David Cullinane (Waterford, Sinn Fein)
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I move:

That Dáil Éireann:

notes that:

— the National Cancer Strategy 2017-2026 is due to end this year, and a new strategy is needed to drive improvements in access to, and the quality of, care from 2027;

— in 2025, 15 per cent of chemotherapy, and 23 per cent of radiotherapy, patients did not get access to treatment in the target timeframe;

— in 2025, 45 per cent of breast cancer surgeries and 39 per cent of lung cancer surgeries, and in 2024, 61 per cent of prostate cancer surgeries, did not happen within the target timeframe;

— a postcode lottery exists in access to care, with access within target timeframes ranging from as low as 60 per cent in some areas, to upwards of 95 per cent in other communities;

— this State has below European Union average levels of diagnostic and imaging equipment, such as Magnetic Resonance Imaging, Computerized Tomography, and Positron Emission Tomography scanners, which is leading to significant delays in access to care, particularly surgeries, and this is caused by a combination of a low density of equipment, out-dated equipment, and poor utilisation of existing equipment;

— there has been a highly concerning shortfall in the number of women screened for breast cancer, with BreastCheck only screening 75 per cent of the anticipated number of women in 2025, which already assumes a 30 per cent fall off from the number of women invited for screening; and

— the most recent implementation review found that only 1 of 23 National Cancer Strategy objectives had been met;

considers that:

— cancer services need a clear roadmap and guaranteed funding levels for the next decade to deliver key enablers, detailed planning, and turn gold standard targets from aspirations into real deliverables;

— the mission of the new cancer strategy must be to improve standards, timely access to care, patient outcomes, quality of life, efficiencies, and innovation;

— a new strategy must include a strong emphasis on prevention, early detection, and proactive treatment of primary drivers, as well as of cancers themselves;

— a new strategy must address access to care, workforce challenges, equipment and infrastructure deficits, research, innovation, all-island planning, and the post-code lottery which currently exists for services;

— a new strategy presents a significant opportunity to drive all-island collaboration in improving cancer care and outcomes, and all-island planning, training, and delivery should feature prominently in a new strategy; and

— clearly identified, protected, and guaranteed new developments funding should be provided to underpin a new strategy, through a multi-annual funding framework averaging €30 million a year, each year, in additional new developments funding;

condemns the failure of Government to provide and clearly identify ring-fenced new developments funding for the National Cancer Strategy in 5 of the 10 Budgets over the lifespan of the current strategy;

resolves that a new cancer strategy should:

— guarantee timely access to cancer diagnosis, treatment, recovery, and follow up care;

— end postcode and income-based inequality;

— provide multi-annual funding certainty;

— expand capacity in line with projected demand;

— strictly manage expenditure to ensure cost-effectiveness without losing sight of the critical social and economic benefits of health investment;

— strengthen all-island cancer cooperation;

— reduce the financial and social burden of cancer; and

— position Ireland as a leader in research and innovation; and

calls on the Government to:

— commit to a new cancer strategy, to cover the period 2027 to 2037;

— guarantee €30 million in additional new developments funding each year, to underpin delivery of the new strategy;

— end the postcode lottery in access to cancer care, through targeted investment;

— implement a specific campaign to increase uptake of BreastCheck, catch up on women who did not attend screening invitations, and provide the option for information on breast density through BreastCheck;

— implement a managed programme for replacing outdated equipment;

— mandate Health Service Executive Regions to implement site specific equipment utilisation plans, including roster reform agreed with workers, to maximise use of existing equipment;

— extend service hours in the evening and over weekends, following constructive engagement with workers, for diagnostic imaging, laboratories, and treatment options, and ensure a commensurate increase in staffing levels, to maximise utilisation of equipment and capacity;

— fund additional training places in areas of strategic need in the health workforce, and work with graduates to ensure employment in the Irish health service;

— abolish hospital car parking charges for patients and visitors;

— immediately increase medical card thresholds in line with GP visit card thresholds, and increase funding for discretionary medical cards, to widen compassionate access;

— increase the health capital budget to €2.5 billion per annum for the remainder of the National Development Plan, to ensure sufficient funding for all of the Government's infrastructure commitments in Health;

— adopt a systematic approach towards clinical trials and life sciences innovation, aiming to make Ireland a world leader in clinical trials and the development of new medicines and therapies; and

— place Sláintecare wait time targets into law.

I will be sharing time with colleagues. I start by thanking all those working in our healthcare system who provide the very best cancer services they can. I commend all the nurses, doctors, radiographers, radiation therapists, those who work in primary and community care, and those who provide diagnostic scans. The problems with the national cancer strategy are not down to the hard work of those staff. In terms of research in cancer care, I am blown away by what I see right across our healthcare system and also advances in new medications, a lot of which are produced here by pharmaceutical companies and their workers. I want to put on the record my appreciation of all those working in our healthcare services who provide first-class services to cancer patients.

Cancer care was one of those areas where we were hitting our targets and people were getting rapid access to care. However, in an area where we were doing so well, we are now beginning to see slippage which really disappoints me. Replies to parliamentary questions that I have tabled over the last year or so, particularly over the last number of months, show slippage in the key performance targets and the gold standard access times for diagnosis, chemotherapy, radiotherapy and indeed surgeries. There are a number of reasons for that but first I just want to go through some of the figures. In 2025, 15% of chemotherapy patients and 23% radiotherapy patients did not get access to treatment in the target timeframe. In 2025, 45% of breast cancer surgeries, 39% of lung cancer surgeries and 61% of prostate cancer surgeries were not done on time, and people were not seen within the gold standard. They are shocking figures and represent a dramatic reduction on where we were only a number of years ago.

I have spoken to healthcare professionals, the Irish Cancer Society, advocates and cancer patients themselves. They tell me that one of the problems is we do not have enough staff. We know we have a shortage of radiographers and radiation therapists but we also have a shortage of surgeons in some hospitals which is why we are seeing a postcode lottery. For example, in Cavan, people are waiting much longer for chemotherapy than they are in other areas. In Waterford, for example, the majority of patients were not seen within the proper timeframe. It is unacceptable to have a postcode lottery that depends on where someone lives and depends on the surgery as to what access and how quickly they will get that service. One of the problems is that we do not have the staff.

The second problem is with the cancer machinery and equipment. I again discovered through parliamentary questions that we have a lot of cancer equipment which is out of date. In fact, in some hospitals, the majority of equipment is out of date. It could be chemotherapy equipment, radiotherapy equipment or diagnostic equipment. A lot of the time it is not functioning property. Hospital equipment is at partial capacity, again because we do not have the staff. We do not have the radiographers, radiation therapists and so on. It is a problem to have very expensive equipment either lying idle or only operating at partial capacity. The current national cancer strategy ends next year. In five of the past ten years, the national cancer strategy received no additional funding. It cannot operate in a piecemeal way like that. If we want the national cancer strategy to work, it has to be funded consistently every single year which is why our motion calls to ring-fence €30 million each year for the next five years, a total of €150 million.

We also want to increase the capital healthcare budget because we know there is not enough money to build elective hospitals, a new maternity hospital, finish the children's hospital and deliver the beds that were promised. That is why we do not have the money to replace equipment and allow for new equipment for cancer care in hospitals, and that is hurting.

Our motion also calls for cutting the cost of cancer care for patients. That is a big issue which comes up a lot. We want to abolish the car parking charges but we also feel that cancer patients should have a medical card. Sometimes cancer patients who apply simply do not get it even though they have a cancer diagnosis which is deeply unfair. We all signed up to the principles of Sláintecare where money should not be an issue and people should have access to high-quality care. It makes no sense years on from Sláintecare that cancer patients still do not have access to a medical card. Our motion today is a call for action from the Government. We do not want half-measures. We do not want slipped targets or slippage. We want a new national cancer strategy that is robust, that is properly funded and that works for cancer patients.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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I thank my colleague Deputy David Cullinane and for bringing forward this motion this evening which gives us the chance to have this very important discussion. I also thank him for the proposals he has consistently brought forward which would make a real and meaningful difference not just for patients but also for people working in our health services.

8 o’clock

As was rightly pointed out, the issues that are faced in the cancer control and the cancer care programme are not caused by the men and women working hard in it. They are not the ones who should be held accountable. The delays are due to underfunding. The chaos often at the heart of this Government has caused what many used to consider a world-class, gold-standard service to actually go backwards, and the figures as described by an Teachta Cullinane bear that out. We know the number of people on lists is increasing and the delays are increasing, and all the while it is very expensive to be sick in this State. Time off work, car parking charges - all these things add up. It is really expensive, and the delays make it more expensive. They mean more expense for people, more time off work and more time on reduced hours. They wait and they wait and they panic. When they know they need treatment, when they often know what that treatment is and they cannot access it, that is deeply concerning.

I encourage the Minister of State to examine making the PSA test part of the national screening programme. It is a very simple test and it saves lives. I have close-hand and personal experience of the fact that it saves lives. It should be included as part of any screening programme.

Pa Daly (Kerry, Sinn Fein)
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In April 2023 a location to serve the long-term oncology needs of University Hospital Kerry was identified within the grounds of the current hospital. The HSE had decided to pursue a more substantial, permanent proposal of a day treatment ward, an outpatient ward and a haematology unit. A revised brief and schedule of accommodation were provided in September 2023, costing was identified and a stage 1 report was issued in August 2024. It was supposed to be prioritised; however, nothing has happened since. People in Kerry are waiting and waiting for this. I am not sure what has happened. There is a huge demand for beds in the same hospital. Because of the demand for beds, has this oncology unit been pushed to one side? I do not know. We deserve the same oncology services as any other county and as any other citizens. It is not fair. Geography deciding your chances and your timely treatment is not acceptable to us.

I want to raise one more issue with the Minister of State and that is medical cards for people who have cancer. I have been dealing recently with a woman who lost her husband in tragic circumstances. She subsequently developed cancer. She has had to have 17 rounds of radiotherapy, and in the middle of all that stress and all that anxiety and dealing with her issue, she applied for a medical card but was told she was over the means test threshold. Surely, however, that is a circumstance where discretion should be applied. It is not being applied, and I ask the Minister of State to look into that. It is totally unfair.

Rose Conway-Walsh (Mayo, Sinn Fein)
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I thank my colleague David Cullinane for bringing forward this motion. As the last speaker, Pa Daly, said, medical cards for cancer patients are a real issue, as is the affordability of access to care. I ask the Minister of State to bring that back to the Minister to ensure that something is done about it.

I commend all the staff working in oncology. They work really hard. In Mayo cancer patients are served by Galway and Mayo university hospitals. The biggest problem we have in Mayo is the delays in diagnosis. If you can afford to get the scans and everything else, you get the treatment more quickly. What kind of a country are we when your life depends on how much money you have? That absolutely should not be the case. Then you have the diagnosis and people undergo treatment and there is no bed there. When I say there is no bed, obviously I mean there is no bed that is fully staffed there for the clinicians who are there to give the treatment. What a waste of money. They stand there waiting for the patients but there are no beds to put them in in order that they can treat them and that they can recover. That absolutely has to be addressed. This is not a problem from today or yesterday; it has been a problem particularly since we have had the centres of excellence. The centres of excellence are a good idea but not if you cannot access them. This has to be made accessible for people. We cannot continue to operate on a postcode lottery whereby if you live in Mayo, you have less of a chance of surviving cancer than you would anywhere else. We have to stop that. We have to bring equity into the system. I think the way we can do that is by having an all-island approach. Wonderful work is done with the all-island cancer research group. We should use that model to spread that across the island in order that there is joined-up treatment of cancer care here.

In the motion we refer to car parking charges. Trying to get a car parking space outside Galway University Hospital is absolutely horrendous. I remember the day my mother died and driving around the hospital looking for a car park space.

