Dáil Éireann debate -
Wednesday, 7 Dec 2022

Vol. 1030 No. 6

Saincheisteanna Tráthúla - Topical Issue Debate

Care of the Elderly

Deputy Marian Harkin

Many day centres in counties Sligo, Leitrim, Roscommon, Donegal and elsewhere have not reopened or only partially reopened since the Covid-19 pandemic. Before I go into detail as to the location of these centres, it is important to make clear why I am raising this matter. It is very simple. Day care centres are a lifeline for many older people. Above all, they provide company, a social setting and an opportunity to meet other people of a similar age in a social setting and to chat in a warm, safe and cosy space. Most day centres provide a meal and often a bit of entertainment, such as a sing-song, a few basic exercises or a game of cards. Crucially, most of them provide services like chiropody or shower facilities. It depends. They also provide people with information about their own healthcare. They also point them in the direction of other services that may help them.

I recently visited a day care centre in Ballymote, County Sligo, run by the Sligo LEADER group. It was just lovely. People were delighted to be there. They could not stop telling me how much it meant to them to have the centre for a few hours five days per week. It was a warm, welcoming and comfortable place. On the day I was there, there were musicians who I believe come regularly. Some people were brought to the centre by local bus services, while others walked and-or got a lift. They got a great opportunity to have a chat about lots of different things, including with the staff. One of the things that struck me was that, for those few hours, two heated rooms of a decent size kept 20 people warm. People were delighted that their day care centre reopened. I will give a shout-out to the Sligo LEADER group and the HSE, which provided funding to make sure this happened. I asked person after person how much it meant to them because I had received various representations from people who were concerned about centres not reopening and every person was grateful to have this day care centre. I felt bad for the older people in other parts of Sligo and Leitrim, many of whom are living alone, who do not have such a centre.

I raised this matter with the Taoiseach during Leaders' Questions with specific regard to St. Patrick's Community Hospital in Carrick-on-Shannon, Arus Carolan in Mohill, the centre in Manorhamilton, which is down to two days, the Easky centre in County Sligo, those in Cliffoney and Carrigans, and the centre in Ramelton, County Donegal, about which I had a query. He said he would raise it with the Minister and, since then, I have received a response from the HSE.

St. Patrick's in Carrick-on-Shannon is a walk-in centre beside the old folks' home. Houses for older people were specifically built beside St. Patrick's so that people could be close to the day services. On any given day, 20 to 30 people might have dropped in. Sometimes people travelled by bus. Covid came and the service was closed. It never reopened. People want to know when the centre is going to reopen. In a response from the HSE, I was told that there were a number of other centres in Leitrim suitable for people and five were listed. Drumsna is 7 km away, Ballinamore is 28 km, Drumkeeran is 29 km, Carrigallen is 36 km and Ballinagleragh is 53 km away. Whoever sent me that response knows nothing about County Leitrim and older people getting to care centres.

What can be done about St. Patrick's and the Easky centre in County Sligo? The centre in Easky is still running two days a week only. We are told a recruitment campaign is under way. When can we hope for these centres to full reopen?

Minister of State at the Department of Health (Deputy Mary Butler)

I thank the Deputy for raising this issue and I welcome the opportunity to discuss day care centres because they are such an important provision for older people. There are three key points in supporting older people to live well in their own homes: home care, day care centres and meals on wheels. When the three are working in collaboration with each other, it makes an important difference to an older person's life.

As the Deputy will be aware, the HSE has operational responsibility for planning, managing and delivering health and personal social services including day centres. A wide range of core services are provided for older persons, including home support, day care, community supports in partnership with voluntary groups, such as the Sligo LEADER group the Deputy mentioned, and intermediate care as well as long-stay residential care when remaining at home is no longer feasible. These services are fundamental to the health and well-being of our older population.

Access to day centres can make an important contribution by providing, as the Deputy said, invaluable support, advice and social interaction for older people who may, for many reasons, be experiencing isolation and loneliness. Older people also benefit from increased physical activity, cognitive stimulation, enhanced nutrition, healthcare monitoring and social work support. Day centres are also an important indirect resource for carers. They play a key role in enabling older people to live independently in their own communities.

