Pádraig Rice (Cork South-Central, Social Democrats)
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We have received apologies from Deputies Colm Burke and Sorca Clarke and Senators Maria Byrne and Teresa Costello. Deputy Donna McGettigan is substituting for Deputy Clarke and she is very welcome.

I advise members of the constitutional requirement that they must be physically present within the confines of the Leinster House complex in order to participate in public meetings. I will not permit a member to participate where they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask members partaking on MS Teams that, prior to making their contributions to the meeting, they confirm they are on the grounds of the Leinster House campus.

The minutes of the meetings of 14 October and 15 October have been circulated. Are they agreed? Agreed.

Today, the committee will consider issues relating to the health services for cancer. This is a very important topic and one we all care about deeply. It is important to note that cancer services were once the jewel in the crown of the health service and a good example of what could be achieved with sustained investment and political will. However, the focus has slipped a bit on the national cancer strategy and we are having this session in part to put a spotlight back on this issue, especially around the implementation and funding of the strategy. While patient outcomes have improved over recent decades, we are seeing delayed diagnoses, missed targets, regional variations and staff shortages, unfortunately. Hopefully, we can tease out many of these issues this morning, and the issue around funding for cancer services in particular.

The session this morning is divided into two parts. In this first part, we have the representatives of the Irish Cancer Society and, after a short break, we will have representatives from the HSE in the second part of our meeting. To commence our considerations of these matters, I welcome from the Irish Cancer Society: Mr. Steve Dempsey, director of advocacy and communications; Ms Amy Nolan, director of clinical affairs; and Dr. Michael McCarthy, the president of the Irish Society of Medical Oncologists

As a note on privilege, members and witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that may be regarded as damaging to the good name of a person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.

I invite Mr. Dempsey to make the opening remarks on behalf of the Irish Cancer Society.

Mr. Steve Dempsey:

I thank the committee for its time this morning. It is very much appreciated. One of the most important functions of the Irish Cancer Society is amplifying the voice of cancer patients for politicians. I want to start by giving the committee a flavour of some of the things we hear from our support line and in our daffodil centres. One patient asked for advice in relation to a suspicious lump noted during an endoscopy and they were told they would be waiting around one year for a biopsy. Another told us their scheduled surgery was cancelled due to overcrowding. They are still awaiting a new date nearly three months later. Another patient was waiting 18 weeks after surgery to commence radiotherapy. They had been given no date for planning an appointment and were really concerned. One 34-year-old patient had been informed they had a platelet count so low they were referred to haematology in their local hospital, and they got an email from the hospital to say they would not be seen for three months. Finally, a Ukrainian living in Ireland told us that they had bowel cancer symptoms. Due to long delays in waiting time for colonoscopies, however, they returned to Ukraine for a colonoscopy and subsequent surgery for bowel cancer.

In 2024, our nurses had 28,000 interactions like these with members of the public. It is no surprise given that one in two of us will get cancer in our lifetimes. Cancer is the leading cause of death in Ireland, and while our mortality rate is 13th out of 27 EU countries, we have the third highest mortality rate in western Europe. By 2045, twice as many people will have a cancer diagnosis compared with 2015. Survivorship is on the rise, which is great news, but it is rising further and faster in other countries.

The Irish Cancer Society feels that a complacent notion that we are doing very well has crept into the dialogue around cancer, and while cancer outcomes have improved in the past 30 years, we do regularly hear about delays, issues with staffing and other critical concerns. To give a flavour of those - these numbers relate to January to July of this year - more than 4,100 people were waiting more than the recommended 28 days for urgent colonoscopies, 5,800 women were not seen within the recommended ten working days at urgent symptomatic breast disease clinics, some 880 people did not start radiation therapy within the recommended 15 days, and not enough patients with pancreatic, prostate, breast or lung cancer were getting their cancer surgery within recommended timeframes.

These issues, while startling, are a direct result of the lack of consistent ring-fenced funding for our national cancer services. They indicate a dire failing, and it is not a failing of the strategy itself, the HSE or the national cancer control programme but, rather, a political failure of successive Governments which have not adequately funded the national cancer strategy. Given the complexity of funding streams and the cost of medicines, it is very hard, from our perspective, to say what adequate funding should have been for the current strategy that runs out next year. Our understanding is that over its lifetime the projections for the strategy should have resulted in incremental increases in funding year on year, and this would have allowed it to scale up and facilitate long-term planning in relation to staffing, infrastructure, capital expenditure and other things. The strategy received incremental funding in fewer than half of the past nine budgets, and this year we are told the funding will be allocated directly to REOs via a letter of determination outside of the budget. Weeks after the budget, we have no notion of the funding for next year’s cancer services and we may never get that detail. This is due to a new budgetary process in health which we are told is designed to empower the REOs. We have received reassurances from the Department that it is committed to a review of the current national cancer strategy and that there will be a follow-on cancer strategy after this one. It has also stated there is no desire to undermine the role of the NCCP in the next strategy, which is really good to hear. However, we do have a real concern that the good work that has been done to centralise cancer services in previous cancer strategies will be undermined in a push for regional subsidiarity.

It is worth reminding ourselves that the cancer strategies to date have worked. It is important to note that between 1994 and 1998 only 44% of Irish people were alive five years after a cancer diagnosis, but by 2018, after our first two national cancer strategies, that percentage had reached 65%. One of our messages is that centralisation has really worked. Patients have benefited from multidisciplinary services in one location, where cancer is treated in all its complexity with surgery, radiation therapy and medical oncology. For example, breast cancer surgery, which used to happen across 32 hospitals, is now centralised to eight cancer centres. That sort of specialisation really makes a difference in outcomes.

We also wish to point out a similarity, and some of the differences and divergence, with Denmark, which seems to be doing this quite well. We were in a similar position in the year 2000. In 2000, one in two people survived cancer in both Ireland and Denmark. Cancer survival rates in Denmark are now at 71%, and ours, while increasing, lag behind the Danes, at 65%. We have similar populations and healthcare expenditure relative to population. What has Denmark done differently? It has invested heavily in scanner systems. It has double the computed tomography, CT, scanners and more than five times the positron emission tomography, PET, scanners of Ireland. In the past few years, it has launched three times as many clinical trials as we have annually, and it offers quicker access to new medicines. Some 69% of new cancer medicines for breast and lung cancer are reimbursed in Denmark, compared with 39% in Ireland. Earlier this year, it launched its fifth initiative in the state's cancer plan. Critically, from our perspective, this included commitments to ring-fence the plan with €80 million in funding. Underpinning all this success is political consensus, and this is really where the battle with cancer is going to be won or lost in Ireland. From the 1990s onwards in Denmark, all major parties agreed that cancer should be a priority. The chief executive of the Danish Cancer Society stated, "Politicians must promise each other there is going to be a long, lasting partnership. And health leaders need to operate on a 10, 15, 20 year basis.”

What we want to discuss with the committee, and what we really want its help with, is to get an understanding of how funding will be allocated for cancer services in 2026, and what the role of the NCCP is in relation to the letter of determination to the REOs that will be sent out in due course by the Minister. We do not have a timeline yet. In the longer term, we want to build a political consensus to set up the next cancer strategy for success and that would include multi-annual ring-fenced funding to allow for long-term planning, staffing and capital expenditure. In particular, given there is a new role for the REOs in the budget process, it is critical that we get an understanding of the status of the NCCP going forward. It needs to be more than an advisory body floating somewhere between the HSE and the REOs. It has the expertise and knowledge to improve cancer outcomes in Ireland and we need to ensure it has the reach, resources and muscle to do that.

Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Mr. Dempsey. I now turn to members for questions. As discussed yesterday, we will take five minute slots for this first half. Our first slot is for Fianna Fáil. I call Deputy Daly.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank our witnesses for coming here this morning. Mr. Dempsey has laid out an interesting case. There is no doubt that it took significant political decision-making to centralise cancer services under the cancer strategy. A lot of capital was expended but it was repaid in heaps in better outcomes. Sometimes when we reform health services, we do not replace the services we remove with better quality services. In the cancer strategy, that happened and that is why there were better outcomes. I accept that.

One of the big questions is capacity. That is not just in the area of cancer; it is throughout the health services. We have had a growth in population of 1.2 million in the past 20 years and we have a projected growth of 100,000 a year going forward for the next 15 years, which is very significant growth in a very short period of time. We probably have the fastest-growing population in Europe. The question almost answers itself. Cancer is related to age, by and large. Of course, we get the terrible highlighted stories of younger people who get cancer, but the reality is that burden of cancer comes with older age. As one gets older, there is a higher risk. What type of investment are we talking about? Has the Irish Cancer Society done any analysis on that?

Mr. Steve Dempsey:

I thank the Deputy for his question. As I said in my opening statement, it is very hard for us to get a good sense of the econometric modelling required. We did have an indication some years ago about the planning around the current national cancer strategy, but it was not very detailed in terms of what we got, although the planning itself was detailed. As regards Deputy’s points about capacity and ageing, incidents are going to be rising, as is survivorship. What that means is cancer is going to put increasing pressure on the healthcare system overall. The Deputy might get a better answer from the NCCP in the session later today, but what we really believe is important is that the funding is multi-annual in nature and ring-fenced.

Martin Daly (Roscommon-Galway, Fianna Fail)
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Mr. Dempsey pointed out that he believes there is going to be a fragmentation with the new regionalisation of the HSE structure. Is there a fear we are going to lose that national co-ordination for cancer services?

Mr. Steve Dempsey:

That is the fear. It is a risk. I take in good faith the plans the Minister is trying to put in place. We do not have a lot of detail on it. If it was a detailed plan we could discuss it, but it is a bit notional. It would be good to know the plan in its detail to make sure we could mitigate against that risk.

Martin Daly (Roscommon-Galway, Fianna Fail)
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Mr. Dempsey compared Ireland and Denmark. It is important to have comparative countries of similar income and demography, as Denmark and Ireland have. I refer to investment in diagnostic imaging. We had a step change. There was a cancer strategy, but there was an issue around diagnostics, especially in primary care and in general practice. Covid changed that. Suddenly there was access to diagnostics, which seemed to be ring-fenced to the hospital service. I am not sure it was political turf we were talking about there. It seemed to be medical politics raising its head. However, it certainly worked very well, but there is a big demand there and there is surprise that there is a demand there. Most of it is absolutely appropriate, in my experience. Early diagnosis is so important in cancer because it reduces the burden of care later on and it raises survivability. What is Mr. Dempsey’s view of the diagnostic landscape at the moment?

Mr. Steve Dempsey:

My colleagues might be better placed to answer that.

Ms Amy Nolan:

We know there are not enough PET scanners across the country for the huge number of people requiring access to them. Dr. McCarthy can attest to this from his experience in Galway and Cork.

If you are in Limerick and need a PET scan, you have to go to Cork while all those from the geographic area around Cork are also accessing the same scanners. These PET scans are really needed for appropriate diagnosis at the early stage, which can then be followed up. There are definitely gaps in the system. When we had a cancer strategy that was effective and funded, there were some fantastic examples of things being achieved. I refer particularly to the acute haematology oncology service. Patients can call a designated line and have symptoms related to treatment assessed. That has been a fantastic outcome. It is only available Monday to Friday from 9 to 5 while, as we all know, cancer patients can be sick at any point in the day. That service needs to be extended but that can only happen if it is funded.

Martin Daly (Roscommon-Galway, Fianna Fail)
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My time is short. What Ms Nolan has said answers the question I asked. There is no PET scanner for the western region.

Dr. Michael McCarthy:

I am a practising oncologist in Galway and am talking on behalf of the Irish Society of Medical Oncologists, ISMO. Any examples I give come from that perspective. There is a PET scanner in the Galway clinic. That is private. There is a service level agreement that allows public patients from the region to access it. However, in terms of capacity and to talk to the Deputy's point about early diagnosis and early treatment, we regularly have to make decisions as to whether to start treatment quickly or to wait for the PET scan, which could harm the outcome. More capacity for PET scanning in the region would be very welcome.

David Cullinane (Waterford, Sinn Fein)
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I will first pick up on that issue of PET scanners. We do not have one in the south east either, other than the one in private hospital. From responses to parliamentary questions I have submitted, I know the business case for a PET scanner has been submitted by University Hospital Waterford. To reinforce how important these scanners are from the witnesses' perspective, they have said they are needed for appropriate diagnosis and for detection at the early stages. What are the potential consequences for patients if they wait too long for a PET scan? In Waterford and the south east, patients have to travel to Cork or Dublin if they cannot avail of the private PET scanner in Waterford.

