Acting Chairperson:

Senator Seery Kearney. I welcome the Minister. I call Senator Pauline O'Reilly.

Pauline O'Reilly (Green Party)
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I move:

“That Seanad Éireann:

recognises that: - hair loss during cancer treatment or chemotherapy-induced alopecia is one of the most common side effects of cancer therapy; it can have a profoundly negative impact on cancer patients, often compounding the worry and trauma they are experiencing dealing with the cancer itself; further recognises that: - there is a hypothermia treatment which can help minimise hair loss for those undergoing chemotherapy, known as scalp cooling; this involves using a ‘cold cap’ machine during chemotherapy to reduce blood flow to the scalp;

- meta-analyses of studies of scalp cooling have found that it is an increasingly effective method to prevent hair loss, particularly for specific types of chemotherapy and for those undergoing treatment for breast cancer; acknowledges that: - a scalp cooling service is provided in seven hospitals nationally; these are St. Vincent´s University Hospital, University Hospital Limerick, Cork University Hospital, Tallaght University Hospital, St. Luke´s General Hospital Carlow/Kilkenny, Sligo University Hospital and Cavan General Hospital;

- the Midland Regional Hospital Tullamore had previously provided this service, but it was paused during the pandemic and has not yet resumed; calls on the Government to: - ensure that a scalp cooling service is provided in all of the 26 public hospitals providing systemic anti-cancer therapies (SACT) in Ireland, namely by purchasing the necessary machines in the remaining 18 hospitals and restoring the service in the Midland Regional Hospital in Tullamore;

- ensure that the following hospitals will be equipped with the necessary machines:

- Galway University Hospital;

- Portiuncula University Hospital;

- South Infirmary Victoria University Hospital;

- University Hospital Kerry;

- Tipperary University Hospital;

- Letterkenny University Hospital;

- Mater Misericordiae University Hospital;

- Mercy University Hospital Cork;

- Naas General Hospital;

- University Hospital Waterford;

- Our Lady of Lourdes Hospital Drogheda;

- Wexford General Hospital;

- CHI at Crumlin Hospital;

- St. Luke's General Hospital Kilkenny;

- Beaumont Hospital;

- St. Luke's Hospital Rathgar;

- St. James's Hospital;

- Connolly Hospital;

- ensure that all those undergoing chemotherapy will be advised of the nature, side effects, efficacy of scalp cooling, and offered the option of using the service.”

Róisín Garvey (Green Party)
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I second the motion.

Pauline O'Reilly (Green Party)
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I thank the Minister for being here today. I also thank Bríd McGrath who is in the Public Gallery. She raised this issue with me and since then we have been working together on it. We have discovered that a large number of people in Ireland have benefited from cold cap treatment in hospitals. In some ways it is quite straightforward. Much research have been done and in over 50% of cases, cold caps significantly reduce hair loss. There is also a large amount of research which shows that hair loss is reported as the most important factor when people think about the side effects of chemotherapy and other forms of medicine during cancer treatment. This is particularly the case for women. People often want to undergo treatment privately. They do not necessarily want to announce to the world that they are going through cancer treatment, it is completely up to them. People, particularly women, feel quite exposed and vulnerable.

The Department of Health and the Department of Social Protection have done great work in relation to wigs for cancer treatment patients. I would love to see this initiative progressed further. We can also look at preventing hair loss in the first place. We have done some work on this and submitted a parliamentary question, which demonstrates that the cost of these machines is €20,000. We have 19 hospitals that have no facility at all for these cold caps. That would amount to €364,000 in total to get a machine in each of those hospitals. We often talk about the postcode lottery for many things in Ireland. However, there is no need in this particular case because it is such a small cost. One particular hospital in Tullamore did have the facility but it was taken away during the pandemic and never reinstated.

I know the Minister's commitment to treatment and healthcare when it comes to women. For this reason, I feel he is the appropriate Minister to bring this issue to. I am hopeful that he will see the benefits.