The Deputy is as passionate as I am in wanting to see the resumption of day care services following their necessary closure in 2020 in response to Covid. In 2021, a general manager within older persons' services was requested to take the lead role on the resumption of day care services for older people. A day care focus group with both HSE and cross-organisational representation was established. During the pandemic, a risk assessment of each day care centre in the country was carried out. Some were not fit for purpose as regards infection prevention and control measures. Some did not even have hot running water in the bathrooms. We took this opportunity to reconfigure some day care centres. Key issues in reopening included staff being redeployed, some buildings no longer being fit for purpose under new guidance and others having challenges associated with HIQA requirements. The HSE allocated more than €6 million to the community health organisations between 2021 and 2022, within existing resources, to assist with the reopening of services and the expansion of existing services, where possible.

The reopening of day centres for older people as quickly and as safely as possible remains a priority for me. In budget 2023, I secured additional funding of €4.1 million for service resumption. The current target is to open 333 day care centres. At the end of October, 300 were open. Some 315 will have reopened by Christmas. We will also have 40 dementia-specific day care centres open by Christmas.

I have been working very closely with the Alzheimer's Society of Ireland to ensure that people with dementia can receive these supports. Like the Deputy, I have visited many daycare centres in the past few months and older people are so happy to be back and re-engaging again. Some of the centres are not open five days, four days or three days a week, like they were previously, because of staffing challenges but we are trying to work through that. The Deputy will be aware, as all Deputies will be, that many day care centres were dependent on community employment schemes to deliver some of the supports and because we are almost at full employment now, we have lost some of that resource that was available.

The reference to St. Patrick’s Community Hospital was not in the original question and, therefore, I do not have the detail on it but I will certainly look at it for the Deputy and I will return with more information in my supplementary response.

Deputy Marian Harkin

I thank the Leas-Cheann Comhairle and the Minister of State. She mentioned, as I did, the importance of day care centres which is a social setting. It gives people an opportunity to get out of their homes and makes such a difference to their mental health, as well as their physical health. That is all a given.

The Minister of State stated that one of the reasons that some day care centres were not reopened related to infection prevention and control. While that is important, we have to strike a balance. We cannot just say "No, no, no" to the positive benefits of reopening as quickly as possible. I am not asking the her or anybody in the HSE to reopen centres that they consider dangerous or that would not be beneficial for people, but if everything has to be perfect, A1 down the list of tick boxes before a centre can open, she and I know that instead of the 333 centres that she had hoped to have opened at the end of October, as she has said or the 315 centres she hopes to be open by Christmas, that will not happen. That is good progress and she is getting there with her target and I hope that St Patrick’s Community Hospital and some of the other centres that I spoke about will be among those.

That will certainly give me great courage to think that could have happened but we need to be practical about this. According to the information I received, St. Patrick’s Community Hospital needed toilets to be refurbished, painting and a new floor. That is the sort of thing that can be done fairly quickly. Carrick-on-Shannon is the county town and the biggest town in Leitrim but to think that it is without a day care centre, and to think that somebody sent me a response to say that there were centres open with the exception of one, a small centre 25 km to 53 km away is nonsense. Carrick-on-Shannon needs to be prioritised and the other centre that is causing a great deal of concern is Easky, County Sligo.

Deputy Mary Butler

The Deputy is quite right in what she said. We all know the benefits of day care centres. It is one of my priorities to get them open as safely and as securely as possible.

One of the areas where we have seen challenges is in day care centres that were adjacent to or part of amenity nursing units, which were our old-style community hospitals. Any place in which there was a day care centre, there were challenges. We still have approximately 70 nursing homes throughout the country with Covid-19. The difficulties were that we were bringing people from outside into an inpatient centre and most of the problems we had were where the day care centre was associated with the community nursing hospital in that particular area.

The Deputy is correct about infection prevention and control, which is important. We learned quickly that some of the day care centres were in community facilities and were not dedicated day care facilities. We have changed that now and the majority of them are now stand-alone day care centres with the correct supports that people need. The Deputy is also correct in that we have to find permanent solutions and that is what we are trying to do but there have to be certain standards.