Dr. Michael McCarthy:

There is clear data on the effectiveness of treatments commenced within a certain timeframe. The main value of a PET scan is that, when you are planning an aggressive and usually curative treatment for a patient, you do not want to put somebody through a treatment with that level of toxicity if their cancer is more advanced than we realised from other cross-sectional imaging. In that context, it is clear. I treat head, neck and cervical cancer myself and two common curative modalities for those cancers are concurrent chemo-radiotherapy. It would be better for the patients if, when the multidisciplinary team was planning care for individual patients, we knew we could get access to a PET scan within a week or two as opposed to the typical waiting time of four to six weeks.

David Cullinane (Waterford, Sinn Fein)
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I am looking at the opening statement from the Irish Cancer Society. It talks about 4,100 people waiting more than the recommended 28 days for an urgent colonoscopy and states that "Too many women are waiting too long for urgent breast clinic access". We saw a lot of data in that area emerge in the summer. Some 880 people did not start radiation therapy within the recommended 15 days. There is obviously slippage and areas where we need more staffing, more infrastructure and more funding. I have gone through the budget booklet upside-down and inside-out, put down parliamentary questions and raised it with the Minister but I have no idea what additional funding there is for any area in health under budget 2026. I have no idea how much additional funding is in the budget for the national cancer strategy. I note that, in the statement the HSE is to deliver later, there is talk about €20 million in 2025, which is great, but I want to know what is in the budget for 2026. Have the witnesses had any discussions with the Department? Can they shed any light on whether there is any additional funding? On that point, I have engaged with the Irish Cancer Society a lot over the last number of years and I know that multi-annual funding is really important for planning and to ensure there is certainty in relation to funding. A continuous pipeline of funding is really important. Will the witnesses enlighten us to how much additional funding is being made available, if they can? How important is consistent year-on-year investment in cancer services?

Mr. Steve Dempsey:

It is probably easier to take the last part first. From our perspective, it is absolutely vital. In terms of slippage, we have seen a strategy that had good intentions, was put together quite well and was quite progressive in nature being consistently underfunded due to the nature of how we decide our budgets. We need some mechanism to take the funding for strategies out of the voted expenditure and the politics of doing a budget so that clinicians like Dr. McCarthy can plan and so that the REOs and the HSE can put in place a plan to scale up the workforce, understand the capital limitations as regards infrastructure and put in place plans for capital expenditure.

David Cullinane (Waterford, Sinn Fein)
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I agree with all of that.

Mr. Steve Dempsey:

It is vital.

David Cullinane (Waterford, Sinn Fein)
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The key issue is the question of what new funding is made available each and every year. If there is a lack of transparency around that and we do not how much additional funding is coming and where it is going, we cannot make any genuine assessment as to whether we are investing in improved services. To go back to my fundamental question, we were clear on how much additional funding was to be given in 2025, 2024, 2023 and 2022. In some years, it was given and, in other years, it was not. I have no idea this year. It is a departure from standard practice. I assume the witnesses' organisations have been in contact with the Department to ask that question. Can they enlighten us as to whether there is any additional funding for the national cancer strategy in budget 2026?

Mr. Steve Dempsey:

We are in the dark too. We do not know if there is any additional funding. At this stage, it has not been made clear to us that there will be any dedicated additional funding. We have heard back from the Department with a bit more detail about the new process. What the Department is saying, which we have to accept is said in good faith, is that it wants to combat regional inequalities by giving authority and subsidiarity directly to the REOs, who will then be able to allocate the funds accordingly. That all sounds absolutely fine in theory but, in practice, what does it mean for a centralised approach to cancer? We do not know. That is our major concern.

David Cullinane (Waterford, Sinn Fein)
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I have one final point. That is okay in principle but not if it is being done to shirk accountability. It could be a recipe for disaster and we may never know where any money or additional funding is going in the health service. National strategies are national strategies for a reason. It should be crystal clear because, if there was additional funding, there would be political benefit for the Minister in saying so. I am suspicious as to whether there is any additional funding. I will leave it at that. I will take the matter up with the HSE.

Pádraig Rice (Cork South-Central, Social Democrats)
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I have a number of questions. To pick up on some of what Deputy Cullinane has said, I am hearing real concerns around funding shortages and a potential risk of fragmentation. As was said in the opening statements, cancer services used to be the jewel in the crown of the health service. I think about what could be achieved with sustained funding, a good strategy, political will, investment and co-ordination but we are seeing and hearing about issues around delayed diagnoses, missed targets, staff shortages and regional variation. There are real concerns there and it is really important that we tease them through. What I am hearing from the witnesses is that, with the new health regions, there is a risk of fragmentation. Is that their concern?

Mr. Steve Dempsey:

Absolutely. What is really needed is a plan. As with everything, things have been announced and changes have been made but nothing has been documented in full from end to end that would give us confidence.

Pádraig Rice (Cork South-Central, Social Democrats)
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What information has the Irish Cancer Society received from the Department regarding the role of the national cancer control programme in the budgeting process and the next strategy? What further assurances is it seeking?

Mr. Steve Dempsey:

The Department and the Minister herself have given us a really firm commitment that cancer is and will continue to be a priority. When this new approach, the REOs, was first announced in a kind of secondary question as part of the budget press conference, it gave everyone who is closely involved with cancer a bit of a shock. That is what prompted us to engage with the Department. What we got back from it was very good. It said it is firmly committed to NCCP and how it is constituted and said that it would like to increase its ability. The devil is in the detail, however. It is very easy to say you are committed to the NCCP but to disempower or defang it because you are also committed to something slightly different. That would be really detrimental. Because of the NCCP's staff members' knowledge and skills in respect of centralisation and the protocols required to do things correctly, they are experts in their field.

Abnegating responsibility to make decisions in relation to cancer services to REOs and avoiding the experts in specific areas is a risk, as far as we are concerned.

Pádraig Rice (Cork South-Central, Social Democrats)
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I would say to the Minister, show me your budget and then I will be able to understand your priorities. We are not really seeing the priority for cancer in the budget, unfortunately, and there is no clarity there, so that question about the prioritisation is an open one.

What role do you see for the national cancer control programme in those new HC structures? How should that work well within those structures?

Dr. Michael McCarthy:

I have worked with the NCCP in a variety of roles over the past several years and it seems very clear to me that, in terms of implementing the national cancer strategy fairly across the country, it is critical that the funding is distributed and guided by the NCCP. While the risk of distributing money directly to the regions could work in principle, I think we need a sustained focus on cancer and the cancer strategy if we want to face the challenges we have at the moment in terms of capacity. To have that delivered fairly across the country, there needs to be an independent voice.

Pádraig Rice (Cork South-Central, Social Democrats)
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Do you think the cancer strategy can be implemented in full by the end of 2026 or are there too many outstanding actions?

Mr. Steve Dempsey:

There is stuff in there that is really well intended and stuff in there that just probably does not necessarily belong in the overarching strategy. I am not sure how any strategy that just relates to cancer could bring about a big socioeconomic change like bringing smoking rates down to 5%. There are some elements - the more clinical elements, I think - where the focus could really be delivered but other things that are slightly vaguer and more amorphous as to how you would go about achieving them are well beyond the ability, I think, of an organisation like the HSE even, not just the NCCP, to deliver.

Ms Amy Nolan:

The lack of funding for recent years has really had an impact. It is impossible to achieve a strategy if it is not being funded. I think they have been hamstrung by that.

Mr. Steve Dempsey:

In fairness, they have delivered some results against their KPIs, so they are doing some stuff well. The NCCP has shown that its piloting programmes like the community oncology service in Glasnevin can take people out of the trial and out of the healthcare system overall. I think the acute haematology nursing service deals with 21,000 people-----

Pádraig Rice (Cork South-Central, Social Democrats)
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Briefly, what do you think should be the priority for the next strategy?

Mr. Steve Dempsey:

One of the things the Department is committed to doing is a review of the current strategy. In our mind, that is really an answer for the clinicians. Dr. McCarthy can give a specific answer to that. What I would like to see, as part of the next cancer strategy, is ring-fenced multi-annual funding.

Pádraig Rice (Cork South-Central, Social Democrats)
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We can pick that one back up. Next is the Labour Party and Deputy Sherlock.

Marie Sherlock (Dublin Central, Labour)
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I thank Ms Nolan, Mr. Dempsey and Dr. McCarthy for attending. I might start with Dr. McCarthy. I am conscious that a lot of what we are talking about here is the national cancer strategy, but one issue I want to raise is the inequality in access to cancer drugs. Last week we had Professor Michael Barry before our committee and he pushed back on the notion that there is an inequality in access to oncology drugs in this country. Dr. McCarthy might give me his assessment of where things are with that, public versus private.

Dr. Michael McCarthy:

This is a complex and multifaceted area, and the HSE has made great progress on this over the past several years. For example, since 2016, for solid organ cancers and medical oncology, about 125 new high-cost drug indications have been funded, and that is reflected in the cancer drug spend. In 2012, approximately €140 million was spent on cancer drugs and that rose to approximately €600 million in 2024. That is at list price; in actual cost probably 10% off that. That is all very positive and welcome and it was delivered by a lot of hard-working, well-intentioned people who showed great determination to get us this far, but, in terms of my own areas of practice, I treat gynaecological, head and neck and endocrine cancers. For example, it is my responsibility medically and legally to make sure I know what the cutting-edge treatment is for each cancer type. Just to list off some examples from the top of my head, there is toripalimab chemotherapy for advanced nasal-pharangeal cancer; cemiplimab for advanced basal cell skin cancer; cemiplimab for advanced cervical cancer; mirvetuximab for advanced ovarian cancer, which is coming in the next year to an earlier stage of the treatment; dostarilmab - the Deputy can tell me to stop if she wants - in second-line endometrial cancer. There are about 12 or 13 different drug treatments across my cancer groups that have a good evidence base for effectiveness, that are approved by the EMA, which gives an assurance that the trial was conducted in accordance with the regulations and that basic risk-benefit analysis-----

Marie Sherlock (Dublin Central, Labour)
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But they are not available here in the public system.

Dr. Michael McCarthy:

They are not available in the public system and I guess they are-----

Marie Sherlock (Dublin Central, Labour)
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And they are available in the private system, are they? Sorry; I do not mean to cut across.

Dr. Michael McCarthy:

In principle. If I see a patient with insurance that is in one of these categories, every time I refer them to a colleague in a private hospital they have got access to the drug, and I know plenty of cases where it was demonstrated to be effective. Just this past weekend, at the European Society of Medical Oncology conference, which is a European flagship conference for systemic therapy, it was announced that there were a range of breakthroughs across multiple cancer types. I would expect that many of those will get EMA approval in the months ahead. I think it is plausible to believe that private cancer patients with insurance will have access to those drugs in the months ahead. For public patients, however, I would expect that a fraction of those drugs will reach a HSE reimbursement decision within the next two to three years. Going ahead, therefore, I can see this gap in access only widening. Now, there are all sorts of subtleties to this debate and you have to add into that things like cost-benefit analysis and how we want to spend our money, but the reality is that they are treatments that, in my professional opinion, I would like to have available to treat patients with.

Marie Sherlock (Dublin Central, Labour)
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How big is this an issue not only for Dr. McCarthy's own clinical practice but indeed for his colleagues in that the drugs are not available in the public system? What share of patients, in his view, does this affect?

Dr. Michael McCarthy:

In my experience, I did not go down the full list, but recently, immunotherapy for concurrent chemo-radiotherapy and cervical cancer patients treated curatively has been shown to be beneficial and, similarly, for head and neck cancer for patients with curative intent. For my patients, I would estimate that maybe 20% to 30% of patients fall into that category-----

Marie Sherlock (Dublin Central, Labour)
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Wow.

Dr. Michael McCarthy:

-----where I have to try to figure out how to get access to the drug, whether asking companies to provide it free of charge or other mechanisms, but it is a growing problem.

Marie Sherlock (Dublin Central, Labour)
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As regards the national cancer strategy, I know the Irish Cancer Society produced figures a number of weeks ago which showed that three out of the 28 targets are not being met. Who is responsible for that? Is that the national cancer control programme or is it the head of the HSE? When we talk about more funding to cancer services, I am not clear if that is funding into the national cancer control programme or funding generally into services across the health sector.

Pádraig Rice (Cork South-Central, Social Democrats)
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Could we get a quick answer?

Mr. Steve Dempsey:

Ultimately, we would say that it is the Government that has failed to provide funding. There are KPIs that should be hit, but without the funding how are they going to be hit?

Marie Sherlock (Dublin Central, Labour)
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But where does the buck stop? Who is responsible for that not being met?

Pádraig Rice (Cork South-Central, Social Democrats)
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You are out of time on this slot, Deputy.

Dr. Michael McCarthy:

I will respond very briefly, if that is okay. The problem is that, in terms of the KPI and accessing the treatments that are available, the HSE, the people I work with, have worked very hard to try to deal with a rapidly rising demand on our services. I can go through that in detail later if the committee would like, but the issue, it seems to me, is that we need more capacity and more staff nurses. It is not clear to me that it is the NCCP's responsibility to supply us with all the staff nurses and clerical staff you would need to implement a service, so, ultimately, it would be with the HSE.

