Seanad debates
Wednesday, 8 October 2025
Supports and Services for Patients with Head and Neck Cancers: Motion
2:00 am
Gerard Craughwell (Independent)
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I move:
That Seanad Éireann:
acknowledges that: - Ireland's current approach to pre-radiation oncology dental care and post-surgical dental rehabilitation is under-resourced, under-staffed and unsafe. Adequate pre-radiation and post-surgical dental services are essential components of cancer care;
- immediate investment and legislative action are necessary to ensure that patients with head and neck cancer (HNC) receive timely, equitable and safe treatment;
- HNC patients in Ireland face significant and avoidable risks due to inadequate pre- and post-radiation and post-surgery oncology dental services;
- the Dublin Dental University Hospital (DDUH) currently manages approximately 400 new patient referrals annually with only a single consultant-led service, and Cork University Dental School and Hospital manage approximately 160 patient referrals annually, with only a single specialist-led service;
- severe capacity constraints are leading to delays in radiotherapy, inadequate dental preparation and increased long-term debilitating risks such as osteoradionecrosis (decaying/dead jaw and facial bones) and radiation tooth decay (dental caries);
- HNC is affecting increasingly younger patients, who will live with the side effects of the disease and its treatment for the rest of their lives;
- this is a national issue, and as a result of the Human Papilloma Virus (HPV), the incidence of HNC is rising, currently involving a quarter of the current pre-radiation dental referrals; such cases are projected to increase by 66 per cent by 2045;
- current delays in dental treatments and post-surgical oral rehabilitation contribute directly to radiation treatment postponements, reducing survival rates from this cancer and compromised quality of life; notes that: - there is a geographical spread with 4 per cent of referrals from the Mid-West, South-West, West and North-West regions combined, 46 per cent from Dublin City and County and 50 per cent from the North-East, South-East and Midlands with associated substantial costs and travel time for patients and their carers to attend dental appointments in Dublin;
- there is at least a 9 per cent increased mortality rate associated with every 4-week delay in the commencement of definitive radiotherapy;
- 43 per cent of patients present without a regular dentist, further limiting post-treatment care, while 181 patients await post radiotherapy review – some for up to 14 months;
- the running costs of providing these services in the DDUH at current activity levels is €1.367 million annually, approximately €811,000 is funded by the HSE, leaving an additional funding requirement of €556,000;
- the absence of a national HNC dental pathway and critical workforce gaps in prosthodontics, oral surgery and dental hygiene compound this crisis;
- there is a strong connection between HPV and the presence of HNC, this underlies the importance of the HPV vaccine for young males and females;
- based on empirical evidence there is a need for treatment facilities in the West (Galway) and increased services in the South (Cork);
- currently, the necessity for patients to travel to Dublin for treatment significantly impacts families in relation to time and finances; calls on the Minister for Health to: - provide a commitment to ring-fencing funding of €1.367 million annually for pre-radiation oncology dental services in the DDUH, with adjustments in line with inflation and expansion of services;
- provide full supports for regional dental oncology care centres in Cork and Galway;
- introduce statutory recognition of pre-radiation and post-surgical rehabilitation dental services so that they will be formally integrated into cancer care pathways;
- create permanent consultant posts in oral surgery and restorative dentistry for Cork and Galway centres;
- outline guaranteed timelines so patients can be seen by dental services within 7 days of their cancer multidisciplinary team meeting;
- implement a minimum 10-day healing period prior to the commencement of radiation therapy;
- introduce a comprehensive suite of rehabilitative dental and medical services for post-operative and irradiated patients.
Gerard Craughwell (Independent)
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I welcome the Minister of State, Deputy Murnane O'Connor. This is the first time I have addressed her since her elevation, on which I congratulate her. We are joined in the Distinguished Visitors Gallery by the chairman and the CEO of Dublin Dental University Hospital, along with staff involved in the treatment of head and neck cancer.
I speak on this matter not only as a legislator but as a parent. My daughter Rebecca's journey through head and neck cancer has been one of unimaginable strength and quiet suffering. It is her experience and that of so many others that compels me to speak today. Head and neck cancer is not just a clinical diagnosis; it is a life-altering reality that affects how a person speaks, eats, breathes and sees himself or herself in the mirror. I know this intimately as it hits close to home. Rebecca has lived it and still lives it every day. Her journey through Ireland's healthcare system has been marked by courage but also by struggle. We waited for scans, referrals and answers. In those long, uncertain days and years, we learned that time is not a luxury cancer patients can afford.
The national oral health policy was first published in 2019, yet six years on, its implementation plan remains at the draft stage and was released for initial consultation in the summer of 2025. While it is encouraging that head and neck cancers are recognised as a priority, the proposed care pathway will not be outlined until the end of 2026 and no national funding commitments have been disclosed. Critically, the designation of the advanced care centres is deferred to phase 3 of the implementation plan, which is scheduled for 2031 to 2032.
This timeline is unacceptable, as I am sure the Minister of State will agree. Head and neck cancer patients cannot afford to wait another decade for access to safe, timely and specialised care. Already, patients face long delays for pre-radiation treatment, often leading to avoidable post-operative trauma. The struggle to access dental specialists prior to the commencement of radiotherapy can, as I said, lead to post-operative complications. Patients often begin radiotherapy without the dental care that is essential to their safety.
Approximately 400 new patients are referred each year to Dublin Dental University Hospital, which has only one consultant-led service. Similarly, Cork University Dental School and Hospital manages 160 patient referrals annually with only a single specialist-led service. This bottleneck is not just inefficient; it is dangerous. Every four-week delay in radiotherapy increases mortality by 9%. That is not just a statistic. It represents the life of a daughter, son, father or mother. It represents a person who is somebody's world. Behind every percentage point is a person whose chance of survival is slipping away because of systemic delays that are preventable. Timely access to treatment is not a luxury but a lifeline.
There is growing evidence that the human papillomavirus, HPV, is associated with head and neck cancers, and it is on the rise, particularly among younger individuals. This demographic shift is deeply concerning as these patients face lifelong consequences from both the disease and its treatment. This trend represents a significant national health issue, driven by the increased prevalence of HPV. Currently, HPV-related cases account for approximately 25% of pre-radiation dental referrals, with that figure projected to surge to 66% by 2025. Delays in pre-radiation dental oncology assessment and treatment are directly contributing to postponed initiation of radiation therapy. These setbacks not only reduce survival rates but also severely diminish patients' quality of life.
