Seanad debates

Monday, 9 November 2009

10:00 pm

Photo of Cecilia KeaveneyCecilia Keaveney (Fianna Fail)
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I thank the Minister for taking this Adjournment matter at such a late hour. It is a sensitive and difficult issue for many women and must be raised given its significance. I refer to the provision of prosthetics for those who suffer from breast cancer. Prosthetics is a form of artificial breast that fits into a bra in order to replace the natural breast. According to the latest data from 2006, an estimated 16,000 women in Ireland have undergone breast surgery and require external breast prosthetics. The provision of a well-fitting prosthetics in a mastectomy bra is an essential aspect of the healing process. For a woman's body image, femininity and well-being following breast cancer surgery, it is a vital part of the recovery process.

There are many types of prosthetics, including standard, partial, shell, light-weight, self-supporting, foam and temporary. At present there is a significant problem in certain parts of the country with the type of prosthetics available to women. The service is patchy and ad hoc, and depends completely on the policy of the local hospital manager. The prosthetics fitting service and the standards which should be applied for this extremely important aftercare are not being applied nationally. A good quality prosthetics fitting service with equity in access, as well as consistently high standards of care, is vital for any women who needs it for her body image, femininity and psychological well-being.

There is a need for the Minister for Health and Children to indicate what is to be done to maximise the holistic approach to lifelong aftercare for breast cancer patients, particularly those who need prosthetics. The Irish Cancer Society invited a number of us to a meeting recently to talk about this matter. The society considers, however, that nothing has happened since 2006. We have invested so much in creating world class standards of care so that no matter where one lives, once one walks through the doors of a designated cancer service one will have exactly the same high quality experience. However, cancer care does not stop at the hospital door, so we need to do better on after care. The standards for prosthetics provision should be under the remit of Professor Tom Keane in the national cancer control programme. All suitable products should be available to all women in all parts of the country, and there should be equitable costs and expenses nationwide.

HIQA is currently developing quality safety standards that will cover all health care sectors and services. Part of the process will involve a review of the national quality assurance standards for symptomatic breast disease services. The Irish Cancer Society will be recommending the inclusion of standards of care for breast prosthetics supply and fitting in the revised standards.

In 2006, the Irish Cancer Society conducted research in partnership with DCU, funded by the Health Research Board, to investigate the woman's experience in the provision, supply and fitting of breast prosthetics in Ireland. They talked to women with prosthetics, with medical staff and prosthetics suppliers. They broke it down into three different areas: the patient's viewpoint, the environment and the prosthetics flitters. From the patient's viewpoint there was dissatisfaction with aspects of the prosthetics - in particular, the wait. Some 24.4% had a problem with that, while 17.3% had an issue with comfort and 14% of people had a difficulty with body movement.

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Almost half of the women had not received information on prosthetics and nearly 70% said that a choice of centres was important. There was a need for the best possible fitting environment with a range of products and the space and privacy to try them on. There are no national or service guidelines for retail fitters. There is a need for a trained, competent, knowledgeable and sensitive female fitter.

In 2006, in response to the issues raised in the research, Action Breast Cancer, a programme of the Irish Cancer Society, developed the standards of care for prostheses. They are endorsed by the Irish Breast Care Nurses Association, Europa Donna Ireland and Reach to Recovery. These standards of care give women an understanding of what to look for from a prosthesis and bra-fitting service and provide useful guidelines for those providing the service.

I visited London some years ago with Europa Donna Ireland and saw the difficulties that arise in trying to provide an holistic cancer care service. The consultants there told me not to fight for services in my local hospital just because it is local. We have been lucky in the north west in that Letterkenny has been linked to Derry. There is a service there that will equal those of the other seven cancer care services.

I am not speaking today about the north west but about the national service. If someone has had a mastectomy, she must live with the consequences for the rest of her life unless she opts for breast reconstruction. It must be dealt with regularly as people grow older. It is an issue that is not known about as much as it should be and there is definitely not a nationwide service which should be in place. The service should be integrated into the cancer care service under the aegis of Professor Tom Keane. I hope the Minister will have some positive news for the 16,000 women with breast cancer and the others who will suffer from it in the coming years. There but for the grace of God go any of us. I look forward to the Minister's response.

Photo of Brian Lenihan JnrBrian Lenihan Jnr (Minister, Department of Finance; Dublin West, Fianna Fail)
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I am responding on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. The HSE's national cancer control programme was established in 2007 to implement the strategy for cancer control in Ireland. The goals of the programme are better cancer prevention, detection and survival through a national service based on evidence and best practice for all cancers. This involves significant re-alignment of cancer services to move to a system which is consistent with best international practice in cancer control.

More than 2,300 women are diagnosed with breast cancer each year in Ireland. The first priority for the national cancer control programme has been the reorganisation of breast cancer services. I am sure the Senator is well aware of the nature of that reorganisation. Three years ago, there were 33 hospitals in Ireland providing breast cancer surgery. Today, there are nine. By the end of this year, all breast cancer diagnosis and surgery will take place in eight cancer centres, with an outreach service from University College Hospital Galway to Letterkenny General Hospital. The final service to be transferred will be transferred from the South Infirmary Victoria Hospital to Cork University Hospital next month when the new cancer centre opens at the latter following a €5 million refurbishment project.

This is a radical transformation of breast cancer services. I very much welcome the fact that the designated cancer centres are achieving the target of seeing 95% of urgent cases within two weeks of referral. In addition to the reorganisation of diagnostic and surgical services, prevention and early detection are key features of the national cancer control strategy.

Community oncology has been subject to considerable work. The major focus of this work has been on creating capacity and knowledge among health professionals in the community to promote best practice in cancer control. A great amount of work is ongoing in respect of the development of referral pathways and the education and training of general practitioners and their staff on the appropriate care and follow-up of cancer patients outside the hospital setting. The development of community oncology has been described by Professor Tom Keane, interim director of the cancer programme, as perhaps the most significant change that the cancer programme will effect over the long term.

With regard to breast prostheses, the national cancer control programme staff have been made aware that there is a variation in the availability and type of prostheses that are provided to women in different parts of the country. The Irish Cancer Society has recently highlighted its concerns in regard to prostheses supply and fitting services throughout the country.

This service has been traditionally provided by the Health Service Executive's community health offices. Direct contact has been made by the cancer programme staff with the appropriate managers and it has been recommended that a national standardised approach to the management of this service be established. It is important to ensure the needs of this group of women, irrespective of where they live, be addressed in a consistent and equal manner and that women receiving this service receive the same high-quality service regardless of where they live. In this regard, Professor Keane stated when appearing before the Joint Committee on Health and Children on 21 October that he would be happy to engage with the Irish Cancer Society on this important issue.

Breast cancer services have been radically transformed over the past two years and breast screening has been extended to all parts of the country. Considerable progress is also being made in the development of community oncology. It is acknowledged that services in regard to the provision of prostheses require work and in this regard the national cancer control programme has been in contact with the relevant managers within the wider HSE structure and Professor Keane has indicated his willingness to engage with the Irish Cancer Society on the issue.

Photo of Cecilia KeaveneyCecilia Keaveney (Fianna Fail)
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I thank the Minister for his response. I ask that politicians be kept - pardon the pun - abreast of developments.