One area about which I am also worried is that while many people have come back to day care and embraced it, we also have a small cohort who are finding it hard to re-engage and who have not come back to the day care centres. They may have lost their good friend during Covid-19 with whom they used to engage, and this is also an area on which we are putting a focus. I am asking communities to reach out to these people who always went to a day care centre previously and now do not have the heart or are probably afraid to re-engage. I will certainly check out those centres for the Deputy.

I agree with what she said in that it is not appropriate to ask somebody to travel 7 km, who may not have transport, and I believe the Deputy also mentioned a distance of 24 km. That is just not going to happen. I will check those two centres out for the Deputy and I thank her, as usual, for her interest in this matter.

Cancer Research

Deputy Gino Kenny

I thank the Leas-Cheann Comhairle for taking this important matter. The European Commission recently published a new study on breast cancer screening across the European Union. One of its recommendations was to extend breast cancer screening to include women from the ages of 45 to 74. As the Minister of State knows, in Ireland, the screening process begins at 50 and ends at 69. The European Union is saying that for better outcomes for women, the screening process age should be lowered to 45 and end at 74. The figures and evidence are quite compelling in respect of breast cancer in Irish women.

One in nine million women will develop breast cancer over their lifetime. Recovery rates from the disease are high, which is important. The startling statistic, however, is that 23% of all women who are detected are under the age of 50. Between the ages of 20 and 50, the figure is 23%. Some 36% of the women who are diagnosed are over 70. Some 56% of women then are not in that screening process. The evidence is, therefore, quite compelling in respect of the lowering of the screening age for women.

For example, in some European countries the age of screening starts at 45. Sweden, which is a good example, starts at 40. That country has found that when it started the process of screening at 40, there were 26% fewer deaths, which is a good result. The national screening advisory committee, NSAC, has stated that it will prioritise the proposal by the Commission. Will the Government take on the Commission’s report? Will it review the current screening process and, as women will ask for, will it lower the age of screening as per the recommendations of the Commission?

Deputy Mary Butler

I thank the Deputy for raising this important issue and it is great to get the opportunity to discuss it. The Minister and I are committed to supporting our national population-based screening programmes. As we all know, screening saves lives and it is important that decisions on changes to our existing screening programmes, such as changes to the age range eligible for screening, are made in line with international best practice.

When a woman turns 50, she receives a notification to attend her BreastCheck appointment and the take-up is very high, which is great to see. Many people who are screened find that they might be challenged with breast cancer. As the Deputy said, the outcomes are good.

As he may know, decisions about population-based screening in Ireland are made on the advice of the NSAC. This independent, expert committee makes recommendations to the Minister and the Department of Health on population screening in Ireland. As he may appreciate, the assessment of the evidence for making changes to screening programmes is a thorough process, done in line with internationally accepted criteria and with scientific rigour. In addition to the scientific and technological information required to make evidence-based decisions, ethical, legal and societal issues arise when planning an enduring population-based screening programme of this nature.

As the Deputy stated, BreastCheck currently invites women aged 50 to 69 for screening. Extending the programme to those up to the age 69 was a programme for Government commitment, which I am pleased to note has been met and is now being implemented. The NSAC's first annual call in 2021 for proposals for new screening programmes or changes to our existing programmes, received more than 50 submissions. This included proposals on expansion of the age range eligibility for breast cancer screening from a number of sources, including from the BreastCheck programme.

The NSAC have asked HIQA to look at the evidence for the expansion of the age range eligibility for breast screening to women aged between 45 and 74 and preliminary scoping work has begun. I agree wholeheartedly that it would be important to extend the range. One person contacted me who had contracted breast cancer at the age of 45. She was lucky in that she was proactive and went about dealing with it.

She made the point that many others have breast cancer and do not realise it.

I think that 45 years is a good age to start and I am glad that the BreastCheck programme has also endorsed this. Under Europe’s beating cancer plan, a proposal for an updated European Council recommendation on cancer screening was adopted by the Commission in September. The final recommendation is expected to be formally approved by the Council of the European Union on 9 December and then published.

