I am committed to supporting Ireland's population screening programmes which are valuable part of our health service. The programme for Government commits to evaluate the current lung cancer screening pilot in line with the WHO criteria and to develop recommendations for a way forward. The pilot, which was led by researchers in Beaumont and the RCSI with support from the EU, the Irish Cancer Society and my Department, is under way. It has issued a call for proposals to advance research in this area focusing on outstanding uncertainties. I have had several meetings with Gillian Ryan who is a leading lung cancer advocate and a leading advocate for a mobile screening service. I have met her in Cork and have hosted her and her daughter here in Leinster House. I met her again last week to unveil Ireland's first White Ribbon for Lung Cancer campaign. I know the Deputy was involved in that and did the breathlessness piece. Lung cancer is a very serious condition, particularly for those who are not identified as being at high risk. For example, a number of non-smokers are getting lung cancer and they would not necessarily see themselves as being high risk. They deserve to have the opportunity to have themselves tested. I particularly favour the mobile unit but I recognise that we have a screening programme and screening advisory programme that have worked well for us. This is under broader consideration. We need to do a complex set of calculations to get a careful balance to deliver population benefit. I am told lung cancer is particularly challenging due to the very significant budget impact. There are difficulties with risk stratification and high levels of incidental findings that are not necessarily lung cancer that cause their own problems as well. As I am learning, there is a particular complexity to lung cancer screening that was not apparent to me on the first go. Nevertheless, we are continuing to try to assess what may be done through established evidence-driven protocols, as always. I very clearly hear the Deputy and agree with her that there is a particular need to look at this more closely.
Sentiment score: -0.08
I am not in a position to give that date at the moment but I will try to come back to the Deputy as soon as I can. Very few countries have introduced lung cancer screening because of the uncertainty around its effectiveness. That does not mean we should not explore it. As the Deputy has done, I want to commend the pilot programme that has been introduced, instituting a community-based lung health check programme by inviting individuals from north Dublin and the north-east region identified as being at high risk of lung problems to attend for mobile screening, for breath tests and for low-dose CT scans. I have met a number of people who were not high risk who have developed lung cancer. They run marathons and do not smoke, and yet they have lung cancer. As the Deputy has said, in those cases diagnosis often happens at a considerably more advanced stage, which is obviously exceptionally problematic. How do we best capture that group? How do we screen in that group? Under Europe's Beating Cancer plan, in 2022 the recommendation was for further expansion of cervical, breast and bowel cancer screening, and feasibility studies on gastric, prostate and lung cancers. We have to get that balance right around effectiveness. I am so glad to have the opportunity to discuss it in the Dáil today with the Deputy.
Sentiment score: -0.12
I am not in a position to say that because I do not know what the recommendation will be. Thankfully this is a country driven by science and scientific evidence. This is a matter of real concern to me. The Deputy referenced advances in cervical screening. While I have the opportunity, I want to reference that it is expanding and that there are home testing kits, which is a huge advancement for women who do not necessarily feel comfortable presenting for screening or who just want to avail of their sheer convenience. This will help us to make sure those screenings get done. In the same way, we have now extended bowel cancer screening through the community pharmacy agreement. I am so glad to see so many pharmacies sign up to this fantastic opportunity to diagnose common conditions and provide prescriptions to people right around the country from early next year. It also enables pharmacies to identify people within their cohort of patients or customers who should be screening for bowel cancer, register them for the system and give them the kits over the counter that may be used at home and sent back. These are life-changing interventions that can happen in people's homes. I ask anyone who is watching to engage in cervical or bowel screening or any of our screening programmes.
