Martin Daly: Ireland lags on digital health and cancer prevention

So I suppose just building on about the ageing demographic, we've sort of explored the networks pretty well now and I think we've made the point and we will be driving it along certainly as politicians because we can just see the benefits that that would bring. And I think people really buy into the idea of local, accessible, protocol driven, evidence based, European Union quality assured care in their local hospital. In terms of chemotherapy not everything can be in the local hospital and we know that. I suppose coming back, I've just come out from the Disability Committee and we had the excellent Dr Martin McMahon and Dr Mary McCarran talk about ageing and the challenge for disability. We had Professor Roseanne Kenny in here a couple of weeks ago talking again about the ageing demographic. We're going to have a million more people over 65 by 2040, a million over 65 by 2030 and cancer is a disease of old age. I think we hear all this terrible stories about younger people getting cancer but by and large the volume of cancer is as you get older you're more at risk of getting cancer. So coming back to prevention to Dr Thomas Hoffmacher, I was taken aback by some of the figures on the cancer dashboard, especially around tobacco because we certainly self congratulated ourselves. Michal Martin brought in the workplace tobacco ban which was really a hugely pioneering move. Why are we so far behind in those preventative indices, alcohol consumption, tobacco and is there a reason for it? Do you have any idea or is there any data behind that? Well thank you for this question. I think when it comes to tobacco Ireland has made enormous progress because the rates have been really decreasing from very high levels in the 1990s to much lower levels now. But I think the fact that Ireland was very ambitious in taking on measures, banning smoking in certain places, increasing taxes has been very helpful. Also fully aligned with international recommendations on how to approach tobacco control. But then again you know the target as defined when it comes to tobacco consumption is to lower the prevalence to less than 5% in order to achieve what's called a tobacco free generation. And you know it seems that despite the current measures there's still a long way to go to achieve those targets. But I think just looking at what has been accomplished over the last 30 years those measures have really had the intent effect. So I think continuing on that path is very important. Because I mean the volume of disease that's going to come in the next, we simply no matter how much money we invest we're simply not going to have that capacity. So we really need as people live longer. I think Rosanne Kenny made this point that we really need to be looking at public health programs starting in 40s and 50s, 4th and 5th decades in relation to smoking. How would you feel about the proposed generation smoking ban in the UK? I'm aware of it and I think there are more countries than the UK, even New Zealand was looking into this option. Denmark was also looking into this option of banning, simply banning sales to younger generations. I mean it's a political question in the end, you know, how much should be decided from a political level, how much freedom is there for individuals to make their own choices, informed choices of taking on tobacco smoking. But of course from a public health perspective, if that's the only consideration, the public health perspective, then of course an outright ban for younger generations to never start smoking, that would be the best. The hugely powerful lobby forces both in the tobacco industry and they've tried to circumvent public health policy by bringing in new products, vaping and tobacco bags which were being provided free apparently outside Croke Park last weekend. And the alcohol industry as well, I don't think we place, I think that's going to be a major challenge for us. Just coming back again to the panel about digitalisation, I mean we really are so far behind in the European Union commission compass target of 2030 of having every European Union citizen having access to a fully digitalised health record. I mean when we look at the graphs, I know I sound like a broken record but I'm going to say it again, when you look at the graphs you can't find Ireland because we are so far off the charts. I mean how can, when we talk about networks, when we talk about integration, I think David you had said, integration, coordination and cohesion, I mean how can we deliver that without a properly, collaboration, cohesion, integration, how can we deliver principles like that in healthcare delivery unless we're digitalised fully? Thank you again for the question. It is a huge challenge. We certainly from a local perspective have looked to try and develop digital systems and integrate systems within our cancer centre. When we underwent our OECI review, we were criticised rightly in terms of IT infrastructure. It was commented that we were 20 years behind Portugal. And I do think that this is a major issue for the department because we do need significant investment to bring the IT infrastructure up to a reasonable level. The current projections for electronic healthcare records are anything between 7 and 10 years away. That really is too long. We can't wait that long. There is European legislation that is coming in that will entitle all patients in Europe to access to their medical records. We're in nowhere close to that space. And again I think for the proper functioning of a network, I think that we are all agreed that a network structure is the way to deliver cancer care into the next decade. It's got to be underpinned by an adequate IT infrastructure that allows us to capture data. As I commenced my role as clinical director, one of the first things I was looking to do was demonstrate survival data, follow-up data, outcome data. Without that type of data, not only can you not measure your performance and audit it, you cannot project into the future with what your requirements will need. So I think that that is a very, very important part of the process over the next number of years. And I have to say, following committee meetings here, we've spoken to Minister Jennifer Carmack. Neil is fully committed to this digitalisation project, as is her Secretary General, Dirk Tierney. He has reiterated his support and commitment to this and the HSE and Minister Jack Chambers in terms of the funding of it, because we continue to throw money at our health service. But unless we have the infrastructure right and the digital infrastructure right, we are going to be wasting money. We're not going to achieve maximum productivity. Thanks for your evidence. Thank you. I just ask, Dr. Hofmecker, in relation to screening, and you know you've made a big issue about this in your report, we have made some progress in the whole area of screening, made a lot of progress, but you referenced two issues. One, in relation to the uptake, especially in relation to bowel screening, in relation to it's only 42% of men. And then in relation to people coming from lower educational attainment, where we also seem to have lower