Severe capacity constraints are causing critical delays in radiotherapy, inadequate dental preparation and heightened long-term risks for patients, including osteoradionecrosis, which is the decay of facial bones, known as dead jaw, and radiation-induced dental caries. Alarmingly, 43% of patients present without a regular dentist and are severely limited in terms of access to essential post-treatment care.Currently, 181 patients are awaiting post-radiography review, with some delays extending up to 14 months. Young patients often have a better prognosis but face lifelong side effects. Many start radiotherapy without proper dental clearance, risking complications like osteoradionecrosis and radiation caries. Osteoradionecrosis, as my daughter Rebecca will tell you, is a painful incurable condition of the jawbone caused by radiation requiring complex ongoing care and repeated surgeries that severely strain patients' physical and emotional being. This conditions hinders gentle rehabilitation, making implants or dentures difficult and severely impacts nutrition, speech, appearance and well-being. The hardest part is not the treatment, it is what follows – lost speech, altered appearance, altered speech and the fear of being forgotten in an overstretched system.
This motion urges statutory recognition of dental oncology care as part of cancer treatment, mandating timely access, adequate staffing, regional equity, structured rehabilitation and national oversight, so surviving cancer does not mean suffering in silence.
We seek an immediate €556,000 increase in the Dublin Dental University Hospital, raising its annual budget to €1.3 million. In addition, €4.2 million is required in national funding to expand dental oncology services across north Dublin, Cork and Galway. The sum of €4.2 million I speak of only covers staffing, excluding the vital infrastructure needed to meet the rising patient demand.
The national cancer control programme, the HSE Dublin and South-East have been key supporters of dental oncology, with multiple engagement over six years and vital backing for initial head and neck cancer funding. Previously, Government support for head and neck cancer ended at abolition, with no national reconstruction provision, despite reconstruction being as essential as it is in breast cancer. Breast cancer reconstruction often focuses on restoring the form and femininity, rebuilding the chest to reflect identity and symmetry. In contrast, head and neck cancer reconstruction is a fight to reclaim function, speech, swallowing and facial recognition. While one journey is about reshaping the silhouette, the other is about rebuilding the very tools of human connection. Both are acts of survival, but each tells a different story of resilience. However, as dental oncology services take place in primary care, no national funding mechanism is in place to support these patients on a countrywide basis.
I raised the funding issue in a Commencement matter in February 2024. I revealed that the national oral health office cut the budget by €500,000. This was done without consulting key stakeholders like the Dublin Dental University Hospital, the HSE or the national cancer control programme. Ireland's current approach to dental oncology care is critically underfunded, under-resourced and unsafe. It is failing to meet the needs of patients, many of whom face delayed, inequitable and inadequate treatment during some of the most vulnerable moments of their lives.
This Private Members' motion seeks that the Minister would enshrine in law the provision of comprehensive dental oncology services as a core component of cancer care. Legislative action and immediate investment are essential to ensure timely, safe and equitable treatment for all patients, aligning Ireland with best practice international standards and preventing avoidable harm.
I ask this House to support the motion, not just for my daughter Rebecca, but for every patient who deserves better. Let us act now with compassion and conviction to build a system that truly cares. The system is the cause of its own behaviour to a large extent. Rebecca was diagnosed with cancer of the tongue at just 19. No one prepares for what comes after. The follow-up is not a single moment; it is a relentless series of appointments, fillings, procedures, and every imaginable effort to save her teeth, but despite it all, by the age of 30 she had lost them. It was not just the surgeries; it was heartbreaking to watch her fight to preserve not only her smile but her jaw, which was threatened by osteoradionecrosis. Through it all, her dentist stood beside her, just as devastated, just as determined. They were not just treating her, they were fighting to save her.
The Dublin Dental University Hospital has been a lifeline for us. They have never sugar-coated the truth, but they have always stood with us – with me, Rebecca and my wife Helen. My wife Helen and Rebecca took the brunt of it. I was privileged insofar as I could walk away every day and work and leave it behind me. I feel like we are a team – the Craughwells and the Dublin Dental University Hospital – united on a mission to save every bit of Rebecca's smile and her beauty. The staff who are sitting here today will never truly know how deeply my family appreciate them and their support. It is nearly 30 years since we first met the people in the hospital and they have been our lifeline.
When it comes to head and neck cancer care across Europe, the contrast between countries is striking. Sweden stands out as a leader. Patients there begin treatment within weeks of diagnosis. Survival rates are among the highest in Europe and access to cutting-edge therapies is swift and widespread. Ireland, while making great progress still faces challenges. Treatment delays are more common and access to innovative medicine is slower. Our survival rates, though improving, remain below Sweden's benchmark. These gaps are not just numbers, they represent lives. They represent outcomes and the urgency for reform. If we aspire to match the best, we must invest in faster assessment and treatment, better infrastructure and policies that prioritise timely access to care, because every patient deserves the best chance, not just the best intentions. I thank the Minister of State for taking the time to come here today. I look forward to her response.
Michael McDowell (Independent)
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I have great pleasure in seconding Senator Craughwell's motion. He has spoken very eloquently and movingly about the personal aspects of this particular issue, which is raised in the notice of motion. I just want to say a few things. I am very grateful to him that he used the time of the Independent group of Senators to put this issue before the House. In large measure, it is something that is not spoken about. The HPV vaccination programme has been rolled out among school pupils, which is a very good thing, but it should be effectively brought to the attention of nearly everybody under the age of 30 that the vaccine is available, especially in the migrant world in which we now live, there are people who do not go to secondary school and who will not be dealt with in that way.