Sentiment score: 0.16
I thank Deputy O'Shea. As he is aware, over €230 million is invested in public oral healthcare services annually. The dental treatment service scheme, DTSS, provides oral healthcare free of charge to medical card holders aged 16 and over. Services are provided by private dentists and clinical dental technicians who hold a contract with the HSE. In the north Cork HSE area, there are currently 33 active DTSS contractors, which is up slightly from the 31 who were active in the same period in 2024, although it is not enough. A package of measures was introduced in 2022 to expand the care available under the DTSS and to significantly increase the fees paid to contractors by approximately 40%, which is a very significant increase. Those measures should improve access to care as indicated by patient and treatment numbers which, to be fair, have increased since 2022. The Department and the HSE are committed to the reform of services for medical card holders, particularly in the context of the design and development of packages for expanded preventative care. That will require a multi-annual programme of work which is currently being scoped by the Department. We are also trying to improve patient access to oral healthcare in a number of different ways through the implementation of the national oral health policy, which is a complete transformation of oral healthcare services and an expansion to children and adults. I am very focused on the deficits that are there today, particularly for children. There is a three-year implementation plan for the first phase of acceleration of reforms. When I was in Cork last week, I had the good opportunity to attend the annual conference of the Irish Dental Hygienists Association, the members of which perform enormously good preventative work, cleaning work and identifying work. I commend their work to date. Hygienists can play an important role as part of the Government's priority to improve access to preventative oral healthcare, especially for currently underserved populations including people with disabilities, people in residential homes and children in certain areas. There is a body of work there that is not yet completed but is very possible.
Sentiment score: 0.43
In fact, there are 836 contractors on the scheme as of September 2025, although that is a reduction because there was a major data clear-out. There were 1,490 in 2019, when the number was reducing, and there are now 836. A number of inactive dentists were taken off the list in 2022. I can confirm that the fees paid to private dentists to engage in this scheme have increased by 40% to 60%, depending on the nature of the treatment. It is a matter of some astonishment and some disappointment to me that more of them do not wish to engage in it. Notwithstanding that, an additional 256,000 patients have been treated since 2022. As a result of the expansion of the dental facilities in Cork North-West, for example, an additional 44,208 patients were treated in 2024 compared to 2022. I will give this data to Deputy O'Shea directly. The fees to contractors went up from €49 million to €69 million in the same two-year period. It is a very considerable expansion. Indeed, activity in north Cork has increased this year with an additional 286 treatments provided. I recognise it is not enough, but it is a very considerable expansion within a two-year period.
Sentiment score: 0.02
I commit to trying to expand access to oral health and preventative oral health in every way. We need to look at the role of dental hygienists within the dental profession. In every other aspect of workforce planning in healthcare, we recognise that we do not have enough healthcare workers to meet our need. As I mentioned earlier, we are trying to have pharmacists work at the top of their expertise in their profession in order that they can diagnose basic common conditions. We now have an agreement with them that they will do that, but they should be working at the top of their expertise. We will try to have pharmacist technicians there to support them. In the same way, there is a much bigger opportunity for dental hygienists. We have advanced nurse practitioners and clinical nurse specialists. We have all of these advances in practice. Dental hygienists can play a particularly important preventative role and community support role. I am not saying they can provide all of the treatments - of course that is not the case - but I do not think we have come to the end of workforce planning in this respect. I know the people of Deputy O'Shea's constituency would welcome the opportunity to see a dental hygienist at a much earlier stage than has been possible to date. I have some work to do to try to support that.
Sentiment score: 0.38
I thank Deputy Timmins. I think it may be closer to one in seven - possibly one in six - women who are affected by endometriosis, rather than one in ten. We are learning more about it together. Our specialist endometriosis services are monitored by the HSE's national women and infants health programme. At the end of September 2025, 719 specialist endometriosis surgeries had been carried out. The most complex endometriosis surgeries are performed by multidisciplinary teams. Some 263 of the reported 719 surgeries took place in our complex centres in Tallaght and Cork. Surgeries for less complex endometriosis may also be performed in our acute gynaecology services. I am committed to expanding the scope and standard of our endometriosis services and improving supports for women. In recent weeks, I approved a plan to expedite access to care for women with endometriosis. The HSE will, as a consequence, carry out more than 100 additional surgeries by the end of this year. We expected 1,200 but will instead have 1,300 by the end of this year, an important addition. I have provided an additional €0.5 million directly for this purpose. By way of progress update, in October, 34 additional surgeries had been completed against a target of 33. The majority of these were excision surgeries. Complex and severe cases were prioritised. An additional colorectal surgeon is also being actively recruited to try to facilitate more complex surgical treatments. On 18 October, I launched the national framework for the management of endometriosis. It is a necessary expansion of services. The HSE’s budget will help to enable expansion and improve all of our services, including endometriosis. We have to increase awareness. I have written directly to all GPs to try to drive awareness where it is not already there and try to drive a better opportunity for women to have referral pathways much more quickly and a presumptive diagnosis, recognising that women are, of course, the most reliable narrators of their own experience and pain.