figures of people availing of the screening programme, both in relation to bowel cancer, in relation to breast cancer, in relation to cervical cancer. I'm just wondering, what have other countries done as regards, you know, trying to get more people to take up the option of going for screening? And what should we need to do now in the next 10 years on that whole programme? And the other issue that you raised about lung cancer screening, you know, there is a pilot project which you referred to about if this has been rolled out in other countries, then how has it worked out? Yeah, great. Thank you for these questions. I think when it comes to, you know, screening, there's so much potential to really make sure that the patients can get a much higher chance to survive. And when you look at the participation rates in Ireland, they are fairly good for breast cancer, fairly good for cervical cancer, but they're not good for colorectal cancer. And then you have, in addition, this gradient by level of education, where highly educated people are more likely to participate and people with lower education less likely to participate in screening. I think these are patterns that we've also seen in other European countries, but there are several other European countries that achieve simply higher participation rates. And I think one lesson from more successful countries, this is really to make sure that access to screening is as easy as possible for people, eligible people. In Sweden, we have struggled also a lot with our immigrant populations who are not participating to the extent we want them to participate. But for instance, for cervical cancer screening, we have switched to sending out self-sampling kits to their homes so they can take the test at home instead of coming to a clinic and get the examination, which might be, you know, afflicted with stigma so that they don't want to do it in that way. But this self-sampling has really helped us to improve participation, even in hard to reach population groups. Same goes for breast cancer, where, you know, instead of having women come to clinics using mobile trucks to get the screening to the women is something that also has been successful and makes it simply easier for women to overcome this sort of barrier that they are facing to participate. And for colorectal cancer screening also, I mean, the way you test is very important and successful countries have simply started to send out self-sampling kits to all eligible people in order to facilitate the uptake because then they can test at home. They don't need to come to a clinic. And it makes life a lot easier and has been proven successful. I think that when it comes to lung cancer screening, there are many countries that have piloted lung cancer screening. There is one country, Croatia, that has already implemented lung cancer screening nationwide since 2020 with very good results that have been published also. So there are more and more countries doing it and more are now really at the brink of going from this regional pilots to full nationwide implementation. I mean, the science is already there. It works. In the end, it's again a question of capacity. So are there enough radiologists, human workforce, you know, available to actually perform the tests, follow up on those tests in a timely manner because it's no use of trying to detect lung cancer early and you get the diagnosis, but then you have to wait for a very long time until you get treatment. So again, the capacity issue I think is very important and also the stigma component for lung cancer screening and even there is a good example from the UK where they also use mobile trucks in order to bring the screening to the people instead of having current and former smokers come to a clinic because that doesn't work in many cases. Dr. Finlay there in relation to this issue about screening? Again, I think we're fortunate in Ireland in that we have had good screening programs in a variety of the larger volume cancers. Education is key. Education and capacity. Again, if I speak to our current issue, we house a national screening program in bowel cancer on site in St. Vincent's UCD Cancer Center, but the space and the allocation of time competes with our other national designations in terms of specialty sites. So we are also a national center for cholangiocarcinoma that requires considerable endoscopy expertise and as we provide a national service that obviously competes with space for the screening program. So again, it comes back to capacity. We have the healthcare professionals, we have dedicated clinicians who are willing and able to provide the service. We just need the support with the infrastructure to allow us to do that. Can I just ask, just on the education side there about getting information out, I mean do you think a lot more could be done in that area? Yes, but I might just come back to the screening if I may for a moment please Deputy. So as you may know, the Irish Cancer Society was one of the funders of the Beaumont or CSI lung health check pilot, which the results are actually phenomenal. We have some results in already through I suppose working with local GAA clubs and working with local doctors. They were able to identify a significant cohort of people who are at risk. Of the people they screened, 33 lung cancers were detected. 10 of those people have already had curative surgery. They were detected at stage 1. That is almost never heard of. The team in Beaumont are kind of finalizing some of the outcomes and the results right now. I think we'd welcome the opportunity to maybe bring those to the committee at a later date if that were at all possible. And then just to your second point on education, I completely agree with you. I am quite concerned. We are talking about older demographics. I'm quite concerned we're actually going to miss a cohort here of young people who cancer seems to have just kind of gone over their heads because they weren't part of the smoking generation. We are seeing young people who are not taking up HPV vaccines, who are vaping, who are using sunbeds, who don't understand the cancer risk for alcohol. And I think we need to be really careful that we don't miss those in the next cancer strategy because they're not on the radar at the moment. Unfortunately, if we don't address this, they will be. But we need to engage young people where they are. So it can't be us or the state going out and telling young people what they need to do. We need to have proper communication programs and engagement programs to educate them about the risk in a way that we get them to buy in. And coming back to, I suppose, the Irish Cancer Society is also doing another pilot program with Trinity St. James' on young onset cancers, where we've invested about 4 million in this program, where we're helping identify people who have young onset cancers and GI cancers and head and neck cancers. We are funding nurse navigator posts in that pilot program. We would love the opportunity to come back and tell you about that again as it's moving forward. But I do think we just have to be very careful that we're not missing a cohort and that we're engaging with them in a way that's really effective.