2026-01-14

I want to raise a very alarming and distressing case. It is the case of a woman from the west of Ireland left to wait six weeks to start her chemotherapy. At the end of November last, this mother of two young children received the devastating news that she had breast cancer, the same cancer her mother had died of in her 40s. To get a diagnosis of cancer is traumatic enough but to be told you have the same cancer that took the life of your mother is really terrifying. However, she did not give in to fear, she was up for the fight and she expected the health system would have her back. She was referred to University Hospital Galway for chemotherapy and expected to commence her treatment with the urgency required. However, as she waited the days rolled into weeks. Christmas came and went and still no appointment. The stress and anxiety of having cancer, worrying about it growing and spreading but not being treated got worse for her day by day. Her husband says they began, to use his words, "begging for chemo". She even offered to travel to other hospitals but her wait continued. By the second week of January this woman was still waiting for her chemotherapy appointment. Then she presented at the accident and emergency department in significant pain. She was left, by the way, to wait on a trolley. Only after being admitted to hospital did she begin her chemotherapy and it is very shocking that she started treatment only after she was admitted to hospital as otherwise she would have still been waiting. No cancer patient and no family should ever have to go through what this woman and her family went through. We all know early treatment is vital when it comes to surviving cancer. The National Cancer Strategy 2017-2026 states treatment should start within 15 days of diagnosis but patients are being left to wait way beyond that timeline. Last summer the Irish Cancer Society rang the alarm bell loudly. It raised the major regional disparities that exist in accessing cancer treatment, with patients in the west often waiting seven or even eight weeks for their chemotherapy. That is terrifying. This is not the first time I have raised serious concerns about access to chemotherapy. The Taoiseach will recall the scandal of 800 children’s chemotherapy appointments being cancelled in 2023. The National Cancer Strategy was designed to guarantee prompt diagnosis and treatment but while Ireland has come a long way experts Dr. Michael McCarthy have warned that it is getting tougher and tougher to deliver care on time. He says we are now behind the curve and we are slipping back. Advocates have repeatedly warned we do not have enough staff, space or equipment to cope and the human cost is being paid by patients and families. This has to change because lives are on the line. Níor chóir go bhfágfar aon duine a fhaigheann diagnóis ailse le fanacht ar feadh seachtainí roimh ceimiteiripe a thosú. Caithfidh an Rialtas a chinntiú go bhfuil fáil ag othair ar chóir leighis chun a mbeatha a shábháil gan mhoill. I want the Taoiseach to tell me how many other cancer patients are currently left waiting and waiting like this. I want him to tell us what action he is going to take in this regard to guarantee not a single patient is left to wait weeks and weeks to start their lifesaving chemotherapy.

First of all, I thank the Deputy for raising this issue, which is an extremely important one. Obviously I am not familiar with the background of the specific case she has referenced just now. If she wishes to send me the details of the case, with the permission of the person concerned, I perhaps will be in a position to interrogate the issue more with the NCCP, which is the national cancer control programme, and indeed with the HSE and the hospital. We have invested very significantly in cancer care. Cancer is a very traumatic diagnosis for any individual or family and, obviously, given the levels of investment in our services, we want the best possible outcomes. Thankfully, over the last number of decades, we have improved outcomes of cancer diagnoses significantly, particularly in terms of breast cancer. Breast cancer survivors are now the largest cancer survivor group in Ireland, making up 22% of all cancer survivors. Almost 50,000 women have had a breast cancer diagnosis. That does not mitigate or take from the trauma that the individual person the Deputy referred to this morning has experienced. As the Deputy knows, there have been a variety of new treatments, new drugs and so on for cancer. We have invested significantly in all of that. In the last three to four years, close to €650 million has been invested in new drug therapies for cancer alone and the radiation-oncology centres have been established and so forth. On the waiting times, symptomatic breast disease clinics operate in approximately nine hospitals around the country - the eight cancer centres and a satellite clinic in Letterkenny. The HSE national cancer control programme, NCCP, has set a target of 95% of urgent referrals being seen within ten working days and 95% of non-urgent referrals to be seen within 12 weeks. To date, 62% of urgent referrals have met the timeframe of ten working days. That needs to improve. Of that, there is no doubt. In October, three cancer centres - St. James's Hospital, University Hospital Waterford and University Hospital Limerick - exceeded the 95% target for urgent referrals. An additional three centres - St. Vincent's, University Hospital Galway and the Mater - reported that they expected to meet the target by the end of the year. Galway, which I think is the hospital involved in this case, has said to the NCCP that it expects to meet the target by the end of 2025. Certainly, if the Deputy sends me on the details of the case, I will pursue that with the hospital and the NCCP because the NCCP is working with various hospitals in terms of restoring the service within the agreed timeframes. When there is a particular performance issue, the HSE works with the hospital on site-specific measures. That could mean funding additional clinics or additional medical cover, where necessary. In terms of the variation across the country, the NCCP has introduced a range of guidelines aimed at ensuring standardised access to cancer services across the country leading to more appropriate referrals within cancer services. It is examining the national symptomatic breast disease pathway, including triage, review of key performance metrics and updating the national clinical guidelines. We need to work out the specific issue here because University Hospital Galway, I have been informed, has indicated it would be on target by the end of last December-----

