I thank Deputy Cullinane and Sinn Féin for introducing this timely motion on cancer services, which the Labour Party supports. I was going to give out that the Government is opposing this motion. It is disappointing that it has decided to nitpick at what is a very good motion. Surely to God, we should all join together to identify the very clear issues that exist at the moment. While it used to be the case that Ireland was a global leader with regard to cancer care, we are now a long way off that because of a lack of investment but also because of a lack of focus on how we organise our health service - not just our hospital services, but right down to our primary care GP services. This is why we are not getting cancer services right in this country today. The reality is that, sadly, one in two people will get cancer in their lifetime in this country and one in three people will die from it. Ireland has the second highest incidence rate of cancer diagnosis in the EU. The number of cancer diagnoses is projected to grow by 47% between 2022 and 2040, so it is something we need to get right in terms of our services. To me, this conversation has to be about funding and how we organise our health services. We await the new national cancer health strategy next year. It is critical that ring-fenced funding is there and is rooted in prevention, particularly with regard to primary care and looking at those socioeconomic factors. Inequality is at the heart of the higher incidence of cancer among lower-income parts of our population and communities. Funding has to be ring-fenced for early diagnosis through screening, early treatment, innovation and access to technology and medication. Screening is the low-hanging fruit of cancer services. We know that 40% of women called to attend BreastCheck last year did not go. BreastCheck missed its target by 46,000 mammograms last year and that target has been missed three years in a row. I have not heard any answers or any research into why that is the case. We can speculate. There are many potential reasons, including difficulty getting the time of work, the fear of the mammogram procedure because it is painful, and the potential outcome. My colleague, Deputy Duncan Smith, has a Bill coming this Thursday that will seek to provide for legislative provision for workplace leave for cancer screening. However, we need to see the research and the understanding undertaken by the Department as to why women are not presenting for BreastCheck. To my mind, the conversation has to be about reducing the eligibility age for BreastCheck. In particular, it should be extended to women below the age of 50 to ensure we catch the incidents of cancer at a much earlier stage. We have to send out a message that if breast cancer is diagnosed at stage 1, there is a 99% chance of survival. That is why early detection is so vital. We need to get to the bottom of why the take-up is much lower than it should be. The other key concern for me is with regard to bowel screening. We know that the target of 50% is obviously much lower than we would like, but the take-up of bowel screening is far below what it should be. The rates of colorectal cancer in this country doubled for those under the age of 50 between 1994 and 2019. In an article published by the Irish Medical Journal last year, researchers from Cork University Hospital and Cancer Research Ireland predicted that by the 2030, young onset colorectal cancer will be the leading cause of death for adults between the ages of 20 and 49. One in ten people with colorectal cancer in Ireland at the moment are under the age of 50. We need to get serious about that very real challenge over the coming years. Not only do we need to look at the take-up of the existing screening programme, but we also need to lower the age as well. To me, screening is the easy, low-cost part of the cancer services. The other key part is with regard the in-hospital services. We see what has happened with regard to radiation oncology, the delays in terms of access to treatment. Two in ten people are not starting radiation in time. In 2025, two in five women were not being seen on time for their appointment at an urgent breast clinic. Of course, in the Dublin area, 90% of the LINACs are beyond the ten-year lifespan. That points to an enormous Government failure to ensure investment in infrastructure. The other key aspect of what I want to touch on is outside of the hospital system. It is about the overall system of cancer care, which is the first port of call, namely our GP system. The EU Country Cancer Profile 2025 stated that Ireland faces shortages of various cancer care professionals, including GPs. I have stood in this Chamber a number of times, including with the Minister of State a number of weeks ago, when we discussed the huge geographical inequality that exists across this country with regard to accessing GPs. To be very frank about it, if people have to endure a long wait to access their GP, that is going to deter them from turning up, particularly if it is an issue relating to testicular cancer, prostate cancer, breast cancer or some of the cancers that may be a bit more sensitive for people in terms of presenting. We have to change that. It is not good enough in