Seanad Éireann debate -
Wednesday, 17 Nov 2004

Vol. 178 No. 15

Hospital Services.

Mr. Kenneally

I thank the Cathaoirleach for allowing me to raise this matter and I welcome the Minister of State to the House. This is an important matter for the people of Waterford and the south east region. I have never seen a region so united on any issue as the people of the south east are on this one. The Irish Society of Medical Oncologists has made the following submission to the National Cancer Forum:

The members of ISMO consider the development of comprehensive cancer centres to be the major cancer care requirement urgently needed under the next phase of the national cancer strategy. We recommend that these centres be developed at eight sites currently providing major cancer care in Ireland. These are Cork University Hospital, the Mid-Western Regional Hospital, Limerick, University College Hospital, Galway, Waterford Regional Hospital, St. Vincent's University Hospital, the Mater Hospital, Beaumont Hospital and St. James's Hospital.

These are the experts in their field. They would not suggest this was the level of care required if they did not think it was in the interest of their patients and of the population in general. The society's submission is a balanced one, particularly in view of the fact that representation on the body which formulated the submission has a regional balance to it.

The same could not be said of the group, which formulated the Hollywood report. It was largely made up of consultants and medical people from Dublin and Cork. They had their own agenda, which is only natural. If people from Waterford or Limerick had produced a similar report their bias might go in a different direction. The bias in the Hollywood report is skewed in a certain way. The Hollywood group also set out to justify the supra-regional concept, which is used in some larger countries. It will not work in Ireland because of our lack of infrastructure. The group should have looked at models in countries such a New Zealand and Norway.

An attempt was made to keep the ISMO submission quiet. The Cancer Care Alliance submitted a freedom of information request and got what it thought were all the documents relevant to the Hollywood report. The alliance subsequently discovered that the ISMO document had not been made available to it. This is disturbing. Why was it suppressed? Was it because it went against the tenor of the Hollywood report? Were all the members of the Cabinet aware of this vital piece of information?

There is a song, with the lyrics that "two out of three ain't bad." However, two out of three is bad for cancer care in the south east region. Waterford Regional Hospital's cancer service consists of surgery and chemotherapy but not radiotherapy. This is a nonsense. The entire range of facilities should be available together. The facilities for cancer patients in Waterford Regional Hospital are sub-standard. There is no proper dedicated oncology unit.

There is a tremendous oncology unit in the University Hospital in Limerick. The mid-western region, which the Minister of State, Deputy Parlon, represents, is also seeking radiotherapy facilities. The people of that region are right to demand that service. Given the size of the region they also should have radiotherapy but at least they have a fully functioning dedicated oncology unit. We do not have such a unit in Waterford.

BreastCheck is turning out to be a joke. It was announced in March 2003 but I am informed that we are unlikely to have the service in Waterford until 2006. Once again, the people of Waterford are being treated as second class citizens. They are being told that if they want mammography they must go to Cork. This is not good enough.

We were promised proper travelling facilities for people who had to access radiotherapy facilities in other areas. Recently I heard of an old man who was given a 7 a.m. appointment, which is not suitable for someone who has to travel. He was to have 26 daily radiotherapy sessions. He was told to take the appointment or leave it. The South Eastern Health Board did not have a transport infrastructure in place and had to provide a taxi for this patient. It is nonsense to say travel facilities are available or that access will be provided to other regions. It is not happening.

The Tánaiste and Minister for Health and Children has made great play of the additional funding she hopes to be given for the health services in the forthcoming Estimates and budget. She is right to tackle the problems in the accident and emergency service but there is also a serious problem in cancer care. Cancer is the only disease, which will touch every family in the country. One cannot say that of any other disease. I plead with the Minister to ensure that sufficient funding is provided so that proper care can be given to cancer patients.

Mr. Killeen

I thank Senator Kenneally for raising this matter on the Adjournment and for giving me this opportunity to set out the current position on the provision of radiation oncology services nationally. I wish to reiterate the position as set out by the Tánaiste, that the Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland. To this end, the Government will provide considerable investment in radiation oncology facilities in the coming years. The central aim is to ensure access by cancer patients throughout the country to high quality radiation oncology in line with best international standards.

The submission referred to by the Senator was made by the Irish Society of Medical Oncologists to the National Cancer Forum in the context of the development of a new national cancer strategy and was discussed by the forum at its meeting in May 2003. The National Cancer Forum is the national advisory body on cancer services and is a multi-disciplinary group of experts, including representatives of all modalities of cancer care.