Thank you, Taoiseach.

-----following recruitment and the running of additional clinics.

The issue is that it is not a specific or isolated incident. I would like to know the extent of this. I know about the case of this woman in particular. I have given the details of it. Dr. Michael McCarthy, who is president of the Irish Society of Medical Oncology, during the summer said: The reality in Galway is that patients are now typically [and I emphasise "typically"] waiting seven to eight weeks for their first session. With every week that passes, the risk increases that their cancer will grow, or worse that it will spread to other parts of their body. This is not an isolated phenomenon. I have set out the profound terror and distress this woman and her family experienced, but she is not on her own. I want to know more from the Taoiseach. We need numbers-----

Thank you, Deputy. The Taoiseach to respond.

-----and to know exactly how widespread this experience is and, more important, what the Government will do to fix this urgently.

As I said earlier, I would appreciate if the Deputy could give us the specifics of the individual case she has identified because then we could track that with the hospital. It is important to do that because Galway hospital said late last year that it would meet the NCCP targets by the end of December.

That is a different target.

That is for referrals.

Yes, but also in terms of treatment. We need to get-----

No.

In any event, I think it would be useful if the Deputy could send us the details of the case-----

I can certainly do that.

-----with the permission of the person, obviously. Confidentiality will apply, without question. There has been a lot of investment in cancer services, and quite rightly so. Symptomatic breast disease was one of the first areas that we identified a long time ago as requiring a specific allocation of resources and investment from cancer screening right through, and, from a national point of view, it has had very improved results in terms of outcomes, which is what we all want for cancer. It is important that, overall, survival rates have improved very significantly. That needs to be said as well-----

Thank you, Taoiseach.

-----to ease any concerns that people who might have been recently diagnosed will understandably have.

Unfortunately, long waits for basic healthcare are now the norm. That should trouble the Taoiseach, especially as a former Minister for health. Waiting lists are no longer a backlog - they are the system. Ireland has become a country of waiting lists, a nation where a health challenge is all too often met with a letter and not with the necessary care. The new figures from the National Treatment Purchase Fund, NTPF, are stark. We know from these that 900,000 people are waiting for outpatient care or an operation. This is a crisis unfolding on the Taoiseach's watch. The Government's Waiting List Action Plan 2025 has patently not worked. The number of people waiting more than six months has increased by 12% in just one year. That is a stunning figure. Nearly one in six adults waiting for outpatient care has languished on a waiting list for more than a year. For children, it is even worse, with more than 17% waiting more than 12 months. It is not just outpatient care either. We learned this week that several children with mental health or developmental difficulties had been left waiting up to, or even in excess of, 11 years for a psychology assessment. As waits get longer, patients get sicker, our emergency departments get more and more crowded and our healthcare staff burn out. We all hear about it every day. Over the weekend, for example, we heard of a stroke victim in her 90s who spent hours on a trolley in the corridor of a Dublin hospital. Her family was unable to contact her or anyone who could reassure them or give an update. That is unacceptable. There is nothing normal about a modern hospital being unable to treat the sick because of capacity constraints, and capacity is at the heart of this crisis. The problem is not a lack of money; it is a lack of urgency. There is not a lack of plans - we are seeing lots of plans - but a lack of delivery. The HSE national service plan for this year proposes just 134 additional hospital beds. That compares with the 297 beds committed to last year, a target that was missed. Two thirds of our hospitals are operating with unsafe bed occupancy levels and this lack of capacity has real consequences for real people, with overcrowded departments, cancelled procedures, exhausted staff and patients left waiting far too long for care they need. This is not a surprise. Capacity constraints and chronic understaffing are well known. The public has gone past the point of shock when it comes to our shambolic health system. Ask anyone how they think the system is performing and they will say they have no faith in the plans coming out of the Department of Health. They will shake their heads and roll their eyes if asked. The problem is that when failure is normalised, accountability disappears. Therefore, I am asking the Taoiseach to take responsibility and answer some straightforward questions. Why has a €420 million waiting list action plan failed to deliver on its minimal targets? Why is the 2026 service plan retreating on bed capacity? What changes will we see to ensure improvement this year?

