Today I raise the chronic shortage of radiographers and the related fragile state of our diagnostic imaging capacity. As the Taoiseach is probably aware, the HSE has acknowledged that radiology and radiation therapy departments remain under-resourced, with waiting lists for diagnostic scans continuing to grow. We saw earlier this year a report on RTÉ showing that, despite over 200 radiography graduates qualifying annually, many are being forced to emigrate because of appointments not being made. This is not just poor workforce planning; it could be called a misuse of public finds, wasting money training professionals who we then lose abroad while we scramble to import more. The HSE radiology workforce report outlines workforce projections and training requirements and recommends increasing the radiology trainee intake from 39 in 2025 to 75 in 2028, highlighting that Ireland's radiologist numbers per capita are substantially below European norms. This report was prepared to feed into the broader national radiology strategy and while the Minister for Health has confirmed a strategy is being developed and under consideration, we have not yet seen the finer details.

Then, of course, we have our diagnostic imaging capacity problem - a shortage of machines. Where machines go in, that is only half the story.

I want to put a human face on one element of this to explain. A constituent wrote to me. He had just had surgery for prostate cancer this month but twice now his PET scans have been cancelled because the batch of radiation required for the scans failed. This happened because the HSE and the Department of Health rely on a single provider and when that supply chain breaks down, no patient in the country can get their scan. This is not an isolated incident. The European Medicines Agency has warned that radiopharmaceutical supply chains across the EU are fragile, with occasional shortages already reported in other member states. The OECD confirms that Europe's reliance on a small number of reactors and suppliers for specific isotopes creates a systemic risk. In Ireland, we are directly exposed to these vulnerabilities and we have no contingency plan.

Imagine the stress. The scans people have these conditions are not optional. It is the way of knowing whether or not the cancer has spread beyond the prostate. It determines the course of treatment and cancelling it not once but twice leaves the patient in limbo facing surgery without the full picture. The person who wrote to me said, "I am one of God knows how many people experiencing this stress, yet it is never heard about. The teams I have been dealing with are phenomenal but they are also been put under huge pressure"’. It is not only related to systemic failure in terms of prostate cancer. It also relates to other areas, such as breast cancer, for example, because PET scans used for staging in treatment and planning in breast cancer require radiopharmaceuticals, such as fluorodeoxyglucose, FDG, as well, which are isotope dependent. This needs to be addressed.

First of all, I thank the Deputy for raising this issue. I take the Deputy's overall point that there are challenges in terms of the European-wide supply chain issues here but also personnel. Globally, radiologists and radiation oncologists are in short supply and in high demand and that creates challenges. This may not be consolation but if you look at where we were ten years ago or 20 years ago as compared to where we are today, we have significantly improved but I do not in any way understate the challenges that lie ahead.

Since 2017, approximately €105 million has been invested in the national cancer strategy. Capital funding of over €140 million has been used since that date - one is current and the other is capital - to provide state-of-the-art radiation oncology facilities in Cork and Galway and to establish a national cervical screening laboratory, and then to update cancer infrastructure and chemotherapy wards and lab facilities.

In the past six years, the radiology training programme has grown by 32% and more than 20 additional radiology specialty training posts have been established in the last three years. New radiology posts will enhance the specialist care of many specialties, including cancer care. Budget 2025 included funding for five additional training specialist registrar posts along with four additional training posts.

On the replacement programme, the demand is increasing in line with expectations identified by the National Cancer Registry and the National Cancer Control Programme. We have five public radiotherapy treatment departments in Ireland, with a total of 22 linear accelerators in operation across these services. Galway has four machines. Cork has five machines. St. Luke's Radiation Oncology Network has 14 machines operating across three sites in Dublin: St. James's, Beaumont and St. Luke's. The HSE has a planned radiotherapy equipment replacement programme in place and has advised that all linear accelerator, Linac, machines in the St. Luke's Radiation Oncology Network will be replaced over a five-year period out to 2030 with an additional two machines to be located at the Beaumont site. The design process is currently under way. Step 1 of the procurement process for the works and equipment will commence in Q1 of next year, with a contractor in place later in the year. If we can accelerate that, we will. The replacement programme has come under the national development plan. It is being progressed under its aegis. It is included in the capital plan for 2025 and the health sectoral capital plan from 2026-2030. The facilities in Cork and Galway are newly-built facilities, opened in 2019 and 2023, respectively, involving capital investment of €120 million. Advanced radiotherapy technology in Ireland has also been implemented, including the stereotactic ablative body radiotherapy and the stereotactic radiosurgery, SRS, which aims to reduce the number of treatment sessions.

However, we are coming from a low base historically in this sector.

I thank the Taoiseach.

We have made a lot of progress but I acknowledge we have more to do.

What the Taoiseach did not go into was what contingency plans are in place or whether he can commit to putting contingency plans in place to ensure that patients are not left without scans because of single point of failure. The diagnostic imaging is hugely important in modern medicine but without some sort of action to have a separate contingency plan in place when the radiation fails, will we have these lists lengthening and lengthening? It is not a good or an efficient way to run a health service.

Obviously, I take on board that more machines are being put in place but we still have a situation where qualified radiographers who we have paid for through the system and who want to live and work in Ireland are being forced to go abroad. Like teachers and other professionals, once they go abroad, it is hard to get them back. It is a two-pronged thing. It is about putting the staff in place with secure long-term jobs and about making sure we have a plan B for when we are missing the isotope provision. We need a second supplier.

I will inquire of the HSE in respect of that, although I would make the point that we have an alternative. The HSE outsources selected patients to private radiotherapy providers to ensure timely access to treatment when clinically appropriate. There is room for improvement and we will continue to work towards meeting the targets. In St. Luke's Radiation Oncology Network, 65% of patients are within the target while all other centres are meeting the 90% KPI.

Approximately €10 million is spent on outsourcing radiotherapy appointments every year and that is in addition to the privately provided services in Limerick and Waterford, which are contracted to deliver services on behalf of the HSE. Then there is an important service level agreement between the HSE and Health and Social Care Northern Ireland to provide radiotherapy on a cross-Border basis at the North West Cancer Centre, which I visited in Altnagelvin Hospital in Derry. That initiative offers cancer patients within a 90 minutes road journey of the city of Derry access to radiotherapy in Altnagelvin and this provides important access in the north west to patients who would otherwise face long travel distances. We are utilising private capacity and Northern capacity, which we have invested in as part of the North-South co-operation. We are trying to build up the capacity on all fronts.