Pádraig Rice (Cork South-Central, Social Democrats)
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We are back to a Fianna Fáil slot, so I call Deputy O'Sullivan.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I am sorry for being late. I was listening upstairs. I will follow on from Deputy Sherlock's points about drugs. We had a meeting here last week, and I do not want to put words in Professor Michael Barry's mouth, but there was almost an impression given that the public system is performing reasonably well. Deputy Sherlock made the point there about people having access to drugs possibly through their private insurers and so on, but in one of his retorts, Professor Barry said that some drugs are available on the public system that might not necessarily be available to private patients at one stage.

Is that the case? How many? Could Dr. McCarthy quantify that?

Dr. Michael McCarthy:

In principle insurers have said publicly that any EMA-approved drugs will be reimbursed privately. There is a big list of about 14 different indications in my area of practice that fall into that category. In my experience, insurers are not living up to their promises. Some insurers are more comprehensive than others. The issue really is that the HSE is almost being outflanked by the pace of development of genuinely groundbreaking improvements in treatment.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I would like to talk about that groundbreaking progress. Let us be straight about it - quite a lot of new cancer drugs are orphan drugs. We do not have any separate reimbursement process for those drugs. Is a separate pathway something the Government and the Minister should be looking at?

Dr. Michael McCarthy:

I think so. It is important to have a robust reimbursement process so we can use taxpayers' money wisely but the reimbursement process in Ireland is one of the most robust internationally. When it comes to the reality of getting access to drugs, the Irish market, for commercial companies, does not make Ireland a priority if it is difficult for them to get drugs assessed for reimbursement. Not all the EMA-approved drugs should be made available, on a cost-benefit basis, but not all are assessed by our current process. In a substantial proportion of cases, the applicants withdraw their application before reaching a decision. If the reimbursement process could be streamlined to deliver faster decisions, that is the scenario in which insurers would come back on board with the public standard, as they used to do three or four years ago.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I am not trying to put words in Dr. McCarthy's mouth but he said we have a "robust" process here. Does he mean get we very good value for money or is the process lengthy and complex? What did he mean by robustness?

Dr. Michael McCarthy:

It is very stringent. We demand more information of commercial companies compared to other countries. It could be more transparent. I think the Department released a tracker that gives some information on drugs going through the process but it could do with an overhaul to make it easier to apply to and more transparent. At the moment, looking at it from a private perspective, if the drug company gets EMA approval for its drug in principle, that is available to private hospitals. In the public system, the first step is that a company needs to apply to the HSE for reimbursement. If it does not apply, there is no route for us to ever get access to the drug. A company does at some point apply for about 50% of the emerging drugs approved by the EMA. There are delays on both sides. If the process was easier to comply with, we would see a higher rate of application for reimbursement.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I have spent all my time talking about drugs; apologies for that. I might come back if there is more time later. On clinical trials in the Irish Cancer Society's submission, what is the genuine fear? I assume the society deals with pharmaceutical companies and industry the whole time. What is the genuine concern they express to the society in relation to attracting clinical trials to Ireland?

Dr. Michael McCarthy:

The big problem at a top level is trial set-up time. When you open a clinical trial, there is a lot of regulatory paperwork to be covered, there is ethical approval, and there are contracts that need to be negotiated and signed off by the hospital clinical trials team. The lead-in time between the company selecting a hospital as a site and the point at which the hospital can open a trial is too long in Ireland. It makes Ireland a poorly attractive place for companies which have better options in other countries with bigger centres and more patients available. It is hard for Ireland to compete in that setting.

Nicole Ryan (Sinn Fein)
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I thank everybody for being here. My first question is around breast cancer. Yesterday, we had Breast Cancer Ireland in. It did an informative talk about BreastCheck. One of the stark things it talked about was diagnosis for breast cancer is now as low at 15 years of age. It also spoke about the barriers in being so young and trying to get a diagnosis. Sometimes the barrier could be with GPs not believing you when you know there is an issue. Is there more of that? Is it becoming an issue?

Ms Amy Nolan:

We are seeing more people attending their GPs with complaints around lumps and referral to our BreastCheck clinics. There is a barrier when they get to the BreastCheck clinic because they are triaged as urgent or not urgent. As mentioned, there are huge delays in that area so there can be a diagnosis at a later-stage presentation. We are seeing younger people but we always encourage people to attend for their breast screening also. If there is a backlog in a system like this, we hear on our support line that patients are delayed and very fearful. It creates a huge amount of anxiety by the time they get through the triple assessment. It is important to say our clinicians and healthcare professionals are really working hard. Their feeling is it is all about KPIs across the hospitals and achieving them. They are trying to do workarounds to achieve those KPIs which does not benefit anybody. It does not benefit the system. Somebody needs to have chemotherapy and we cannot get them into the day ward because there is no chair in the day ward. So, we then try to get them into a bed in the hospital which does not make any sense for a day ward treatment. People are working around the system to achieve the KPIs but the capacity in the system does not exist.

Nicole Ryan (Sinn Fein)
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On HSE South West and statistics, the national statistic for breast disease clinics was that over 5,000 patients were not seen within the timeframe. In CUH, 335 patients were not seen within the timeframe of ten working days. What is the timeframe - I am sure it is broad - within which people are generally seen if they are not seen within ten days? How far does it range?

Mr. Steve Dempsey:

I do not think we collate data on that. We can only go on the publicly available data. Sometimes, we get anecdotal information that someone is waiting, as we said in the opening statement, up to three months. There is huge variation in what people say depending on where they are. There is probably selection bias in terms of the people who contact us and the same selection bias if members have constituents coming to them directly with representations. It is very hard for us to get a good sense of the vista across the country.

Nicole Ryan (Sinn Fein)
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The society gave a comparison with Denmark. What level of annual funding would the society need, in a blue-sky world, to get to where our EU counterparts are?

Mr. Steve Dempsey:

As everyone has said, a lot of issues relate to capacity across the entire healthcare system. In some ways, the Danish example is an unfair comparison because it has electronic health records. It starts at a different level from us. A lot of baseline analysis would be required, but electronic health records would be great start. We called in our pre-budget submission for a review of all the infrastructure across the country to understand the infrastructural deficit we currently face. We have not seen the kind of baseline work required. The figures we have been talking about around the budget relate to our understanding of how the budget should have ramped up over the lifetime of this strategy. I think we did a back-of-the-envelope analysis that it is about €80 million down from where it should have been. We were calling for at least €20 million. In some instances, you can call for it to be adequately funded but it would not be possible to fully spend all that money because we do not have the staff to get people on board and we do not necessarily have the capacity elsewhere to facilitate what is required to do that.

Nicole Ryan (Sinn Fein)
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The baseline stuff is not done and therefore it is really hard.

Mr. Steve Dempsey:

It is very hard but the baseline would be a great start as part of the review for the next national cancer strategy.

Michael Cahill (Kerry, Fianna Fail)
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I welcome the witnesses. In regard to cancer services in Kerry, a priority for the hospital and for Comfort for Chemo Kerry is to develop a permanent oncology and haematology unit on the grounds of University Hospital Kerry, UHK. The number of patients requiring chemotherapy are increasing year on year. Last year, over 5,000 patients were treated in UHK and the facility there does not have the capacity to cope with increased demand. It would be of huge benefit to Kerry patients and their families if such a facility was on the grounds of UHK. They would not have to travel to Cork and many other locations for treatment. Does Dr. McCarthy have anything to add to that or does his organisation have any involvement with the campaign that is going on?

Dr. Michael McCarthy:

While I am not directly involved in the campaign it is a common problem across the country. In the north-west region we also have satellite units, in Castlebar and Portiuncula. One of the big challenges we do not have good solutions for yet is that medical oncology and radiation oncology and surgery are increasingly becoming more sub-specialised, because the pace of change in what the standard of care should be for different types of cancers is changing quickly. One of the concerns is how we make sure the patients from County Kerry or Dingle get access to that same level of expertise in terms of decision making as people who are living in Wilton in Cork. That is a real challenge. We have strong multidisciplinary teams set up around different cancer types and linking in peripheral sites with one of the designated cancer centres is critical. We cannot have a designated cancer centre in every county and the national clinical programmes, NCP, model of care so far has been to build up the expertise in the designated cancer centres and then those consultants travel to other sites. It often comes up as a question when a hospital becomes busy enough, when is the tipping point reached that permanent on-site expertise is more appropriate. It is a commonly-asked and good question.

Michael Cahill (Kerry, Fianna Fail)
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I have one other question. Does Dr. McCarthy think enough is being done to improve Ireland's access to new cancer medicines and clinical trials etc?

Dr. Michael McCarthy:

There has been incredible work by lots of good people in the NCP and the HSE to deliver access to new cancer drugs. I mentioned earlier there have been 125 new approvals for reimbursement for high-cost drugs since 2016 and that is very welcome. The challenge is the pace of change internationally, which is a good problem to have. There are more and more treatments coming out more quickly that are demonstrating effectiveness, that have evidence, are becoming European Medicines Agency, EMA, approved and are ending up in international expert consensus guidelines on how to treat cancer. The HSE is approving them at this rate through a lot of hard work by a lot of people. The rate of approval of new drugs is shooting past that. How do we capture that? How do we target our money? How do we get the drugs that work best to the patients who need them? These are the challenges.

Pádraig Rice (Cork South-Central, Social Democrats)
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Thanks very much. There are three speakers remaining, Deputy McGettigan, then Senators Clonan and Conway.

Donna McGettigan (Clare, Sinn Fein)
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I thank the witnesses for coming in. At the beginning of the discussion they talked about patients. I will talk about another patient. His journey started over five years ago. He had pancreatitis at the time. He started to get really yellow and lost a drastic amount of weight. He could not eat. He could not sleep because he was constantly itching. He had been sent to different hospitals. There were delays in endoscopes and appointments. Hospitals kept sending him home. He was extremely thin and should never have been sent home. One doctor said there were signs of cancer, but a doctor in a different hospital said no, there is not. When the witnesses spoke earlier about electronic health records, something like that probably could have helped him. His family and friends could all see something was seriously wrong and there seemed to be some sort of cancer eating this man up. He was sent home from hospital once again but eventually was brought up to Dublin, had an operation and was told that he had stage four cancer and had six months to live. That man was my husband. He passed away four years ago because of this. There was no accountability there for us as a family. Nobody has answered our questions as to why this has happened. I am sure this is replicated around the country. He is not the only one to have suffered this.

In terms of my colleague, Deputy Cullinane, saying earlier that there seems to be no funding in the 2026 budget, what do the witnesses think the new strategy can do if no new funding is made available, if they do not know where new funding is coming from or if there will ever be any new funding? What do the witnesses think could be put in the new strategy that could help these kinds of cases?

Dr. Michael McCarthy:

This is a story that I hear too often. If there is no dedicated funding put into a strategy and if the NCP is not there to implement that strategy nationally then it is likely services will decline over time. A good model for these types of situations is a rapid access clinic. We have these established for several different types of cancer.

An example from Galway is a model for these types of situations where, if a patient sees their GP and there is any concern he or she might have lung cancer they can get an appointment to see a specialist consultant within a few weeks. The patient can attend on that and get a bronchoscope, CT scan, an ultrasound or whatever type of diagnostic that may be needed to make an assessment as to whether somebody had cancer or not. Those results automatically go on to the lung cancer multidisciplinary team, MDT, to be discussed with the whole team of consultants, surgery, meta-oncology, radiotherapy and respiratory. If there is a finding of cancer and treatment is required the patient is automatically then booked into what we call a joint thoracic clinic, which is an outpatient clinic, where there are medical oncologists, radiation oncologists, surgeons and all the people who would need to be there to make decisions for the treatment plan. The whole thing works in a very smooth way so for anybody where there is a suspicion of lung cancer, we have a very clear model of how we should deal with that.

There are also rapid access clinics for prostate cancer. It would be good to see similar clinics set up into the future to prevent things like this happening. Centralised care with dedicated resources where a GP, whether in Buncrana or Tipperary, knows if they are worried about a gastrointestinal, GI, cancer they can send the patient to a GI rapid access clinic, for example. That is a good model of care we should look to develop.

Mr. Steve Dempsey:

In terms of the Deputy's actual question about what we can do without the funding, she can ask the NCCP directly after we are done because that is what they have been living with for the past few years. Also, I am very sorry to hear about your husband.

Donna McGettigan (Clare, Sinn Fein)
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That is okay. It is just one of those cases that happens and it is replicated. However, I think the electronic health record will help. One hospital is not talking to another hospital and that is a bit issue. Once again, we are not talking about going out to court but there has to be somebody there to say sorry. That is not happening because nobody is taking responsibility.