Ar dtús báire ní aontaím leis an Teachta go hiomlán mar ar an taobh eile den scéal tá dul chun cinn le feiscint i gcuid mhaith nithe sa córas sláinte agus caithfear é sin a adhmháil mar aon le gach scéal eile. The key issue with waiting lists is waiting times and that always has to be the target. The shorter the time someone has to wait for an operation or other intervention, the better the outcome, and that is always the priority in respect of capacity and waiting times. Over the last while, we have had the biggest expansion of access to free GP care in the history of the State, so it is not a shambolic health service. We have had a 12% reduction in patients on waiting lists exceeding 12 months and a reduction in average times from 7.2 months to 6.5 months at the end of 2024. That is the average waiting time. That is against the backdrop of a 9% increase in outpatients and a 5% increase in inpatient and day case attendances. There is a lot more to achieve and we have a lot more to do here. I acknowledge that. We want to get to the ten-to-12-week waiting time under Sláintecare objectives, and funding has been allocated, but I do think we need to see things in perspective. The Deputy describes it as "shambolic". It not shambolic.

Hear, hear.

It is wrong to say that because when you look at our overall outcomes as a country, there is huge funding that has gone into health and I am sure the Deputy will acknowledge that. She has said it is not an issue of resources and significant funding has gone in, but in terms of key health outcomes over the past decade, there have been significant achievements. Ireland is now among a small group of only seven European Union countries where life expectancy is above 82 years. Our mortality rate fell by 11% over the decade 2014 to 2023. The mortality rate for all circulatory system diseases fell by 20% in that period, with heart disease and stroke falling by 28% and 37%, respectively. The Deputy had a cut at the stroke services and every individual case is terrible and traumatic when it happens, but surely she must acknowledge the progress that has been made on stroke and interventions over the last number of years with the new stroke centres and so on. It has been quite dramatic and transformative in the treatment of stroke in the country. The mortality rate for all cancers dropped by 15% in that period, with cancers of the trachea, bronchus and lung and breast cancer dropping by 21% and 22%, respectively. The mortality rate for all respiratory system diseases has fallen by 15%, with chronic lower respiratory diseases and pneumonia falling by 9% and 41%, respectively.

Thank you, Taoiseach.

I do not say that to minimise any trauma any individual goes through but we need a balanced debate in perspective and to acknowledge the progress that has been made while resolving to do even better in respect of other issues.

Try as the Taoiseach may to dissemble them, the figures do not lie. They point to failure and are indefensible, and I stand over the comment of "shambolic". Anyone watching the news last night will have seen shambolic overcrowding and anyone watching or hearing of the experiences of the patient I referenced, or other patients whom we all know, will know that, while there is of course progress being made in some areas and that is great to see, it is still shambolic for all too many patients and they are still waiting too long. The Taoiseach talked about waiting times. Of course, that is crucial and the Taoiseach's own plan set a relatively modest target, that 90% of outpatients would wait less than a year by the end of 2025, but that target was missed. Look at the number waiting more than 18 months for an inpatient appointment. That number rose by more than 25% last year. By any measure, the 2025 waiting list action plan failed. Meanwhile, we are hearing advertisements from private hospitals like Kingsbridge Private Hospital in Belfast. That is no way to run a healthcare service, to see private hospitals from other jurisdictions touting for business in this way.

