Address by Micheál Martin, T.D., Minister for Health and Children at the publication of the Report: “An Evaluation of Cancer Services in Ireland: A National Strategy 1996”
Ladies and Gentlemen,
When we talk about cancer, we´re talking about a reality that touches each and every individual in this country, sooner or later. It´s the most frequent cause of premature death in Ireland. One in three of us will develop cancer. One in three. And, because we have an aging population, we can expect as many as 8,000 new cases of cancer by 2015.
The 1996 National Cancer Strategy was the first national integrated cancer strategy. It addressed all of the key elements of a dedicated cancer control strategy – prevention, screening, early detection, treatment services, rehabilitation, palliative care and research. It also kick-started a significant investment programme across the cancer services. It recommended key organisation changes, it proposed the establishment of a multi-disciplinary Cancer Forum to advise on cancer and the appointment of Regional Cancer Directors in each Health Board area.
Seven years have passed since the first Cancer Strategy was launched. It is timely that the current Cancer Forum should evaluate the achievements of the original strategy as part of the development of a second strategy to cover the period 2004 to 2010. In planning for the future, it is essential that we review the past, acknowledge the achievements, establish the shortcomings and address new and emerging needs especially in a rapidly developing area such as cancer.
The key goal of the 1996 Strategy was to reduce the death rate from cancer in the under-65s by 15 per cent in the ten year period from 1994. I am pleased to announce that this goal was achieved in 2001, three years ahead of target. This is a considerable achievement. All too often, we tend to overlook the return on investment in our health services. We should more often acknowledge progress and achievements in good quality health care provision.
While recognising this achievement, it is by no means a cause for complacency. Our age standardised mortality rates are higher than the EU average and there is scope for improvement to bring our rate in line with other EU countries. The reduction since 1994 in cancer mortality rates is as a result of improved diagnosis, earlier interventions and improved and more widely available cancer treatments. I expect these trends to continue as a result of developments in cancer services and continued improvements in treatments.
The Evaluation highlights a significant number of areas where substantial progress has been made in implementing the 1996 Strategy.
- The Government´s commitment to the implementation of a broadly based cancer care policy has resulted in an additional cumulative investment of over €400 million in cancer services since 1997. This represents a 15 fold increase in funding for these services over the lifetime of the Strategy and has enabled significant developments in cancer services.
- In addition to the revenue investment, there has been considerable capital investment in these services. The Report points out that an additional sum of approximately €90 million has been invested in capital projects in cancer services, including the €54 million capital invested in the development of radiation oncology and the €12m capital investment in the BreastCheck programme.
- An additional 87 Consultants have been appointed in key areas of cancer services, including medical oncology, surgical oncology, radiotherapy, histopathology, radiology and haematology. 245 clinical nurse specialists have been appointed in cancer services. Clinical nurse specialists are developing an increasingly important role as they have a sustained and direct contact with patients.
- The cause of most cancers is multi-factorial but that there is strong evidence that lifestyle factors, in particular smoking, alcohol and diet play an important role. The promotion of healthy lifestyles is a key element of the work of the Department´sHealth Promotion Unitand spending by the Unit since the launch of the Strategy is in excess of €17m. The Report acknowledges that the impending ban on smoking in the workplace will see Ireland as a leader in this area in Europe.
- The Report also recognises the importance of primary care in the delivery of cancer care. The Primary Care Strategywill provide us with the capacity to ensure that people can experience a well co-ordinated and integrated package of services appropriate to their needs in their own communities and in their homes. It will broaden the focus of services to include health promotion, prevention and supportive care for those who have recovered from cancer, are living with cancer or are dying from cancer.
- There have been very positive developments in the area of early detection and screening, particularly with the introduction of the breast and cervical screening programmes on a phased basis. Under the national extension of BreastCheck, approximately 150,000 women in the target population 50 to 64 years of age will be eligible for screening.
- The number of new patients per annum receiving chemotherapy treatment has increased from 2693 in 1994 to 3519 in 2000, representing an increase of 30% nationally. In relation to medical oncology, the evaluation highlights the fact that there has been a four fold increase in medical manpower in this modality. In 1996, there were only four medical oncologists in the entire country. Since then an additional 15 have been appointed. The Evaluation points out that the number of chemotherapy sessions has almost trebled over the period.
- Data from the National Cancer Registry shows that the number of new patients per annum receiving radiotherapy treatment has increased from 2402 in 1994 to 3809 in 2000. This means that an additional 1407 patients are accessing these services, representing an increase of 58% nationally.
- The number of patients receiving oncology surgery has increased by 26 per cent. Significantly, fourteen general surgeons with a special interest in breast disease have been appointed since 1997, in line with the Report on the Development of Symptomatic Breast Disease Services. The increase in the number of surgeons working in cancer control is reflected in the increase in surgical activity. In 1997, about 1,300 breast cancer procedures were performed; the comparable figure in 2002 is over 1,800.