The second point I wish to raise relates to funding. I appreciate that everybody wants more money, but this money is extremely well spent. The figure in the motion that is of the greatest importance is that there is a 9% increased mortality rate associated with every four weeks that radiation treatment is postponed for oropharyngeal cancers. That is a clear indication that speed is of the essence and that properly established, funded units, staffed with expert personnel are provided to deal with this issue. That is essential.Our dental system is deficient, and many dentists both in the university hospitals and in private and State practice are struggling to give Ireland the kind of dental service it needs. At this end, however, the mortality rates and suffering rates that go with oropharyngeal cancer are very significant. There are things we can do on a prophylactic basis to warn and vaccinate people and get them to go to dentists so that these things are noticed in a timely manner. Anything the Government can do in relation to the HSE to concentrate resources and bring to the public's attention the real dangers of not dealing with symptoms and conditions that are indicative of oropharyngeal cancer should be done. It will save lives, improve the life experience of people who are afflicted with oropharyngeal cancer, improve their families' sense of well-being and bring about a fairer and more equitable health system. Excellence should be pursued. It is not enough to do what we are doing at the moment, which amounts to limited resources for a condition or set of conditions that will respond to increased resources and increased personnel.
I take pleasure in seconding the motion.
Dee Ryan (Fianna Fail)
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I thank the Senator very much. Before I call the Minister of State to respond, I welcome Deputy Tony McCormack to the Visitors Gallery with his guests. I thank them for joining us for this very serious motion on the topic of supports and services for patients with head and neck cancers.
Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank Senator Craughwell very much. I welcome his daughter here today. Since I became Minister of State with responsibility for health, cancer has come up so much. So many families are affected by cancer. It is not only the Senator's daughter but he, his wife and all of them together who are affected. As he said, they are a unit working within the hospital. I want to say well done. It was very emotional today. It is great to see the Senator's daughter here. As Senator McDowell said, timing is of the essence, and it is important. Senator Craughwell spoke about the €500,000 that has been cut. He can be assured that I will definitely convey that message to the Department. Officials from the Department are here taking notes and, as he knows, I am representing the Minister, Jennifer Carroll MacNeill, who cannot be here today. He can be assured that I will go back and highlight the issues.
I am delighted to take this debate on behalf of the Minister. We will not be opposing the motion. That is important. All of us working together is going to be really important now. I thank the Senator for tabling the motion and giving us the opportunity to discuss oncology-related dental services and head and neck cancer. This is an opportunity to listen to and acknowledge the very real challenges faced today, to set out some of the progress made to date and to inform the Seanad of the ongoing work in both the critical prevention side and the necessary improvements nationally for head and neck cancer services. Central to this is the need for the development of a clear patient journey for head and neck cancer patients. The delivery of a national head and neck cancer oral health pathway is a priority under the national oral health policy and will be included in phase 1 of the implementation plan, which is expected to be published shortly. I will try to find out more on that for the Senator. It is important to know when it will be published. I will make sure the Department comes back to him on this.
The HSE national cancer control programme, NCCP, is responsible for implementing and overseeing cancer services in Ireland. The NCCP is progressing the development of a pathway for head and neck cancer patients. The NCCP, the dental hospitals and Department of Health and HSE stakeholders, that is, the national oral heath office, the access and integration team and regional services including the integrated health area, IHA, manager, for Dublin Dental University Hospital under the service level agreement, are collaborating to improve head and neck cancer services nationally, including better oncology-related dental services. This group aims to define the optimal dental oncology pathway and is actively progressing this work. The group is meeting again this month to continue its efforts to improve head and neck cancer dental services nationwide.
Head and neck cancers encompass a broad variety of anatomical sites, including the oral cavity. Over the past few years, the incidence of head and neck cancer has increased in Ireland. Demographic changes may be causing a growing number of younger people to be affected by the disease. The NCCP has indicated that this trend could be due to the increasing prevalence of HPV, about which both Senators have spoken. Primary prevention of cancer associated with HPV infection can be achieved through vaccination. The HPV vaccine has been provided to secondary school children to help prevent HPV. One of the Senators said it is important that we highlight the necessity of this and look at the information and awareness and get that into schools and to parents. That is also something we also really need to look at. One of the programme for Government commitments is to extend the HPV vaccination to anyone under 25 who may have missed it. As an initial step, the Minister for Health has committed to the introduction of a school-based HPV catch-up programme. This will be put in place in 2026. It will provide students who have previously been offered a HPV vaccine another opportunity to receive it. From our point of view, we need to better explain the dangers and how important it is to get this vaccine. We definitely need to look at that.
The Government is committed to the continued implementation of the national cancer strategy. To date, more than €105 million has been allocated to cancer control under the strategy. This includes funding to support and expand population-based cancer screening programmes. It also includes funding to bring new treatments to Ireland and supports for community organisations supporting the growing number of people living with and beyond cancer. Additionally, capital investment of more than €140 million has been made, which has delivered new lab facilities, day wards and new radiation oncology facilities. Since 2020, the Health Research Board has awarded €43.7 million in cancer research funding. This includes €21.6 million for clinical trials infrastructure.
Today, over 220,000 people are living after receiving a cancer diagnosis, up from 150,000 in 2017. That is a 32% increase. This includes nearly 5,800 head and neck cancer survivors. The national cancer registry of Ireland reports an average of 786 head and neck cancer patients each year and this is projected to increase by 66% in the next 20 years to reach over 1,000 cases by 2045. Some of this increase arises from our growing and ageing population, improvements in our diagnostic services and the growing awareness of cancer among our population, which leads to more people seeking help.
Patients are also presenting younger. The median age of diagnosis is falling and there is a shift in demographics resulting in a growing number of younger people being affected by the disease. While this trend may be attributed to the increasing prevalence of HPV, we know for certain that these patients will be living with the after-effects of cancer and cancer treatment for longer. Using data from the national cancer registry, we also see differences in outcomes across different cancer types, socioeconomic status and geographical areas. Cancer incidence is higher and survival rates lower among the most disadvantaged quintile in Ireland. This inequity also applies to head and neck cancers. One of our key priorities is to promote equity in cancer care, ensuring patients receive high-quality care regardless of where they live, which hospital they attend or the doctors they see. We also know the dominant cause of mucosal head and neck cancers is nicotine inhalation. While smoking prevalence has come down from 27% in 2004, 18% of our population still smoke today. We know restrictions in this area can have positive long-term effects. As fewer people take up smoking, we are keen to build on our progress and are working to bring two important pieces of legislation into effect this year. This legislation will bring important changes to the licensing, sales and distribution of tobacco and nicotine-inhaling products, particularly to those under the age of 21.