The NSAC will consider the recommendation and advise the Minister and the Department of Health on the evidence as it applies to Ireland, including in respect of breast screening. It is important to remind ourselves that screening is for healthy people without symptoms and I advise everyone to take up their invitation for screening when they receive it.

It is important that every woman is breast aware. This means knowing what is normal for them so that if any unusual change occurs, they will recognise it. In light of all this, I trust the public can be assured of the Minister’s and my own ongoing commitment to further expansion of population-based screening in Ireland. It cannot happen soon enough. It is such an important provision.

The Deputy noted that it is 33% under 50 years and 36% over 70 years. Expanding the programme by those extra nine years could have many positive outcomes for women's health.

Deputy Gino Kenny

That sounds quite positive. This will take time and more resources. I was on the health committee where experts were brought in to talk about the pros and cons of extending the screening process. The case was quite compelling. It makes it less evasive. There is also an issue of women seeking early diagnosis. I know it can be lengthy and can run into years. For any cancer, early diagnosis and prognosis is important.

The Commission's support for the new European Council recommendation is positive and I am glad NSAC has taken it on. There is compelling evidence for reducing the age to 45. If it saves one life, and if one person watching this is saved, it will be worth it. Anything is worth it if it saves one life. I am quite positive. There will be extra costs and resources but the Department of Health and the NSAC are willing to take that on and, hopefully, they will implement it as soon as possible.

Deputy Mary Butler

I thank the Deputy for raising this. As he said, if it saves one life, it will be important. I reiterate how important it is that when people are invited to screening appointment, they take it up. Some 13,000 people in Ireland a year are diagnosed with skin cancer. I was one of those people this year. Thankfully, even though I had a malignant tumour, I was lucky that I got the all-clear recently after two procedures. It does focus the mind when you realise that there can be positive outcomes if it is caught early enough.

The latest cancer trends report, published by the National Cancer Registry Ireland recently, focuses on cancers that are currently screened for, including breast cancer. The report highlighted the positive effect BreastCheck has had on breast cancer incidence and mortality in Ireland. The Minister and I are committed to the further expansion of screening in Ireland. It is something I will keep a close eye on because of the points the Deputy made in favour of extending the programme to those aged 45 and aged 74. Population-based screening programmes must be considered thoroughly and carefully and assessed against international accepted criteria but all the criteria and international best practice are going in the same direction. I am positive that we can move on this.

Medicinal Products

Deputy Neale Richmond

I am grateful that the Minister of State has come to the House to take all these matters this morning. It is great credit to her own work ethic and commitment.

I raise a somewhat niche issue in that it only affects a small number of women in the country but it is serious. Hyperemesis is severe nausea, or morning sickness, during pregnancy. It affects 1% to 2% of pregnancies. In budget 2023, the Minister for Health announced that Cariban, which treats hyperemesis, will be reimbursed. This is welcome and long sought-after. However, to get a prescription for Cariban, the patient must first go to a consultant rather than her GP. This adds delay and cost and creates a great deal of distress to women who are extremely sick during a vulnerable time in their lives. It is hard to describe how badly hyperemesis can affect those who are unfortunate enough to suffer from it during pregnancy but it is debilitating. That they would have to wait for a consultant appointment and be seen before they may be prescribed this prolongs the misery.

A lady in my constituency was diagnosed with hyperemesis at eight weeks. She was losing 2 kg a week. This was before it was placed on the drugs payment scheme and she was not eligible to get this so she had to go onto a less effective drug until she was six months' pregnant. She became pregnant again more recently and again fell foul of hyperemesis and, unfortunately, had to wait an additional three weeks to be seen and prescribed by a consultant rather than just being able to get an appointment with her GP the next morning. That was three weeks off work, losing weight and away from the care of the infant child she had simply because there is no joined-up thinking. I am asking for a little bit of common sense in the application of this important scheme for those who need it most.