Thank you, Deputy.

Can we expect an improvement this year for those who are facing these long waiting lists?

They are doing a good job.

Yes, we can. Indeed, over the last number of years, we have dramatically increased capacity. Deputy Bacik mentioned the beds but she forgot to mention that, by the end of 2024 alone, we had 1,300 additional beds in the system. As the Deputy will know, during the Covid period, we took the opportunity to dramatically increase bed capacity in our hospital system, particularly in the critical care area, where there was significant increase in the number of beds. We expanded our ICU capacity by about 28%, which is significant. Obviously, health is a comprehensive area, so primary care is critical. We now have 180 primary care centres - that is 51 extra since 2020 - and we will continue to work on that. We are progressing the development of four elective hospitals, which I think will be very important in the context of waiting times, and the surgical hubs that the Minister has committed to. As the Deputy will know, the first surgical hub at Mount Carmel has opened and that has already had a very significant impact on waiting times in that area.

Thank you, Taoiseach. The Social Democrats are next, with Deputy O'Callaghan.

Four more are due to open in 2026.

I wish to begin by welcoming a number of representatives from different disability organisations who are in the Public Gallery with us today. I thank them for the strong and powerful contributions they just made in a briefing for all Oireachtas Members in the audiovisual room. They told us about the extreme hardship being faced by many disabled people. We heard about people who had had to stop getting their dialysis at home because they could no longer afford the electricity bills. This has a huge impact on their quality of life and well-being. We heard about people being forced to choose between heating their home and charging their electric wheelchairs and mobility aids, trapped now all winter because they cannot afford to charge their electric wheelchairs and being robbed of their independence. The decision by the Taoiseach's Government, which slashed incomes for disabled people by up to €1,400, is cruel and regressive. This is what disabled people have had to say about these budget cuts. Saoirse said: I am in pain constantly and I have to pay for physiotherapy because the community physiotherapy lists were too long. The physio appointments cost me €75 per session." Gary said the only way he could feed himself was to buy food that was going out of date and reduced, cook it off and freeze it. He goes on to describe his choices as being between eating and being cold or being in the dark. Another disabled person told us that, after Christmas, they were now faced with a €500 electricity bill and they did not know how they would pay it. This is the reality for the tens of thousands of disabled people all over the country who feel targeted and attacked by the Taoiseach's Government. They are among the most vulnerable and most at risk of poverty in our society. They face enormous additional costs running into thousands of euro every year because they have disabilities. This Government, instead of supporting them, has cut their incomes. The only thing it has to offer are platitudes. We are told a cost of disability payment is now a priority for the forthcoming budget, but if the Government acknowledges the very real costs and the need for such a payment, why did it cut the incomes of disabled people so dramatically in the budget? What does the Taoiseach expect disabled people to live on? Fresh air and broken promises? People with disabilities just want to live full and independent lives but Government decisions are pushing more and more people into poverty. The Government loudly claims that it wants to target resources to those who need it most while at the same time quietly cutting the incomes of the most vulnerable. It is wrong, it is reprehensible and it can and must be addressed.

Thank you, Deputy. The Taoiseach to respond.

The ask is very simple; it is a modest ask. Will the Government introduce an emergency €400 winter payment to disabled people and will it introduce that now?

