For a country that prides itself on its biotech credentials and innovation economy, Ireland’s approach to genetic testing remains oddly regressive.
While demand for genomic diagnostics has soared in recent years – in cancer care, prenatal screening and rare disease detection – our health system continues to rely on overseas laboratories for services that could be delivered faster and without the current logistical, data governance and quality oversight risks.
These tests are often central to clinical decision-making, patient diagnosis and time-sensitive interventions. Yet, in most cases, the delays incurred by sending 20,000 samples to 80 laboratories in the UK, Germany, Spain, Finland or the United States is arguably exacerbating hospital waiting lists and leading to increased costs.
The reliance on so many different laboratories reflects a fragmented and inefficient procurement system rather than the complexity of the tests themselves. Meanwhile, a single accredited Irish provider with the right capacity could deliver all these tests from one site once the appropriate accreditations are secured for each test.
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The reasons for this disconnect are not technical. They are structural and procedural. The State has underinvested in building a co-ordinated, resilient testing framework. Public hospital laboratories, often lacking the resources, technology or accreditation to run advanced diagnostics, are left to procure services independently, frequently defaulting to overseas providers.
This was not the vision set out in the National Strategy for Accelerating Genetic and Genomic Medicine, published in 2022. That strategy promised faster results, better outcomes and more integrated care. Three years later, implementation has been slow.
One key index of that plan – the National Genomic Processing Service – remains stalled, with no delivery of a centralised National Genomics Centre. At a time when health budgets are under strain, establishing this service within the public system would require significant investment in infrastructure, personnel and equipment.
Despite a ready-made solution, fully accredited commercial laboratories already operating in Ireland are excluded from service provision, which raises serious questions given they are already appropriately resourced, accredited and ready to deliver fast results.
The consequences of this inertia are profound. In some cases, patients wait up to eight months for results that could be available in two days from a local commercial laboratory.
From a public expenditure perspective, the missed opportunity is twofold. Firstly, there is a direct cost to the health system. Prices for testing start at a few hundred euro but when multiplied across 20,000 samples sent overseas, the financial burden becomes substantial, with no line in the Department of Health’s budgetary estimates or the HSE service plan to account for this.
Secondly, there is a strategic cost. By failing to fully leverage domestic capacity, Ireland forfeits the chance to build a resilient, future-focused genomics ecosystem.
Genetic testing is not just a clinical service, it is a cornerstone of personalised medicine, early diagnosis and targeted treatments. Countries that invest early and build strong foundations will be better placed to manage population health effectively, attract innovation and respond to emerging challenges.
The State has acknowledged this in principle. The establishment of the National Genetics and Genomics Office, along with the publication of the HSE’s recent Laboratory Strategy, points in the right direction. But what’s needed now is action, not just plans.
Reform must begin by recognising that suitable capacity already exists in-country, across both public and commercial laboratories. Commercial labs such as Genseq have the infrastructure to provide the full range of genomic diagnostic tests currently being outsourced abroad.
Allowing such labs to take on a more central role would avoid the need for major public capital investment while unlocking immediate benefits. It would generate economic value by creating skilled jobs, supporting the development of a domestic talent base in clinical genetics and helping to retain scientific expertise that too often leaves Ireland for better-resourced systems abroad.
Keeping samples in-country reduces logistical risks such as temperature degradation or delays in transit, while ensuring greater control over chain of custody. Meanwhile, under the current system, data collected from Irish patients is stored and processed in other jurisdictions, raising legal and ethical concerns around privacy, consent, retention and future use. The memory of legacy decisions to outsource diagnostic services, without robust oversight, should serve as a reminder of the risk to patients.
Ultimately, this is not just a question of laboratory throughput. It is about long-term health system resilience, public trust and ethical responsibility. The current system risks degrading public confidence in data protection while delaying interventions that could dramatically alter a patient’s outcome.
Ireland has long positioned itself as a global hub for life sciences. But it has yet to apply that ambition to its own diagnostic infrastructure. A truly sovereign healthcare system cannot outsource core functions indefinitely. It must act quickly, securely and with full accountability, especially when it comes to matters as sensitive and powerful as genomic data.
The case for change is clear. Accredited Irish capacity exists. Demand is growing. And the stakes for patients, the health system and the economy are too high to ignore.
Reforming this space does not require a breakthrough in science. It requires a breakthrough in implementation and execution – and at pace. The ability to act decisively often separates leaders from laggards. The question now is whether Ireland is ready to lead in genomic medicine or is content to keep sending its future out by post.
Paul Reid is managing director at Genseq, an commercial, accredited clinical genetic testing laboratory facility in Dublin