On the HSE's website, there is information about the prevention of hair loss. It says that it may be possible to reduce the chances of hair loss by wearing a cold cap while having chemotherapy. A cold cap looks like a bicycle helmet and cools the scalp during a treatment session. This reduces blood flow to the scalp, reducing the amount of medicine that reaches it. Whether a person can use it depends on the type of cancer they have. In Bríd McGrath's case, her oncologist recommended it because it was available in St. James's Hospital. In my own area of Galway, treatment is not available in all. It is not available in Portiuncula University Hospital and in many other places across the country. It is simply an inequality that needs to be addressed.

The national cancer control programme, NCCP, also recommends it. It has said that ensuite single rooms should be provided for privacy or clinical reasons, for example for those posing an airborne infectious risk, for elderly frail patients and for those using scalp cooling treatment. It gives the issue a bit of weight that both the NCCP and the HSE recommend it. It is time we took the small step to make treatment for everybody, but particularly for women, much more humane and respectful. I do not think there is much more to say on it. It quite a simple, straightforward, relatively cost-effective measure we could take as a Government. I hope the Minister will respond positively.

Róisín Garvey (Green Party)
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I thank the Minister for being here today. This is very straightforward. I have many male friends and they get very depressed when they start to go bald. It can occur naturally as early as in their 20s, and up to their 50s. It is upsetting for them even though it is natural for men to go around being bald despite them not perhaps always loving the idea. If that is upsetting, then how upsetting must it be for a person going through cancer treatment? The person possibly might not have to go through the upset of losing their hair if they happen to be near one of the seven hospitals out of 26 providing cancer treatment that can offer scalp cooling therapy. That is the bottom line really. It is such a small cost, €20,000 per machine. We need them in 26 hospitals and only have them in seven. It would only cost €380,000. Everybody who has to go through chemotherapy could be given the choice of having this treatment. It does not mean they have to do it, but it seems very straightforward if it is something the person would like to do.

Personally, I would be devastated if I were to lose my hair, although I have shaved my hair off for charity in the past. Having known the Minister for the last three and a half years, I think this is something he will understand and appreciate the importance of. The studies show that one of the most upsetting things for many people with cancer is losing their hair. Not alone is it bad that the person has cancer, but one of the most upsetting thing statistically for people is the hair loss. I have friends who have been battling with cancer. A positive mental attitude is such an important part of dealing with cancer at whatever stage.

If the hair loss is affecting a person's positive mental attitude, then that is a good enough reason to fund this initiative. It is a really good motion and I want to thank my colleague, Senator Pauline O'Reilly, for working on this. It is important to note that the Government has provided grants for wigs for people on medical cards and under the PRSI treatment benefit scheme. The Government has thereby acknowledged the importance many women place on not losing their hair. It makes perfect sense that we would follow it up and instead of funding the purchase of wigs, we could fund a means to prevent people needing to wear wigs in the first place.

Lorraine Clifford-Lee (Fianna Fail)
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I thank Senators O'Reilly and Garvey for bringing this excellent motion. I am very happy to speak on it. Some very good points have been set out. It is clear that prevention is better than cure. It is incredible to think that when somebody is faced with a life-and-death situation like cancer, the most upsetting thing is hair loss. This is because it is so visible and makes people feel very vulnerable and exposed. Many people try to hide their illness, particularly from their children. Things are in flux in the family and they like to protect their children from the graver aspects of their illness. Losing one's hair is a very visible sign that something is not right. If we can do something to prevent that we should explore all options. My colleague Teresa Costello is a Fianna Fáil councillor in South Dublin County Council and a breast cancer survivor and activist. She founded a support group called Breast Friends. The topic of cold cap therapy comes up regularly with the members of the group. They discuss how people have fared with it and its availability. None of us wants to see a postcode lottery in regard to the health service. On the surface this looks superficial, but it is not, because as Senator Garvey pointed out, if it leads to somebody having a positive attitude towards their treatment, prognosis and outcomes, that can only be a good thing and can only help with the medical aspect of it.