Turning specifically to oncology-related dental services, the Government allocates more than €230 million towards the provision of oral healthcare every year. This shows our commitment to delivering oral healthcare services. There have been additional investments to oncology-related dental services due to the increasing demands of the service provided by Dublin Dental University Hospital, DDUH. This has resulted in increased funding being provided to DDUH since 2023. The HSE initially provided €311,000, which increased to €578,000 by the end of 2023. This excludes education funding of €189,000.
In 2024, over €900,000 was allocated to continue the development of head and neck cancer services for the treatment of patients. This funding is available to the HSE which engages with dental hospitals to ensure the use of the funding meets the needs of the patients. The Minister for Health wants to do much more to improve oncology-related dental services and work is ongoing with the HSE to improve these services.
There have been some recent developments in oncology-related dental services I would like to highlight today. Since March 2022, out-of-pocket expenditure for patients attending DDUH for head and neck cancer-related care has stopped. The appointment of a consultant for medically compromised patients, treating head and neck cancer, to DDUH in April 2023, and a dental consultant in St. James's Hospital in September 2023 has helped support the provision of reconstructive care to patients following head and neck cancer.
To enable the development of the patient care pathway for individuals with head and neck cancer, the NCCP team has been working with the Department of Health on issues of oncology-related dental services. To enable the development of these services for patients with head and neck cancer, the appropriate staffing and skill mix will need to be outlined which will require a clinically led focus that responds to patients' clinical needs.
In respect of dental services and supports more generally, a range of measures have been put in place since 2022 within the dental treatment service scheme for adult medical card holders. This introduced, and then reintroduced, elements of preventative care. The fees paid to contractors for most treatment items also increased by 40% to 60%. Those who have a medical card and are aged 16 and over can access a range of treatments under the DTSS free of charge for head and neck cancer patients. They are eligible for several dental treatments under the DTSS.
The dental hospitals provide a pathway for individuals to access dental treatments, but dental treatments can also be availed of through dentists who operate the DTSS. However, I acknowledge there are challenges with this scheme at present. Some of these challenges will be addressed through the implementation of the national oral health policy, Smile agus Sláinte. This policy aims to radically transform our current oral healthcare service, recognising we need an entirely new approach to oral healthcare to meet the needs of our population into the future. The policy provides a framework to transform oral healthcare services in Ireland, where prevention and promotion are an integral part of all service provision. Smile agus Sláinte is informed by and aligned with other relevant Government and health policies, including the primary healthcare approach, Sláintecare, our overall framework for better health in Ireland and a healthy Ireland. The implementation of the national oral health policy is a programme for Government commitment to support the focused and structured implementation of the policy. The Department of Health and the HSE are currently finalising an implementation plan for the first phase of the roll-out. This phase of implementation includes the development of a national head and neck cancer oral health pathway.
I assure Senators and thank them again. I have another meeting but the Minister of State, Deputy O'Donnell, will be coming in shortly. I thank the House. We will continue the ongoing work being delivered by the Department to address the current challenges faced with head and neck cancer nationally. We are grateful to Senator Craughwell for tabling this motion. While the ongoing investments being made are important, ultimately, the development of an optimal dental oncology pathway will better enable the provision of care to those patients with head and neck cancers.
I can only say I will go back and speak to the Minister, Deputy Carroll MacNeill, who apologises that she cannot be here. The seriousness of this is such that time is of the essence. With cancer patients, everything is about timing and how quickly you can access services and get your treatment. On an emotional point, I thank Senator Craughwell and say to his daughter and everyone who is here to support her and who gives her the services that I wish them well. As I said, we will not be going against this motion; we will be supporting it.
Dee Ryan (Fianna Fail)
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I thank the Minister of State, Deputy Murnane O'Connor. Before I call the next speaker, I welcome Deputy David Maxwell and his guests to the Visitors Gallery. They are very welcome.
Teresa Costello (Fianna Fail)
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I welcome this important motion on supporting services for patients with head and neck cancers and commend Senator Craughwell on bringing it forward and sharing his family's own personal experience. There is nothing more powerful than lived experience. I also thank Senator McDowell for sending out the briefing document, which is very graphic and informative but is something we needed to see. I appreciate that also.
Fianna Fáil welcomes this discussion as it is an issue that affects patients and families across the country. It is one that demands continued focus, investment and reform. Each year in Ireland, more than 760 people are diagnosed with a cancer of the mouth, head or neck. These cancers encompass a broad range of anatomical sites and can have devastating effects on speech, swallow, appearance and quality of life, as the Senator referenced.
Traditionally, head and neck cancers were most commonly in men over the age of 55 but we are now seeing a clear demographic shift. The gap between men and women has narrowed to just 2:1 and the number of younger people affected is increasing. Over the next 25 years, incidences are projected to rise by 30%. This change is due, in part, to the increasing prevalence of HPV which is now recognised as a key factor in many head and neck cancers. Addressing this means continuing our dual approach of primary prevention through vaccination and secondary prevention through screening.
The HPV vaccine has been available to girls since 2010 and to boys since 2019. Under the programme for Government, there is a clear commitment to extend the Laura Brennan HPV catch-up vaccination programme to everyone under the age of 25 who may have missed it. As part of this, the Minister for Health has introduced a schools-based HPV catch-up programme, ensuring students who previously declined or missed the vaccine have another opportunity to receive it. These are vital public health measures that will save lives in the years ahead. I encourage people to avail of it. I had no hesitation whatsoever to ensure my son availed of it and I genuinely worry about the drop in the uptake of it in recent times. I always remember Laura Brennan in that because the work she did was phenomenal.
At the same time, we should ensure those already living with or recovering from head and neck cancer receive the best possible care and support. These patients often face complex oral and dental issues because of their cancer or its treatment. I know from personal experience the effect chemo alone has on dental health. During my chemo, my tooth fell out with no warning. It was so traumatic for me so I cannot begin to imagine the trauma faced by a person dealing with a head or neck cancer diagnosis.
