Dáil Éireann díospóireacht -
Tuesday, 21 Oct 2003

Vol. 572 No. 6

Cancer Treatment Services.

Dr. Cowley

I wish to share time with Deputy Liam Twomey. We are not looking for a radiotherapy centre for every town and village in Ireland, as has been implied, but are simply trying to ensure people have proper access to one. It is obvious that Dublin has a surplus of radiotherapy centres but the plan is to site even more in the city. That does not make sense and represents centralisation, the enemy of ordinary people. It would make more sense to sell the site at St. Luke's and develop centres beside the universities because of the need that exists on the peripheries.

The Minister has said that proximity to a centre will not be a deciding factor in the siting of the units but he misses the point. Proximity to a cen tre is not sought for personal convenience but because many cancer patients are too unwell to travel and consultants will not send people to centres where the distances are too great. Half of those who require radiotherapy need it for palliative reasons to reduce pain and relieve suffering. They cannot travel now and the proposed system will make matters even worse.

The report of the expert group used the findings of a patient study to highlight that distance to travel for treatment was ranked 13 in order of importance. The Minister stated that this is significant because it challenges the notion of the three most important aspects to the organisation of services from the users' perspective – location, location, location.

Shamefully, only 19 counties were represented in the sample for the report with 44% of patients travelling less than ten miles one way and fewer than 3% travelling more than 100 miles one way. Only 13% spent two or more hours on the journey and, significantly, some consultants in St. Luke's refused to participate because they disagreed with the study format. That data should be thrown out.

The Minister has said that geography will not be a barrier to equal access but he has ignored the findings of the small areas health research unit study in Trinity College that state the inclusion of Limerick and Waterford would increase the population within 60 minutes travel time by up to 15%.

There is no significant advantage in terms of maximising catchment population by including three Dublin hospitals instead of one. The additional two Dublin hospitals increase the catchment population by under 1% in each travel time band of 30, 60, 90 and 120 minutes. In the initial phase until 2014, each health board will experience a doubling of elderly and cancer patients. What, then, is the rationale in further centralising the service doing the work? It is already too centralised and the proposal to further centralise it makes no sense.

Dr. Twomey

I thank the Minister for Health and Children for attending on this important issue. Many of the arguments we make have been made before, but we will keep reiterating the point.

The south-east region will have an increased population with more elderly patients and expected increases in cancer care by 2010, as outlined in the report to justify a full accelerator unit for the region, which has again been rejected by the review group. The Minister spoke recently of regional centres of excellence for certain speciality care, a proposal contained in the Hanly report. The south-east region has regionalised its cancer services because everyone understands the concept of critical mass and quality care and we are only awaiting radiotherapy services.

We should question the Government's commitment to the development of these regional centres of excellence. One cannot say that the regional hospitals in many areas are on a par with many of the Dublin hospitals. Unless there are plans to put an embargo on consultant appointments to the teaching hospitals, it is unlikely that the regional centres, never mind the local hospitals, will be on a par with some of the Dublin hospitals.

What is the timeframe for improving the radiotherapy services? That it has taken ten years to get as far as producing a report on the European Working Time Directive does not bode well for the implementation of these reports' provisions. The report on radiotherapy services states that restricted numbers of treatment centres require the development of innovative transport solutions. This has not happened in recent years. The Hanly report stated that when acute services, be they accident and emergency or maternity, are closed, the workload should be carried by GPs. As someone who works at the front line, although not as much as I used to, I cannot understand how this workload can be passed on to general practice in view of the problems I see developing over the next five years. I cannot see that anything innovative can be done to the ambulance services without the provision of massive amounts of money. What will be the outcome for the local and regional hospital set-up? If the consultants' contracts are not re-negotiated quickly and radically, it is unlikely that many of the proposals in the Hanly report will work out. All we are seeking in this matter is that irrespective of where one lives in the country, one has equal access to the same quality of care in an equitable manner.

Mr. Martin

I welcome the opportunity to set out the Government's position on the future development of radiation oncology services nationally and thank the Deputies for raising the issue.

