Seanad Éireann debate -
Wednesday, 15 Oct 2008

Vol. 191 No. 8

Cancer Screening Programme.

Senator Pearse Doherty

I wish to share my time with Senator Cecilia Keaveney. It is right that Senator Keaveney and I should address this issue because it is one which affects the women of Donegal. When talking about cancer, the threat of cancer, patient safety and patients' lives, we need to put away party political differences and look at what is in the best interest of the patient. That is why I ensured this issue was raised in the Seanad.

I refer to the national cervical screening programme which was announced at the beginning of September. I welcome the fact the programme has been up and running since 1 September but there was an announcement that Letterkenny General Hospital would not accept any new referrals for the cervical screening programme from 5 September onwards. The hospital continues to treat patients within the hospital.

The people of Donegal, elected representatives from all sides, patients and people who have been through the system demand that Letterkenny General Hospital be designated as one of the hospitals that will receive referrals from CervicalCheck and that the hospital be recognised as one of the hospitals that will be given priority. While I understand there are difficulties with regard to bringing the hospital up to the required standards, no Minister has given the reassurance required that Letterkenny General Hospital will be one of the centres to which patients can be referred. When the announcement was made and the Health Service Executive was asked why the hospital was not among the 11 centres, mention was made of international best practice, a phrase that is beginning to be hated in Donegal because we hear it in terms of cancer services and all the rest.

There is no excuse for not having a service in Donegal. What is being suggested is that patients transfer to Sligo General Hospital. If patients live in my area, that will require a four-hour round trip. If they live where Senator Cecelia Keaveney lives, the journey will be 240 km. If we are to have a screening programme, we must ensure people avail of it and we must make it simple and easy to use. That is the reason the service is retained and that a statement needs to be made on the issue in the House tonight.

A campaign is being led in Donegal, not by politicians but by an action group called Donegal Action for Cancer Care. I commend that group for the effort it has made, in co-operation with Cancer Care Northwest, to ensure the issue is dealt with effectively. The postcards the group has sent to all of us say it all: "Will I die because of you? We the people of Donegal demand a public colposcopy clinic be retained in Letterkenny General Hospital." That is our demand tonight.

Senator Cecilia Keaveney

I thank Senator Doherty for sharing his time with me. I had put forward a motion that the Minister for Health and Children should outline the outstanding issues that remain for the colposcopy service at Letterkenny to attain national cancer screening service, NCSS, recognition and how these issues can be overcome. I must begin by declaring my interest because I could well be the woman, never mind the politician, who might need these services in the near future. However, this is not a female issue as such because most households comprise both males and females and, therefore, the issue cuts across the board.

The problem is the uncertainty with regard to the withdrawal of a health facility. I have made various representations on the issue, but I get the same type of response all the time. I am told that Letterkenny was not one of the initial 11 centres, but that the door is not closed to having other situations recognised. I am told too that the NCSS is looking to recognise other facilities, including in the north west, and will be in the north west to look at Letterkenny General Hospital and that discussions are ongoing in that regard.

The reasons for our concern are clear. The current uncertainty has frightened people and has led to them resorting to contacting us via postcards. I welcome the number of people who have contacted me but I wish they put their address on the postcards so I could respond to them individually. As matters stand, I am trying to get my message out and I rely on the media and press releases to carry that message.

The NCSS has identified 11 colposcopy services to support cervical check initially. The colposcopy service at Letterkenny General Hospital has not been identified for referrals. However, in the interim, Letterkenny General Hospital will continue to provide colposcopy services to women already attending or awaiting colposcopy. The hospital requires a number of enhancements to meet the quality assurance standards defined by the NCSS, but no matter how often I ask the questions or to whom I address them, I cannot get the answer on the specifics. What are the problems? Are they medical, clinical or is it a matter of support staff. Is it a staffing or competence issue?

Ultimately, I want the best service for the area and believe Letterkenny General Hospital can deliver that service. I hope the meaningful negotiations I am told are ongoing between the hospital and the NCSS clearly define the issues. Whatever the issues, we as constituents and representatives of the area want to see the problems overcome and the hospital designated as a centre. When the representatives of the NCSS visit Letterkenny General Hospital in the coming days, we want the good work being carried out there and the increasing work of the north-west centre of excellence for cancer to be recognised and we want to ensure the uncertainty and fear in the area are overcome.

I hope the Minister of State has the answer to some of my questions tonight. I commend those who have championed this issue, but Senator Doherty and I have also championed the cause. It is just as possible that we may be the patients in question in the future. There but for the grace of God go any of us.

Deputy Noel Ahern

I am taking the Adjournment on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. Senators Doherty and Keaveney seem to be up to speed on what is happening, so I am not sure this reply will provide them with any additional information. I understand the ongoing discussions are about quality assurance standards and as Senator Keaveney said, further discussions are to take place this week.