Deputy Mary Butler

I thank the Deputy for raising this important issue. I am taking this matter on behalf of the Minister for Health. The Minister and I appreciate that hyperemesis gravidarum, or severe nausea, is a debilitating condition for women. The Minister is anxious that our health service should support women with this condition in every way possible. Improving women's health outcomes is a priority for the Minister and the Government. We made a strong commitment to promoting women's health in the programme for Government and are fully committed to the development and improvement of women's health services.

We have made progress on women’s health issues. VAT has been removed from HRT, which has improved equality of access for women across the country. The free contraception scheme commenced this year and will be expanded to include women up to 30 years next year. IVF treatment will be provided in the public health system next year. We also intend to create additional women’s health hubs. These are all initiatives that will positively impact the lives of women in Ireland.

As part of the women's health agenda, officials supporting women's health in the HSE and the Department of Health worked with urgency to identify all of the available options to better support women with hyperemesis gravidarum. As part of budget 2023, the Minister announced €69.2 million in funding for women’s health in 2023, to include dedicated funding for Cariban. The dedicated funding for Cariban will help women who experience hyperemesis, a severe form of morning sickness, during pregnancy, which is difficult to deal with.

On the question of access to medicines to treat the condition, unfortunately the situation is not straightforward. As the Deputy will be aware, the HSE has statutory responsibility for medicine pricing and reimbursement decisions under the Health (Pricing and Supply of Medical Goods) Act 2013. Under the Act, only items that have been granted market authorisation by the European Medicines Agency or the Health Products Regulatory Authority can be added to the reimbursement list. However, that is not the question the Deputy has asked. His question relates to where patients must go to a consultant before they can get a prescription for Cariban. I did not realise that.

Deputy Neale Richmond

To get it reimbursed.

Deputy Mary Butler

Sorry, to get it reimbursed. However, I assume their doctor can prescribe it.

Deputy Neale Richmond

But they have to pay for it.

Deputy Mary Butler

Okay. The answer does not really deal with the question the Deputy is asking and, therefore, I will raise this with the Minister and his officials to see if anything can be done.

Perhaps the Deputy can clarify, in his response, if a patient must go to a consultant and pay for that appointment in order to get the prescription to claim the cost back.

Deputy Neale Richmond

Just to clarify, it is an ever-changing issue. Unfortunately, there are situations like this with drugs and many different treatments all the time. The Minister of State deals with these issues on a daily basis, as does the Minister for Health. The situation, in this case, is that because of the nature of the drug and the regulatory environment with the European Medicines Agency, there is a requirement for patients to get a prescription from their GP, but they need to have a consultation with a consultant first.

I note and welcome the Minister of State's comments. I hope, following engagement with the stakeholders, we can find an opportunity to provide timely treatment for the 1% to 2% of pregnant women who suffer from this debilitating condition. I highlight that the HSE has discretion in the area of exceptional patient-specific processes. We have seen it in the implementation and roll-out of other drugs for many other illnesses. It is about getting around the system of waiting for EMA regulatory approval. We saw it with Covid vaccines and we have seen it with many other medicines. The important point is that the condition is extremely time-sensitive. Women do not know if they are going to get hyperemesis gravidarum before they get pregnant. Often, the patient does not present with symptoms until the eighth or ninth week of pregnancy. There is a need to work quickly to treat the condition, so having to attend a consultant appointment not only delays treatment by up to four weeks but imposes a major cost on the women who simply have to get access to this drug. I ask the Minister of State, when she goes back to the Minister or, more pertinently, the HSE, to ensure that a system is put in place whereby there is no requirement for women to attend a consultant appointment in order to get a reimbursement. They should be able to get access to the drug through a GP because this is a time-sensitive exceptional need. I think all of us agree that Cariban is recognised as a safe drug. It is seen as such. We must ensure we put in place the process to get ahead of the delay on a wider regulatory matter.