Sentiment score: 0.17
Not all of the surgeries take place in Cork and Tallaght but the most complex ones do. I have expanded a scheme to treat women who require complex surgery abroad. It was the case that they would go abroad and get the funding back via the cross-border directive. We very quickly put in place a scheme whereby people could get funding upfront for such surgery in many clinics in the UK and Europe. I have actively asked clinicians in the HSE to visit two clinics in Athens and Bucharest that women report to me as being very good but which did not meet the criteria in the first instance. We are trying to expand services. On 1 September this year, I held a patient voice forum in the Department of Health. The Chief Medical Officer, the CEO of the HSE and the chief nursing officer listened to the voices of 60 or 70 women with very complex and painful endometriosis. On 5 September, I put in place a new action plan, drawn up based on the needs of the women at that forum. From 1 October, we had a new plan for additional surgeries in Ireland to be carried out over three months. On 18 October, I launched a framework and plan to support women who are not able to get the scale of intervention they need here, so that they can get that help internationally while we collectively scale up our complexity on imaging and surgeries in Ireland.
Sentiment score: 0.12
There are not 35,000 people with endometriosis on outpatient gynaecology lists. Approximately 700 are waiting for endometriosis surgeries. An additional colorectal post has been prioritised and advertised for recruitment in Cork University Hospital. The time it will take will depend on the interest generated but I very much hope it will be done as soon as possible. The Deputy is correct. I do not necessarily want women to be travelling abroad. I would much rather they get surgery here but it is not an either-or situation. I want them to be able to get the right surgery as soon as possible. As we scale up, we must also facilitate women to be able to get the surgery they need. There will be a major conference in January, which will be driven by the Royal College of Physicians and the college of obstetrics regarding endometriosis and the skills available here. One surgeon, who will remain nameless, offered to travel with her patient to a clinic in the UK to shadow the surgery and better inform herself in order to learn how to provide a better service to her patients. It is that sort of leaning in that I have seen from consultants in recent months who want to provide a service to women, many of whom have advocated for this and want to do more and better for their patients. I was heartened to hear that story from a patient about her surgeon.
Sentiment score: 0.16
I thank the Deputy for raising this case. He is right that this drug is reimbursed for post-menopausal women with osteoporosis. I would like an opportunity to check this but, as I understand it, the European Medicines Agency, EMA, originally assessed the drug for use in both women and men. However, the company withdrew the male indication during the process following concern over the benefit-risk profile. It has been added to the HSE reimbursement list for post-menopausal women at high risk of fracture but it is not licensed for use in men for that reason. As prescribing it for men would be off label, the HSE does not extend reimbursement to male patients. There is no licence to use it to treat osteoporosis in men. The company marketing the medicine withdrew the licence application for that use. I am sorry to tell the Deputy there is nothing I can do about that.
Sentiment score: 0.06
The Government remains committed to investing in and developing the National Ambulance Service, NAS, including in the south east. The allocation in 2025 includes an additional €28 million of new service development funding for up to 180 additional posts. Those posts will focus on strengthening front-line emergency services, expanding alternative care pathways and developing specialist services, including critical care retrieval. Government investment in NAS has increased by 64% since 2020. The HSE Dublin and South-East region is served by 14 NAS ambulance bases. Two NAS pathfinder teams aimed at older persons operate from Waterford and St. Luke's hospital in Kilkenny. Four NAS community paramedics also operate in the region. The south-east region has benefitted from two additional 24-7 emergency ambulances based in Tipperary and Arklow. Additionally, it is served by the NAS national clinical hub, which offers alternative pathway options for low-acuity patients. The Deputy will be aware of ongoing NAS capital projects in the region, including new ambulance bases for New Ross and Gorey, which are scheduled to proceed to detailed design phase shortly. In addition, a new ambulance base regional training facility and business support hub project is planned for Carlow town and is proceeding towards detailed design phase.