Tom Clonan (Independent)
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Apologies I was not here earlier as I was at the disability matters committee meeting. If any aspect of my question has already been dealt with I apologise in advance. As we have heard, every family in Ireland has been impacted by cancer. I lost a sister to breast cancer when she was 43. She was very unlucky as she had a very aggressive tumour. My mum passed away from cancer. I had an encounter with it myself and I was very successfully treated by Dr. Pat Ormond in St. James's Hospital.

I am very grateful for that. In all of our experiences with those pathways, two of which were in St James’s Hospital, the oncology teams were absolutely amazing. In particular, the psychological supports that my sister got they were really useful, especially with the long goodbye, when a person knows she is going to die and leave two young sons. Ironically, one of them is now doing postgraduate medicine. Go figure. I hear it reiterated, and this is not a criticism of the teams, that we have suboptimal outcomes for cancer in the Republic, that by European standards we have less positive outcomes than they have in other European countries. Can the witnesses comment on that generally? Is there something specific we can do as public representatives to address that or to try to ameliorate that?

Mr. Steve Dempsey:

It is worth going back over what we said about Denmark at the start. They were in a similar position to us in 2000. While survival rates in Ireland have improved, the Danes have improved them far further and far faster than we have. They have taken a number of steps and we outlined some of them in the opening statement. What it really comes down to is there was political consensus to have a centralised strategy and to fund it on an ongoing basis. Once the politicians came together and made that agreement, that allowed the clinicians actually to operate on a longer time line. They had certainty in terms of what they were delivering and their plans for five, ten, 15 and 20 years which is something that we are not doing at the moment. From our perspective, the biggest structural difference that could be made in relation to improving cancer outcomes across the board in the country would be that hardening of political will to really make sure we can put a strategy on a funding level so that there is a level of certainty there.

Ms Amy Nolan:

What the Senator said there about psycho-oncology and what his sister availed of in St James's Hospital, that is a model of care that the NCCP is working on at the moment. Unless it gets funding to achieve that it will not be able to achieve it across Ireland. As the Senator knows, it is so important.

Dr. Michael McCarthy:

I had the direct experience, in the past three to four years we went from having no psycho-oncology team and relying on liaison psychiatry with no special interest, to having now a fairly well-established team as per the model of care for psycho-oncology. If the NCCP was not in control of the funding for that and the strategy for that, if it did not develop the model of care, I wonder where we would be today. Overall, outcomes are improving. One point I would make is that the rate of change, of progress in terms of international research into access to medications and how well they work, is happening very quickly. The HSE is doing great work in many aspects of delivering the care. However, we are being outpaced by the international pace of development of research into anticancer drugs. The other pressure that we struggle with on a daily basis is rising demand on our service.

Tom Clonan (Independent)
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Of course, yes.

Dr. Michael McCarthy:

For example, in Galway in 2016 we had 13,000 patient visits per day ward. Last year it was closer to 23,000. Where are the resources coming from to ensure that we can continue to deliver the same quality of care to more and more patients?

Tom Clonan (Independent)
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In the 30 seconds left, no pressure, aside from the Danish model, on medical leadership, should we have a greater emphasis or greater autonomy for medics? My own bias is that all of our specialties should be medically led. There is an element of managerialism in the HSE that is getting in the way of some of this progress.

Dr. Michael McCarthy:

There is a role for medical oncologists in the heart of the planned leadership programmes in the NCPE and the NCCP and in the development of strategies going forward. I can certainly say that medical oncologists across the country would be happy to step up and do so in many ways through a range of organisations to take on voluntary roles of leadership. However, we do not get close to control of any budgets which is the issue.

Martin Conway (Fine Gael)
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I acknowledge the fantastic work that the Irish Cancer Society does, particularly the nurses and the daffodil nurses and so on. This committee, in its previous iteration, was very supportive of the asks from the Irish Cancer Society. I would like to think that some progress has been made even though much progress clearly still has to be made. Underfunding is a challenge. It is not the only organisation to suffer that but ultimately it is the patient who suffers. That is where we come in to try to see if we can bridge that gap.

My question relates to operations, specifically around the volunteer drivers. The volunteer driver programme is a great programme. I presume it is funded out of fundraising resources and it is run efficiently. It has been brought to my attention that an 85-year-old lady in Thurles is going for CLL treatment. She was going once every two or three months at UHL. That is now every three weeks. As the witnesses can appreciate, at her age a journey of over 150 km in the morning was quite arduous. They opened a satellite in Nenagh and the medical staff advised this lady that she could get her infusions and so on in Nenagh, which is about 70 km from her home. However, for some obscure reason which seems inexplicable to me, the volunteer driver scheme is not facilitating her. They are quite happy to bring her to Limerick but not to Nenagh. That seems bizarre, given that we have all lobbied to see satellite centres opened and that there is a satellite centre in Nenagh which is willing to give her the treatment. However, she cannot get there. What is the logic for that? Can the witnesses offer some explanation as to why in God's name an 85-year-old woman will be brought by the volunteer drivers to Limerick but not to Nenagh?

Mr. Steve Dempsey:

We can, Senator, so thank you for the question. It is worth noting overall, as he said, the transport service is run very efficiently. It is run out of the money we get from fundraising. We are seeing a 20% increase year on year in the growth in demand. It is a challenge to keep it at its current level. In relation to the particular person the Senator is talking about, we are aware. I think I know the case he is talking about. They were attending a healthcare facility that we did do drives to. We were driving to UHL but Nenagh is not currently a key partner. We have agreements and I can share the list of who are key partners. They were no longer receiving chemotherapy was our understanding and they were no longer going to a key partner. We do not have the drives and the administration function set up to do that.

Martin Conway (Fine Gael)
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No, just before you go any further, it would seem to me from the information available to me that they are getting the same treatment in Nenagh that they were getting in UHL and that you were prepared to drive her to UHL. Now we are down to an issue as to whether the facility in Nenagh has been recognised by the Irish Cancer Society or not.

Mr. Steve Dempsey:

No, it is up to the facility to agree to be a key facility.

Martin Conway (Fine Gael)
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My understanding is that Nenagh is prepared to be that so where is the blockage? For people looking in here today that is inexplicable. It would come across as unnecessary red tape for an 85-year-old woman who the system to be fair to it, and we criticise the system a lot, in this case is facilitating to have a better quality of life at her age and have her treatment nearer to her home. From a carbon footprint perspective, from every perspective, it makes sense. Yet, the blockage seems to be coming from the Irish Cancer Society's end. That is not acceptable to me.

Mr. Steve Dempsey:

What I was about to say is that once we heard about this case we met with the NCCP to discuss the current setup for the treatments for patients in satellite sites like Nenagh. Our head of service operations spoke to the patient advocate at Nenagh Hospital and at UHL to understand the current lay of the land and the options for patients in the area. We are very open to changing it. We are openly talking to everyone now so that we can facilitate this patient and other people who want to go to Nenagh.

I have not heard any update that Nenagh has decided to become a key partner. I will go and check that afterwards.

Martin Conway (Fine Gael)
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Would there be a reason why it would not?

Mr. Steve Dempsey:

I am not aware. The Senator would have to ask the hospital itself.

Martin Conway (Fine Gael)
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Perhaps the Irish Cancer Society might come back to the committee with a note and an update on this issue because time is of the essence given this lady's age.

Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Senator. That concludes our questions. I thank the representatives of the Irish Cancer Society for their engagement this morning. I also thank the society for its ongoing work, including its advocacy, research and policy work. I know there is a whole team that does great work and keeps us well briefed. Really good research, supports and services are provided to people across the country. It is greatly appreciated by me and the other committee members. We will now take a break for five minutes to allow the witnesses from the HSE to come to the meeting. Is that agreed? Agreed.

Pádraig Rice (Cork South-Central, Social Democrats)
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We will now resume our consideration of matters relating to cancer services. I welcome Mr. Damien McCallion, deputy chief executive of the HSE, and his team. I invite Mr. McCallion to make his opening remarks on behalf of the HSE. We have received the full statement, so we will just get the headline remarks.

Mr. Damien McCallion:

Good morning. I thank the committee for the invitation to discuss the current issues relating to health services for cancer. I am joined today by Professor Risteárd Ó Laoide, national director of the national cancer control programme, NCCP; Mr. Tony Canavan, regional executive officer, HSE West North West; Fiona Murphy, CEO, national screening services; and Dr. Triona McCarthy, assistant national director of our national cancer control programme.

Cancer is one of the most significant health challenges we face as a country. Each year more than 24,000 people are diagnosed with invasive cancer and that number will continue to rise over the next two decades as our population grows and ages. One in two people will experience cancer during their lifetime. These facts underline the continuing need for a strong, well-governed national approach to cancer control.

Turning to the national cancer strategy implementation, the delivery of cancer services has had clear policy direction provided through the three national cancer strategies published in 1996, 2006 and 2017. Each strategy aims to set out the steps required over the subsequent ten years to deliver a cancer control system that meets the needs of the people of Ireland. The continued focus on a data-driven and evidence-based policy, that considers the needs of the entire population and applies the best, innovative approaches to cancer control, is essential to ensuring we continue to build on the strides made over the last 20 years in cancer mortality and quality of life. It is the intention of the Department of Health and the HSE to review the implementation of the current cancer strategy and commence the development of a new strategy in 2026.

Moving to funding, cancer services are funded in a number of different budget lines. It is included in the HSE's drugs budget, and in lines for cancer screening, hospital treatment, primary care, palliative care, support services, diagnostic services and community aids and appliances, and indeed in other areas like primary care. In addition, there is specific funding for the current national cancer strategy. Since it was published in 2017, approximately €90 million has been put into cancer services, including €20 million in 2025. This investment has supported the creation of over 800 posts across the public cancer service, including approximately 120 consultant doctors, 300 nurses and 300 health and social care professionals.

In terms of implementation, the HSE has now established six health regions in the HSE and it is important they take on responsibility for the implementation of the national cancer strategy, under the oversight of the NCCP. As we move into 2026, with further autonomy for the health regions in the allocation of resources, the national service plan will set out very clear targets for the health regions in performance across our key indicators for cancer.

The NCCP will be strengthened going into 2026 with a primary role in the planning of cancer services, enabling performance oversight and providing assurance in relation to the quality of our cancer services. In addition, where key strategic decisions need to be made such as in the placement of new services, deployment of digital solutions or development of national solutions such as the acute haematology oncology nursing service, these will be directed by the NCCP.

In the interest of time, I will not go through the improvements in cancer services but I will give headlines of some of the areas around rapid access clinics, cancer surgery being centralised with better outcomes, guidelines, pathways, various models of care, new radiation oncology facilities in Cork and Galway, molecular diagnostics and cancer genetics services, substantial investment in cancer medicines and also in areas like the acute haematology oncology nursing service, the alliance of cancer support centres and the cancer information system that has been deployed in 22 of our 26 hospitals, with the remaining to be rolled out. There is a huge amount done but recognition that further work is needed.

Screening services are reshaping cancer-related screening and care through the delivery of its five-year strategic plan, which my colleague Ms Murphy can talk to later, to strengthen quality, equity and accessibility across all our screening programmes. The four programmes continue to make an important contribution to the reduction of cancer-related deaths and illness in our population. Through CervicalCheck’s delivery of high uptake of HPV cervical screening, Ireland is on track to eliminate cervical cancer by 2040.

However, there are challenges and the committee will have heard some of these earlier. Cancer services in the country do face many challenges. We want to ensure the best treatments are available to patients as early as possible, by enabling timely access to innovative and targeted therapies. We want to support people living with and through cancer with improved follow-up pathways, and more supports for the psychological impact of cancer and the many physical effects of cancer and its treatment on survivors of cancer.

Increased population growth, heightened awareness of symptoms and improved detection are all placing significant demand on existing services, as evidenced by performance data. The development of capital infrastructure capacity for cancer services is one key enabler to improving the timeliness of cancer diagnosis and treatment. While there have been some excellent advances, such as the new radiotherapy centres in Cork and Galway, we recognise there is a need to invest in our equipment.

Our estates teams are working with the national cancer control programme and the relevant health regions to address this as part of our national equipment plan. We are working on theatres, oncology day wards and on our overall diagnostic capacity. Our national radiology strategy, which will be endorsed under the 2026 national service plan, will allow us to plan forward on that basis.

In summary in the interests of time, looking to the future, Ireland’s experience over the past two decades has shown that national leadership in cancer control delivers measurable results. Regional delivery can best succeed when guided by clear national standards through the national cancer control programme. This will protect the coherence of cancer policy, ensures equity across regions and supports the regional structures now emerging within the HSE to deliver care within a single national framework. The next national cancer strategy will provide the opportunity to reinforce that approach. We are a relatively small country and it is critical that we maintain a national focus when planning cancer care.

