Erin McGreehan (Louth, Fianna Fail)
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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.

Alan Dillon (Mayo, Fine Gael)
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I thank Deputy McGreehan for raising this important issue.

Ireland's healthcare system is changing with the introduction and implementation of Sláintecare, the first cross-party plan for major health reform in Ireland which was introduced in 2017. The Sláintecare vision is to provide universal, accessible, affordable, person-centred, safe and high-quality health and social care for all the people of Ireland. As the Deputy said, it should be based on need, not on the ability to pay.

The Path to Universal Healthcare: Sláintecare and Programme for Government 2025+ was published in May 2025. It includes three high-level priority areas, which are: improving access, improving service quality and delivering capacity. Good progress has been made to date in terms of access. However, the latest hospital waiting list figures, for August 2025, show that important progress has also been made under the waiting list action plan approach which was implemented in late 2021. The number of patients on waiting lists has been reduced, as has the length of time they are waiting. Since September 2021, there has been a 56% reduction in the number of patients waiting over 12 months. In the same period, the total weighted average waiting time for patients on waiting lists has reduced by approximately 44%. We are seeing continued progress in terms of long waiters and the most recent figures indicate there has been a reduction of 7% in the number of patients waiting over 18 months since this time last year.

A total of 66% of consultants have now signed the public-only consultant contract, made up of 943 new entrants and 2,147 change of contracts. This is a key reform aimed at creating a universal, single-tier healthcare by removing private practice from our public hospitals. We have also seen an 8% reduction in the cumulative daily 8 a.m. trolley count for January to August 2025. There were almost 5,700 fewer patients waiting when compared with 2024. This is despite an increase in emergency department attendance of over 10,000, or 7%.

Some 2.53 million people in Ireland, or 46% of the population, currently have private health insurance. Most consumers have private health insurance plans which provide substantial cover in private hospitals, but this cover is mainly provided for semi-private accommodation. Some 8% of consumers have plans which provide cover in mainly public hospitals and these are typically less expensive. Private health insurance is voluntary and there are many reasons that people take out private health insurance. The Government continues to support those who choose to take out private health insurance through tax relief and community rating. This spreads the risk across the system and allows more affordable access for older and sicker people.

The Deputy made reference to specific areas around early access, pilot medication programmes and ensuring the removal of barriers to new innovative medicines becomes part of Government's primary policy. The Minister, Deputy Jennifer Carroll MacNeill, whom I am deputising for today, is very much focused on how we can ensure that medicines are increasingly accessible.

Erin McGreehan (Louth, Fianna Fail)
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The Minister of State got an answer that was about access to consultants and doctors; it was not about treatments and therapies, which was the question I asked. The Minister of State got an answer to a different question of inequity in healthcare.

I reiterate we cannot continue to allow to have two-tier access to oncology drugs and vaccines based on whether people have the ability to pay. I will keep repeating this. The area access pilot programme to oncology drugs has to come in. We have to, basically, cop-on in the Department of Health in the area of running through and reimbursements of healthcare. People are dying in the public health system because they are not getting access to drugs. People who cannot afford to pay for shingles drugs, for example, are getting sicker, spending time in hospitals, spending time out of work, and unable to take part in their communities and their normal lives because of their inability to pay for a vaccine that works, that is effective and cost-effective, and proven so.

The Minister of State is only reading off what the Department provided and he is not in the Department, and it shows. It is a prime example of why a Minister from the Department should be here answering the relevant questions.

Alan Dillon (Mayo, Fine Gael)
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I thank the Deputy for raising this important matter. I certainly agree on the necessity around an early access programme. We are making significant progress in regards to the treatment of cancer. However, I would agree that access to medicines should not become a barrier; it should become part of the normal process. I will report what the Deputy has said here to the Minister.

In regards to the Government's continued work to support the model of care through its Sláintecare programme, we are very much committed to ensuring that patients get first-class access. Indeed, we will continue to invest. We will continue to look at how we can reform the system, very much being focused on productivity but also patient care. It is very much the Government's priority that we continue to improve service delivery, increase capacity across all the hospitals - acute, step down and community healthcare - and, indeed, reduce waiting lists and times, and also, to the Deputy's point, ensure that all patients and all citizens have access to the best medicines available.