Seanad debates

Tuesday, 20 November 2007

Cancer Services: Statements

 

4:00 pm

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)

I reiterate the apology I made in the other House to the women in Portlaoise who have been caused needless anxiety by a necessary review of their mammograms. Most of all, I apologise to those women who have been badly let down by a false negative initial reading of their mammograms. We owe it to them to do all in our power to ensure it never happens again. At least these women are now to get the expert care they should have received from the start.

I welcome the opportunity of this debate to reiterate our plans to deliver the best possible cancer care and control. There is only one over-riding motivation in this. It is not about money, hospitals, institutions, winners or losers, consultants and staffing, constituencies or counties, rural versus urban, east versus west, large versus small or HSE versus health boards, but simply about the best cancer care we can provide.We will make significant changes in cancer care because it is the most effective way to offer the best care possible to all who present with cancer in Ireland both today and in the future.

I say to women and men: if you have cancer, this plan will give you the best chance of survival. If you are worried about cancer, this is the best assurance we can give you that the best care will be there if you need it. If you live in rural Ireland or outside a major city, you deserve the same care as a person living beside a major cancer hospital and you will get it. It is a fundamental to this cancer plan that you will get the best cancer care regardless of your income, address or age. We can only do this, and we will do it, with teams of cancer specialists working together in major centres on a large number of cases. We will provide you with as many aspects of cancer care as close to home as possible. And if you need help travelling to a major centre for surgery we will assist you.

We are at the start of the journey to achieve these things. I recognise that as we leave present and past arrangements behind, in some parts of the country people are worried about whether we will reach our destination. I am confident we will. I am also confident we will bring with us the best aspects of what we have provided hitherto as we expanded our cancer services in recent years. There are excellent surgeons, nursing staff and levels of real care and support being provided. We value all of this and I am determined that none of it will be lost as we make the transition to the best quality-assured cancer care we can possibly organise. We will work with all concerned who provide care now to make sure of this.

The background to our plan is as follows. Last year, the Government strongly endorsed A Strategy for Cancer Control in Ireland, which was prepared by the National Cancer Forum and launched in June 2006. While the HSE is the centrepiece of the delivery of these services, the framework also provides a role for HIQA and the voluntary sector. It also makes recommendations to allow quality of care standards to be applied equally between the public and private sector. The implementation of the cancer control strategy is a major priority for me and for the Government. One of the basic reasons we set up the HSE to replace the health boards was to ensure that national level decisions could be made and implemented to deliver the best possible health outcomes for all people.

There is now a real opportunity for cancer control to be the key driver of overall health reform. It will require a significant change in how things are done. To facilitate this, the HSE has decided to establish a national cancer control programme and to appoint Professor Tom Keane as its director. Professor Keane took up his position yesterday. He is on secondment from his post as consultant radiation oncologist and head of the division of radiation oncology at the British Columbia Cancer Agency in Vancouver. I acknowledge the valuable contribution by the British Columbia Cancer Agency to the Irish health care system by agreeing to second Professor Keane for a period of two years to lead and manage the establishment of the HSE national cancer control programme. Professor Keane has my full support and that of the Government in this regard.

Professor Keane is expected to quickly designate clinical national leaders for radiation, surgical and medical oncology. I understand the HSE is making arrangements to enable him to take control of all cancer developments from 1 January 2008 and progressively take control of all existing cancer services and related funding and staffing. In consultation with various people and organisations, Professor Keane intends to designate locations for a range of cancer specialties from among the eight centres by early January. He will therefore be engaging in detailed planning to facilitate these designations and the orderly phased transfer of services between locations.

The designation of cancer centres is being carried out with the aim of ensuring that patients receive the highest quality care while allowing local access to services where appropriate. Patients enjoy a 20% improvement in survival rate if they are treated in specialist centres which provide multi-disciplinary care. If diagnosis and treatment planning is directed and managed by multi-disciplinary teams based at the cancer centres, much of the required treatment, apart from surgery, can be delivered in local hospitals. The implementation of managed cancer control networks will require the establishment of appropriate capacity at the cancer centres as we move services from other locations. It will be necessary for the distribution of other acute services in the hospital sector to be rebalanced by the National Hospitals Office. It is likely that those hospitals withdrawing from the provision of surgical oncology will be in a position to receive non-oncology services displaced from the cancer centres as a result of their increased oncology workloads and resulting demands on core services and facilities. The HSE plans to have completed 50% of the transition to the eight designated cancer centres by the end of 2008 and 80 to 90% by the end of 2009.

