Marie Sherlock: Ireland's Cancer Care Is Failing - Fix the System

I want to thank Deputy Colnán and Sinn Féin for introducing this very timely motion on cancer services, which we'll be supporting. Thank you Minister. I was going to be given out that the government are opposing this motion this evening, and look, it is disappointing that the government are deciding to nitpick at what is a very good motion, and surely be to God we should be all joined in identifying the issues, the very clear issues that are there at the moment. The reality is that while I think there is a perception that Ireland used to be, or certainly it used to be the case that Ireland was a global leader with regards to cancer care, we are now a long way off of that. A long way off of that, and I suppose it is because of the lack of investment, but also because of the lack of focus on how we organise our health service, not just our hospital services, but right down to our primary care GP services, is why we're not getting cancer services right in this country today. The reality is that sadly one in two will get cancer in their lifetime in this country, one in three will die from it, and Ireland has the second highest incidence rate of cancer diagnosis in the EU, and the number of cancer diagnosis is projected to grow by 47% between 2022 and 2040. So it is something that we need to get right in terms of our services. To me, this conversation has to be about, as I say, funding and how we organise our health services, and we obviously are awaiting the new national cancer strategy next year. It is critical that ring-fenced funding is there, rooted in prevention, particularly with regards to primary care, looking at those socioeconomic factors, because inequality is at the heart of the higher incidence of cancer amongst lower-income parts of our population and our communities, and also in terms of the early diagnosis through screening, early treatment, innovation and access to technology and medication. I want to start with what I consider to be the low-hanging fruit with regards to cancer services, and that is screening. Minister, we know that 40% of the women called to attend breast check last year did not go, so breast check missed its target by 46,000 mammograms last year, and that target has been missed by three years in a row, and I am frankly not hearing any answers or any research as to why that is the case. We can speculate. There are many, in terms of getting the time off work, the fear of the mammogram itself, because it is painful, and of course in terms of the outcome. My colleague Duncan Smith has a bill coming this Thursday seeking to provide for legislative provision for workplace leave for cancer screening, but we need to see the research, we need to see the understanding undertaken by the Department as to why women are not presenting for breast check, because to my mind the conversation has to be about reducing the age of breast check, particularly to women below the age of 50, and ensuring that we catch the incidence of cancer at a much earlier stage, and that we send out the message that if there is a diagnosis of breast cancer in stage 1, that there is a 99% chance of survival. So that's why early detection is so vital, and we need to get to the bottom of why the take-up is much lower than it should be. I think the other key concern for me is with regards to bowel screening, and we know that the target of 50% is obviously a much lower target than we would like, but of course the take-up of bowel screening is far below what it should be. And when you look at the rates of colorectal cancer in this country, they have doubled, and those under the age of 50, between 1994 and 2019. And we see in an article published by the Irish Medical Journal last year, with researchers from CUH and Cancer Research Ireland, that by 2030, young onset colorectal cancer will be the leading cause of death for adults between the ages of 20 and 49. One in ten people in Ireland at the moment with colorectal cancer are under the age of 50. And we need to get serious about that very real challenge over the coming years. So not only do we need to look at the take-up of the existing screening programme, but we need to lower the age as well. So to me, that's the easy part, that's the low-cost part of the cancer services. The other key part of course is with regards to in-hospital services. And we see what has happened with regards to radiation oncology, the huge shortage with regards to the delays in terms of access to treatment, two in ten people not starting radiation in time in 2025, two in five women not being seen on time for their appointment at an urgent breast clinic. And of course knowing that in the Dublin area, that 90% of the lineacs in the Dublin area are beyond the 10-year lifespan. And that points to an enormous government failure to ensure investment in infrastructure. But the other key aspect of, I suppose what I want to touch on this evening, is outside of the hospital system. And it is about the overall system of cancer care, which is the first point to call, which is our GP system. Now we know that the EU country cancer profile 2025 talks about Ireland facing shortages of various cancer care professionals, including GPs. Now I've stood in this chamber a number of times in dealing with you Minister a number of weeks ago, where we talked about the huge geographical inequality that exists across this country with regards to accessing GPs. And to be very frank about it, if people have to endure a long wait to access their GP, then that is going to deter them from turning up. Particularly if it is an issue relating to testicular cancer, or prostate cancer, or breast cancer, or some of the cancers that may be a bit more sensitive for people in terms of presenting. And we have