Claire Kerrane (Roscommon-Galway, Sinn Fein)
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In January I was contacted by a father and husband whose wife had been diagnosed with cancer at the end of November. She had been referred to University Hospital Galway for chemotherapy. She has young children at home and she was obviously extremely worried, first, to be diagnosed with cancer but, second, with a cancer that had taken her mother. About five weeks into waiting for the chemotherapy, she travelled up there, she presented to the accident and emergency department in pain and, eventually, five weeks after her diagnosis, well after the 15 working days that is the targeted timeframe, she received her chemotherapy. She had begged for weeks for chemotherapy and she had not received it. I imagine that if she had not shown up at the accident and emergency department in pain, she would not have received it within five weeks either.

In terms of UHG, we know there are significant issues with meeting target timeframes that are in place. We know that in 2025 27% of cancer patients did not get access to chemotherapy within the target timeframe of 15 days. The figures are stark as well when you look at the delays in accessing surgery for prostate cancer, with just 21% of patients in UHG getting the surgery within the recommended timeframe of 30 days, that is, only 21% of patients who needed that surgery getting it within the timeframe and the vast majority not getting it. There is a serious issue with resources and people diagnosed with cancer receiving their treatment or surgery within that targeted timeframe, which is so important. Having to contact a TD to try to get help accessing chemotherapy is really concerning and should not happen.

Joanna Byrne (Louth, Sinn Fein)
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As we have just had Daffodil Day, I feel we must mention the Irish Cancer Society here. Every one of us knows somebody who has battled cancer, and with one in two people in Ireland affected, this cause sadly touches us all. The Irish Cancer Society provides significant support for cancer patients and their families in County Louth, with services witnessing higher demand throughout 2025. With only 5% of annual funds needed each year coming through State funding, it is vital that we support this organisation where we can.

In Louth we have many other phenomenal groups also supporting cancer patients and their families. We have the Gary Kelly support centre, Cara Cancer Support Centre and the North East Cancer Research and Education Trust, all of which are vital and all of which have to constantly fundraise to keep the lights on and the doors open. Our Lady of Lourdes Hospital Drogheda is a major centre for cancer care in the north east. It is clear that despite the tireless and fantastic work done by the front-line staff day in and day out the length and breadth of this country, this Government is failing them and the cancer patients they treat when it comes to accessing treatment. People in Drogheda have to wait longer for access to chemotherapy than people in most other places in the country. Out of 25 hospitals providing chemotherapy, Drogheda ranks 16th, with 17% of people not getting their chemo within the target timeframe of 15 working days. That is 67 people who faced serious delays in Drogheda for chemo in 2025. Around the country hundreds are left waiting as hospitals miss their targets to start chemo, and it is just unacceptable. Behind all these figures are hundreds of people who are sick with worry, facing delay after delay, trying to cope with the fear that their cancer is progressing while they wait. The staff in Our Lady of Lourdes Hospital and the patients behind all these statistics deserve better. We ask the Government to do its job, support this Private Members' business and action everything in it. The very fact that all of this has to be spelled out to the Government is utterly shameful.

Mairéad Farrell (Galway West, Sinn Fein)
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A woman in my constituency of Galway West got the devastating diagnosis last year that she had cancer.

She expected she would be seen and begin her treatment within days, but instead she had to wait three months to start it. When families receive a diagnosis of cancer, or when a person receives that diagnosis, they have a lot to process. The last thing they need to be doing is fighting and getting on to local TDs and getting on to the hospital to try to access treatment. That should be basic and should be something given to them immediately. Unfortunately, this woman's situation is not unusual, and that is probably the most frightening aspect of this. Thousands of cancer patients are having to wait longer than the Government's 15-day target for cancer treatment. Every cancer patient should have timely access to high-quality care and they should get that immediately. Instead, it seems to be a postcode lottery. Last year, 141 cancer patients at University Hospital Galway had to wait longer than the 15-day target to access their first chemotherapy treatment. Everybody should be getting the care they need and it should not be based on where they live.

There are two other issues that I want raise having seen them in the past year. First, I find it shocking that when a chemotherapy patient lands into the emergency department, they wait for hours to get a trolley and when they get one, they are put in an open place. They are not supposed to be mixing with people, yet they are left on a trolley. I have put in representations about this but the hospital is bursting at the seams and it tries but it cannot cope. We have a situation where chemotherapy patients are exposed in that way. Second, I want the Minister of State to look at the issue of those with pancreatic cancer having assistance with the pump they can get, because of the issues of type 1 and type 2 diabetes.

Thomas Gould (Cork North-Central, Sinn Fein)
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I stand here today as a cancer survivor. A year and a half ago, I was diagnosed with bowel cancer and had to have a tumor removed. Then I had to wait a space of time so that I could get chemotherapy, which went on for over six months. I know that it will be years before I can say I am free from cancer. I know that and I am not counting my chickens. However, I want to send out a thank-you to all the doctors, nurses and staff, who are so professional and caring. The work they do is just unbelievable. I met patients in the hospital while I was getting chemotherapy. I was struck by the humanity when I was going through the treatment. For some people, treatment delayed can be a death sentence. I had stage 3B, which is right on the edge. I was not scared but my wife Michelle, and my daughters Aoife and Orlaith, my sisters, my dad and my extended family, they always feel it. For anyone with cancer, their family feel it more than them. That is why this is such an important motion that Deputy Cullinane has brought here today. It a really important piece of work because everyone deserves to have the opportunity to live as long as they can and to spend as much time as they can with their family.

This is just a simple thing: in CUH last year, €3 million was collected from parking fees. A lot of that is from families of patients going to see them. I remember a lady who had skin cancer and she could not get a medical card. There should be no barriers to health. I just want to say to people who are going through the journey, I know it can be scary but have hope. We have some of the greatest doctors and nurses, if we had enough of them.

My final point is this. I had Irish doctors and nurses along with doctors from Pakistan, India, Hong Kong, Africa and all over the world. I remember lying in bed in the middle of the night and the people would be coming in with smiles on their faces and it did not matter what colour their skin was or where they were from. The treatment was brilliant; it is just that we need more of it.

Verona Murphy (Wexford, Independent)
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Thank you, Deputy Gould, for sharing a very personal experience.

Kieran O'Donnell (Limerick City, Fine Gael)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"notes that:

— while a large proportion of cancers are preventable, our growing and ageing population is a key driving factor behind the increase in cancers;

— today, over 220,000 people in Ireland are living with or after cancer, a 50 per cent increase compared to a decade ago;

— the National Cancer Registry predicts that 1 in 2 people will receive a cancer diagnosis in their lifetime;

— fortunately, survival rates for patients after receiving a cancer diagnosis have continued to improve, with 65 per cent of patients living five years after a cancer diagnosis in 2014-2018, compared to 44 per cent in 1994-1998;

— Organisation for Economic Co-operation and Development data shows that cancer mortality rates in Ireland are falling faster than the European Union average, and faster than our economic peers;

— these improvements were achieved under reforms delivered by three consecutive National Cancer Strategies, dating back to 1996, and these Strategies provided a clear, evidence-based, approach to cancer control, taking a whole-of-population perspective;

— the current strategy was launched in July 2017, setting out an ambitious set of actions to be completed within 10 years, and an evaluation of the strategy will be conducted this year, and the outcome of this will inform the development of the next strategy;

— the new strategy will provide an important opportunity to plan for the introduction of new therapies and treatments across the cancer continuum from prevention, screening, treatment, survivorship and palliative care;

— the current strategy contains 52 recommendations, with 43 of these having been implemented, and the National Cancer Control Programme is continuing to progress implementation of the remaining nine;

— the National Cancer Control Programme plays a key role in the planning and oversight of cancer services, setting national standards, monitoring regional performance and driving service reform;

— cancer services are delivered by a large and dedicated workforce, who strive to provide the best possible care for their patients;

— while services have improved overall, unfortunately, there are periodic regional variations in the performance of some services, and the transition to the new regional health structure, with greater autonomy and stronger performance accountability at local level, is designed specifically to address regional inequality and to improve patient outcomes;

— since the beginning of the current National Cancer Strategy in 2017, the Government has allocated €105 million to the National Cancer Strategy to support cancer services and improve outcomes for patients;

— this has enabled the recruitment of over 670 staff to our national cancer services, including the recruitment of an additional 180 staff to national cancer screening and treatment services as of the end of 2025;

— between 2021 and 2024, approval for reimbursement by the Health Service Executive (HSE) was given for 74 drugs for cancer, and the total spend on cancer drugs in this period exceeded €645 million;

— capital funding of over €140 million has been used to provide state of the art radiation oncology facilities in Galway and Cork, to establish a National Cervical Screening Laboratory, and to update cancer infrastructure in chemotherapy wards and lab facilities;

— more widely, the 2025 National Development Plan (NDP) review secured the largest ever capital investment plan in the history of the State and largest investment ever in health infrastructure in the State, and the NDP Health capital allocation is €1.56 billion for 2026 and the enhanced NDP provision for the health sector for 2026–2030 is €9.25 billion;

— the Government is progressing multi‑annual budgeting across the health services, and capital investment is already on a multi‑year basis;

— since 2020, total staff working in Government funded HSE services has risen by over 22,000 Whole Time Equivalent (WTE), from 107,000 WTE to 129,600 at the end of January 2026, an increase of 21 per cent;

— the HSE continues to focus on service expansion and improvement, and the National Cancer Control Programme has developed a number of programmes to improve capacity at specialist cancer centres, and to support patients in avoiding Emergency Departments;

— the Government has provided significant investment in cancer screening programmes in recent years, and funding of €2.9 million was provided in 2025, to support the recruitment of 22 WTE posts, 15 additional WTE posts were also approved to help expand and futureproof the programme to meet increasing demand, and in 2025, 173,000 women participated in screening, the highest number in BreastCheck's history;

— the Programme for Government contains a commitment to extend the Laura Brennan Programme to anyone under 25 who missed it, and in January 2026, it was announced that the Laura Brennan Human Papilloma Virus (HPV) Vaccine Catch-Up Programme would be reopened, to offer an additional opportunity for students in fifth and sixth year of post-primary school to receive HPV vaccination in 2026;

— the Productivity and Savings Taskforce is advancing improvements in equipment utilisation, diagnostics and theatre capacity, including through roster reforms and extended hours where required;

— the expansion and rollout of the Public Only Consultant Contract, alongside the revised 2025 Framework Agreement with health sector trade unions, provides a strong platform to support the extension of services;

— through the National Plan for Radiation Oncology, a major equipment replacement and expansion programme is being progressed, including replacing 14 linear accelerators at St. Luke's Radiation Oncology Network and adding two at Beaumont, with associated diagnostic upgrades;

— new advanced services including CAR-T cell therapy and advanced radiotherapy have been introduced, removing the need for certain cohorts to travel abroad;

— significant Government investment is being provided to expand healthcare education, and within the last training year, the total number of doctors enrolled in training programmes has increased by 7 per cent, with the Minister for Further and Higher Education, Research, Innovation and Science recently announcing a €28.5 million investment to support the delivery of more than 1,100 additional healthcare training places annually over the next three years across medicine, nursing, therapy professions, pharmacy and dentistry;

— almost 1,600 first year students now enrol in medicine each year, along with 2,200 nurses; and

— in June 2025, the Government approved a significant expansion in training places for Health and Social Care Professions, and this saw up to 310 additional student places created in 2025, and a further 151 in subsequent years, including 23 additional places in radiotherapy and 80 additional places in radiography across 2025 and 2026.".

I welcome the opportunity this evening to discuss cancer services on behalf of my colleague the Minister for Health, Deputy Jennifer Carroll MacNeill. I join with the Ceann Comhairle in commending Deputy Gould on his personal account. I am glad to see him doing so well.

Thomas Gould (Cork North-Central, Sinn Fein)
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Go raibh maith agat.

