Wednesday, 7 May 2008
Cancer Treatment Services
I welcome the Minister of State, Deputy Brendan Smith, to the House. He looked very relaxed as he waited. I wish him well for this afternoon.
I thank the Chair for allowing me raise the issue of services at Mayo General Hospital on the Adjournment. Last week the Minister for Health and Children was in Castlebar to open the BreastCheck unit there. She gave some figures on the number of breast cancer operations that have taken place at Mayo General Hospital to the media, to the public and to seven ladies who are involved in a campaign to save the cancer services at the hospital. The figures have greatly embarrassed the hospital's senior management, senior consultants and staff. I heard the Minister say on the radio that there were 37 operations annually at Mayo General Hospital and that, as this was less than one a week, they could easily be catered for at the proposed centre for excellence in Galway, notwithstanding the huge problems there are in Galway, not only in hospital capacity but in traffic and parking.
Yesterday, my party leader Enda Kenny, our health spokesperson Deputy James Reilly, our MEP, Jim Higgins, Deputies Michael Ring and John O'Mahony and I met the senior management and staff at Mayo General Hospital. The figures they gave us show that 97 breast cancer operations took place in 2007 at the hospital. That differs greatly from the figures given by the Minister for Health and Children, and great concern has been expressed by Mr. Barry, the senior consultant surgeon at the hospital. He has been taken aback by the interpretation and the figures that the Minister has put forward. There is no doubt that she has done that to downgrade Mayo General Hospital and take cancer services away from it. Mr. Barry told us clearly yesterday that, in 2000, the then Minister of State at the Department of Health and Children, Tom Moffat — a Mayoman — and Mary Hinds opened a satellite centre in Castlebar, which was linked to Galway in every way. We want to hold that centre in Castlebar at the Mayo General Hospital. The consultants at Galway and Castlebar work in conjunction with each other.
Mr. Barry said that the criteria laid out at the opening of the centre was that more than 50 operations would take place annually and that the hospital would stand up to scrutiny. There is no doubt that 97 operations took place last year. Mr. Barry has said that if the figure drops below 50 and if the centre does not stand up to scrutiny or the centre of excellence strategy, it should be closed. However, he guarantees that it is above board and will stand up to any scrutiny for any centre of excellence throughout the world.
I must put it on the record that the Minister for Health and Children did a huge disservice to the morale of the staff in the hospital. She should apologise to the staff and management of Mayo General Hospital. The national cancer strategy includes eight centres of excellence, with which we have no problem. However, if the strategy is based on the figures that the Minister for Health and Children gave to the media and put out into the public domain — 37 operations, instead of the 97 that took place — we have got the strategy completely wrong. I want to know where Professor Keane stands on the issue. What are his views on the figures indicated by the Minister for Health and Children?
I want also to know what is the Minister's definition of a centre of excellence. Is Castlebar a centre of excellence in its own right as a satellite of Galway? What is the position with Sligo? The Minister of State is in a hurry but I want to put on the record those issues and the deep dissatisfaction felt in Mayo General Hospital with how the Minister has put figures into the public domain. Will the Minister of State clarify the discrepancy between the figures? What year and what figures was the Minister for Children and Health talking about?
I will take this Adjournment matter on behalf of my colleague the Minister for Health and Children, Deputy Mary Harney. At the outset, I thank Senator Paddy Burke for raising this important issue regarding the restructuring of cancer services, with particular reference to Mayo General Hospital.
Data on surgical cancer procedures is collated by the hospital inpatient inquiry system, commonly referred to as HIPE, based on information supplied by hospitals. The information is supplied by all public hospitals to the Economic and Social Research Institute, which validates the data. The HIPE system collects information on all discharges and deaths. The data provided by Mayo General Hospital show that in 2006, 43 surgical procedures were carried out on women with a principal diagnosis of breast cancer. The HIPE data for 2007 are almost 90% complete and show 35 cases. Data for 2008 have yet to be collated.
The HIPE analysis counts every occurrence of these procedures in which the patient has a principal diagnosis of breast cancer and so may include more than one procedure per person. Therefore, the data presented refer to the number of breast cancer related procedures and not the number of women.
The Department of Health and Children is unclear as to the basis for recently issued figures from Mayo General Hospital that differ from the HIPE figures. The hospital inpatient inquiry system provides validated figures that have been used to inform the decision-making process with regard to the establishment of the managed cancer control networks and designated centres. The National Quality Assurance Standards for Symptomatic Breast Disease Services provide that each specialist unit should manage a minimum number of 150 new breast cancer cases per annum. Mayo General Hospital falls well short of this figure.
We must be clear about the need for the change to higher case volumes. People in the west and south have a poorer survival rate for common cancers, including breast cancer, than the remainder of the country. The designation of cancer centres aims to ensure that patients receive the highest quality care while allowing local access to services where appropriate.
As Seanad Éireann is aware, Professor Tom Keane has been appointed to lead and manage the establishment of the Health Service Executive national cancer control programme. Professor Keane has ambitious plans and has already made significant progress in implementation of the programme. The key objective of the national cancer control programme is to ensure equity of access to services and equality of outcome irrespective of geography. This will involve significant realignment of cancer services to move from the present fragmented system of care to one that is consistent with international best practice in cancer control.
The decisions of the HSE in regard to four managed cancer control networks and eight cancer centres will be implemented on a managed and phased basis. The HSE plans to have completed 50% of the transition of services to the cancer centres by the end of this year and 80% to 90% by the end of 2009.
The HSE has designated University College Hospital Galway and Limerick Regional Hospital as the two cancer centres in the managed cancer control network for the HSE western region, which includes County Mayo. The designation of cancer centres aims to ensure that patients receive the highest quality care while allowing local access to services, where appropriate. Where diagnosis and treatment planning is directed and managed by multidisciplinary teams based at the cancer centres, much of the treatment, other than surgery, can be delivered in local hospitals, such as Castlebar. In this context, chemotherapy and support services will continue to be delivered locally.
The Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland in accordance with best international practices and standards. The developments I have outlined will ensure that a comprehensive service is available to all patients with cancer in the western region including in County Mayo. I assure Deputy Burke that in view of the fact that his figures do not run parallel to those I have given in reply, I will ensure that his contribution is brought to the attention of the Minister for Health and Children and to the attention of the senior management of the HSE.