Marie Sherlock (Dublin Central, Labour)
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77. To ask the Minister for Health to account for the dramatic drop over the past eight years in breast cancer patients with an identified B5 or C5 receiving surgical intervention within the 20-working day target - with surgery identified as the first treatment; and if she will make a statement on the matter. [52489/25]

Marie Sherlock (Dublin Central, Labour)
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From the Department's hospital productivity dashboard, we know that the specialty that has seen the largest increase in waiting times over the past three years has been breast surgery. From parliamentary questions we have asked, we are aware that for breast cancer patients for whom surgery is the first treatment there is a HSE commitment to treatment within 20 days. Over the past eight years there has been a sustained and dramatic drop in meeting that target. In 2017, just over 10% did not get timely treatment but that number is now at 40% of all the women. We want to hear from the Minister how she will account for these failings and what actions are being taken by the Department.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The Government is of course, as is everybody else, committed to improving cancer care, ensuring better prevention, maintaining improvements in cancer survival rates, and timely access to treatments. The national cancer control programme, NCCP, has a number of metrics for breast cancer services. They are consistently reviewed to guide service advancements and to make improvements.

Since 2017 the total number of patients annually receiving this type of surgery increased by 10% to well over 1,500 in 2023. Over this period the percentage of patients seen within the recommended 20 days has decreased from 84% to 60%. The time to surgery can be influenced by a number of factors, including imaging and inpatient capacity, as well as the individual circumstances of the patient. The HSE is working on several initiatives to improve surgical capacity, including consideration of imaging and inpatient capacity in several cancer centres. Waiting times for radiology and diagnostic services are very seriously recognised as an issue.

The NCCP has produced a range of guidelines aimed at ensuring standardised access to cancer services across the country. These will, I hope, reduce variation in the management of patients and will lead to more appropriate referrals and management of patients within cancer services.

The Deputy will already be aware of the scale of the investment into the national cancer strategy since 2017. Significant improvements have been made with regard to breast cancer in recent years, in line with the overall objectives of the national cancer strategy. We do need to see a good deal more, as the Deputy will be aware.

Marie Sherlock (Dublin Central, Labour)
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For the past two decades we have seen some very significant improvements in cancer care in this country but there is a very real and very well-founded concern now that cancer care outcomes may regress if the current trend in the delays in care continue. We have an excellent framework in terms of the deadlines that have been set down within the NCCP with a 95% target of ten working days for an urgent referral and 20 days for where surgery is required. We know, however, that this is so patchy, as the Minister herself acknowledged, across hospitals and indeed will be missed by the majority of hospitals. We heard from the Irish Cancer Society this morning that 3,600 women this year are not seen within the ten-day target. All of us here have had people come to us really distressed because they are told they need an urgent appointment and then they are given an appointment, such as in one case that I was dealing with, of seven weeks later. The reality of course is that this is one part of the cancer care process. I understand that the conversion rate breast screening to diagnosis is about 8%.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The five-year net survival rates for breast cancer grew from 71% in the 1990s to 87.5% for the 2019 to 2022 period. We are going in the right direction. The Deputy is absolutely right to highlight it. We have had more people through the system and demand is increasing year on year. More than 56,000 patients were seen in clinics in 2024, up from 50,000 in 2019.

From my analysis, the single biggest issue, although there are many, is the timely access to MRI as a diagnostic tool. From the data I have, the reason for being out of target, say in 2022, was that imaging was at about 30%. It is now at 41%. We need to focus all of our efforts on access to imaging, the way in which our imaging technology is being used, the consistency, the hours that it is being used and the commitment of hospital staff to do that at all times and days of the week. As part of the productivity we were speaking about, this is an example of why that matters so much. Access to imaging, as far as I can see at the moment, really is the most challenging part.

Marie Sherlock (Dublin Central, Labour)
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I very much share the Minister's concern but I know, for example, that there is an MRI scanner in a major hospital for which they cannot get access to the post because there has been a suppressed post. I can talk to her afterwards about this.

There is also the reality of the very significant inequality for some women out there. Research published this year by the National Cancer Registry Ireland shows that 41% of women from deprived backgrounds have a much higher risk of death within five years of diagnosis compared with those from more affluent backgrounds and 24% have a higher risk of being diagnosed with late stage disease. We have had 4,000 diagnoses in 2022. One in seven of us women will get breast cancer in our lifetime. These wrinkles within the hospital system are down to the equipment that is not being properly optimised because of suppressed positions, and the delayed response to business cases by the HSE for breast surgeons. These are very real issues.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I would be very grateful for the specifics of what the Deputy is asserting. I will check that out. It is very much the opposite to what we are trying to do. Considering the number of vacancies we are desperately trying to fill, I would be very concerned about that. I would appreciate if the Deputy could help me out with more information on that.

Several cancer centres have plans for additional theatre and inpatient capacity specifically for cancer and inpatient care because the theatre access is so important. Part of what will help with this is completion of the surgical hubs nationally, which will alleviate some pressure on our acute theatre capacity by moving lower complexity procedures, obviously since it is surgical hubs. Aligned to that is the theatre utilisation project, which is changing start times of theatres and maximising the flow and capacity within that. As I said, if there is a particular issue in a hospital I would be very glad to know about it.