Jim Daly (Cork South West, Fine Gael)
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Go raibh maith agat, a Leas-Cheann Comhairle, as ucht an deis a thabhairt dom labhairt ar an ábhar tábhachtach seo anocht. I thank you, a Leas-Cheann Comhairle, for the opportunity to raise this important issue on the floor of the Dáil. I thank the Minister of State, Deputy McEntee, for coming in to take this Topical Issues debate.

I can say with confidence that, normally, if I have an issue with the HSE, I can deal directly with the management and they are co-operative and always forthcoming with information. I have always found them most helpful.

However, this issue caused me some alarm over the past week when the Dáil was not sitting and I was anxious to bring it to the Minister's attention on the floor of the House. I refer to the significant delays in the provision of radiotherapy treatment at Cork University Hospital, CUH, for cancer patients. Patients attend on a daily basis for radiotherapy treatment as they battle cancer. CUH is a centre of excellence serving County Cork and the only facility providing this treatment for cancer patients. Obviously, it is of vital importance to an enormous region in the context of a very dangerous illness, cancer. As such, we want to ensure that the service runs at 100% of capacity. Having spoken to a number of patients who have been availing of the radiotherapy in CUH, I understand that there have been significant delays in treatment in the past number of weeks. The service is operating at 75% capacity usually but on the Thursday before last an incident with one of the machines meant it was running at only 50% of capacity. That delayed the treatment of patients, many of whom had to wait for hours. That wait of hours occurs in a context where patients must attend every day for a period of six to eight weeks. They travel long distances from the constituency I represent in west Cork. If one lives on the Beara Peninsula and must travel to CUH, it is a round trip of more than three hours. If one has delays of two or three hours each day during one's treatment, it is very significant and an added trauma we want to avoid for patients at all costs.

There is also an issue with optimum treatment time. If a person is post-operative, it is ideal to have the treatment begin within six weeks. However, I spoke to someone whose treatment did not begin until nine weeks after an operation due to the delays in CUH. While the treatment is not being cancelled, it is certainly being delayed significantly for patients. There appears to be a level of underperformance at this centre of excellence and I am adamant and anxious on behalf of patients that whatever resources are needed be given to the management of CUH without delay to ensure that radiotherapy services can operate at the optimum level so that patients get timely access to life-saving and necessary treatment. We must avoid inflicting any further stress on them. Every patient to whom I spoke asked me to acknowledge the exceptional courtesy, care and attention they receive from staff at CUH. They are clearly doing everything they can to ensure that patients are looked after. However, I understand that there are a number of issues with resources. I am grateful to have been allowed to raise this important issue.

Helen McEntee (Meath East, Fine Gael)
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I thank Deputy Jim Daly for raising this extremely important issue. I join him in acknowledging the excellent work of the staff and the care they provide. The priority is to ensure that people who are suffering do not have that suffering added to. We must provide them with as much support as possible. The Minister, Deputy Harris, sends his apologies, but I welcome the opportunity to speak on the issue.

The radiation oncology unit at CUH is currently installing a new oncology information system which requires the transfer of patient data to a new system. The work is being undertaken on a phased basis and two of the four linear accelerator machines in the radiation unit in Cork have now been upgraded to the new system. Following this upgrade, there were some delays which affected capacity on the linear accelerators. The cause of this problem has been identified and the necessary changes to the software have been made to rectify the situation. CUH has assured the Department that at no stage during this installation programme has a patient's treatment been cancelled. The CUH management team is continuously monitoring the upgrade programme. I acknowledge, however, that while no appointment has been cancelled, there have been some delays because the service has been unable to operate at full capacity.

Radiation therapy is an integral part of cancer treatment with 50% to 60% of all cancer patients requiring it at some point in the care pathway. Modern radiotherapy now requires highly sophisticated hardware and software to deliver treatment. This increased complexity has resulted in the more accurate delivery of radiation doses to cancers while simultaneously sparing more normal tissue. New advances are being made in radiation therapy treatments, including the provision of brachytherapy, leading to improvements in patient outcomes. Radiation oncology is provided in five public hospitals in Dublin, Cork and Galway and services are contracted from private facilities in Limerick and Waterford. Patients from the north west can now be referred to the north west cancer centre at Altnagelvin Area Hospital in Derry for treatment. That offers them treatment much closer to their homes than was previously available. The national plan for radiation oncology will oversee the further development of radiation oncology facilities in Dublin, Cork and Galway. The completion of the national programme for radiation oncology is a priority for the Department.

I am pleased to inform the House that work on the new radiation oncology facility at CUH is under way. Construction on the main contract to provide what will be a very important and much-needed facility for patients receiving radiation oncology services in Cork commenced yesterday. The new unit will comprise five new linear accelerator machines which is one extra over the current capacity. It is expected that the new facility will be fully operational by the end of 2019. The Minster reiterates his commitment to providing safe high-quality radiation therapy to patients in Ireland and assures the House that at no stage through this installation programme has a patient's treatment been cancelled. However, I acknowledge that the hospital would like to schedule more patients for treatment on daily basis. Due, however, to the outdated machines currently available, that has not been possible. With the five new accelerator machines, which is one additional machine, the hospital will be able to increase provision.

Jim Daly (Cork South West, Fine Gael)
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I thank the Minister of State for her reply and the HSE for the prompt response today. "Cancellation" is a word which the HSE can state definitively does not apply, but I understand that one cannot cancel radiotherapy treatment as such. It must continue albeit it can be delayed for a day or two. However, it cannot be cancelled. We may be mixing up words or perhaps it was not the best word to put forward in the debate. While I appreciate that nothing has been cancelled, there have been delays and it is that issue which is causing people concern. The HSE has put up its hands and said the installation of new equipment has caused delays. No party to this debate needs me to explain the trauma cancer imposes on people. It is incumbent on the HSE management and on us as legislators to ensure that when new systems are put in place, a smooth transition occurs and that no delays are caused. They contribute very significantly to the burden on patients who are attending on a daily basis and must wait around for three, four and five hours for treatment. Others may have to wait for another week for a treatment to start. It is not good enough that we are using the installation of new machines as an excuse. This is a modern era in which we should be able to prepare for such transfers and avoid adding these delays and traumas to people's existing burdens. The cancellation issue arises in respect of the rolling closures of the theatre for cancer patients which is an added complication. Several procedures for cancer patients have been cancelled in theatres because of staffing issues at CUH, which is another cause of concern and something I wish to bring to the attention of the Minister of State to pass on to the HSE.

Helen McEntee (Meath East, Fine Gael)
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I do not disagree with what the Deputy says. The HSE's national cancer control programme has set performance targets to measure timely access for patients to radiation oncology treatments. The target is that 90% of patients will undergo this therapy treatment within 15 days. According to the national figures for 2016, 83% of patients commenced radiotherapy treatment within 15 working days. In Cork, the figure was 71%, which was slightly below the national average. The latest figures available, which are for January 2017, show that the national figure was 75%, with 72% of Cork patients commencing treatment within 15 working days. While it is not an excuse, the HSE has identified the new equipment as the reason patients' treatment was not able to progress. The HSE hopes the extra linear accelerator machine will allow CUH to process patients faster and possibly outdo the national average.

On the rolling closures, the recruitment embargo has left many hospitals, including CUH, in a difficult position. The opening up of that recruitment means it is hoped to fill those places and to cease rolling closures by the end of April this year. Any of the Deputy's other queries which I may not have addressed, I will bring back to the Minister on his behalf.