Marie Sherlock: Gobsmacked by Ireland's Radiotherapy Crisis

Thank you all for being here today and I must say I find myself gobsmacked that we're even having this conversation to understand and to hear that we have the oldest radiotherapy fleet in Europe, even though we're the wealthiest country in Europe in terms of our public finances, or certainly our public finances are in the healthiest position, and that there's no national plan for replacement, so any piece of equipment, and you talked earlier about the dishwasher in if you're running a restaurant, if you run any organisation in the country, there's a plan for depreciation for maintenance, and to hear that there is no plan for what is the workhorse of our cancer services in this country in terms of radiation therapy is frankly outrageous. I think as well, there will be an element of striking terror into people this morning, and while we have incredible staff obviously working in our cancer services, because of our older machines, that they're less than precise than what should be the case out there. That is a damning indictment of our services, and that is no reflection on yourselves, but if we've got older machines, and if they're less precise, like in this day and age, it's unacceptable. And of course all the upset then that is caused by delays and the backlog for yourselves, and with all the talk of productivity in our acute hospital system, and we've heard a lot of talk about productivity in our hospital system over the past 12 months in particular, to think that we're still having this kind of groundhog day conversation about relatively small sums of money is astounding. I looked at the HSE capital plan this morning, and I only went back to 2023, but in 2023 there was a commitment in the HSE capital plan for the refreshment and replacement programme for St Luke's, St James's and Beaumont, and it was design, build, equip and maintain, and it's the exact same reference in 2024 HSE capital plan, the exact same reference in 2025. You know all this, but I'm saying this for the record, the exact same in 2025 HSE capital plan, and again this year. Copy and paste every year. So you talked about the business cases there. Can you tell me when you first started putting in the business cases, particularly for the four linear accelerators in St Luke's that were put in in 2008? When did the first business case for their replacement go in? We anticipated a 10 to 12 year replacement cycle, but we started this process in 2020. 2020, okay, so we're six years on now. Now I was told in a parliamentary question just before Christmas that the procurement process would commence in Q1 2026. Has it commenced? No. Okay. So again, you know, HSE capital plan 2027 would probably still be a copy and paste job of all the preceding years. With regards to Beaumont, and again I think the point you make about the very elaborate procurement processes there, the tender process will commence in the coming months was what I was told on the 1st of October 2025. Has that tender process commenced for the new radiation oncology building in Beaumont? So the building has gone up on e-tenders just very recently. Not the equipping side of it, but the building side of it. They go up just very recently, yes. Okay, okay. In terms of when equipment has to be replaced, I understand that there's obviously works to the physical infrastructure of the building as well. You might just talk through a little bit about that in terms of the disruption, because the reason I ask this is because when I talk to hospital chief executives, they talk about having to repurpose wards, and they come up with all sorts of weird and wonderful ways of actually managing to put patients into another place temporarily for a week or two, while they manage to repurpose spaces for their need. So what kind of disruption is involved in having to put a new machine in? And I'm sorry that I'm even asking this question, it sounds so basic, but I think we need to understand it because I think we're all in shock that we're still having this conversation about these machines. So in terms of in our two new centres, well they're not new, but they're our newer centres in Beaumont and James's site, we built the bunkers to future-proof them to a certain extent. So in terms of the rooms themselves, they just need refurbishment rather than a rebuild. But in terms of a linear accelerator, a linear accelerator is quite a difficult piece of apparatus to take out and put a new one in. So typically taking them out is easy, they're scrap, but they're a week or so. But it takes a couple of months for installation of a new machine, commissioning of a new machine and bringing it into clinical service. Okay, but there's I presume a plan in place to relocate activities, is there for when the machines are being replaced or you know what's the contingency? It's a very challenging thing to replace linear accelerators in terms of workflows. You take the machine out, there's no immediate replacement. What the system does is it extends the day, so we will extend the day, we may even treat them to weekends, this is you know going beyond routine hours, that's to cope. Now if you think about we've got 14 machines to do all at once in St Luke's and it's not just actually that displacement of treatment, but what Brendan's team in medical physics have to do, they have to accurately commission the machine. We need these machines to be very highly accurate, so there's a lot of work to make sure that what we've accepted from the company treats patients very accurately and that's a huge amount of work. To do that over 14 machines in a couple of years will be really really challenging, we'll have to you know think about how we actually staff that and run that, that's not going to be a very easy task and that's why this plan program is so important. We don't do it as a plan, we've got this massive tsunami of work to do over the next couple of years, let alone cope of the breaking down machines, extended days and yada yada yada. So there is a, it's not just about putting a machine in a room and turning it on, there's a lot of impact on the service around that, just to highlight that bit in a way. The process of commissioning, when we get these new machines, it's one thing to commission them to operate in the way that we're used to operating, but these new machines have new technologies and new capabilities and we haven't had one of those new machines in 10 years, so we don't have the day-to-day expertise to get the most out of our machines. We'll be under huge pressure to get people onto these machines, get them on, and we won't end up commissioning the extra capabilities of these machines that can make a huge difference to patient outcome. So just in terms of staffing then, because obviously I think that that's a question with regards to being able to get the most out of the machines whenever they are in place, like I just like to, because my understanding is there hasn't been the same push with regards to radiation therapists in terms of the training of those as there has been let's say in other areas, so I'd just like to hear about that. And then the second question was I'm conscious of my time, so if I understand there's 23 across the country, sorry my sums, 23 across the country, and you're saying how many are on standby for when there is a breakdown? You referenced one earlier, is there more than one or just one? Just one, okay, thank you. Just maybe to the staffing question please. So that we do have the required number of physics staff for instance to commission machines, but they haven't done it in 10 years, so we want rolling expertise in that area rather than a huge start, stop approach to it, and I mean Brendan's team have commissioned machines before, but the newer machines have newer capabilities that they won't have dealt with. Okay, and to the radiation therapist training piece? Yes, so the numbers have increased and we are grateful for that in provision, and there's also increased provision in the clinical tutors. We're not there yet, but it's actually, there's a really good step in that direction. It will take a number of years before they come online, and we do still have challenges around staffing radiation therapists, particularly around retention. I mention retention because that bit about the kind of workforce impact the day in day out, that does cause loss of radiation therapists out of our public system to other sectors. Thanks very much.