Mark Daly (Fianna Fail)
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Cuirim fáilte roimh an Aire Stáit.

Teresa Costello (Fianna Fail)
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I am calling on the Minister to outline the measures that are being taken to improve access to lymphoedema services across Ireland, with a particular focus on prevention, education, early intervention and support for breast cancer patients.

Lymphoedema, for anyone who does not know, is a chronic and progressive condition that affects thousands of people throughout Ireland. I know many people who developed the condition following their treatment for breast cancer, yet awareness of the condition is very limited. While we have made significant progress on breast cancer treatment and survival rates, a lot of patients continue to face barriers in accessing the information, services and supports they need to live well after treatment.

Speaking from my personal experience, I know how traumatic and upsetting the development of lymphoedema can be. I always knew that there was a risk I could develop lymphoedema because of the surgery I underwent as part of my breast cancer treatment. However, after 12 years I did not expect lymphoedema to develop. Like many patients, I believed the passage of time had significantly reduced my risk. To develop a lifelong condition so many years after treatment was very unexpected, distressing and emotionally challenging. Lymphoedema can cause swelling of limbs and people can become very self-conscious of their appearance when that happens. My own experience highlights an important reality that lymphoedema can develop many years after cancer treatment. The risk does not disappear with time and patients need to understand that from the outset. Education cannot stop when active treatment ends. Women and men are living beyond cancer and they need ongoing information, reassurance and access to services when problems arise.

Prevention and early intervention must become a real focus in our approach to lymphoedema care. Every breast cancer patient should receive clear and consistent information before and after surgery about the risk of developing lymphoedema and the steps that can be taken to minimise that risk. Patients should be educated about preventative measures such as maintaining a healthy weight, engaging in appropriate exercise, practising good skincare, reducing the risk of infection, avoiding trauma to the affected limb where possible and recognising early symptoms such as swelling, heaviness, tightness or discomfort. Early identification and intervention can prevent lymphoedema progression and significantly improves outcomes.

Education on lymphoedema is equally important for healthcare professionals such as GPs, public health nurses, physiotherapists and community healthcare teams. They must be equipped with the knowledge to recognise lymphoedema early, provide advice and ensure patients are referred promptly for specialist assessment and treatment.

There is a pressing need to strengthen specialist lymphoedema services across the country. Many patients experience lengthy waiting lists or must travel considerable distances. We need an increased number of specialist staff, additional lymphoedema therapists and equitable access to services regardless of where a patient lives. Community-based supports are vital.

I know that in Beaumont Hospital there was talk of examining the potential for advanced treatment options, specifically a lymphoedema surgical procedure for breast cancer patients. However, progress on that initiative seems to have stalled even though we have the expertise. I think the initiative lacked aftercare, which would have included healthcare providers such as physiotherapists.

I ask the Minister of State to outline the measures that have been taken to improve education and awareness and to strengthen preventative care. Lymphoedema affects an awful lot of people but it is little spoken about.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for raising this important matter. I thank her for providing me with an opportunity to highlight the supports available for people living with lymphoedema and the work under way to improve services across the country. I am taking this Commencement matter on behalf of the Minister for Health, Deputy Carroll MacNeill.

Lymphoedema is a chronic and progressive condition that can have a significant impact on a person’s health, mobility, independence and quality of life. In Ireland, it is estimated that over 20,000 patients are affected by both primary and secondary lymphoedema. For many people, including those who develop lymphoedema following cancer treatment, managing the condition requires ongoing access to specialist assessment, treatment, education and support. I fully recognise the challenges that patients and their families face, and the importance of ensuring that services are delivered as close to home as possible. I thank Senator Costello for outlining her experience and the challenges she has faced.

We are committed to improving care and supports for people living with lymphoedema. A key foundation for this work is the HSE lymphoedema and lipoedema model of care, which was approved in 2019. The model sets out a patient-centred and evidence-based approach for prevention, early detection, treatment, education and support.Since the model of care was endorsed, the HSE has progressed implementation through a proof-of-concept approach. This has resulted in the establishment of three specialist lymphoedema clinics in the community, located in Clare, Meath and Donegal, together with three early detection services in acute cancer centres at the Mater hospital, St. James’s Hospital and University Hospital Limerick. These services are continuing to receive funding in 2026. Further roll-out of this proof of concept is a matter for the HSE’s service plan Estimates process.

The evidence emerging from the proof-of-concept clinics is encouraging. The specialist lymphoedema clinics have demonstrated improvements in quality of life, improved access to care and high levels of patient satisfaction. Among patients reviewed after 12 months of treatment, there was an 88% reduction in episodes of cellulitis, an 80% reduction in hospitalisations associated with cellulitis, significant reductions in GP and public health nurse visits, and reduced demand on both acute and community services.

Particularly noteworthy is the impact of the early detection services on cancer patients. Current data indicates that these programmes have reduced the incidence of lymphoedema in breast cancer patients from approximately 25% to 1.7%, underlining the value of early intervention and surveillance. In conjunction with the early detection services, the national cancer control programme has developed several breast cancer national clinical guidelines in consultation with a multidisciplinary group of stakeholders, including patient representatives. These guidelines aim to reduce variation in practice, improve patient outcomes and experience of care, and support the optimal use of healthcare resources.

Investment has been made in workforce development and education. National funding has supported specialist lymphoedema training since 2022 and 74 healthcare professionals have now completed specialist education in lymphoedema management. The national lymphoedema and lipoedema education group continues to support professional development and has produced a range of patient information resources, including information booklets and digital supports, that help patients understand their condition and manage symptoms effectively.

Teresa Costello (Fianna Fail)
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I would like to know how much money is actually allocated to lymphoedema services. With regard to compression garments, many people do not realise that there is a need to replace them. I know several people who have worn the same one for years without realising that replacements are available from the State.

Lymphoedema is not spoken about enough. It is one of those conditions that does not get an awful lot of attention but it can have an awful impact on people. When I started in the Seanad, I did not have it but then, one day, I noticed that one of my arms was bigger than the other. I have been managing the condition since. I have been getting great care in St. James's Hospital. The hospital is definitely understaffed, however. The service is under a huge amount of pressure. If more staff and funding were allocated, the service would be much better for people.

I will also follow up on the Beaumont surgical option. Will that be progressed? Does the Minister of State know anything about that?

Frank Feighan (Sligo-Leitrim, Fine Gael)
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The national lymphoedema and lipoedema education group continues to support professional development. It has produced a range of patient information resources, including information booklets and digital supports, that help patients like the Senator understand the condition and manage symptoms effectively.

With regard to compression garments, I emphasise that the HSE provides compression garments, including compression sleeves, for eligible patients where a clinical assessment identifies a need. Provision is based on evidence-based practice. Recognised clinical standards ensure that patients receive the most appropriate supports for their condition.

I am aware of the importance of community-based care. The model of care envisages a strong community focus, ensuring that people can access specialist services close to home while maintaining links with acute hospital services, where necessary.

While significant progress has been made, I acknowledge that further development is required. The HSE remains committed to advancing the implementation of the model of care and ensuring that people living with lymphoedema can access timely, high-quality and equitable services right across the country.

The Senator has raised a few questions. I will bring them back to the Minister.

Chris Andrews (Sinn Fein)
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Before we move to the next Commencement matter, I welcome Lisa McInerney and her friend Leah Farrell to the Public Gallery. Leah is visiting us from Australia and has worked for many years as an official in the Parliament of Australia. They are guests of Senator Conway. I hope they have a nice visit. They are in good hands.