Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Is the Minister for Health coming?

David Cullinane (Waterford, Sinn Fein)
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He is not. It will be the Minister of State from the Waterford constituency.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Very good.

David Cullinane (Waterford, Sinn Fein)
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I move:

That Dáil Éireann: recalls that the National Cancer Strategy 2017-2026, the third such strategy, was launched in 2017 with a then-estimated cost of €140 million additional current expenditure by 2026;

notes that:

— the Government has only properly funded the National Cancer Strategy 2017-2026 in two of the last five years and has not revised the funding requirements in light of inflation, unpredicted demographic changes, or the impact of the Covid-19 pandemic;

— only one of the 23 objectives of the National Cancer Strategy 2017-2026 has been met according to the latest progress report; and

— according to the European Cancer Inequalities Registry, Ireland has the second highest rate of cancer incidence in Europe and is ranked mid-table of the 27 European Union member states for cancer survival, and performs poorly in comparison to western European peers in terms of uptake of cancer screening programmes;

further notes:

— remarks made to the Oireachtas Joint Committee on Health on 10th April, 2024, by the Chief Executive Officer of the Irish Cancer Society, Ms Averil Power, that:

— "Inadequate Government funding and the impact of Covid-19 on cancer diagnosis and treatment means that we are no longer confident that will be the case. In fact, we are concerned that Ireland's cancer outcomes may have stagnated or even disimproved since the strategy was published";

— "In some areas, things have significantly disimproved since 2017. Waiting times for radiotherapy have increased, with expensive equipment lying idle in several hospitals due to an ongoing shortage of radiation therapists. Inequality between public and private patients is growing, particularly in terms of access to new medicines"; and

— "Our key recommendation to the committee today is a call for multiannual funding. One cannot plan for workforce, for capital or for anything properly without multi-annual funding"; and

— remarks made to the Oireachtas Joint Committee on Health on 10th April, 2024, by the Chair of the National Cancer Strategy Steering Group, Professor John M. Kennedy, when asked why life-saving equipment was left lying idle due to the shortage of radiation therapists, that:

— "The basic answer is we are not training enough of them because we have not reacted to the increased requirement over the past several years. That is true in many areas of infrastructure in the health system. It is the predominant reason"; and

— "Owing to the difficulties we have with unscheduled care, by which I mean sick people coming to the ED, time-critical surgeries are continually delayed because we cannot get patients into the hospital for them ... because the hospital was overwhelmed by urgent care"; and

— responses given to the Oireachtas Joint Committee on Health on 10th April, 2024, by the National Director of the National Cancer Control Programme, Professor Risteárd Ó Laoide, confirming that the Health Service Executive sought €20 million in funding for the National Cancer Strategy 2017-2026 in 2024 but "did not get anything for 2024";

considers that the failure to properly fund the strategy, to properly plan and grow the workforce, and to resolve hospital overcrowding are the consequences of conscious political decisions made by this and previous Governments;

condemns the Taoiseach, Simon Harris TD, for his failure as the Minister for Health and as a member of this Government to properly fund the National Cancer Strategy 2017-2026, and as the Minister for Further and Higher Education, Research, Innovation and Science to put in place a workforce plan to address staffing deficits in the health service; and

calls on the Government to:

— immediately revise the health budget for 2024 to provide the funding needed to deliver the National Cancer Strategy 2017-2026;

— commit to full multi-annual funding of the National Cancer Strategy 2017-2026;

— end the recruitment embargo across the Health Service Executive;

— fund the 1,500 acute hospital beds which are needed to reduce overcrowding; and

— implement a medium- and long-term workforce plan for the health service to address staffing deficits, including in cancer services.

Cancer is a leading cause of death in Ireland. It is a sobering reality that one in two people will develop it at some point in their lives. The facts are that Ireland has the third highest mortality rate from cancer in western Europe and the Government is failing to get ahead of the problem. The first and second national cancer strategies were the poster children of success in the health service, and rightly so. Many of us have commended the real progress made under them. The reason progress was made was that funding was given to put in place the additional supports, staff, infrastructure and healthcare capacity that could deliver better health and cancer outcomes for patients. There have been tremendous improvements in cancer care since the first strategy. I pay tribute to all the staff who work in cancer services.

The problem, as outlined very clearly by the Irish Cancer Society last week and also outlined in a letter penned to all the major newspapers and news outlets today and yesterday by 21 clinicians and medics who work in cancer care, is that, under the current national cancer strategy, they do not have confidence that continued improvements in cancer outcomes are going to happen. In fact, they say there will be regression in many areas. They rightly pointed out that, in five of the seven years of the current strategy, it has not been properly funded. For 2024, €20 million was needed to fund the strategy properly. What did the Government allocate for it for the entirety of this year? It gave zero in additional funding. For the past several years, the national cancer strategy has not got any additional funding, meaning all the additional staff needed and all the additional measures that need to be implemented to ensure cancer patients can have the health outcomes they need have not been put in place. Medics should not have to raise these issues for the Government to act. The Government can take issue with anything I say and can even take issue with what the Irish Cancer Society says, but it cannot take issue with all those medics at the heart of developing the strategy and delivering cancer services. These medics are telling the Government that all the issues that I and others are raising, such as hospital equipment not being properly utilised and a lack of radiation therapists, radiographers and cancer care staff, are all having an impact on cancer outcomes. There is nobody in this State who has not lost someone to cancer. As the Minister of State knows, I lost my own mam a number of years ago, as have many. It is really traumatic for anyone to lose a loved one to cancer.

All we and society want is to ensure that we do our best to provide the best services. We should juxtapose that with the position of the Government, including Simon Harris, the current Taoiseach. It has decided, despite a request from the National Cancer Control Programme, NCCP, for €20 million in 2024 to start to make the improvements necessary, to say "No" and give it zero euro. What does that say to all those staff who are working in cancer services who are crying out for help? We can see this when they write letters to Taoiseach. What does it say to cancer patients and their families who are at their wits' end coming to terms with a diagnosis and having to go through all the necessary treatments? It is a real slap in the face. We have had 13 years of Leo Varadkar, Simon Harris and Stephen Donnelly as Ministers for Health. We see a major problem with overcrowding in our hospitals and are aware that one of the consequences of this is that hospital managers are forced to cancel procedures. We know that many of those are cancer procedures, as we have heard from the chair of the steering group of the national cancer strategy at a meeting of the Oireachtas health committee last week. We are aware that in all the years in which Simon Harris was Minister for Health, he failed to properly fund the national cancer strategy. In fairness to the current Minister, Deputy Donnelly, he did make a difference in the two years in which he did fund the strategy. Six hundred and seventy staff were hired. Then the funding was stopped and there was nothing after that. You cannot stop and start; there needs to be a continuous flow of funding.

From my perspective, we need a change of direction in healthcare. We need new ideas and leadership. We have had 13 years of failure from three Ministers – Leo Varadkar, Simon Harris and Stephen Donnelly – and it really is time for a step change, new ideas and a new direction in healthcare. I propose the motion.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I pay tribute to the cancer support groups in my constituency, including Ballyjamesduff Cancer Support Fund, CUAN cancer support in Cavan, and Crocus cancer support in Monaghan, and also the Moylagh JFK 50 Mile Challenge committee, which has raised over €1.2 million for cancer services and research over the past 11 years. These groups provide vital services and support for cancer patients and their families, with little or no central government funding. I commend my party colleague Deputy Cullinane for introducing this motion in the Dáil.

The current national cancer strategy was published in 2017 and has the potential to significantly improve Ireland's cancer outcomes; however, the Government has failed to properly fund the national cancer strategy in five of the past seven years, including every single year in which Simon Harris was Minister for Health. As a result, while some improvements have been made, the National Cancer Control Programme has not been able to deliver fully on its ambition. The NCCP and the HSE sought €20 million in additional funding through budget 2024 to deliver the strategy but received zero. The Government must immediately revise the health budget for 2024 and provide the funding needed to deliver the strategy. It cannot say it was unaware of the consequences of the underfunding. The National Cancer Control Programme has reported that the lack of funding will have an impact on cancer outcomes and that it no longer has confidence in the strategy's chances of improving cancer survival rates.

According to the European cancer inequalities register, Ireland has the second highest rate of cancer incidence in Europe and is ranked only mid-table of the 27 EU member states for cancer survival. It performs poorly in comparison with many other western European countries as well with regard to uptake of cancer screening programmes. Early detection and treatment are vital if we are to improve the outcomes for people with cancer. We are calling on the Government to revise the health budget for 2024, provide the funding needed to deliver the strategy, end the recruitment embargo and implement a deliverable workforce plan for the health service.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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With the Ceann Comhairle's indulgence, I will first acknowledge the passing of former Cork North-West Deputy, Gerard Murphy, who died today. My condolences. I served on Cork County Council with him for two years. He was a very courteous and wise man. My condolences to his family and indeed to Fine Gael.

Very few people in this country are not touched by the ravages of cancer. It causes untold damage. Over the course of past cancer strategies, significant progress was made in some respects. In the course of the last cancer strategy and under the stewardship of three Ministers for Health, Deputies Harris, Varadkar and Donnelly, we have gone backwards. Over the last 13 years, the Ministers, Deputies Harris, Varadkar and Donnelly, have made the health service worse. Cancer services are not being funded properly. In five of the last seven years, the strategy has not received enough funding. In the years where it was funded, as Deputy Cullinane has pointed out, a difference was made. In five of the last seven years, it was not funded adequately. Only one of the 23 objectives in the current strategy has been met. There is much concern among people who are working in the area of cancer. Twenty-one clinicians wrote a letter expressing serious concern that things will likely regress. It is simply not good enough. There are numerous problems, many of them to do with recruitment.

It is so frustrating. With the housing crisis, people get frustrated about empty and boarded up houses. What could be more frustrating for people with cancer who are waiting for treatment and let down by the system than to hear about equipment not being used? In Cork, one linear accelerator is never used. One CT scanner is idle and never used. It has been lying idle for three years. How galling is that to families who have cancer? It is absolutely maddening. I have no doubt that they find it the same.

Things are beginning to regress in several respects. The clinicians are identifying that. That is a concern. It is simply not good enough. Deputy Cullinane has outlined the plan that Sinn Féin has to resolve this. It includes ensuring there is adequate funding and, crucially, addressing the recruitment embargo, which is such a blunt instrument and is doing significant damage across the health system as a whole.

Denise Mitchell (Dublin Bay North, Sinn Fein)
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I am really concerned by the latest progress report that states that only one of the 23 recommendations highlighted back in 2017 has been met. When we look at how cancer treatment is rolled out in other European countries, we are ranked mid-table for cancer survival. In some areas, we are going backwards due to the struggle with training, recruitment and retention of staff. Last Wednesday, the chair of the national strategy steering group attended the Joint Committee on Health. He outlined how pressures on emergency departments were impacting on the scheduled, time-sensitive surgery for cancer patients. At the same committee, the CEO of the Irish Cancer Society, Averil Power, called for multi-annual funding to be put in place. She pointed out the wait times for radiotherapy as one example of where we are regressing.

