Erin McGreehan (Louth, Fianna Fail)

It is good to have the Minister of State here. We pride ourselves on having a health service based on need and not on the ability to pay. Unfortunately, a two-tier system is growing around us, and growing faster than ever before. From lifesaving treatments to basis prevention and, devastatingly, in cancer care, the divide is becoming ever greater. If people can pay privately or if their insurance covers it, people may be able to get access to innovative oncology medicines months or even years before public patients. People who cannot pay have to wait. For people with cancer, waiting is not neutral - it is absolutely lethal. This is not what our State wants. It grates against my core values and I am sure those of the Minister of State and we should not be accepting it. I certainly do not accept it.

The facts are stark. Irish patients wait on average from 644 days to 694 days. Some data actual shows it is up to 1,000 days between European Medicines Agency, EMA, authorisation and HSE reimbursement for new oncology drugs. Only one quarter of EMA-approved cancer medicines since 2020 are available here, which is the lowest rate in western Europe. Every four-week delay in starting cancer treatment increases mortality rates by around 10%. We are building delays into a system that is, sadly, costing lives.

Other countries have acted. They run structured early access schemes that give patients highly governed, time-limited access to breakthrough drugs while price and health technology assessment, HTA, processes continue. Ireland has no such national pathway. Access is ad hoc and clinician by clinician. The system has inequity in it by design.

The programme for Government promises quicker access to innovative medicines. The time has come when we must commit to creating an early access pilot programme for innovative oncology medicines, with a budget line in the 2026 Estimates, clear eligibility criteria, a parallel HTA process and real-world data collection to improve value for money. It is not a blank cheque. It is targeted. It is an evidence-based bridge that stops your treatment options being defined by your ability to pay.

The same two-tier reality is playing out in prevention of disease. Let us take adult vaccination. People in their 50s and 60 today who want a shingles vaccine must pay privately. It costs almost €480 for a two-dose course. People who cannot afford it have to go without. The irony is that this vaccination is among the most cost-effective interventions in healthcare. International studies show that shingles vaccinations prevent thousands of cases of severe disease and long-term nerve pain at cost-effective levels, well within accepted thresholds.

Broader analysis suggests adult immunisation programmes return up to €19 in benefit for every €1 spent. There are savings in hospitalisations, productivity and long-term care.

We are creating a two-tier system, at the end of life and in the prevention of disease. For those who can pay out of pocket, they are protected. For those who cannot, they are absolutely exposed. It is neither fair nor financially sensible.

We have to commit to establishing the area access pilot programme for innovative oncology medicine as soon as possible. We also need to look at the principle of equity and to apply it to adult vaccinations, starting with shingles, by negotiating fair prices and including it in the public immunisation schedule. Cancer does not care whether you are public or private. Shingles does not care whether you can pay €480 to the pharmacy or not, and the State certainly should not care either. Healthcare should be based on need and not on your pocket.

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