Tuesday, 8 December 2009
Dáil Eireann Debate
33. Deputy Jan O’Sullivan asked the Minister for Health and Children her views on the reported advertising of a private clinic offering oncology services in Sligo while the public cancer services in Sligo are being moved to Galway due to the size of the population in the north west; and if she will make a statement on the matter. [45808/09]
Deputy Mary Harney: The Deputy may be referring to recent media reports regarding an application before Sligo County Council to rezone land which would permit a planning application to be made in respect of a private health facility. The reports state that such a facility may provide certain medical services, including oncology. It is not clear whether the facility will ever be established but I want to make it clear that I have no intention of encouraging or supporting the provision of any services which cannot meet the required standards of safety and care.
I am aware that a number of private health facilities have advertised various oncology services which they provide. I contacted hospitals in the independent sector in 2007 urging them to take steps to ensure that their breast cancer services complied with the national standards for symptomatic breast disease. I also brought the standards to the attention of private health insurance providers and the chief medical officer wrote to health insurers and the independent hospital sector again in October this year reminding them of their responsibilities in this regard.
We have been preparing to work on legislative proposals for a mandatory licensing system to cover both public and private health care providers, based on explicit standards to be set by the Health Information and Quality Authority. I intend to bring these proposals to Government next year. This will ensure that all services, whether publicly or privately provided, meet the same high quality care standards for all patients.
Under this national strategy for cancer control, the HSE has designated eight specialist cancer centres, each serving a minimum population of 500,000. University Hospital Galway is the designated centre for Sligo. Breast cancer diagnostic and surgical services were transferred from Sligo General Hospital to University Hospital Galway in August, but medical oncology services and outpatient radiation oncology clinics continue to be provided in Sligo. Other than non-melanoma skin cancer and a limited volume of bowel cancer cases, the vast majority of other curative cancer surgeries have never been undertaken at Sligo and are routinely referred to one of the eight designated cancer centres.
Irrespective of media reports regarding the possible development of other services, I believe that the concentration of breast cancer services into eight designated specialist centres is the only way to achieve the best results for our patients. The application of national standards, and ultimately the mandatory licensing of public and private facilities, will provide the best way forward.
Deputy Jan O’Sullivan: Does the Minister think it is ironic, inadequate and possibly dangerous for private patients that private facilities are not regulated? Does the Minister know how many private facilities in Ireland provide cancer services of any type, particularly in the context of the cancer control programme and the need for critical mass, triple assessment and multi-disciplinary teams? How long will it take to introduce the legislation required? The Minister mentioned next year but the private sector can do what it likes in the provision of health services without HIQA having any control whatsoever. Does the Minister believe there is an urgent need to ensure that all patients have properly regulated health services?
Deputy Mary Harney: As the Deputy is aware, patient safety is a priority for me and that is why I established the patient safety commission. All the reform taking place in acute hospitals is with a view to their meeting minimum standards for licensing in 2012 and 2013. As I stated previously here and at committee meetings, if we had the legislation and pressed the green button in the morning, many of the services currently provided would not meet minimum standards and, therefore, are not licensable. This is why there is such a momentum behind the reconfiguration of acute hospital services in particular.
With regard to the provision of cancer services, the Blackrock Clinic in Dublin and Barringtons Hospital in Limerick have stopped providing surgery for breast cancer. In the case of Barringtons Hospital, that was at my request. The health insurance providers are taking this matter seriously and if they honour the symptomatic breast disease standards, I do not foresee anybody being foolish enough to put their money into a private facility of the type suggested in Sligo. That is my honest opinion. I do not believe that anyone would do so. Other private facilities such as St. Vincent’s Hospital and the Mater Hospital in Dublin are co-located private facilities and have the volumes required under the symptomatic breast disease standards. The only other facility that I am aware provides breast cancer surgery is the Beacon Hospital in Dublin.
Deputy Jan O’Sullivan: Does the Minister for Health and Children have an obligation to ensure that facilities which do not comply with the basic minimum standards are not available to the public? This is specifically with regard to cancer; I accept a broader issue arises.