the communities that I represent. There is one GP for 3,000 people in Cabra while it is one GP for 3,500 people in the north inner city. In some of the fast-growing communities, particularly in Kildare, Lucan and east Meath, we are seeing one GP to 4,000 or 5,000 people. That is unacceptable. I sometimes think when we are having this conversation I am having it with people who can pick up the phone to their GP, talk to the secretary and get the appointment the following day or the day after. If that is the case for the vast majority here, that is wonderful, but that is not the reality for many people in the community. The Government opposed our Bill to ensure that the HSE takes responsibility for an even geographic distribution of GPs across the country. We have to get that right if we are making sure that people are presenting at the first port of call within the health system. The last issue I raise is palliative care. While we are all about early detection and treatment, the reality is people die in this country from cancer. Deputy Farrell raised it earlier, but I raise the lack of pathways when somebody has cancer in this country into the hospital system, whether they are currently in treatment or in palliative care. It is really frustrating to think that people with cancer have to present themselves to an emergency department and sit there for a number of hours or days before they get the treatment they need. St. Vincent's and other hospitals across this country have begun to provide quick access for cancer patients, chemotherapy patients in particular, to their clinics. I spent time yesterday with a 42-year-old woman who is in palliative care. She is a single mother to a young son. She had to wait three hours for an ambulance yesterday to be brought to her local major hospital in Dublin. She had to wait until 4 o'clock this morning for a bed. She is in palliative care. Because she has been discharged from chemotherapy and even though she is with the hospice, she is not at death's door to go into the hospice just yet. She is in limbo. There is nobody to look after her. She needs a nephrostomy, which is effectively a procedure to ensure that the urine leaking out of her back can be stopped. She had to go into that same hospital a number of weeks ago and waited four whole days, taking up a hospital bed, waiting for a one-hour procedure that does not require a general anaesthetic. I am telling this story this evening to highlight the lack of pathways, particularly for those in palliative care into the hospital system. There is a complete disconnect from when people finish their treatment to when they die or when they go into a hospice. By the time they are admitted into a hospice, they are only a few days or a week or two from passing away. What about those weeks in the middle? That is critical. Part of it relates to hospital organisation. The other part is the 2024 national palliative care strategy, and it is very welcome. It states great objectives, but I am not at all convinced, when I look at the HSE service plan or the letter of determination from the Minister, that there is any focus on that at all. In some ways, it should not take an awful lot to ensure that somebody with palliative care presenting to a hospital has a particular pathway to get their treatment and get them back out. It is not good enough that a palliative care patient is taking up a vital bed for somebody who may live, if we call a spade a spade, but second, in terms of affording them dignity in their final weeks and months of life, that they would spend any time unnecessarily within a hospital system. This is not really about massive amounts of funding; this is about how we get our systems right. I am afraid that those systems are not right. There are stories across this country of people having to get into ambulances and present to emergency departments unnecessarily when there should be another way for them. I thank Sinn Féin for tabling the motion. There is enormous work to be done to ensure Ireland can go back to being a global leader in cancer care. Ultimately, to make sure we get back to that place, we have to get the investment into our equipment right and the investment into access to medicines. We know there is a gross inequality in Ireland between those who have the luxury of private health insurance - when I say luxury, you are paying a fortune for health insurance - or those reliant on the public system and the access to drugs. Across a whole range of cancers, people's potential for survival is greatly enhanced if they can go through the private system and access those drugs licensed through the EMA that have not been licensed for this country. In my book, if a drug has been licensed through the EMA, we need a greatly simplified system through the National Centre for Pharmacoeconomics of how we process approvals for drugs in this country. Yes, cost is one of them, but I do not hear anything from the Government about pushing at European level about how drug prices are collectively negotiated. In some ways, the market model is coming back to bite us in Ireland. We need to make sure we collectively negotiate at the EU rather than doing it individually here.

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