We all know that many people with cancer can also suffer from depression and PTSD and other very serious medical conditions. If we can do anything to lessen the impact on people who are already going through a horrendous time, we should explore all options. I look forward to listening to what the Minister has to say because he has been very proactive when it comes to various innovative treatments and making the lives of women in particular better. This, while it is applicable to everyone, has most impact on women who are going through chemotherapy. I look forward to the Minister responding positively to this excellent motion. I commend my colleagues on bringing it.

Martin Conway (Fine Gael)
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The Minister is very welcome to the House. I commend Senators Pauline O'Reilly, Garvey and Hackett for introducing a very practical Private Members' motion. This could be achieved for a small cost. This evening the Minister can confirm to the House that the Department will fund the acquisition of this necessary equipment for hospitals in Ireland. There is no reason we cannot do it and I am very confident the Minister will do so. All I can say is that this makes sense. A lady in the Gallery has benefited enormously from this. Let us make it happen tonight.

Pippa Hackett (Green Party)
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I am here to support my colleagues with the motion. Everyone can relate to what it means to people. Pretty much everyone in the country has been touched by cancer or had a close friend or family member touched by it. My mother went through this. She had shortish hair at one stage and it was not so bad losing it. We were younger at the time - I was in my late teens or early 20s - but it was distressing for me and my brother to see someone lose their hair. This impact on wider families is also something to be cognisant of. Wigs are great but my mother did not find a wig particularly comfortable so she chose not to wear one. There is an impact there. It is not a large ask in the greater scheme of things. I know decisions have to be made and there are budgetary considerations but this is a worthy motion. I thank Senators O'Reilly and Garvey for bringing it forward. This issue affects many people and we should look at it.

Fintan Warfield (Sinn Fein)
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I know this is a very sensitive issue, and I commend the motion and the proposers of motion, but I cannot help but think about the underfunding of the health service, particularly at a time of surplus. I cannot let the opportunity pass without criticising the decision to underfund the health services at a time of surplus. It is morally wrong. The hospitals named in the motion would probably love the opportunity to invest in improving services such as this and provide scalp cooling therapy during chemotherapy. I call on the Minister to reverse the decision to underfund the health service and the recruitment freeze that has been triggered by the Government's underfunding of the health service. Seven thousand posts have just vanished. This recruitment freeze will see our dedicated staff pushed to work in increasingly unsafe and unsustainable conditions.

Róisín Garvey (Green Party)
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It was never decided to underfund the health system. Senator Warfield is saying the Minister should reverse his decision to underfund the health system.

Fintan Warfield (Sinn Fein)
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That is not a point of order.

Róisín Garvey (Green Party)
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The Minister never made that decision. This is a point of information, just to clarify the matter.

Fintan Warfield (Sinn Fein)
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If we learned anything from the previous-----

Róisín Garvey (Green Party)
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On a point of information, the Senator is asking the Minister to reverse a decision he never made.

Mary Seery Kearney (Fine Gael)
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Senator Warfield is in possession. Let him finish his point.

Róisín Garvey (Green Party)
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It is a point of information.

Fintan Warfield (Sinn Fein)
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If we learned anything from the previous debate, it is that there is no such thing as a point of information.

Róisín Garvey (Green Party)
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Facts are facts.

Mary Seery Kearney (Fine Gael)
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We need to allow the Member in possession to speak.

Fintan Warfield (Sinn Fein)
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The recruitment freeze will see dedicated staff pushed to work in increasingly unsafe and unsustainable conditions. It is extraordinary that when almost 1 million people are on some sort of health waiting list the Government has made this decision. We know it will result in further delays in diagnosis and treatment which will lead to worse outcomes for patients. The decision to underfund the health service should be reversed. That is all I want to say. I cannot let this important opportunity pass without making the point that we need to fund the health service. I wanted to make that point during the debate.

Lorraine Clifford-Lee (Fianna Fail)
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A Leas-Chathaoirligh, I would like to welcome some guests to the Gallery.

Mary Seery Kearney (Fine Gael)
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As the Chair, I will do the welcoming. The Senator sent a message to me. Senator Clifford-Lee has already made her contribution to the debate.

Lorraine Clifford-Lee (Fianna Fail)
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She also sent the message to me.

Mary Seery Kearney (Fine Gael)
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You have already made your contribution.