I want to acknowledge the commitment of our staff across our cancer control services, including the staff providing cancer services in hospitals community and voluntary services. Their dedication and commitment to quality and to delivering the best care they can for patients, often with mounting challenges, demonstrates the commitment that has facilitated the improvements in cancer care and survival in Ireland.

Pádraig Rice (Cork South-Central, Social Democrats)
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I will now open the meeting to members. The first slot is Fianna Fáil and Deputy Daly.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank everyone for coming in. I appreciate it. Taking into account what was said at the previous meeting and what Mr. McCallion said in his opening statement, has there been actuarial modelling on the needs going forward based on age profile, the growing population and the increasing burden of cancer? Because people are surviving longer now with cancers, we will have to provide more services and there are more layers of treatment. That is the first question.

Mr. Damien McCallion:

I will ask Dr. McCarthy to take that in terms of our population health planning.

Dr. Triona McCarthy:

From a population perspective, we have had a 1 million-plus growth in the population size overall since the establishment of the cancer control programme. It was particularly in the over-65s, where that has been an the 80% growth. As well as that, while incidence rates may be decreasing in many cases, the numbers of people we have to treat needs to be accounted for. The complexity of treatment also has to be taken into consideration. It is important to emphasise it not just the population. Particularly when we are looking at chemotherapy or systemic treatments, when we look at our cancer register data we are looking at the numbers of people who are diagnosed with cancer. Thankfully, 220,000 people are living with cancer but many of those people are being treated again and again for recurrences and surviving. That complexity is being factored into the capacity needed in that part of the system as well.

Martin Daly (Roscommon-Galway, Fianna Fail)
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Has modelling been done on that? Is there active modelling?

Mr. Damien McCallion:

There has been modelling done on systemic therapy capacity, yes.

Martin Daly (Roscommon-Galway, Fianna Fail)
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That is good to hear. I am sorry, we have tight time.

Mr. Damien McCallion:

To make one brief point, when we look at some of the issues around diagnostics, theatre and so on, they are impacted by the wider pressures so we also have to reflect that to understand how we get access to theatres and beds so that people can access care.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I understand that. It is true. The population is growing by 90,000 a year so we have another million to look forward to in the next 12 years.

Another issue concerns me. The national cancer strategy was a huge success. It took considerable political capital to deliver it to divest some hospitals of cancer care and to centralise it. Now we are seeing decentralisation again. I do not doubt that the regions will try to provide the best services it can but we know in the west of Ireland that we do not get all the resources that we should, and that is a fact. Mr. McCallion stated that the CCP will have "a primary role in the planning of cancer services, enabling performance oversight". We know that unless someone has budgetary input and executive control, those models do not work. How does he see see that relationship working? That is for Mr. McCallion and Mr. Canavan.

Mr. Damien McCallion:

I will start with that and Mr. Canavan can come in. Basically, with the new health regions, if you look at the factors that influence the performance of the system, whether it is access to theatre for surgery, having sufficient daycare beds or any aspect of cancer care, many of those are impacted by the wider pressures on the system. If appointments for surgery are cancelled, it is often because of emergency care pressures. Hence, the value of the regions would be to try to look across the entire system to make sure the cancer access is there. The NCCP will drive that new strategy and it will own that strategy with the Department of Health. It will be commissioned through the Department. From the HSE’s perspective, however, the NCCP will be at the fulcrum of it.

In the cervical plan process, our intention is that it will provide clear guidance to the regions on what it sees as the national priorities. The regions will develop their plans as part of the national service plan and they will then provide assurance around that to make sure the priorities are being addressed. That will be very important.

Martin Daly (Roscommon-Galway, Fianna Fail)
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It will be a really important relationship because we have seen issues around governance and joint management that have not worked in the past so we need to be reassured about that. I do not mean to cut across but I would like to ask a specific question and Mr. McCallion will know the time is short.

Mr. Damien McCallion:

Sure.

Martin Daly (Roscommon-Galway, Fianna Fail)
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We do not have a PET scanner in the western region. I know there is access to a private scanner but that is not the answer to our population’s needs.

The other question on the west, for Mr. Canavan, is whether there are any plans to develop further outreach oncology day services such as into Roscommon University Hospital. We have a facility there in the west that is under-utilised. It might be something that could be done to bring cancer care out. Everyone cannot funnel to Galway.

Mr. Tony Canavan:

We have very significant plans for the development of cancer services across the whole region. It involves all of the hospitals with their particular roles and with a specific role for the cancer centre in Galway. What we have seen is those facilities are undergoing pressure, as we referred to earlier, so we do need to look at other options in the community and possibly in other centres as well. They absolutely have to be consistent with the delivery of best care and the provision of care in the most appropriate setting.

Martin Daly (Roscommon-Galway, Fianna Fail)
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One hundred percent. That is the bottom line. Thank you.

Pádraig Rice (Cork South-Central, Social Democrats)
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The next slot is Sinn Féin and Deputy Cullinane.

David Cullinane (Waterford, Sinn Fein)
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I am sure Mr. McCallion is aware of the phrase “show me the money”. In his opening statement, he referred to budget 2025 and €20 million in additional funding for the national cancer strategy. Nowhere in his opening statement did he mention any additional funding for new measures for budget 2026. We have been asking about this. We have asked the Irish Cancer Society. It is in the dark. Nobody seems to know how much additional funding is in the budget for any part of the health system but specifically for the national cancer strategy. Can Mr. McCallion tell me today how much additional funding is in the budget for the national cancer strategy for 2026?

Mr. Damien McCallion:

When we look at the total expenditure on cancer-----

David Cullinane (Waterford, Sinn Fein)
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I am not asking about total expenditure. I am asking about additional funding for new measures. I do not want any other answer. It is either "Yes" or "No". Mr. McCallion either knows what it is or he does not. It is for new measures and new funding. Reference was made to €20 million for 2025. What is the comparable figure for 2026?

Mr. Damien McCallion:

That process is still under way. We are still waiting on our letter of determination. We will not have a figure for the committee today. When we look across the total expenditure, cancer accounted for €1.5 billion of new money in the health budget this year. Some of that will go to existing pressures and some will go to enhancement of services.

David Cullinane (Waterford, Sinn Fein)
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I am not asking Mr. McCallion about all those other measures. We will talk about those later. I am talking about the national cancer strategy. It is deeply disappointing that we do not have a figure. It is suspect that we do not have one. There is a fear that there is no new money for the national cancer strategy this year. Others have spoken about a fear of decentralising. I do not really share that fear. There is a role for the regions but there is also a role for national strategies and experts who feed into those national strategies and steering groups. The people who sit on those steering groups do not know what is happening. How can they plan if they do not know what the line funding is?

Mr. Damien McCallion:

I will say a couple of things. The cancer control programme will be strengthened through our new model with the regions. As the Deputy has said, the regions effectively will have autonomy but the cancer control programme will set out clearly the parameters and what needs to be improved in outcomes for patients, whether it is access to rapid access clinics or access to diagnostics, because-----

David Cullinane (Waterford, Sinn Fein)
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If a person is a member of the Irish Cancer Society, or perhaps is a person who has cancer, none of the data that was presented to us this morning answers the fundamental question as to where additional resources will come from. We learned this morning that from January to July of this year, 4,100 people were waiting more than the recommended 28 days for urgent colonoscopies. What is in the budget for this year that will improve that?

Mr. Damien McCallion:

On colonoscopies, I will ask my colleague Mr. Tony Canavan to come in here in relation to-----

David Cullinane (Waterford, Sinn Fein)
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I am asking Mr. McCallion about increased funding. I am talking about funding. What matters here is what is new and what additional money will be put in. We know there is a growing population and increased demand. When we already have 4,100 people waiting more than 28 days for a colonoscopy, I want to know what is in the budget for next year that will make a difference. Point to me where the additional funding for new measures is in that.

Mr. Damien McCallion:

I will say two things. A lot of that improvement can come within the resources we have. We need to use that better. We know we have agreements-----

David Cullinane (Waterford, Sinn Fein)
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I am talking about new measures and new money.

Mr. Damien McCallion:

I am sorry but it is really important to look at this. In terms of the funding streams, the regions will be allocated the budgets. Within their budgets that are there today, we believe there is scope for improvement in the outcomes and in responsive services. That is one aspect. Within that €1.5 billion-----

David Cullinane (Waterford, Sinn Fein)
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I cannot accept that if already this year, 4,100 people were waiting more than the recommended 28 days for an urgent colonoscopy. A total of 5,800 women were not seen within the recommended ten days at urgent symptomatic breast disease clinics. Again, this was from January to July. A further 880 people did not have radiation therapy on time. Those people were all waiting within the existing budget the HSE has and Mr. McCallion wants us to believe that next year, magically, this will all change without any additional resources.

Mr. Damien McCallion:

There will be additional resources but in terms of the process we are in at the moment, we are waiting in the HSE on the letter of determination we will get. That will set it out. We will then develop a service plan. The service plan will have clear direction for cancer priorities from the national cancer control programme. Those will be allocated to the health regions and they will have to come up with their plan to address-----

David Cullinane (Waterford, Sinn Fein)
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So, in every other year-----

Mr. Damien McCallion:

-----some of those other issues-----

David Cullinane (Waterford, Sinn Fein)
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Mr. McCallion came into the committee this morning and reaffirmed the €20 million figure for last year. I have been a health spokesperson since 2020. In 2021, we knew what funding was going into the national cancer strategy and in 2022, 2023, 2024, and 2025. This year, we are being told zero - silence. If Mr. McCallion cannot tell me a figure, I can only surmise that there is no additional funding going into it. There is no transparency. The reason we have national cancer strategies is so that we can all see exactly what is being done, where the money is going, what it is being spent on and how much new money is there. All I am getting today is, "We will do our best with the existing money we have and maybe we will do better" and "There may be new money but I cannot tell you what it is".

Mr. Damien McCallion:

There is a timing issue, which is the first thing. We have not got our letter of determination yet, from the HSE's perspective-----

David Cullinane (Waterford, Sinn Fein)
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Was that needed in previous budgets?

Mr. Damien McCallion:

The letter of determination will indicate that cancer will be a priority within that. Within our service plan,we will identify between the NCCP and the regions where we will be investing and what the new funding will go to. We are trying to move to a model that is focused on outcomes and on how can we improve rapid access clinics and improve our day wards. Each region will develop a plan around that and we will be able to come back to the committee-----

David Cullinane (Waterford, Sinn Fein)
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To conclude, I have spoken to very senior officials in the Department of Health and they have told me that the vast majority of the €1.5 billion of additional funding was for existing levels of service. There is very little, if any, new money for new measures. There needs to be a degree of honesty here. There is no point having sessions where we want to talk about additional supports and additional services and ask where is the additional money if there are no answers - none. There are no answers here today in relation to where any new money for cancer services will come from.

Pádraig Rice (Cork South-Central, Social Democrats)
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I have a number of questions I would like to put to the witnesses as well. We have heard real concerns around delayed diagnoses, missed targets, regional variations and staff shortages. There are real concerns about a service that in the past was seen as a key performing service and as a jewel in the crown of the health services, and about where things are going in cancer services. This is one of the reasons we decided as committee to have this session and put the spotlight on it to see how we can figure out what is happening and how things can improve.

I want to pick up on what Deputy Cullinane was asking about funding and the approach to funding the national cancer strategy. How does this compare with other national strategies such as the maternity strategy?

Mr. Damien McCallion:

The national strategy as a whole will identify a set of priorities as we move forward. The health regions have just been established. I will bring Mr. Canavan in shortly to give context around how the regions will approach that. With maternity, there is a national maternity women and infants office, as there is a national cancer control programme. They will clearly set the direction, oversee it and ensure that in the service plan every year, priorities are being addressed, whether that is through more productivity from within the existing system or new funding, as Deputy Cullinane has stated. I will ask Mr. Canavan to give an example on the regions and how that will work in practice.

Mr. Tony Canavan:

The key to the relationship between the regions and the national picture is through the service plan. The strategy will be set for cancer services through the NCCP. We need that within the regions. It is important that we continue to take a national approach to the delivery of cancer care. It is important that our service plans each year reflect that.

That said, it is fair to say that each region is facing different sets of pressures and different sets of challenges. What might be addressed in the west or the north west as a priority for cancer care might be slightly different but all of them are driving towards improving outcomes for cancer patients across the country overall.

Pádraig Rice (Cork South-Central, Social Democrats)
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What is the role of the NCCP in the budget process?

Mr. Damien McCallion:

It is important that we look at the total budget because we tend to focus on that extra €20 million. For example, we spend over €600 million on cancer drugs. There is significant money embedded in the hospitals for diagnostics. There is cancer screening and HPV vaccinations, aids and appliances and the cancer support centers. The overall budget is a much bigger budget. We do not necessarily have visibility of all of that. The cancer control programme will set the direction, as Mr. Canavan has said, for the regions. It will give assurance when the regions come back with their service plans to make sure that the key issues that need to be addressed in each region are addressed within that service plan. Looking at diagnostics, for example, some of that will come through our renewed pay agreement and around an extended working week so we can open up those diagnostic facilities into the evening and into Saturdays as well. This will hopefully ease the flow on some of the challenges as set out by the Irish Cancer Society earlier.

