Wednesday, 17 December 2014
Topical Issue Debate (Resumed)
National Cancer Strategy Implementation
I thank the Minister for Health, Deputy Varadkar, for attending the midnight shift here in the Chamber. This Topical Issue matter is entitled mammography services at Sligo Regional Hospital, but it could have been called the impact of political decisions, broken promises and the very future of a hospital. If I may, I will set the context for Sligo Regional Hospital. The hospital serves a catchment area covering counties Sligo, Leitrim, south Donegal and west Cavan and even covers parts of counties Roscommon, Longford and Mayo. It provides a wide range of specialty services and generally is highly regarded for the quality and outcome of services. I have a personal interest in the future of the hospital because I spent a number of years working there and all of my children and grandchildren were born in that hospital. Consequently, it is close to my heart, as well as to the hearts of most people in the north west.
Up to 2009, women with breast cancer could avail of a full range of services at the hospital. Again, the service was highly regarded and the patient outcomes compared favourably with the best national and international performance standards. It made such a difference to women with breast cancer that they were not obliged to travel to Galway or Dublin for the services because it is a six-hour round trip to Galway for people from the furthest end of Sligo Regional Hospital's catchment area, which is a very long trip. In 2008-2009, the then Fianna Fáil-led Government announced that the breast cancer services were to relocate from Sligo to Galway. That announcement stunned local people, who spontaneously arranged several protest marches, which were among the biggest marches I have ever seen in Sligo. However, the Government and the HSE were not for turning. Spokespersons for Fine Gael and the Labour Party promised before the 2011 general election that if elected to Government, they would reverse this decision and restore full breast cancer services to Sligo Regional Hospital. That promise was a major factor in the 2011 election, which resulted in two Fine Gael Deputies, thankfully one Sinn Féin Deputy and no Deputy representing Fianna Fáil being elected for the constituency. Unfortunately, it did not take long for me and the people in the constituency to realise this was an empty promise and the incoming Government did not keep its word. As a sop, it stated that a luxury bus would be used to transport women with breast cancer between Sligo and Galway and that bus did operate for a couple of months before being withdrawn.
I will now turn to the issue of mammography.
Mammography equipment at Sligo Regional Hospital has lain unused for some time because, according to HSE, there are not enough trained mammographers to operate it. Also, in the interests of fairness and accuracy, the HSE today advised me that the mammography equipment was decommissioned as it was more than nine years old and does not meet current guidelines. Clearly it did not strike the decision-makers that the equipment could and should have been replaced.
The HSE made gave a solemn promise to politicians and people in the north west that it would ensure the necessary mammographers would be trained and assigned to the service at Sligo Regional Hospital. This equipment has been spirited away. When I last spoke on this issue I was attributed as saying that the equipment had been stolen from the hospital. I would like to correct the record. What I actually said was that the equipment had been spirited away because "stolen" implies an illegality and spirited away means only that it was removed with a lack of openness.
The HSE has now announced that mammography services will not be provided at Sligo Regional Hospital. This means women who could have availed of the service in Sligo must now travel to Galway or Dublin. This is an outrageous breach of several promises and a slap in the face for the women of Sligo. It is not good enough. Can this decision be reversed? Any person, agency or Government that cannot or will not keep their word should not be making decisions on behalf of sick people.
I thank the Deputy for raising this important matter and welcome the opportunity to speak about mammography services at Sligo Regional Hospital.
The Saolta University Health Care Group has decided that patients in the west-north west region who are recovering from breast cancer treatment will continue to attend University Hospital Galway for follow-up surveillance mammography services. This is a service decision for the hospital group and was not subject to Ministerial consent. This is a continuation of the service arrangements that have been in place since 2009. I am informed that this approach is supported by the National Cancer Control Programme as the most effective way of providing quality assured follow-up services to patients who have undergone surgery for breast cancer.