Lorraine Clifford-Lee (Fianna Fail)
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There is no need to take the head off me.

Mary Seery Kearney (Fine Gael)
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I am not taking anything out of you, with due respect. I am the Chair, thank you. You have made your contribution-----

Lorraine Clifford-Lee (Fianna Fail)
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I said "a Leas-Chathaoirligh" and acknowledged you as Leas-Chathaoirleach.

Mary Seery Kearney (Fine Gael)
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Under Standing Orders, you have made your contribution. Thank you.

I am very glad to welcome Senator Ardagh's friends here today. They are Lorcan O'Connor, Claire O'Connor, Betty Sheerin, Seamus Sheerin, Padraic McShea and Garrett McShea. They are all very welcome to the Gallery. The other people in the Gallery are also welcome. No doubt the usher can inform me as to who they are.

The Minister has 15 minutes and I have no doubt he will tell us of his support for this and much more.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Senators O'Reilly and Garvey for tabling the motion. I have to say I was very interested in it when I saw it. I was not familiar with the therapy and took the opportunity to look into it. It is impressive; there is no question about that. The unfortunate reality for all of us is that an awful lot of people in our country will interact with our cancer services, either directly as a patient or as a friend or family. We are blessed with very good cancer services in this country and I will speak about them shortly.

The reality that many people will interact directly or indirectly with cancer services is one of the reasons I have fought very hard, along with colleagues in Government and in the Government parties, to increase significantly funding for cancer patients. Our healthcare workers have done a fine job in turning this additional resource into better services for patients, better access for patients and better outcomes for patients.

I acknowledge the distress that can be experienced in receiving a cancer diagnosis and the related treatments, and the negative impact on the patient of hair loss and chemotherapy-induced alopecia. As outlined by Senators O'Reilly and Garvey in the motion, a scalp-cooling service is offered to patients undergoing chemotherapy in seven of the 26 hospitals that provide systemic anti-cancer therapies, including chemotherapy and immunotherapy. This service can be of use to some patients. As the Senators pointed out, it is not suitable for everybody but it is suitable for some.

The scalp-cooling machines cost approximately €216,000 to install in the centres that do not have them. There are also associated costs and impacts on services that we would also need to consider. The machines are generally operated by healthcare assistants. The additional roles in the hospitals would cost approximately €600,000. Providing the service also requires additional capacity in oncology day wards. We do not want it to have an impact on the number of patients who can receive chemotherapy. There are the machines, the staff to run the machines and the physical space required.

Provision of a scalp-cooling service in the remaining hospitals needs to be considered in the context of growing demand for cancer services across the board. We have a proposal to expand the oncology day ward in Kerry University Hospital, which would cost approximately €10 million. For next year, the focus will be on improving performance in cancer services within existing services. As colleagues are aware, new development funding for healthcare for next year has been tight. The additional allocation for the national strategies, unfortunately, is quite constrained for next year.

We have seen significant improvements and expansion in cancer services. In 2021 and 2022, we allocated approximately €70 million in additional funding for cancer patients. This included approximately €40 million in services and new development funding and another €30 million in new cancer medicines. This has had a real impact on access to diagnostics, treatments and supports. We continue to work closely with the national cancer control programme to help and support the implementation of the national cancer strategy.

In recent years, we have recruited an extra approximately 400 staff into our cancer services, mainly consultants, nurses and health and social care professionals.What this means is that the waiting times are down, thankfully. The waiting times for patients are down by 46 to 72% across rapid access clinics for breast, lung and prostate cancer. The clinics have seen in excess of 43,000 people this year, 800 more than they would have seen in 2019. More than 10,000 cancer surgeries have been performed so far this year, which is extraordinary. That is approximately 700 more than in 2019. Approximately 75,000 chemotherapy and other anti-cancer therapies have been administered, and some of those patients are exactly the ones who might benefit from this motion. Over the past two years, 50 new drugs have been approved for cancer patients and total funding allocated for new drugs since 2021 is nearly €100 million, supporting 129 new drugs.