Sentiment score: 0.15
We continue to invest at pace. There are an additional 500 NAS staff since 2020, with the total going from approximately 2,000 to 2,500, which is a very considerable increase of 26%. That increase is needed to ensure the distribution of staff and the different ways in which they can try to keep people close to home, particularly older people whom we do not want having to present at acute hospitals. The south-east region currently has 14 ambulance bases, with 277 whole-time equivalent staff, including paramedics, advanced paramedics and advanced emergency medical technicians. We have new development funding in 2025 for two additional 24-7 ambulances. There is the new rapid response vehicle operating from Newcastle, County Wicklow. The south-east region is served also by 50 active community first responder groups, which play an enormous role. Further aeromedical support is provided to the region by the NAS helicopter emergency service and the Irish Coast Guard. These are the different ways in which we are trying to provide support and divert lower-acuity patients.
Sentiment score: 0.23
I recognise the work done by volunteer groups like Arklow Cancer Support and the support they give to cancer patients travelling for blood tests, infusion services and so on. The HSE is not a land development or transport company. I recognise there are many different groups providing an enormous service to cancer patients, some with some measure of State support and others not. While the HSE will never be a transport company, I have met Volunteer Ireland to ask it to compile a list of all the different volunteer groups who provide transport services for health patients, cancer patients or in the disability space - many overlap and intercept. When I have that complete list, I will sit with the Minister for rural affairs, Deputy Calleary, and in particular the Minister of State, Deputy Buttimer, who sits both in the Department of rural affairs and the Department of Transport. There is something we have not yet imagined in terms of rural support services and transport services. It is not the responsibility of the HSE. It should not really be. We cannot do high-quality cancer care and transport. That is not the role but there is something better, more imaginative and more co-ordinated that can be done. I am grateful for the opportunity to discuss it today.
Sentiment score: 0.09
I thank the Deputy for giving me the opportunity to raise this matter again. It is fantastic to see the amplification and awareness of endometriosis in Ireland. That is part of what the framework is trying to do. We launched the framework on 18 October. I will set out the timeline again. This was in gestation for some period but it was becoming very clear that we were not meeting the needs or responding or perhaps hearing the acuity of what women were describing in terms of their pain, suffering and the impact on their lives. I also have to recognise the very many women in Ireland - I have met and discussed it with them - who received treatment that was absolutely satisfactory for them but perhaps they are at a different level of acuity. For the most complex and severe cases of endometriosis, it was not the case that we were meeting that need. We were not recognising it either in our public awareness of the impact on a person's life in terms of sport, attendance at work, opportunity to look for promotion and to participate in life in a normal way and how that impacts women and girls and can do so for a very long period of their lives. It is also not recognised that many women got surgeries that were successful here but at the more complex end were travelling abroad, paying considerable sums. In many respects they got all or much of that back through the cross-border directive or the treatment abroad scheme but after the fact. It is not satisfactory to me that women should have had to do that and that the surgeries were not available to them here. Part of what we are trying to do is upskill what we are doing here and the complexity of surgeries. We are recruiting additional colorectal surgeons in Tallaght and Cork to try to enable more complex surgeries. We need to improve our understanding of the diagnostics and imaging. Endometriosis is very difficult to see sometimes. Different types can be very difficult to see. We need to do a lot better on that and upskill more broadly our capacity to do complex surgeries. In the meantime, I want to try to provide women with upfront support to those who need to travel abroad.
Sentiment score: 0.09
I did not know that. I am sorry I did not. I am so glad the Deputy and I have the opportunity to describe the pain women face every day. As she said, it is like a knife fight inside you and yet she comes to the Dáil, working an extraordinarily demanding job, as everybody here knows. It is exceptionally physically and emotionally difficult and that is just the job. That is on top of all the things we bring to work with us. It has not been understood. The Deputy knows that better than me. She does not need me to explain that to her. I am glad we have a different understanding. I attended a fund-raising last night for a local rugby club and a gentleman came up to me to talk about his 28-year-old who had been in precisely the same situation for a very long time. The impact on women's participation in normal life has to be understood. Teenage girls cannot participate in sport and perhaps cannot sit their exams. There are women who have gone through university, doing phenomenal jobs in the workplace, taking significant periods off and are not able to explain or have that understood by their employer. This impacts women's lives. It is important that it be broadly understood and named. It is a series of cells that can move through the body with exceptional pain right through from pelvis, through the diaphragm up to their shoulders, thoracic region and into women's brains and eyes. It is exceptionally painful. The more we try to explain that pain women have been going through, it will be better understood. It helps me to generate urgency around improvement in services.
