In 2013, there were just over 21,000 invasive cancer cases diagnosed in Ireland. By 2022, that figure had risen to 26,000 annually. Of course, the population grew very considerably in that time as well. That increase is in line with projections made by the National Cancer Registry Ireland. With a growing and ageing population increases in cancer cases are to be expected, with cancer being more prevalent as one ages. While we are seeing more people being diagnosed with cancer, those people are living longer with and beyond cancer. When the concurrent national cancer strategy was published in 2017, there were 150,000 people living following a diagnosis of invasive cancer. That figure has now increased to 220,000. In 2021, there were almost 9,600 deaths from cancer in Ireland. In 2013, that figure was 8,700. While still too high, cancer mortality rates in Ireland are falling faster than the EU average, having fallen by 17% between 2011 and 2021, compared with the EU average of 12%. More than €105 million has been invested in the implementation of the national cancer strategy since 2017. This includes €23 million for cancer services in 2025. That investment has allowed us to recruit more than 670 new staff to cancer services. This Government is fully committed, as I know everyone in this House is, to developing and improving cancer services. Our investment in cancer services is delivering better outcomes for patients. I will arrange for a table outlining cancer cases and deaths to be provided to the Deputy. I have to say that when I first looked at the data, I was quite struck. I had not realised quite how high the proportion is of people who are dying from cancer. Nevertheless, I take some measure of comfort from our falling mortality rates relative to the rest of the EU and the return that we are getting on investment where more and more people are living with and beyond cancer.
Sentiment score: -0.46
It is really important to look at where we are versus the rest of Europe in terms of the impact of the investment we deliver. The most important impact is that people are living longer and recovering from cancer and living with and beyond cancer. When we talk about investment, that is what we are trying to achieve. Of course we want to use the resources we have in a way that will deliver the best return on our investment for all of our people. I have spent some time on this. Report after report, whether it is the OECD country cancer profile or the EU analysis, shows that Ireland is doing better beyond its European peers in its cancer performance and mortality rates. The Deputy is right that there were measures of delayed diagnoses during a period where the health system was shut down for the benefit of the broader community with a highly transmissible lethal virus that was killing many people in this country. The Deputy is right that there was an impact in that respect, but notwithstanding that, our cancer strategy is trying not just to address that but is also trying to make sure we are delivering on the additional services brought by the previous two strategies.
Sentiment score: -0.21
I am a supporter of the public health system. That is what I am trying to drive investment into. I would like to see everybody treated in the public system. That is what this programme for Government and this House is about. It is about Sláintecare and delivering the best service in the public health system. My concern is making sure that happens. The Deputy has cited Sweden and the UK and it is important we do that. We want to be the best and for the people of Ireland to have the best experience. The Deputy is quite right to highlight where other countries are doing better. I am always interested in why and how that is happening. I always want to have the conversation about how we do this better. However, I also recognise the progress we are making. Our cancer mortality rates are falling faster than the EU 27 average and than our economic peers. Our EU country cancer profile in 2025 comments favourably on the measures taken to reduce cancer risk and prevention-----
Sentiment score: 0.22
Excuse me.
Sentiment score: 0.08
I certainly understand the frustration and worry that comes with having difficulty in accessing GP services. That is not what we want. Timely and available access to GP services is critical to good healthcare. In rural and remote areas, in particular, general practice is often in a role of clinical leadership for patients for whom access to other services is farther away. Being aware of this, and that the country as a whole needs more GPs, the Government has taken a series of measures in recent years - and is committed to continuing them - to increase the number of GPs. Significant investment in general practice has been made under the 2019 and 2023 GP agreements, which provide for increased fees and supports for GPs, including specific supports for rural practices, making general practice in Ireland as a career more attractive, I hope. The agreements also provide for new services for patients, including the GP chronic disease management programme, which is having a transformative effect on patient care. In addition, recruitment of GPs from abroad is ongoing under the international medical graduate, IMG, rural GP programme, with 114 IMG GPs in practice as of October last. Placement of GPs under that programme is targeted at underserved and, in particular, rural areas. Most important for the future, the number of GP training places available has been increased from 202 in 2019 to 350 last year, and that will feed through to an increased number of GPs graduating and entering practice. I welcome the initiative of the University of Galway to develop medical and pharmacy education with a focus on the differences and additional challenges of delivering services in rural areas. It is appropriate and important that people are being attracted into that from an early stage. The continued use of increased GP training places and GP recruitment under the international GP programme is committed to under the programme for Government, which also - I think we will come back to this - recognises the potential for using HSE-employed GPs in a variety of locations.
