Strategy is still tackling the themes of a decade ago
THE first National Cancer Strategy published during Michael Noonan’s tenure as Health Minister 10 years ago was for all cancer patients to have equal access to treatment services regardless of where in Ireland they lived.
A key aim in 1996 was “reorganising cancer treatment services to promote a strong patient focus and ensure equity of access throughout the country”.
A decade on, the new National Cancer Strategy has had to return to that theme, as there are still major problems in some parts of the country.
In the north-west, it has been reported that women opt for mastectomies because they cannot manage travelling back and forth to Dublin for breast cancer treatment or arrange for the necessary lengthy stays away from home.
In the south-east, a campaign has grown up around the lack of radiotherapy services that could yet cause grief for the Government in the next general election.
The new strategy beefs up its equality goals, aiming to ensure that “diagnostic, treatment, supportive and palliative services are consistent, accessible, equitable and high quality throughout the country irrespective of geography or ability to pay”.
While the 1996 strategy was the work of the rainbow government, its implementation became the responsibility of Brian Cowen under the Fianna Fáil-PD coalition which came to power in 1997.
Since then, the Government and three health ministers have faced the challenges with limited success, as a comparison between what was said in 1996 and what was achieved by 2006 shows.
The 1996 strategy pledged: “To reduce death rate from cancer by 15% in the under-65 age group by 2004.”
Tánaiste and Health Minister Mary Harney said yesterday: “We have reduced mortality from cancer in the under-65 age group.”
The 1996 strategy said: “Ireland has a higher mortality from cancer than the EU average.”
Mary Harney admitted yesterday: “At the moment we get very bad outcomes for many common cancers as compared to other European countries.”
A key fault identified in 1996 was that: “At present, treatment services are not always well co-ordinated between or within primary and hospital-based levels of care. Cancer treatment services must be reorganised to ensure that they meet the needs of patients as efficiently and effectively as possible.”
Ms Harney said yesterday: “At the moment we have huge fragmentation of services ... the whole purpose of today’s strategy is about reorganising, rationalising, about putting a new governance structure in place.”
The solution identified in 1996 was to create: “revised organisational structures involving the establishment of regional services based on designated groups of hospitals, and three supra-regional services responsible for providing the full range of cancer services for a defined catchment area”.
The 2006 plan recommends reorganising services into four Managed Cancer Control Networks, each serving a population of about one million, and eight regional Cancer Centres, based around population groupings of about 500,000.
Preventative cancer screening was another major plank of the 1996 plan. Its aim was “devoting resources to screening and early detection programmes of proven value, including the establishment of national programmes of screening for breast and cervical cancer.”
To date, neither screening programme is fully national. The new strategy sets targets for full national roll-out, with BreastCheck to go countrywide next year and the cervical screening programme to follow by 2008 with the rider it should be “based on an affordable model”.
Both the 1996 and 2006 strategies make strong commitments to research, with the early document stating as an aim: “A Cancer Clinical Research Unit to be established through the Health Research Board.” No physical unit was set up but since 2002 the Health Research Board has supported clinical trials across a network of 10 hospitals, co-ordinated by the Irish Clinical Oncology Research Group.
One aim of the 1996 strategy which was achieved was to tackle the incidence of smoking through legislation and taxes. The workplace smoking ban introduced in 2004 met a large part of that agenda, while price hikes in Budgets have made the price of a pack of cigarettes increasingly unattractive.
But as Mary Harney said yesterday, the population’s rising age profile and increased cancer detection mean the number of cancer cases will increase dramatically by 2020.
The question then will be whether the 2006 strategy was a breakthrough document, or merely a carbon copy of the 1996 plan in both content and outcome.
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