First of all, the Deputy has made an assertion and equated the ending of the one-off cost-of-living measures that were introduced during the height of the Ukraine energy crisis and so forth with cuts. That is wrong and he knows that. That is the first assertion, premised upon which his arguments are made, that is flawed. We must embed into the permanent social protection system, employment system, transport system, education system and health system supports that are permanent for people with a disability. That is what I intend to do and that is what this Government intends to do, through the Cabinet subcommittee on disability and through the new disability unit within my Department. We are prioritising the budgetary measures towards disability and will continue to do so. The ESRI's analysis in terms of the last budget bares that out. I accept the one-off measures had an impact right across society but it simply was not fiscally sustainable to continue with one-off measures, bottom line. However, what is sustainable is, in terms of our various budgets through social protection, education and health, creating additional and permanent resources for people with disabilities. That is what we have been doing and will continue to do. As regards the cost of disability issue, first of all, in the budget we delivered a record 20% increase in disability services funding through the Department for children and disability, increasing that to about €3.8 billion. That is to invest in services, which is needed by any yardstick. We have to continue that and consistently increase it over time. We have significantly prioritised education, particularly investment in special education and special classes right across the board, higher education and independent living, particularly in terms of participation in third level education and research for students with disabilities. On the cost of disability support payment, the Minister, Deputy Calleary, is leading this work in close partnership with disabled people, advocates and the organisations involved and will come to the Government with proposals in the first half of this year. Analysis by the ESRI and the Department of Finance confirms the impacts of the decisions we took in the budget in terms of the at risk of poverty rate across the population falling by 1.7% and the population affected by disability reducing by 3.8%. Older people felt the largest impact and then for people with disabilities, it fell by 3.8%. The measures we took in the budget had impact and they are permanent measures. That relates to social protection. There was the €20 increase in domiciliary care allowance and, as the Deputy knows, the earnings disregard for the carer's allowance for a single person and for a couple expanded.

Thank you, Taoiseach.

The disregards will continue to expand in budgets to come.

Does the Taoiseach recognise that disabled people are €1,400 worse off as a result of the budget and the decisions the Government made? Can he imagine what it would be like not to be able to leave your home because you cannot afford to charge your electric wheelchair or mobility aid? There are people in that situation now because the Government took away income supports and did not replace them. Of course, income supports should be permanent, not once off - there is no disagreement on that - but to take €1,400 off disabled people, not replace it and just have promises of future actions does not work for people who are forced to stay at home now because they cannot get out of their homes as they cannot charge their mobility aids or electric wheelchairs. That is the result of decisions the Government has made. It is utterly unjustifiable at a time when there are billions of euro in budget surpluses. The Government could afford to do this. It would be fiscally sustainable. The Government's decision is cruel and regressive. I will ask the Taoiseach again. Will the Government now introduce an emergency payment for disabled people? They are asking the Government to do this. It needs to happen now. They cannot wait any longer.

We are not restoring once-off payments across the board. We are not going to do that but we are going to continue to support, right through every area of government, supports for people with disabilities. We are going to implement the new strategy, which was agreed with advocates and organisations that advocate for people with disabilities, in consultation with the various organisations, in particular, in the fields of employment. In the field of mobility and transport, the Minister for Transport will be coming to the Government shortly with a new scheme in respect of financial supports and adaptations that is much broader than earlier schemes have been. We are working in every Department to improve the situation for people with disabilities, particularly in the areas of education, employment and health. Measures already introduced in the budget facilitate that. Broadening the income disregards for carer's allowance was one of the most significant measures this year in the budget compared to previous budgets. That will continue. We are going to do it in a sustained and consistent way that will be permanently embedded in the public expenditure system in this country.

I call Deputy Tóibín, representing the Independent Technical Group.

The Government is one of the most significant drivers of rip-off Ireland. Many of the costs affecting families currently are being driven up by the Government. To take electricity as an example, Ireland has one of the highest electricity costs in the whole of the European Union and the gap between retail price and electricity costs here is one of the largest in the world. The ESB is a semi-State company. It operates under Government policy. It is one of the biggest players in the market and is profiteering to the tune of €706 million in the jaws of a cost-of-living crisis. There are 300,000 people currently in energy arrears. The Society of St. Vincent de Paul has said it dealt with a quarter of a million people on its helpline calls before Christmas. This month, the Government increased the tax on petrol and diesel. It already increased the tax on petrol and diesel in the budget, only three months ago, and it increased the tax on heating oil and gas on families. In 2024, the Government took €4.1 billion in fuel taxes, the highest ever in the jaws of a cost-of-living crisis. The cost of filling a car is currently €19 more today than it was five years ago. That is not because of market issues or anything other than Government taxes. The Government is not finished with fuel taxes. It's aim is to increase carbon taxes for the next five years, irrespective of the economic circumstances of citizens at any given time. The Department of Transport has admitted in response to a freedom of information, FOI, request that there will be no new public transport capacity provided this year. The Government is using extra fuel costs and taxes as a stick to beat people out of their cars while refusing to provide a carrot of extra public transport capacity this year. At the start of this month, the Government also increased tolls on the M50 and other motorways. Some 160,000 people use the M50 on a daily basis because they have to. It is the busiest road in the country. Last year, we paid €212 million on tolls on the M50, not to a public private partnership, PPP, but to the Government because we own those bridges. We have paid €2.2 billion in tolls already on those two bridges that cost £58 million to build. It is incredible. We have bought those M50 bridges 30 times over. The Government is using them as a cash cow and as a tax on commuters and workers. Increasingly, the squeezed middle is having Government costs on it increased. What will the Taoiseach do to make life affordable for these people?