We are failing cancer patients by not properly funding this strategy. We need the Government to revise the health budget for 2024 and to provide for the strategy. We need to see a commitment to multi-annual funding. Sinn Féin is calling for an end to the recruitment embargo in the HSE, which is having a detrimental impact on patient care. We need an increase in funding that reduces overcrowding so that cancer services can focus on scheduled surgeries, in particular, and treatment more generally. We need to train and hire more professional healthcare staff to address staff shortages.

The people attending hospital to receive cancer treatment need a Government that is willing to put them first. This motion is giving the Government the opportunity to do just that.

Paul Donnelly (Dublin West, Sinn Fein)
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This Government needs to end the recruitment embargo and implement a workforce plan for the health service. People shake their heads in disbelief at the recruitment embargo. The Government needs to train more radiation therapists and hire the staff needed to utilise all radiotherapy equipment. It is a scandal that expensive life-saving equipment is lying idle due to staff shortages. The Government needs to fund the 3,000 hospital and community beds needed to deal with overcrowding and avoid hospital cancellations. It needs to properly fund the cancer strategy on a multi-annual basis to drive improvements in cancer detection and survival rates.

The Irish Cancer Society sent us a document today which states that the current national cancer strategy, published in 2017, "has the potential to significantly improve Ireland’s cancer outcomes through investment in cancer prevention, detection, treatment and survivorship supports." However, it has only received proper funding in two of the seven budgets since then.

Why do we need to do those things? It is because cancer has affected every single family in this country. One word comes to mind every time we hear the word cancer, which is fear. It is fear about the diagnosis, how bad it will be, what stage it is at and whether it has been detected early enough. There is fear about the road ahead and the impact of the treatment process, including on the person's family. There is the stress of the income loss and how the person will cope if the worst happens. What people should not fear is the state of the health service itself, getting a diagnosis in time to prevent it from getting worse, and that there will be any delays in their diagnosis or treatment. That fear is elevated for people who rely on the HSE and do not have private health insurance.

A report from some years ago always sticks in my head. It laid bare the facts of our two-tier healthcare system. The death rate from cancer in Mulhuddart in my constituency is nearly three times that of Castleknock. Those two areas are geographically beside each other. In fact, just the Ongar Road separates them. Cancer death rates from 2009 to 2011 varied from 381 people per 100,000 in Blakestown to 128 people per 100,000 in Castleknock. Access to timely healthcare is critically important to outcomes.

This Government has failed. It has failed those people who need that treatment. That is why we need a general election and a new Government.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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There is nobody in this country who has not been affected by cancer in some shape or form. It is a devastating disease, not only for those who are fighting it but for their loved ones too. Around 42,000 people a year will get a cancer diagnosis. Each and every one of them deserves the best possible chance of not only surviving the disease but of enjoying a good quality of life afterwards. That will only happen if we have a properly resourced national cancer strategy. That same strategy has not received adequate funding in five out of seven years, which means the Government has failed to make available the necessary funding for cancer protection, detection, treatment and survivorship supports.

Across the country, radiation therapy machines are currently lying idle due to a chronic shortage of staff. Screening has not been expanded as planned. Target times for tests are not being met. Surgeries are frequently delayed to shortages across hospitals. We are even missing the modest target of having 6% of cancer patients participate in clinical trials. We are one of the slowest countries in western Europe to make new medicines available to public patients. The Government is simply failing. We now rank 13th of the EU-27 for cancer survival. Thirteen years of Simon Harris, Leo Varadkar and Stephen Donnelly have made the health service worse. We have the highest waiting times and chronically overcrowded hospitals. Our services are not being funded. Expensive life-saving equipment is lying idle.

What needs to happen now is clear. We need to properly fund the cancer strategy on a multi-annual basis to improve detection and survival rates.

We need to end the recruitment embargo. The Government needs to speak with workers and put a realistic and deliverable workforce plan in place. The recruitment embargo needs to end but really what we need now is a general election. The Government has failed on this as it has failed on so many issues. If the Government needs any proof as to how that failure is affecting the day-to-day lives of even children in this country come down to Mullingar and have a conversation with the parents who engage with the paediatric diabetes service.

Pearse Doherty (Donegal, Sinn Fein)
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Last week I raised with the Tánaiste the deliberate decision by the Government, and it was deliberate, to deny adequate funding to cancer services and the cancer strategy. Today's debate offers an opportunity again to put the facts on the table. The Government has failed miserably to properly fund the cancer strategy in five of the past seven years. The HSE sought €20 million to improve cancer services for this year but did not receive a red cent from the Government in the recent budget. We know that expensive and life-saving equipment funded by the taxpayers is lying idle and unused in hospitals as a result of staff shortages brought on by the Government. Radiation therapy, as we all know in the House, is crucial to shrink tumours and ultimately remove cancerous cells but we have heard there are machine closures in our hospitals throughout the State due to staff shortages. For example, in Cork University Hospital a linear accelerator and a CT scanner have never been used. They have been sitting idle for three years. It is an absolute scandal. It is happening on the watch of the Government.

Yesterday 21 leading cancer doctors and researchers wrote to the Taoiseach. Among them was one from my county, Dr. Lukasz Milewski, who is a consultant medical oncologist at Letterkenny University Hospital in Donegal. The warnings by this doctor and others cannot be brushed aside by the Government. They warn that cancer screening has not been expanded as planned. They warn the targeted waiting times for cancer are not being met. They warn that cancer surgeries are frequently delayed due to shortages in staffing beds and theatre space. Yet there was not a red cent from the Government, or any one of the Ministers who sat at the Cabinet table, to provide funding to the national cancer strategy in each the past two years. What does this tell us? It tells us the Government is completely failing people on health, particularly those who have cancer. It is an indictment of the Government.

The long and the short of it is that Fianna Fáil and Fine Gael cannot be trusted with our health system. The evidence of this is to be found in every community. Over the past 13 years Deputy Varadkar, the Taoiseach and the Minister, Deputy Donnelly have been our Ministers for Health. Their record is high waiting times, hospital overcrowding and underfunding of critical cancer services. There is an alternative, which is to provide proper and multiannual funding for our cancer strategy to improve outcomes for patients, to end the recruitment embargo and to fund the 3,000 additional beds in our hospitals and communities that are so desperately needed. This is what Sinn Féin in government would do. It is what Deputy Cullinane has brought before the Dáil. It is what every Member should support. They should turn their backs on the Government, which has failed desperately the people who are relying on a proper health service. It has driven it into the ground over the past 13 years. It has deliberately decided not to fund cancer services. It is allowing equipment to lie idle. It is a shame and a scandal and it needs to end now.

Mary Butler (Waterford, Fianna Fail)
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I move:

To delete all words after "Dáil Éireann" and substitute the following: "recognises and notes:

— the work of our healthcare workers in improving the health outcomes for patients with cancer;

— the improvement in survival rates in Ireland during the current National Cancer Strategy 2017-2026, with more than 215,000 people living in Ireland following a cancer diagnosis compared to 150,000 in 2017 when the Strategy was brought to Government;

— the strong performance of Ireland compared to other European countries in reducing the rate of deaths from cancer;

— that studies for the period 2011-2019 found that Ireland reduced cancer mortality by 14 per cent for men and 13 per cent for women, compared to the European Union (EU) average of 10 per cent for men and 5 per cent for women;

— the substantial investment that has been made into the National Cancer Strategy 2017-2026 since the formation of this Government in 2020 of €40 million, with a cumulative total of over €120 million in additional funding spent on the National Cancer Strategy 2017-2026 since 2020;

— the recruitment of an additional 670 new staff to national cancer services since 2017, leading to improved access to treatment for cancer patients;

— the provision of improved treatment for cancer patients since 2020, including new treatments now available in Ireland for the first time, tailored anti-cancer therapies, and new radiotherapy treatments;

— the development of new infrastructure for cancer since 2017, including new radiation oncology facilities at Cork and Galway with a total capital spend of over €120 million, and the extensive cancer infrastructure projects which are currently ongoing within the Health Service Executive;

— the investment into screening services since 2020 of €30 million in new development funding, including €20 million to support the opening of the National Cervical Screening Laboratory in December 2022;

— that Ireland's screening programmes rank highly for uptake rates in comparison to the EU member states which have these screening programmes in place: BreastCheck seventh out of 23 member states, CervicalCheck third out of 19 member states, and BowelScreen sixth out of 16 member states;

— the ambitious target set by this Government to eliminate cervical cancer by 2040, which Ireland is on track to achieve;

— the sustained funding of cancer research of €37.6 million between 2020 and 2023, which represents 14 per cent of the Health Research Board's overall funding portfolio;

— the funding allocated in the last three years to new medicines, including 61 cancer drugs, of €98 million, and the total spend on cancer drugs in the last three years of over €600 million;

— the support given to smoking cessation initiatives of over €60 million from 2020-2024, and the extensive body of legislation enacted since the formation of this Government to address tobacco consumption as the biggest single cause of cancer in Ireland;

— the initiatives progressed under this Government to address alcohol as the fourth highest modifiable risk factor for cancer in Ireland, including the further commencement of the Public Health (Alcohol) Act 2018 to introduce minimum unit pricing, health labelling of alcohol products, the regulation of advertising and sponsorship, and the reduced visibility of alcohol in mixed trading outlets;

— the Government is committed to increasing capacity in our public hospitals; 1,182 new acute hospital inpatient beds have opened since 2020, which includes 56 beds opened so far in 2024; and

— there was a significant increase in the number of additional student places available on health-related courses in 2023; in total over 660 additional student places have been provided in medicine, nursing and midwifery, pharmacy, and other key healthcare courses in the academic year 2023/24; and this includes over 220 student places across Nursing and Midwifery and Allied Health Professional courses in Northern Ireland.".

I welcome the opportunity to discuss funding for the national cancer strategy. I thank the Deputies for tabling this Private Members' motion. The Minister, Deputy Donnelly is not available to respond to it as he is in the Seanad with legislation. The unfortunate reality is that a large proportion of people in Ireland will interact with our cancer services. This could be as a patient or as a friend or family member of a patient. This is why the Government and the Minister for Health have advocated for and ensured funding for cancer services in Ireland. I will set out clearly what has been spent on cancer services over the lifetime of the Government.

Successive national cancer strategies have shown the benefit of continued investment in national cancer services. The benefits for Irish cancer patients come from earlier diagnosis, better treatment and improved rates of survival. Seven years into the national cancer strategy, 40 of the 52 recommendations - I repeat that is 40 of the 52 recommendations and not one as was said across the floor - are now implemented and work is progressing on the remaining recommendations.