There have also been some important advances in new cancer treatments and models of care. One of the ones I have spoken about in the Seanad previously, which blew me away, is CAR T-cell therapy, a form of immunotherapy. It is being offered to children and adults in St. James's Hospital and CHI. There are others treatments, like peptide receptor radionuclide therapy, PRRT. That is a treatment for neuroendocrine tumours and it is in St. Vincent's. We recently opened a new €70 million radiation oncology centre in University Hospital Galway, which is state-of-the-art. Fantastic new services are being provided with better outcomes for patients. There is less sickness, illness and associated challenges with the therapy. There are a lot of patients who would have previously had to come to Dublin from the west but who will now be treated there. I say all of this by way of acknowledging that while we will continue to invest in them, our cancer services are getting better. The types of therapies are getting better and we are creating more college places for the likes of radiation therapy and other posts that are important.

The motion speaks to psycho-oncology. We are rightly investing a lot more money in new cancer drugs for patients and in cancer diagnosis, screening and treatment in the hospitals. As a result of this, we are seeing better outcomes but that is not enough. We are investing in psycho-oncology supports. I had the great honour of launching the youth and adolescent psycho-oncology framework last year. We are rolling out new services. We have provided funding this year, for the first time at this level, to the community cancer support groups. We have provided €3 million in one-off funding for them, which is a fivefold or sixfold increase in State funding for the hugely important work they do.

The type of proposal before us this evening, caps for scalp cooling, is important. I get it and I understand why it is important. I fully accept the feedback from patients. It is the patients who are saying that this is one of the biggest stresses they have while going through everything they are going through. As the Minister of State, Senator Hackett, said, many do not only have to mind their care but they have to think about their kids, protect them and manage all of that as well. I fully support the idea and it is only a question of funding. The funding for this year was tight for new development and then we have to make calls on whether we spend the money on this, a new cancer drug, more chemotherapy chairs or the new day oncology service in University Hospital Kerry. These are the tough decisions we all have to make. The proposal fits well with the new philosophy that is being introduced in cancer care in Ireland, which is a focus on screening, acute treatment and psycho-oncology. That is the mental and emotional well-being of the patient and the patient's family as they are going through treatment. It fits well within that context.

The good news is we have seen a dramatic improvement in survivorship for people going through cancer treatment. The five-year survivorship rate is a standard one that is used. Over the past 20 years, the rates have gone up from approximately 44% to approximately 65% for the period from 2014 to 2018. We fully expect that the rates are much higher now. We have had improvements in symptom recognition, access to screening and treatments. We are seeing that the five-year survival rates for some common cancers, such as breast and prostate cancer, have increased to 88% and 93%, respectively. That is a great testament to all of the healthcare workers working on this. Improvements in the five-year survivorship rates over the past two decades present additional challenges for those living with and beyond cancer. Believe it or not, there are approximately 215,000 people in Ireland living with and beyond a diagnosis of cancer. That is one in every 25 people in the country. When we go home tonight and walk down the street, one in every 25 people we see, on average, has survived five years with cancer. That is a positive thing and we need to keep investing in it.

The alliance of community cancer support centres and services was set up by the national cancer control programme, NCCP, with the aim of delivering a collaborative framework for the community-based centres. The alliance promotes participation in capacity building activities, communication, networking forums and others. The NCCP is acting as a roadmap for these centres, and as I have said, we have invested €3 million in community support.

I know there are calls on me to come in here and announce the funding but, as Senators will be aware, that is not how funding allocations work. They work through the budgetary process and new development funding in the budget. There is no new development funding allocated for this into 2024. However, we know there are individual hospitals that have invested in it and that have made the decision. We know this is important for patients. It is important to have it debated in the Seanad because it increases awareness and the likelihood of future investment. It has stimulated a debate here and within the Department of Health. I commit to Senators that we will keep this in mind. For the first time, we have a business case developed for roll-out across the entire country. I support it and it is an important thing to do. We will keep it in mind as we continue to invest in cancer services, and critically, in the psycho-oncology aspects of those services.

