I thank the Deputy. He is correct. On Monday, the Tánaiste and I met with the parents of Harvey Morrison Sherratt, along with other advocates who were there to support the family. The Tánaiste and I listened carefully to what his parents said. It must have been a particularly difficult time, as all of this period has been for them, but also recognising it has been two months since the death of their little boy. At the meeting, it was agreed that we would work in partnership on the structure of an inquiry into spina bifida and complex scoliosis services at CHI. As the Deputy will be aware, there are a number of different models of inquiry and investigation. I have committed to scoping out the different models that are possible and the pros and cons of each of those models, while recognising that some of them have limitations, and to presenting that back to the parents and the advocates. It is important we would have a follow-up meeting when they have had the opportunity to reflect on that therefore it is my intention to write to them within two weeks and then to meet them a week after that. I have a little bit of work to do on that yet. The inquiry will be part of the wider reflection on paediatric services in CHI. The Deputy and the House will be aware that there is an important audit going on into waiting list equity or equity of access to the waiting lists in some of these services. It is important to say that. There is also the CHI oversight improvement steering group which is working regularly and oversees the implementation of the range of different reports of which the House is already aware, including the HIQA review. It will also oversee upcoming reports, including the Nayagam review, and a range of other measures.
Sentiment score: 0.14
Yes, it would be my intention, irrespective of the form of investigation or inquiry, that it would be comprehensive in the way the Deputy has outlined, that it would be transparent and that it would be an inquiry that is also capable of making recommendations, as the parents and advocates have looked for. As he will be aware, in some forms of inquiry where information is presented during the inquiry, it can never be used in other proceedings. I am very conscious, for example, of a comparable model in relation to Limerick where there are disciplinary proceedings happening. That has never happened in the health service before. The Frank Clarke report did not step over that, but a different form of inquiry would have stepped over that and precluded some of those disciplinary proceedings continuing. That is the balance I am trying to strike. Again, this is for a discussion with the advocates and with the person who will, ultimately, be in charge of this. It will be intended to have a senior legal figure and a clinical leader of this inquiry. It is very important that we get their perspectives as well on what is likely to work, what is going to be the right timeframe, what is capable of being comprehensive, and not precluding other proceedings that may be appropriate.
Sentiment score: 0.17
Again, I agree with the Deputy. On the Dickson report I will provide a note to Deputies on this. There is a follow-up process with those families. I do not have the details to hand but I would like to provide that information to them. Deputy Cullinane is absolutely right about developing services now. An inquiry should not prohibit or preclude that. He will be aware that I have strengthened very considerably the board of CHI with appointments most recently, and in particular with Fergus Finlay who is a very strong advocate in this space, and who I know will be a very strong advocate on the board and hold CHI very strongly to account, especially in relation to spinal services. As I said at yesterday's health committee meeting, I am really not satisfied with this year's performance. I cannot account for the reduction in the number of families travelling abroad. It is not clear to me how that is being offered to them, at what stage it is being offered to them or the breadth with which it is being offered. I am pleased that the adolescent complex surgeries have begun in the Mater. This is after a period when they were being paid for and not being done. Since July it has now been agreed that these will be done, and I am trying to see what options I have, domestically and internationally, that go beyond what we currently have to see how we can do more. I will report back to the House on that. I do not have an answer on that yet.
Sentiment score: 0.14
The Government is of course, as is everybody else, committed to improving cancer care, ensuring better prevention, maintaining improvements in cancer survival rates, and timely access to treatments. The national cancer control programme, NCCP, has a number of metrics for breast cancer services. They are consistently reviewed to guide service advancements and to make improvements. Since 2017 the total number of patients annually receiving this type of surgery increased by 10% to well over 1,500 in 2023. Over this period the percentage of patients seen within the recommended 20 days has decreased from 84% to 60%. The time to surgery can be influenced by a number of factors, including imaging and inpatient capacity, as well as the individual circumstances of the patient. The HSE is working on several initiatives to improve surgical capacity, including consideration of imaging and inpatient capacity in several cancer centres. Waiting times for radiology and diagnostic services are very seriously recognised as an issue. The NCCP has produced a range of guidelines aimed at ensuring standardised access to cancer services across the country. These will, I hope, reduce variation in the management of patients and will lead to more appropriate referrals and management of patients within cancer services. The Deputy will already be aware of the scale of the investment into the national cancer strategy since 2017. Significant improvements have been made with regard to breast cancer in recent years, in line with the overall objectives of the national cancer strategy. We do need to see a good deal more, as the Deputy will be aware.