The Government’s commitment to implementation of the national cancer strategy is evidenced by significant investment in recent years. We have seen significant progress on the implementation of the strategy with clear evidence-based policy direction from the Department and strong implementation by the HSE's national cancer control programme.

The Government has invested an additional €40 million into treatment services under the national cancer strategy, and the total cumulative additional funding into treatment services under the strategy since 2017 is more than €230 million. This funding has enabled the recruitment of more than 670 staff to our national cancer services since 2017, including an additional 200 nursing staff, 100 consultants, and 180 health and social care professionals in designated cancer centres. Additionally, €30 million has been invested in screening since 2020, including €20 million for the development of the new national cervical screening laboratory which opened in December 2022. This means that our national cancer services have been strengthened, that more patients are receiving treatment, and that waiting times to access treatment are reduced.

Capital funding of more than €120 million has been used to provide state-of-the-art radiation oncology facilities in Cork and Galway, which opened in 2020 and 2023, and to update cancer infrastructure in chemotherapy wards and laboratory facilities for the benefit of patients. In the past three years, additional investment of €98 million in new medicines has included approvals for 61 new cancer drugs. This brings total spend on cancer drugs in the past three years to more than €600 million. Taken as a whole, this represents a significant investment towards the implementation of the aims of the national cancer strategy. Since 2017, the total additional funding across screening, prevention, treatment, new cancer drugs and cancer research is more than €180 million.

The strategy recognises the impact of catching cancer early on a patient's prognosis, and the importance of preventing cancer where possible. Current estimates show that four out of ten cancer cases can be prevented by a change in lifestyle or environment. Since the beginning of 2020 the Government has spent more than €60 million on measures to assist people with quitting smoking. This funding allows people to receive smoking cessation medications and it funds our national quit line as well as staffing and other programmes.

In 2022, the HSE national cancer control programme launched the Early Diagnosis of Symptomatic Cancer Plan 2022-2025. The plan focuses on raising awareness of the signs of cancer among health professionals and the general public, with a particular emphasis on marginalised groups. Nine out of ten cancers are diagnosed when individuals present to their GP with symptoms and electronic referral is in place for breast, lung, prostate and suspected skin cancer. More patients are being seen now than ever before in rapid access clinics, with more than 53,000 attendances in 2023.

The strategy sets out a vision for continuous improvement of cancer services, following on from the progress under the previous two cancer strategies. A particular focus is the centralisation of cancer surgery, which is now 85% complete. This means that expertise and resources are concentrated in designated centres, ensuring that patients have the best care available for cancer surgery.

Early intervention in cancer is extremely important, and as part of the urgent and emergency care plan this year time-sensitive cancer surgeries are given priority where possible. The NCCP engages closely with designated centres to monitor the activity of surgical services, and by the end of 2023 more than 17,000 cancer surgeries had been carried out, which was more than 1,000 more than in 2019. Since 2020, new cancer treatments and models of care have been launched in Ireland thanks to the increased funding for the national cancer strategy, including CAR-T for certain blood cancers, PRRT for neuroendocrine tumour patients and the SABR advanced radiotherapy treatment now available in our new radiation oncology centres.

The Government has also allocated significant investment to ensuring new medicines are available for cancer patients. A total of €98 million additional funding was allocated for new medicines over the past three years, which includes funding for 61 cancer drugs. The total spend on cancer drugs in the past three years has been more than €600 million. I am setting out the facts.

When this strategy was brought to Government in 2017, there were 150,000 people living after a cancer diagnosis in Ireland. That number is now at 215,000, a 43% increase under this strategy. Thankfully, I am one of those people. This is a massive achievement, and it means that the aim under the strategy to increase patient involvement and maximise quality of life becomes even more important.

Over the lifetime of this strategy, the NCCP has developed models of care for psycho-oncology, which incorporate best international practice and ensure that psycho-social supports for cancer patients and their families are to a very high standard. This has included specific models of care for children, adolescents and young adults which recognise their different needs from adults. These models of care have the aim of improving outcomes for cancer patients who face a heavy burden throughout their treatment and beyond, into recovery. The NCCP has also developed guidelines for community services that have been adopted by the NCCP Alliance of Community Cancer Support Centres. The Minister for Health allocated €3 million in funding to these centres for 2024, recognising the impact these centres have on cancer patients and their families in communities throughout Ireland.

The ongoing transformation of cancer services is a priority under the strategy. This is enabled by integrating research into cancer care where possible, and making use of innovative methods to improve how our national cancer services provide care. The national cancer information system, NCIS, is live in 18 out of 26 sites nationwide, with the remaining hospitals expected to be completed this year. The NCIS is essential for risk reduction and the optimal and safe delivery of multidisciplinary systemic anti-cancer treatment. It also allows for electronic prescribing and administration of cancer drug treatment in public hospitals. The NCIS enables an integrated approach to patient care across multiple sites, which benefits patients as their record travels with them.

Since 2020, the Health Research Board, HRB, has invested €37.6 million in cancer research. This represents almost 14% of the total health research investment. Of this funding, €21.6 million went towards support for developing cancer clinical trials infrastructure, to help achieve one of the aims of the strategy which is to increase patient participation in clinical trials. In addition to this funding, this year, the HRB announced a provision of €1.2 million in funding for cancer research projects operating on a North-South basis as part of the cancer consortium, which involves co-operation between Ireland, Northern Ireland, and the United States' National Cancer Institute.

As I mentioned earlier, under this strategy there has been an improvement in cancer survival rates in Ireland. Looking back to the period between 1994 and 1998, the five-year survival rate for patients diagnosed with cancer was 44%. This increased dramatically to 65% for people diagnosed with cancer between 2014 and 2018. Ireland is performing strongly in comparison to other European countries in its reduction of cancer mortality. European comparisons for the period from 2011 to 2019 found that Ireland reduced cancer mortality by 14% for men and 13% for women, compared to the EU average of 10% for men and 5% for women. In addition to this, recent estimates by the European Cancer Inequalities Registry, ECIR, suggest that Irish cancer mortality rates have fallen below the EU-27 rate. This is proof of the benefits of our long-term strategic approach to cancer, with strong policy oversight from the Government and a national cancer control approach led by the NCCP.

As cancer will affect one in three of us in our lifetimes, support for cancer services and cancer patients will continue to be prioritised as part of the overall health budget. This Government has invested heavily in the national cancer strategy and associated initiatives in recent years, enabling the further development of our national cancer services.

Patricia Ryan (Kildare South, Sinn Fein)
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Gabhaim míle buíochas to Deputy Cullinane for the opportunity to speak on this vital issue. Since in inception in 2017, the national cancer strategy could have been a shining example of how to do things properly. However, the continuing failure of this and previous Fine Gael and Fianna Fáil Governments to properly fund it means Ireland's cancer outcomes are in danger of going backwards. Ireland now holds the dubious honour of having the third-highest cancer mortality rates in western Europe and is ranked 30 out of the EU-27, which the Minister of State has just spoken about, for cancer survival.

It is unlucky for those, perhaps. It is unlucky for those 42,000 people who are diagnosed with cancer every year and who trust in the health service here to help them. It is unlucky for those who are seeking treatment when vital, hugely expensive medical machinery is left lying idle, as we discovered last week, because of insufficient funding or no staff to operate it. Why is there no staff? Is it because of the recruitment embargo that has been imposed by the Government, perhaps? Why is there insufficient funding? Is it because Fine Gael and Fianna Fáil have for years failed to properly fund cancer services? Imagine your child's treatment being cancelled because of this. The answer to all those questions is an absolute "Yes".

The Minister of State's claims that there are significant advancements in cancer treatments are ridiculous. There were three in five people receiving radiation therapy by 15 days post-diagnosis in 2023 compared to four in five in 2018. That is a drop of 20%. Let us imagine being one of those people in that 20%. Thirteen years and three failed health Ministers is too much. It is time for real leadership to do what cancer sufferers need. It is time to have Sinn Féin in government and it is time for Deputy Cullinane to be a health Minister.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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First, I commend Deputy Cullinane on tabling this motion. We always recognise that many people in our communities and families have had the devastating news of a cancer diagnosis and have experienced the trauma of that. There is no family across the country that is not touched by that. Of course, we recognise that great work is being done by many people in our health service to try to make things better and, in many cases, there are very good outcomes.

We had a cancer strategy in 2017, and the then Government put it in place. We all recognise that everyone was on board. This was going to be something that could turn things around for what was up to then and probably still is, unfortunately, the devastating situation in our cancer services around the country. Yet, the reality is that the Government refused and failed to fund that adequately. It has only gotten the funding in two of the past seven years, and we then wonder why we do not have the outcomes. When the Minister of State was speaking, she spent a long time on how good things are and about the good outcomes, etc. Let us imagine if the Government had gotten had gotten the proper funding how much better it could have been. That is the reality that most people are recognising here. The Government is not putting the funding in place. It is not providing the kind of service that is required to ensure we can look after people properly across the State.

With regard to staff vacancies, almost one-third of the radiotherapy posts are vacant. Let us think about what impact that will have on people who are on waiting lists and waiting for treatment. There is all this very expensive equipment that is lying idle in various hospitals around the country, as well as the impact that has on patients. There is also the impact it has on the psychological aspect that cancer patients and their families are going through. They know that there is the potential out there for life-saving services to be provided to them, but they simply have not been funded. That is devastating and the Minister of State needs to take a long, hard look at this situation. It is simply not acceptable to continually spout off all kinds of statistics about how great things are-----

Mary Butler (Waterford, Fianna Fail)
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It is a fact.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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-----when the reality is in front of us. The Irish Cancer Society made it very clear; the reality is that the funding has not been put in place to deliver the cancer strategy that the Government - and the Minister of State supported the previous Government as well in 2017 - has put in place. We need to see this situation being resolved.

Finally, we are calling on the Government to immediately reverse the health budget for 2024, and provide the funding that is needed to deliver on the national cancer strategy. That is what need to do. That is what we need to ensure happens. We need to ensure there is multi-annual funding for the national cancer strategy. We also need to end the recruitment embargo. This is one of the key things the Government can do. It can end the embargo on our people around the country because we cannot recruit the level of staff that is required to provide the services to people so we can save lives.

David Cullinane (Waterford, Sinn Fein)
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Hear, hear.

Martin Browne (Tipperary, Sinn Fein)
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I also want to thank Deputy Cullinane for tabling the motion. The Minister of State said in her contribution that she would give figures; I am also going to give figures. First, we have had 13 years with Deputies Harris, Varadkar and Stephen Donnelly as Minister for Health that have made the health service worse, with higher hospital overcrowding, hospital waiting times and wasteful spending.