Kieran O'Donnell (Limerick City, Fine Gael)
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I join with other colleagues across the House in acknowledging the great work of all healthcare workers, including medical, nursing and administrative staff and others throughout the health service. They do fantastic work. This year will mark the 13th anniversary of the launch of Ireland’s first national cancer strategy and is an opportune time to reflect on the progress made since 1996 and to look ahead to how we advance and build on what has been achieved.

The Government recognises the objective of the Sinn Féin motion in seeking to provide the best possible care for cancer patients now and into the future. Many of the points that have been raised will be brought back to the Minister. All of us in the House share that goal and are working to ensure the very best outcomes for patients and their families. However, the Government is opposing the motion and has tabled a countermotion setting out our clear commitment and the detailed actions we are taking to drive further improvements in cancer services. It is important to point out that the Opposition motion does not recognise the levels of investment and funding provided under the current cancer strategy, with €105 million allocated to new developments, along with €44 million in cancer research funding, €140 million on capital projects and €645 million on cancer drugs between 2021 and 2024. Notably, the motion attempts to place Sláintecare wait-time targets into law, a measure this House debated and voted not to support just four months ago.

With over 24,000 invasive cancers diagnosed each year, the National Cancer Registry predicts that one in two people will receive a cancer diagnosis in their lifetime, as a Member referred to earlier. While a large proportion of cancers are preventable, the reality is that ageing is a key driving factor behind the increase in cancers. As the Irish population ages and grows, the number of people diagnosed with invasive cancer is expected to grow by between 50% and 100% over the 30-year period from 2015 to 2045. Alongside an increase in numbers, the cancer burden is rapidly expanding as it becomes, for many people, a chronic disease they live with for many years. Fortunately, this is a good marker, as the number of people surviving a cancer diagnosis is growing all the time.

In the latest reporting period, 2019 to 2022, over 65% of patients were alive five years after a cancer diagnosis, up from 43% in the period 1994 to 1998. Over 220,000 patients are alive today, having received a cancer diagnosis at some point. We have seen very good progress in the detection and treatment of many of the most common cancers, and in the case of breast cancer for example, five-year net survival has grown from 71% for the 1994-98 period to 87.5% for the 2019-2022 period. Breast cancer survivors are the largest cancer survivor group in Ireland, representing 22% of all cancer survivors and nearly 50,000 women. For prostate cancer we have seen the five-year survival rate go from 66% in the early 1990s to 93% in the most recent data and we now have 46,500 survivors of prostate cancer.

Of course, far too many people still have their lives cut short by cancer and I join Deputies across the House in wishing to ensure that our health services strive to deliver the very best cancer care for patients. The progress we have made would not have been possible without the evidence-based, whole-of-population approach taken under our three consecutive, decades-spanning national cancer strategies. The international evidence demonstrates that sustained progress in cancer control is best achieved through the consistent implementation of appropriately designed and resourced cancer strategies. Research published by The Lancet in 2022 reported that Ireland’s cancer strategies, dating back to 1996, were a significant factor in improving cancer outcomes.

Furthermore, a study published by Professor Mark Lawler in January of this year in the Journal of Cancer Policyevaluated national cancer strategies across 20 countries and ranked Ireland among the highest in policy development and governance scores. The EU and the WHO continue to advise that cancer control is optimised through the development and implementation of national cancer control plans and strategies. We can be thankful that many patients will become cancer-free following their treatment but, for others, their cancer will be chronic conditions requiring prolonged surveillance and episodes of treatment over many years, with the associated significant implementations for service demand. With the development of the next cancer strategy, we will continue to progress our structured and strategic approach to the delivery of cancer services.

Investment under the strategy has ensured that more patients are being seen in specialist centres, more patients are being reviewed by multidisciplinary teams, new drugs and therapies are being made available, patients are receiving better supports during their cancer treatment, psycho-oncology services have been developed and major advances are being delivered for adolescents and young adults.

With regard to the workforce, our investment in infrastructure, research, medicines and staff focuses on providing the best possible outcomes for patients. However, these improvements would not be realised without the commitment of those working in our health service and the dedication they bring to their work, which I and many others have alluded to. In the past five years, we have increased the overall health workforce by 27%. Since the launch of the current national cancer strategy, we have added over 200 additional nursing staff, 100 consultants and 180 health and social care professionals in designated cancer centres. At the same time, we have fostered and expanded pioneering services, creating new roles and teams in psycho-oncology, genetic services and cancer prevention.

Working in collaboration with the higher education sector, significant progress is also being made in increasing the number of student training places. My colleague, the Minister, Deputy Lawless, recently announced a €28.5 million investment in 2026 to support the delivery of more than 1,100 additional healthcare training places annually over the next three years across medicine, nursing, therapy professions, pharmacy and dentistry.

While we are adding more training places and funding more students, we are also ensuring that more graduates are retained in our health service. A mandate was introduced in March 2025 offering all nursing and midwifery and health and social care profession graduates of Irish colleges permanent contracts of employment when successful at interview. This mandate includes radiation therapist and radiography graduates, who are crucial for cancer services.

In parallel with an increase in staff numbers, it is important that we maximise the existing workforce. The expansion and rollout of the public-only consultant contract, along with the revised 2025 framework agreement with health sector trade unions, provides a strong platform to support the extension of services. Health regions are actively leveraging these arrangements to progress delivery of services in the evenings and at weekends across a range of areas, including diagnostics, patient pathways and community services.

As we invest in staff and expertise, we are also investing heavily in infrastructure and technology. Major infrastructure projects opened under the national cancer strategy include state-of-the-art radiotherapy centres in Cork and Galway in 2019 and 2023, respectively, at a cost of over €120 million and the establishment of a national cervical screening laboratory, which opened in December 2022. The 2025 national development plan review resulted in the largest ever capital investment plan in the history of the State and the largest investment ever in health infrastructure in the State.

Investment in cancer care, particularly in equipment for radiation oncology, is a key strategic priority. Through the national plan for radiation oncology, the Department of health is progressing a major equipment replacement and expansion programme that includes replacing 14 linear accelerators in the St. Luke's Radiation Oncology Network and adding two at Beaumont, with associated diagnostic upgrades.

In light of the limited time I have, I will leave the rest of the written statement and go straight to the closing remarks. I once again thank the Deputies for the opportunity to discuss cancer care for patients in Ireland, the progress we have made and our commitment to continuously improve cancer services in Ireland. I acknowledge our shared commitment to improving the lives of cancer patients. On behalf of my colleague, the Minister for Health, Deputy Jennifer Carroll MacNeill, I ask Deputies to support the Government's countermotion.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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I thank Deputy Cullinane for bringing forward this motion this evening. The national cancer strategy is due to be reviewed. As has been evidenced by the Deputies who have spoken before me, while the targets that are set are very logical and would ensure that people get the treatment they need within an appropriate timeframe, in many cases, they are clearly not being met. That is not the case just in one place in the country but across the entire country. I know of a gentleman in my own constituency who had a cancer diagnosis. He was waiting for radiotherapy and contacted the hospital in Galway, which he has to travel to all the way from Leitrim, and was told he was on a waiting list. After several weeks of my office trying to deal with the HSE, he was finally able to move ahead with his treatment but he and his family were extremely stressed because his brother had previously passed away from the same type of cancer he had been diagnosed with. Many people find themselves in that situation.

The Minister of State has tabled an amendment to our motion that states how great everything is going but that is unfortunately not the experience of a great many people. That is very difficult to say because, in fairness, the HSE and the health service have traditionally provided a very good service, particularly when it comes to cancer care. Most people would say that, once you got into the system, you were treated fast, you were dealt with quickly and things progressed as you needed them to. That has changed in the past number of years and particularly in the past 12 to 18 months. I know from talking to my colleagues that many people across every constituency are experiencing the very same thing. There are delays and there is difficulty in accessing treatment and in getting diagnostics. When we talk to the clinicians and the hospitals, they tell us that staffing, medical equipment and facilities are all problems. All of these things need to be dealt with. While the Government's countermotion may suggest it is going to produce the answers, we are very doubtful it will.

Shónagh Ní Raghallaigh (Kildare South, Sinn Fein)
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Thirty years ago my mam was diagnosed with non-Hodgkin's lymphoma. At that time, she went to her GP with a lump on her neck. She was told it was a cyst. She went back again and was dismissed again. It was only on the third consultation that she was referred for cancer screening. Had the cancer been detected in the first instance, my mam's journey would have looked very different. I commend Professor John Crown, who kept her alive for as long as he did.

Fast-forward 30 years and we still have endemic delays. In County Kildare, 951 people are diagnosed with cancer every year. Many of those people face difficulties accessing timely diagnosis and treatment, which negatively impacts their health outcomes. A constituent of mine, Áine, was diagnosed with Hodgkin's lymphoma last year, just three months before her leaving certificate. I am thankful that she has made a great recovery, having received great care in Tallaght hospital. Áine has highlighted the significant delays to her chemotherapy caused by PET scan waiting times. At the moment, our equipment density is too low and equipment is out-of-date and underutilised. She was told she was lucky to receive chemotherapy when she did because there was just one space left in Tallaght at the time. Another shocking element of Áine's story is that she had to sleep in a ward of six beds with patients with various illnesses. This was extremely dangerous as her immune system was suppressed by medication.

In Kildare, we need beds for cancer patients at Naas General Hospital. At the moment, many are forced to travel. Long-term planning is essential. There will be an increase of 100% in the number of cancer diagnoses by 2045 compared to the number in 2015 so investment in infrastructure and new developments must be a priority.

We all have a personal story. Tá scéal pearsanta againn go léir sa Teach seo a bhaineann le hailse. Tuigimid ar fad cé chomh dáiríre agus chomh tábhachtach atá an cheist seo. Mar sin, oibrímis le chéile chun cúram ailse den chéad scoth a bhaint amach in Éirinn.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Many people will have harrowing stories to tell today that are personal and connected to them. The unfortunate fact is that cancer has a huge footprint. We have often spoken about people coming to us to say that the system is brilliant once you get into it but we are talking about slippage here. That is the reason Deputy Cullinane is highlighting the absolute necessity of a new cancer strategy. Some 15% of chemotherapy patients and 23% of radiotherapy patients do not start treatment on time. It is as simple as that. There are delays in surgical care, with 61% of prostate cancer surgeries, 45% of breast cancer surgeries and 39% of lung cancer surgeries not happening within the recommended timeframes.

That speaks for itself. It is just not good enough.

Our Lady of Lourdes Hospital in Drogheda ranks 16th out of the 25 hospitals providing chemotherapy with 17% of people not getting chemotherapy within the target timeframe of 15 working days. As Deputy Byrne said, 67 people in Drogheda faced serious delays for chemotherapy in 2025. That is not good enough whatsoever. We know that there are issues with resources, outdated rosters and outdated equipment. They just need to be dealt with.

In the small amount of time I have left, I want to bring up an issue that a constituent has brought to me. It relates to stomas. I appeal once again for people with stomas to be included in the long-term illness scheme. A person wears an ostomy bag for a number of reasons, one of which is obviously cancer. It is an absolute necessity for people, but at the minute they are paying a minimum monthly expense of €80 per month, whereas if they were up the road in Newry this would not be the case. It needs to be looked at and delivered upon.

Donna McGettigan (Clare, Sinn Fein)
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I thank my colleague, Deputy Cullinane, for bringing this motion forward. He has been very vocal on these issues, which hit nearly every home in the State.

I was personally affected by cancer when my partner at the time, Noel, was very ill. For 18 months, Noel lost a lot of weight and was in a lot of pain. He could barely hold himself up. Noel was yellow. His skin was yellow. His eyes were yellow. He was a bag of bones, yet he was repeatedly sent home from hospital. Noel was shifted between doctors. None of them seemed to talk to each other and because we do not have digital records, there was a complete lack of communication between doctors. Noel could not keep food down. We knew that Noel had cancer. The dogs in the street knew that Noel had cancer, but we had no diagnosis. We had to fight for a medical card. We were paying for petrol and parking costs. We were in and out of hospital, as well as dealing with the pain and the worry.

