Ireland's general election: new goals for cancer care?

Abstract

The 2020 Irish general election took place on Feb 8, delivering a major shift in direction for mainstream Irish politics. For the first time in history, Sinn Féin—previously a minority party with historical links to paramilitary organisation the Irish Republican Army (IRA)—won the highest number of votes, changing the once two-party system into a clear three-horse race. Many voters seemed to be calling for change in bringing Sinn Féin to the fore, neck-and-neck with previous opposition party Fianna Fáil, and leaving outgoing Taoiseach (prime minister) Leo Varadkar's Fine Gael party in third place. However, none of the three parties secured the 80 seats needed to form a majority government and negotiations to establish a government in various possible guises have ensued. If Sinn Féin were to secure a prominent role in the next Irish government, how might this manifest in Ireland's health-care policies? With the mission of “giving workers and families a break”, Sinn Féin's policies have clearly struck a chord with a substantial portion of the voting public by answering their calls for improvement on the current state of social and housing affairs. Sinn Féin's manifesto pledge to reduce hospital waiting times in Ireland—one of the worst in Europe—might also have contributed to the unprecedented surge in support. In other health care-related policies, Sinn Féin pledged €4·5 billion to be spent on the health service (more than twice that promised by Fianna Fáil, but €0·5 billion less than Fine Gael's pledge). Sinn Féin also committed to implementing Sláintecare—a 2017 all-party report into health-care reform. The proposed reforms aim to move Ireland away from the current two-tier health system, in which out-of-pocket payments are required for some health-care services. As the only member of the European Union (EU) that does not offer universal health coverage, moving towards a single-tier, universal health-care system would be a major achievement. In its manifesto, Sinn Féin also outlined several policies to improve care for patients with cancer, such as implementing the National Cancer Strategy to improve cancer survival. Although Ireland saw the highest overall increases in cancer survival between 1995 and 2014, it ranked lowest in terms of 5-year survival for ovarian cancer compared with six other high-income countries in the International Cancer Benchmarking Partnership. The party also committed to improving education and awareness of breast cancer and cervical cancer and investing in clinics that provide long-term aftercare for patients with gynaecological cancers. Sinn Féin has made provision of medical cards to patients with cancer a priority, which would enable the estimated 40 000 people diagnosed with cancer in Ireland annually to access free health care without incurring out-of-pocket expenses. Holders of medical cards are entitled to free hospital, general practitioner, and dental services, among others, as well as prescription drugs and medical devices, but they are currently only available to people receiving welfare payments, those on low incomes, and senior citizens. However, Sinn Féin's manifesto did not cover all aspects of cancer care. For example, funding for cancer research and clinical trials were promised in the manifestos of Fianna Fáil and Fine Gael, but seem to be absent from their new opponent's policies. Sinn Féin's manifesto also lacks details about many other major cancers and on the challenges Ireland has faced surrounding access to imaging, diagnostics, and state-of-the-art treatments. However, in terms of health and cancer care at least, there does seem to be more that unites the three parties than separates them. Ireland's membership of the EU might also help it to achieve some of the goals for health-care reform. On Feb 4, 2020, the president of the European Commission, Ursula von der Leyen, launched a consultation on the EU Beating Cancer Plan to build support among EU member states for an overarching strategy to address prevention, diagnosis, treatment, and aftercare of patients with cancer at a national level. With the percentage of eligible women receiving a mammogram in the past 2 years ranging from 0·2% to 82% in different EU member states, a unified strategy is clearly needed to align cancer priorities and fix disparities between countries. The plan will begin with a consultation phase, and although it is too early to tell how ambitious it will be, the opportunity to be part of the development and implementation of the plan will be valuable for member states such as Ireland. Working towards laudable goals such as universal health care, and improvement of cancer care for all, is an important and achievable target for Ireland. The Irish public voted for change; it is now up to the new government to deliver it.