Cancer services are one sector that the Government has not funded properly, because it has failed to fund the cancer strategy in five of the past seven years, even though we have the third highest rate of cancer in Europe. Here is another figure for the Minister of State: 70 out of 240 radiation posts are still vacant. Some members of staff are working ten hours per day just to facilitate the longer cancer waiting lists and burnout is a real issue. A lack of career development is also a major deterrent in the retention of these staff.

In a survey of radiation therapy, RT, professionals carried out last year, 60% said they will not be working in that profession in five years. That should sound alarm bells with the Minister of State and the Government, but it is not. They seem to have no interest in it.

Cancer surgeries are being cancelled because of hospital overcrowding. We need to end the recruitment embargo straight away and recruit or retain enough people in that sector. Sinn Féin has a plan and will deliver better health services. It is time for new ideas and leadership in health, with Deputy Cullinane at the helm.

No one in this Chamber has not been affected by cancer. We look on a weekly basis at how the Government is running the system and it is no consolation to anybody who has been through that experience that the Government is still in charge. We need a new government with Deputy Cullinane in charge.

Dessie Ellis (Dublin North West, Sinn Fein)
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Cancer remains one of the leading causes of death across the State. It is particularly prevalent in areas of the country that are more economically disadvantaged. A report published by National Cancer Registry Ireland in 2023 showed that people in such areas have an almost 30% higher risk of dying from cancer within five years of diagnosis than those from less economically vulnerable areas. The Irish Life insurance company, in its annual claims report from 2015 to 2023, showed that cancer has resulted in the largest percentage of cause of death claims. For example, 65% of specified illness claims in 2020 were due to cancer. In 2021, 61% of specified illness claims were due to malignant cancer. More than one in three death claims in that year were due to cancer. Breast cancer was generally the number one overall cause of specified illness claims for women, and for men, prostrate cancer was the main cause of cancer-related claims. By every metric, cancer is not just the leading cause of death but also has a great impact not only on individuals but on their families, communities and society in general.

Cancer imposes a substantial economic burden on the State so it is imperative that a proper cancer strategy is put in place. This important strategy is crucial as we have an increasingly ageing population, along with improved long-term cancer survival rates. It is particularly important for those who have the greatest need, such as the elderly, those on low incomes and those with no family support. The lack of implementation of a cancer strategy is evident in the inadequate funding for treatment, along with increased waiting times for treatment and radiotherapy, as well as specialist staff shortages, especially in radiology, and along with serious hospital capacity issues. It is clear that this Government is failing people diagnosed with cancer and it goes without saying that they do not have the luxury of waiting until this Government gets its act together.

Johnny Mythen (Wexford, Sinn Fein)
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I thank Deputy Cullinane and the Sinn Féin team for tabling the motion, which is about a life-and-death issue. I can safely say there is no one in this Chamber, or outside it, who does not have a relative or friend, or who does not know someone, who has either survived cancer or died because of it. Ireland ranks 13th out of 27 countries in terms of cancer survival. In fact, Ireland has the third highest mortality rate in western Europe.

Cancer is on the increase, with an average rise of 3% in the general population every year. These statistics should ring alarm bells in every corridor in the Department of Health, and with the Minister for Health, but, unfortunately for many people who cannot afford private tests, it is an even harder uphill battle. Inequality in cancer care is prominent and growing on a daily basis. Between 2016 and 2019, 14% of all cancer diagnoses were made in emergency departments, usually for older patients in a later stage of the disease who are, more often than not, from deprived areas. The Irish Cancer Society stated that waiting times are translating to inequality in the healthcare system. At the end of 2023, 260,000 people were waiting on a list, 135,000 of whom had been waiting for longer than three months. Action is required now. The Government should end the recruitment embargo. Approximately seven out of 240 radiation therapy posts are filled. This has the direct impact that valuable life-saving machines are not operating at their full capacity and across the country RT machines, which cost millions of euro, are lying idle because of the lack of qualified staff.

According to the HSE national service plan for 2023, just over three in four people assessed received radiation therapy within 15 days. This is vital for the fast-growing tumours. In 2018, four in five people were being seen on time.

Duncan Smith (Dublin Fingal, Labour)
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I thank Sinn Féin for bringing forward this motion. It is important that we are honest about the failings of this Government on cancer care. I had hoped that the Minister, Deputy Donnelly, perhaps on Daffodil Day on 22 March or as part of, or instead of, a countermotion, would have announced a commitment to funding a national cancer strategy in the upcoming budget. It would not have been seen as flying a kite or a cynical act. It would have been broadly welcomed, given the debacle we had last year and in previous years, and the desperate need we have for funding of our national cancer strategy. Alas, it does not seem that the Minister is minded to do that at this point. The closer we get to the budget without such a commitment, the more we all fear a repeat of last year and the year before.

In budget 2024, funding was not allocated. Since the national cancer strategy was most recently updated in 2017, it has received just €40 million in new developmental funding when we know it requires €20 million annually. It is not penny-wise and pound-stupid but penny-stupid and pound-stupid. In fact, it is penny-pinching of the highest order for a disease that has touched, either directly or indirectly, the lives of everybody in this country.

The reality is that this Government has only properly funded the national cancer strategy in two of the past seven years. As the motion rightly points out, it has not revised the funding requirements in light of inflation, demographic changes that were not predicted or the impact of the Covid-19 pandemic. In fact, if we were to put a report card against this Government on cancer care, it would make for shocking reading. On the national cancer strategy, it would have to be granted a failing grade. We have only achieved one of the 23 objectives of the strategy according to the latest progress report. That also would require a failing grade. Ireland performs poorly in comparison with our western European peers in the uptake of cancer screening programmes. It is failing in that regard. Waiting times for certain treatments, such as radiotherapy and colonoscopies, are increasing. We are failing in that regard as well. It is absolutely unacceptable that the Government has gotten cancer care so wrong, particularly with so much money in its coffers and those of the Minister for Health.

Earlier this year, I asked him about the impact on a number of cancer care programmes of the decision not to award any new development funding to the national cancer strategy in the most recent budget. I was told that cancer services are a top priority for this Government. We are more than four years into the life of this Government - in fact, it is entering its final few months - and seven years have passed since the most recent update of the national cancer strategy, but we have seen no evidence or particular action to show it is a top priority for this Government or Minister.

Last month, I asked the Tánaiste to commit to multi-annual, ring-fenced funding for a national cancer strategy. To his credit, he said in his response it was something we had to do and see but, unfortunately, we have not yet seen that commitment. He spoke of the importance of the introduction of national cancer strategies and the impact they had in the 1990s and 2000s. He is correct that those strategies played a significant role in lowering mortality rates and progressing care. Between 1998 and 2018, when the first two national cancer strategies were completed, five-year cancer survival rates increased from 44% to 65%, as the Minister of State mentioned. That makes it all the more confusing that this Government's commitment to these strategies is faltering in respect of funding.

When representatives of the Irish Cancer Society were before the Joint Committee on Health last week, their call was crystal clear. There is a need for a commitment to multi-annual funding. The problem with the way we are operating at the moment is that we simply cannot plan for workforce, capital or anything else without a multi-annual funding model. These services are being asked to work with one hand tied behind their backs and with resources that pale in comparison with what they need. It is not the way a modern health service should operate. The inefficiencies this causes were laid bare to the committee last week. Life-saving equipment is being left idle across hospitals and there is a real shortage of radiation therapists in our health service. The reasons are simple: poor planning and underfunding. As noted by the chair of the national cancer strategy steering group, Professor John Kennedy, we are not training enough radiotherapists because we have not reacted to the increase requirement in recent years. Across the St. Luke's radiation oncology network, there is one linear accelerator, which is shut, and a skin cancer machine that is only operating part time. Cork University Hospital has one linear accelerator and one CT scanner that have never been used. Both have been sitting idle for three years.

At University Hospital Galway, a second scanner has been delivered in the past week but there is uncertainty as to whether it will be operational due to staff shortages. We know that radiotherapists are stepping up to plug gaps that they should not be expected to, having now agreed to facilitate longer working days to make up for staff shortages. In some instances, they are working in excess of ten hours per day in order to facilitate and work through the ever-growing cancer waiting list.

These workers need to be provided with support, which can come in a variety of ways. First, we need to see an increase in graduate places. In 1998, the number of college places for radiotherapists in Trinity College Dublin and nationally was 12. In 2024, it has grown to 42 nationally. Training more workers needs to be a priority moving forward. That should include starting a second postgraduate programme in the west that would have a meaningful impact in tackling the increased levels of burnout we are seeing in this area. According to a survey of radiotherapists carried out last year, 60% said they will not be working in the profession or do not see themselves working in the profession in the next five years. This has to be addressed or the waiting lists that these overstretched workers are working so hard to bring down and manage will increase further.

We also know that the inequality between public and private patients is growing, particularly in respect of access to new medicines. While funding for new medicines is vital and we should be ring-fencing funding rather than having a situation similar to budget 2024 when there was no committed funding and the Minister told us funding would instead be found in savings, we also need to look at how long it is taking to get these new medicines into the hands of the people who need them. In Ireland, it takes on average two years from the date of application to patient availability. When it comes to oncology drugs, the time to availability is longer, with a median of 704 days, and we rank 32nd out of 37 countries in a survey published by the European Federation of Pharmaceutical Industries and Associations in 2023. We are lagging so far behind.

The pressure on emergency departments, which we know is at astounding levels, is also having a serious impact on the care that those with cancer are receiving. We usually talk about a winter surge but now we know we have a year-round surge and pressure on our emergency departments. This is because our health service is not getting the necessary funding or resources, and nothing encapsulates this as much as the current recruitment freeze in the HSE, which needs to end. We also need to see some honesty from the Government on this being a recruitment freeze. Every time the freeze has been raised by members of the Opposition, we have seen members of the Government, particularly the previous Taoiseach, deflecting and trying to wave away concerns by saying it is not actually a recruitment freeze and more people have been hired than were planned or needed. We know that is not the case.

Despite the Government's claim to the contrary, the ball has been dropped on cancer. It is time to get down to brass tacks. The Government will say that mortality rates for all cancers have dropped by 11% in Ireland in the past ten years. While that statement is true, it ignores that the latest survival data we have, from 2019, shows that Ireland has the third highest mortality rate in western Europe. That was pre-Covid, and the related impact on cancer services, which the Government has acknowledged, has been significant. The Government will also say that cancer survival rates are steadily increasing but Ireland still ranks 13th out of the EU-27 in terms of survival. I certainly do not feel, and I do not think the Minister of State or anyone in this House feels, that we should be settling for a mid-table ranking for cancer survival.

The significant advancement in treatments for cancer that the Government has touted since taking office ignores the idle machines I referred to and the evidence that some care is going backwards, including statistics that show that in 2023 more than three in five people accessed their radiation therapy within 15 days, which is vitally important for fast-growing tumours, according to the HSE national service plan. This is in stark contrast to 2018, when it was four in five people who were being seen in that time. Again, we are going backwards.