The Government is fully committed to improving oncology-related dental services. The HSE, through the national cancer control programme, has established a working group to define the optimal dental oncology pathway.The NCCP has been engaging with dental representatives at St. James's Hospital, Beaumont Hospital and the Dublin Dental University Hospital to strengthen this pathway. Significant progress has been made in recent years. Since March 2022, out-of-pocket costs for patients attending the Dublin Dental University Hospital for neck and cancer care have been eliminated.
Funding to the Dublin Dental University Hospital has increased substantially from €311,000 in 2023 to €579,000 by year end, excluding education funding of €189,000. A further €594,000 has been provided by the Department of Health to support supplementary dental treatments for cancer patients. In 2024, more than €900,000 was allocated nationally to advance these services and ensure patients can access the care they need.
There have also been key staffing appointments to strengthen the system, including a consultant in medically compromised patients at the Dublin Dental University Hospital and a consultant in maxillofacial prosthodontics and oral rehabilitation at St. James’s. These posts are essential to building a multidisciplinary model of care.
The Department of Health and the NCCP continue to meet on this issue, with the next follow-up scheduled for 21 October demonstrating ongoing engagement and commitment to resolving system challenges and expanding regional care capacity.
Looking ahead, the HSE is considering the inclusion of oral health networks of care within its new regional structures. This is a crucial step, as oral and dental health cannot be treated in isolation; it must be embedded within our broader cancer and community healthcare frameworks.
The Government's wider oral health reform agenda is being driven through Smile agus Sláinte, the national oral health policy, which represents a major reconfiguration of oral health services. The policy is a programme-for-Government commitment and is aligned with the World Health Organization's global oral health action plan.
Developing a clear, consistent patient journey for people with head and neck cancers spanning prevention, diagnosis, treatment, rehabilitation and survivorship will be central to improving outcomes. This requires not only investment, but also co-ordination, skilled staff and clinically led pathways that place patients at the centre of care.
This motion rightly draws attention to the gaps that still exist, particularly around access to dental oncology services, rehabilitation supports and post-treatment care. These are issues that the Government acknowledges and is actively addressing. Progress has been made but there is more to do.
I reiterate that Fianna Fáil welcome's this motion and supports the continued expansion and reform of services for patients with head and neck cancers. The measures under way, whether through enhanced funding, workforce expansion, HPV vaccination or the implementation of Smile agus Sláinte, represent meaningful progress. Ultimately, our focus must remain on ensuring that every patient receives timely, comprehensive and compassionate care from diagnosis to recovery. That is the standard we must continue to work towards. I thank Senator Craughwell for his contribution today.
Maria Byrne (Fine Gael)
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I thank the Minister of State for coming today to discuss this all-important motion. I compliment Senator Craughwell and the Independent Senators, but also Senator Craughwell's daughter, Rebecca, whom I welcome, and the consultants and staff from the Dublin Dental University Hospital. It shows how concerned they are about it that there are so many people here today.
On behalf of the Fine Gael, I thank the Minister of State for coming here. As the man says, "I know there is a lot done and a lot more to do." Certainly, his commitment and the commitment of the Government not to oppose the motion is important.
I thank Ms Samantha Long who, on behalf of the Independent Senators, sent the briefing note. I was just reading it. I am not sure whether the Minister of State has seen it. In fact, the majority of people who are diagnosed live on the east coast of Ireland but on the west coast, there are low numbers of people being diagnosed. One would have to question whether there is something there that needs to be researched and whether there is something that causes this. Certainly, the HPV vaccine has been highlighted. It is important that a message go out from here that it is important for people to take up the vaccine when they are being offered it. When people go through the trauma, it is not only affects those who are diagnosed, but also their family and friends as well. It is brave of Senator Craughwell to highlight this issue because his family have been through it themselves. As Senator Costello said, there is nothing better than the lived experience. That is what is shining through here today.
While there has been a lot of investment in it in the past and the Minister of State spoke about what will happen into the future and the campaign, Smile agus Sláinte, that has been initiated, it is important that we support the people who are going through this process in every way. There is the shock of being diagnosed. When Senator Costello referred to the fact that her tooth fell out, we can only imagine what people with throat and neck cancer experience. I have two friends who were diagnosed with something similar. One lost their voice box. The other had to get implants and get different things done, along with reconstruction. While, to this day, you possibly would not notice it other than up close, the person always knows that they had to have the surgery. It is brave of anybody who comes forward to speak about their personal stories.
As a government, it is great that we are not opposing this. I welcome every support that can be put in for the patients but also the people that are offering the service and the different surgeries and expertise, because I read in the report that there is only one surgeon looking after people in this way but there are 780 people a year presenting themselves. We need to look at ways of expanding the service and how we can roll out the programme to support people, but to support the staff who are working in this situation as well. Those staff need every support, from financial support to maybe resources and equipment. I am sure there are different ways that the Department can look at supporting it.
Overall, I am in favour of this. I thank Rebecca and everybody else for their bravery in coming forward to highlight this. All the resources need to be put in place as soon as possible. One message that should go out is that the HPV vaccine is so important to young children. People became maybe lax about or did not believe in vaccines, but when they see the proof that this could help with the situation. All it can do is defer or maybe help with it, but we need to encourage as many people as possible to take these services when they are being offered them.
Dee Ryan (Fianna Fail)
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Before calling the next speaker, I welcome Deputy Paul McAuliffe and his guests, Maurice and Wendy Thibault, to the Gallery. We are having a discussion on a Private Members' motion regarding supports and services for patients with head and neck cancers. I call Senator Collins.
Joanne Collins (Sinn Fein)
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I welcome the Minister of State. I welcome the opportunity to speak on the motion. I thank my colleagues in the Independent Group for tabling this important motion forward, and especially Senator Craughwell for his heartfelt and to the point graphic, but needed, speech. It is great to hear the lived experience. I also welcome all those in the Gallery.
The motion highlights what too many patients and family already know, which is that cancer services in the State are in crisis. The focus today is on head and neck cancers, in particular, the lack of pre-radiation dental oncology and rehabilitation supports, but, in truth, these are symptoms of a much deeper systemic failure to deliver timely, equitable and safe cancer care right across the board.