Pádraig Rice (Cork South-Central, Social Democrats)
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What is the status of multi-annual funding?

Mr. Damien McCallion:

That is a commitment in the programme for Government. We are not at that point yet but the Department is working on that with us.

Pádraig Rice (Cork South-Central, Social Democrats)
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Has the HSE engaged with the Department? Is there a timeline for that?

Mr. Damien McCallion:

Yes. Last year, we had a two-year model in terms of what is here, but we are trying to work through what will that look like. Obviously, it is not just with the Department of Health but also with the Department of public expenditure and reform. I do not have a timeline on it but it is something we are working towards. It is a commitment within the term of the Government to address that.

Pádraig Rice (Cork South-Central, Social Democrats)
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With the next cancer strategy, due in 2027, does Mr. McCallion see that having a multi-annual ring-fenced budget?

Mr. Damien McCallion:

Ideally, clearly, any strategy would have a multi-annual plan because that allows us to look forward. It is important, however, to look at the total spend in any area, whether it is in maternity, cancer or mental health, because there is a lot of other expenditure outside that. This is one of the benefits of the regions. Mr. Canavan will have the flexibility to look at priorities. For example, if he has pressure or needs are expanded in oncology day wards or day beds, he can then look to see what he needs to prioritise in that. It might not be as big a factor in other parts of the country. Equally, that will all be done under the auspices of the cancer control programme.

Pádraig Rice (Cork South-Central, Social Democrats)
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In my last minute, I have a question on one service in particular. There are real concerns around radiation therapy and I think it is a good example to look at in terms of where we need to change. In some parts of the country, we have old machines that need to be replaced but we do not have a clear replacement programme. Other places have new machines without people to staff them. Graduates who are graduating are not guaranteed jobs and yet there are staff shortages. Then we are outsourcing services at huge cost, with €17 million spent in the first half of this year. To me, it makes absolutely no sense across the board. We should have a clear replacement programme for the machines and we should be hiring graduates as they graduate. There were thirty graduates out of Trinity last year only ten of them got jobs, and then we are saying that the services do not have staff and we are outsourcing. It makes no sense.

This seems to be a real waste of public funds, and it needs to be addressed. I am interested in hearing the thoughts the witnesses have on that.

Professor Risteárd Ó Laoide:

Does the Chair mean the equipment replacement programme?

Pádraig Rice (Cork South-Central, Social Democrats)
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On radiation therapy generally across the system in the context of staffing, machines and employing graduates. It all has to work together.

Professor Risteárd Ó Laoide:

I completely agree that they all have to work together. Certainly, we have a problem with recruiting radiation therapists. The situation has improved in the past couple of years. Last year, we had a 30% vacancy rate in our units in the context of the recruitment of radiation therapists.

Pádraig Rice (Cork South-Central, Social Democrats)
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If graduates are guaranteed jobs, they are more likely to apply for them. In addition, there are real delays in the recruitment process.

Professor Risteárd Ó Laoide:

Yes.

Pádraig Rice (Cork South-Central, Social Democrats)
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That means people do not take up these jobs.

Professor Risteárd Ó Laoide:

Part of that delay was due to the Coru process. I gather that the process has been tightened up and that there is a significant reduction in the time gap for registration.

The equipment replacement programme is critically important. It highlights one of the issues that the Chair mentioned about multi-annual funding. There should probably be a multi-annual process for equipment replacement because St. Luke’s radiation oncology network has 14 machines that need to be replaced. Even on an international scale, it will be a major project to do that on an active site. I know it has begun, but it is a critical process that we need to-----

Pádraig Rice (Cork South-Central, Social Democrats)
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Maybe that is a matter we can tease out again. The next speaker is Deputy Sherlock from the Labour Party.

Marie Sherlock (Dublin Central, Labour)
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There is a huge shortfall when it comes to targets versus patients who are waiting too long for treatment. Obviously, we need to make sure that the necessary resources are in place for the health service next year. We have a problem in that we do not know if there will be any new money going into cancer care next year. If I heard him correctly, Mr. McCallion indicated that there is going to be a big focus on productivity. Does he accept that new money also needs to go into cancer services? While I totally understand that the HSE must await the letter of determination from the Department of Health, I want to hear from him as to what the executive has sought from the Department regarding investment in cancer care next year from the point of view of current expenditure?

Mr. Damien McCallion:

I will ask Professor Ó Laoide to go through the priority areas in a moment. Effectively, there will be new money. We need to be careful not to get into the spin of all the news. There is an additional €1.5 billion going into the health system next year. A proportion of that will be for cancer services, and to support further development through the process I mentioned in terms of the national cancer control programme working with the health regions. We need to look at some of the issues around access to diagnostics. Those are never been addressed through the additional funding that comes under the cancer strategy. They are addressed through a system-wide response.

Marie Sherlock (Dublin Central, Labour)
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I am not specifically focusing on the national cancer strategy; I am focusing on cancer care overall. Is McCallion saying he is satisfied that the HSE will get, from the overall health envelope that was announced in the budget, the increase that is required to significantly improve on the missed targets in cancer care next year?

Mr. Damien McCallion:

There is always a range of priorities, and we will always look for additional funding. As I mentioned earlier, next year we will focus on how matters look from the point of view of what we have and how we will leverage the €1.5 billion within the regions. I will ask Professor Ó Laoide to set out what we see as the priorities for cancer for 2026.

Professor Risteárd Ó Laoide:

We have heard today, including from the Irish Cancer Society, that the demand that is required in the context of cancer care is increasing significantly. Infrastructural requirements are critical for that. One of those is diagnostics.

Marie Sherlock (Dublin Central, Labour)
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Yes.

Professor Risteárd Ó Laoide:

In the breast rapid access clinics and prostate clinics, diagnostics are increasingly becoming part of the pathways.

Marie Sherlock (Dublin Central, Labour)
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Of course.

Professor Risteárd Ó Laoide:

I refer, for example, to MRI for prostate cancer. Now there is much more MRI work being done. For family history screening, we are going to be introducing more MRIs. The development of a proper infrastructure is critical from our point of view.

Marie Sherlock (Dublin Central, Labour)
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Great. What detail do we have with regard to adding to that infrastructure next year? We have been aware of the national development plan since the summer. That has given the HSE a clear indication of the envelope for the next five years. What additional infrastructural capacity will be put into the system in 2026?

Professor Risteárd Ó Laoide:

I do not have that answer.

Mr. Damien McCallion:

There were a couple of points there. On diagnostics and radiology, Professor Ó Laoide, in his other role, developed a national radiology strategy. That will set the basis because many of the diagnostics are also used for other services. That will set out what is there.

In terms of cancer, a number of projects are under way. We mentioned radiation oncology. There is plan around, in particular, the Dublin areas that have the oldest facilities. That will then be extended into the other regions, in which there are newer facilities.

On the medical equipment side, there was around €12 million last year. That will increase next year in terms of the other equipment within the cancer area. In addition, there are number of projects under the capital plan - I can share that long list with the Deputy - in terms of further developments.

What I would say that the regions give us, if you take the pressure on oncology day wards, which has been highlighted well and the implications for patients earlier, we would see working with the NCCP next year and the regions, that each region, and Professor Ó Laoide can talk to it, will develop a plan around that based on population projections. That work is under way already.

Professor Risteárd Ó Laoide:

We have set up an NCCP strategy plan for all health regions in the context of systemic therapy capacity. Dr. McCarthy, who was before this committee earlier, is Saolta's representative on that. We are bringing them together to create a plan for the capacity for systemic therapies.

In the context of An Teachta Daly's question on projections, we projected that we require a 70% increase in day beds. That will take us up to 2045.

Marie Sherlock (Dublin Central, Labour)
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Yes.

Professor Risteárd Ó Laoide:

We have asked the regions to develop plans on how they are going to do that. Some of them are incorporated in larger developments but we have an interim phase where we will need to develop the chairs. Some of that is happening, and Mr. Canavan might comment. They are developing six new chairs in Galway, and St. Vincent's has nine new chairs. We need to staff those chairs and get them up and running.

There are other things, apart from the infrastructure itself, that we in the NCCP want to do with the regions. For example, our breast clinics have asymptomatic patients attending them, including people who require surveillance and people who are high risk. We have developed national strategies to take those people out of those clinics in order to create additional capacity. We hope to roll out that initiative in the next number of months, because they are critical. It is not just the actual capacity; it is developing smart capacity.

Pádraig Rice (Cork South-Central, Social Democrats)
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Next is Senator Clonan.

Tom Clonan (Independent)
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I thank the witnesses for all of the progress that has been made generally in terms of cancer treatment. I have a number of concerns. I am of the view that there could be a fairly easy fix for one of them. We have the lowest rate of availability for newly licensed cancer medicines within Europe. On average, the delay in this regard is up to two years. I will address my questions to Mr. McCallion. It seems that there is a blockage. I rather suspect that I know who or what is causing that blockage. It is unacceptable to have delays in the context of the overall progress and the positive work being done, which I really appreciate. What is the HSE going to do about that? How does it intend to resolve the blockage?

My next questions are more general. The HSE has a lot of challenges around equipment and workforce in the context of bringing about positive outcomes. Some of this relates to retention and recruitment, particularly retention of clinical specialists like radiologists and radiation therapists.

My next question is for Mr. Canavan. Bullying is a major problem within the HSE. Some 30% of clinicians reported being bullied by colleagues or managers. That is according to the HSE survey that was undertaken in 2017. In 2023, there were 85 separate ongoing investigations into bullying and harassment within the workplace. There are live and ongoing cases relating to bullying in respect of which there seems to be no urgency or desire to find resolutions in a timely fashion. Can Mr. Canavan indicate how he deals with instances of bullying? We are both aware of specific cases of bullying which are quite extraordinary, and I have had correspondence with him. How does he intend to deal with bullying and stamp it out in the context of recruitment and, in particular, retention? When I say urgency, what timeline does he envisage for resolving these issues?

Mr. Damien McCallion:

On cancer drugs, the spend has gone up to €650 million from €240 million in 2017. That is just one context and it is across all areas. It is estimated because it is quite complex to calculate across our hospitals, but it relates to our primary care reimbursement scheme, our hospitals and other areas. We have a robust approval process for new drugs. There have been challenges. As the Senator said, there was a report done by Mazars that we are implementing. We are putting more resources in place to try to ensure that what is needed will be available. That has been an advance on one level.

In terms of early access to drugs, which is another requirement and pressure, we are in a process, which I will get into today, with the Department, the pharmaceutical association and the Government to try to look at how that might develop.

That is work in progress, so I am not going to get into it. Clearly, those negotiations are at a sensitive point. We are trying to approve and shorten the cycle for the normal process around drug approvals. We are satisfied that the process it goes through is fairly robust but we are conscious of the timeline. I will hand over to Mr. Canavan.

Tom Clonan (Independent)
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Thank you very much.

Mr. Tony Canavan:

On the specifics for the issues relating to bullying, we have a policy within the HSE called dignity at work that helps and guides managers when issues or allegations arise and that outlines the steps we should take. As a policy, it reflects good practice in the sense that it attempts to address issues at the lowest level before they become more serious or embedded, at which point they become more difficult to resolve. It also tries to provide for the resolution of these issues at the lowest possible level in order that they do not rise to a senior management scenario. Again, the more formal these situations get, the more difficult they are to resolve and the more damage that is done along the way. As a large organisation, we recognise that the potential for bullying to occur in the workplace is there. We have processes in place to deal with it when it arises in terms of both reporting and following through on the policy.

One of the shared concerns we have is that when the policy operates well, it operates quickly, resolutions are found quickly, issues are addressed and normal working relationships are restored. At times, however, these matters do become embedded. I am certainly familiar with a number of cases, without commenting on any specific case, where it has taken considerably longer for us to engage in an investigation and follow through on that. The difficulties that arise in those circumstances, particularly where there are multiple parties involves, is that we need to protect the rights of all the parties involved in that investigative process in the context of arriving at a resolution. When it gets to that stage, it can be quite difficult. Unfortunately, it does take a long time. Organisationally, we are also focused on trying to develop a culture where workplace bullying is not acceptable and where people understand the direct connection between civility, good working relationships within the workplace and good patient care. The way we relate to each other impacts directly on the care we provide. That is a work in progress, and it is going to take us some time to work it through across multiple settings.

Tom Clonan (Independent)
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There are some very good people and good clinicians who are experiencing reprisals. Mr. Canavan is familiar with the case in question. If it could be dealt with and expedited, it would really help them. They are living in an existential hell, essentially. These are good people. I have met them.