Sentiment score: -0.11
The five-year net survival rates for breast cancer grew from 71% in the 1990s to 87.5% for the 2019 to 2022 period. We are going in the right direction. The Deputy is absolutely right to highlight it. We have had more people through the system and demand is increasing year on year. More than 56,000 patients were seen in clinics in 2024, up from 50,000 in 2019. From my analysis, the single biggest issue, although there are many, is the timely access to MRI as a diagnostic tool. From the data I have, the reason for being out of target, say in 2022, was that imaging was at about 30%. It is now at 41%. We need to focus all of our efforts on access to imaging, the way in which our imaging technology is being used, the consistency, the hours that it is being used and the commitment of hospital staff to do that at all times and days of the week. As part of the productivity we were speaking about, this is an example of why that matters so much. Access to imaging, as far as I can see at the moment, really is the most challenging part.
Sentiment score: 0.02
I would be very grateful for the specifics of what the Deputy is asserting. I will check that out. It is very much the opposite to what we are trying to do. Considering the number of vacancies we are desperately trying to fill, I would be very concerned about that. I would appreciate if the Deputy could help me out with more information on that. Several cancer centres have plans for additional theatre and inpatient capacity specifically for cancer and inpatient care because the theatre access is so important. Part of what will help with this is completion of the surgical hubs nationally, which will alleviate some pressure on our acute theatre capacity by moving lower complexity procedures, obviously since it is surgical hubs. Aligned to that is the theatre utilisation project, which is changing start times of theatres and maximising the flow and capacity within that. As I said, if there is a particular issue in a hospital I would be very glad to know about it.
Sentiment score: 0.06
I thank the Deputy. As he is aware, the programme for Government will set out a review of the national development plan as a key priority. Through the NDP review, we are prioritising critical economic growth but also the health infrastructure we need to have, which the Deputy has articulated. The substantially enhanced NDP provision for the health sector of €9.25 billion will support the delivery of equitable, accessible and high-quality healthcare across Ireland. We have seen a number of examples of that happening so far but there is quite a lot of work to do, such as the new surgical hub at Mount Carmel, the HSE health app and the 96-bed ward block in UHL. That is what has happened so far. As the Deputy and I both know, we have to drive further ahead. The NDP settlement recognises that there are certain key programme for Government priorities in health that will progress to statutory approval towards the latter part of the current NDP. In relation to shovel-ready projects, I have assurance from the Minister for Public Expenditure, Infrastructure, Public Service Reform and Digitalisation and his Department that they will be priorities for funding in the post-2030 NDP. The basic point is that if we get something to shovel-ready, we will be making the case to central Government for the funding to be enabled for that. The Minister for public expenditure and reform has also confirmed that should there be underspends evident in the overall NDP allocation, the first allocation for that will go to the Department of Health. We have a programme of funding for the next five years. We have a challenge to meet that and get those to construction phase. Where we get something else to shovel-ready, I will be going to the Minister for public expenditure and reform looking for unspent allocation in other NDP programmes, the first call on that and indeed the first round of funding. My challenge is, frankly, getting things to shovel-ready stage. I am confident of the funding for electronic health and for the infrastructure projects we have. Our bigger difficulty is getting them to shovel-ready.
Sentiment score: 0.10
The question is around what is capable of being delivered to absolute completion within the next five years and how we balance and manage that. I do not think it is question of right or wrong. Both the Deputy and I want to see the infrastructure delivered immediately if possible but we both live in the real world where we have to go through planning and procurement processes. There is a slowness in doing that, unfortunately - in the Government and the public sector doing that - which does not challenge the private sector in the same way. It is very frustrating but we both want to see the projects delivered. I now have a capital envelope the size of which we have not had in health. There was an underspend on capital investment for a very long time in health, with significant additional funding on the current side. That was fine and necessary but there has been an underspend. I have secured a large capital portion of the NDP and the additional programme that is there. I have the assurance that where I get something to shovel-ready, I will get the funding for that and I would welcome the Deputy's support when I get to that point.