As the Deputies are aware, I recently launched a report on the development of radiation oncology services. The report is a most authoritative analysis of radiation oncology and provides a detailed plan for the future development of radiation oncology services in this country. It represents a milestone in the development of radiation oncology services in the country. The Government has accepted the report's recommendations.

I reject what has been said by Deputies Cowley and Twomey. I am disappointed that both Deputies, who are general practitioners, would be so critical of the conclusions of the expert group on how radiation oncology services should be developed across the country. How can one argue that developing first class centres in Galway and Cork is akin to the centralisation of all services in Dublin? We are currently faced with an historical deficit of radiation oncology services. This means that we have one centre of excellence in St. Luke's, which is the only cancer care centre in the State, and two machines in a developing centre in Cork. The report was basically saying that we need a backbone before we can move forward. We need to walk before we run and be practical and realistic about what is achievable in the short to medium term.

Dr. Twomey

We have no timeframes.

Mr. Martin

The Government also agrees that a major programme is now required to rapidly develop clinical radiation oncology treatment services to modern standards. Furthermore, the Government has agreed that the first step of such a new programme should be the development of a clinical network of large centres in Dublin, Cork and Galway. I agree with the report's conclusion that this is the best model to provide a radiation oncology service to the highest standards. These centres will collectively have the staff and treatment infrastructure to permit a rapid increase in patient access to appropriate radiation therapy and will form the backbone of future service expansion. The development of radiation oncology services, along the lines recommended in this report, is my single most important priority in cancer services in the acute setting.

In the short term, I have approved the purchase of two additional linear accelerators for the Cork centre and the necessary capital investment amounting to €4 million to commission this service as rapidly as possible. I have also approved the appointment of a project team to prepare a brief for the rapid expansion of current capacity from four to eight linear accelerators.

I also intend to prioritise the necessary resources to ensure that the radiation oncology centre in Galway is in a position to treat patients from spring 2005. I have also requested the Western Health Board to prepare a development control plan to facilitate the expansion from three to six linear accelerators in the medium term. I will give early approval to the establishment of a project team to plan this expansion.

The report recommends that two treatment centres should be located in the eastern region, one serving the southern part of the region and adjacent catchment areas, and one serving the northern part of the region and adjacent catchment areas. I propose to discuss the implications of the report with the St. Luke's Hospital board shortly. I have asked the chief medical officer of the Department of Health and Children to advise on the optimum location of radiation treatment facilities in Dublin. The chief medical officer will apply the guidelines established by the group. Based on the advice from the chief medical officer, who will be supported by my Department's hospital planning office and external assistance, I will decide on the location of the services.

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. The radiation oncology centres will provide outreach services to hospitals in adjoining regions. This is currently the case and as more radiation oncologists are appointed, it will be necessary to ensure that there is an equitable spread of outreach services.

It is important to note that in a patient survey, carried out on behalf of the expert group, distance to travel for treatment was ranked 13th in order of importance. The highest level of patient care was considered to be the most important aspect of service.

Dr. Cowley

It was a biased survey.

Mr. Martin

It was not. It was an independent—

Dr. Twomey

That goes without saying. People cannot currently go and get care.

Mr. Martin

It was an independent survey of patients' views. Having spoken to patients, the bottom line is that people want to go where they will have the best chances of survival.

I fully endorse the report's findings that equity of access to the highest quality radiation oncology facilities is a right of all cancer patients. The Government has also decided that in the further development of services, consideration should be given to developing satellite centres at Waterford, Limerick and in the north-west. Such consideration will take into account the international evaluation of satellite centres, the efficacy of providing this model and the need to ensure quality standards of care.

It is my intention to develop a national integrated network of radiation oncology. The twin objectives of equitable access, regardless of location, and an effective national quality assurance programme need to be supported by a co-ordinating mechanism, as recommended in the report. A national radiation oncology co-ordinating group has been established which will, inter alia , facilitate improved access to existing and planned services. The group will comprise clinical, technical, managerial, academic and nursing expertise from different geographic regions.

The report on the development of radiation oncology services in Ireland marks a significant milestone in radiation oncology services nationally and its guidelines and recommendations are essential in the development of these services for cancer patients over the next number of years.