Mr. Tony Canavan:

I fully accept that.

Pádraig Rice (Cork South-Central, Social Democrats)
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That is the end of the Senator's slot. Next is Deputy Michael Cahill. He will be followed by Deputy McGettigan.

Michael Cahill (Kerry, Fianna Fail)
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A stand-alone permanent oncology and haematology unit is required at University Hospital Kerry. The number of patients requiring chemotherapy is increasing year on year. Over 5,000 patients were treated at University Hospital Kerry last year. The facility there does not have the capacity to cope with the increased demand. A new facility would reduce the need for Kerry patients to travel to Cork and elsewhere. Regarding the proposed unit at UHK, and notwithstanding the establishment of an interim oncology unit in 2023, it has been long recognised in the south-west region that the service requires a permanent stand-alone oncology and haematology unit. That was the essence of the response I received from Dr. Andy Phillips, the regional executive officer of the HSE south west, to a query I raised with Mr. Bernard Gloster. I previously raised the concerns of the patients and staff of Comfort for Chemo Kerry who to date have raised in excess of €1.5 million. I wish to acknowledge their work and fundraising to date.

The most recent delays are having a huge impact in the context of inflated prices and I urge that this project is expedited to deliver for the people affected and to get value for money. Everybody agrees that the project is vitally required and that the revised design plans were required because of the risk of escalating costs. With that, the delay itself is attracting further rising costs. I previously emphasised in my correspondence that this unit on the grounds of UHK is a top priority of mine. The facility will include a chemotherapy day unit, an outpatient department and an aseptic compounding unit, all designed to provide Kerry patients with the dignity, privacy and comfort they deserve during what is the most challenging period of their lives. We must endeavour to have all aspects of the plan included for our hard-pressed patients. Can I get a timeframe for the delivery of this facility?

I have two other quick questions. What is being done to improve Ireland's access to new cancer medicines, clinical trials and so on? What initiatives or programmes has the HSE not been able to expand or roll out due to the lack of funding for the cancer strategy?

Professor Risteárd Ó Laoide:

I will come in on the first question about Kerry. I am pretty familiar with the hospital. I know it had significant struggles over Covid providing chemotherapy and systemic therapy in general. We in the NCCP are fully supportive of the development that should take place in University Hospital Kerry. It fits in totally with our systemic therapy model of care, which delivers care closest to where the patient can have it safely. We are fully supportive of that. I do not have the specifics on where the project is at the moment, but it is critically important. It is crucial for the whole region that the patients in Kerry get their services locally in a safe manner.

Mr. Damien McCallion:

Andy Phillips is the regional executive officer. We can certainly get him to keep in touch with the Deputy around the timings on that. Does Professor Ó Laoide want to respond on the second question?

Professor Risteárd Ó Laoide:

The second question was on the trials. What is important about the trials is that the Minister for Health ordered a review of clinical trials generally in Ireland. There is a report that is going to be published very shortly on an outcome of clinical trials. It was raised at the previous presentation. There are impediments to getting clinical trials in Ireland. I am very hopeful and confident that the plan that will be produced will put a national focus on this, and will show how we can bring trials in nationally rather than through each cancer centre, which really has been the bugbear in the context of the speed at which we can deliver clinical trials in this country. That plan is supposed to be launched very shortly by the Department of Health. It was chaired by Donal Brennan, and it was a clinical trials oversight group. We have seen interim recommendations and I think they will be very strong in strengthening our ability to deliver clinical trials in Ireland. It is important to say as well that the Mater hospital opened up a phase 1 clinical trials unit in the past year, which is another good step and represents progress in our delivery of trials in Ireland.

Donna McGettigan (Clare, Sinn Fein)
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I thank the officials for coming in today. On earlier diagnosis, I would like to talk about lobular cancer. It accounts for 10% of breast cancer cases. The problem is that when you have dense breasts, this cancer is very hard to detect. Women are going for mammograms and being told they are all clear. They are then leaving and not realising that they could have cancer within them. They are not even being told the density of their breasts or that they could go on further. Why are we so reliant on the mammogram so much when these women would need ultrasound or clinical breast exams? When you see the breast density, you know it could be the case that there is something there, but you are giving them the all clear. Lots of these women are only finding out their information through online support groups because it is a lived experience. In creating a new strategy, could these support groups be included among the stakeholders? They do have information and lived experience. They are helping these women.

Professor Risteárd Ó Laoide:

I am delighted that we are going to develop a new strategy. There will be a number of key elements to it that will be critically important. We have discussed governance and how that is done for cancer in this country. There is a Goldilocks aspect, which is particularly important. Research for the strategy is crucial, as is integrating the benefits of research. This is because we know that research-intensive institutions produce better outcomes for patients.

Education is critically important. Underpinning all of this is equality of access and outcomes for all patients, including the patients the Deputy mentioned.

The other issue the Deputy raised brings up the issue of ultrasound and MRI access for patients. Obviously, in each individual case, a clinical decision will be made by the clinicians seeing the patient about the investigations he or she should have. The wider element of MRI and ultrasound access, however, is an issue. With the support of the Department for a national radiology strategy, it will be critical for us in order to have significant diagnostic capacity available for those patients.

Donna McGettigan (Clare, Sinn Fein)
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Clinicians cannot see anything in the mammogram, through no fault of their own, because the density of the breast is not showing it.

Professor Risteárd Ó Laoide:

If they have a concern, they will go on and do something like an MRI scan or an ultrasound. That would be on an individual-case basis.

Donna McGettigan (Clare, Sinn Fein)
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That is not happening, according to the women I spoke to. It is usually too late by the time they actually get their MRI scan.

Earlier, I spoke about my husband. He went from doctor to doctor and hospital to hospital. When will electronic health records help in that regard, because it did not seem like two doctors or two hospitals were talking to each other?

Mr. Damien McCallion:

That is a good question. I will say two things in that regard. In the short term, we are rolling out the national cancer information system, which is now in 22 of the 26 hospitals, with four hospitals remaining. That system is focused more on the drugs and treatment. With regard to the benefits of such a system, from talking to patients the other day who went from one hospital to another, at least in terms of oncology and the drug piece, that information is available across hospitals.

To take a wider perspective, we are currently finalising a business case. We are going through a fairly robust approval process with the Government for a full electronic health record for Ireland. We are bottom of the EU when it comes to the digitalisation of health records. We have a new strategy, namely, Digital for Care 2030. We have a team of up to 20 people now working full time on this business case and its implementation and we have made senior appointments. We are confident, through working with the Department, that we are aligned on this. We are determined to try to progress it. It is in the programme for Government, so we are positive to that. It is a big programme, which will amount to significant expenditure over the years. Ultimately, it will mean that cancer patients will have a lot of other interactions with the health system, such as with their GPs and so on.

While the cancer information system is a first step, we need to get to something that is much more integrated because, as the Deputy said, patients from the north west, where I live, will go to Dublin. They could go to two centres in Dublin. They could have cancer treatment and other treatments happening at the same time. That is our plan and we have a clear direction around it. It is a commitment in the programme for Government. We are working through that preliminary business case. We put a tender out for pre-market consultation earlier this year and we hope to place a prior information notice, PIN, to get into a shortlist of venders. We have appointed a strategic partner for the project as well. We have taken a lot of action to try to build momentum behind the project because it is a crucial step not just for cancer, but for a lot of our services.

Donna McGettigan (Clare, Sinn Fein)
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Are we talking about 2030 for implementation?

Mr. Damien McCallion:

The strategy is up to 2030. Realistically, the procurement process takes approximately 15 months and then we aim to have a period of about two years to get the first region live. We have already identified the first region, which is Dublin north east, simply because of the age of some of the systems. The systems in the Mater and Beaumont hospitals are 30-plus years old and have to run what they do today, which is not even the full electronic health record. That will be the first region. From there, it will be contingent on the tenders as to how quickly or otherwise we can go. We have come up with a strategy for implementation, that is, when we do one region, we will do one more and then we will do the other two together.

Northern Ireland has just implemented this system and we are in close co-operation with it in this regard. While there was a break during Covid-19, it completed implementation in a ten-year period, approximately, from the business case to full implementation. Its last trust went live a couple of months ago. I visited several times with the people up there. They have done a super job and it is giving them a full health record.

While we have this system in maternity services, it is isolated to the six maternity hospitals. We need to get something that is system wide. That is our aim.

Pádraig Rice (Cork South-Central, Social Democrats)
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It is the hope of the committee to examine this issue in detail and support it where we can. It is crucially important to progress it. Deputy O'Sullivan is next. We will have additional time if any member wishes to come in again with additional questions. We have time for an additional round if members are interested.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I welcome everyone this morning. I will stick to what I spoke to the Irish Cancer Society about previously, particularly the area of drugs and reimbursement. I have been on this train for a while when it comes to raising this issue. First, I acknowledge there has been progress in recent years. While we are getting money allocated to new drugs, the process of reimbursing drugs, particularly orphan drugs, is still painfully slow. When we are talking about cancer, the treatments are becoming so specific and targeted that virtually every drug - not every drug that comes to the market, but a high proportion of them - will be an orphan drug into the future because they are so targeted and the patient cohorts are so limited. I know the witnesses all know that. In recent weeks, we have spoken with Professor Michael Barry, the Irish Cancer Society and now the HSE. Does the HSE believe the reimbursement process is fit for purpose?

Professor Risteárd Ó Laoide:

At the national cancer control programme, we want the patients to get the best drugs and care we can provide in Ireland. The process in place has been agreed by a lot of the stakeholders involved. That process was then reviewed by Mazars, an external agency. It came up with some issues around it concerning tracking and transparency.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I am talking about the process itself, not the transparency issue because we should be doing that anyway. We do not need Mazars to tell us that, to be fair. Is the reimbursement process effective, efficient, timely and patient-centred?

Professor Risteárd Ó Laoide:

There are time delays in it. Those time delays involve a lot of the stakeholders that are involved, including the companies and the HSE. Negotiations for pricing, which is critically important, also account for time delays. In the public sector, we work under the 2013 Act on pricing, which places a big onus on us to ensure that what we spend on drugs is not being taken away from other critically important elements of healthcare. That is a legal, statutory obligation.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I am sorry to interrupt Professor Ó Laoide. Over the years, I have seen a number of presentations such as the one given to us today. We are making comparisons this morning with Denmark, which has a similar size economy and population, but is dramatically better, faster and more efficient at getting drugs and treatments to patients. Where are we going wrong?

Professor Risteárd Ó Laoide:

The market is small. Mr. Michael McCarthy mentioned the other day that, in Ireland, a lot of the companies are not putting their drugs through the system, a system which he referred to as “robust”. There are rare cancers with small patient cohorts where orphan drugs are in use, but those drugs are not being put through the market because of the size of our market. There are current engagements taking place in that regard.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Is the market here any different from the market in Denmark in terms of patient cohorts? I assume they are similar.

Professor Risteárd Ó Laoide:

Certainly, some of the companies would say that the process here-----

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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So it is the process, rather than-----

Professor Risteárd Ó Laoide:

Yes. There is engagement currently taking place between the Government, the Department of Health and the industry. This is the time for an agreement which would take into account the difficulties that we have at the moment and come up with a new agreed process that could be delivered-----

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I am sorry to be pushy but I am watching the clock. With regard to the early access programme, the Minister, Deputy Carroll MacNeill, said on the record that she is looking at this. Thank God that, after many years, she is looking at it. Where does the HSE stand in that regard? How does it envisage its roll-out? I know it is very tentative at the moment.

Mr. Damien McCallion:

That process is under way. It is very sensitive, as the Deputy can imagine, between the industry association, ourselves and the Department. It is a piece. I will not speculate on it today. What I will say, which goes back to the Deputy's question and builds on what Professor Ó Laoide said, is that the process is robust around the quality and the way it works. Is it timely enough? No. We know that and that is something we need to work on.

The early access piece is important. Clearly, the Minister has set that out. That process is active and we need to let that run to conclusion. I am hopeful there will be an outcome at the other end.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Professor Ó Laoide was right to acknowledge at the start that there are myriad of reasons for the delays. It is not just the public side. Sometimes, it is the industry and the negotiation piece.

Professor Risteárd Ó Laoide:

The negotiation piece has delivered significant savings to the State.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Yes. Professor Michael Barry told us that last week, to be fair. Do the witnesses feel that the one-size-fits-all approach to the reimbursement process is working, notwithstanding the time issue? Is it suitable to put all the drugs in that process or should we have something more bespoke?

Mr. Damien McCallion:

The Mazars process looked at the options around how the process ran. The conclusion around the process as a whole was that it was fairly robust in terms of the inputs it took from patients and different advocacy groups, as well as the expert evidence it gathered and the international piece around it.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Take the quality threshold as an example, which we debated last week. No rare disease drug is going to meet that quality threshold. Last week, Professor Barry said that one such drug met that threshold in the past year. To take that example by itself, what do the witnesses think of that process?

