Seanad Éireann debate -
Tuesday, 13 Jun 2023

In this Commencement matter, I call on the Minister for Health to provide an update on the pilot lung cancer screening programme and to indicate when a full programme will be rolled out nationally.

Lung cancer is one of the biggest killers in Ireland, accounting for 22% of cancer deaths in males and 20% of such deaths in females. There are 2,500 new cases of lung cancer diagnosed every year and 1,800 deaths annually. Unfortunately, approximately 70% of lung cancers are currently detected at quite an advanced stage, with most at stage 3 or 4 at the time of diagnosis. Late presentation of lung cancer limits the treatment possibilities. However, the good news is that there are really good treatments available when lung cancer is diagnosed at a very early stage. The other good news is that Ireland is very good at targeting the causes of lung cancer. We have made great strides in terms of banning tobacco and are making great strides with regard to vaping. We are really leading in that area across Europe. However, what is missing is screening. Evidence shows that lung cancer screening detects lung cancers at an early stage and we have the drugs to successfully fight early-stage lung cancer.

There are pilot programmes ongoing in Ireland and the United Kingdom and the data indicate that lung cancer screening programmes are effective. In Ireland we have three screening programmes for cervical, bowel and breast cancer. Those screening programmes are very important because they catch many cancers at an early stage. While there may be certain issues or problems with the current screening programmes, that should not prevent us from rolling out a lung cancer screening programme.

I wish to highlight an important issue with regard to lung cancer in Ireland. We often hear that cancer does not discriminate but in Ireland cancer does discriminate. Cancer in this country disproportionately affects those living in marginalised areas because they do not have adequate access to a GP in order to get an early diagnosis.

Nearly 50% of lung cancer patients are getting diagnosed at a late stage in emergency departments, especially those from disadvantaged areas. Access is a huge problem. I am calling for a national lung cancer screening programme that will take away any inequality because it will be available to all of the public and everyone will get a chance to have their lungs screened and have access hopefully to the many amazing treatments that are out there. We need early detection and a screening programme and we need equality of access to medical care.

I thank Senator Ardagh for bringing this important issue to the House. I am taking this on behalf of the Minister for Health, Deputy Stephen Donnelly. As a Government, we are fully committed to supporting our population screening programmes, which are a valuable part of our health service. Lung cancer screening is receiving increasing attention and the international evidence in this area continues to build. An updated European Council recommendation on cancer screening was published in December 2022 and it recommends the gradual introduction of screening for new cancers. Ireland will be actively engaged at European level to take forward the updated recommendation on cancer screening, informed by the evidence and advice emerging from the wider international work in this area. Ireland has always strongly advocated for the implementation of smoking cessation policy in tandem with the introduction of screening for lung cancer. Ireland also welcomes the emphasis on equity and on the importance of ensuring participants in cancer screening programmes are as informed and empowered as possible.

I am aware that lung cancer is the leading cause of cancer death in both men and women in Ireland. However, five-year survival rates for lung cancer in Ireland have increased greatly from 9% to over 24%. Treatment for cancer is centred on eight designated cancer centres, with rapid access clinics providing diagnostic services for lung tumours. It is important to emphasise that our policy priority continues to be a focus on primary prevention. We know that nine out of ten lung cancers are caused by tobacco consumption, so we continue to do what we can to drive down our smoking rates. There are several initiatives in place in Ireland in relation to smoking cessation. These are recognised as an important element of a comprehensive tobacco control strategy. Among many other initiatives, the Department of Health is progressing legislation that requires the licensing of every retailer of tobacco products in Ireland. It bans the sale of cigarettes from self-service vending machines and at locations intended for children and events organised for children. A range of measures have been introduced to further reduce the use of tobacco and nicotine-inhaling products such as e-cigarettes, particularly among young people. We have also undertaken a range of measures to help people quit smoking such as the QUIT campaign that uses real life stories. Cost is regularly highlighted as a barrier to accessing or adhering to nicotine replacement therapy. Therefore, the removal of VAT on all nicotine replacement therapy was a longstanding recommendation in the Tobacco-Free Ireland policy. In addition, we have year on year increased the price of cigarettes.

With regard to lung cancer screening, I understand that researchers in the Royal College of Surgeons Ireland, RCSI, and Beaumont Hospital are currently preparing to run a pilot of lung cancer screening in Ireland, with funding from the Irish Cancer Society and the European Union. The pilot will provide valuable information on the feasibility of implementing lung cancer screening in the Irish context, including the best methods to identify the target population of high-risk smokers and ex-smokers. As the Senator may be aware, decisions on whether to introduce new screening programmes, are made on the advice of the national screening advisory committee, NSAC. All population cancer screening programmes are associated with both benefits and harms, and lung cancer screening is no different. It is important we have rigorous processes in place to ensure our screening programmes are effective, quality-assured and operating to safe standards. The NSAC will consider the updated European Council recommendation on cancer screening and advise the Minister and the Department of Health on the evidence as it applies to Ireland. In light of all this, I trust the public can be assured of the Minister’s ongoing commitment to further expansion of population-based screening in Ireland.

