Hospital Services.

Tuesday, 29 June 2004

Seanad Eireann Debate
Vol. 177 No. 6

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An Leas-Chathaoirleach: Information on Paddy Burke  Zoom on Paddy Burke  I welcome the Minister of State, Deputy de Valera, to the House.

[450]Mr. Cummins: Information on Maurice Cummins  Zoom on Maurice Cummins  I too welcome the Minister of State to the House. I note the need for the Minister for Health and Children to provide an integrated cancer care service, including radiotherapy, at Waterford Regional Hospital as it now satisfies the critical mass criteria laid down in the Hollywood report, which was accepted by the Government. Less than a month ago, 15,000 people marched through the streets of Waterford demanding fair play and equity of access to radiotherapy services for the people of the south east.

The region is united in its quest for a totally integrated cancer care service at Waterford Regional Hospital. Government general election candidates, including a current Minister, promised this facility would be up and running within three years. The fact that this promise continues to be reneged on wreaked havoc on Fianna Fáil and Progressive Democrats candidates during the local elections. Fianna Fáil has just one representative out of 15 on Waterford City Council and the Progressive Democrats were wiped out completely. The story is the same on Waterford [451]County Council where Fianna Fáil lost three seats and likewise in south Kilkenny and New Ross.

This is a major issue. The message must be clear by now that the people of the south east demand equity of access to radiotherapy services, similar to Dublin, Cork and Galway. The Hollywood report spoke of critical mass or population requirements to secure radiotherapy in a region. The population projections from the Central Statistics Office indicate an increase in population growth to approximately 418,000 by 2010 and 423,000 by 2015 in the south east region, which would justify two linear accelerators. The fact of the matter is that the south east currently has a population of 423,616 as per the 2002 census figures. The region already surpasses the criteria laid down in the report and accepted by the Government.

The Department appears hell bent on proceeding with the recommendations of the report. The people of the south east demand that, as we satisfy the requirements and conditions, immediate steps must be taken to plan for radiotherapy facilities at Waterford Regional Hospital to cater for all the people of the south east, including public and private patients. The red herring of a private hospital providing facilities has added to the frustration of the people in the region. The Minister is on record as being opposed to buying services for public patients from private operators. The Minister of State, Deputy O’Malley, and the Tánaiste are of a different view. The fact is that the Government is dithering on this matter while patients die in the south east.

I call on the Minister of State to give a clear and unequivocal statement that Waterford will be given the same equity of access to radiotherapy as Cork, Dublin and Galway and that, as the Minister said, funding will be concentrated and prioritised in the regions that satisfy the criteria laid down in the Hollywood report. Waterford cannot be forgotten if the Minister insists on implementing the provisions of the report. The ordinary decent and caring people of the south east will not allow the issue to go away. The bottom line is that Waterford must now be part of the national backbone which will create sufficient volume, machines and expertise in a multidisciplinary team as outlined in the Hollywood report.

Minister of State at the Department of Education and Science (Miss de Valera): Information on Síle de Valera  Zoom on Síle de Valera  The Minister apologises for being unable to be here this evening and he has asked me to reply to the debate on his behalf.

As the House is aware, the report on the development of radiation oncology services was published in October 2003. The recommendations of the report, which have been accepted and endorsed by the Government, provide the only sustainable plan for the future development of radiation oncology services nationally. The development of these services on the lines recom[452]mended in this report is the single most important priority in cancer services in the acute setting. In developing its recommendations, the expert group undertook an extensive review of the organisation of radiation oncology services in countries such as Sweden, Norway, the Netherlands, Britain, Canada and Australia. The predominant view of the group, based on international guidelines of best practice, was that radiation oncology services would be best developed in the context of a clinical network model of large centres where new treatment centres have appropriate staff and equipment resources based around a minimum four to six linear accelerator treatment capacity.

The development of a modern radiation therapy centre is an extremely complex process which requires the installation and integration of high technology treatment equipment and the parallel appointment of an extensive range of health care professionals, particularly in the fields of radiation oncology, radiation therapy-therapeutic radiography, medical physics, engineering and information technology and oncology nursing. The group developed a series of guidelines to facilitate the future identification of suitable locations for the development of additional radiation therapy facilities. These include a sufficient patient population existing within a proposed catchment area to support the existing and future development of a radiation oncology service.