Mr. Damien McCallion:

That is something the Deputy discussed with Professor Michael Barry last week. He is probably better placed than I am to address that from that perspective. The early access process that is under way is important. There is no point in speculating about it today because it is active and live.

There is no point in speculating about it today because it is active and live and we just have to see what comes out of that. There is a commitment, as the Deputy said, to try to develop that in Ireland, and that is important. That is probably something to come back to, I respectfully suggest, once we see what that looks like in terms of where it takes us.

Pádraig Rice (Cork South-Central, Social Democrats)
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We have a bit of time left so we can do another round of questions. I will put a few first and then we will hear from Deputy Cahill.

On radiation therapy, and the infrastructure in particular, my understanding is the internationally accepted lifespan of radiation therapy machines is ten years. Of our public machines, eight are already more than 15 years old, with two approaching 17 years. There are nine that will be required to be replaced within the next five years and, overall, 75% of the machines require replacement now or within five years. It is my understanding, however, that there is no national replacement programme. These antiquated machines are being replaced on an ad hoc basis, with some reaching breaking point first. In Rathgar, there are two machines that are 15 years old and another two that are almost 17 years old. That centre is limited to the use of three machines at any one time to mitigate these frequent breakdowns, which means a quarter of the capacity there is being lost. A replacement programme is under way in the St. Luke's network, which includes Rathgar. Why was the situation allowed to deteriorate so badly before anything was done? These machines need to be replaced every ten years. It is a predictable problem and one we should have a plan for.

I have a number of questions I will put to the executive together. Why is there not a dedicated replacement programme for radiation therapy machines? The need for this was identified in the evaluation of the 1996 cancer strategy. As I said, the replacement programme for Rathgar, St. James's and Beaumont hospitals has been approved. How long will it take? I put in some parliamentary questions on this and the HSE responded that the procurement process would only commence in 2026. Rathgar already has two machines that are 15 years old and another two that are 17 years old. We need to get information on the timelines.

Is any preliminary work being carried out on replacing the machines in Cork? These machines are already six years old. We do not want the same thing to happen as happened in Rathgar where we have machines breaking down and limited capacity. If we have a repeat of the situation in Dublin either in Cork or Galway, further outsourcing will be inevitable. Is the HSE not of the view that this is a poor use of public moneys, especially given the need to replace these machines is entirely predictable? As I noted earlier, the outsourcing costs are staggering. Between 2020 and 2024, €75 million was spent outsourcing radiation therapy to private providers and up to July of this year, €17 million was spent. These are huge sums of money because we are allowing the public system to be run down. It seems to be a predictable problem and if we had a plan, we could have saved that money and invested in the services instead of outsourcing to the private sector. It is a real cause of frustration. I am interested in hearing the witnesses' thoughts on that.

Mr. Damien McCallion:

We have a new national director for strategic capital and estates. He has put a plan together on this. Dublin will go to tender either at the end of quarter 4 or very early in quarter 1. That will include, I think, two machines in Rathgar and that process involves an implementation period of approximately four months. We can come back on the specific timelines post the tender process, but the tender will go out either very close to the end of the year or very early next year. The plan is to also have replacements scheduled in Cork and Galway.

In many countries, the machines go beyond the manufacturer's time - they are maintained - but I accept the point. There is one out of four out of action. It has an up-time of about 90%, so ideally that would be reduced. There is scheduled maintenance and so on required around it in terms of how they operate. Estates, under our new director, has put a plan in place on that and we will be working with the NCCP on that. We talked about it again in the last couple of days in the context of the committee.

There is a tender already developed and it will go out in quarter 4 of this year or in early quarter 1 of 2026. The plan then is to move on and also have a full replacement plan in profile for expenditure on those. They are complex projects to implement because you are trying to maintain a service as you replace them, as I understand it. There is about a four-month window for implementation. I take on board the point about St. Luke's. I think two machines are from 2016 and four are from 2008. However, they are operational and, as I said, they maintain a 90% up-time. Notwithstanding that, we want to get to a point where they are replaced. The tender will go out and the plan is to move on to Cork and Galway from there.

Pádraig Rice (Cork South-Central, Social Democrats)
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Does anybody else want to come in on that?

Professor Risteárd Ó Laoide:

The Cathaoirleach is right that the machines have that life cycle. I said earlier that a rolling replacement is the way to do this. The machines are safe. Patients need to know that when they come to St. Luke's in Rathgar and the machines are working, they are safe and there is no issue of patient safety or quality attached to this issue.

Pádraig Rice (Cork South-Central, Social Democrats)
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That is important. We will now hear from Deputy Cahill.

Michael Cahill (Kerry, Fianna Fail)
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About two years ago, I was contacted by a constituent in regard to concerns she had. She stated that within a two-mile radius of her house, eight different people were diagnosed with cancer. Three of them were terminal and have sadly passed since. The question the laypeople are asking all the time is whether it is the water they drink, the air they breathe or the food they eat. Do the witnesses have any comments on that?

I repeat a question I asked earlier. What initiatives or programmes has the HSE not been able to expand or roll out due to a lack of funding for the cancer strategy?

Dr. Triona McCarthy:

I might respond on the increasing incidence or numbers of cancer cases you might see in a locality. We would often describe it as what looks like a perceived cancer cluster, where a number of people are diagnosed. The first thing to say is that cancer is, unfortunately, a very common condition and one in two of us will be diagnosed with cancer in our lifetime. Sometimes it is just the ageing within a particular community, where people have settled in an area at a particular time. We have talked about the ageing of our population. There are modifiable and nonmodifiable risks for cancer. One of the most obvious nonmodifiable ones is age. Almost all cancers will increase with age. We have seen in our population how we have had such an increase in the number of people over 65. That is a driver. That said, there are other modifiable, preventable causes of cancer that are really important to focus on.

In terms of what we can do about cancer risk, a lot of those things are called out in the cancer strategy. Between 30% and 50% of cancers are preventable, so we are looking at alcohol, tobacco use, weight and physical activity. It is very important that communities understand there are things they can do to reduce their risk. Infections are a cause of cancer, so taking vaccinations matters, as does screening to catch cancer early or identify and treat things that are precursors for cancer. It is important not to be too fatalistic about the increasing number of people with cancer and instead look at the positives around the many things we can do to reduce our cancer risk. Accessing the health service is part of that, as is empowering communities to avail of preventative measures and, at a government level, having good public policy that reduces people's exposure to risk factors.

Michael Cahill (Kerry, Fianna Fail)
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A lot of these people are very young.

Professor Risteárd Ó Laoide:

On funding, a lot of the projects we run are continuous. Somebody mentioned recurrent predictable funding. That is a really critical issue for the roll-out of strategies. I hope that will be part of the next strategy. It is like trying to build a house in that you know where you are starting and where you want to get to but it will take a number of years. It also allows you to make judicious use of the resources as well, so you do not have to spend it this year and you can spend it over a number of years. For example, we have the acute haematology oncology nursing service which is being set up. That is a super service. I should congratulate the NCCP. What that does is it stops the patients with cancer who have acute symptoms going into casualty and being seen. It is an acute nursing service that stops that. The people at the front line have been rolling this out in Mr. Canavan's area and lots of other areas. It is a very good service, but it currently operates from 8 a.m. to 4 p.m. To roll that out on an 8 a.m. to 8 p.m. basis, or 24-7, requires us to have additional funding. With predictable funding, we would know when and how we would roll that out.

Another example is stratified self-managed follow-up, which we do for patients. That is empowering the patients to take charge of their own follow-up, while ensuring they have close contact with the hospital, that there is somebody identified in the hospital who can deal with them and that they know what their red flag symptoms are and how to get quick access to diagnostics, etc. Again, we have rolled that out for some of the tumour types, like prostate, but we want to roll it out for breast tumours.

Those systems will have a knock-on effect on our acute hospital system, which is currently overburdened. The answer to the Deputy's question is we need money to keep those projects rolling and make sure they are rolled out completely. The national cancer information system is another one of them. Obviously, funding is required as well to help with the capacity constraints members have heard about today from us and from the Irish Cancer Society in regard to diagnostics and day ward capacity. To increase day bays and beds, increased funding is needed.

Mr. Damien McCallion:

I will make a couple of brief additional points. First, as part of the new cancer strategy, the intention is to review where we are at to see what has gone well and what needs to be leveraged into the next strategy. We will be able to identify those issues in a more detailed way. Second, going back to Professor Ó Laoide's point, the capital plan each year will start to build. Whether it is for radiation oncology or otherwise, there will be a multi-year plan. Some of the pieces that are under general pressure from the system will be dealt with within the regions. Mr. Canavan will know what challenges he faces in the west. If patients are not getting access to daycare or are not getting into theatre because of surgical delays, that needs a system-wide view. It may need additional funding but it is not a sort of niche pot. We must look at the system as a whole. That is really important for those issues, alongside the specialist areas, as Professor Ó Laoide said, that will be driven out by the NCCP.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Clinical trials were mentioned. One of the things that has defined my outlook on reimbursement, which the witnesses may have gauged from earlier discussions, was a meeting Deputy Lahart and I had with a group of public servants from Denmark who set up an ad hoc rare disease committee a number of years ago. They came here to learn about how Ireland is the leader in terms of manufacturing, workforce, corporation tax investment, foreign direct investment and all of that. They came to take learnings from us on that side of the matter. However, when we sat down with them afterwards and spoke about our processes in terms of reimbursement, clinical trials and so on, they were kind of gobsmacked at where they were compared with us. As I said, that meeting has defined my outlook on how we should do things here. There is a target in the national cancer strategy to increase access for patients to clinical trials from the current 2% or 3% to 6%. How are we to bridge that gap?

Professor Risteárd Ó Laoide:

The clinical trials oversight group will be key. The report is coming out very shortly on how we can develop a national approach to this issue, which is what was done in Denmark. We have met with European colleagues on this matter. We were engaged in a process in the NCCP looking at how cancer infrastructure was being developed throughout Europe. We want Ireland to be part of the comprehensive cancer infrastructure around Europe. Our European colleagues see Ireland's size, with a population of 5 million, as a Goldilocks population that can have a single comprehensive cancer infrastructure. The governance of that needs to be part of our next cancer strategy. As part of our engagements with the Europeans on that, we had a discussion with the Danish on their clinical trials process. We can learn from them by creating a national structure for it, rather than going through each of the cancer centres, as I mentioned earlier. That is what has slowed up the process.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Would proper resourcing of, and investment in, European reference networks be fundamental to that?

Professor Risteárd Ó Laoide:

Yes, I think so.

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I understand we are not doing that at the moment.

Mr. Damien McCallion:

As part of the work on electronic health, we have met with a lot of the CEOs of the life sciences sector, IDA Ireland and so on. One of the issues is getting data and the other is access to professionals to do the trials, as well as the framework around that. There is work going on at the moment to look at how we might use even the data we have. We will have every image in the country by the end of this year when St. Vincent's goes live. Every X-ray, CT and MRI scan will be in one national database. That will apply to lots of modalities, including cancer and other disease groups. We have registries. We have some information while we wait to roll out the electronic health records. We want to support the sector to do research, whether private or in academia, because that maintains employment, maintains tax income and allows governments to invest in the health system because a lot of our tax take comes from that sector. We are keen to work with people on that aspect as well as on the clinical trials, as referred to by Professor Ó Laoide. An interim report with interim recommendations is publicly available. The final recommendations will, I hope, set out a better framework with which to move forward. We have an interest in that as well for the reasons I have stated.

Pádraig Rice (Cork South-Central, Social Democrats)
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That draws our considerations to a close. I thank the witnesses from the HSE and the Irish Cancer Society for their engagement today. I realise a lot of work goes into preparing for these meetings and I really appreciate their effort and the frank answers and exchanges we have had. I understand Professor Ó Laoide is due to retire soon. I thank him for his service, all his work with the health services over a long period and his engagement with the committee over many years.

Mr. Damien McCallion:

Professor Ó Laoide has worked actively in cancer services as well as leading the service, which is not a bad thing in terms of our system. He enjoys huge respect within our system, among advocacy groups and, most importantly, among patients. He has also taken on actions like the radiology strategy, which is really important and is separate to the day role, alongside still being in practice. To echo the Cathaoirleach's sentiments on behalf of all in the HSE, I wish him well in his retirement. He may still keep some sort of role; we do not know. I am sure he will keep a watching interest in cancer services.

Professor Risteárd Ó Laoide:

I thank the Cathaoirleach and Mr. McCallion. I will go down to Carrauntoohil first.

Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the witnesses and members. Our next meeting will be in private session at 3.30 p.m. on Tuesday, 4 November.