Health is set to dominate the election, with cancer services a key test of performance. Dr Muiris Houston highlights the gulf in cancer services between the Republic and Britain
Reading the National Cancer Strategy for the Republic and the NHS Cancer Plan for Britain is like reading a children's Ladybird book followed by a Booker Prize-winning novel. The 1996 Cancer Strategy is, quite frankly, a lamentably unambitious document.
Much of it is a review of the state of cancer care in the Republic seven years ago; there is very little in it in terms of specific aims for the future.
Its broad aim was to reduce the death rate from cancer in the under-65 age group by 15 per cent in the 10 years from 1994; latest figures from the National Cancer Registry show no reduction in cancer mortality in the five-year period to 1998.
In contrast, the NHS Cancer Plan, which was published in 2000, positively bristles with targets and performance indicators. It specifically states that by 2005, there will be a maximum one-month wait from diagnosis to treatment for all cancer sufferers.
The NHS plan promises that by the end of 2003, there will be 50 new MRI and 200 new CAT scanners to aid earlier diagnosis. By the same date, the system will have 45 new linear accelerators - the machines which deliver radiotherapy treatment to cancer patients.
The NHS document acknowledges that "there are real inequalities . . . in terms of who gets cancer and what happens to them when they do. People from dep- rived backgrounds are more likely to get some types of cancer and overall are more likely to die from it once they have been diagnosed."
And it sets out how these inequalities will be addressed through a more even provision of services and an end to the lottery of cancer treatment.
The recent five-year report from the National Cancer Registry in the Republic showed strong evidence of inequalities in access to cancer treatment here.
A high percentage of patients receive no cancer-directed treatment of any kind, especially those with lung and stomach cancer and leukaemia.
Older people are less likely to receive treatment.
Patients in the Western and Mid-Western Health Boards receive significantly less radiotherapy than people living in the east and south, where current radiotherapy facilities are located.
Dr Patricia Riordan, a specialist in public health medicine with the National Cancer Registry, says the registry is the source of most comprehensive cancer data in the Republic.
"However, the major emphasis has been on data collection, with very little history of translating the data into useful targeted information that can be used to highlight and understand why inequalities exist in cancer care in this country."
Referring to our cancer strategy, she notes, "the last cancer strategy was drawn up in 1996 and was short on hard-hitting, measurable targets. The result is that it has been inconsistently implemented".
The National Health Strategy, published in November 2001, commits the Department of Health to a "reviewed Implementation Plan for the 1996 National Cancer Strategy by the end of 2002".
Why not a new cancer strategy? The original is so short on specifics that a renewed implementation plan promises nothing.
'Yet the systems simply are not in place to draw together the kind of information which would allow us to set national targets and agree performance indicators.
Why is the Cancer Registry confined to data collection? Why not expand it into a cancer intelligence unit which would give us detailed information on cancer waiting times, cancer surveillance and which would contribute to national policy development?
Instead, we have a long-awaited report on radiotherapy services, which several sources suggest is ready for publication, but which won't see the light of day until after the election. Why? Probably because it is politically sensitive.
As long as politics takes precedence over international scientific evidence, cancer services in the State will not progress.