Sentiment score: 0.04
I will do everything I can do try to drive clinical trials and research. I am launching the clinical trials oversight group this evening. This is an obvious space. It is under-researched more broadly though there is an opportunity for us in France that I might to talk to the Deputy about separately. It is really important that she mentioned fertility. Fertility is inextricably linked to the experience of endometriosis. Many women have not been able to have children, have had to postpone fertility to try to receive endometriosis treatment and there are women trying to work out that intersection. This is why awareness is so important. I have met teenage girls who have had it suggested to them by professionals in the medical system that they have a baby because that would release the symptoms of endometriosis. If it was a once-off case, I would not say it in the Dáil. I have listened to women of different ages, including teenagers, who have been told, go and have a baby; that will fix it. Of course, it will not. I have spoken to women who have had children and it does not necessarily fix it-----
Sentiment score: 0.06
-----or women for whom it has come as a consequence of pregnancy. Can we just put a line under that now that it never happens ever again in an Irish medical facility that a teenage girl is told to go and have a baby and that will sort her endometriosis?
Sentiment score: 0.00
Cavan and Monaghan operate as a single entity with integrated managerial and clinical governance systems, care pathways and support functions. They are 46 km apart from each other. Cavan and Monaghan hospitals currently have two CT scanners and one MRI scanner. Two CT scanners is one more than is available to the people in Mayo, where there is only one CT scanner in Mayo university hospital. There is no business case submitted by Cavan and Monaghan hospital for a CT scanner. The hospital does not have plans to seek additional CT capacity as clear clinical pathways exist to support the region. The replacement to the existing MRI has been approved. Works are expected to be completed by the end of the year. It is clear to me that the number of scans done at Cavan general hospital this year is very considerable and has increased but the opportunity to do more also exists. Up to 31 May 2025, around 22,000 CT scans took place in Cavan and Monaghan hospital, which is a year to date increase of about 6%. As I look at the operating hours, there are normal working hours of nine to five, two outpatient scanning per week from 5 p.m. to 8 p.m. and 24-hour seven-day-per-week emergency department services provided. There is always a well-acknowledged challenge in respect of radiographers and radiologists but it certainly shows that there is capacity in the existing CT machines with additional staffing and rostering to considerably increase utilisation. A business case has not been submitted by Cavan and Monaghan hospital for a third CT scanner. I have heard about Monaghan hospital a number of times. It is really important to express how much investment in additional staff have gone in there. The budget has increased by 54% since 2020 and the number of staff in the Monaghan element of the Cavan and Monaghan hospital has increased by 70%, which is an outstandingly large outlier having regard to all of the other hospitals.
Sentiment score: 0.24
There is nothing the Deputy likes better than a good campaign and nothing he likes less than a few facts. Staffing has increased by 70%. I am so glad to hear him acknowledge it today because there are so many times when I do not hear that about Monaghan.
Sentiment score: 0.35
That may be the Deputy's perception of all things but if he had been here he would have heard the dialogue around diagnostics, including from his party spokesperson, and the utilisation of them - he is sitting beside Deputy Conway-Walsh, whose county does actually does need a second CT scanner in Mayo University Hospital and the local injury unit. I was there this week.
Sentiment score: -0.02
The Deputy does not like answers that do not operate as convenient for him. He is the only Deputy this morning who talked across me as I was trying to give him an answer. He does not like facts.
Sentiment score: -0.18
The Deputy does not like an answer. I am entitled to give him an answer to his question. He asked me about Monaghan hospital. Here is his answer. Cavan and Monaghan have two CT scanners and an MRI scanner. They are the same unit. Staffing has increased by 70%. The budget has increased by 54% for Monaghan alone. What the Deputy does not like is how my colleague, Deputy Maxwell, reminds him of the number of hospitals and services removed in the adjoining area in the North of Ireland that have been closed under Sinn Féin's watch. It is about time Deputy Carthy recognised the totality of services for people in that region as the rest of the country does.
Sentiment score: 0.01