Will the pandemic result in a better resourced health service?

There is no part of the health service that has not been affected, either directly or indirectly, by Covid-19. In this issue of the Medical Independent, we take a look at how cancer services have managed over the past year. As with other clinical areas, oncology has suffered from a chronic lack of investment. This has resulted in deficits in relation to staff, infrastructure, and treatment.

Delays in the approval and reimbursement of new therapies has meant Ireland has started to fall behind international standards of cancer care. The issue has led to tension between the Irish Society of Medical Oncology and the National Cancer Control Programme (NCCP).

The Covid-19 pandemic has compounded these problems. Due to inadequate infrastructural investment, space was already at a premium in facilities across the country. Social distancing guidelines resulting from Covid has put more pressure on capacity. There have been major delays in terms of diagnosis and treatment.

Last November, the National Director of the NCCP Prof Risteárd Ó Laoide, said that approximately 2,000 cancers may have been “lost” because of the disruption caused by the pandemic.

In the face of all these problems, the system has coped as best it can. Doctors on the frontline have spoken positively about the ingenuity and creativity of staff in developing new care pathways in the most challenging of circumstances. Digital health has taken big strides forward. There are lessons to be learned for the future when the dangers of the pandemic eventually recede.

The funding received for cancer services has also risen, with €34.35 million made available to the NCCP in the HSE Winter Plan 2020/2021 and in the National Service Plan 2021. The impasse on drug funding has been lifted, for now at least, with the HSE announcing that a number of innovative cancer therapies have been approved for reimbursement. So, amid all the difficulties over the past year, there are positives to take.

In an interview for this edition’s main feature, Prof Owen Smith, Professor of Paediatric and Adolescent Medicine, University College Dublin and Consultant Paediatric Haematologist, Children’s Health Ireland, Crumlin, spoke of how the pandemic has revealed the vulnerabilities of paediatric cancer care, particularly from a staffing perspective.

He also explained while Crumlin has 95 per cent of the treatments provided by other comprehensive cancer centres, patients requiring certain therapies, such as CAR T-cell therapy or proton therapy, currently need to be sent abroad.

Prof Smith said it is important that paediatric cancer care is “self-sufficient”, given the threat to international healthcare links posed by mutations in the SARS-CoV-2 virus and political developments, such
as Brexit.

The argument can be extended to the rest of the health service. Health was the number one issue in the 2020 general election, and it is even more so now. It can only be hoped there is political recognition that a properly resourced public health system is not a luxury, but a vital necessity and not just in times of crisis.