Seanad Éireann debate -
Thursday, 12 Dec 2019

Vol. 269 No. 3

Appointment of Sarcoma Specialist at St. Vincent's University Hospital: Statements

Minister of State at the Department of Health (Deputy Finian McGrath)

I welcome the opportunity to update the House on this matter. St. Vincent's University Hospital advised my Department on 25 September that the person recruited to fill a permanent post of consultant medical oncologist with a special interest in sarcoma would not be taking up the post. The individual was due to commence this position on 1 September. However, on 17 September, human resources at St. Vincent's University Hospital was advised that the individual would not be taking up the post due to personal reasons.

St. Vincent's University Hospital is a voluntary hospital that operates its own recruitment policy and has full discretion regarding appointments. The post was re-advertised on 6 October with a closing date of 3 November. I am advised that St. Vincent's University Hospital has completed the short-listing of candidates for the consultant medical oncologist post and that interviews are scheduled for the end of January.

Over 200 adults are diagnosed with some form of sarcoma every year in Ireland and it is important that decisions on the management of these cases are made through a multidisciplinary team process. Multidisciplinary teams can involve clinicians and other medical personnel, as well as health and social care professionals, based in several hospitals. The output of their deliberations provide recommendations on the best approach to investigations, treatment and follow-up for the individual patient.

It is important to note that both St. Vincent's University Hospital and Cork University Hospital will continue to provide excellent care for this cohort of patients. A national clinical lead in soft tissue sarcomas is in place and will continue to oversee these services. Patients have their cases presented and discussed at one of the two sarcoma multidisciplinary teams and members of these teams have links with European specialists in sarcoma. St. Vincent's University Hospital and Cork University Hospital are designated cancer centres and have an extensive range of multidisciplinary services and expert clinical advice available. St. Vincent's University Hospital also has access to all of the relevant specialties for treatment, including surgery, medical oncology, radiation oncology, radiology and pathology. This Government and the Health Service Executive are committed to providing a high-quality, responsive and sustainable service for sarcoma patients.

The National Cancer Strategy 2017-2026 aims to meet the needs of cancer patients in Ireland for the next decade and sets out the plan for the development of cancer services. Effective prevention, early diagnosis, access to quality treatment, survivorship, patient involvement and safe, high-quality, patient-centred care are key aims of the strategy. Services for rare cancers, such as sarcoma, received considerable attention in the development of the strategy. Many rare cancers can be difficult to diagnose and require complex treatment. The importance of improving awareness of rare cancers among both healthcare practitioners and the public is acknowledged. The strategy also identifies the need for clear care pathways for the diagnosis and treatment of patients, with particular emphasis on timely treatment planning at multidisciplinary team level. This includes sub-specialty expertise in diagnosis and treatment with linkages to international centres of excellence for specialist advice and intervention.

Senator Máire Devine

I welcome the Minister of State but I am extremely disappointed, as are sarcoma patients listening to this from their hospital beds in St. Vincent's University Hospital and from home along with their families and carers. I had hoped and expected the Minister for Health to be here but he is not so I guess I will just have to get on with what we have and deal with it. I thank the Leader for organising this debate for today. It is just unfortunate that the Minister is not here.

In June 2016, I said in this Chamber:

I want to bring to the attention of the House a group that will hold a protest outside the Dáil. It is Sarcoma Action Group Ireland.

I made this statement in June 2016. I quoted it because the first point I want to make today is about the unacceptable length of time it has taken to try to sort out this issue. It holds a particular place in my heart because it was the first issue I took on when I got elected.

In July 2016 in his office, the Minister for Health met those seriously ill patients and gave the imprimatur for a specialist sarcoma consultant. The hospital had a wonderful consultant, Dr. Alexia Bertuzzi, but for some reason, the board of the hospital did not see fit to allow her to continue in her locum post or a temporary post moving to a permanent post. The hospital did eventually and reluctantly advertise the post after the Minister gave the imprimatur. It would appear that the management had no intention of following the Minister's instructions. Years of friction at St. Vincent's University Hospital are well known. Perhaps the Minister of State has noted my loss of patience but the loss of patience on the part of patients is more significant and I am their voice in Leinster House. I have been trying to shout about their case for almost four and a half years.

How the whole saga unfolded involved the recruitment process and the members of the hospital's board of management who were possibly professionally vulnerable and could not see that they already had an expert in the country and decided that this person was not fit to fill that role. A lovely man named David Wilkins contacted me and very bravely told me about his struggles. He is in St. Vincent's University Hospital at the moment. He told me about the indignity of being so sick. This year alone, he has had three major surgeries for treatment of sarcoma. His demand is so modest for someone in the midst of such personal struggle. He told me that out of the more than 3,000 consultants in the HSE, all patients want is one specialist.

The second point I wish to make concerns a fundamental flaw regarding this issue. We give millions of euro to St. Vincent's University Hospital and have done so over the decades. According to the HSE's own policies, external recruitment candidates are required to take up duty within three months. I repeat that these candidates must take up duty within three months of receipt of a formal offer of employment.