Much has been said about the requirement for extra resources to be provided in the designated centres in support of the implementation of standards for symptomatic breast disease. This is fundamentally about bringing together people with the best expertise to deliver the best care. Building up our centres of excellence will involve a continuing effort to build teams of excellent people delivering excellent care in major centres. That is what we will see, rather than cranes on the skyline and new buildings. We will of course continue to add investment to provide facilities for patients and to support clinical expertise but the main focus will be on people working together in new ways. We will be changing how we do things, not simply doing more of what we do already.

In Ireland we have high admission rates for cancer compared to other countries and when patients with cancer come into hospital they spend far longer on average in hospital than patients in other countries — longer than they need to be there. We can make better use of our existing hospital resources for cancer patients while not compromising on the objective of improving quality of care and cancer survival rates. To exemplify this, I am advised that there is significant variation among different centres in terms of the time that patients with similar care requirements spend in hospital. The average length of stay for patients having breast cancer surgery, for example, varies from as low as four days to more than ten days. The best patient care should mean that people are ready to go home as quickly as possible the moment they are medically ready, as most would wish.

We have been making progress in this area too. Between 1997 and 2006, the average length of stay for women having breast surgery has fallen by three days from nine to six days. The effect of this is that we have increased the number of women who have been treated with surgery each year by almost half — 44% — while at the same time slightly reducing the numbers of bed days they require. This not only represents a significant improvement in the efficiency of our hospitals, but it is a significant improvement in access to the services that women with breast cancer have received in the last decade. No patient wants to stay in hospital longer than is medically necessary, so we will ensure that this trend continues.

I am expecting Professor Keane to make symptomatic breast disease services a priority. I am confident there is now a clear pathway that is understood by all to enable the implementation of the quality assurance standards for symptomatic breast disease services in accordance with the time frame set by the HSE last September. I welcome the important and significant progress made by the HSE in announcing the cessation of services in hospitals undertaking low volumes of breast cancer surgery. I agree that the difficulties in recent months have been a source of worry for the women concerned, their families and the wider public. We must begin to learn lessons from these cases and to take all actions necessary to minimise the chance of mistakes. I strongly favour a culture of blame-free reporting of adverse incidents and I look forward to this being promoted more in our health service.

At present there are approximately 2,500 new breast cancer cases per year in Ireland. Data quoted in the OECD report published last week shows that there has been a rapid increase in survival rates for breast cancer in Ireland in the last decade — greater than in most other OECD countries. We are now getting close to the EU average. We recognise that there is room for improvement in cancer survival rates relative to other EU countries. This has already been clearly set out in the strategy for cancer control. That is precisely why the journey on which we are now embarking is so necessary.

The two most important contributors to improving this pattern will be enhanced access to early diagnosis through the roll-out of BreastCheck and the implementation of the quality assurance standards for symptomatic breast disease services. BreastCheck has commenced screening services in the south and west. There have been major developments and improvements in cancer services over the past years. Ongoing work in the National Cancer Registry shows that survival for most cancers continues to improve in Ireland. For example, breast cancer patients diagnosed during the period 1999-2003 had a five-year relative survival — 6.7 percentage points higher than those diagnosed in the period 1994-98. However, there is some way to go before we can attain the survival performance of the best European countries.

I particularly appeal to our doctors to work with us and lead this change to the best cancer services. All doctors are aware of the evidence about what provides the best outcomes for their patients. I am encouraging them to support Professor Keane in the tough challenge he has taken on as director of the National Cancer Control Programme. With the support of our many excellent cancer doctors I am confident that Professor Keane will succeed.

I will chair regular review meetings involving the HSE and Professor Keane to monitor delivery of the programme. Progress will also be considered on an ongoing basis by the Cabinet sub-committee on health and children. My Department will engage on an ongoing basis with the HSE on detailed arrangements for the progression, monitoring and evaluation of the programme.

One result of recent events is that the public better understands and accepts the rationale for the development of cancer centres and the changes that must follow. It is now incumbent on all of us in the health system to ensure that we deliver on this.

There have been major developments in cancer control. We are embarking on a journey towards the best cancer care we can provide in our country. We will take with us the value we have built up in the recent expansion of cancer services. We are asking people to come with us. There will be no reduction of cancer care services as we go on this journey, only an assurance of improvement in quality and outcomes.

We are moving in the right direction and we have a national leader in Professor Keane to ensure cancer is given the priority and expertise it deserves. We will work to ensure the implementation of the National Cancer Control Programme is fully supported and that it is given every opportunity for success and, ultimately, for excellent patient treatments and care. This will benefit our cancer patients nationally and prove that Ireland can become a benchmark for other countries in the provision of quality assured cancer care. Both I and the Government are committed to delivering these improvements.

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