'It's getting tougher': Hospitals failing to consistently start chemo on time

The Journal

07-07-2025

MORE PEOPLE ARE waiting longer than recommended to start vital cancer treatments in Irish public hospitals.
'It's getting tougher and tougher,' Dr Michael McCarthy, consultant medical oncologist told
The Journal Investigates.
'Waiting to start curative treatment could impact the chances of being able to successfully cure cancer, or control it to maximise the quality of somebody's life.'
The HSE recommends that once patients are ready for treatments like intravenous chemotherapy and immunotherapy that they should receive them within 15 working days.
Hospitals have a target to treat 90% of patients within this time – about 10% can 'have more complex needs that confound or delay treatment', the National Cancer Control Programme (NCCP) told us.
But since 2023, all but one of the public hospitals offering these life-saving treatments missed the HSE's monthly target at least once,
data obtained
by
The Journal Investigates
through a Freedom of Information (FOI) request revealed.
A shocking 10 hospitals missed the target in more than half of the months, where data was returned, between January 2023 and April 2025.
That means people can be left waiting many days or weeks more than recommended for their cancer treatment.
'This is not just a delay – it can be life altering,' Averil Power, CEO of the Irish Cancer Society, told
The Journal Investigates
.
It risks disease progression, it worsens survival outcomes and it inflicts deep psychological harm on patients and their families.
'That's why these figures should serve as a wake-up call to Government to provide the investment that's needed in Budget 2026.'
A spokesperson for the NCCP said: 'The HSE recognises the critical importance of timely access to cancer treatment and the impact that delays can have on patients and their families.' They added:
'While this target is being met in many instances, it is acknowledged that a number of hospitals continue to experience challenges in consistently achieving this standard.'
Hospitals are responsible for ensuring they meet this target, but the NCCP engages at a regional and hospital level to 'enable performance at a system level', including the identification of 'systemic barriers'.
The Department of Health told us that 'Government is fully committed to improving cancer care, ensuring better prevention, maintaining improvements in cancer survival rates, and timely access to treatments'.
'Since 2017, funding of €105 million has been invested in the National Cancer Strategy, including €23 million in 2025,' they continued.
But for McCarthy, a consultant in Galway University Hospital and chair of the NCCP Medical Oncology Clinical Leads Group, 'the link between demand and resourcing has gone astray'.
More and more, after he breaks the news to patients that they have cancer or that their cancer is back, he then has to tell them 'the next treatment slot is in seven weeks'.
'Psychologically, for many people to be waiting that long, is very challenging.'
This was echoed by a number of people with cancer who contacted our team.
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There are infrastructure deficits in day wards, according to the National Cancer Control Programme.
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Some hospitals drastically underperforming
Nationally, access to chemo and similar treatments, is taking longer.
An average of 87% patients received it on time in 2023. This dropped to an average of 85% in 2024 and 84% from January to April this year.
This KPI only captures new parenteral systemic therapy in a day ward setting – such as chemotherapy and immunotherapy – so does not include additional cycles of treatment.
The lowest performer during that time was Letterkenny University Hospital, which never met the 90% target.
Just 12% of cancer patients in Letterkenny were treated within 15 working days in 2024. But 'after significant efforts' last year, 'incremental improvements' were noted since November, according to the NCCP.
The figure from January to April stands at an average of 72% treated on time. This stood at 82% in the most recent returned data, from April.
Proposals have been made for 'significant investment at Letterkenny University Hospitals', a HSE West and North West spokesperson told us. That includes 'a stand-alone facility to provide ambulatory (non-inpatient) care'. They added:
'The hospital will be making every effort to secure funding and progress this significant capital development… in as expedient a manner as possible.'
But three other hospitals continue to drastically underperform – Waterford, St Luke's in Kilkenny and St Luke's in Rathgar.
Less than 70% of patients here, on average, started chemo on time between January and April this year.
People attending St Luke's in Kilkenny fared worst in more recent times. More and more are waiting longer there each year. The KPI dropped from 84% in 2023 to just 62%, on average, in the first four months of this year.
Data for South Infirmary Victoria University Hospital in Cork was not returned to the NCCP since 2023 when 86% of patients, on average, started chemo on time.
Power said she was 'particularly alarmed by the regional disparities because where you live should not make a different to your cancer treatment and outcomes. It's shocking to see that it is.'
'The NCCP are aware,' a spokesperson said, 'that there are infrastructure deficits in day wards, some of which are addressed by the Capital Plan 2025.'
This plan, they continued, 'outlines that progress will be made in 2025 on the design' of oncology day units at hospitals in Cavan, Tallaght, Kerry and Tullamore.
From the FOI's figures, Cavan was the only hospital that always met this KPI since 2023, with 100% of patients receiving treatment on time every month.
'No single solution'
A delay of four weeks in getting surgery, chemotherapy or radiotherapy can affect a person's chances of surviving cancer, according to the Irish Cancer Society.