Deputy Mary Harney: As I stated on previous occasions, I can only do so when we have a legislative way of doing so and we cannot do that in advance of having licensing, authorisation or accreditation. Some of the misdiagnoses that have come to public attention occurred in both the public and private sectors, in services that are organised around extremely small volumes of patients and where the critical mass of specialist doctors, etc., does not exist. Discussing matters with the independent hospitals and advising insurers to follow the guidelines is the most appropriate way to ensure we meet the patient safety standards.
Deputy Mary Harney: The question relates to Sligo and I presume it arose on foot of Fintan O’Toole’s article in respect of a meeting of Sligo County Council. It is my view that people would be extremely foolish to invest resources in a facility which could not deal with the volume of patients required to qualify for licensing and to meet the relevant standards.
34. Deputy James Reilly asked the Minister for Health and Children the number of contracts or leases that have been signed by the Health Service Executive with general practitioners in respect of primary care centres; the location of these centres; and if she will make a statement on the matter. [45897/09]
Deputy Mary Harney: The HSE sought expressions of interest in December 2007 and July 2008 for the provision of primary care centres for primary care teams. Negotiations with interested parties proceeded in respect of 163 locations. Letters of intent have issued in respect of approximately 80 of these locations. Of those 80 locations, one centre has opened in Letterkenny, seven centres are due to open by the end of January 2010 at Kinnegad, Moate, Gorey, Waterford City, Carlow, Callan and Trim, respectively, and a further 37 are scheduled to open during 2010. These 80 locations will provide accommodation for 105 primary care teams and approximately 350 general practitioners will provide services from them.
The terms and conditions of the leasing arrangement stipulate that the HSE will sign a lease with a landlord only when GP involvement in providing services from the primary care teams accommodated in a centre has been agreed. The HSE has indicated that negotiations may not be completed in all of the chosen locations due to planning issues, withdrawal of developers or banking or market conditions. The HSE is also continuing to develop primary care centres through its Exchequer funded capital programme, with seven such centres opened in 2009 at Irishtown, Mark’s Lane and Dundrum in Dublin, Strokestown in County Roscommon, Inis Mór and Clonbur in County Galway and Westbury in County Clare.
Deputy James Reilly: We know the Minister has a large number of plans and that some of Professor Drumm’s bonus was apparently based on having teams in place. For the most part, these teams are virtual in nature. In other words, they do not really exist. A letter of intent is just that and it has no legal status or standing. My question is very straightforward and seeks to discover the number of contracts that have been signed this year. On each occasion we inquire about this matter we are informed that there are 90 centres. Mr. Brian Gilroy of the HSE is on record as stating that there are 90 centres, some of which have two teams and some of which have three. The fact is, however, that there are not 90 centres. I would be grateful if the Minister would indicate the number of centres in respect of which contracts were signed in the past 11 months.
Deputy Mary Harney: The significance of primary care teams has nothing to do with buildings or new facilities, even though there are many of both. These teams involve health care professionals working differently together around patients. As stated previously, I recently met a health care nurse who has reduced, by half of one working day a week, the amount of time she spends seeking to make contact with colleagues dealing with the same patients as her.
By September last, 165 teams were operational. By the end of the year there will be some 210 teams in operation. The Deputy’s question relates to contracts in respect of new facilities and I informed him that negotiations with interested parties proceeded in respect of 163 locations. These negotiations are at various stages.
Deputy Mary Harney: There are some people who are not happy with the terms that have been put to them. These individuals have come to see me and they have probably also visited the Deputy. Some arrangements have not been concluded but I am not in a position to inform the Deputy with regard to the different stages at which they stand. I informed him that 80 centres will open next year and that 350 doctors will be involved in the teams located at these centres. I believe the purpose of the Deputy’s question was——
Deputy James Reilly: I will ask my question again. How many contracts have been signed? I do not want to know how many we aspire to sign, nor am I interested in the difficulties we face. I merely wish to discover the number of contracts that have been signed in the past 11 months.
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