Noel was told he had cancer and then a week later told he did not. Noel was eventually brought to Dublin where he was opened up and it was then we were told the devastating news that he had stage 4 cancer. It was too late. Nothing could be done for him, but Noel, being mister positive, wanted us to use the six months he was given for us to be happy and get married. I set about arranging a wedding. It was during Covid-19 so we could not have all our family with us. I could not help but cry when it came to the words "in sickness and in health" because I knew there would be no health for Noel. We did not even get to celebrate our first anniversary together. At Noel's funeral during Covid-19, we could only have ten people. The sad thing about our story of delayed diagnosis is that we are not alone in this. I hope no other family has to go through this. We need to provide better diagnoses and cancer care for people so that nobody else has to go through this.

Louis O'Hara (Galway East, Sinn Fein)
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Some of the personal testimonies we have heard this evening underline the need for change and better outcomes in this area. I speak as a representative of the west of Ireland. We know there is a postcode lottery when it comes to accessing cancer treatment across the State. The Irish Cancer Society, medical professionals and many others have consistently highlighted that waiting times to access cancer treatments in the west are among the worst in the State. For too many cancer patients, accessing treatment in a clinically appropriate timespan does not happen. To give an example, data from the HSE shows that almost 30% of cancer patients deemed fit for chemotherapy at University Hospital Galway did not receive it within the recommended 15-day clinical window. Those people are expected to wait weeks to start chemotherapy treatment while knowing that the cancer inside their bodies is not being treated. These are real people who are being put at increased risk. It is unacceptable.

The root cause of these delays and failures is the lack of resourcing and staffing for cancer services. There are plans for the development of a new cancer care centre as part of the master plan at University Hospital Galway. There is still no timeline for that and there are real concerns that the Government has not provided sufficient resources in the HSE capital budget. There is currently no PET scanner operating in the public cancer care system in the western region. This imaging technology is vital for cancer diagnosis. At the moment, patients are being forced to travel really long distances to access these scans, or they are being referred to private operators at a significant cost to the State. We have been told that the delivery of a PET scanner to University Hospital Galway is not planned to be completed until 2033. This means that for many more years, cancer patients in the west will continue to experience challenges in accessing the scans they need and this inequality will continue.

This motion is an opportunity for the Government to acknowledge the failings that too many cancer patients are facing within the public system. It is also an opportunity to end the postcode lottery and improve patient outcomes. I urge the Government to implement the practical solutions outlined in the motion.

Marie Sherlock (Dublin Central, Labour)
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I thank Deputy Cullinane and Sinn Féin for introducing this timely motion on cancer services, which the Labour Party supports. I was going to give out that the Government is opposing this motion. It is disappointing that it has decided to nitpick at what is a very good motion. Surely to God, we should all join together to identify the very clear issues that exist at the moment. While it used to be the case that Ireland was a global leader with regard to cancer care, we are now a long way off that because of a lack of investment but also because of a lack of focus on how we organise our health service - not just our hospital services, but right down to our primary care GP services. This is why we are not getting cancer services right in this country today. The reality is that, sadly, one in two people will get cancer in their lifetime in this country and one in three people will die from it. Ireland has the second highest incidence rate of cancer diagnosis in the EU. The number of cancer diagnoses is projected to grow by 47% between 2022 and 2040, so it is something we need to get right in terms of our services. To me, this conversation has to be about funding and how we organise our health services. We await the new national cancer health strategy next year. It is critical that ring-fenced funding is there and is rooted in prevention, particularly with regard to primary care and looking at those socioeconomic factors. Inequality is at the heart of the higher incidence of cancer among lower-income parts of our population and communities. Funding has to be ring-fenced for early diagnosis through screening, early treatment, innovation and access to technology and medication.

Screening is the low-hanging fruit of cancer services. We know that 40% of women called to attend BreastCheck last year did not go. BreastCheck missed its target by 46,000 mammograms last year and that target has been missed three years in a row. I have not heard any answers or any research into why that is the case. We can speculate. There are many potential reasons, including difficulty getting the time of work, the fear of the mammogram procedure because it is painful, and the potential outcome. My colleague, Deputy Duncan Smith, has a Bill coming this Thursday that will seek to provide for legislative provision for workplace leave for cancer screening. However, we need to see the research and the understanding undertaken by the Department as to why women are not presenting for BreastCheck. To my mind, the conversation has to be about reducing the eligibility age for BreastCheck. In particular, it should be extended to women below the age of 50 to ensure we catch the incidents of cancer at a much earlier stage. We have to send out a message that if breast cancer is diagnosed at stage 1, there is a 99% chance of survival. That is why early detection is so vital. We need to get to the bottom of why the take-up is much lower than it should be.

The other key concern for me is with regard to bowel screening. We know that the target of 50% is obviously much lower than we would like, but the take-up of bowel screening is far below what it should be. The rates of colorectal cancer in this country doubled for those under the age of 50 between 1994 and 2019. In an article published by the Irish Medical Journal last year, researchers from Cork University Hospital and Cancer Research Ireland predicted that by the 2030, young onset colorectal cancer will be the leading cause of death for adults between the ages of 20 and 49. One in ten people with colorectal cancer in Ireland at the moment are under the age of 50. We need to get serious about that very real challenge over the coming years. Not only do we need to look at the take-up of the existing screening programme, but we also need to lower the age as well.

To me, screening is the easy, low-cost part of the cancer services.

The other key part is with regard the in-hospital services. We see what has happened with regard to radiation oncology, the delays in terms of access to treatment. Two in ten people are not starting radiation in time. In 2025, two in five women were not being seen on time for their appointment at an urgent breast clinic. Of course, in the Dublin area, 90% of the LINACs are beyond the ten-year lifespan. That points to an enormous Government failure to ensure investment in infrastructure.

The other key aspect of what I want to touch on is outside of the hospital system. It is about the overall system of cancer care, which is the first port of call, namely our GP system. The EU Country Cancer Profile 2025 stated that Ireland faces shortages of various cancer care professionals, including GPs. I have stood in this Chamber a number of times, including with the Minister of State a number of weeks ago, when we discussed the huge geographical inequality that exists across this country with regard to accessing GPs. To be very frank about it, if people have to endure a long wait to access their GP, that is going to deter them from turning up, particularly if it is an issue relating to testicular cancer, prostate cancer, breast cancer or some of the cancers that may be a bit more sensitive for people in terms of presenting. We have to change that.

It is not good enough in the communities that I represent. There is one GP for 3,000 people in Cabra while it is one GP for 3,500 people in the north inner city. In some of the fast-growing communities, particularly in Kildare, Lucan and east Meath, we are seeing one GP to 4,000 or 5,000 people. That is unacceptable. I sometimes think when we are having this conversation I am having it with people who can pick up the phone to their GP, talk to the secretary and get the appointment the following day or the day after. If that is the case for the vast majority here, that is wonderful, but that is not the reality for many people in the community. The Government opposed our Bill to ensure that the HSE takes responsibility for an even geographic distribution of GPs across the country. We have to get that right if we are making sure that people are presenting at the first port of call within the health system.

The last issue I raise is palliative care. While we are all about early detection and treatment, the reality is people die in this country from cancer. Deputy Farrell raised it earlier, but I raise the lack of pathways when somebody has cancer in this country into the hospital system, whether they are currently in treatment or in palliative care. It is really frustrating to think that people with cancer have to present themselves to an emergency department and sit there for a number of hours or days before they get the treatment they need. St. Vincent's and other hospitals across this country have begun to provide quick access for cancer patients, chemotherapy patients in particular, to their clinics.

I spent time yesterday with a 42-year-old woman who is in palliative care. She is a single mother to a young son. She had to wait three hours for an ambulance yesterday to be brought to her local major hospital in Dublin. She had to wait until 4 o'clock this morning for a bed. She is in palliative care. Because she has been discharged from chemotherapy and even though she is with the hospice, she is not at death's door to go into the hospice just yet. She is in limbo. There is nobody to look after her. She needs a nephrostomy, which is effectively a procedure to ensure that the urine leaking out of her back can be stopped. She had to go into that same hospital a number of weeks ago and waited four whole days, taking up a hospital bed, waiting for a one-hour procedure that does not require a general anaesthetic. I am telling this story this evening to highlight the lack of pathways, particularly for those in palliative care into the hospital system. There is a complete disconnect from when people finish their treatment to when they die or when they go into a hospice. By the time they are admitted into a hospice, they are only a few days or a week or two from passing away. What about those weeks in the middle? That is critical.

Part of it relates to hospital organisation. The other part is the 2024 national palliative care strategy, and it is very welcome. It states great objectives, but I am not at all convinced, when I look at the HSE service plan or the letter of determination from the Minister, that there is any focus on that at all. In some ways, it should not take an awful lot to ensure that somebody with palliative care presenting to a hospital has a particular pathway to get their treatment and get them back out. It is not good enough that a palliative care patient is taking up a vital bed for somebody who may live, if we call a spade a spade, but second, in terms of affording them dignity in their final weeks and months of life, that they would spend any time unnecessarily within a hospital system. This is not really about massive amounts of funding; this is about how we get our systems right. I am afraid that those systems are not right. There are stories across this country of people having to get into ambulances and present to emergency departments unnecessarily when there should be another way for them.

I thank Sinn Féin for tabling the motion. There is enormous work to be done to ensure Ireland can go back to being a global leader in cancer care. Ultimately, to make sure we get back to that place, we have to get the investment into our equipment right and the investment into access to medicines. We know there is a gross inequality in Ireland between those who have the luxury of private health insurance - when I say luxury, you are paying a fortune for health insurance - or those reliant on the public system and the access to drugs. Across a whole range of cancers, people's potential for survival is greatly enhanced if they can go through the private system and access those drugs licensed through the EMA that have not been licensed for this country. In my book, if a drug has been licensed through the EMA, we need a greatly simplified system through the National Centre for Pharmacoeconomics of how we process approvals for drugs in this country. Yes, cost is one of them, but I do not hear anything from the Government about pushing at European level about how drug prices are collectively negotiated. In some ways, the market model is coming back to bite us in Ireland. We need to make sure we collectively negotiate at the EU rather than doing it individually here.

Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Sinn Féin for tabling the motion, which the Social Democrats will support. Cancer services were once the jewel in the crown of our health service and an example of what the system could achieve if sustained investment was matched by political will, but the focus on delivery has waned over the lifetime of the current strategy. As a result, we have delayed diagnoses and treatment, missed targets, shocking regional disparities, ageing infrastructure and major staff shortages, none of which were acknowledged by the Minister of State in his opening statement. To put it mildly, it was disappointing, particularly given the stories we have heard tonight.

Ring-fenced funding for the cancer strategy has been sporadic over its lifetime. When the strategy was launched in 2017, the then Minister for Health, Deputy Simon Harris, promised substantial current and capital funding over the ten years of the strategy. However, as the motion notes, the strategy has not received dedicated development funding in every budget since. There is a direct link between this failure to fund the cancer strategy and the missed targets, staff shortages and rampant outsourcing. You cannot starve a strategy of funding and expect it to be a success.

When the Irish Cancer Society appeared before the health committee last October, it was very clear about the need for multi-annual ring-fenced funding for the strategy. The programme for Government commits to developing a multi-annual funding approach for the entire health service. However, multi-annual health service funding has been promised by every Government since 2016, yet none has delivered it. The Minister for Health should have insisted that it was delivered in this Government's first budget. Budget 2026 did nothing to advance multi-annual funding. Last year, during the Estimates process, the Minister told me that it was her ambition to progress multi-annual funding this year, subject to an agreement with the Department of public expenditure. We need to know if this is still progressing and if it will be implemented in budget 2027. The next cancer strategy must have multi-annual funding. Otherwise, it will suffer the same fate as the current strategy.