The national cancer strategy was launched with ambition in 2017, yet eight years on it has only been properly funded for two of those years. Of the 23 objectives it set out, one has been achieved.We have a workforce crisis in cancer care. Radiation therapists, radiographers and oncologists are stretched to breaking point. Up to 70 of the 240 radiation therapy posts nationally are vacant. Life-saving equipment sits idle while professionals burn out or emigrate because of low pay and poor progression. These shortages are not felt evenly. The postcode lottery in cancer care remains stark. Patients in the west, south and north west are still travelling hundreds of kilometres for diagnosis or treatment. Centralisation has a place for specialist services, but it cannot become an excuse for the permanent neglect of regional capacity.
The human cost of this neglect is devastating. For every four-week delay in starting treatment, the risk of death increases by 9%. These are not abstract numbers. They represent people who could have a better chance - mothers, fathers, sons, daughters - but whose lives are being cut short because our system is moving too slowly. This is happening at a time when public patients are being outsourced for private treatment, which is a far greater cost to the taxpayer. That is not efficiency; it is failure and we are paying twice for it.
Sinn Féin fully supports the motion, but we also need to state clearly that the issue raised here today is not confined to dental oncology. It cuts across the entire cancer system from screening and diagnostics to surgery and radiotherapy and recovery. We need a cancer service that is comprehensive, equitable and properly funded. We need to end the recruitment embargoes that are paralysing care. We need multiannual funding and planning so that services can recruit, train and retain the staff they so badly need. We need to invest in regional capacity so that no patient is left behind because of where they live.
This is about dignity. Delays in treatment or rehabilitation are not statistics; they are life and death for patients and their families. The Government must stop treating cancer services as an annual budget line and start treating them as a national priority. Sinn Féin will continue to press for a fully funded, regionally balanced and patient-centred cancer strategy, one that delivers for every community and not just those within the M50.
Tom Clonan (Independent)
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I welcome everybody from the Dublin Dental University Hospital to the Chamber, in particular Rebecca. It was lovely to meet her. I am working with her dad who has taught me everything I know, or at least some of the things I know.
I am delighted to hear the Government is not going to oppose the motion. Frankly, it is something that one could not oppose. It is a categoric and ethical imperative to support the work our colleagues are doing in the Dublin Dental University Hospital. This is a rare occasion when we see people from the front line in the House. Regarding all of the failures in our health service, it is not Bernard Gloster, Robert Watt from the Department or the Minister's officials who will be held to account. Rather, it will be individuals by way of the Irish Medical Council or litigation. Staff are on the front line and are living every day in the workplace the shortcomings that have been set out here.
Senator Craughwell is using his voice as a legislator, Senator and father. I have a son who has a neuromuscular disease which is progressive and is also losing his voice. I am aware of the lack of a proper treatment pathway for those conditions. It is fragmented. Notwithstanding the best efforts of the wonderful team in St. Vincent's, it was suggested to us that we would have to do the voice banking for him due to a lack of proper physiotherapy support and would have to find funding. His 17-year-old brother would have to look at old family videos and see whether he could harvest audio of his voice. This is completely unacceptable in a developed European Union country.
I take on board what is set out. I thank Senator Craughwell for drafting the motion. The motion refers to a recurring theme across the health service. A proper national head and neck cancer pathway, in particular for oral cancers, with all of the associated workforce required to support it, and proper dental oncology care are required. The Minister has heard the statistics. Some 400 patients per annum present with oral cancers and the profile is younger and younger. For lack of a proper integrated service, the outcomes and prognoses can be quite stark. There is a 9% increase in mortality for every four-week period of delay.
What surprises and shocks me is that the amount of funding being sought is €1.3 million. There is already funding of €900,000, to which the Minister referred in the response. The difference between that and €1.3 million is, not to be facile or trite, less than the price of a bike shed. Such funding would have a significant impact.
The Minister, Deputy Carroll MacNeill, cannot be here but the officials are present. This is a matter that should be dealt with now. The experts are in the room and the Minister has been told about the situation. When the Minister found out about this and what she did about it are the main questions. This is not a big ask; we are talking about €400,000 or €500,000. That should be done within the week, or certainly within the month. I cannot think of a reason that could not happen. The figure is extraordinary.
There is a medical health professional in our family who also operates in a system that is inadequately resourced and funded, with all of the workforce challenges involved. The people who carry out this service experience recurring moral distress and cumulative moral injury due to seeing suboptimal outcomes for want of the simple interventions that their higher specialist training and expertise indicates should be there.
Not only do we need to look after the patients; we need to look after our teams. That is one of the reasons we cannot retain people and so many of our wonderful therapists and medical professionals are in New Zealand, Canada and Australia. It is because they look after them. We are talking about funding of €400,000 or €500,000.
I will commit to checking in with the team from the Dublin Dental University Hospital and Senator Craughwell in six months' time. If there has been no progress, as a member of the Joint Committee on Health I will ensure we will add it to the work schedule and get the Secretary General of the Department, the Minister and the HSE in to answer these questions.
I am proud to see Senator Craughwell use his voice for his daughter's voice. We might add our voices to that in this House to advocate for the very simple and modest request set out in the Private Members' motion. Of all of the Private Members' motions we have had in the House over the past three years, this one will stay in my memory. As our Sinn Féin colleague said, it was heartfelt. I appreciate the support we are getting from our Government colleagues across the floor.
Joe Conway (Independent)
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A short week ago, I knew very little about this topic. By chance, my daughter and I met Senator Craughwell in the coffee dock, of all places. He told me he was bringing this Private Members' motion to the floor of the House today. Like any habitué of this House, I got to work on doing a little bit of self-enlightenment on the topic. I was absolutely amazed by the complexity of the condition and the harrowing effects it has on those who suffer. I want to applaud Senator Craughwell for bringing this to the attention not just of the House but of the nation. It is a first for me to see such a fantastic team tog out to support the Senator in the Gallery.These things are all greatly appreciated by us and I am sure by him and Rebecca. In our idealistic days of youth many of us in or outside this House would have read a book by John Kennedy called Profiles in Courage. We are seeing a great profile in courage here with Rebecca and Senator Craughwell.