Sentiment score: 0.29
I always thank Deputies for raising practical problems and barriers I can interrogate and investigate within the Department and HSE. I do not know the status of every application so I really appreciate it. I am informed by the Minister of State, Deputy Butler, who also serves the community in Waterford, that she met HSE Estates last week on the Tallow project, which is important. She will be keeping a close eye on the progression of that. She also informs me Tallow GP service now has four GPs operating. It is a small rural town and it needs the GP services but this is a welcome development and we will continue to work with HSE Estates. The locum situation in Lismore has been resolved, with a permanent GP now in place, as is appropriate. The Department is working with several practices in west Waterford on their premises. There are plans for a new primary care centre in Lismore. We always want to hear about-----
Sentiment score: 0.20
I will indeed.
Sentiment score: 0.00
I have not seen that for some time. It is welcome to see it.
Sentiment score: 0.23
The Government was making the same case during the election and continues to make the case for employing GPs through the HSE. It does not matter where an idea comes from. Let us just do it. Deputy McGuinness referenced barriers in his earlier intervention and I did not answer him. To be fair, the Government has tried to place a particular focus on rural supports. The 2023 contract is an example. Practices in receipt of rural supports receive the maximum rate of practice staff subsidies in a significant effort to reduce staff costs for those who will establish their own practice. They also receive the maximum rate for locum supports for leave taking. On new GPs, the Deputy is right that when a retirement happens it is very disruptive. As I said, the GP training scheme increased by 80% from 2019 to 2024 with 350 new training places and 346 new entrants commencing training last year, an increase of 21% on the previous year's intake of 286. The very crude replacement rate is estimated at a rate of one to three GP graduates taken on board for every GP retirement and we have that particular focus on rural GP training.
Sentiment score: 0.08
I thank the Deputy. I have been informed in recent weeks that a benefit-in-kind liability was identified by the HSE for staff using the NAS response vehicles when travelling from home to work. A review is under way in the National Ambulance Service, which it is hoped will be concluded in April. The National Ambulance Service took the prudent step of informing relevant staff members of a potential benefit-in-kind liability that may exist in 2025. The Deputy will appreciate that the HSE must comply with Revenue Commissioners regulations, like everybody else, in relation to what may be considered a potential personal use of a publicly-owned vehicle. The National Ambulance Service is also preparing to seek a ruling from the Revenue Commissioners in the matter. It is important to clarify that the response vehicles highlighted by the Deputy are not patient-carrying vehicles and that is a really important distinction. The vehicles in question are rapid response vehicles for authorised NAS staff to respond to an incident in support of an emergency ambulance while on duty but they are not patient-carrying ambulances or patient-carrying vehicles. The decision taken by the National Ambulance Service, pending the ruling by the Revenue Commissioners that has been sought, does not impact on the National Ambulance Service emergency ambulance provision. I emphasise the Government's commitment to investing in our National Ambulance Service, with an allocation of €285 million in 2025. That includes €8 million new service development funding, with a full year investment of €16 million in 2026, to deliver up to 180 additional posts this year.
Sentiment score: 0.13
I thank the Deputy and of course, I clarify for the benefit of others watching and not for him in respect of the patient-carrying vehicle. I know that he knows this but perhaps others have not been as involved in this issue as his good self. This review was prompted by the National Ambulance Service itself. It undertook a review in September 2024 of the procedures governing the out of hours use of official response vehicles. It identified a potential benefit-in-kind liability. It is much better and more prudent to have taken that approach rather than to find out after the fact that it had been done wrongly and a liability had accrued. It is a precautionary measure and it has sought a ruling from the Revenue Commissioners. We all have to comply with the rulings of the Revenue Commissioners. The NAS has sought such a ruling and the review of the scale of the use of response vehicles for out-of-hours incidents is being examined. The results of that review will be presented to the HSE in April 2025. I agree about the good work done but it has to comply with the rules as well.
Sentiment score: 0.19
I do not disagree with the Deputy one bit about the value of the service they are providing. The National Ambulance Service prudently is seeking a ruling on whether there is a benefit-in-kind liability and has informed people there may be a liability to put them on notice of that. We await a determination. The review is useful more broadly because it will look at the scale of use of response vehicles for out-of-hours, as I said, but it will also determine the benefit and balance of the use of those vehicles out of hours compared to others existing out-of-hours or voluntary responses including, as we all know, the community first responder schemes. We have 300 of those schemes and 4,000 community first responder volunteers nationwide, which is extraordinary. We also have the NAS off-duty responder scheme, where we have 682 National Ambulance Service staff involved. Pending the results of the review, the National Ambulance Service took it upon itself to inform people there may be a benefit-in-kind liability. Had it not done that, it would have been rightly criticised for being aware there may be a liability that would accrue to people and not having informed them. We await a ruling of the Revenue Commissioners on it.