There is no doubt that patient outcomes have improved over recent decades. However, the absence of sustained, year-on-year funding has meant that too many people are not getting access to timely tests and treatment. The Irish Cancer Society has provided an overview of recent testing and treatment pathways. Last year, 6,200 people waited more than the recommended time for a colonoscopy. The target is zero patients within more than 28 days. Two in five women were not seen on time for urgent symptomatic breast disease clinics. The target was 95% seen within ten working days. In the first half of the year, seven in ten people waited more than three months for an MRI, while six in ten people waited over three months for a CT scan.

Similar things are faced in terms of cancer surgeries in 2025. Two in five people did not have lung cancer surgery within the recommended 25 days. Three in ten women did not get their breast cancer surgery within the recommended 20 working days. In 2024, which is the year for which the latest data are available, three in five men did not get prostate cancer surgery in the recommended 30 working days. The bottom line is that these delays caused avoidable deaths. Research published by the British Medical Journal found that every four-week delay in starting cancer treatment can increase mortality by 10%. This is precisely why we have targets in the national cancer strategy. We know that a person’s chances of surviving cancer are up to four times higher when treated at stage 1 rather than stage 4.

One of the biggest issues in cancer care is the hollowing out of public radiotherapy services. Since 2020 over €113 million has been spent outsourcing radiotherapy for public patients to private providers. In 2020, €12 million was spent on outsourcing radiation therapy. Since then it more than doubled to €28 million in 2025.

One of the biggest reasons for this shocking spend on outsourcing is the failure to plan. Radiation therapy machines have a ten-year lifespan yet 50% of public machines are over 15 years old with four of these over 18 years old. After the ten-year mark, machines break down, maintenance costs increase and the standard of care decreases. St. Luke's Hospital in Rathgar, for example, is limited to using just three of its machines at any one time to mitigate frequent breakdowns. This means it is losing a quarter of its capacity on any given day. I accept a replacement programme is finally under way in the St. Luke’s network but why do machines have to reach breaking point before action is taken? Not one machine in Dublin is under ten years old and, as I said, four are approaching 20 years old. The need to replace machines is entirely predictable yet there is no rolling national radiotherapy equipment replacement programme in place. The machines in Galway will need to be replaced by 2032 and the machines in Cork will need to be replaced by 2029, just four years from now, yet no planning is under way. We need a rolling replacement programme and not an ad hoc system of replacement. This would also save the State money by buying equipment in bulk.

There are similar issues in relation to staffing. We now have a radiation therapy staffing shortage of between 15% and 22%. The increased reliance on outsourcing is creating a vicious cycle. In CUH, a radiation therapist told me that patients are being outsourced to private providers because the public system does not have enough staff. Outsourcing creates more business for private centres which, in turn, hire more staff. This means that even more consultants and radiation therapists leave the public system for the private system, which is booming on the taxpayers' dime.

Another issue I want to raise relates to radiography practice tutors. Radiographer tutors play a vital role in clinical education and training of students within our hospitals but their value is not recognised, not least in their current terms and conditions. We know that experienced radiography practice tutors are stepping down because the pay does not reflect the level of responsibility. If we are to attract and retain more tutors, they must be remunerated and graded appropriately. The cancer strategy is clear on the need to increase the number of student places and I welcome that the Government is implementing this recommendation. Just last week, however, I heard reports of radiography students studying in the library instead of doing clinical hours because of a lack of practice tutors to support their placements. One tutor described this to me as being akin to learning to drive by simulator. Hospitals must be funded to deliver these extra placements and there needs to be more joined-up thinking. What good is having college places if the tutors are not there in the hospitals? This escalating crisis requires an urgent intervention by the Minister for Health. It is time to support and value these tutors not just in words but in actions. Otherwise we will not be able to increase the number of tutors or retain them or provide patients with timely diagnostics.

I sincerely hope this debate is a wake-up call and in particular the really harrowing personal stories Members have shared about themselves, people they know, their constituents and family members. We really need to improve cancer services for people right across the country. This next strategy must not be starved of funding and it must not be at the whim of every budget cycle. We must have multi-annual funding. I would like the Minister of State to take that message back to the Minister. The downward trend in cancer care can and must be reversed. We have done it before and we can do it again. We need to have the same commitment to deliver that was present for the first two cancer strategies but notably absent in the third. I urge the Government to change track on this, to invest in cancer services and to start improving cancer services so we can improve outcomes, improve lives and prevent avoidable deaths.

Gary Gannon (Dublin Central, Social Democrats)
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I welcome the motion put down by Deputy Cullinane and Sinn Féin. I acknowledge the personal testimony shared by Members throughout the debate. It is really appreciated and I know it will matter to a lot of people.

Today’s motion is very timely, coming just a week after Daffodil Day when people across the country showed solidarity with those affected by cancer. People across this House showed the same solidarity by wearing daffodils and meeting local cancer survivors and advocates here in Leinster House 2000. I am very conscious that when representatives of the Irish Cancer Society come here, we all take pictures and share them but they expect us to take decisions. The decisions they are asking for are reflected in today’s motion.

After the failure to deliver the last strategy, there can be no more delay. We need a new national cancer strategy for 2027 to 2037 backed with proper ring-fenced multi-annual funding, including an additional €30 million a year in new development funding, as the motion sets out.

Cancer touches every family in this country. People should not be left waiting when they are diagnosed, at a time already filled with so much stress and uncertainty, but that is exactly what is happening. In 2025, 45% of breast cancer surgeries did not happen on time, while 39% of lung cancer surgeries and 61% of prostate cancer surgeries were delayed in 2024. It is not just surgery: 23% of radiotherapy patients and 15% of chemotherapy patients did not receive treatments within their target timeframes either. Those are not small gaps. Behind every one of those statistics, there are real people who have been left waiting when time matters. In our role, how often do we knock on a person’s door to be told such a story? It happens too often in my constituency.

The most recent implementation review found that only one of 23 national cancer strategy objectives had been met. Nearly a decade later, we are below the EU average for MRI, CT and PET scanners. This is not pressure on the system; it is a systematic, documented failure of investment and follow-through.

We know that cancer does not impact communities evenly. In more deprived areas, including parts of the north inner city which I represent, there are significantly higher rates of lung and cervical cancer. Those communities have historically been under-served by screening and early detection. We learned that BreastCheck only screened 75% of its anticipated numbers in 2025, having already accounted for a 30% drop-off in invitations. We know that the women least likely to be reached are often those who need it most. We cannot allow inequality in outcomes to deepen because of a failure to invest in infrastructure, equipment and community-level screening. That is exactly how a postcode lottery becomes permanent.

Alongside all of this, there is the crippling financial cost of diagnosis. People are not just dealing with their illness; they are also dealing with the travel costs, car-parking charges, time off work, childcare and bills. In my own constituency, the operator of the Mater Hospital car park charges €15 a day. That is an outrageous cost to someone attending daily for treatment. I live less than half a kilometre away from the Mater Hospital. It is all too frequent that I get a phone call from a relative, a friend or someone asking if there is any free parking available in the locality. You often see people parking far away from the Mater Hospital and walking to it because of the cost of car parking. Some of these are people in the middle of cancer treatment. That is why the practical measures in this motion matter. We need to abolish hospital car-parking charges, increase medical card thresholds in line with GP visit cards, properly fund discretionary medical cards and place Sláintecare waiting time targets into law so that access to care is not optional but guaranteed and can be vindicated through the courts if that basic necessity is not met through the allocation of budget resources. Cancer already takes enough from people and their families. The system should not add to that burden.

Before I conclude, I acknowledge the healthcare workers who do immense and incredible work. People often share their stories and talk about the great service they received from individuals within the system. This motion is incredibly reasonable. It is timely and necessary and we support it. I know the Minister of State supports it in theory, but we need follow-through from the Government as a whole.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I thank Deputy Cullinane and Sinn Féin for bringing forward this very important motion on cancer services, which I am very happy to support. It is more or less a year since I started my cancer treatment for throat cancer.

9 o’clock

The most important thing I wish to say is how grateful I am to all of those who work in cancer services, from the doctors and nurses to the radiotherapists and nutritionists, from the orderlies and porters to the receptionists and the people who research in the area of cancer and help to develop the treatments - all these huge numbers of people. There are a lot more that I am probably not mentioning. Without them, I might not be standing here, or I might be facing a bleak future, but instead the treatment was successful. It was thanks to those amazing people and all the work they did. I am very grateful. Given that 50% of the population will have a scrape with cancer, it is important to know that it is not a death sentence as maybe going back not so long ago it was seen as such. The treatment is advancing all the time if, ideally, we catch it early or it gets treated. If we invest and resource the people who work in this area properly, support them, the research necessary, the equipment necessary and the capacity and resources, then we can save a lot of lives. I am certainly a major beneficiary of that.

I am not quite sure why the Government has put down an amendment to Sinn Féin's motion because it could certainly add things to it. Sinn Féin's motion is very reasonable in saying that, of course, there should not be a postcode lottery. I have had a very good experience. It varies around the country. In more rural parts of the country, in particular, it can be very different. I would not like having to travel. I was lucky in that regard. I went to St. Luke's. I am well paid, so it does not matter so much, but in St. Luke's patients do not have to pay for parking. In St. Vincent's, there is a parking charge, and it is quite a lot. It is crazy to put financial obstacles in the way of people when they are in this sort of situation. There are other financial obstacles to accessing services, such as if a person does not have a medical card they still have to pay. The amount of money that they have to pay is significant for some people. We should not place financial obstacles in the way of people when they are in this sort of situation.

I agree with the motion. We need a cancer strategy for the next ten years. We need to resource that on a multi-annual basis, so there is certainty. We need to have equipment replacement programmes. It has already been referred to. The age of the linear accelerators is ridiculous. The vast majority of them are way past their sell-by date. That makes a big difference. One of the things a patient is affected by when getting treatment is the collateral damage of the treatment in terms of the side effects, but the newer the machinery and the more precise the treatment is, the better it is for dealing with the cancer and it lessens the impact of the side effects. This makes a real difference to the quality of life of people who get the treatment and to the precision of the treatment. We need to have that properly organised national equipment replacement scheme rather than it being done on an ad hocbasis.

Senior radiation therapists should be on a senior pay scale. A lot of the people who are qualified in this area are leaving the country because they do not have comparable pay rates to people in other parts of the country. We also have a problem that out of the eight PET scanners in this country, only one is fully publicly funded and one is partially funded. They are in private hands. The only place that the stuff that goes into PET CT scanners is made is Blackrock Clinic, a private clinic, which is ridiculous. There should not be that level of privatisation of the means to produce PET scanners and the equipment because it raises questions about equality of treatment when dealing with cancer. There are many more things that I could say but I am out of time. Hopefully, the Government is listening.

Charles Ward (Donegal, 100% Redress Party)
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I thank Sinn Féin for tabling this motion. I fully support it. I call on the Government to commit to a new cancer strategy. The postcode lottery in healthcare access across the country is unacceptable and deeply unfair. People in rural communities, such as Donegal, are at a severe disadvantage when they fall ill and require emergency treatment or treatment of any type. My constituents are facing chronic shortages of GPs and very limited services in rural areas. Many of them are forced to travel long distances for basic treatments, often delaying care and worsening health outcomes. The longer waiting times and the reduced local services have contributed to increased stress, financial strain and in some cases, preventable illness and deterioration. A particular highlight comes from cancer care access in Donegal. It is shown by the report in The Journal investigates article last year that just 12% of cancer patients in Letterkenny University Hospital received treatment within the recommended 15 working day timeframe. Cancer patients in Letterkenny have to wait 50% longer than patients in any other hospital in the HSE West and North West region. This impact is life-threatening. The research has shown that the delays reduced the treatment options that are available for cancer patients. In some cases, it has caused avoidable death. Distribution of resources and services has clearly led to inequalities in healthcare outcomes. We have to address this.

