Thursday, 12 July 2012
Topical Issue Debate
I thank the Minister for taking this matter, which I accept is at this stage only speculation. However, I believe it is speculation with a basis.
There is speculation that a recommendation will shortly be submitted to the Minister in regard to the withdrawal of oesophageal and stomach cancer services from Galway University Hospital, leaving only two centres in the country providing these services. I understand this arises out of a plan under consideration by the national cancer control programme. If this were to happen, patients from the west of Ireland would be required to travel to Dublin for treatment. I often think people believe everybody in the west of Ireland lives in Galway city. There are people for whom travelling to Galway takes half the time it would take to travel to Dublin. We are speaking, therefore, of many people for whom Dublin is more than four hours away.
Currently, there are four regional units providing this service. I accept that it is not possible to provide every service everywhere. I agree that we need to decide the appropriate level of service for each particular speciality. I have always accepted that. I believe that, as pointed out by the Minister in response to the previous matter, services currently provided centrally will be provided closer to people's homes while other services will be provided in one particular centre. However, I am concerned that despite the intention to provide regional centres of excellence, taking geography into account, the system - I accept this proposal has not yet come before the Minister - will try to recentralise everything. In terms of the medical issues that arise, there is a need to look beyond medical speciality and to ensure that if all services are to be provided centrally all other back up services will be available, including beds, car parking spaces and so on.
I am asking the Minister to consider this proposal, which no doubt will come before him, in the context of whether it is the right decision taking into account quality of life issues and the fact that it is possible to ensure there is peer review when the service is being provided by only four centres in the country. I hope the Minister can confirm to me today that regardless of what recommendation is made to him he will not be inclined in that way. I hope also that he will take into account that the services in Galway also provide investigative services for non-cancerous conditions such as stomach ulcers and so on.
I hope the Minister's vision of the health service will dictate that where there are good quality regional services available, as in this case, he will resist any proposal to centralise those services at huge inconvenience on a human level for people. I am not a doctor. I do not believe there is any overriding medical reason this should be done. Any case put forward on that basis would have to be considered alongside the case that people have a right to the provision of a top class service within reasonable distance in their region.
I thank the Deputy for raising this important issue.
The Strategy for Cancer Control in Ireland 2006 recommends that all major cancers, including oesophageal and stomach cancers, be treated in designated centres where patients are managed by multidisciplinary teams, in accordance with the best standards of cancer diagnosis, treatment and care.
The HSE's national cancer control programme, NCCP, recently undertook a quality review of oesophageal cancer surgery in the period 2008 to 2010. This involved an examination of services at four designated cancer centres - St. James's Hospital, Galway University Hospital, University Hospital Cork and Beaumont Hospital. The review examined quality of services against a range of standards of best practice. The outcome of the review was that the overall quality of oesophageal and upper gastrointestinal cancer surgery in Ireland in the four designated centres is within an internationally acceptable range for quality of the procedures, morbidity, mortality and post-operative complications, compatible with the volumes of patients treated in each centre.
In assessing the situation the national cancer control programme was mindful that evidence in international publications indicates that long-term outcomes have been demonstrated to be significantly better in high-volume centres. This necessitates that the programme for managing stomach and oesophageal cancer ensures that it harnesses the strengths of the entire national team of experts in co-ordinating services and monitoring quality in Ireland.
Following the review it has been decided that St. James's Hospital will be designated the national centre for oesophageal and gastric cancer. The national cancer control programme has appointed a clinical lead for upper gastrointestinal cancer. University Hospital Galway, together with Beaumont Hospital and Cork University Hospital will be designated as the three satellite centres for oesophageal and gastric cancer care including radical surgery, radiation therapy and chemotherapy.
The new programme will ensure there is integration within a multidisciplinary service based in each designated cancer centre with access to medical oncology, radiation oncology and specialised upper gastrointestinal surgical expertise; sustainable expert surgical services supported by specialised surgeons, inpatient beds, theatre access and an intensive care unit; sustainable volumes of procedures compatible with maintenance of surgical and nursing skills; implementation of video-conferenced national multidisciplinary team meetings to ensure optimal treatment decisions for selected complex patient management; collaboration with the national cancer control programme's national gastrointestinal tumour group in the development and implementation of national clinical practice guidelines; development and regular reporting of key performance indicators which build on the elements of this recent review; and planning of resources to ensure that money follows the patient.
I am confident the arrangements put in place by the NCCP will help to ensure best outcomes for patients.
The answer is comprehensive and I am very pleased with it. Can I take it that these are the decisions for the medium to long term? Will this be the arrangement to be in place? If it is, it is a very satisfactory outcome, which will give the perfect balance between having all the co-ordination, each one working in tandem with the other. I have no difficulty with one having a lead role in a speciality, which makes sense. If this is as it will be and if this is the decision from the national cancer control programme, it is a very satisfactory answer to the question I raised and it should allay the fears of many people. The surgery, radiation therapy and chemotherapy will be available locally while on the other hand every piece of national information, skill etc. will be available through a linked-up system between the four centres. I ask the Minister to confirm that my reading of the situation is correct.
The arrangements are as I have stated. That is the plan and those are the arrangements that have been put in place. I welcome the Deputy's comments. We want all citizens with oesophageal cancer and upper gastrointestinal cancer to get the best treatment. Like the Deputy, I believe that where possible we must have the volume of patients going through to maintain the expertise. Transposition of excellence will occur more quickly with IT link up and regular multidisciplinary team meetings in individual hospitals and also in conjunction with the main centre through IT linkage and video-conferencing, which is something we are developing. We acknowledge that for some parts of the country because of our geography and the population spread long distances are involved for people. I am pretty familiar with the road from Clifden and beyond coming into Galway city, which is a considerable journey in itself.
I am pleased the Deputy has accepted the answer that it will allow for the best of both worlds with a spread of the service in the country and yet have the volumes and expertise to keep us at the top of international best practice.