Sentiment score: 0.08
I thank the Deputy for raising this important issue, which has been a hidden difficulty for many women for many years. It is great to see it mentioned so freely in the Seanad yesterday and in the Dáil today. I thank her for raising it. It is estimated that one in ten women will be affected by endometriosis and although not all women will be symptomatic and not all women will experience it in the same way, it can be really debilitating for some women and our health service should support those women in every way possible. Treatment for endometriosis ranges from everyday pain medication and hormone treatments to surgical interventions. Budget 2024 provided an allocation with a full year cost of €2.175 million for 2025, which brings the total investment for endometriosis care to more than €5 million since 2021. The development of a national endometriosis framework was announced in 2023 and the HSE has advised that framework is nearing completion. I know that women with endometriosis have a keep interest in seeing that framework, as they rightly should. The HSE is engaging with all stakeholders in its attempt to finalise the framework. The clinical pathway for endometriosis care spans primary, local and specialist hospital care. Not everybody needs specialist hospital care but for those who do, they absolutely need it. The model of care ensures treatment through supraregional specialist centres with a support network of five regional endometriosis hubs. The HSE has advised these sites are currently taking referrals and providing treatment pathways. The supraregional sites offer specialised care to more complex cases. It is a good thing to note that 1,150 new patients were seen across those sites in 2024, though I imagine there are more in need. Personally, I am committed, as I know this House is, to fully implementing the Women's Health Action Plan 2024-2025 to continue to improve women's health outcomes and experiences.
Sentiment score: 0.36
It is always important as well to recognise the debilitating impact that endometriosis can have on somebody's life, their ability to be at work or their ability to care for children. It is a serious condition that needs intervention. It is important to set out where the specialist centres are. There are supraregional ones in Dublin, in Tallaght and in Cork University Maternity Hospital. The five regional hubs are in the Rotunda, the Coombe, the National Maternity Hospital, University Hospital Limerick and University Hospital Galway. The idea is to try to provide interdisciplinary care to women experiencing endometriosis up to a moderate stage - for example, the cohort of women whose symptoms cannot be adequately managed in their primary care setting. All of those five regional hub sites are now taking referrals and providing treatment pathways for those women.
Sentiment score: 0.25
I thank the Deputy, and I look forward to working with him as we worked together on the public accounts committee. Eligibility for a medical card is primarily based on a financial assessment, as the Deputy is aware, which is conducted by the HSE in accordance with the Health Act 1970. The HSE assesses each medical card application on a qualifying financial threshold. That is the amount of money that an individual can earn per week and still qualify for a card. It is specific to one's individual financial circumstances. People under 70 are assessed under the general means-tested medical card thresholds which are based on an applicant's household income after deduction of tax, PRSI and universal social charge. Certain expenses are also taken into account. People aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, those aged over 70 can also be assessed under the general means-tested scheme where there are particularly high costs. I assure the Deputy that my Department keeps medical card issues under review in order to ensure the medical card system is responsive and sensitive to people's needs. Over the course of 2025, we will review the existing eligibility framework to clearly assess what is working well and to inform future policy proposals regarding the eligibility framework based on robust evidence. That is an important step towards delivering universal healthcare in Ireland.
Sentiment score: 0.15
Of course, every extension of eligibility means that we cannot do something else, and we have to try to get the balance right. In 2023, GP visit card eligibility was extended enormously. While that does not meet everything, if you have a GP visit card plus the drugs payment scheme plus, potentially, the long-term illness scheme, there are a lot of measures that the State is taking towards reducing your costs in different ways, and the combined effect is very significant. What I really struggle with is that while 430,000 people were estimated to be eligible under that expansion, as of 13 January this year only 38,517 GP visit cards have been awarded under that median income expansion. It is not as though we do not want people to take them up. As a result of that initially slow update, a media campaign was rolled out to encourage uptake in 2024, including radio ads, out-of-home ads and in-office screens. The other 400,000 people who are eligible for a free GP card might look at the income limits and see if they are eligible.
Sentiment score: 0.12
Again, yes, it is about getting a balance, and we want to extend eligibility and reduce costs as much as possible. The very last thing that I or anybody else in this House wants is somebody not getting medical care because of a question of cost. The Government has taken a range of different ways to spread the benefit it is giving to people in the broadest possible way in addition to medical cards. The GP visit card is one. I would love to see 430,000 people taking it up and using it when they need to use it, supplemented by the drugs payment scheme, supplemented by the long-term illness scheme, which I think needs review as well, supplemented by removing the public inpatient charges for children and adults, and supplemented by our extension of contraception. We are trying to reach different groups in the broadest possible way and reduce the cost of medicine and access to medicine. In addition, all children under the age of eight years and all people aged 70 and over are now automatically eligible for a GP visit card. On the basis that most of our primary care is attempted to be delivered through the GP and primary care network closest to home and getting the original access, it is a really important step. I encourage every Deputy to encourage their constituents to check if they are eligible.