We have been talking about the human papillomavirus and I am going to add to this as an educator. There is an old Irish expression which says an té nach gcuirfidh greim, cuirfidh sé dhá ghreim. It roughly translates as an ounce of preparatory work will reap a pound of reward. In education, particularly in the primary schools, it is then that the seeds of good health and health education are sown. We seem to have taken our foot off the gas in relation to health education, the importance of minding our bodies and looking after healthy lifestyles. This includes promoting healthy living environments, as well as aversions to alcohol and tobacco. These are fundamental messages to give children as they grow up. They can save a lot of trauma in the after times. Equally, we talked a lot about the HPV vaccination and what seems to be an fall-off in the uptake of it. This is very regrettable but it seems to be a trend all over the world. There is a growing scepticism to the whole idea of vaccinations. It is a very worrying trend that is probably generated by that awful thing called social media and influencers. It is a message to Government that, as educators and members of Government looking after the welfare of our people, we should be redoubling our efforts to zero in on the importance of vaccinations and health education.
Following on from what Senator Clonan was saying, mar fhocal scoir, now that the Minister of State is here, we are inundated this week because it is budget week. We are coming down with figures falling around our ears. The figures the Minister of State revealed to us relating to the modest amount of money Dublin Dental University Hospital is asking for seem quite paltry to me as a layman. I do not think it is beyond the wit of humanity to bridge the gap. The people down there are quite a team. They deserve to be equipped and financed to engage with problems such as this. My dear late mother used to say: never ever boil your cabbage twice when you are talking. I am not going to repeat the things that others have said. I applaud Senator Craughwell, thank Dublin Dental University Hospital and all our colleagues, Government, Independent and Opposition. There is a great turnout and a great show of solidarity for this case. Well done, Rebecca.
Martin Conway (Fine Gael)
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I thank Senator Craughwell for putting down this motion. As the fella says, when you talk with personal experience, you talk with passion and power. I have spoken to Senator Craughwell many times and I welcome Rebecca here today. I have spoken to him many times over the years about the challenges his family and Rebecca have faced in dealing with this issue. As somebody with a lived experience of a disability, I know what it is like to talk because you are talking with the knowledge, experience, heartache and hope. One always have hope. I commend the Senator and his family on what they have done and on bringing this here because it is going to get results. I have no doubt about that.
I listened to what the Minister of State said and Senator Craughwell's presentation. I agree with Senator Clonan that, if there has not been movement in the right direction in six months' time by the professionals sitting here, we will have to address it in some other way. I have no doubt that the Minister of State will make sure that this happens. She is here and is listening. Having worked with her over the years, I know what she is like and know her determination. I am very hopeful. It is not a lot of money when we are looking at the €25.7 billion health budget that was announced yesterday, but it is critical. The money involved is critical because it will make a difference.
I appeal to families and parents to make sure their children and young adults avail of the HPV vaccine. I have worked on the whole issue of HPV awareness over the past number of years. I salute the late Laura Brennan and her parents who have kept the campaign going. When the Government announced it was extending the vaccine programme, I remember how proud and delighted Laura's parents were that her legacy lived on. It is always important to keep reminding people of the importance of the vaccine. I continue to salute the Brennan family in the work they do. I am sure everyone here would join me in encouraging families to have the conversation, but more importantly, take the vaccine because it works and it saves an awful lot going forward.
I am glad the Government is not opposing Senator Craughwell's motion. When I read it, I assumed it would not but I am glad it did not because it is the right thing to do. The one great thing about this Chamber, and I say this to our visitors, is that when something is the right thing to do, in most cases we come together. We speak in unison and with one voice. When we do that, it can be very powerful. When we do not divide when it is the right thing to do, we can be a very influential and powerful Chamber. That is why the people voted to retain us: to do this type of thing, to support colleagues who have lived experience and make very sensible, pragmatic and necessary proposals. That is what is happening here. I am glad that this Chamber at least will come together behind our friend and colleague Gerard and his family on this very personal mission to deliver and achieve so as future generations will benefit. I am glad it is happening. I hope the united voice of this Chamber that has gone out loud and clear this evening is picked up on and influences, informs and supports the Government in doing what it needs to do to make sure the desired outcome is achieved.
Victor Boyhan (Independent)
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I welcome the Minister of State and officials from the Department of Health. I particularly welcome our guests in the Distinguished Visitors Gallery and, of course, Rebecca. It is so great to see her and looking so well. I thank Gerard and Helen for sharing their and Rebecca's story. I do not think Senator Craughwell would have ventured in here without Rebecca's blessing. I know Rebecca, having had the opportunity to talk to her in the past. Rebecca, Helen and Gerard's story is remarkable. When he tells their story in here, it is a very powerful testimony and shines a light on a particular issue.
I also thank the people from the Dublin Dental University Hospital.It is not too often that so many distinguished, capable and able experts come to the Distinguished Visitors Gallery to bear witness to the debate in this House with regard to that. I will not be a cynic, but I am here long enough to know that many motions are debated but they tend to go on a shelf and we hear no more about them. I particularly welcome the proposal by Senator Clonan, who is also a member of the Independent group. I might say that all of us now on this side of the House are members of the Seanad Independent group. I am proud to lead that group and I am proud of its achievements. We keep our focus on being advocates. We are politicians, but we are also advocates. We advocate for particular issues, and we unite and work together to highlight and shine a light in particular areas.
I also take this opportunity to thank Senator Craughwell's staff. I know how committed they are to the Senator and to the causes he champions. That is important. The level of input that has been made in the preparation of this motion has come from their office. It has also come from Rebecca's lived experience, of course. I acknowledge that it has also come from Senator McDowell and Samantha, and their office, with the preparation of briefing documents and bringing people on board. It is very important, as the Minister of State has said, that the Government is not opposing it. Why would the Government oppose it? How could the Government oppose it, quite frankly? I thank the Minister of State for reading a difficult and long official response - no doubt it came from the Department - that clearly had the approval of the Minister, Deputy Carroll MacNeill, which would be the right thing anyway. I thank the Minister of State for taking us through all of that.