Furthermore, the HSE reserves the right to withdraw an offer of employment should appointees fail to meet these timeframes. However, as the Minister of State noted, St. Vincent's University Hospital stated it is a voluntary hospital which operates its own recruitment and has full discretion over appointments. We are paying it out of public funds. A letter from Ireland East Hospital Group in response to a request for an oncologist stated that recruitment at St. Vincent's University Hospital is conducted in line with legislation and best practice and in accordance with the terms and conditions set down by the HSE. Waiting for two and a half years for a person to take up a post does not fall within the terms and conditions of the HSE. I am sure the panel that was formed, if any, has long since gone out of date. I am unsure whether that could be investigated further.

A recruitment process has been started. I urge the Minister of State to go back to the Minister, Deputy Harris, and tell him to ensure an appointment is made in a timely manner because the patients are suffering. There are 200 new cases each year and there is no specialist in the hospital. I am unsure whether that constitutes neglect of duty by the hospital or whether the families of the patients who have died have any recourse. The duty of care is not being taken seriously. I hope a candidate is speedily recruited. I have waited more than four years for that to happen, as have the patients. There is something rotten somewhere. I will not state where I think it is, but the Minister of State will probably be able to guess at that from my response. I ask him to, please, protect these patients. The role of a Minister of Health is to protect public health and patients' interests. He needs to slap down with a hard hand and get this appointment done.

Senator Jerry Buttimer

I join with Senator Devine in welcoming the Minister of State to the House. I support her on this matter. I have had the benefit of meeting families advocating for loved ones regarding the issue of a sarcoma national clinical lead specialist. To be fair, the Minister, Deputy Harris, cannot be here and the Minister of State, Deputy Finian McGrath, is present in his stead. I understand the frustration of Senator Devine. This is a very important situation. We can dress it up whatever way we like, but what happened is very disappointing. As Senator Devine stated, a doctor was in situ but, at the 11th hour, not reappointed for some reason. The person due to take up the position did not do so. Senators may get all the emails in the world and make speeches in the House, but it is only when one meets people who explain their family situation-----

Senator Máire Devine

I have done so.

Senator Jerry Buttimer

When one has that experience, one understands the gravity and import of the matter. I do not mean that disrespectfully. All Senators have experience of dealing with issues involving cancer, such as family members who died or loved ones who, thankfully, recovered. It is when one meets people face to face that one understands they are trying to be advocates and ensure specialist treatment is available for their son, daughter, father in law, mother in law or other loved one.

It appears that the post was filled by a very thorough and professional expert who was not given the job. Another person was offered the job but did not take it. If one has cancer, one goes to see a doctor who specialises in that cancer, be it breast cancer, prostate cancer or sarcoma. Many of those affected by this issue are children. The national cancer strategy has worked quite well. We all have an opportunity to effect change. The national cancer strategy has done a significant amount. The Minister of State mentioned that Cork University Hospital and St. Vincent's are centres of excellence. The gravity of the situation is brought home through the experience of meeting those affected and receiving emails from them. I know from the response of the Minister of State and from engaging on behalf of people that the job has been readvertised and St. Vincent's has drawn up a shortlist. We cannot allow a situation such as this to happen again. There must be no groundhog day.

The patients travel to St. Vincent's from various parts of the country. We need to restore confidence and put in place a pathway and continuum of care. The appointment of a medical oncologist with sarcoma expertise is the key factor in so doing. The Minister, Deputy Harris, met advocacy groups and sarcoma patients and approved funding for the position in St. Vincent's but unfortunately, as Senator Devine stated, some of the patients have gone to their eternal reward, while others have come to us to advocate and champion this issue. I commend the Senator on the role she has played. It is because she raised the matter in the Seanad that people came to me on it having seen the transcript of proceedings. That was the reason for my meeting family representatives. Our bona fides are that we are speaking on behalf of patients and their families. This is not a political matter put forward by Fine Gael or Sinn Féin. Rather, it is being raised by individual Senators who have met families and people who benefited from the clinical lead with expertise in sarcoma. We want such expertise to be available at St. Vincent's.

Minister of State at the Department of Health (Deputy Finian McGrath)

I thank Senators Devine and Buttimer for raising this very important issue. I share their frustration and, in particular, the frustration and concerns of patients. I wish to confirm that in September St. Vincent's University Hospital was advised that the selected consultant medical oncologist with a special interest in sarcoma would not be taking up the post for personal reasons. As St. Vincent's is a voluntary hospital, it operates its own recruitment policy and has full discretion regarding appointments. Although I understand that patients may be frustrated by the delay in the role being filled, I am advised that it was readvertised with a closing date of 3 November. The hospital has completed the shortlisting of candidates and intends to hold interviews at the end of January with a view to ensuring that a suitable individual is appointed as soon as possible. Of course, I will bring the Senators' concerns back to the Minister, Deputy Harris. I assure Senator Devine that, in the meantime, high quality service will continue to be delivered to sarcoma patients by St. Vincent's hospital through its multidisciplinary team with oversight by the national clinical lead in soft tissue sarcoma.

Senator Máire Devine

I ask the Minister of State to ask the Minister to seek an update from the hospital, particularly given that the interviews will not be held until January, because we need to keep the pressure on. We must avoid another long delay. This needs to be done as soon as possible

Deputy Finian McGrath

I will so do.

The Seanad adjourned at 1.50 p.m. until 1.30 p.m. on Tuesday, 17 December 2019.