Sentiment score: 0.32
Not only that, but when women do express symptoms, they have often not been listened to. That was particularly evident to me in the new funding we have given from the women's health fund to cardiovascular care in particular yesterday, where there was an acknowledgment of bias in understanding symptoms and the way in which women describe them. The implementation is ongoing for the second women's health action plan for 2024-25. Our goal is to improve health outcomes and experiences for women and girls nationwide, and that has been supported by additional investment of over €180 million. Specifically, as regards County Louth, significant investment has been provided to Our Lady of Lourdes, Drogheda, for its maternity and gynaecology services, including the midwifery-led unit operational, with services extending to the community. Water birth services commenced in late 2023. Postnatal services are to be further developed in 2025. Of course, it was one of the first hospitals to implement termination of pregnancy services. It has also had an ambulatory gynaecology clinic operational since late 2022. Within the Louth-Meath CAMHS service, two new advanced nurse practitioner posts have been approved specifically for eating disorders. This is a particular problem for young girls especially, as the Deputy has identified. Funding has supported the provision of free period products in buildings and facilities managed by Louth County Council. BreastCheck is also currently operating a mobile breast screening unit in Drogheda. There are 56 cervical screening contract holders in primary care in County Louth. I am committed to women's health action right across the country, but these are some specific examples. This is additional to women and girls in County Louth being the beneficiaries of the broader supports in relation to HRT yet to come and the cost of contraception supports.
Sentiment score: 0.22
I launched three such research programmes identifying exactly that aspect, as well as identifying women who may experience particular risk factors through gestational diabetes or experiences during pregnancy or maternity generally that may be markers for cardiovascular difficulty in future. I also wish to highlight to everybody quite how easy it is to have an early marker check. Yesterday, I went through the horrid situation of having my blood taken and checked, which I despise. Nevertheless, it is a very useful process. I got the results 20 minutes later, which, notwithstanding some stress, were absolutely fine. The point is that they could just as easily have shown an early marker. Would we not much rather find out about an early marker for risk for the future? These are readily available to be done and I encourage everybody to try to spread this word, especially when it is women's health week. I thank the Deputy for her focus on women's health during this week.
Sentiment score: 0.12
I thank the Deputy for allowing me to update the House on this matter. Significant consideration has been given to developing primary care centres for both Maynooth and Leixlip. Since 2015, while several site locations for a primary care centre in Maynooth were explored, no suitable option has come about. As a result, a larger primary care centre will be built in Leixlip to serve both the Maynooth and Leixlip populations and their surrounding areas. However, and importantly, as part of that plan, the HSE will continue to deliver health services locally from the Maynooth health centre which will serve as a satellite and complementary unit to the larger north-east Kildare primary care centre in Leixlip. The development of the larger primary care centre in Leixlip has some advantages for service users which include access to a larger multidisciplinary team and the co-location of both core services and the enhanced community care programme community specialist teams in a larger and improved clinical space. It is welcome news that we are moving forward with more services in that region generally. A schedule of accommodation is being finalised with a view to the HSE tendering in the second quarter of 2025. I recognise that the population is growing in Leixlip and Maynooth. I welcome the HSE's commitment to continuously review infrastructure in those areas in conjunction with Kildare County Council. I examined the location, distance and public transport routes between Maynooth and Leixlip to best understand how people would access the more significant service that will be available in Leixlip. I am aware that Maynooth continues to grow. It was the original intention to have that facility there. A number of issues have been thrown up in that infrastructure process that give me pause as Minister for Health as to how we will deliver better infrastructure around the country.
Sentiment score: 0.45
I could not agree with the Deputy more. The intention was to do this in Maynooth. Several site locations for the Maynooth area have been explored since 2015 within HSE and State capital, but with no success. The important point is that the HSE applied for planning permission to develop a primary care centre on the site of the current health centre in Maynooth and it was not approved. The HSE had to seek planning permission to turn a health centre into a health centre, and it was not approved. I have a serious commitment to developing health infrastructure in this country. I want to deliver the services that I believe Maynooth and everywhere else needs. I am serious about the infrastructure guidelines and how we have to go about doing things. It will hamper the delivery. I am not trying criticise planners or their decisions - I appreciate that every application is different - but there was a need for a site in Maynooth, planning permission was applied for to turn a health centre into a health centre and now we have to do it in Leixlip.
Sentiment score: 0.10
I am well aware of how much the town of Maynooth has grown in population and in its need. The best we can do is make sure that the Leixlip site is delivered and services are available there, that services in Maynooth are also delivered to the extent possible and that the broader community has access to both centres. I thank the Deputy for his question. There is no lack of commitment in relation to Maynooth, just this direct problem which I hope we do not continue to have. We will have to figure out a way around it, otherwise we will not get anything built.
Sentiment score: 0.24