I thank Sinn Féin for tabling the motion, which the Social Democrats will support. Cancer services were once the jewel in the crown of our health service and an example of what the system could achieve if sustained investment was matched by political will, but the focus on delivery has waned over the lifetime of the current strategy. As a result, we have delayed diagnoses and treatment, missed targets, shocking regional disparities, ageing infrastructure and major staff shortages, none of which were acknowledged by the Minister of State in his opening statement. To put it mildly, it was disappointing, particularly given the stories we have heard tonight. Ring-fenced funding for the cancer strategy has been sporadic over its lifetime. When the strategy was launched in 2017, the then Minister for Health, Deputy Simon Harris, promised substantial current and capital funding over the ten years of the strategy. However, as the motion notes, the strategy has not received dedicated development funding in every budget since. There is a direct link between this failure to fund the cancer strategy and the missed targets, staff shortages and rampant outsourcing. You cannot starve a strategy of funding and expect it to be a success. When the Irish Cancer Society appeared before the health committee last October, it was very clear about the need for multi-annual ring-fenced funding for the strategy. The programme for Government commits to developing a multi-annual funding approach for the entire health service. However, multi-annual health service funding has been promised by every Government since 2016, yet none has delivered it. The Minister for Health should have insisted that it was delivered in this Government's first budget. Budget 2026 did nothing to advance multi-annual funding. Last year, during the Estimates process, the Minister told me that it was her ambition to progress multi-annual funding this year, subject to an agreement with the Department of public expenditure. We need to know if this is still progressing and if it will be implemented in budget 2027. The next cancer strategy must have multi-annual funding. Otherwise, it will suffer the same fate as the current strategy. There is no doubt that patient outcomes have improved over recent decades. However, the absence of sustained, year-on-year funding has meant that too many people are not getting access to timely tests and treatment. The Irish Cancer Society has provided an overview of recent testing and treatment pathways. Last year, 6,200 people waited more than the recommended time for a colonoscopy. The target is zero patients within more than 28 days. Two in five women were not seen on time for urgent symptomatic breast disease clinics. The target was 95% seen within ten working days. In the first half of the year, seven in ten people waited more than three months for an MRI, while six in ten people waited over three months for a CT scan. Similar things are faced in terms of cancer surgeries in 2025. Two in five people did not have lung cancer surgery within the recommended 25 days. Three in ten women did not get their breast cancer surgery within the recommended 20 working days. In 2024, which is the year for which the latest data are available, three in five men did not get prostate cancer surgery in the recommended 30 working days. The bottom line is that these delays caused avoidable deaths. Research published by the British Medical Journal found that every four-week delay in starting cancer treatment can increase mortality by 10%. This is precisely why we have targets in the national cancer strategy. We know that a person’s chances of surviving cancer are up to four times higher when treated at stage 1 rather than stage 4. One of the biggest issues in cancer care is the hollowing out of public radiotherapy services. Since 2020 over €113 million has been spent outsourcing radiotherapy for public patients to private providers. In 2020, €12 million was spent on outsourcing radiation therapy. Since then it more than doubled to €28 million in 2025. One of the biggest reasons for this shocking spend on outsourcing is the failure to plan. Radiation therapy machines have a ten-year lifespan yet 50% of public machines are over 15 years old with four of these over 18 years old. After the ten-year mark, machines break down, maintenance costs increase and the standard of care decreases. St. Luke's Hospital in Rathgar, for example, is limited to using just three of its machines at any one time to mitigate frequent breakdowns. This means it is losing a quarter of its capacity on any given day. I accept a replacement programme is finally under way in the St. Luke’s network but why do machines have to reach breaking point before action is taken? Not one machine in Dublin is under ten years old and, as I said, four are approaching 20 years old. The need to replace machines is entirely predictable yet there is no rolling national radiotherapy equipment replacement programme in place. The machines in Galway will need to be replaced by 2032 and the machines in Cork will need to be replaced by 2029, just four years from now, yet no planning is under way. We need a rolling replacement programme and not an ad hoc system of replacement. This would also save the State money by buying equipment in bulk. There are similar issues in relation to staffing. We now have a radiation therapy staffing shortage of between 15% and 22%. The increased reliance on outsourcing is creating a vicious cycle. In CUH, a radiation therapist told me that patients are being outsourced to private providers because the public system does not have enough staff. Outsourcing creates more business for private centres which, in turn, hire more staff. This means that even more consultants and radiation therapists leave the public system for the private system, which is booming on the taxpayers' dime. Another issue I want to raise relates to radiography practice tutors. Radiographer tutors play a vital role in clinical education and training of students within our hospitals but their value is not recognised, not least in their current terms and conditions. We know that experienced radiography practice tutors are stepping down because the pay does not reflect the level of responsibility. If we are to attract and retain more tutors, they must be remunerated and graded appropriately. The cancer strategy is clear on the need to increase the number of student places and I welcome that the Government is implementing this recommendation. Just last week, however, I heard reports of radiography students studying in the library instead of doing clinical hours because of a lack of practice tutors to support their placements. One tutor described this to me as being akin to learning to drive by simulator. Hospitals must be funded to deliver these extra placements and there needs to be more joined-up thinking. What good is having college places if the tutors are not there in the hospitals? This escalating crisis requires an urgent intervention by the Minister for Health. It is time to support and value these tutors not just in words but in actions. Otherwise we will not be able to increase the number of tutors or retain them or provide patients with timely diagnostics. I sincerely hope this debate is a wake-up call and in particular the really harrowing personal stories Members have shared about themselves, people they know, their constituents and family members. We really need to improve cancer services for people right across the country. This next strategy must not be starved of funding and it must not be at the whim of every budget cycle. We must have multi-annual funding. I would like the Minister of State to take that message back to the Minister. The downward trend in cancer care can and must be reversed. We have done it before and we can do it again. We need to have the same commitment to deliver that was present for the first two cancer strategies but notably absent in the third. I urge the Government to change track on this, to invest in cancer services and to start improving cancer services so we can improve outcomes, improve lives and prevent avoidable deaths.

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