Launch of the National Cancer Strategy 2017-2026
*check against delivery*
Simon Harris, T.D., Minister for Health
Launch of the National Cancer Strategy 2017-2026
Wednesday 5th July 2017
I am delighted to see you all here today to mark the launch of the National Cancer Strategy 2017-2026. I know that many of you have contributed to the development of this Strategy through sharing your experiences and expertise and I really appreciate that.
This National Cancer Strategy is about
- preventing cancer across our population;
- diagnosing cancer early;
- providing optimal care to patients; and
- maximising their quality of life;
- while ensuring the delivery of evidence-based high-quality services throughout.
The breadth of willing engagement that was forthcoming from the outset of my Department’s work on the development of the Strategy was most heartening. So many stakeholders have been involved, illustrating the pervasive nature of cancer and the impact that a cancer diagnosis can have on the patient, their family and their friends.
Great strides have been made under the current National Cancer Strategy with clear evidence-based policy direction from my Department and strong implementation by the HSE’s National Cancer Control Programme. Working together, our achievements include:
- the provision of equal access to quality treatment;
- progress on the centralisation of cancer surgical services
- the establishment of designated cancer centres;
- multi-disciplinary management as the standard of care;
- Rapid Access Clinics for breast, lung and prostate cancer;
- increases in access to medical oncology and cancer drug treatment;
- a national programme for radiation oncology; and
- three cancer screening programmes – BreastCheck, CervicalCheck and BowelScreen.
However, we have much to do. Ireland is placed around mid-table in the survival by country statistics for common cancers across Europe. Under this Strategy we are setting the bar at a high level. We aim to make further strides in cancer control such that survival rates can reach the top quartile of European countries by the end of the Strategy period. The challenges involved in achieving this are very significant, especially given our increasing and aging population, so it will take a huge collective effort to achieve.
The Strategy set out four goals:
- · Reduce the cancer burden;
- Provide optimal care;
- Maximise patient involvement and quality of life; and
- Enable and assure change.
Reduce the cancer burden
The National Cancer Registry forecasts that the number of cases of invasive cancer will increase by 50% in men and 40% in women by 2025 – and that the overall rate will nearly double by 2040.
But we won’t just accept this as a given. Every individual cancer case avoided is so important for the people involved. Also, cancer prevention offers the most cost-effective, long-term approach for cancer control.
I don’t think that we have got the message across that 30% to 40% of cancers are avoidable. Our chances of avoiding cancer are very much improved by not smoking and through improved diet, more exercise, reduced alcohol intake and limited exposure to ultraviolet radiation.
Generally people now realise the dangers of smoking and we will work towards the goal of making Ireland tobacco-free by 2025. We also need to work to increase public awareness of the link between lifestyle and cancer, and the steps we can all take to reduce our cancer risk. The prevention measures planned under the Strategy will be fully integrated with the overall health and wellbeing initiatives under the Healthy Ireland programme.
If cancer does occur, early diagnosis is crucial in terms of catching the disease early, in reducing the treatment interventions needed and in achieving successful outcomes. BreastCheck, which currently covers women aged 50-64 years of age, is being expanded to women of 65 to 69 inclusive, and the expansion of BowelScreen over time to all aged 55-74 is also recommended. The concept of a continuum of care will permeate all our activities. Particular efforts will be needed to ensure co-ordination between primary care, acute care and social care as patients can repeatedly move between different areas across their cancer treatment journey.
Provide optimal care
A broad objective of the Strategy is to have models of care in place that ensure that patients receive the required care, in a timely fashion, from an expert clinical team in the optimal location. Multidisciplinary team working will be key.
This Strategy builds on progress made to date by supporting the key role of designated cancer centres in cancer treatment. The centralisation of surgical services for all cancers will be further progressed to ensure that optimal treatment is provided and outcomes are improved. There is clear evidence that patients who receive treatment in hospitals with a high patient volume, from doctors who themselves see a high volume of cases, have better outcomes.
Radiation oncology services will also be further developed. Services in Dublin, Cork and Galway will be renewed and expanded over the Strategy period to meet increasing demand. I also welcome the recently introduced provision of radiation oncology services for patients from Donegal in Altnagelvin Area Hospital, Derry, through a Service Level Agreement. I will continue to pursue opportunities for cross-border co-operation in relation to cancer services with a view to achieving mutual benefit.
Technological advances, including in molecular cancer diagnostics and in genetics in cancer, are resulting in improvements in cancer detection, treatment and survival. Over the past two decades a scientific revolution has taken place in understanding the molecular basis for cancer and the genetic alterations that underlie the development, growth, spread and persistence. Advances will continue, and probably accelerate, over the Strategy period. This is an area of real potential. However, it also presents challenges, as is the case internationally, in balancing equitable access to services within finite resources.
We also aim to substantially improve cancer services for children and adolescents/young adults, as well as for older people, under this Strategy.
Maximise patient involvement and quality of life
From the outset of the process of developing this Strategy our top priority has been to make things better for patients. The establishment of the Cancer Patient Forum facilitated a direct patient input to the Strategy, which has been extremely valuable. Who can better inform strategy formulation than the service users? It is fair to say that the final Strategy is significantly different, and much better, for the input of the Patient Forum.