There has not been a recognition from the Government that screening has not been expanded as planned. Target waiting times for cancer tests are not being met. Cancer surgeries are frequently delayed due to shortages in staffing, beds and theatre space. Investment in infrastructure has been lacking despite increased infection control issues and rising cancer incidence.

With regard to what we need to see now, I echo the calls made in the motion and by the Irish Cancer Society for a sustained, predictable, multi-year funding model. This is vital to ensuring the full implementation of the national cancer strategy, while also determining the level of resource required over an appropriate timeframe to fully implement the recommendations in the national cancer strategy and ensure the key performance indicators, KPIs, are being achieved.

Alongside this, we need to see infrastructural investment in combination with an audit of our current cancer infrastructure; ring-fenced capacity for cancer diagnostics and treatment away from acute and emergency care; increased staff in parallel with increased college places; dedicated theatre time for genetic services; an assessment of the feasibility of other methods of investigating risk; and an urgent examination due to the unacceptable colonoscopy waiting list, including the use of fit tests for people on routine waiting lists.

Róisín Shortall (Dublin North West, Social Democrats)
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I thank the Sinn Féin Party for tabling this motion, which the Social Democrats will be very happy to support. It is deeply regrettable that the implementation of the national cancer strategy is clearly no longer a priority for this Government. At last week's meeting of the Joint Committee on Health, the message from the Irish Cancer Society was received loud and clear - the strategy is being starved of funding.

David Cullinane (Waterford, Sinn Fein)
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Hear, hear.

Róisín Shortall (Dublin North West, Social Democrats)
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For a long time, our cancer strategies were the success stories of the health service. They were prime examples of what the HSE could achieve if sustained investment was matched by political will. Patient outcomes were greatly improved by the first and second strategies, launched in 1996 and 2006, respectively. According to the Irish Cancer Society, between 1994 and 1998, just 44% of Irish people were alive five years after a cancer diagnosis. By 2018, those survival rates had increased to 65%, which was a huge achievement.

The second strategy delivered a major restructuring of cancer care services. Critical to the success of that strategy was the steady leadership of Professor Tom Keane, who always made a distinction between strategy and implementation. He saw the dangers of, as he put it, "endless talk", and placed his focus firmly on delivery. That is why we saw such success. Unfortunately, this kind of foresight appears to be absent now in respect of the current strategy.

When the strategy was launched in 2017, the then Minister for Health, Deputy Simon Harris, promised substantial current and capital funding over the ten years of the strategy. However, that turned out to be just another empty promise from our new Taoiseach's tenure in the Department of Health. Instead of providing ring-fenced, multi-year funding, this strategy has only received funding for implementation in two of the last seven years. Bear in mind that over that period of seven years, the coffers were overflowing. Ministers did not know what to be spending money on. Governments did not know what to allocate money to at budget time and large amounts of money were frittered away. For the last seven years, adequate funding has only been provided for the implementation of the cancer strategy and the life-saving measures in it. That necessary funding was only provided in two of those seven years. How on earth can that possibly be justified? There is a direct link between this failure to fund the strategy and several missed targets, delayed surgeries, staff shortages and, now, the shocking rise in cancer rates. That is an appalling reflection on this Government's priorities.

When it comes to the success or otherwise of any strategy, data is crucial. After all, you cannot manage what is not being measured. Unfortunately, data collection is a major shortcoming when it comes to the cancer strategy. Last month, the Parliamentary Budget Office published a report on investment in cancer services and found that there is no official aggregated data regarding health spending on cancer. This means that it is not possible to determine the total level of investment in or spending on cancer services. This is absolutely ridiculous. We need to know how public moneys are being spent.

Similarly, there is very little up-to-date information on the core objectives of the strategy.

Only one of the 23 objectives had been met in 2022, while there is no data available for many of them. Furthermore, it has been 15 months since the last progress report was published, making it very difficult, if not impossible, to hold those responsible to account. Presumably, this is the thinking in not collecting this data and not making it available. One of the recommendations that we know has not been delivered is the expansion of BowelScreen to all those aged 55 to 74. This was to be delivered by the end of 2021. While the age target has been brought down to 59, we are still way off the target of 55.

To make matters worse, then, the uptake target within that age cohort has actually been reduced from 60%, which is in line with international best practice, to a mere 45%. There is, therefore, reduced funding and reduced data collection and reporting, and now a cynical reduction in targets as well. Another area of major concern is increasing wait times for radiation therapy. In 2018, 80% of people accessed their radiation therapy within the recommended timeframe, which was 15 days. By 2023, rather than this timeframe improving, the target had slipped to just 60% of people achieving the 15-day objective. These worsening wait times are a result of a shortage of radiation therapists across the country.

In Galway University Hospital, one of the five HSE radiation treatment centres, the radiation therapist vacancy rate is almost 30%, while in Cork University Hospital, the vacancy rate is an absolutely shocking 39.4%. I am glad to see that the Minister of State, Deputy Colm Burke, who is from the county, has arrived into the Chamber. I will repeat the statistic, with which I am sure he is familiar, that the vacancy rate for radiation therapists in Cork University Hospital is a shocking 39.4%. Almost four in ten of those posts remain vacant. This increasing level of vacancy has resulted in machines lying idle, very valuable machines it must be said, while patients wait for treatment. In St. Luke's Hospital, where the vacancy rate is 25.1%, a radiation therapy machine is being left completely unused. Similar problems exist in St. James's Hospital and in the hospitals in Cork and Galway, where machines are either underused or, in some cases, severely understaffed and not in use at all. The SIPTU representative for radiation therapists in St. Luke's Hospital, Olivia Brereton, has said outsourcing is being used to offset the closure of these machines. This outsourcing, while unsurprising, is not the solution. We should stop looking to outsourcing to solve every problem in the health service. It is not the solution, not least because of its costs. The Irish Cancer Society has found that the cost of outsourcing patients in Galway amounted to approximately €6,000 per patient.

In December 2022, we had a situation with the ongoing delay with the independent review of the radiation therapy profession, which is the cause for concern. That review was initiated in December 2022 and we are still waiting to see it published. This, of course, does not bode well for patients or staff, who need the Government to urgently get to grips with the staffing deficit. There are several aspects to this context. There is, obviously, of course, the fact that there are not enough third-level places. A major barrier to increasing the number of these places, however, is securing additional clinical placements and practice tutors in the health sector. I understand that additional tutor posts will be allocated to support placements, and this is welcome, but will it be delivered in time for the September intake?

I raised this issue of problems across the board with recruitment in the HSE with the then-CEO some two years ago, who denied there was any issue with clinical placements. That is a major factor in relation to difficulties in recruitment and must be addressed as a matter of urgency-----

Marc Ó Cathasaigh (Waterford, Green Party)
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I thank the Deputy.

Róisín Shortall (Dublin North West, Social Democrats)
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-----not least in relation to radiation therapists. We are told it is being dealt with, but it seems it is still under consideration and awaiting a Government decision.

Marc Ó Cathasaigh (Waterford, Green Party)
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I thank the Deputy.

Róisín Shortall (Dublin North West, Social Democrats)
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There is no justification for this situation. These are people who are essential to saving people's lives.

Marc Ó Cathasaigh (Waterford, Green Party)
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I thank Deputy Shortall.

Róisín Shortall (Dublin North West, Social Democrats)
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These are people who have serious cancers yet the Government has failed to act to tackle this obvious issue that needs to be dealt with.

Marc Ó Cathasaigh (Waterford, Green Party)
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The Deputy is running over time now.

Róisín Shortall (Dublin North West, Social Democrats)
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There are also issues in relation to delays with visas and when it comes to accreditation with CORU. The solutions are there. What we need now is action from the Government.

Marc Ó Cathasaigh (Waterford, Green Party)
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I thank the Deputy.

Róisín Shortall (Dublin North West, Social Democrats)
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Its failure to take that action and to be serious about the cancer energy is absolutely unforgivable at a policy level and certainly for the many families depending on the Government to take action.

Marc Ó Cathasaigh (Waterford, Green Party)
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The Deputy is well over her time.

Róisín Shortall (Dublin North West, Social Democrats)
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It is completely inexplicable.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I commend Sinn Féin on this very important motion. I attended the Joint Committee on Health last week where the issue concerning the situation with cancer services was discussed. Representatives of the Irish Cancer Society presented a very sombre view of cancer services in Ireland. There is much to be proud of in our public health system, but there is also a lot to be concerned about in our system that treats people who have cancer. Cancer is a very prevalent condition. One in two of us will have the condition, which is to say that 70 or 80 TDs in here, who make up the composition of the Dáil, will possibly have cancer. This is a sobering thought. We will also encounter cancer through the experiences of our relatives and loved ones. It is, therefore, very prevalent. Obviously, we are also living longer. This is a great thing but we need medical intervention at the right time. This is very important. The national cancer strategy is a great concept but it has certainly stalled in recent times, especially since 2017. Again, the Irish Cancer Society critiqued where it is, in some ways, stalled and, in some ways, has actually gone backwards. This is very worrying in terms of the prevalence of cancer and the rapidity of intervention in this regard. When people get timely intervention with cancer, then the outcomes are extremely good.

There is also the issue of the inequalities in our health system. People in the private health system will have better access to screening and diagnosis and to new medicines. This is a stain on our society. I refer to the divide between public and private treatment in relation to whether people live or not. This is really what it comes down to and this issue of access is a blight on our health system. There are also the usual social determinants in relation to health inequality, wealth inequality and lifestyle factors. These are major factors in determining who gets cancer and who does not, and this can play a major role in terms of the prevalence of cancer.

The Minister is gone, but I also wish to raise another issue. I raised it at the health committee last week as well and it is important. Cancer is a broad spectrum in terms of its diagnosis. In Ireland, we have a breast screening programme that starts at the age of 50 and covers those up to 69.

In recent years that has gone from 65 to 69, which is a good thing, but there is a school of thought that screening should begin before 50. In some European countries this screening starts at 40 or 45. Some 23% of all breast cancers were diagnosed in women under the age of 40. We should be thinking about expanding this programme for those under 50. We have seen a really good example in Sweden, which brought the age for the screening programme down to 40, and the age of mortality and diagnosis went down by a quarter. There is considerable credibility in the screening programme, particularly for breast cancer.

As some other Deputies have said, some of the equipment that has been bought at great cost is not being used in particular hospitals around the State, which is pretty unbelievable. We have very advanced medical equipment not being used because people are not being recruited or retained to use this equipment. It is really damning that equipment, which could and should be used in trying to save people in the public health system, is not being used. That is a really bad indictment.

The national cancer strategy needs to be reviewed and it needs a new impetus. It is a great concept but it needs a review and it needs to be updated. I wish the Minister of State, Deputy Colm Burke, well in his new role.

