I thank the Ceann Comhairle for selecting this Topical Issue for debate on world cancer day. I thought it was important that this Dáil should mark world cancer day and discuss the issue of resources and funding for cancer services in this country, not least because I had a cancer diagnosis last year and have undergone treatment. I am very grateful to the cancer services and to all the fantastic people who work in it: the doctors, the nurses, the allied health professionals, all the people in our cancer and health services, and indeed the people who are working and researching things like cancer treatments and cancer prevention and advocacy groups like the Irish Cancer Society. They all deserve our gratitude and their work deserves to be highlighted on this important day.

The statistics on cancer make it clear that it is an issue for absolutely everybody in this country. Every three minutes in Ireland somebody will get a cancer diagnosis. That means 44,000 people this year will be diagnosed with cancer. We have, unfortunately the second highest ranking among EU member states for new cancer diagnoses. Tragically, more than 10,000 people a year will die as a result of cancer. Ireland also unfortunately has the third highest rate of cancer mortality in western Europe. Central to the concerns of those in the Irish Cancer Society and those who work in our cancer services is that the expected increase in cancer diagnosis that will take place between 2015 and 2045 is 100%. That is against a background where already 50% of people will be affected by cancer in their lifetime.

This is a serious issue. It is going to affect most people and there are worrying signs that cancer is increasing in prevalence. There was a report in the last couple of weeks by the Irish Cancer Society and the OECD that while it is often associated with older people, there is a very concerning rise of cancer in people younger than 49.

There are a lot of issues you could bring up. The Irish Cancer Society produced detailed reports that are asking about investment in resources, infrastructure, services, staffing and so on in a range of areas such as prevention, genetic services, costs of cancer screening, early detection, timely access to treatment, children and adolescents living with cancer, the end of life, and capital investment and infrastructure. All of those need to be addressed. The Minister is probably familiar with them.

There are worrying statistics and worrying instances of people not getting their cancer treatment in time. Early cancer treatment is critical. We have, for example, one hospital in the country where only 12% of people were getting cancer treatment on time. Ten hospitals missed their target of getting cancer treatment in time for their patients in half of the months of the year. That is a very worrying sign.

I have also raised the fact that there needs to be, on behalf of those working, a national replacement programme for radiotherapy machines - linear accelerators - because 35% of our machines, which are supposed to be replaced every ten years, are now 15 years old or more, and 40% of our machines need to be replaced in the next five years. While there is a replacement programme under way, those working in the services say that this is not centrally organised and is not being organised in advance, so we are responding to the immediate need but not planning for the future, particularly when there is a massive increase in demand projected over recent years.

There is a lot more else I could say, but I hope the Minister will respond to some of those points.

I thank the Minister for that response. First of all, the inconsistency between the experience people have in different parts of the country has to be addressed as a matter of urgency. Indeed, I was conscious when I was getting my own treatment that people were coming from different parts of the country. There was a place available for them in St. Luke's to stay, but it was not provided by the State. To the best of my knowledge, it was funded by the Irish Cancer Society. The Minister can correct me if I am wrong on that. Services such as where people could stay should not simply be dependent on charitable organisations raising funds. My understanding was that the place that people could stay overnight was not run by the hospital even though it is fantastic that it was there for them, but that is an aside.

On the linear accelerators in the national replacement programme, the Minister has given me some answers. I got some answers from the HSE on the replacement programme. It is worth saying, while it is under way, that all in the St. Luke's Radiation Oncology Network, SLRON, are supposed to be replaced after ten years. Two of those will only be replaced when they are 19 years old, two will be replaced when they are 21 years old, two will be replaced when they are 14 years old, two when they are 18 years old, and two when they are 17 years old. All will be well over the ten years it is supposed to be. That shows a lack of planning to have a replacement programme that is organised centrally and that is ahead of the game rather than reacting afterwards and realising we have not replaced the machines and therefore the machines are breaking down, causing hardship for the staff providing the treatment and for those who are awaiting the treatment, often impacting on things such as childcare and their ability to travel back to where they live in other parts of the country.

On equality of access, I will read the following from a report that was sent to me by a radiation oncology medical physicist. He was talking about PET CT scanners. He said that only two of the Republic of Ireland's eight current PET CT scanners are fully or partly publicly funded and that there is a system where 75% of net national PET CT imaging capacity resides in private institutions. He has done a report on that. I do not know the detail of that, but that shows a worrying lack of those scanners in the public system, funded publicly rather than being only available in the private sector.

I am here for the public system. I am here to invest in the public system and to champion the public system. A total of 80% of our cancer care gets delivered through the public system and that is my focus.

The Deputy is correct to highlight the replacement programme in St. Luke's. I have updated the Deputy that there is a replacement equipment supply commencing in quarter 1, with a contractor in place this year. In quarter 4, we are also working on a detailed business case for the Beaumont phase 2 expansion. There is also work to be done in Cork and Galway. There is a particular difference with St. Luke's, but the work is progressing. The Deputy is quite right that it should have progressed before now.

I highlight as well some of the other important developments that are happening more broadly. It is about machinery, treatment and additional staff. It is also about prevention programmes and screening programmes. We have recently announced the extension of the Laura Brennan HPV catch-up vaccination programme targeted at fifth and sixth years in schools.

We would encourage anyone whose child, male or female, has not had that vaccination to get it where it is offered. We know it is most effective when a child is about 12 or 13, before they become in any way sexually active. Please take that vaccination if you can. It is there to try to eliminate cervical cancer.

I am examining, with the screening control programme and NSAC, the opportunities to most effectively extend screening for bowel cancer in a way that is going to get the best for us. I am very conscious of the “do not attend” rate and the rate of participation for that. It is one of the reasons we have prioritised that for the pharmacy extension, and in the agreement that we have reached with pharmacists, who are now going to try to proactively register some of their patients on the bowel cancer screening programme in an effort to get more people onto that screening programme.

Encouragingly, I met Professor Daniel Ryan from Beaumont this week regarding different options for lung screening and what opportunities may be there. We are not doing enough on lung cancer screening, particularly for those people who are not symptomatic or are very young. We are now able to pick that up much better than has been the case heretofore.

The Deputy and I could speak about all of the different elements of cancer care, from vaccinations to screening to identification. We have to recognise the exceptional work that is being done at the research level in targeting and manipulating cancer cells in completely different ways, so people are living longer. This year is an exciting year to try to really drive forward with ambition with what we are going to do for the next ten years.