Dr. Gabrielle Colleran:

To come in on the cancer strategy, it is a great strategy but the reality is that there has been no real funding for it until this year. For it to succeed and be implemented, there must be year-on-year support. The costs were clearly outlined at the time of the strategy's publication in 2017 but putting in the governance without the funding impairs success. There is a need for separate infrastructural funding. If the strategy is to be implemented properly, we need sustained funding. When I say infrastructure, I am talking about dedicated beds, theatres and diagnostics. Many of the recent increases in funding were required to increase resilience in the system that had been weakened by a lack of funding in previous years. That was particularly necessary as a result of Covid.

With regard to diagnostics and how to increase access within our public hospitals, it is often the case in public hospitals that staff are willing to do evening or weekend lists but that the hospitals cannot get funding to pay radiographers time and a half to provide the service. The public hospitals are told that staff have to do this at the basic rate. One cannot realistically expect staff to do that in the evening and at the weekend when childcare costs are higher. We have this awful situation whereby diagnostics are outsourced at a cost higher than that of paying agreeable rates locally. That is a short-term measure. The long-term and medium-term solutions are to get more radiologists and radiographers and to have more equipment. In the short term, however, we could make better use of the scanners and staff we have by doing lists evenings and weekends. The Haddington Road agreement and pay scales cause issues with such insourcing. Insourcing takes away the quality issues that sometimes arise with outsourcing and address the issue of being unable to compare to priors. As to the cost of outsourcing, it is cheaper to insource but we run into issues around pay scales. If we could get a bit more flexibility in that regard, we could do more insourcing in the short term. It is really critical that we do because the backlogs and waiting lists for diagnostic imaging are now very long.

I will make that point again with special regard to children. It is one thing to wait a year or two for an MRI scan when someone is 40 but if someone is four and waiting for an MRI scan for a scoliosis operation, he or she will not get on the waiting list for that operation until he or she has had an MRI. Many of these children are having trouble with running around the playground. They are breathless. It really impacts their quality of life and their schooling. As a State, we are really failing them. We just have to do better. It is just not excusable.