Where a person lives should not determine how they get their treatment. The people of Donegal deserve the same healthcare outcomes as everybody else. The failure to invest and fairly distribute healthcare resources has left rural Ireland at a real severe disadvantage. The geographical isolation undermines the principle of access, the most recent example being the planned changes to the cancer flights from Donegal to Dublin and the removal of the midday flight, which has caused severe anxiety among the people and the cancer patients who are fighting for their lives. The passengers rely on this route to get necessary life-changing treatment. They are having to fight for this midday flight. It is the difference between getting treatment and not getting it, getting a hospital bed and not getting one and a getting a favourable outcome and not getting one. The proposed changes would cause people to miss critical treatment times. Many of them would have to stay in Dublin overnight at financial costs for themselves while severely ill, not able to afford hotel rooms and trying to travel on a bus. A bus up to Donegal from Dublin takes five hours. Coming out of chemotherapy and travelling up on a bus is not a desirable thing for anybody to do.

When they come in, they are looking for equality. The flight would give them that. The flight allows them to go, get their treatment, go back up in the evening and be home instead of coming to Dublin, trying to get a hotel room for €200, €300 or €400 that they do not have, then suffering and getting the flight first thing in the morning back up to Donegal. I ask the Minister of State to do whatever she can to make sure that this is highlighted and that we can make sure this flight is restored. I have spoken with the Minister, Deputy O'Brien, about this. I said that we need to make sure this flight is restored to Donegal. Otherwise, these patients are going to be suffering unnecessarily.

Brian Stanley (Laois, Independent)
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I welcome the proposal in this motion. Unfortunately, the incidence of cancer is increasing. Many cancer patients are being failed. There are roughly 42,000 people diagnosed with cancer per annum in the State. That is a huge number of people. The State has the third highest mortality rate for people with cancer in the European Union. Poorer former eastern bloc countries are doing better than we are. For example, in County Laois, approximately 270 people were diagnosed each year. That does not include non-melanoma skin cancer. Unfortunately, in the most recent figures that we have from 2024, 138 people died from cancer.

I acknowledge the great work done by the Cuisle Cancer Support Centre in Portlaoise. Those centres need more Government support. A lot of the money is raised voluntarily. In Laois, people also face challenges with costs. Obviously, many of them do not have medical cards. They have to travel to hospitals generally in Dublin. They have to pay tolls, parking fees and extra fuel. One of things that needs to be done is to waive the parking charges for cancer patients. It is a very simple measure that can be taken.

The delays in surgery are shocking. They are not being done within the timeframe. According to the Irish Cancer Society, 61% of prostate surgeries are not being done within the target timeframe. A total of 45% of breast surgeries and 39% of lung operations are not being done within the targeted timeframe. There are delays in radiotherapy, with 23% of cases not being done within the target timeframe, while in chemotherapy, the figure is 15%. That is shocking. Imagine the stress and worry for people who are delayed. I know somebody who was waiting and waiting. I had to intervene on their behalf at the time to get the necessary treatment that they needed. That is not good enough.

There is also a lack of awareness around the symptoms and delayed diagnosis. We need to increase public awareness around that.

In short, we need to expand the outdated diagnostic equipment that we have, invest in modern equipment and infrastructure in our hospitals and scale up because one in two of us is going to get cancer. That is the bad news. We need to expand the number of training places for cancer treatment staff because without staff, it cannot be done. Bowel cancer screening and BreastCheck are fantastic. Some work needs to be done to expand screening.

We need a greater emphasis on prevention and awareness. We need to strengthen North-South co-operation. One of the things that we can do on a North-South basis is strengthen co-operation in cancer research and treatment. There is a lot of talk about screening. Maybe when we get older, we encounter this but the number of people I come across who have prostate cancer is significant. We need to provide free screening and free blood tests for prostate cancer for men aged over 60. We need to ban sunbeds. Using sunbeds is crazy. A ban on them is recommended by the Irish Cancer Society and I do not know of any sensible person who would not support such a ban.

We need to give cancer patients automatic entitlement to medical cards. I have come across a case where a person died from cancer without being able to get a medical card. This person was not a millionaire. Their income was very modest but they could not get medical card because of the low income thresholds. If somebody has particularly stage 3 or 4 cancer, give them a bloody medical card because they need one. We should waive car parking charges for cancer patients. We should ask each hospital to do that. A simple voucher would do it.

Peadar Tóibín (Meath West, Aontú)
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Like many other Deputies in this Chamber, I am a cancer survivor. I am blessed to be six years cancer-free. When you have cancer, it is like an enormous cloud descends upon you and your family. The more important message to go out tonight is that if you get treatment fast, the sun will shine again and that cloud will lift from your family. Getting treatment is the key issue and the problem is the fact that where someone lives in Ireland determines whether he or she gets treatment in a timely fashion. There is a postcode lottery in this country when it comes to cancer treatment and, therefore, cancer outcomes. The Irish Cancer Society has released damning information that shows massive variations in cancer diagnostics and treatments in this country. Patients in major cities, particularly those travelling from the north west, face delays of up to eight weeks for chemotherapy despite the national cancer strategy stating that a person should not wait for more than 15 days. People with breast cancer and prostate cancer are being denied timely, life-saving chemotherapy and radiotherapy. I met a doctor in Letterkenny who told me that just 12% of cancer patients in that hospital received treatment within the recommended 15-day working timeframe. In Galway, patients are waiting seven to eight weeks for treatment. The National Cancer Control Programme has written to Aontú stating that the HSE is failing to meet its own radiation treatment targets. In the year to August 2024, treatment targets were met only once in Galway and only twice in Cork. Cancer services in the north west are being shut down. Cancer centres in Galway, Waterford and Limerick do not have the necessary PET scans, antique radiotherapy equipment is breaking down and people are dying for the lack of timely treatment.

The Irish Cancer Society has said that the Government has met only one of its six targets set for cancer treatment and tests. A reply to a parliamentary question from Aontú has shown that breast cancer survival rates can differ by 14% from one county to another. The Minister of State will be glad to know the breast cancer survival rates are as high as 94% in Cavan, but they are as low as 80% in the likes of Kerry. Last summer, BreastCheck, a countrywide screening service for women between 50 and 69, missed the target for 195,000 screenings by 30%, an incredible figure.

Aontú also discovered that there is a 12% differential in outcomes for breast cancer depending on whether someone is diagnosed in a public or private hospital. Someone diagnosed in a cancer centre has an 85% chance of surviving, while someone diagnosed in another public hospital has an 81% chance of surviving. However, someone diagnosed in a private hospital has a 93% chance of surviving. A patient diagnosed in Sweden is 7% more likely to survive, while a patient diagnosed in Britain is 5% more likely to survive. Other countries are doing far better and more people are being protected. Why is this? It is because the money in this country is not getting to the front line.

Many staff are going abroad. A reply to another Aontú parliamentary question has shown that 13,000 nursing staff left Ireland in the past five years. That is an incredible legacy left by this Government. In some years, the majority of graduating doctors are also leaving this country. Thankfully, cancer survival rates are increasing but that is because of better medicines, improved technology and improved treatments. It is certainly not because of the actions of this Government.

Michael Collins (Cork South-West, Independent Ireland Party)
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We are talking about whether people in this country get seen, get treated and get a fair chance or whether they are left waiting, worrying and wondering if the system will fail them again. We have a national cancer strategy but only one out of 23 objectives has actually been delivered. Many Deputies have spoken today about personal tragedies when it comes to cancer. A cancer diagnosis is a dark moment in a person's life. It is not always a very dark journey but it certainly is a dark moment and a great difficulty. My mother died of cancer at 54 years of age - a young woman. At that time, which was 30 years ago, I thought 54 was a great age but I am above that age myself now so I find it to be a very young age. It was a young age at that time too but, unfortunately, it got the best of us - a strong woman.

We have a delivery problem, with patients paying the price. We have people missing chemotherapy and radiotherapy timelines and people waiting far too long for breast, lung and prostate surgeries. Depending on where you live, your access to care can swing from 60% to 95%. That is nothing short of a postcode lottery. We are short of scanners and staff and we are not even using the equipment we have properly, yet the Government could not even ring-fence funding in half the budgets. If it is not ring-fenced, it is not guaranteed and if it is not guaranteed, it is not going to be delivered.

Independent Ireland is calling for simple practical tips, such as using hospitals in the evenings and at weekends, training and keeping our staff here, replacing outdated equipment and supporting patients properly. Obviously, parking charges are a huge difficulty for people battling cancer. There needs to be a clear focus on that, including on family members who are visiting them. It is hard enough to be hit in one way but to be hit in the pocket as well is very unfair.

There is one thing we need to spend some time thinking and talking about here. We talk about a caring Government or a caring country but why are cancer patients not getting medical cards just for the duration of their disease, which could be six or 12 months? It hurts quite a lot of people coming to me. It sounds as if we are racist but we are not. People are coming in from around the world and we are nearly handing medical cards out to them at the airport when there are people who have worked hard all their life and cannot get them. People can apply and the hospital can apply but the disease has to be terminal or extremely serious before they get the medical card. I had a dispute here with the previous Minister of State on that issue. That Minister of State was wrong. We know that because we are the people who are making the applications and we know they are being turned down. Sometimes I worry about whether people are going to get a medical card because of their prognosis. It might not be the best for them and that is not good enough. This country needs to work in that direction so that if people can prove they have cancer, their illness is covered for the period of time they have it. If we cannot move towards that, then this is not a caring society.

I need to commend one sector. I was part of this organisation some time back. Cancer Connect in west Cork started under Local Link and has run an incredible service over the past number of years under Helen O'Driscoll and her team in the office in Bantry. They are taking people every day for cancer treatment free of charge. They are picked up at the door if it is a more serious cancer where the person cannot be in the bus. If it involves chemotherapy, the person is picked up in Castletownbere, Mizen Head and Sheep's Head or wherever and the team works its way up through Clonakilty, Skibbereen, Bandon and Bantry. It is free of charge and all of it is done to perfection. They wait for them for a short period, everyone is looked after and all of them are put back on the bus back to west Cork in the evening. It is a fantastic service. I think other counties are copying it. This is something we built about 15 or 20 years ago and it is a really powerful service that has really delivered.

Michael Fitzmaurice (Roscommon-Galway, Independent)
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I welcome the opportunity to speak on this motion.

There is not a family in Ireland that has not been affected by someone belonging to them having cancer, people recovering from it or, sadly, some of their loved ones passing away.

When the strategy was done, we were going to have centres of excellence. A centre of excellence in Galway should be the same as one in Dublin, Cork or anywhere else in the country. We have failed abysmally. Go to Galway and look at the lab that people have to work in and then go to some of the places here in Dublin. Go to the Cathaoirleach Gníomhach's local hospital in Limerick and see what happens. It is disgraceful that parts of the country are being left behind.

Think of a person in Donegal who has to go to Galway for treatment by bus and then travel home again. In this day and age, that is not on. A person in the north west or the west should not be left behind. People are being left behind. It is not the fault of consultants or nurses. They are doing the best they can. However, people are not able to get chemotherapy. The statistics and the facts show that they are not getting chemotherapy at the times they are supposed to be getting it.

Have a look at the capital plan. What funding under the capital plan was put into the west of Ireland in the past ten years in comparison with other areas? Anyone can look at it. It is a disgrace what has happened. I was at a meeting in Galway. We, as politicians, went to hear Professor Kerin, an expert, speak. He stated that if you are in the west of Ireland, you have a lesser chance of survival than in any other part of the country. That was a damning statement.

We listen to people, day in, day out, telling us about treatment being delayed. That is not good enough. Even in Galway, they have to send some of their patients to Dublin for more expert treatment. Centres of excellence should be in all parts of the country. A centre of excellence should not at my backdoor, no more than at anyone else's. These centres should be located in all parts of the country in order to help people.

We also need to be mindful of people. As Deputy Collins and others stated, it is a stressful time when a person is told that they have cancer. Medical cards should automatically be given to people instead of them having to fight for them. The only way you will get a card urgently at present is if you have a terminal illness. We need to look at that.

