population health planning. Yeah, I mean in terms of, I suppose from a population perspective, absolutely we've had that kind of million plus growth in terms of the population size overall since the establishment of the cancer control programme. And this was particularly in the over 65s, you know, an 80% growth. So I suppose there's that. And then there's also, you know, there's the, well, you might have incidence rates in certain, many cases are decreasing but that will mean that the numbers of people that we have to treat, you know, that's what needs to be accounted for. There's also, I suppose it's also been taken into consideration that the complexity of treatment, I suppose. So it's not just the population, I think that's important to emphasise. So particularly when you're looking at what's called chemotherapy or systemic treatments, you know, more and more people, you know, when we look at our cancer register data, you're looking at, you know, the numbers of people that are diagnosed with cancer. But thankfully we've 220,000 people living with cancer, but many of those people are being treated again and again for recurrences and surviving. So that complexity is being factored in in terms of the capacity that's needed in that part of the system. So has there been modelling done of that? Is there active modelling? There has been modelling done in terms of systemic therapy capacity, yes. And that's good to hear. I'm sorry, we have tight time. That's one very brief point. When we look at, I suppose, some of the issues around diagnostics, theatre and so on, those are impacted by the wider pressure, so we also have to reflect that in terms of understanding how you get access to theatres, access to beds in order that people can access care. You're right, the population is growing by 90,000 a year, so we've got another million to look forward to in the next 12 years. And the other issue that sort of concerns me, like the national cancer strategy was, you know, was a huge success. It took considerable political capital to deliver it, to divest some hospitals off cancer care and to centralise it. Now we're seeing a decentralisation again. And the concern is, and this is the question, is that I don't doubt that the regions will try and provide the best service. We know in the west of Ireland we don't get all the resources that we should, and that is an actual fact, OK? So you talk about NCCP will be the primary role, planning council service, enabling performance and oversight. Unless someone has budgetary input and control and executive control, we know those models don't work. So how do you see that relationship working? I suppose it's for yourself and for Tony as well. I might start off with that, Deputy, and Tony might want to come in in terms of... So basically with the new health regions, if you look at the factors that influence the performance of the system in terms of whether it's about access to theatre for surgery, having sufficient daycare beds, whether it's about any aspect of cancer care, many of those are part and impacted by the wider pressures on the system. So if people are cancelled for surgery, it's often because of emergency care pressures. And hence the value of the regions would be to try and look across the entire system to make sure that cancer access is there. The NCCP will drive that new strategy and they will own that strategy with obviously the Department of Health. It will be commissioned through the department. But from the HSE's perspective, the NCCP will be at the full of them. In the survey planning process, our intention is they will provide clear guidance to the regions in terms of what they see as the national priorities. The regions will develop their plans as part of the national service plan and they will then provide assurance around that to make sure that the priorities are being addressed. And I think that's going to be very important. I think it's going to be a really important relationship because we've seen issues around governance and joint management that haven't worked in the past. So we need to be reassured about that. I don't mean to cut across, but I would like to ask a specific question. And you know the time is short. You realise that. In terms of the west of Ireland, we don't have a PET scanner in the western region. I know there's access to a private scanner, but that's not the answer to our population's needs. And the other question then, Tony, to you in the west would be, is there any plans to develop further outreach oncology day services such as Interescommon University Hospital? We have a facility there in the west that is underutilised and it might be something that could be done to bring cancer care out because everyone can't funnel to Galway. You know, that's my question. Well, so first of all, I would say we have very significant plans for the development of cancer services across the whole region. It involves all of the hospitals and all of them with their particular roles, with a specific role for the cancer centre in Galway. And I think what we have seen is that those facilities are undergoing pressure, just as we've referred to earlier on. And so we do need to look at other options and options in the community and possibly in other centres as well. But they absolutely have to be consistent with the delivery of best care and the delivery of care in the most appropriate... That's the bottom line. Thank you very much. Thank you very much. Our next thought is for Shiloh.