Deputy Mary Butler

The Deputy is absolutely right that time is of the essence. If a woman is eight or nine weeks pregnant and is extremely sick, the last thing she wants to do is to get up and try to make a consultant appointment. Cariban, which is regarded as a beneficial treatment for hyperemesis, does not have a marketing authorisation from the European Medicines Agency or the Health Products Regulatory Authority and, therefore, cannot be added to the formal reimbursement list under the 2013 Health Act. I assume that is the reason women have to make a consultant appointment to access it. Of the €69.2 million in funding allocated for women’s health in budget 2023, €1 million is for the unlicensed medicine Cariban. As with the Minister for Health, I am hopeful that this medicine will make a meaningful difference to the well-being of pregnant women. There could be an opportunity for pregnant women to access the drug when they go for their regular check-ups and scans in a maternity hospital, without having to see a consultant privately. Perhaps that could be looked at and streamlined. I will certainly raise the issue with the Minister. By allocating the €1 million for Cariban in 2023, we can ensure that pregnant women who were not previously able to get Cariban can now access it. However, there seems to be one small barrier that we need to overcome. I will certainly raise the matter with the Minister. I thank the Deputy for bringing it to the House.

Departmental Funding

Deputy Jackie Cahill

I thank the Minister of State for being here to take this Topical Issue matter. I raise the issue of funding for the Circle of Friends Cancer Centre in Tipperary town. To provide some background information, when I visited the centre first it was operating in an old building near the railway which was completely unsuitable for the purposes the organisation was trying to achieve. With huge voluntary fundraising efforts and donations, as well as Government support, a pristine cancer support centre has been built, which is a real credit to the people of Tipperary and the surrounding areas. For this centre to operate efficiently, it needs funds. Unfortunately, use of the centre has increased dramatically. It is estimated that 1,197 individuals will use the centre's services in 2022, which is a significant number. That figure is expected to double in 2023. The organisation has applied for section 39 funding from the HSE amounting to €98,318. The funding will be used to meet core staffing requirements and provide a cancer support outreach worker, counselling and individual therapies. There is a huge voluntary effort in this organisation, but the professional people who are providing counselling and therapy services have to be paid. They are providing supports such as physiotherapy, financial advice and others for people who have unfortunately been diagnosed with cancer. It would be a tragedy if the organisation were to run into funding difficulties after doing all the hard work in getting the new centre built and up and running. As I mentioned, the centre and its services are widely used by people living in Tipperary town, west Tipperary and County Limerick. It covers a catchment area of over 76,000 people. It is really delivering what it says on the tin. It is providing excellent counselling services in a superb environment. There are beautiful gardens surrounding the centre.

Circle of Friends is getting help from community employment schemes for some of the services that are needed in respect of maintenance at the centre, etc., but the core issue I am raising is the need for funding to maintain the services. I have a detailed budget that I will pass on to the Minister of State, which breaks down the figures. The centre needs €98,318 in funding. I also emphasise strongly that the funding must be provided on a permanent basis. The organisation cannot live from hand to mouth, hoping that it will get funding from the HSE each year. I hope the section 39 funding application is accepted and funding can be provided more regularly and on a permanent basis, so that the organisation knows it will receive the funding it requires to provide its services in the following calendar year. That is imperative. I met with representatives of the organisation on Monday. While it has some financial reserves, they will only cover 12 months of running costs. If this centre is to survive long term, there must be certainty in respect of funding. We cannot talk about value for money when it comes to the provision of cancer support services. They are absolutely essential for people who are unfortunately diagnosed with cancer. I urge the Minister of State to use her influence to get funding for the centre.

Deputy Mary Butler

I thank the Deputy for raising this most important issue of the section 39 funding requirements of the Circle of Friends Cancer Support Centre. I also thank and acknowledge the staff and volunteers for the valuable work they do at the centre. The need to address survivorship care for those living with and beyond cancer is now recognised internationally, and groups such as the Circle of Friends Cancer Support Centre emphasise the importance of quality of life during and after cancer treatment. People living can require life-long, evidenced-based healthcare, both preventive and general medical, as well as psychosocial care and care specific to the cancer diagnosis involved. For others, access to support groups can fulfil most of their needs.

Circle of Friends has previously received funding through national lottery funding and from the HSE in 2018. I understand the charity has recently made an application for further funding through the HSE of €98,318, which the Deputy has previously discussed with me. I think it is very impressive that an estimated 1,200 people will avail of the supports that Circle of Friends provides in the Tipperary area.

