National charity's chief executive is worried by a fragmented approach to treatment and the HSE's organisational ability to deliver on control strategy, writes Laura Slattery

It was one of fate's little quirks that led to John McCormack, an accountant by trade, devoting his life to one of the most pressing crusades in western society: controlling cancer.

It is an epidemic that requires urgent attention. This year, it is estimated that 22,500 new cases of cancer will be diagnosed in the Republic: as a result of our ageing population, the figure is forecast to grow to 43,000 new cases by 2020.

Tackling this overwhelming increase in the incidence of cancer involves "playing an enormous amount of catch-up", according to McCormack, who was working as an auditor for what is now BDO Simpson Xavier in the late 1980s when he began providing accounting assistance to the management of the Irish Cancer Society (ICS), one of BDO's clients.

After a period as financial controller and company secretary, he has been chief executive of the national charity for cancer care since 2002.

McCormack is dismayed by the ongoing lack of access to screening services, the fragmented approach to cancer treatment across the State and the absence of a national cancer research plan, among other things.

The publication of the national strategy for cancer control last June should prove to be the starting point for massive organisational change in the health service.

But the implementation of the strategy, which involves a more centralised and uniform approach to cancer care, depends on the effectiveness of the Health Service Executive (HSE), an organisation that is still in its infancy.

McCormack is worried, and not unduly. "The Irish Cancer Society would have some concern about their ability to deliver on the cancer control strategy," he says.

Progress so far has been disappointingly slow. McCormack is still waiting for the appointment of the new clinical director of the cancer control strategy.

"That advertisement hasn't been placed yet. It is happening, but until we see the ad . . ."

Part of the Republic's problems with treating cancer stems from a shortage of consultants in several specialist areas.

This includes a severe shortage of the urologists needed to diagnose and treat prostrate cancer. (It is forecast that there will be a 275 per cent increase in the incidence of prostrate cancer between now and 2020.)

"We have to compete for cancer consultants with other countries," McCormack says bluntly.

"In much the same way that allowed us to get the likes of Hewlett-Packard and Compaq here, we need to create the infrastructure that will attract the best cancer consultants."

Those consultants will look at the kind of back-up they would receive through the Irish health service for diagnostic tests, clinical trials, cancer information and access to laboratories and ask if it is an environment that promotes excellence in detection and treatment.

At the moment, their conclusion will too often be "no".

Nowhere is this more obvious than in the State's failure to implement a free national cervical screening programme, when one has existed in the UK for 40 years.

This will now be rolled out by the end of 2008, but the delay has cost lives. In 2006, 70 women died from the cancer - one of the highest rates in western Europe.

"The women of Ireland have been badly let down by the lack of access to cervical screening services and access to information about cervical cancer," says McCormack.

Meanwhile, the BreastCheck screening programme, which picks up nine cancers per every thousand women screened, is still only available in the eastern region, although it will be in operation in Galway and Cork by the end of 2007.

The ICS is now pushing for colo-rectal cancer screening to be made available: bowel cancer is the second most common cause of death from cancer in Ireland, but carries a good prognosis if caught in time.

Screening is one of three areas that the society intends to focus on following a strategic review of its activities.

The society currently funds oncology liaison nurses and services for families nursing terminally ill people, but perhaps bearing in mind that it is a charity, not a substitute for a national health service, it has been agreed that the HSE will eventually take over the funding of these services, freeing the society to concentrate on early detection services, prevention programmes and more lobbying.

The society is now seeking corporate partners that will sponsor future prevention programmes, which will focus on lifestyle risks such as excessive alcohol consumption, obesity and the pastime to which 40 per cent of all cancers are directly attributed; smoking.

The society wants to extend its provision of health and safety programmes to employers, which include a six-week smoking cessation course - the society's "core competency", according to McCormack. It worked with 150 employers last year, but is anxious to do more.

"The national smoking rate is 24 per cent, but if you're a large employer with 10,000 employees and a large young female workforce, the chances are that the rate is 40 per cent," he says.

The current lung cancer epidemic among Irish women wasn't helped by the Government's decision not to increase the price of cigarettes in three successive budgets between 2003 and 2005 - a time when disposable incomes increased, McCormack points out. The society is now in talks with the social partners to use a consumer price index inflation figure that excludes tobacco when negotiating wage deals, so that the Government doesn't have to fear that an increase in the price of a pack of cigarettes will fuel wage inflation.

McCormack is also lobbying the Government to put in place a VAT refund mechanism for charities. The ICS paid €250,000 in VAT last year.

"We are looking for money the Government has taken from us. We are not looking for a grant," says McCormack.

The VAT refund issue is now top of the agenda of the Irish Charities Tax Reform Group, which McCormack founded back in 1991.

Next on the agenda for the society is Daffodil Day.

Last year, out of a total of €12 million in funds raised by the society, €3.3 million came from Daffodil Day.

McCormack is aware that the society would not survive without these donations and the support of the thousands of voluntary workers who will sell daffodils on its behalf on March 23rd.

Cancer affects almost everyone in the end: if we are not diagnosed with it ourselves, we will have a close family member or friend who is.

For McCormack, limiting mortalities from the disease is now a question of organisational skill.

But the HSE's ability to implement the cancer control strategy within a reasonable timeframe is "a real anxiety", McCormack reiterates.

"There are hopes and there are anxieties."

Factfile

Name:John McCormack

Age:46

Position:chief executive of the Irish Cancer Society

Family:Married to Maura, three children: Aidan, Simon and Orla.

Background:Attended Oatlands College in Stillorgan and Rathmines College of Commerce. Member of the Institute of Certified Public Accountants, MBA from Dublin City University. Sits on the board of Alcohol Action Ireland.

Hobbies:Walking

Why he is in the news:20th anniversary of Daffodil Day, the Irish Cancer Society's main fundraising event, on March 23rd with €3 million target this year.