I thank all colleagues who have made such personal contributions, not only about their own experiences but also facilities and gaps that remain on the island within cancer services. If I could be indulged, I wish to acknowledge a wonderful young girl from Bailieborough, Orlaith Lennon. At 24 years of age, she has lost both of her parents, her dad only a month ago. She had the bravery to go out on Friday for Daffodil Day, like so many other volunteers right across the country, to do some fundraising for the Irish Cancer Society. I do not know where people gather the strength to do things like that when they have had such personal experiences. I acknowledge her incredible work. Colleagues have talked about the volunteers of many cancer groups, particularly in rural areas. In Cavan-Monaghan, where I live, there is Bailieborough Cancer Comfort, which provides the volunteers who provide transport. As we have discussed, transport can be such a big issue for cancer patients who have to get to the main urban centres and specialised hospitals for treatment. There is incredible work done by volunteers, as well as their fundraising, to make sure that compassion, care and transport is provided for patients. I thank all my colleagues around the House who contributed on this most important topic of cancer services right across the island of Ireland. While many of our services deliver excellent, high-quality care, I acknowledge and recognise there can sometimes be delays in getting cancer treatment for some patients. I acknowledge the distress felt by them and their families when they face such delays. Where hospitals are challenged to meet service targets, they typically respond with a mix of local improvement plans, additional clinics, outsourcing of diagnostics and reviewing patient pathways where needed. As clinics typically run at full capacity, any disruption of services can lead to a backlog which can take time to clear. Where centres fail to meet their performance targets, the NCCP works closely with hospitals to ensure that improvements to services are achieved and sustained, and that patients are seen to as quickly as possible. Every effort is made to address waiting times and patients are prioritised on the basis of clinical need. Often, not meeting performance targets arises from staff shortages or problems in accessing diagnostics or radiology services. Deputies will be aware that there is a global shortage of healthcare workers, and where we have very specialised services like those in cancer care, it can be difficult to recruit when vacancies arise. In addition to local measures, the NCCP continues to monitor performance nationally and has implemented a range of initiatives to optimise capacity with rapid access clinics, particularly for those with breast cancer. Updated referral guidelines have been introduced, aimed at ensuring standardised access across the country and, where appropriate, post-cancer patients are participating in stratified self-management follow up, rather than attending unnecessary specialist appointments. These will reduce variation in the management of patients and will lead to more appropriate referrals within cancer services. The HSE is also working to expand capacity. The HSE capital plan introduces funding for the design and construction of oncology day units and chemotherapy infrastructure at Midland Regional Hospital Tullamore, University Hospital Limerick and University Hospital Kerry. Deputy Cahill asked very specific questions. I will ask the Minister to respond on any issues raised specifically in respect of infrastructure. A major radiotherapy equipment replacement programme is also in place, and work is underway to update equipment across St. Luke's Hospital radiation oncology network in Dublin. Long term, the delivery of surgical hubs and three elective treatment centres, once operational, will increase overall surgical capacity in our acute hospitals. In budget 2026, the first steps have been taken towards a new approach to funding, intended to strengthen performance by devolving health budgets to the new health regions. This provides greater autonomy to meet local needs, while holding them accountable for their targets and national standards. This will enable the HSE leadership to target resource allocation where it is most needed to address regional variation. The NCCP will continue to lead on cancer service design and development nationally. It will monitor performance and work closely with the REOs to ensure the delivery of safe, effective cancer services in all regions, working to reach the same high standards across the country. This new budget approach will build on the success of the national cancer strategy, which has, over the years, fostered a culture of improvement and innovation, as seen through the development of pioneering services. In the last ten years, we have seen the rollout of cutting-edge therapies, including radio labelling therapy, CAR-T cell therapy for adults and specialised radiotherapy treatments, which will reduce the number of treatment sessions compared with conventional radiotherapy treatments. More recently, and supported by our 2025 programme for Government commitments, the acute oncology nursing service has expanded, keeping ever more cancer patients out of emergency departments when they feel unwell. The rollout of the SSMFU framework is also helping recovering patients to avoid unnecessary hospital outpatient appointments, and it provides better management in their aftercare. In recognition of the incredible contribution of the voluntary and community sector in providing services to cancer patients and their families, which we have all referred to tonight, the programme for Government made a commitment to continue to invest in community cancer support services. To support this commitment, the NCCP Alliance of Community Cancer Support Centres was allocated €5.5 million in funding for 2025, and that is now recurring. We have also provided access to new and innovative medicines. Between 2021 and 2024, Ireland allocated an additional €128 million for new medicines, allowing for the introduction of 74 new medicines for cancer. Budget 2026 also allocates €30 million specifically for new medicines. New treatments have been introduced. CAR-T cell therapy became available in 2021, removing the need for patients to travel abroad for treatment. The service is being expanded to University Hospital Galway this year, and recruitment is under way. This will provide CAR-T cell therapy for adult patients in the south and west of the country and increase overall capacity nationally. We are also seeing an improvement in new developments for patients, with the creation of the comprehensive cancer centres. This designation requires close collaboration between hospitals, universities and research centres, bringing care, teaching and clinical research together in a deeply integrated way. Patients attending these centres have greater access to clinical trials and the important benefits that brings. I am delighted that all of our eight cancer centres are participating in the EU project to gain accreditation and access to the EU Network of Comprehensive Cancer Centres. Membership of this project will enhance our treatment, teaching and research work, and this will in turn help to attract the best international experts. We have a strong track record of supporting cancer care with investment in research, and I am determined that we will build on this. The cross-border cancer consortium research partnership between Ireland, Northern Ireland and the US National Cancer Institute has seen 25 years of progress, with over 35,000 patients participating in clinical trials. Annual investment in cancer research by the Health Research Board has increased significantly in recent years, from €5.4 million in 2017 at the start of the current strategy to €9.4 million in 2025. Since 2020, the Health Research Board has awarded €43.7 million in cancer research funding, including €21.6 million in clinical trials infrastructure. We are also creating and embedding a culture of innovation in health research more broadly. In November last year, the final report and recommendations of the national clinical trials oversight group were published. The implementation of these recommendations aims to streamline the regulatory processes needed to establish clinical trials, enhance public and patient engagement, establish clear, consistent approaches to conducting clinical trials and grow the clinical trial staff around the country. The current national cancer strategy was launched in July 2017, with a ten-year implementation framework. This year, the Department of Health will commission an independent evaluation of that strategy. While the details have not yet been finalised, the previous strategy was evaluated by a three-person panel of international experts. Their report provided a detailed analysis and recommendations to guide the development of the next strategy. The evaluation process will examine the full continuum of cancer care, from prevention to screening, diagnosis, treatment, survivorship and palliative care. Patients are, of course, at the heart of our services. There will be opportunities for meaningful stakeholder involvement, including patients, their families, healthcare staff and all the cancer advocacy groups, among others. I thank the Deputies again for their thoughtful, measured and considered contributions. We all share an absolute commitment to delivering the best outcomes for patients. The new national cancer strategy will be a critical step in planning our services for the decade ahead.

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