In 2020 and 2021, cancer services continued to be provided in Ireland during a challenging time for health services globally. The national action plan on Covid-19 identified the continued delivery of cancer care as a priority. Cancer diagnostic and treatment services continued to operate, including breast, lung and prostate rapid access clinics for cancer diagnosis.

In 2021, the Government allocated €57 million to cancer services, with a further €35 million allocated in 2022. This has brought the total allocation for cancer services in the national service plan to €139.2 million. This includes funding provided by the national cancer control programme to cancer support centres across the country.

Hospital and Community-based Psychosocial Care for Patients with Cancer and their Families: A Model of Care for Psycho-Oncology was published by the national cancer control programme in 2020. It sets out how psychosocial support for cancer patients and their families will be developed in Ireland over the coming years. It also recognises the necessity for a comprehensive psychosocial support service that spans acute hospitals, primary care and the community and voluntary sectors.

The national cancer control programme has also developed NCCP Best Practice Guidance for Community Cancer Support Centres to ensure a seamless transition in support between hospitals and the community. This set of guidelines will help to form the foundations on which we can continue to grow and enhance the services offered by cancer support centres across the country. The Cancer Patient Advisory Committee was established in 2019 and meets quarterly. This committee builds on the work of the Cancer Patient Forum and facilitates patient input into the oversight of the implementation of the national cancer strategy.

I welcome this opportunity to discuss funding for cancer support centres and encourage Circle of Friends Cancer Support Centre to engage with the HSE locally on any funding applications or concerns it has. It is evident that people living with and beyond cancer benefit from psychosocial supports, and cancer support centres across Ireland are providing such an important service to those who use and need it. It is important to have supports in one's own locality where possible. Could the Deputy ask the organisation to engage locally? I will speak to the Minister, Deputy Donnelly, and make sure the centre's funding is considered. I am hopeful regarding budget funding considering the centre's work this year to support 1,200 people through their cancer journey.

Deputy Jackie Cahill

I thank the Minister of State for the positive response. I do not have to say that she recognises what the cancer centres around the country do. The centre set up in Tipperary town and its work are an example to any cancer support group. The centre expects its number of users to double in 2023. I acknowledge that the door is open for consultation with the HSE and that the Minister of State will use her influence to bring the negotiations to a successful conclusion.

When making my opening remarks, I made a point on funding certainty. An organisation like the centre in question cannot wait until December each year to see whether it will get funding for the next calendar year. There needs to be certainty about its funding stream. It got funding from the national lottery in the past. Obviously, there will always be fundraising. That will not be an issue for the centre as there is a great community spirit. The centre was founded by cancer survivors, who comprise its hub. The first time I went to the centre, which was when it was operating out of what was virtually a derelict building, I met a young lady who, thankfully, is still at the hub of the centre, has survived cancer and is in good health. She has always been a driving force behind the centre. There are many cancer survivors. People diagnosed with cancer should have someone to talk to about financial issues and problems they may have as a result of their illness. Mental issues also arise. There are so many obstacles to overcome and hills to climb when people get the dreaded news that they have been diagnosed with cancer. However, the centre is playing a pivotal role in supporting those diagnosed with cancer. The Minister of State has committed to doing her best to ensure funding is secured for the centre.

Deputy Mary Butler

I thank the Deputy for raising the importance of Circle of Friends Cancer Support Centre. We are all familiar with similar organisations in our constituencies. Waterford city has Solas Cancer Support Centre. It is such an important place. I know how important cancer support centres are. They are key in providing psycho-oncology and psychosocial support, and it is important that the development of dedicated survivorship programmes continue in order to enable patients to maximise their quality of life.

The important work of the centres cannot be underestimated. The Deputy has said Circle of Friends has had about 1,200 referrals this year and expects this number to double. Since Covid, there has been pent-up demand from people dealing with cancer diagnoses.

Once again, on behalf of the Minister, I welcome the opportunity to discuss funding for cancer support centres. I encourage Circle of Friends Cancer Support Centre to engage fully with the HSE in the funding application process. I compliment the staff and volunteers at the centre and thank the Deputy for raising the issue.