The national cancer screening service, NCSS, is responsible for the implementation of CervicalCheck, the national cervical screening programme. Colposcopy services are an integral part of a population-based cervical screening programme, but a colposcopy service is not a cancer service. Colposcopy services are provided as a dedicated number of hours or sessions within the wider gynaecology clinic. Women who have pre-cancerous cell changes detected by their smear test are referred for colposcopy.

One of the reasons for establishing a national, population-based, cervical screening programme is to end the need for opportunistic screening and ensure women are screened at the appropriate intervals. To date, much screening has been carried out on an ad hoc basis and women have been offered varying structures and processes of care in addition to sometimes lengthy waiting times. The NCSS is responsible for the monitoring and audit of colposcopy services provided under the programme to ensure the quality assured standards, based on those defined by the Royal College of Obstetricians and Gynaecologists, are adhered to.

The roll-out of CervicalCheck has provided an opportunity to focus on the development and organisation of colposcopy services in Ireland. The NCSS is making a significant investment to enhance colposcopy services and this will ensure timely access to a quality assured colposcopy service for women who require further investigation. In preparation for the launch of the national cervical screening programme, the NCSS, in co-operation with the National Hospitals Office of the HSE, completed a baseline analysis of existing colposcopy services in Ireland. This service-by-service analysis examined facilities, staffing, systems management, information management, information technology and governance.

It is important to ensure that as part of CervicalCheck, women can access colposcopy services within international best practice timeframes based on adherence to quality assured clinical practice and the achievement of best clinical outcomes for women. The purpose of identifying and investing in these colposcopy services is to ensure this is the case for all women, regardless of which location they are referred to.

Existing services are at different stages of operational development. Using the baseline analysis, the NCSS has identified 11 colposcopy services to support CervicalCheck initially. The colposcopy service at Letterkenny General Hospital has not been identified for initial referrals of women. However, in the interim, Letterkenny will continue to provide colposcopy services to women already attending or awaiting colposcopy.

The provision of additional colposcopy services to women in the north west is being examined. The colposcopy service at Letterkenny General Hospital requires a number of enhancements to meet the quality assurance standards defined by the NCSS. The National Cancer Screening Service is working with the hospital on this issue. The question of the hospital's future participation in the colposcopy service for CervicalCheck will be considered in this context. Discussions between the hospital and the NCSS are due to take place this week.

This is an answer to the question of what the discussions are about. I hope the discussions taking place this week will move matters on and that the service will be organised in a way that offers the best outcomes for all women, including those in the north west.

Senator Pearse Doherty

I thank the Minister of State for his reply. I am not happy with it and I do not believe the people of Donegal will be happy with it either. What we should have got from the Minister was not just a statement that colposcopy at Letterkenny General Hospital was being examined but a commitment that Letterkenny General Hospital would be included in the list of recognised colposcopy services subject to the enhancements being made. There is nothing concrete here.

The Minister of State stated in his reply that Letterkenny General Hospital "will continue to provide colposcopy services to women already attending or awaiting colposcopy". Can he clarify whether new referrals of patients for colposcopy as a result of a smear test will be to Sligo or to Letterkenny? Are those on the waiting list and those already attending at Letterkenny the only ones who will be accommodated there?

Senator Cecilia Keaveney

Although 11 colposcopy services have been recognised, I am still asking the same question with which I started. Perhaps the Minister of State could obtain for me an explanation of the outstanding issues that are preventing the colposcopy service at Letterkenny from attaining recognition and how these can be overcome. One of the statements made again and again over the last number of weeks is that there has been a significant investment to enhance colposcopy services. If it is an investment issue, we need an assurance that we are going to invest in Letterkenny, but if it is an issue within the hospital it is important we know that. All I am asking at the moment is what are the outstanding issues and how they can be addressed. In addressing them we will gain what we are looking for, which is recognition.

Deputy Noel Ahern

I can only pass on the queries of the Senators to the Minister for Health and Children. There were one or two paragraphs in my reply that would seem to provide the answers. I cannot give — and I do not think the Minister will give — the outcome of the discussions that are taking place locally. That is where the issue will be resolved. If it is a matter of reaching the required standards with regard to the different categories I listed in my reply — facilities, staffing, systems management, information management, information technology and governance — there must be some aspects of the service under these headings which have not been clarified to the satisfaction of the NCSS. Whether the discussions taking place this week resolve the matter or not, I hope the issues will be dealt with satisfactorily and that Letterkenny can be added to the list. However, I can only pass on to the Minister the issues of concern to the Senators. I understand their points of view but I do not know whether the Minister, Deputy Harney, will have the answers either. She is probably waiting to hear the results of the discussions taking place locally this week.

The Seanad adjourned at 7.55 p.m. until 10.30 a.m. on Thursday, 16 October 2008.