There is another part to this. People with cancer cannot work. Thankfully, many people recover from cancer. That needs to be said. However, while they are going through treatment, be it radiotherapy or chemotherapy, they may have to have operations. It is a minimum of 12 months, and at times longer, where they are out of work, where an income is not coming in and where they have to attend hospital appointments. Even after therapy, they still have to attend hospital appointments. As for funds, they struggle to keep going. We have got to be mindful of that.

I ask that the relevant Ministers look at the state of cancer services and hospital infrastructure in general. The hospital infrastructure in Galway is abysmal. We deserve better. It is not just Galway; it is the entire west and north west.

Conor Sheehan (Limerick City, Labour)
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Thank you, Deputy.

Michael Fitzmaurice (Roscommon-Galway, Independent)
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It is a damnable thing to say that Galway hospital does not have a PET scanner. Imagine that. A private hospital up the road has one, but the main hospital, the centre of excellence, does not. It is time that money was invested.

Danny Healy-Rae (Kerry, Independent)
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Like every other county in Ireland and, I suppose, other places across the world, Kerry has its fair share of cancer patients. Sadly, many people have passed on at a young age as a result of cancer. As a public representative, I come across more than my share of these patients from day to day.

Kerry is lacking in many ways because of the distances involved. A person with cancer who lives in Cahersiveen, Dingle, Lauragh or other places nearby is 50 miles or 60 miles from Tralee, in the first instance, and over 100 miles from Cork. Kerry has been promised, in the grounds of University Hospital Kerry, UHK, oncology services. We are still waiting for those. Comfort for Chemo Kerry has done a lot of fundraising for this project, which the HSE has approved. These services would help a lot of people who are currently to CUH for treatment.

I thank those who operate the "cancer bus" that takes people for treatment, chemotherapy or whatever. That bus is funded on a voluntary basis. If anything deserves to be funded by the State, it is the bus that takes patients for treatment.

When people get cancer, they should be entitled to medical cards. Whatever means you have or whatever number of children, you are not able to work and you need a medical card to pay for treatment. Otherwise, you are treated as a second-class citizen. People feel like that.

Early diagnosis is of paramount importance, as is early treatment. We need to ensure that happens in every case.

Conor Sheehan (Limerick City, Labour)
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Thank you, Deputy.

Danny Healy-Rae (Kerry, Independent)
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The other thing we must look at is what is causing it. I have been saying that the South American beef is not vetted in the same way as Irish beef, and I am worried about that.

Barry Heneghan (Dublin Bay North, Independent)
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Táim an-bhuíoch as an deis chun caint ar an ábhar seo. Gabhaim buíochas le Páirtí Shinn Féin as an deis seo. I will start by saying "Go raibh míle maith agat" leis na daoine atá ag déanamh obair na gcapall sna hospidéil agus i ngach uile áit inár health service. It is commendable.

Three weeks ago, sadly, I lost my best friend, Eleanor Lanigan, to cancer. The men and women in St. Vincent's Hospital were there to the end working to make her as comfortable as possible. Ar dheis Dé go raibh a hanam.

In recent weeks, I have been contacted by a number of constituents in Dublin who are deeply worried about diagnosis, delays and uncertainty. I commend Deputy O'Gorman and everyone who has served on the Oireachtas committee to do with cancer. I have been working on it since I came into this House.

I am grateful to the Irish Cancer Society for all the great work it is doing and all the details it gave us at the recent briefing, particularly in respect of my constituency.

When I was writing this speech, I rang a constituent, Jennifer Murphy, whose case I have been working on, and she gave me permission to mention her. Jennifer outlined how she was initially told that she would be waiting over 12 months for a non-urgent colonoscopy. It was only after she went back to her GP and following interventions by me, my office and other public representatives that her case was reclassified as urgent and she was given an appointment. That should not be how the system works. People should not have to fight to have their cases reclassified as urgent. They should not be left in limbo, particularly when we know early diagnosis is critical.

I suppose that no one in this House can say that they have not been touched by cancer. If anyone has gone through it, cancer is a really horrific way to go. We need to provide every type of support for people who have cancer.

I welcome much of what the Deputies from every party and none have said during this debate. Behind the numbers there are people, families and friends. This should not just be about highlighting problems. We all know what we need to do. I read the Government amendment, but I suppose it is more about action. A lot of the time when we come into this House, we are just here to talk. We need to get out there and do it.

Conor Sheehan (Limerick City, Labour)
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Thank you, Deputy.

Barry Heneghan (Dublin Bay North, Independent)
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We need to expand capacity, particularly in north Dublin, and provide clear and consistent referral pathways.

Cathal Crowe (Clare, Fianna Fail)
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I am glad to be able to participate in this debate. We have all been in community halls across the country and in our constituencies talking about road traffic issues when someone at the back of the hall pipes up and asks, "Does it take someone to die?"

Unfortunately, when it comes to cancer care, there have been far too many deaths. In particular, several very high-profile women were on the national airwaves and leading campaigns here at the front of Leinster House right up to their final hours. It has taken many deaths to get cancer care further progressed and it is still not where we need it to be. As many people have said tonight, there are many objectives of our national cancer strategy that are not being met, and that should be of huge concern to us all.

Just the other day, I was at my GP for a routine check-up and they took bloods. I was low on vitamin D; I need to get out in the sunshine. That is quite typical. However, I, as a politician, was alarmed to hear that the laboratory in University Hospital Limerick could not test for vitamin D. It was "overwhelmed", was the word I got. I will get over the vitamin D deficiency with an over-the-counter tablet and going out in the sunshine; that is fine. However, it is worrying to hear a laboratory that is tasked with detecting so many illnesses, deficiencies and diseases, and which is the gateway where many people find out they have cancer, is overwhelmed to the point that certain tests referred on from a GP practice cannot be followed through. I think that merits further investigation by the Department. I am not here to fault that laboratory; it does fantastic work. It is overwhelmed and needs more resourcing and support.

It would be remiss of me not to mention the news announced in the past week and a half regarding University Hospital Limerick and the choosing of a new site for that hospital in Raheen. I heard about it on the airwaves. The Minister, Deputy Carroll MacNeill, was down there with all her colleagues. She ignored six of us who are colleagues of hers in government, but we tuned into the radio and found out what was going on. I cannot hide my disappointment. This was to be a new hospital campus chosen for the region. It will alleviate the pressures felt at UHL, those incessant trolley times and waiting times, but it does damn all for the people who live in the extremities of west and north Clare. For those people, there is no golden hour. If they get into acute chest pain and collapse on the floor and someone in the household phones for an ambulance, it can take nearly an hour and three quarters - up to two hours - for that ambulance to get back there. They probably will not make it to hospital. Of all the things I have seen happen here over the past six years, if there was one thing that should have happened, it would have been more cognisance of geography in this decision, but that did not happen. I am running out of time-----

Conor Sheehan (Limerick City, Labour)
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Thank you, Deputy. You are over time.

Cathal Crowe (Clare, Fianna Fail)
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-----but I will bring this up in a future debate.

Michael Cahill (Kerry, Fianna Fail)
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A new permanent oncology and haematology unit at University Hospital Kerry is vital to the people of Kerry.

Cancer patient numbers in Kerry are continuing to grow, with many needing to travel from all over Kerry to a hospital, such as Cork University Hospital, the Bon Secours, the South Infirmary Victoria University Hospital, the Mercy Hospital in Cork, and with many others travelling to Limerick, Dublin and elsewhere for intensive treatments. The travelling involved is an extra burden on all those patients, and a permanent oncology unit in Tralee with increased capacity would go some way in alleviating some of the pressure and stress for many patients and their families.

With over 5,000 patients treated in University Hospital Kerry last year, I ask the Minister of State to prioritise this new oncology unit for Kerry patients. I previously received confirmation that it was at stage 1 - design. Could the Minister of State say where exactly this vital capital project for University Hospital Kerry is at now? Sadly, when we look at RIP notices, the number of references to palliative care in respect of cancer patients is worrying, to say the least. As a Government, we must invest more in cancer research. A new stand-alone oncology unit for University Hospital Kerry is vital for all cancer patients and their families in our county. I impress upon the Minister of State and the Minister for Health, Deputy Carroll MacNeill, the urgent requirement for a stand-alone oncology and haematology unit on the grounds of UHK to provide Kerry patients with the dignity, privacy and comfort they deserve during one of the most challenging periods in their lives.

As I previously stated in this Chamber, the Comfort for Chemo Kerry committee, a wonderful organisation, has already raised in excess of €1.5 million in funds, and a site has been designated for the purpose within the UHK campus. We are told one in every two will get cancer in their lifetime. When it comes to cancer, the question on everybody's lips is what is causing it. Is it the food we eat, the air we breathe or the water we drink? This project is extremely important to us in Kerry, and I am anxious that it proceed as soon as possible. Delays only mean an escalation in cost for an already costly undertaking. As I previously mentioned, this vital project would lessen the need for many Kerry patients to travel to hospitals in Cork, Limerick and Dublin, some in multiple trips.

The temporary oncology unit in UHK simply cannot cope with the over 5,000 patients and rising who were treated there last year alone. I am anxious for us to do everything humanly possible to get this vital project over the line.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I thank all colleagues who have made such personal contributions, not only about their own experiences but also facilities and gaps that remain on the island within cancer services. If I could be indulged, I wish to acknowledge a wonderful young girl from Bailieborough, Orlaith Lennon. At 24 years of age, she has lost both of her parents, her dad only a month ago. She had the bravery to go out on Friday for Daffodil Day, like so many other volunteers right across the country, to do some fundraising for the Irish Cancer Society. I do not know where people gather the strength to do things like that when they have had such personal experiences. I acknowledge her incredible work.

Colleagues have talked about the volunteers of many cancer groups, particularly in rural areas. In Cavan-Monaghan, where I live, there is Bailieborough Cancer Comfort, which provides the volunteers who provide transport. As we have discussed, transport can be such a big issue for cancer patients who have to get to the main urban centres and specialised hospitals for treatment. There is incredible work done by volunteers, as well as their fundraising, to make sure that compassion, care and transport is provided for patients.

I thank all my colleagues around the House who contributed on this most important topic of cancer services right across the island of Ireland. While many of our services deliver excellent, high-quality care, I acknowledge and recognise there can sometimes be delays in getting cancer treatment for some patients. I acknowledge the distress felt by them and their families when they face such delays. Where hospitals are challenged to meet service targets, they typically respond with a mix of local improvement plans, additional clinics, outsourcing of diagnostics and reviewing patient pathways where needed.

As clinics typically run at full capacity, any disruption of services can lead to a backlog which can take time to clear. Where centres fail to meet their performance targets, the NCCP works closely with hospitals to ensure that improvements to services are achieved and sustained, and that patients are seen to as quickly as possible. Every effort is made to address waiting times and patients are prioritised on the basis of clinical need. Often, not meeting performance targets arises from staff shortages or problems in accessing diagnostics or radiology services. Deputies will be aware that there is a global shortage of healthcare workers, and where we have very specialised services like those in cancer care, it can be difficult to recruit when vacancies arise.

In addition to local measures, the NCCP continues to monitor performance nationally and has implemented a range of initiatives to optimise capacity with rapid access clinics, particularly for those with breast cancer. Updated referral guidelines have been introduced, aimed at ensuring standardised access across the country and, where appropriate, post-cancer patients are participating in stratified self-management follow up, rather than attending unnecessary specialist appointments. These will reduce variation in the management of patients and will lead to more appropriate referrals within cancer services.

The HSE is also working to expand capacity. The HSE capital plan introduces funding for the design and construction of oncology day units and chemotherapy infrastructure at Midland Regional Hospital Tullamore, University Hospital Limerick and University Hospital Kerry. Deputy Cahill asked very specific questions. I will ask the Minister to respond on any issues raised specifically in respect of infrastructure.