Sentiment score: 0.09
There is no barrier to them in the context of the funding side of it. The bigger issue is the planning side but we will work through it together. I had the good fortune to be in Waterford, a really excellently run hospital. I was in the CAT labs and got to see the different theatre configuration, which, of course, has been delivered. It is the case that the cardiologists have been recruited and that was confirmed to me by the hospital management and the IHA management so we will see that commitment delivered. The current funding was put beside it.
Sentiment score: 0.13
There was a recruitment process, and there you go. I stood, as I am sure the Deputy has done, and his party colleagues were there with me, outside the pretty magnificent surgical hub that is being completed there. We would very much like to see that. If anybody is going to run that well, I am confident that Waterford will do it. Those projects are being delivered and I look forward to seeing the physical transformation of that hospital as much as every other hospital with the ongoing capital investment that has happened and continues to happen, and the major projects, such as the one in the Deputy's own constituency, which is being delivered in front of his constituents' eyes.
Sentiment score: 0.39
I thank the Deputy. The Government is obviously committed to improving cancer care generally. As the Deputy is aware, a total of €105 million has been invested in the strategy since 2017, including €23 million in budget 2025. Under the national plan for radiation oncology, state-of-the-art radiation oncology centres have opened in Cork and Galway in 2019 and 2023, respectively, which was €120 million capital investment. In Dublin, the St. Luke's Radiation Oncology Network, which includes St. James's and Beaumont Hospitals, were developed under phase 1 of the national plan in 2010. The design of the phase 1 facilities made provision for future expansion for phase 2, is now under way at Beaumont Hospital as a priority. On staffing, I wish to acknowledge the incredibly important role of radiation therapists in the provision of cancer services in this country. There are currently 220 radiation therapists in Ireland, an increase of over 20% since 2020. While recruitment for radiation therapists is challenging globally, radiation therapist staffing vacancies in the HSE have improved from 30% in 2024 to about 15% to 22% at present. It is not fully staffed but it is going in the right direction, notwithstanding a challenging global environment. There are currently 40 radiation therapy student places available annually across Trinity College, Dublin and University College, Cork. In the last six years, the radiation therapy training programme has grown by 32% and more than 20 additional specialty training posts have been established in the last three years. The national radiation therapist review, completed in 2024, provides a strategic review of the profession in Ireland and recommendations are being progressed by the HSE. The review recommended the development of new advanced practice radiation therapist roles and those posts are expected to be advertised in the coming weeks. To maintain improvements, NSP 2025 included 5.5 radiation therapy posts and six advanced practice radiation therapists.
Sentiment score: 0.20
There are five public radiotherapy treatment centres with a total of 22 linear accelerators across the services. Galway has four, Cork has five and St. Luke's has 14 machines across the three sites in Dublin. The HSE also contracts radiation oncology services for public patients to centres in Waterford and Limerick and has a service-level agreement with the North West Cancer Centre in Altnagelvin to provide radiotherapy services for patients within a 90-minute road journey of Derry. Under the National Plan for Radiation Oncology, NPRO, Ireland has developed state-of-the-art radiation oncology centres, as the Deputy is aware. I will look into the examples the Deputy has given relating to the management and replacement of different machines. I just need to spend more time doing that. I thank the Deputy for highlighting it.
Sentiment score: 0.01
There are a couple of different things. Staffing vacancies have decreased considerably, from 30% in 2024 to 14% in Dublin, 15% in Galway and, I acknowledge, 22% in Cork. CORU has changed some of the registration requirements, which has brought Ireland closer to international standards, providing access to work in Ireland for more radiation therapists generally. We have funding allocated in 2025 for the development of advanced practice roles in radiotherapy, which, again, is an effort to help people to work at the absolute top of their profession, which is really important. Recruitment is ongoing for vacancies in radiotherapy services. We are actively looking for people to come and work in these services. We are trying to enhance the workforce through advanced practice opportunities and to really drive in that direction. We know how much people have to offer. We have the funding for the additional posts. We want people to come and work in this service. We are taking all of the steps we can to try to attract them. We cannot compel people to be in the public health system either.