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Cancer diagnoses could double by 2045 without urgent action, warns Irish Cancer Society
Martin* from Dublin, who died from cancer in his 50s last year, was one such person impacted in this way, his family told
The Journal Investigates
.
His brother, and best friend, said that after Martin was diagnosed, he was told that chemotherapy was needed before he could have surgery.
Because of a long waiting list for treatment in his local public hospital, Martin turned to private care but 'one was as bad as the other', his brother said. It took three months to get a place on the day ward to start treatment.
By that time his cancer had spread, his brother told us, and he was no longer suitable for surgery.
His whole world fell apart.
To improve cancer care, Power said that an extra €20 million is needed for the National Cancer Strategy. This would help to address staffing and infrastructure issues. She warned:
'It will only get worse is the government doesn't provide urgent investment.'
The Department of Health told us that 2025 funding 'will support recruitment of 179 additional staff to national cancer screening and treatment services'. The spokesperson also said that capital funding has been used since 2017 'to update cancer infrastructure in chemotherapy wards and lab facilities'.
Delivery of cancer services and developments in treatments 'have led to a significant improvement in cancer survivorship', they added.
Averil Power of the Irish Cancer Society called for urgent investment in cancer services last week.
Andres Poveda
Andres Poveda
Dr Michael McCarthy told us there is 'no single solution', but tackling three key areas would help reduce delays and improve outcomes.
These are infrastructure, staffing and improving workflows in oncology units.
The oncology team he is part of has worked hard on the last solution, ensuring treatment slots are used as efficiently as possible – with cancelled slots filled and treatments pre-prepared to reduce the amount of time needed per slot.
The Galway team are working on a plan to open on bank holidays, which are 'a disaster', according to McCarthy, as 'you're trying to squash five days of treatments into four'.
Working on weekends 'will be trickier again', but he does acknowledge that it will be part of the service in the future.
The NCCP told us that 'some hospitals have already started offering services on Saturdays and bank holidays to address local capacity challenges' and is actively monitoring the impact of these initiatives.
'Any decision to implement this approach nationally would need to balance patient access, workforce sustainability and overall system capacity,' the spokesperson added.
Delays predicted to get worse
Cancer services are set to be under more pressure in the coming years.
Last week, in the Irish Cancer Society's
pre-budget submission
, Power said that 'without urgent action, the number of people getting cancer in Ireland is expected to double by 2045″.
The charity's submission showed that people were not only waiting for chemotherapy but also for diagnostic tests, surgery and radiation therapy.
We detail how these waits are having a devastating impact on people with cancer in part two of this series
McCarthy told
The Journal Investigates
that delays are 'a problem throughout the country' and it's 'likely to get worse'.
'Demand on our day wards is rising predictably year-on-year. We know that next year there'll probably be about a 10% increase again, and it's likely that rate of increase will continue for the next five to ten years.'
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Part of this growth is because we have an aging and increasing population.
But the main reason demand is increasing is because 'cancer treatments are more effective so people are living for longer', he explained. That means more treatments are needed over the course of their lifetimes.
The other driving factor is the increasing complexity of treatments.
McCarthy used the example of a new immunotherapy for head and neck cancers, set to be available in Ireland in the coming years. This more effective treatment requires around triple the current number of visits to the day ward.
Dr Michael McCarthy says the current struggle to schedule treatment is set to get worse.
Ray Ryan (via Dr Michael McCarthy)
Ray Ryan (via Dr Michael McCarthy)
This is concerning, given it's already 'a struggle' to get people booked for treatment – McCarthy's patients are often allocated a provisional waiting time of seven weeks for chemotherapy or immunotherapy.
This struggle is not fully reflected in Galway University Hospital target numbers reported to the HSE, even despite their recent drop. An average of 73% of patients received treatments such as chemotherapy within 15 working days, down from 91% in 2023 and 76% in 2024.
The 'only reason' the KPI is even in the 70s is because of the nurses and pharmacists working extremely hard to screen patients so they're ready for treatment and call people with last-minute cancellations, McCarthy said.
The other option, if we need to start chemotherapy urgently, is to admit people to our inpatient ward.
But, the oncologist said, 'that has consequences for people who need inpatient care', as beds are no longer available for them.
A cancer care network for the west and northwest, to include a cancer centre at Galway University Hospital, is set to be delivered in the National Development Plan 2021-2030.
The NCCP told us that 'this infrastructure development for the West North West Health Region is expected to improve dayward capacity regionally'.
But to properly deal with ongoing delays, McCarthy said that staffing and infrastructure deficits have to be addressed.
Though it is clear what is needed, he is not hopeful.
'How bad will it need to get before the resources become available to improve it? Do [patients] need to be waiting eight or nine weeks?'
*Name has been changed
The Journal Investigates
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