Seán Canney (Galway East, Independent)
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I also welcome the opportunity to speak on this subject, which is important not just to everyone here in the House, but also to every family in Ireland. I congratulate the Minister of State, Deputy Colm Burke, on his appointment. This is my first time speaking to him in the House; best of luck to him.

The cancer strategy we have is a good strategy. I think everybody agrees that we should be proud of the strategy as written on paper. Where we are running into trouble is that the implementation of that strategy leaves a lot to be desired. There are many reasons for that. One of the biggest reasons is that, as the Irish Cancer Society has pointed out, we need to have a multi-annual funding mechanism that will allow for cancer treatment and the strategy itself to be developed to meet the demand. Second, we need to make sure that we quantify the resources we require so that we can actually put them in place. Earlier we heard that equipment is being left unused. Some very expensive equipment is only being used on a part-time basis. It is very inefficient to spend a large amount of capital money on equipment and then just use it for perhaps 40 hours a week. We need to deal with that and we need to ask why we allow this kind of thing to continue to happen.

I will give a small example. Last week, we got an X-ray facility, which is a simple thing nowadays, set up in the primary care centre in the Tuam. The equipment was bought four years ago was left in a room because there were problems trying to get a room built into what we call a lead-lined X-ray facility. That is just a small example of how long it takes us to get infrastructure developed. That is the crime that we are committing. We have created this huge process by which we talk about everything, we invite in a lot of consultants and pay them dearly to tell us things that we already know we want. I mean consultants like environmental consultants, planning consultants and all that type of thing.

I will give a good example and in the west. University Hospital Galway serves 1 million people in the region from County Donegal right down to County Clare. It is showing the worst results in terms of cancer treatments. It is supposed to be a centre of excellence under all of our strategies as written on paper. Everybody agrees that the infrastructure is not there to deal with the services we are supposed to provide. People are coming from Donegal in ambulances and taxis to get their treatment in Galway. We do not think it out right. We need to make sure that we have the infrastructure in place.

Everybody, including those in government, wants to make it happen. The board has been set up to try to deliver what is needed for Galway. If we are going to deliver it in the same timeframe as it took to deliver an X-ray facility in Tuam, we will not see it for 40 years. I estimate it will need an investment of €1.5 billion. People will say that is an awful lot of money, but for the people of the west it is not. It is their right to have access to services they require.

We need to get on with the job of delivering everything that is required, including a new accident and emergency unit, a new maternity unit, a new paediatric unit and a new cancer care centre. People who have visited, including many Ministers for Health, including the current Taoiseach, all agree that the facilities there are not fit for purpose. In five years, we will not be surprised to hear on the news of issues relating to the delivery of cancer services in Galway or any other services to the people in the west. It will be worse than what we are talking about in Limerick unless we take corrective action now. It is a regional economic issue. People should have a right to the same access to cancer services and the same chance of survival in the west of Ireland. I want to give that message to Government.

Cathal Berry (Kildare South, Independent)
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I join Deputy Canney in wishing the Minister of State, Deputy Colm Burke, the very best luck for the remaining term of the Dáil in his new role.

I thank Sinn Féin for tabling this very important motion. I very much welcome the opportunity to make some brief comments on it on behalf of the Regional Group. I commend and pay tribute to our healthcare workers working in this particular specialty - our surgeons, medical oncologists, radiation therapists, palliative care teams and everybody working on the support side. I want to pay tribute not just to their clinical skills but also to their humanity in interacting with patients when diagnosing cancer and also in interacting with the patients' families.

Some 42,000 cancers are diagnosed in Ireland every year. Unfortunately, one out of every two Members of this Chamber may encounter and interact with the services over their lifetime, which is a devastating statistic. Ireland has a disproportionately large incidence of cancer. We feel we should disproportionately allocate resources on that basis. From a demographic point of view, it is not reassuring. Our population is increasing and is ageing, meaning it is very likely that we will need more cancer-treatment resources.

As Deputy Canney said, we have an excellent strategy. It is the third strategy and the first two were good. This builds on them with the emphasis on prevention, early detection and effective treatment. That is exactly where we need to go. In many ways the hard work has been done. All the brain power has been expended, we have a plan and we just need to focus on implementation. There have been some positive elements. For instance, the smoking cessation strategy has been excellent. We have gone from 18% to 5% of children smoking now. Obviously, 5% is still too much, but there has been progress.

I was in Naas General Hospital on Friday when the Minister, Deputy Donnelly, showed up to open a new 11-bed isolation ward, the Swan ward. This shows that there is some progress, but judging by yesterday's letter by the 21 clinicians, that progress has stalled. It has stalled for a number of reasons but mainly due to funding. That should never be a reason for stalling progress. If anything, funding may be the easy part particularly in Ireland where we have a budget surplus. As we are putting €6 billion aside in a saving scheme this year, there should be no reason we cannot afford an extra €20 million.

I have questions to which the Minister of State might respond if he has time in his wrap-up at the end.

Will the Government publish a Supplementary Estimate for €20 million this year to fund the National Cancer Strategy 2017-2026? It will be money well spent. If it cannot, will it reprioritise some of the money already allocated to the health budget to focus on the national cancer strategy? Ideally, we should have multi-annual planning, as Deputy Martin Kenny mentioned. I am unsure what the resistance to multi-annual budgeting is. Perhaps the Minister of State could shed some light on that but it seems perfectly logical to me, if one is planning a programme, that one has a very predictable source of finance over a number of years so that they can be implemented properly.

The obvious question is what do we spend the extra €20 million on. First, it should be on colonoscopies. We know that the waiting lists are very long from a colorectal cancer point of view. If addressing this means mobilising private hospitals on a Saturday and Sunday, they are well capable of doing that extra work if they are refunded for it. That would be money well spent. Number one then is to tackle the colorectal-colonoscopy waiting lists.

Number two, as mentioned by Deputy Shortall, we need more radiation therapists. There is an issue with clinical placements but there is also an issue with university placements.

Number three is to focus on dedicated pathways. It should never be the case that cancer treatment is postponed or even cancelled because of a lack of theatre time, beds, or the pressures in the acute hospital system.

Finally - and I see one of the Minister of State's officials there and he may be kind enough to take a note of this - we need more primary care resources, particularly with GPs. This is an idea which has been mentioned a few times but we could probably capitalise on it. We know that many of our junior doctors go to Australia or New Zealand after their graduation. There is an Erasmus scheme on most college courses at the moment, whether one is doing business or engineering, where one is encouraged to go abroad for six or 12 months to gain extra expertise. We know that GP training pathways are four years long in Ireland at the moment. Is there any reason the Irish College of General Practitioners, ICGP, cannot reach out to their counterparts in Australia and New Zealand to ask if we can send our trainees over there for six or 12 month period and that we have a reciprocal arrangement back in Ireland? It would certainly increase the stay-ability of our new GPs here in the country and prevent people from going to Australia and not coming back.

In summary then, will there be a Supplementary Estimate from the Government this year for the national cancer strategy and, if not, can we reprioritise healthcare spending to focus on that strategy? I thank the Cathaoirleach Gníomhach.

Michael Collins (Cork South West, Independent)
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I would like to first of all welcome the Minister of State to his new position and wish him the very best in the future.

The aim of the national breast screening programme is to detect cancer early and to provide treatment for women who show no symptoms of the disease. There are only five mobile breast units in the whole of Munster and while we all agree that they are doing marvellous work, there are not enough mobile units nationwide given that breast cancer is the second most common cancer in women. That early detection is vital for a good outcome. It is very important to invest in this highly effective screening service by increasing the number of mobile breast units nationally.

One of the mobile units comes to Bantry every 18 months. I have been contacted by a number of ladies who have appointments in the next few weeks and months for their bi-annual mammogram. The screening is directed at women who are aged between 50 and 69 years of age and who are at the greatest risk of developing breast cancer. The mobile BreastCheck unit will not be back in Bantry until the summer of 2025. Therefore, these women, many of whom are full-time carers and cannot spend a full day away from their duties to attend Cork BreastCheck clinic, will skip their appointments and put themselves at risk of going undetected. The five Munster mobile BreastCheck units are currently based in North Cork, Killarney, Limerick, Waterford, and Saint Finbarr's Hospital, Cork but with the increase in population and the high rates of breast cancer in Ireland, it is very important that we continue to increase the number of mobile units to meet this demand. Ireland's cancer outcomes are at risk of declining due to the strain on health care services. People with cancer deserve optimal care for survival and quality of life. Properly resourced cancer services are essential, with protected pathways unaffected by other health service pressures. Like everyone else, I am calling for a reversal of the decision for no new recurrent funding for the national cancer control programme in 2024 and to commit to sufficient multi-annual funding for the National Cancer Strategy 2017-2026.

In the few seconds speaking time I have left, I mention Cancer Connect, a service in west Cork and all over Cork County now, which is bringing patients to Cork University Hospital, CUH, and is an excellent service. That service was promised €50,000 by politicians in the Minister of State's Government. It has not got a brown cent and the people providing this service are doing this on a voluntary basis, where people are giving of their time. It cannot continue like that. I ask that the Minister of State look into that please.

Michael Healy-Rae (Kerry, Independent)
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I congratulate the Minister of State very much and I wish him every good luck in his role.

I thank firstly all of the medical personnel who help people who go through their journey of cancer. I pay a particular word of thanks to the people who work in Kerry on Daffodil Day and to all of the volunteers who voluntarily raise funds. I thank the people involved in the Kerry-Cork link cancer bus which carries people who are suffering from cancer on their journey to the centre of excellence, which is very important.

A very important issue was raised recently with me by individuals with concerns. Currently, bowel cancer screening is open to those aged 59 to 69. Despite commitments made both in the national cancer strategy and the programme for Government in 2020 that this would be prioritised, the Department of Health declined to give a timeline for when the age of eligibility for bowel-screened cancer will be expanded and extended to the targeted 55 to 74-year-old group. That is very important. I cannot see how people could actually think that there is not a possibility of a person getting bowel cancer just because one goes beyond a certain birthday. That does not make sense.

Despite the lack of proper treatments and access to cancer care diagnosis and treatment, we now know that expensive equipment to deliver radiotherapy to cancer patients, for example, is lying idle due to a lack of staff and the inequality gap between those in the public and private system. That is increasing according to the Irish Cancer Society.

I thank the Irish Cancer Society very much for the excellent work it does. There are people in paid positions but there is also an army of people who work on a voluntary basis. I pay tribute to the nurses and to the night nurses who take people through the journey when their time in this world is coming to an end. They are so kind and are like angels sent down from heaven when they go into a house. When they stay overnight, for example, with a person who has a terminal illness, we are forever indebted to those angels of people who help others at their most vulnerable and weakest time. I thank them from the bottom of my heart for that.