Sentiment score: 0.17
I have jobs.
Sentiment score: 0.00
I thank the Deputy for his ongoing concern, driven first by patient safety in Portiuncula hospital, which I greatly appreciate. It is an important focus. As the Deputy is aware, the Walker report came from a review commissioned by the then Saolta Group in 2014 following a number of serious maternity cases at Portiuncula maternity services from 2004 to 2014. It covered 18 cases and was published in 2018, making 154 recommendations. The HSE has advised my Department that all 154 recommendations were independently verified as implemented by both HIQA and an independent national HSE team. HIQA has verified that. One of the recommendations related to the integrated clinical director model, with one clinical director covering Portiuncula hospital and University Hospital Galway. That was in place from November 2021 until June 2024 but was recognised by both sides, I understand, as a challenge from the outset. There were elements of risk due to the distance between the two units and the associated split of the clinical director's time. The model did not lend itself to consistent on-the-ground leadership, and as a result gaps in governance emerged. Following prolonged consideration, the HSE reverted to having a clinical director on both sites from August 2024. All 154 recommendations were implemented and that is one which just did not work and the HSE reverted to having two clinical directors as opposed to one overseeing the complete group. HSE West and North-West has an established clinical network which includes Portiuncula hospital and University Hospital Galway. The network supports Portiuncula hospital in all aspects of clinical maternity care and joint processes have been in place since 2018. Although changes were made in Portiuncula hospital following the Walker review, frankly, similar issues have emerged in Portiuncula hospital, as the Deputy is aware, which is incredibly disappointing for us, but is of life-changing significance to the women whom it impacts and their babies. Twelve reviews are ongoing, which are at various stages of progress. Seven have been completed. Fifty-two recommendations have arisen from these seven reviews to date. Work to implement many of those recommendations is already in place.
Sentiment score: 0.11
I do not know how else to say it to the Deputy but HIQA has verified that all of the recommendations were implemented. Perhaps we should arrange an opportunity for the Deputy to engage with HIQA about its assessment. It is the independent regulator and HIQA advised that they were implemented. One recommendation of 154 did not work and it was moved backwards. The issues that arose in Portiuncula hospital should not have arisen. They should not have happened, because the recommendations of the Walker report were implemented, yet they arose again. I ask myself the same questions. I have asked that of hospital management and I have asked through the reviews. How is it that the same issues, which are not of resources but of management, culture, communication and responsiveness to women, frankly, are occurring? I have met many of these women. I have sat with them and heard the particular experiences of their cases and what happened to them and their babies. It is difficult to accept that those cases should have happened in circumstances where the Walker report was implemented. If we are going to have a political dialogue about a report that has been implemented, which the independent regulator has confirmed as having been implemented, with one recommendation having been walked back, and try to place what happened to those women at the foot of that single recommendation being changed, we are not in a good space.
Sentiment score: 0.02
The Deputy is aware that an external management team, EMT, was put in place in January precisely to try to supervise, assess and make some of the improvements that are needed. There have been some infrastructural works and changes, some of which should have been done before the external management team arrived, which have now been completed, for example a four-bay maternity day assessment unit, MDAU, and a dedicated early pregnancy unit. All of that was in train and should have happened before the external management team arrived. It has now happened. The EMT, and nobody else but the EMT, identified a bungalow adjacent to the hospital that has now been converted to a dedicated maternity outpatient department with six dedicated maternity clinical rooms five days a week from the end of September. That bungalow had been acquired before the EMT commenced but it was for a totally different purpose. It has progressed that as a maternity outpatient department. It should not be the case that we need an external management team in Portiuncula hospital. The patient safety issues have been very significant. I have acted on clinical advice to me that it is not safe for high-risk women to give birth there until the changes that are necessary have been made and sustained in a way that can give confidence to everybody.
Sentiment score: 0.24