Vol. 566 No. 1
61 Mr. Broughan asked the Minister for Health and Children if his attention has been drawn to the findings of a recent report, Surgical Procedures for Selected Cancers in Ireland, 1997-2002, which showed that highly specialised cancer surgery is still being carried out by general surgeons; his views on this situation; and if he will make a statement on the matter. [11985/03]
The report on Surgical Procedures for Selected Cancers in Ireland, referred to by the Deputy, was prepared as part of the work which the National Cancer Forum is currently undertaking in the development of a new national cancer strategy. The report examined oncology surgery between 1997 and 2002 in respect of a number of site-specific cancers, including lung, breast, pancreas and colon.
The forum has advised me that international experience in oncology surgery, especially in relation to complex procedures, is that it should be limited to those hospitals that have adequate case volume and the appropriate skill mix and support services in the various modalities of care. In this context, the forum is of the view that the arrangements for the delivery of cancer services reflected in the data outlined in the report are not generally in accordance with best practice. There is insufficient case volume presented in the data to support the number of consultants and hospitals engaged in oncology surgery.
In terms of the delivery and future development of cancer services, these arrangements cannot be recommended by the forum nationally. The forum will reflect further on this issue as it prepares the next national cancer strategy.
I consider that a broad-based response to the report is required, involving the health authorities, health boards, professional bodies and the forum. In that regard, my Department's chief medical officer has referred the report to the Royal College of Surgeons in Ireland. The chief medical officer has advised that the pattern of activity in the report raises a number of issues relating to the practice of surgery and the arrangements for the training of surgeons in the relevant sub-specialties. He has asked the college to offer its advice as to actions the Department, the college and health agencies might need to take in response to the report.
In addition, my Department has referred the report to the chief executive officers of the health authorities and health boards, and has advised them of the specific views expressed by the National Cancer Forum. My Department has asked the chief executive officers to examine the organisation and delivery of oncology surgery at regional level in light of the forum's advice. Discussions will also take place between the chief executive officers and my Department's management advisory committee. My Department has also referred the report to Comhairle na nOspidéal for appropriate attention.
In addition, I have asked the forum to consider the processes and structures at national, professional or hospital levels that best ensure that we not only deliver a service that is in line with best practice but that we can validate progress in that regard. I acknowledge this important work of the forum and look forward to receiving the new national cancer strategy report later this year.
I thank the Minister for his reply. Would he not accept, however, that it is disturbing for patients to read that such a high level of complex surgical procedures are being carried out by general surgeons who do not have the experience or competence required to meet best practice standards? The Minister should go beyond consulting and set out a direction for the practice in hospitals across the country. Is the Minister not concerned, for example, that as he has employed more consultants, the percentage of consultants who fall into the category of doing less than ten procedures a year – which means that they do not have the necessary experience – has actually risen from 40% to 55%? The Minister may claim that he is providing more consultants but standards are falling as a result of these appointments. Surely the Minister has a responsibility to set out certain guidelines to ensure the required standards for cancer patients, whose outcome is dependent upon the experience and skill of the surgeon. Such patients should feel secure that specialists have a certain level of experience in complex cancer surgery.
I do not have any broad disagreement with a number of the issues raised by the Deputy. There is a strong onus, responsibility and obligation on the professional community to reflect on the data that has now been presented. Members of my Department's medical division, who are also members of the National Cancer Forum, were involved in ascertaining this data. We are not just referring these reports on, we are engaging with the health board chief executive officers, hospital managers and the Royal College of Surgeons to bring about change.
A number of consultants, particularly in the breast cancer area, were appointed in the 2001-2002 period. Therefore, it is reasonable to assume that improvements will occur in that speciality in the next year or two as the new appointments come on stream.
What is the message, do not get bowel cancer?
No. It is important to bear in mind that when the national cancer strategy was published in 1996 it set certain targets, the main one being survival rates. Following an evaluation of that strategy, the preliminary indicators are that we will have exceeded the objective of reducing mortality from cancer. The strategy and the investment we have made are having an impact on outcomes for cancer patients. I hope we will get to the day when cancer, like many other conditions, can be managed and treated as an ongoing illness.
I will point out how the strategy might work. In the south-east, general surgeons sub-specialise in cancers in various small hospitals. They take patients from other regions into their hospitals and look after them. Oesophageal cancers are treated in Wexford, pancreatic cancers in Clonmel, and breast cancers in Waterford. This is a useful way of maintaining smaller hospitals as well as keeping up the level of expertise of general surgeons in certain sub-specialities. By their very nature, general surgeons are in smaller regional hospitals, not in the larger centres. When the next cancer strategy is being drawn up we must take into account that such services are being provided efficiently and capably by certain general surgeons. I support what has been said about a small number of procedures being carried out; they should not be because it is dangerous.
I would not necessarily endorse that. Oesophageal cancers require a specialised response, both in my opinion and that of the National Cancer Forum. I am concerned that more than three-quarters of consultants carried out less than ten procedures in that area alone. I do not think that represents a sufficient case-load to build up the requisite expertise over time. There are some very high-quality people in the country, who are highly regarded internationally in terms of published research on oesophageal cancer. My inclination would be to try to move patients in the direction of the specialists in the specific fields.