Danny Healy-Rae (Kerry, Independent)
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I am glad to get the opportunity to wish the Minister of State well in his new role. All the very best.

I want to thank in particular the Kerry-Cork link bus which takes people to the centre of excellence at CUH for treatment. I also thank all of the volunteers. Again, last Sunday, they put on a massive performance leaving Millstreet and finishing up in the Gleneagle Hotel in Killarney with all of the people involved. They deserve gold medals, to be honest.

We have to especially thank all of the other people who raise money for cancer treatment. The palliative care service in Tralee, which I understand is the best centre in the whole of Ireland, treats people who finish up there on the last days of their lives and receive such good treatment and care. The service also looks after the families.

Early diagnosis is so important. Some people are waiting with undue delay for magnetic resonance imaging, MRIs and scans. The HSE sought €20 million more for cancer treatment this year and, I am sorry to say, that this €20 million was spent by the Government on a referendum that helped nobody. The Government squandered €29 million, in fact.

We see so many young men and women passing away and leaving young families after them. Often, many of these people only get two months notice of their disease. The last person I knew received two and half weeks.

Something has gone wrong, and there is something wrong with the testing or whatever. It is not the diagnosing because these people knew there was something wrong with them for weeks and months before this, but they are not told or it is not found out until it is much too late.

I am sorry; I have gone over my time.

Carol Nolan (Laois-Offaly, Independent)
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I wish the Minister of State well in his new role. I welcome the opportunity to speak on the motion. I commend the invaluable work done by cancer support service volunteers and staff in counties Laois and Offaly, in my constituency. They are the most dedicated people, and I acknowledge that on the public record.

The National Cancer Strategy 2017-2026 recognises cancer support services as a valuable resource to cancer patients and their families outside of the acute care setting, as indeed is the HSE's national cancer control programme in its own works, with a network of community cancer support centres. It has been my experience, however, that while the strategy has very noble aims, there is often a great degree of uncertainty around multi-annual funding provision. This is an element I would really like to see addressed. I would like to see the support services having certainty and being able to plan. Of course, they can do that only if they are guaranteed their funding. We need to be in a position to offer our community cancer support services, as I said, the kind of certainty and ability to engage in forward planning that is so vital to their work and to the patients who benefit from the services.

Fund-raising is critical and will always be necessary to a certain degree, but even in this respect there are issues around the impact of the Gambling Regulation Bill on charities' fund-raising ability. Charities' raffles are being classed as a form of commercial gambling. How is that acceptable or appropriate in this context? Will the Minister of State provide a guarantee that cancer support services will not be adversely impacted by the Gambling Regulation Bill 2022? Will he also recommit to examining the issue of multi-annual funding and giving more certainty to our cancer support services? They do fantastic work and I commend them.

Marian Harkin (Sligo-Leitrim, Independent)
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I congratulate the Minister of State, Deputy Burke, on his new role. We served together in the European Parliament. Who would ever have thought we would serve in this Parliament together? Politics is a strange game.

I thank Sinn Féin for bringing forward this motion because it highlights the fact that the cancer strategy has not been properly funded for three out of the past five years. When it comes to survival rates, Ireland is around mid-table in the EU-27, and when it comes to western EU member states, we have the third worst mortality rate.

At a recent meeting, Professor Michael Kerin, who is the director of the Saolta network, based in Galway, said that the highest incidence of cancer and the highest mortality rate from cancer are in the west and north west. Ireland is performing poorly relative to many western European countries in regard to cancer mortality, and the west and the north west are at the bottom ranking in Ireland. How does the Minister of State think that makes people in the west and north west feel? How does he think that makes people who are newly diagnosed with cancer feel? How does he think it makes people in the middle of their treatment or finishing their cancer treatment feel when they look at those statistics? That is just not acceptable, and the Minister of State will have to agree that it is just not right. All we can do, however, is start from today and make every possible effort to properly fund our cancer services and to attract and retain the specialised staff we need to run those services.

I will concentrate on the regional aspect of the cancer strategy because, as I said, there is an absolute need to prioritise investment in cancer services in the west and north west.

We have the worst outcomes and it is the responsibility of this Government to deal with that. The national development plan has Galway as the cancer centre of a cancer network encompassing Sligo University Hospital, Letterkenny University Hospital, Castlebar and Portiuncula hospitals. Some progress, to be fair, has been made. A project lead was appointed this week to support this model of care. What is crucial is that it is properly funded and resourced from day one so that we can have a world-class cancer service in the region. This must include rapid access clinics to diagnose cancer. Many cancers are picked up by screening or in GP surgeries but we need a specialised diagnostic centre, which will be vital to ensure precise diagnosis. That will then lead to a more precise care plan delivered by multidisciplinary teams that will comprise experts from the cancer centre in Galway and experts from whichever hospital is closest to where the patient lives.

A positive development in cancer care in the past number of years is that we have more precise diagnosis and treatment. Cancer surgery is no longer just one surgeon who deals with many different kinds of cancer but specialists aided by robotic and image-guided surgery in a specialist centre to deliver the best outcomes. That will often be delivered in the cancer centre and all the related care, what are called systemic therapies, including chemotherapy, haematology, oncology, immunotherapy, oral and cancer medications, and ambulatory services will be delivered as close as possible to where a patient lives by a multidisciplinary team and certain surgeries will be delivered in local hospitals. However, none of those interlinked multidisciplinary teams that deliver the best possible outcomes for patients can be put in place unless a national cancer control programme is properly funded and, as far as I am concerned, needs to be properly funded in the west and north west. This summer, the Organisation of European Cancer Institutes will visit Galway, Sligo and Letterkenny to accredit those hospitals as part of comprehensive cancer services. The issue is that in Galway, cancer patients are competing with patients in the emergency department for bed space. That is not acceptable. We have the very best of nurses and doctors delivering a cancer service but it is not properly funded. We cannot wait any longer in the west or north west.

Violet-Anne Wynne (Clare, Independent)
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I support this important motion on cancer care and welcome the opportunity to contribute this evening. An estimated 42,000 people in Ireland are diagnosed with cancer each year. I would like to take this opportunity to acknowledge the fantastic work done locally, day in, day out, by the West Clare Cancer Centre. Last year, Ireland was found to have the third highest cancer mortality in western Europe by the European Cancer Inequalities Registry and was ranked 13th out of the EU 27 in cancer survival. Shockingly, the current national cancer strategy launched seven years ago has only twice received annual funding towards its implementation in the lifetime of this Government. Even more alarmingly, in the past two budgets, no new development funding was granted. At last week's meeting of the health committee, Ms Averil Power, CEO of the Irish Cancer Society, outlined several unmet targets in the current strategy, which is clearly due to a sustained lack of funding, and identified areas where Ireland is incredulously going backwards. That is deeply concerning. How is that the case when we know investment in cancer services works and not only saves lives but saves the State in the long run? It is imperative that the Government ensures properly resourced cancer services with protected pathways that are not disrupted by the many other pressures on the health service.

I also want to take this opportunity to raise a serious matter brought to my attention by Tina. Tina was diagnosed with breast cancer 11 years ago. On Friday, she went to get her mastectomy bra, as she has always done. However, to her horror, this time she was told she must now provide proof of having breast cancer. Both Tina and a staff member were incredibly upset by this situation. The staff member is clearly familiar with Tina. It was completely unnecessary and wholly embarrassing. Tina reacted while she was speaking to me on the phone, asked, "Should I take a picture of my boob? Would that be enough proof?" It is a disgrace that she felt that way. Will the Minister of State look into this matter? It is causing major distress and pure resentment towards this Government. Tina was told that others have had to get a letter from a GP. Will the Minister of State bear in mind that patients will have to pay for this letter from their GP? Many in County Clare face serious issues with access to a GP.

Colm Burke (Cork North Central, Fine Gael)
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I welcome the opportunity to address the House on the issues raised by the Deputies tabling the motion. I would like to begin by echoing my colleague, Deputy Butler, in her opening remarks, and to thank her for the constructive and positive contributions to this important motion on the issue of funding for the national cancer strategy. I apologise that the Minister for Health, Deputy Donnelly, cannot be here this evening, as I understand he is dealing with legislation in the Seanad. I acknowledge the input of all Deputies. It is clear that we are all motivated to ensure that the national cancer strategy is properly supported for the benefit of patients and their families. There were one or two issues - I am going off script in saying this - relating to radiation therapists. I became aware of that issue in September. I arranged for a meeting with the two universities - Trinity College Dublin and UCC - with the Minister in October. There were proposals and submissions by TCD to increase the number of trainees in radiation therapy from 30 to 50 and by UCC to raise the number from 12 to 24. The course in UCC is a master's course of two years. Those proposals were submitted to the Minister in early February. I was involved in making sure action was taken on that.

The National Cancer Strategy 2017-2026 is the third such cancer strategy in Ireland. These successive strategies have shown the benefit of continued investment in national cancer services. It bears repeating that this Government has shown its commitment to implementing the strategy through significant investment in 2021 and again in 2022, for a total of €40 million. The new development funding provided in those years has been added to the total budget for cancer services. Since 2017, more than €230 million in cumulative additional funding has been invested in the strategy. This means that our national cancer services have been strengthened, which is important, as the incidence of cancer is expected to increase in Ireland in the future. When discussing funding for our national cancer strategy, we must remember the 23,000 people who receive a diagnosis of invasive cancer each year. Cancer is a public health issue, as one in three of us can be expected to be diagnosed in our lifetime. The additional funding that has gone into services under this Government has been of direct benefit to cancer patients. Funding of more than €120 million for capital projects has meant that more people can receive radiotherapy in the new facilities in Cork and Galway. Funding of €98 million in the past three years has meant that patients have better access to new medicines, including 61 cancer drugs. The spend on cancer drugs in the past three years alone was more than €600 million. As has been said, there are now more than 215,000 people living in Ireland following a diagnosis of invasive cancer, which is an increase of 65,000 since 2017. This shows how our strategic approach to cancer has made a real difference for people, with strong policy oversight from the Department of Health and implementation by the NCCP.

Under the national cancer strategy since 2020, the Government has invested an additional €30 million in screening services, including €20 million for the national cervical screening laboratory. Our national screening programmes are highly ranked in comparison to other European countries, and we have set the ambitious target of eliminating cervical cancer as a public health concern by 2040.

This is a target we are on track to achieving, thanks to the efforts of everyone involved.