A major radiotherapy equipment replacement programme is also in place, and work is underway to update equipment across St. Luke's Hospital radiation oncology network in Dublin. Long term, the delivery of surgical hubs and three elective treatment centres, once operational, will increase overall surgical capacity in our acute hospitals. In budget 2026, the first steps have been taken towards a new approach to funding, intended to strengthen performance by devolving health budgets to the new health regions. This provides greater autonomy to meet local needs, while holding them accountable for their targets and national standards. This will enable the HSE leadership to target resource allocation where it is most needed to address regional variation.

The NCCP will continue to lead on cancer service design and development nationally. It will monitor performance and work closely with the REOs to ensure the delivery of safe, effective cancer services in all regions, working to reach the same high standards across the country.

This new budget approach will build on the success of the national cancer strategy, which has, over the years, fostered a culture of improvement and innovation, as seen through the development of pioneering services. In the last ten years, we have seen the rollout of cutting-edge therapies, including radio labelling therapy, CAR-T cell therapy for adults and specialised radiotherapy treatments, which will reduce the number of treatment sessions compared with conventional radiotherapy treatments. More recently, and supported by our 2025 programme for Government commitments, the acute oncology nursing service has expanded, keeping ever more cancer patients out of emergency departments when they feel unwell. The rollout of the SSMFU framework is also helping recovering patients to avoid unnecessary hospital outpatient appointments, and it provides better management in their aftercare.

In recognition of the incredible contribution of the voluntary and community sector in providing services to cancer patients and their families, which we have all referred to tonight, the programme for Government made a commitment to continue to invest in community cancer support services. To support this commitment, the NCCP Alliance of Community Cancer Support Centres was allocated €5.5 million in funding for 2025, and that is now recurring.

We have also provided access to new and innovative medicines. Between 2021 and 2024, Ireland allocated an additional €128 million for new medicines, allowing for the introduction of 74 new medicines for cancer. Budget 2026 also allocates €30 million specifically for new medicines. New treatments have been introduced. CAR-T cell therapy became available in 2021, removing the need for patients to travel abroad for treatment. The service is being expanded to University Hospital Galway this year, and recruitment is under way. This will provide CAR-T cell therapy for adult patients in the south and west of the country and increase overall capacity nationally.

We are also seeing an improvement in new developments for patients, with the creation of the comprehensive cancer centres. This designation requires close collaboration between hospitals, universities and research centres, bringing care, teaching and clinical research together in a deeply integrated way. Patients attending these centres have greater access to clinical trials and the important benefits that brings. I am delighted that all of our eight cancer centres are participating in the EU project to gain accreditation and access to the EU Network of Comprehensive Cancer Centres. Membership of this project will enhance our treatment, teaching and research work, and this will in turn help to attract the best international experts.

We have a strong track record of supporting cancer care with investment in research, and I am determined that we will build on this. The cross-border cancer consortium research partnership between Ireland, Northern Ireland and the US National Cancer Institute has seen 25 years of progress, with over 35,000 patients participating in clinical trials. Annual investment in cancer research by the Health Research Board has increased significantly in recent years, from €5.4 million in 2017 at the start of the current strategy to €9.4 million in 2025. Since 2020, the Health Research Board has awarded €43.7 million in cancer research funding, including €21.6 million in clinical trials infrastructure. We are also creating and embedding a culture of innovation in health research more broadly. In November last year, the final report and recommendations of the national clinical trials oversight group were published. The implementation of these recommendations aims to streamline the regulatory processes needed to establish clinical trials, enhance public and patient engagement, establish clear, consistent approaches to conducting clinical trials and grow the clinical trial staff around the country.

The current national cancer strategy was launched in July 2017, with a ten-year implementation framework. This year, the Department of Health will commission an independent evaluation of that strategy. While the details have not yet been finalised, the previous strategy was evaluated by a three-person panel of international experts. Their report provided a detailed analysis and recommendations to guide the development of the next strategy. The evaluation process will examine the full continuum of cancer care, from prevention to screening, diagnosis, treatment, survivorship and palliative care.

Patients are, of course, at the heart of our services. There will be opportunities for meaningful stakeholder involvement, including patients, their families, healthcare staff and all the cancer advocacy groups, among others.

I thank the Deputies again for their thoughtful, measured and considered contributions. We all share an absolute commitment to delivering the best outcomes for patients. The new national cancer strategy will be a critical step in planning our services for the decade ahead.

Natasha Newsome Drennan (Carlow-Kilkenny, Sinn Fein)
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I strongly welcome this motion and commend Deputy Cullinane and his team on their latest health document, Enabling a New Cancer Strategy. It confirms what many of us have long suspected, that cancer services across Ireland have been slipping. The document sets out 42 recommendations for a new strategy, recommendations that would make a difference. We all know someone who has endured a cancer diagnosis. We have seen family and friends battle this disease. From my father to so many friends and family members, it has hit us hard over the years.

What we know is that early detection is vital for effective treatment, but the numbers paint a stark picture. Breast cancer targets are missed by tens of thousands every year. Some 15% of chemotherapy patients and 23% of radiotherapy patients do not start treatment on time. Some 61% of prostate cancer surgeries, 45% of breast cancer surgeries and 39% of lung cancer surgeries are not performed within the recommended timeframes. It is time that some of those in the Department did a bit of self-critique because the numbers do not lie. Patients are being failed in increasing numbers by poor management in the Minister's Department. As a result, we now have the third highest cancer mortality rate in western Europe.

What is missing is a strong emphasis on prevention, early detection and proactive treatment to tackle the primary drivers of cancer. It is anticipated that cancer diagnoses will double by 2045 compared with 2015. With the European Commission so eager to import meat raised on banned cancer-linked drugs, the situation could become even more severe.

In my father's case, he was quite sick and was housebound. Those who are housebound are some of the most vulnerable people. They need extra heating because they cannot move around like the rest of us. To say that I am absolutely disgusted by what has gone on here tonight is an understatement. The measly cut to home heating oil is a disgrace.

Johnny Guirke (Meath West, Sinn Fein)
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I recognise the work of the volunteers who fundraise and provide services, such as the Meath Cancer Support Group. I thank those who fundraise for charities, such as LARCC and the Irish Cancer Society, which get very little of their funding from the Government. In my constituency, a service has been set up and provided by the Moylagh JFK 50 Mile Challenge committee, which provides transport to and from treatment free of charge. We cannot give enough thanks and credit to the volunteers who run the service, and those who give up their time to drive the Moylagh car. These volunteers fill the gaps in services and very often support those who would struggle to find help when they need it. A lot of money is raised through charity events, but volunteers and committees now face the challenge of getting insurance for these events.

I welcome the legislation on the right to be forgotten, which in 2022 had cross-party support and was introduced by a cross-party group. I am, however, disappointed that it has taken this long when we see such legislation passed in other EU countries. The Irish Cancer Society has done brilliant work in lobbying for this.

Access to surgeries must be prioritised. If one surgeon is unable to complete a surgery, another surgeon should be able to step in. I recently heard of a lady who, sadly, passed away. She was due to get a tumour removed but, unfortunately, her surgery was cancelled due to personal reasons with the surgeon. It was suspected that her tumour had burst. How often is this happening, and how are cases like this being recorded?

Money is being spent on encouraging people to get checked, but often, when they attend their GP, they are told that the waiting times for screening are lengthy.

Then there are people who are working but cannot afford to go to their GP to get checked. Last year, the Irish Cancer Society warned that Ireland's two-tier health system was failing public cancer patients and they were not getting the same potentially life-saving cancer treatments as those treated in private hospitals. Private patients have swift access to EMA-approved cancer drugs while public patients must wait on average two years to find out whether they will gain access to the same treatment. Cancer patients often leave work during their treatment, bills continue to come through their doors and they have to fork out for travel, accommodation and prescriptions, but they are refused access to a medical card.

Johnny Mythen (Wexford, Sinn Fein)
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One in two people in our country will be diagnosed with some form of cancer in their lifetime. This is a stark but factual figure. Every one of us in this House, unfortunately, knows someone who has had this awful disease or has died from it, including my own father.

I am sure the Minister of State agrees there is a chance to change things with a new cancer strategy, as outlined by our spokesperson on health, Deputy Cullinane. We can put in place a world-class cancer service with properly ring-fenced and sustainable funding on an annual basis, doing away with the unfair postcode lottery to access cancer services. Early diagnosis and early treatment give each person hope and a far better chance of survival and recovery. However, recently released data paints a startling picture: 41% of breast cancer surgeries and 61% of prostate surgeries are not happening within the recommended timeframe. This includes 20% of radiography and 50% of chemotherapy patients who do not start treatment in time. Will the Minister work with us and take on board Sinn Féin's key recommendations in the recently published cancer strategy report by Deputy Cullinane?

Cancer has no politics and no boundaries but it can be beaten by putting in place a resilient and robust cancer service for all. The postcode lottery system must be done away with, as must the inequality in the system. Most of all, the wonderful staff who treat our loved ones through the toughest of times deserve a system that fully supports them by providing up-to-date equipment, staff supports and proper capacity. I ask all TDs to support the motion.

David Cullinane (Waterford, Sinn Fein)
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First of all, I will correct something I said in my opening remarks when I was talking about chemotherapy patients in Cavan. In fact, 100% of those were seen on time; it was in Waterford that 66% of patients were seen on time, which means 33% were not. For radiotherapy, 98% of patients in Waterford were treated on time, compared to just 67% in St. Luke's Radiation Oncology Network, which covers Dublin, the east and the midlands. They are two examples of the postcode lottery I was talking about.

I thank everybody for their contributions. There were some really strong contributions. People told stories of their personal experiences of cancer and of their family members' experiences. My mother died of cancer and it was a very long year for my family having to watch her suffer as she did. She showed tremendous resilience and did not show any emotions. Maybe when she was alone she did, but when she was with us, she was really strong. I got that from every contribution that was made. Deputy Gould spoke about how family members were very often the ones who feel it most.

I feel passionately about cancer services because they were and still are one of the areas where this State is doing well. Nowhere in the motion does it not recognise that there is a lot of good work being done. I said that in my opening contribution. I am blown away by the healthcare services given by first-class healthcare professionals in cancer care. I see it in every hospital I visit: the research done; the facilities in some hospitals; the staff who provide the services, from oncologists to nurses, radiation therapists and so on; robotic technology; and AI, which is now going to become a feature.

We are seeing huge innovation, changes and progression in cancer care, which is fantastic. That has to be matched by a Government and political system that back that up and provide the supports and resources that are needed. Far too often, hospitals are not getting those supports. If we have expensive hospital equipment lying idle part of the time because we do not have the staff, that does not make sense. That is an inefficiency. People look at that and ask what is going on when they are waiting and waiting for access to chemotherapy, radiotherapy or surgery.

The figures in the motion came from the HSE through parliamentary questions. In some surgeries, we have slippage, we are not meeting the targets and more and more patients are not being seen as quickly as they should be. Those gold-standard targets of 20 to 25 days set for access to surgery, for example, and even less for a diagnostic scan, chemotherapy or radiotherapy, are things we should be proud of and should not be allowed to slip. They are targets we should try to make sure we meet. In some hospitals, they do not have the equipment or staff.

The motion does not state the cancer strategy was not funded, but it was not given new development funding for half of the lifetime of the previous strategy. For five years, it got some funding, piecemeal as it was. For the other five years, it got no funding. That is a matter of fact and I think that is wrong. That is why multi-annual ring-fenced funding is so important. It is so that the health service can plan. Reducing the cost of care for patients is important, which is why abolishing the car parking charges and more discretionary cards are needed.

The motion is about a new national cancer strategy. That is what we need. I will certainly work with the Government. Everybody in this House wants to achieve the best possible outcome for every cancer patient.

Conor Sheehan (Limerick City, Labour)
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In accordance with Standing Order 85(2), the division is postponed until the weekly division time on Wednesday, 25 March 2026.