IMAGINE WALKING INTO a dull, fluorescently lit out-patient room 90 minutes after your scheduled appointment. You are there to talk to a highly qualified specialist cancer surgeon, because – like 42,000 other Irish people every year – you have recently found out you have been diagnosed with cancer.

Your mind is still spinning after the scans and biopsies of the preceding weeks. You are told that you need an operation to cure your cancer. You discuss, in detail, the risks and benefits; what to expect from the procedure; what we hope will go well; what might go wrong.

You then ask, “How soon can you operate?”. The answer: eight weeks from now.

Or imagine another scenario: you are seeing an oncologist to talk about your rapidly progressing cancer that you can feel is getting worse day-by-day.

Six weeks is now our average waiting time to start systemic therapy.

For people with cancer, that is too long to have to wait.

Too many people in this situation end up in the emergency department, which is not good for anyone.

This capacity problem exists throughout healthcare in Ireland.

It affects cancer surgery, diagnostic radiology, interventional radiology, systemic therapy delivery, psycho-oncology, physiotherapy, clinical nutrition, speech and language therapy, occupational therapy, cancer pharmacy, histopathology, laboratory sciences, molecular diagnostics, cancer genetics and cancer nursing at all grades.

Simply adding more consultants will not help with capacity.

The delivery of cancer care is complex and multidisciplinary, requiring clerical support, office space, theatre access, out-patient access, nursing, HSCP service development, laboratory support, pharmacy support etc.

Developing these services fairly, nationally, is a challenge.

Insufficient capacity to deliver existing services is one problem. Insufficient capability to deliver standard-of-care cancer management in key areas is another.

In most areas of cancer care, Ireland is performing well on capability, but there are gaps.

The most obvious gap is the absence of Electronic Healthcare Records.

Ireland is 20-30 years behind Europe.

Have you ever had to explain to your GP the results of your scans, the procedures that you underwent, the new medications that you are now taking following an extended stay in hospital?

That is probably because the letter hasn’t arrived in the post yet.

It is not your GP’s fault.

Have you ever attended a hospital and had to explain your past medical history, family history and current medication list to six different doctors during your stay?

That’s likely because your chart has not arrived yet from storage, and even if it has, trying to find the relevant details in 300 pages of handwriting can be challenging: many times it is faster to just ask, again.

PET-CT scanning is now a standard part of cancer staging for a range of cancers. It is also emerging as an important cancer therapy modality. Every designated cancer centre in the 21st century should have a PET-CT scanner. This is not the case in Ireland.

Access to standard-of-care cancer systemic therapy is a whole other issue. Despite the increase in HSE spending on anti-cancer drugs from €150 million in 2012 to €450 million in 2021, we remain some distance behind the EMA-approved standard-of-care – on average 2 years.

As of 2023, a major division in cancer therapy access has also arisen between public and private hospitals. This challenge remains to be solved.

What can be done?

Addressing these capacity and capability problems is possible.

The next National Cancer Strategy is expected to be developed in the coming years, and will be due publication in 2027. This document will be central to the direction and ongoing development of cancer services in Ireland for a large proportion of what remains of my professional career.

The National Cancer Control Programme (NCCP) should again be tasked with delivering this strategy.

What is the NCCP, and why does it matter?

The NCCP was established in 2007 to guide the development of cancer services in across the country in line with the National Cancer Strategy. Its remit extends across the full breadth of cancer care from cancer prevention to cancer therapy.

Since its establishment 17 years ago, the NCCP has a wide range of notable achievements. For example: the centralisation of cancer surgeries to eight designated cancer centres; the development of a national publicly available database of cancer treatment protocols that are now referenced internationally; the delivery of a national systemic therapy electronic prescribing platform (‘NCIS’) that has cut systemic cancer therapy prescribing errors by more than 80%; the publication of ‘Models of Care’ guidance documents for local service development in systemic therapy, ambulatory cancer care, hereditary cancer genetics, multidisciplinary team meetings and more; and the establishment of an acute oncology nursing service nationally.

But the NCCP has a problem. It has not always been adequately funded.

According to the Irish Cancer Society in its pre-budget submission published last week, the NCCP has received proper funding from the government to implement our National Cancer Strategy in only two of the last seven budgets.

Even more disappointingly, the funding (which had been agreed would grow over time), has never reached the level needed to fully support the National Cancer Strategy.

Over the past eight years, the NCCP’s annual budget for implementation of the National Cancer Strategy should have incrementally grown to reach €110 million more in 2024 than the initial annual budget in 2016. The actual incremental increase has instead been €65 million. The cumulative loss of investment in cancer services from 2017 to 2024 amounts to almost €180 million.

The first step in securing the quality of cancer care that we deserve is a commitment to provide the NCCP with predictable and ring-fenced multi-year funding to deliver the agreed National Cancer Strategy.

This is exactly what the Irish Cancer Society has called on the government to do. It is a call that the Irish Society of Medical Oncology (ISMO) echoes. It’s the minimal effort required in the upcoming budget to care for our patients with cancer.

Earlier this week, we heard the Minister for Health and the Minister for Public Expenditure and Reform had agreed a two-year agreement on health expenditure, which amounted to an additional €1.5 billion in funding for the health service this year and a further €1.2 billion for existing level of service for next year.

I sincerely hope that some of these funds are earmarked for the NCCP. If adequately funded, the NCCP will have the ability to address the capacity and capability problems within Irish cancer services across the country for a generation.

Dr Michael McCarthy is a consultant medical oncologist at Galway University Hospital and secretary of the Irish Society of Medical Oncology (ISMO)