Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

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

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

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

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

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

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

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

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

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

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

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