Since the beginning of the current national cancer strategy, there have been improvements in treatment. This includes the introduction of many new treatments, the provision of treatments previously only available abroad and safer delivery of existing treatments. CAR T-cell therapy is now being provided in Ireland for adults, in St. James’s Hospital since 2021 and in CHI Crumlin since 2022. CAR T-cell therapy is a recent groundbreaking therapy which involves infusing patients with a genetically modified version of their own cells. CAR-T-cell therapy is currently available in Ireland for several cancer types. However, it is expected in future that therapies and use cases will grow substantially. This is why investing in CAR-T infrastructure was so important at the early stages. This was made possible through funding of €3 million for anti-cancer therapies provided in 2022. This year, we have had the introduction of radio-labelled therapy or PRRT at St. Vincent’s University Hospital. The treatment is for people with neuro-endocrine tumours and delivers precise radiation to cancer cells, minimising damage to surrounding healthy tissue. The service was launched in March of this year and is planned to expand incrementally over two years to get it fully operational. Once it is fully operational there will no longer be a need for any patients to travel abroad for PRRT. The expected annual cost of treatments is €3.5 million for 50 to 60 patients per year, reflecting the commitment to delivering treatments for rarer cancers, as well as the most common types of tumours.

Along with new treatments there have been many innovations in cancer care delivery. These innovations have allowed for better outcomes for patients. Centralisation of cancer surgeries to a smaller number of high-volume specialist centres is at 85% completion and it is expected to be complete by the end of this strategy. Centralisation of surgery is important for patients as it means that surgeons have the right level of case volume and expertise to provide the best possible outcomes for patients. Most recently, centres have been designated for sarcoma, skull base and gynaecological oncology surgical services. Cancer surgical services are also increasing in activity, with an additional 1,000 surgeries carried out in 2023 compared to 2019. Other recent innovative practices include updated clinical guidelines for treatment of cancer patients which make more effective use of existing resources. An example of this is hypofractionation for breast cancer patients receiving radiotherapy, which ensures effective treatment can be delivered with fewer doses. This allows more patients to be treated using the same resources and reduces potential side effects for patients. Some €9.8 million was allocated in the HSE capital plan last year to support radiotherapy treatment at our centres in Dublin, Cork and Galway.

Alongside all this work, the national cancer control programme, NCCP, has introduced new models of care in many different cancer areas. This was one of the recommendations of the national cancer strategy. Some recent examples include the launch of the systemic anti-cancer therapy model of care in 2022. This provides a blueprint for the development of services and delivers additional treatment regimens which ensure that treatment can be tailored to the needs of the individual patient. Other models of care include those for psycho-oncology for both adults and young people, ensuring that we can provide psycho-social supports which meet patients' specific needs. This is particularly important now as we have so many more people living with and beyond a cancer diagnosis. Survivorship courses are now delivered through the alliance of community cancer support centres and €3 million in funding was allocated to those centres in 2024. At the other end of the cancer patient spectrum, we have the hereditary cancer model of care which has developed a pathway for people who might have an inherited predisposition to cancer to access testing, counselling and potential treatment. These models of care will ensure that our national cancer services continue to be improved for the benefit of patients.

As cancer is expected to affect one in three of us in our lifetime, support for cancer services and for cancer patients will continue to be prioritised as part of overall health budget. The Government has invested heavily in cancer services in recent years and this has resulted in wide-ranging benefits for patients. Once again, I thank all the Deputies involved in today’s debate, both those who made contributions and those who tabled the motion. I will also take a moment to thank those working in cancer services, in hospitals and in the community, for the care and treatment they provide to patients. In fairness, a lot of good points were made by Deputies tonight and I intend to take them back, but a lot of progress has been made and while we have a lot of challenges, we have delivered a very good service to a large number of patients across the entire country. It is important that we work towards continuing to improve that service.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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We have had 13 years of Fine Gael in government. We have had 13 years of Deputies Harris, Varadkar and Donnelly as Ministers for Health who, in many instances, made our health services worse. The experience of health for many people under this Government means lengthy waiting times, hospital overcrowding and wasteful spending. Nowhere are the Government's failures so evident and so indefensible as in the cancer services. Expensive, lifesaving equipment lies idle because of staff shortages. That is indefensible. Cancer surgeries are now being cancelled because of hospital overcrowding. That is indefensible. Yet, we have Ministers attempting to defend the indefensible. Rather than owning up to their failures, they try to explain away the truth, that the Government has underfunded the national cancer strategy in three of the past five years. Worse still, when Deputy Cullinane of Sinn Féin set out the route to solving the crisis the Government created, it closed its ears.

There are solutions. They have been set out in this motion. They include properly funding the cancer strategy to improve detection and survival rates; ending the recruitment embargo; bringing our doctors, nurses and other healthcare workers home where we need them, in our hospitals; and funding the 1,500 additional beds that are needed to make our hospitals safe. Above all, however, we need a change of Government. We need a Government that will prioritise our health services and do everything possible and necessary to ensure that every single cancer patient has the best chance of full recovery. It has to be said, these folks are not up for the job. It is time to make way for those who are.

Ruairi Ó Murchú (Louth, Sinn Fein)
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Deputy Cullinane brought this motion forward because cancer services are not being properly funded. The Government has absolutely failed to fund the cancer strategy for five of the past seven years. As has already been said, we are dealing with expensive lifesaving equipment lying idle due to staff shortages. Cancer surgeries are being cancelled because of hospital overcrowding. It has been stated explicitly that the Government must fund this strategy, end the recruitment embargo and fund the 1,500 beds, but like many of my colleagues, I do not see any of this happening until there is a change of Government and a Government that is up for business.

The issue I will bring up with the Minister of State is an issue that blew up on Joe Duffy's radio programme and in the House, down to the work of Alison McCabe of Breastcare by Alison. It relates to post-mastectomy products and the fact that the HSE was considering halving the funding for them at one stage.

In fairness, it is one of the few times I saw this place operate to some degree. The Minister, Deputy Donnelly, got up and said that this was not going to happen, and he made a number of promises. I want the Minister of State to come back to me with regard to the review process. I want to make sure that people like Alison are involved in that particular review. I have been in contact with them. I was very lucky to be able to visit where she does absolutely great work for women who have been through mastectomies and who have dealt with huge pain that has been caused by cancer. We need to make sure this review is absolutely patient focused and that there is input from patients, and that we do not have any of the changes with regard to the application process that would put it back on those particular patients. We need to make sure that service providers, such as consultants, breast care nurses and mastectomy fitting professionals like Alison, are all happy to engage in this. We need that information and we need to make sure it happens, and that funding goes up.

Rose Conway-Walsh (Mayo, Sinn Fein)
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First, I want to acknowledge the brilliant work of the world-class surgeons, clinicians, consultants, oncology nurses and palliative care staff we have across this island. The cancer expertise we have on this island is absolutely remarkable. I also want to commend the work of the All-Island Cancer Research Institute and wish its representatives well in the high-level joint Euro-American forum coming up at the end of this month.

The fact of the matter is that the demand for cancer services is not being met in a timely and safe way because of the lack of political will to invest in the very basic infrastructure, particularly along the western seaboard. Target waiting times for cancer tests are not being met. Cancer surgeries are frequently delayed due to shortages of staffing, beds and theatre space. Expensive equipment lies idle. In Mayo University Hospital, the capacity in the oncology day ward cannot meet the current demand for the service. There are ten treatment chairs that can have a turnover up to 30 patients on any given day. This contributes to long delays for patients waiting treatment. The current staffing levels do not meet the demand for patient complexity. Those on maternity leave and long-term sick leave have not been replaced. There is only one toilet for all those patients. The lack of space and overcrowding is intolerable and risky. Why are we forcing staff and patients to wait for hours to have their treatment?

This Government and the previous one have failed to value community, district and regional hospitals. The cancer services are not properly funded, and the Minister of State knows that. We can have all the spin we want in this Chamber, but I am afraid the basics are not being met. We cannot use the expertise we have across the island or the very basic infrastructure that is needed to deliver it. I am asking the Minister of State for multi-annual funding to enable those experts to do their jobs.

David Cullinane (Waterford, Sinn Fein)
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Sometimes you have to own your own failures. I am looking at the countermotion from the Government. Not only does the Government not own its own failures, but in a breathtaking and very arrogant and deliberate way, it actually misrepresents what has been said by all those healthcare professionals who have come out very strongly with regard to the lack of funding for the national cancer strategy and, indeed, the Irish Cancer Society.

In its countermotion, the Government states that there has been an "improvement in survival rates in Ireland during the current National Cancer Strategy 2017-2026." The most recent data that was published was in 2019. That data is relevant to the previous strategies and not the current one. The Government talks about the 670 new staff that have been employed since the strategy was put in place in 2017, and that is correct. That came from the additional funding that was provided in those two years in 2021 and 2022. That shows what can be done, and those staff have made a real difference. Then, however, the Government chose not to fund the national cancer strategy in all the other years.

The Government talks about improvements in new treatments and new medicines and cancer therapies for patients and yet what it does not acknowledge are the very low access rates to new medicines when we compare it to other European countries. It talks about the development of new infrastructure for cancer since 2017. Of course, what it does not talk about is that in St. Luke's Radiation Oncology Network, we have one linear accelerator, which is closed, and a skin cancer machine that is only working part-time. In University Hospital Cork, we have a linear accelerator and CT scanner that have never been used. A new scanner has arrived in Galway but that still has not been used. All this equipment is lying idle under the Government's watch.

The Government talks about staffing and additional recruitment in areas. It talks about every specialty except, of course, the ones relevant to this debate, namely, radiotherapy therapists, radiation therapists and radiographers. We have a dire shortage. The Minister of State said he brought a proposal to the Minister. It is not just a proposal we need. We need funding. We need those areas to be funded and then delivered.

The fact is that we have had 13 years of Simon Harris, Leo Varadkar and Stephen Donnelly as Ministers for Health. They have made the health service worse. We see it every single day with people waiting in hospital corridors and on hospital trolleys, massive overcrowding and, as we know, cancellation of hospital appointments, including cancer procedures, because of the Government's failure to deal with overcrowding. Cancer services are not being properly funded, including in 2024. Expensive lifesaving equipment is lying idle. Cancer surgeries are being cancelled. Therefore, the solutions we are were putting forward to the Minister of State are to fund the national cancer strategy on a multi-annual basis; end the recruitment embargo, train more healthcare professionals and bring them home to have them work in the health service to ensure that we have the radiation therapists and radiographers we need to bring about improved outcomes for cancer patients; and fund the 3,000 beds we are asking the Government to fund - 1,800 hospital beds and 1,200 community beds - to really deal with the capacity problems in our hospitals. We need a Minister for Health who will stand up for people and stand up for cancer patients, children with scoliosis and those patients who are waiting far too long in emergency departments. After 14 years of three failed Ministers for Health, we need a change of direction.

Sinn Féin has a plan to deliver better health services. I, for one, cannot wait for the Minister of State's party to have the guts to go to the people. Let us have a general election. Let us have that battle of ideas. I hope that at the end of that, we will have a Government that will put cancer patients and people first because they deserve much better.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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Hear, hear.

David Cullinane (Waterford, Sinn Fein)
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It is not agreed.