Victor Boyhan (Independent)
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I thank the Green Party for using its Private Members' time for what is a very important proposal, which it has covered well. I also thank the Minister for setting out his stall honestly and frankly, if not somewhat disappointingly. He has been honest and frank and what more can we ask of a Minister? He said that Senators will be aware that there is a finite budget and we all know that. I wish we did not have a finite budget but we do. Our development funding for next year is more limited than I had hoped. All of this was rehearsed during the budgetary process and it was clearly articulated by the Minister and others in the Houses and in the media that he had expected more and unfortunately it was not to be. That is not a failing on his part but the collective decision of Government.

We did not need this motion to convince us all that we had a business case or a need for it; there is clearly a need for it. The Minister was honest and frank and he has said what the case is. It needs to be kept on the agenda. I fully support the Greens in this; it is an important intervention. We should now be mapping out where we could get money and make a case for it. I congratulate Senator O'Reilly on tabling this Private Members' motion. I fully support it. I thank the Minister for at least being honest and upfront. The situation is just the way it is, but I hope that the Minister will commit to driving this. There is a clear case. Cancer is a terrible illness and affects more than just the patients. It also affects their families, their households and a range of others. People need to be given all of the supports, assistance and care possible.

Pauline O'Reilly (Green Party)
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I will first address the cost. The HSE wrote directly to Deputy Leddin, whom I asked to raise a parliamentary question about the costing, and told him that purchasing it would cost between €20,000 and €230,000, including VAT. What price a woman’s health? It is such a small amount of money. We know that women have lost faith in the health service, particularly cancer services, and we have a history of letting them down. This is a small action that could be taken to restore women’s faith to some extent.

When going through the research, I was stunned by how, in an important study in 2001, alopecia was cited as the most disturbing side-effect by 58% of women preparing for chemotherapy. Shockingly, 8% were at risk of avoiding treatment altogether purely on that basis. We sometimes discuss these matters as though they just come down to how people feel when they are going through something and that feeling that way while undergoing cancer treatment is natural, but some people are making the decision not to go ahead with their treatment on this basis. People are suffering unnecessarily when we could provide them with something that is tiny in terms of the State’s overall budget. I anticipate that a greater capital allocation will be available towards the end of next year, so I have to get in early. I ask the Minister to find the money for this. With respect, it is his role to roll out these national plans. It is not necessarily the responsibility of individual hospitals. We have to consider this matter from the point of view of equality.

I thank Senators. Everyone across the three Government parties has an expectation that this need will be fulfilled successfully and the Minister was enthusiastic about it when he saw the motion, so I am hopeful. The budgetary process was not easy for the Minister.

Senator Warfield did not seem to do any research whatsoever on this important issue. The Library and Research Service saw that this motion was upcoming and sent all Senators information saying, for example, what was happening in the North of Ireland. There was an opportunity here to avoid just taking shots at the Government and to instead speak about the importance of women’s healthcare in this country.

Róisín Garvey (Green Party)
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Hear, hear.

Pauline O'Reilly (Green Party)
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I feel strongly that we should use this time with the Minister to try to get over the line something that has been raised with me by numerous women as impacting their daily lives, so I was disappointed by Senator Warfield’s intervention. We all speak about the difficulties in the healthcare system. I did so on radio last night. I would love to see a new cancer building in University Hospital Galway, and we are working on that. However, I did not use the opportunity of this debate to raise other issues. Neither did anyone else. Other Senators spoke to the motion, and that is what we are here to do. This is a Private Members’ motion that we put a great deal of time into and I thank Senators.

I would love it if the Minister had said that he would sign off on this tiny amount of money. I will be on his back about it. Everyone in government is supportive of it. Now is the time to find that small amount of money, not only to make people’s lives better, but to make them more inclined to step up and take the treatment that will ensure they have a better quality of life and their families can have them around for longer.

Mary Seery Kearney (Fine Gael)
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I thank the Green Party Senators. This is a worthy motion deserving of all of our support. I thank the Minister.

Mary Seery Kearney (Fine Gael)
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When is it proposed to sit again?

Pauline O'Reilly (Green Party)
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Tomorrow at 9.30 a.m.