The context of these discussions was the current fragmented delivery of cancer services nationally. In developing the new national cancer strategy, the forum's considerations have been informed by the broad strategic context in which the cancer strategy exists, a comprehensive review of the current status of cancer care, a review of the literature evidence concerning key aspects of the organisation of cancer services and a review of international models of care. The forum has concluded that the current arrangements for the delivery of cancer services are not generally in accordance with best practice and cannot be recommended to deliver best quality cancer care.

As regards radiation oncology, the Government's policy is informed by the report entitled "The Development of Radiation Oncology Services in Ireland". The expert group that developed the report comprised a range of experts involved in the provision of radiation oncology in Ireland, North and South. Some of the leading experts in their respective fields were represented on the group, including radiation oncologists as well as physicists and radiation therapy expertise. Two patient advocate representatives were also members, one from the Irish Cancer Society and the other from Aid Cancer Treatment. The report has been the subject of significant national and international endorsement from organisations such as the Irish Cancer Society, the American Cancer Society and the National Cancer Institute in the United States.

In developing its recommendations, the expert group undertook an extensive review of the organisation of radiation oncology services in countries such as Sweden, Norway, the Netherlands, the United Kingdom, Canada and Australia. The predominant view of the group, based on international guidelines of best practice is that radiation oncology services would be best developed in the context of a clinical network model of four large centres in Dublin, Cork and Galway, where new treatment centres have appropriate staff and equipment resources based around a minimum 4-6 linear accelerator treatment capacity. This report was discussed and unanimously endorsed by the National Cancer Forum at its last meeting on 17 September 2004, as the framework for the future development of radiation oncology services in this country.

Significant progress is being made in implementing the recommendations of the radiation oncology report. Approval has issued for the appointment of an additional five consultant radiation oncologists and recruitment is under way. These developments will significantly improve access to radiotherapy for patients in the south east and elsewhere.

As recommended in the report, the national radiation oncology co-ordinating group has been established. The group comprises clinical, technical, managerial, academic and nursing expertise from different geographic regions. The group's remit encompasses recommending measures to facilitate improved access to existing and planned services, including transport and accommodation. The group will also advise on quality assurance protocols and guidelines for the referral of public patients to private facilities.

Funding of up to €l million is being made available to develop a national telesynergy network for oncology services. The aim of the network is to improve service delivery and efficiency, to better use consultants' time, reduce consultant and patient travel, and support earlier and better diagnosis.

Radiation oncology centres will be required to provide services on an equitable basis which will ensure that patients of equal need will have equal access. Geography will not be a barrier to equal access. Radiation oncology centres at major teaching hospitals will be required to provide outreach services to hospitals in adjoining regions. This is currently the case and as more consultant radiation oncologists are appointed it will be necessary to ensure that there is an equitable spread of outreach services.

The model proposed by the report on the development of radiation oncology services in Ireland will provide a framework that meets the following national and international standards: it will adhere most closely to World Health Organisation, US national institutes of health and gold standard of cancer treatment being delivered within the context of a comprehensive cancer centre model; it will enable the development of specialist clinical teams with both tumour-specific and technology-specific expertise; it mandates the development of more extensive and integrated multi-disciplinary care; it meets the stated and expected medical and paramedical training programmes and their associated national and international accreditation mechanisms; it facilitates the most rapid implementation of new radiation technologies, particularly those with significant complexity and expense; and, fundamentally, it will address the issue of access where a profound shortage of national treatment capacity no longer becomes the dominant limiting factor.

I wish to reiterate the Government's commitment to providing the full range of cancer services for people throughout Ireland. In its decision last year on radiotherapy services, the Government remained open to the provision of a satellite radiation oncology unit in Waterford and elsewhere. The question of networked satellite locations will be kept under active review. New ideas and suggestions are continually being made and they are given fair consideration within the need to avoid a haphazard overall outcome.

We are determined to deliver enhanced services for the whole population as soon as possible. We will keep an open mind on how this objective can be achieved, bearing in mind the recommendations of the expert group, and our objectives of achieving best clinical outcomes for patients and making services both accessible and available to all cancer patients.

The Seanad adjourned at 8.25 p.m. until10.30 a.m. on Thursday, 18 November 2004.