The patient voice in the process emphasised survivorship in particular, though that term is not popular among patients. They made it clear that it is not about just surviving – the aim is to maximise quality of life.
With 150,000 people living beyond cancer diagnosis and treatment, there is a need to develop and implement survivorship programmes for patients with cancer. These programmes will emphasise physical, psychological and social factors that affect health and wellbeing, while being adaptable to people with more specific needs following their treatment.
From many visits to cancer support services during my time as Minister, I have a particular memory of a lady speaking in ARC Cancer Support Centre in relation to her treatment journey and her goal to reach the day when she completed her hospital care. However, when that day came she had no feeling of euphoria – rather she had a mild sense of panic, missing the structure, routine and engagement of treatment and feeling somewhat isolated facing the future. She talked of the hospital, and the associated routine, as being like a comfort blanket and of having a feeling of dropping off a cliff as she left the hospital.
This is a feeling that I think many of our cancer patients have felt over the years, and it is a feeling that we hope to banish through the implementation of this Strategy. We aim to ensure that supports are available to facilitate patients to return to their normal lives, backed up by primary care services and with access to acute services when required.
Building on the significant impact of the Cancer Patient Forum in developing this Strategy, it is proposed to establish a Cancer Patient Advisory Committee. In this and other ways, patient involvement in policy making, and in the delivery of services, will be promoted at all levels.
I also acknowledge the role played by voluntary organisations in supporting patients and their families. A cancer diagnosis affects more than just the patient. Supporting a loved one with a cancer diagnosis can be hard on multiple fronts. Also, the children of patients with cancer can often benefit from extra support at a time of changes in their lives as a result of their parent’s cancer diagnosis. Having a safe space to go to talk about how you are feeling, and to get advice on how to navigate an upsetting situation, can make a world of difference to people who might feel overwhelmed by the impact of cancer in their family.
Enable and assure change
Strong governance is a key component of a comprehensive cancer control system. The HSE’s National Cancer Control Programme has successfully overseen cancer services in Ireland since 2007. I would like to acknowledge the contribution made by Professor Tom Keane, the first Director of the National Cancer Control Programme. Professor Keane led many of the important first steps on building our new cancer system and his vision continues to shape our services. We were fortunate to find a replacement of the calibre of Dr Susan O’Reilly to carry on the work and she has played a huge part in the strides forward that we have made. I also acknowledge the role played by Tony O’Brien, both as interim Director of the NCCP for a short period, but throughout his career in the health services. I am delighted that he is here to address us today.
With Dr Jerome Coffey now at the helm, the NCCP will continue to be central to the implementation of the new Strategy. Indeed, this Strategy envisages an enhanced role for the NCCP, including through the use of Service Level Agreements and through a direct role in the funding and commissioning of cancer services. The NCCP will develop and monitor national quality healthcare indicators for cancer care in line with international standards. Building on clinical guidelines already developed in areas such as breast and prostate cancer, further guidelines will be developed in line with the National Clinical Effectiveness Committee. Cancer services will also increasingly be covered in the National Healthcare Quality Reporting System.
Also, my Department will publish a concise annual report on the implementation of the recommendations and the degree to which the key performance indicators are being met.
I would like to acknowledge the great work being done by our consultants, nurses and many other health and social care professionals in providing services for cancer patients. Indeed, one of our challenges is in retaining these people and in attracting those newly qualified, and those working abroad into our services. I feel that the implementation of the National Cancer Strategy will go some way to providing the type of work experiences, and good patient outcomes, that would excite current and prospective employees.
Obviously implementation of this Strategy will require substantial current and capital funding over the coming 10 years. Revenue funding of €140m per annum, not including the cost of cancer drugs, will be required by the end of Strategy to achieve full implementation.
It is my intention to seek to secure the necessary funding on an incremental basis as part of the annual Estimates process.
The cumulative capital funding requirement is €860m and again this will be sought on an incremental basis in line with capital reviews.
At the outset of the work on the preparation of this Strategy, an international Evaluation Group reviewed the outcomes of the 2006 Strategy and made recommendations for the way forward. Their report proved very beneficial in feeding into the work of the Steering Group. I am delighted that Professor Pádraig Warde, Chair of that Group, has joined us here today to mark the conclusion of the work.
As I indicated, the Cancer Patient Forum made a huge contribution that impacted on all involved and resulted in a better Strategy. Mairéad Mangan will shortly speak on behalf of the Forum. I thank the members for their most willing engagement and, as indicated, I am committed to the continued involvement of patients in the implementation phase.
I would also like to acknowledge the contribution of the Cancer Strategy Steering Group, chaired most effectively by Professor John Kennedy who will also shortly address us. I know that Professor Kennedy put his heart and soul into developing this Strategy, devoting much time to it on top of a very full schedule. I really appreciate this commitment. The Steering Group worked enthusiastically, aided by inputs from many invited participants at their meetings, to finalise recommendations for a really comprehensive Strategy.
Now – lets continue to work together to ensure implementation.