to change that, because it's not good enough that in the communities that I represent, for Cabra, one GP to 3,000 people. In the north inner city, one to three and a half thousand people. In some of the fast growing communities, particularly in Kildare, in Luton, in Eastmeath, we're seeing one to four thousand, one to five thousand, one GP. That is unacceptable. I sometimes think when we're having this conversation, I'm having it with people who can pick up the phone to their GP, talk to the secretary, and get the appointment the following day or the day afterwards. So if that is the case for the vast majority here, that is wonderful, but that is not the reality for many people in the community. And obviously you opposed our Bill, Minister, with regards to ensuring that the HSE take responsibility for the geographic and even geographic distribution of GPs across the country. But we have to get that right if we're making sure that people are presenting at the first port of call within the health system. The last thing I want to raise this evening is with regards to palliative care, because we're all about early detection, we're all about treatment. The reality is people die in this country from cancer. And I want to raise in particular, and Deputy Farrell raised it as well earlier, the lack of pathways when somebody has cancer in this country into the hospital system. So whether you're either currently in treatment or you're in palliative care. And it is really frustrating to me to think there are people with cancer who have to present themselves to ED and sit there for a number of hours or indeed days before they get the treatment they need. Now I know in St. Vincent's and in other hospitals across this country, they have now began to have quick access for cancer patients, chemo patients in particular, into their clinics. But I'm dealing, I spent time yesterday with a 42-year-old woman who was in palliative care, single mother to a young son, who is tonight, who had to wait three hours for an ambulance yesterday to be brought to her local hospital, major hospital here in Dublin. She had to wait till four o'clock this morning for a bed. Now she's in palliative care, right? And because she's been discharged from chemotherapy, and even though she's with the hospice, she's not, she's not at death's door to go into the hospice just yet. She is in limbo and there is nobody to look after. And she needs a nephrostomy, which is effectively a procedure to ensure that the urine leaking out of her back can be stopped. But she had a number of weeks ago to go into that same hospital and waited four whole days, taking up a hospital bed, waiting for a one hour procedure that does not require a general anaesthetic. And I'm telling this story this evening to highlight the lack of pathways, particularly for those in palliative care, into the hospital system. There is a complete disconnect from when people finish their treatment to when they die, or when they go into a hospice. But by the time they actually are admitted into a hospice, they're only a few days or maybe a week or two from passing away. But what about those weeks in the middle, Minister? That is critical. Now part of it is with regards to hospital organisation, but the other part of it is we've got a 2024 National Palliative Care Strategy and it's very welcome and it says great things. But I'm not at all convinced when I look at the HSE service plan, or indeed the letter of determination from the Minister, that there's any focus on that at all. And in some ways, you know, it shouldn't take an awful lot to ensure that somebody with palliative care presenting to a hospital has a particular pathway to get their treatment and get them back out. Because it's not good enough that a palliative care patient is taking up a vital bed for somebody who may live, you know, if we call a spade a spade. But secondly, and in terms of affording them dignity in their final weeks and months of life, that they would spend any time unnecessarily within a hospital system. So if there's one plea I would make to you Minister this evening, because this isn't really about, you know, massive amounts of funding. This is about how we get our systems right. And I'm afraid that those systems are not right. And there are stories right across this country of people having to get into ambulances and present ED unnecessarily when there should be another way for them. Anyway, I want to conclude by thanking Sinn Féin for this motion. There is enormous work to be done to ensure that Ireland can go back to being a global leader with regards to cancer care. But ultimately, in terms of making sure we go back to that place, we have to get the investment into our equipment right and the investment into access to medicines. Because we know that there is a gross inequality in Ireland between those who have the luxury of private health insurance, and when I say luxury, you're paying a fortune for health insurance, or those reliant on the public system, and the access to drugs. And we know that across a whole range of cancers, that your potential for survival is greatly enhanced if you can go through the private system and access those drugs that are licensed through the EMA that have not been licensed for this country. In my book, if a drug has been licensed through the EMA, then we need a greatly simplified system through the National Centre for Farm Economics of how we process approvals for drugs in this country. Cost is one of them, but I don't hear anything from government about pushing at the European level how you collectively negotiate on prices with regards to drugs. In some ways, the market model is coming back to bite us here in Ireland. We need to actually make sure we collectively negotiate with the EU rather than doing it individually.