Martin Daly (Roscommon-Galway, Fianna Fail)
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5. To ask the Minister for Health the number of linear accelerators currently in use for radiotherapy services in the State; their age profile, including the number over 20 years old; the recommended replacement age for such equipment; and whether a rolling procurement and replacement programme is in place. [18169/26]

Martin Daly (Roscommon-Galway, Fianna Fail)
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The number of linear accelerators in use in radiotherapy in the State is 22. Following the discussion we have just had about the cancer strategy, will the Minister make a statement on the procurement and replacement programme by the HSE for new linear accelerators? A number of the accelerators are reaching the age of 18 and the recommended international replacement time is eight to ten years. It costs a lot of money to maintain them.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Under the national plan for radiation oncology, an equipment replacement programme is in place in St. Luke's in Rathgar, St. James's Hospital and Beaumont hospital, along with a phased expansion in Beaumont. The replacement programme is being progressed under the national development plan. It is included in the capital plan and the health sectoral plan. There are 23 linear accelerators, ranging in age from three to 18.

These are located across five public hospitals: Rathgar, Beaumont, St. James's, Galway and Cork. State-of-the-art radiation oncology centres opened in Cork and Galway in 2019 and 2023 respectively, representing a €120 million capital investment. The linear accelerators in Rathgar, Beaumont and St. James's were installed between 2008 and 2016. The HSE advises that the typical lifespan of a linear accelerator is ten to 15 years, although some can be used for longer. An accelerator's lifespan depends on many factors, including the type, how it is used, how it is maintained and the manufacturer support lifespan, which includes software upgrades. There is a degree of variance. The preliminary design process for linear accelerator replacements within St. Luke's is ongoing. In addition, tenders for the main contract for the Beaumont phase 2 expansion and replacement project are due in the coming weeks. We are committed to improving cancer care and to investing in this way.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I am asking this question out of concern rather than as a challenge. We heard a presentation from the Irish Cancer Society and Professor Gerry Hanna last week. From the information the Minister is getting from the HSE and from what we are being told, the international standard is to replace a linear accelerator that is being fully used after eight to ten years. The Minister has raised issues around productivity and management of this infrastructure. It appears the procurement process has been held up for the replacement of those older devices, which have been around for 18 years. I believe there are three of these. They will have been in place for nearly 20 years when they are replaced. With regard to the age profile of our infrastructure, it appears we are an outlier within the European Union. It is important that we have an efficient planned rolling procurement process.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I agree with the Deputy. I would like us to be replacing equipment because we have used it so intensively. Part of this issue relates to the number of radiation therapists. There has been a very considerable expansion in that regard. We have 217 radiation therapists in Ireland, an increase of 21% since 2020. In the last six years, the radiation therapy training programme has grown by 32%, with more than 20 additional specialty training posts established in the last three years. We need the people but we also need organisation to allow these machines to be run hard. I will give an example regarding a performance indicator for radiation oncology, that is, the number completing radical treatment and the percentage commencing treatment within 15 working days in the Deputy's own area of Galway. In January 2025, the percentage was 72%, in October it was 98%, in November it was 98% and in December it was 100%. In Cork, there was a fall-off. The figure was 97% in January 2025 but fell to 91%. That is still reasonably strong but nationally we are just not where we need to be. It is about resources, organisation and consistency.

Martin Daly (Roscommon-Galway, Fianna Fail)
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In talking about management and productivity, the Minister will find an ally in me. She has pointed this out very clearly since she began her tenure as Minister for Health. I agree with her 100%. I acknowledge the investment by the Department and the HSE in the linear accelerators in Galway. That is a hugely welcome development but, as the Minister has quite rightly pointed out, the figures for the time between point of diagnosis and getting to chemotherapy are not meeting the targets in the west of Ireland. We should not have that regional disparity. I am getting off the point but the Minister has acknowledged that, which is very honest of her.

With regard to the linear accelerators, it has been expressed to me that part of the problem is a very slow procurement process, especially for those older machines, which have been in service far longer than internationally recommended. I have been told that, when some of the components break down, not only are the machines taken out of operation for up to three weeks, but the replacement components can cost €300,000 to €400,000. In the context of a machine that costs €2 million to €3 million, that seems inexplicable.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I understand the Deputy's point. We want the machines working hard. There is considerable variance. It should not get to 20 years. We have a programme of replacement. The HSE has a key performance indicator target for 90% of patients to commence treatment within 15 working days. The figure for performance nationally is 79%. The majority are exceeding the target. Unfortunately, St. Luke's is consistently below the key performance indicator target. Is that unfair to say? What are the specific reasons for that? Is it a question of disruption to machines, access to radiation or access to management? As public representatives, the Deputy and I are now able to intelligently interrogate the reasons for that and to challenge or support, as appropriate. Because we have the capacity to tell that story rather than speaking in generalised ways, which unfortunately was our wont some years ago, we are able to have a much more detailed conversation and reflect fairly and honestly on the varying reasons for those things.