- The Evaluation points out that considerable progress has been made in the area of palliative care, in accordance with the recommendations of the 2001 Report of the National Advisory Committee on Palliative Care.
- The Report recognises the importance of research and clinical trials in cancer care. Under the auspices of the Ireland-Northern Ireland-National Cancer Institute Cancer Consortium, awards to the value of €3.5m have been made to allow hospitals to recruit and train staff, improve facilities and take part in world-class clinical trials.
A key benefit of the 1996 National Cancer Strategy was that it provided a framework for the development and funding of cancer services. I have again prioritised cancer services in the Estimates process for 2004. I have allocated €15m for service pressures and priorities across the health boards this year. This includes additional funding for the further development of radiotherapy services in Cork and Galway.
The Evaluation´s number one recommendation concerns the expansion of radiation oncology services to ensure that all patients have reasonable access to this service. The Government accepts that there is a major deficit in this area. The Evaluation recommends that these services should not be located in many centres throughout Ireland, but rather that there should be access arrangements and transfer protocols in place to facilitate patients in accessing these services. This recommendation is in line with the recommendations contained in the recently published Report on the Development of Radiation Oncology Services that have been endorsed by Government and will be implemented over the timeframe set out in that Report. I have already announced a comprehensive programme to implement this Report.
Organisation of Cancer Services
The Evaluation makes a number of important recommendations on the organisation of cancer services. International evidence is that better clinical outcomes are achieved in hospitals with specialist staff, high volumes of activity and access to appropriate diagnostic and therapeutic facilities. Best results in treatment are achieved where patients are treated by staff working as part of an integrated multidisciplinary specialist team. I am convinced that this core principle must inform the current organisation of services and how we plan future services across the various modalities of cancer care.
The Forum, as part of the development of the new Strategy, has concluded that there are too many Consultants performing oncology surgery in too many hospitals. We simply do not have the patient caseload to support the current broadly based organisation of oncology surgical services. The Forum has advised me that the current organisation of these services is not in line with best practice. International evidence is that technically challenging surgery, for example, can best be supported if it is concentrated in a relatively small number of centres. We must face the reality that we cannot continue to expect that we can deliver the highest quality of cancer services across over 30 acute hospitals.
The ultimate objective in terms of the delivery of cancer care is that those in receipt of services experience outcomes on a par with best international standards. The Evaluation Report recognises that Health information is fundamental to assessing and implementing quality programmes. The National Health Strategy provides for the establishment of an independent Health Information and Quality Authority.
The Authority will exercise a pivotal role in relation to a number of key information functions. It is only through focusing on specific information developments such as this, to build on the excellent work of the National Cancer Registry, that we will be able to continuously demonstrate the positive impact that cancer services are having and also to identify the areas which may need to be addressed to further strengthen our cancer care system.
The consultation process clearly highlighted the need for an increase in services to provide emotional and psychosocial support to cancer patients. All of these areas will be addressed in the forthcoming Strategy. I understand that the Forum has invested considerable time and effort in this development. A new Strategy is expected in the Spring of 2004. This will shape and prioritise our cancer services up to 2010.
The establishment of the Forum and the appointment of Regional Directors of Cancer Services are rightly recognised in the Evaluation as key achievements. I want in particular to mention Professor Jim Fennelly this afternoon. As chairman of the First National Cancer Forum, Professor Fennelly has been responsible for advising successive Ministers for Health in relation to cancer services and the implementation of the 1996 Strategy. I want to thank you, Professor Fennelly for your major contribution to cancer services in Ireland, both as a clinician and as Chairman of the First Forum. Indeed as a member of the current Forum, your input into the development of the new Strategy is invaluable. The key achievements outlined in this evaluation are a testament to the work undertaken by Professor Fennelly, Professor Redmond and the other members of the First and Second Forums.
I wish to thank the steering group which was responsible for overseeing this project, comprising Professor Paul Redmond, Professor Jim Fennelly, Dr. Pat Doorley and Dr. Miriam Owens, all of whom are here today. As Chairman of the Second National Cancer Forum, Professor Redmond is leading the development of the new Strategy. I know that this evaluation will offer significant assistance to the Forum as you develop and draft the new Strategy.
Deloitte has produced a significant piece of work. Its recommendations will inform the development of the new Strategy and will be essential in the development of these services for cancer patients over the next number of years. I would like, in conclusion, to thank the members of the National Cancer Forum for your commitment and hard work in supporting the development of high quality cancer services at a national level. I want to assure you of my continued support as you develop the new Strategy and I look forward to its publication next year.