A comprehensive symptomatic breast cancer service is provided to patients from the west-north west region at the symptomatic breast unit based at Galway University Hospital, with a satellite service provided at Letterkenny General Hospital. This service is provided on the basis of clinical need and is in line with the criteria approved by the National Cancer Control Programme for breast cancer diagnostic and surgical services.
Following the reorganisation of breast cancer services into the eight designated cancer centres, GPs in Sligo were requested in 2009 to refer all new patients to Galway University Hospital. The breast symptomatic service in Galway has had excellent outcomes over recent years and patient satisfaction with the service is reported to be very high. The National Cancer Control Programme advises that provision of surveillance mammography at the location where the patient's surgery was carried out is in line with best international practice. This normally involves annual checks for a period of approximately five years. Meanwhile, other cancer services continue to be provided at Sligo Regional Hospital, including the provision of chemotherapy services. Also, approximately 500 inpatients, 5,200 day cases and 2,700 outpatients are treated, between oncology and haematology services at Sligo Regional Hospital each year. Services are provided to patients from across the catchment area of Sligo, Leitrim, South Donegal, west Cavan and parts of Mayo. The service in Sligo is committed to consistently achieving high quality evidenced based care for the management of cancer patients and patients with non-malignant blood disorders.
I thank the Minister for his response. However, it misses the point which I outlined earlier. The breast cancer services in Sligo Regional Hospital compared with the best nationally and internationally in that patient outcomes were on a par with the best anywhere. There was no need for removal of those services from Sligo Regional Hospital.
There were several promises made, many in writing, that mammography services would be restored to Sligo Regional Hospital. Those promises have been broken. I am aware that the Department of Health delegates powers to the Saolta University Health Care Group and the HSE. This is not delegation but abdication of responsibility.
The problem that arises is as follows. If the range of services provided by a regional hospital are reduced no junior doctor worth his or her salt will take up employment there because they want to gain a broad breadth of experience at the hospitals in which they work. Similarly, consultants or registrars want to work in centres that provide a broad range of services. In removing services surreptitiously and promising that things will be done and then not delivering on those promises this is damaging to Sligo Regional Hospital not only now but into the future.
Will the Minister meet with management at the hospital to explore service developments that might be possible there? Can other services be provided at that hospital in light of the decision that breast cancer services cannot and will not be provided there? Will the Minister meet with management of the hospital to explore possible service developments for the hospital? As I said, the catchment area is large. It takes people a six-hour hours to travel from the top of the catchment area to Galway and back.
There are proposals for major capital developments at Sligo Regional Hospital in the coming years. As such I expect that at some point I will be meeting with the hospital group and management at Sligo Regional Hospital. This development is in the mix for the next five year capital plan.
By way of clarification, the powers delegated to the HSE are not delegated by the Department of Health rather they are delegated by the Oireachtas under the Health Acts. The Oireachtas in its wisdom decided ten or 11 years ago that service decisions should best be made by clinicians, the HSE and hospital groups rather than by politicians.
The group has informed me by way of briefing note that following an evaluation by it, re-establishment of the Sligo service would no longer be feasible for two reasons. First, there is concern that the potential for fragmentation of the service would not be in the best clinical interests of patients given it is now more than five years since the service was ceased and women who are already receiving follow-up in Galway will continue to avail of this option. Second, there is no longer a consultant radiology back-up in Sligo Regional Hospital and, therefore, any woman requiring further investigation from a mammogram would need to travel to Galway for this service, with the potential of a further delay in intervention. The group has also said that in order for radiographers trained in mammography to continue to perform their role they must meet quality assurance standards and a minimum number of examinations per annum. There are insufficient numbers of surveillance follow-up patients that would require mammography in Sligo Regional Hospital to maintain the radiographers' skill-set. As Minister, it is hard for me to ignore that.
I am sure the Deputy will agree with me that patient safety must always come before politics and that clinical outcomes must always come before convenience. I hope we can agree on that. I would be happy to see mammograms carried out at Sligo Regional Hospital. I have no objection to that and would be happy to see that service provided again but this would have to be on the ground that it does not compromise patient safety and does not reduce clinical outcomes.