I would just like to follow up on that. European, Dutch and Belgian trials confirmed that very low dose CT screening in people at high risk of developing lung cancer demonstrated a reduction in mortality rate of 26%. This is factual scientific evidence. The European Respiratory Society has urged countries across Europe to implement lung cancer screening programmes without delay. The technology in this area is advanced. As legislators and policymakers, we are always going to be a little behind the technology and the medicine but it is time for us to listen and to implement a lung cancer screening programme without delay because there is a rapid increase in the incidence of lung cancer in Ireland.

We must ensure that we maintain best international standards and that, as legislators, we have the best medicine in place for our citizens.

I thank Senator Ardagh. I reiterate that the national screening advisory committee will consider the updated European Council recommendation on cancer screening and advise the Minister for Health and his Department on this evidence. We are committed to the further expansion of screening in Ireland in accordance with internationally accepted criteria and best practice. I assure the Senator that Ireland will be actively engaged with the significant ongoing collaborative work at a European level to take forward the updated recommendation on cancer screening, including work on lung cancer screening. The Senator referenced some trials in Belgium and the Netherlands. That is why we have a structure to take the evidence. In addition to screening and diagnostics, we must ensure there is a focus on primary prevention around cessation of smoking. Radon control was also implemented as it has an impact on lung cancer specifically. It is important that is not forgotten as a cause. It is important to remind everyone that screening is for healthy people without symptoms. If someone becomes aware of symptoms or has concerns or worries, they should contact their GP who will arrange appropriate follow-up care.

I welcome the Minister of State to the House to discuss this important issue. I ask that the Minister of Health provide an update regarding the new endoscopy suite at Bantry General Hospital, including a timeline for the commencement of the project. The new endoscopy unit originally launched by the former Minister for Health, Deputy Harris, has started in many ways. I will go over the timeline for the project. In January 2022, it went for tender and in February 2022, planning permission was granted. In the capital plan for 2022, it was allocated €1.8 million. In September 2022, I called to the hospital and we walked the site and saw what was happening on-site. In the capital plan announced on 29 May, a total of €1.6 million was allocated for the site and this proposal.

I acknowledge the good work regarding this unit in Bantry hospital. Bantry is a unique location right at the edge of County Cork. The hospital covers three major peninsulas, part of north County Cork and County Kerry. It is a wonderful institution that has a significant influence on healthcare in that part of the world. It is also a significant economic driver in the community. There are more than 330 whole-time equivalent staff working in the hospital, including 17 house doctors and, for the first time ever, six full-time consultants. This shows the level of investment in Bantry General Hospital over the last few years. As well as the endoscopy unit, there is a daycare centre, injury centre, rehabilitation centre, high-dependency unit and stroke unit. Much is happening in the unit.

I am disturbed by political commentary about Bantry General Hospital. It has been made a political football by some politicians, in particular in west Cork, who talk down this wonderful institution daily. I fundamentally believe they are trying to close it on the back of talking it down. I will read out some of the terminology used about Bantry General Hospital and this unit in the last few weeks. It has been published in the local newspapers. These politicians have stated there has not been sight nor sound of developments proposed for this unit. Money has been allocated and major works have taken place on-site. I hope the Minister of State can confirm this afternoon the good work on-site. If this kind of negative publicity continues regarding Bantry General Hospital, it will be undermined so much that it will effectively close for cheap political gain. It is inappropriate, not alone on a political level but for the public who depend on Bantry General Hospital. Every time this wonderful institution is talked down, the knock-on effect is that the hospital finds it harder to get people to come to Bantry to work in it. That is the reality. The hospital has done a fantastic job in having six full-time consultants, 17 house doctors and 330 whole-time equivalents working in it. There has been huge investment, with €6.1 million provided this year alone, and, I hope, another €12 million next year. That is a significant investment in the institution.

The knock-on implication of the continual bad-mouthing or talking down of the institution has to be acknowledged. I fundamentally believe this is the cheapest and lowest form of politics. It is literally working on people's fears for political gain.

I acknowledge the good work of the staff, in particular, and the management as they try to ensure the hospital goes from strength to strength. I hope the Minister of State will outline the timeline for the completion of the project and the budget set aside for this wonderful hospital.

I thank the Senator for the opportunity to address the House on this important matter on behalf of the Minister for Health, Deputy Stephen Donnelly.