I also make an ask of the Members of this House, of all sides, who have parliamentary party meetings. It so happens that some Senators will have a parliamentary party meeting tonight. I have no doubt there will be other things exercising their minds tonight. However, I ask them to keep this issue live. I ask them to bring it to their party leaders, to the Taoiseach and to the Cabinet members they work and network with. They respect the Members. The Members respect them. They are in government. We will of course engage with Government Ministers, who engage with us all the time. Those who look in on us from outside sometimes forget that this is a political establishment. We collaborate well together. We work well together. It is incumbent on all 60 Members of Seanad Éireann, on all sides of the House, to use our contacts with Government Ministers to progress this. As Senator Clonan said, it is important to keep the focus with the Joint Committee on Health. That is important. It is also important to prepare, and to ask Government and Opposition TDs to prepare, parliamentary questions to highlight the issue.
Let us not go out of here feeling pleased that we have articulated something we all know about, because everyone in this room is convinced. We need to get out of here and we need to convince other people. We need to convince the policy makers. We need to convince the people who hold the strings in terms of recruitment, resources and funding. That is important. There are many aspects to cancer and many demands on cancer services, but today we are focusing on head, neck and throat cancer, and all of the issues around that. That is really important, and that speciality is a focus of our debate here.
I again thank Senator Craughwell for sharing what is a family story and a lived family experience. I thank Rebecca, who has allowed her story and journey to be shared with us. It makes it so much easier to communicate when you are talking to the person, exchanging with the person and sharing their concerns. She is brave and courageous, but she is a champion. Tonight we are having this debate basically on foot of her experience, and that of the professionals accompanying and supporting her tonight. It is a great privilege for them and for us in this House that they are present. They have made a difference to this debate for many of us who have been here a long time. When people who are directly involved in the issues we are debating come to sit among us in the Upper House of the Oireachtas, it is special and meaningful. No doubt we will have an opportunity to chat afterwards. I thank everyone involved.
Victor Boyhan (Independent)
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I thank the officials. I thank the Minister of State. I know there are many demands, but I know her to be a decent person. I know her to be a champion of cancer and health rights in particular. I think we are all on the one page, but let us not go asleep or tap ourselves on the back and think it is all done. Today is the beginning. Let us keep soldiering on until we get what we seek to achieve for everyone affected by this illness.
Mark Daly (Fianna Fail)
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Before I call Senator Craughwell, as the proposer, to wrap up the debate, I welcome to the Visitors Gallery Jane, Michelle and Dave Taylor, along with Bernice Rocca and Brian Killalea. They are welcome to Seanad Éireann, as are all our guests in the Distinguished Visitors Gallery. I thank them for being here for this important debate.
Gerard Craughwell (Independent)
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I know the Minister of State has a meeting to go to and deferred that to be here. I thank her for that. Somewhere in Ireland today, tomorrow or next week a family will get the same message we got. I remember Rebecca was 19 at the time and her maxillofacial surgeon did not want to tell her what the diagnosis was after the biopsy. He rang me. I went home to Helen, my wife, and said we had to go to see the surgeon. We knew the news was bad. When Rebecca heard us whispering, she came in and said, "I am over 18, and whatever news I have to get, I will get it myself." I know her surgeon will tell you she is a feisty woman when she decides to take things on. We went and got the diagnosis. We brought her to St. James's Hospital for surgery. On the morning we brought her into the theatre, the surgeon advised my wife and me to speak to her now, because she might never speak again. I cannot tell you the impact that had. She came out of surgery totally unrecognisable because of the nature of the surgery. I would do the late evenings and my wife would do the days. Helen would be with her all day every day and woe betide anybody who would not look after her. I remember sitting one night in the hospital feeling desperately sorry for myself and the next thing I heard this croaky voice saying, "What's your problem; I'm the one who had the surgery." I looked up and there was my beautiful daughter, and she gave me stick that night. We have heard about mortality rates, but this was 26 years ago. I thank the people sitting in the Gallery, who were beside her at every turn. Today somebody referred to me as being brave, but I can tell the House that during the recovery period from the surgery I ran out the door while Rebecca and her mother absolutely went head on because she had to have liquidated food while she was recovering. I could not take it. Rebecca was resistant, but Helen was determined that she would eat. Between the two of them she travelled the recovery route.
Today we are here about the recovery and restoration, and restoring somebody as much as you possibly can. We are talking about approximately €556,000 today. It is loose change in the back pocket of the Department of Health, or of the HSE. On Monday morning, the chairman and CEO of the dental hospital, who are here, can get a telephone call from the HSE saying that it has just signed a cheque for €556,000 and that it will work with them from now on to ensure funding is adequate. The €4.2 million is being sought in order to cut down on travel. Most of us who are here have family members who know what it is like to suffer from cancer and the treatment thereof. The treatment is sometimes worse than the goddamn condition. Expecting people to travel from the west of Ireland to Dublin, and from the south of Ireland to Dublin, for treatment is not on. We must find the €4.2 million urgently. I have seen the people in Dublin Dental University Hospital. I have seen Rebecca's surgeon. I would name them but it is inappropriate to name people in the House. I would get ticked off over that. I can say that these people work on a shoestring.They commit themselves morning, noon and night to their patients. Twice in the past three years, my beautiful daughter has been in intensive care, totally unconscious, and we did not whether she would survive because of difficulties swallowing, which is part of oral cancer. She is still here. When she is recovering in intensive care and we go in to visit and ask how she is, she tells us she is planning a holiday in Lanzarote. That is the way it goes. I thank her employers, Allied Irish Banks, for standing with her, looking after her and keeping her on the staff over the years.
Most of all, I thank the people in the Gallery, who are there all the time, every time. An allocation of €556,000 next Monday morning is not a big ask. As Senator Clonan said, if that money is not given, we will be back looking for it in six, seven, eight or nine months. It is not huge money. I thank the Minister of State for staying longer and the Cathaoirleach for being generous in giving time to wrap up the debate. I thank the people in the Gallery so much for being here. Their presence shows massive solidarity with the team responsible for the treatment of head and neck cancers at Dublin Dental University Hospital. The chairman, chief executive officer and all the senior staff are here. I am humbled by their attendance.
Mark Daly (Fianna Fail)
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I thank the Senators who put forward the motion, all Members who contributed to the debate and the guests in the Distinguished Visitors Gallery for their attendance. I thank Senator Craughwell for sharing his family's lived experience and the Minister of State and her staff for coming to the House.