More fundamentally, we acknowledge that there are very significant pressures on people in terms of costs and pricing and making ends meet. The most effective way to deal with that is how you manage the economy more broadly and how you get inflation down to very low levels and have average wage growth and real income growth that significantly helps people to deal with those pressures. If you look at nominal wage growth in the economy, it is at approximately 5.5% or 5%. Inflation is at 2%. In 2024, 2025 and 2026, we are, for the first time in a while, looking at real income growth, which will help workers. It does not deal with it in its entirety but it will help workers deal with the pressures of increased costs. There were very significant increases in the aftermath of the Russian invasion of Ukraine and the oil and energy crisis that arose from that. We decided in the budget to invest in services, which is important in terms of education, health and so forth, but also to invest in social protection to protect the lowest income groups, which we did fairly comprehensively in the last budget. The results are there from the ESRI analysis in terms of the lowest income deciles, which got the highest allocation of resources. I would like the Deputy to acknowledge that. Those are not my figures; they are ESRI figures in respect of that reality. We did it in terms of the fuel allowance. We increased it but we also increased the coverage of it, in other words, 26% of people will now avail of the fuel allowance, particularly those on the working family payment. This will help in that regard. Our population has grown dramatically, which is really putting pressure on services. It is extraordinary that from 1995 to today, our population went up 52%. That has an enormous impact on services. In many ways, there is positivity in that in terms of the Irish economy growing. In the last number of years, that increase has continued. Fundamentally, managing the economy means creating jobs. The most effective way to deal with cost-of-living and poverty pressures is to make sure there is employment available to people. At the moment, our unemployment rate is in or around 5%, if we take 15-year-olds and onwards. Those are the figures, but our rate of participation in employment is increasing all the time and average weekly earnings are up significantly as well. Through the broader management of the economy, investment in services, infrastructure, housing, education, health and childcare are the areas we decided to prioritise in the budget, along with social protection. In the social protection framework, we said we would look after those at risk of poverty as the key priority, and we did that.

First of all, real income fell in 2021, 2022 and 2023. We are talking about a marginal recovery on those particular years. The Taoiseach talks about fuel allowances. The Government is giving money with one hand but picking the pockets of people with the other. The Government is taking more in fuel taxes than it is giving back in allowances. What we are talking about here is the working poor. In the budget for this year, the Government increased income taxes on the squeezed middle. Property taxes will increase for homeowners this year. An Post, for example, is increasing the cost if its stamps. Rents and house prices are increasing significantly, not just because the Government will not deliver supply into the market, but also because its own rent cap policies have increased rents in recent times to over €2,000 a month on average. That is really important. Look at the My Future Fund auto-enrolment scheme. It will start to bite this month for people who cannot afford their present situation. In terms of rip-off Ireland, will the Government reduce taxes on fuel and the cost of tolls?

We reduced VAT on energy and we extended that reduction to 2030. We did that.

We have the highest electricity costs.

There is an issue with electricity prices. There is no question about that. The Minister has set up an affordability group on energy to deal with that. There are regulatory issues and more pan-European issues. We are an island nation. There is wider distribution. We are investing hugely in the grid and choosing investment in infrastructure because we need to make sure the growing population has access to energy in the years to come. We are prioritising in a strategic way the allocation of resources for the benefit of all of our people into the future. The Deputy referenced the carbon tax and so on. That is helping us to address fuel poverty, particularly for those on the lowest incomes. It is helping us to deal with the dramatic transformation of retrofitting investment, for example, which is a very effective way of reducing the cost of energy for many households. A huge number of households have benefited from that. Agriculture has also benefited from allocations from that source also.