I acknowledge the important service Bantry General Hospital provides to a large and unique geographical area, from the peninsulas in the south west to Clonakilty and Timoleague in the east. Bantry General Hospital has received a substantial allocation of €23.7 million in 2023, an increase of 19.6% since 2019. I am pleased to advise that investment in the endoscopy unit at the hospital is included in the health capital plan of 2023. The unit has gone through the tender process, and construction commenced in January of this year. The South/Southwest Hospital Group has advised that the building stage is progressing and that there are no foreseen delays in delivering this important project. It is expected that it will be completed in June 2024.

I am delighted to confirm that waiting lists for endoscopy services at Bantry General Hospital are reducing and that more people are getting the treatment they need. The National Treatment Purchase Fund, NTPF, has approved insourcing endoscopy initiatives for funding for Bantry General Hospital, which will facilitate treatment for 426 gastrointestinal scope procedures. The latest NTPF figures show the impact of these and other measures. There are currently 311 patients on the Bantry General Hospital gastrointestinal scopes waiting list, representing a reduction of 13%, or 48 people, by comparison with the same period last year. Indeed, the figures for 2023 look even more hopeful, with the gastrointestinal scopes waiting list having decreased by 18%, or 69 people, in the year to date. I commend the effort of Bantry General Hospital, which, due to the hard work and determination of all its staff, has achieved these results.

This Government is committed to continuing to improve access to care. On 7 March, we published 2023 Waiting List Action Plan, which is the latest stage of a new multi-annual approach to sustainably reducing and reforming hospital waiting lists. For 2023, funding totalling €443 million is being allocated to tackle waiting lists, including endoscopy waiting lists at Bantry General Hospital. This funding will reduce hospital waiting lists by 10% in 2023, as well as continue to significantly reduce waiting times in line with the Sláintecare recommendations.

The new endoscopy unit is further evidence of the Government's commitment to Bantry General Hospital, the people of west Cork and south Kerry, and the South/Southwest Hospital Group in providing the right care in the right place at the right time.

I welcome the students from Loreto Primary School, Rathfarnham, to Leinster House today. They and their teachers are all very welcome. I thank them for being here. They are guests of the Minister of State, Deputy Richmond. I hope they have a very good school tour in Leinster House today. They are joining us as we begin our business in the Seanad. In keeping with the tradition associated with visits to Seanad Éireann, I will let them off homework this week. I hope they have a very good visit.

Senator Tim Lombard: The Cathaoirleach is being very generous in saying there should be no homework this week. Fair play to him.

I thank the Minister of State for his really comprehensive response. He has just clarified the position on the scaremongering. He said it is expected that the project will be completed in June 2024. That is a really significant statement. I acknowledge it because it is all about delivering multimillion-euro projects that will benefit rural Ireland and improve the quality of life there. The continual barraging of Bantry General Hospital by politicians for nothing more than their own political gain has to be called out. What Deputy Michael Collins has been at over the past few weeks has to be called out as inappropriate-----

I thank the Cathaoirleach. As I was saying, it needs to be acknowledged that the work is ongoing and near completion. It entails a multimillion-euro project being delivered on the ground.

The project follows on from others that have happened in the past few years. We had a refurbishment of the medical assessment unit in 2015; the extension of St. Joseph's ward in 2016; the radiation suite upgrade in 2017; new labs and an administration building put in there in 2021; a CT scanner put in there in 2019 and now this project will be delivered. I list these to give an acknowledgement of the amount of work that has happened in Bantry. I thank the Minister of State for his acknowledgement of the good work and I look forward to June 2024, when this project will be finished.

I appreciate Senator Lombard raising this important issue. This Government is fully committed to investing in Ireland's healthcare infrastructure and services in line with the ambition and direction mapped out by Sláintecare. We are pleased to confirm that the construction works are progressing on the endoscopy unit at Bantry General Hospital and there is a planned date for its completion. The upgraded endoscopy suite at Bantry General Hospital, which is expected to complete construction in June 2024, is an important service that will safeguard the quality of life for many of citizens of west Cork and south Kerry. I reiterate this Government's commitment to healthcare reform. Significant reform has already been delivered, as the Senator has said, and these reform measures are making an immediate positive impact on patients' lives. The ambitious 2023 waiting list action plan sets out the next steps in the multi-annual approach towards achieving our vision of a world-class public healthcare system in which everyone has timely and transparent access to high-quality scheduled care, where and when they need it, in line with Sláintecare reforms. I thank the Senator for raising this important issue.

I join the Cathaoirleach in welcoming all the students from Loreto on Grange Road. I hope they enjoy seeing democracy in action. It is a good example of such democracy from Senator Lombard in raising the important health issue; the progress of healthcare reform and the obligation on Government to deliver that in line with the expectations of citizens. I hope the students enjoy their day in the Houses of the Oireachtas.