The resident population of a catchment area and, as a consequence, the extrapolated patient caseload is an important indicator of future patient referral, access and use of a radiation oncology centre. The group agreed in principle with the existing international recommendations that a population of greater than 650,000 should be, where possible, the minimum preferred population necessary to support a radiation oncology unit. Based on the 2002 census, the current population of the South Eastern Health Board area is 414,000. The minimum preferred population of itself is not sufficient without adherence to additional guidelines highlighted in the report, which include appropriate staffing and location at or linkage to a university teaching hospital.

Having considered the report, the Government agrees that a major programme is required to rapidly develop clinical radiation oncology treatment services to modern standards. Furthermore, the Government has agreed that the first phase of such a new programme should be the development of a clinical network of large centres located in Dublin, Cork and Galway, providing services for adjoining regions. These centres will collectively have the staff and treatment infrastructure to permit a rapid increase in patient access to appropriate radiation therapy and will form the backbone of the future service expansion. This Government agrees with the report’s conclusion that this is the best model to rapidly provide a radiation oncology service. In addition, the Government has also decided that in the further development of services, consideration should be [453]given to developing satellite centres in the south east, mid-west and north west. Such consideration will take into account the international evaluation of satellite centres, the efficacy of providing this model and the need to ensure quality standards of care.

I wish to take this opportunity on behalf of the Minister to outline the significant progress which has been achieved to date in the implementation of this report since its launch last October. The report recommends that there should be two treatment centres located in the eastern region, one serving the southern part of the region and adjacent catchment areas and one serving the northern part of the region and adjacent catchment areas. The Chief Medical Officer at the Department of Health and Children has been asked to advise the Minister on the optimum location of radiation treatment facilities in Dublin. A detailed request for proposals issued last week to relevant hospitals. Hospitals have until 8 October 2004 to submit proposals for the organisation and development of radiation oncology services in the context of the delivery of supra-regional services.

The immediate developments in the southern and western regions will result in the provision of an additional five linear accelerators. This represents an increase of approximately 50% in linear accelerator capacity. We have also provided for the appointment of an additional five consultant radiation oncologists. This includes three additional consultant radiation oncologists at the emerging centre in UCHG, two of whom have significant sessional commitments to the Mid-Western and North-Western Health Boards. Two additional consultant radiation oncologists will be appointed at CUH, with significant sessional commitments to the South-Eastern and Mid-Western Health Boards. Recruitment for these posts is underway. We currently have ten consultant radiation oncologists nationally. This will result in a significant increase in the number of patients receiving radiation oncology in the short term.

On the development of an equitable service that provides equal access for all, I wish to take this opportunity to assure the House that the principles of equity and access will underpin the development of future services. Radiation oncology centres will be required to provide services on an equitable basis which will ensure that patients of equal need will have equal access, regardless of where they live. This task is not without challenges. It will require the development of innovative transport and accommodation arrangements for patients in outlying regions.

The national radiation oncology co-ordinating group was established by the Minister on foot of the expert group report. The group comprises clinical, technical, managerial, academic and nursing expertise from different geographic regions. The group’s remit encompasses the development of proposals to facilitate improved access to existing and planned services, including [454]transport and accommodation. The group is currently developing proposals in this area which will involve consultation with all health boards.

Recently, the Minister approved €1 million in funding to develop a national tele-synergy network for oncology services involving the current and planned providers of radiotherapy at St. Luke’s Hospital, Cork University Hospital and University College Hospital, Galway. These hospitals will operate as major tele-oncology nodes within a clinical network of hospitals linked to other hospitals outside their health board or authority functional areas, referring patients to the radiation oncology centres for clinical treatment or related services.

The aim of the network is to improve service delivery and efficiency, to better use consultants’ time, reduce consultant and patient travel and support earlier and better diagnosis. This will have important benefits for radiation oncology services in the south east. Tele-medicine is a key enabling technology to improve the networking of radiation oncology centres with outreach hospitals, thus supporting expert case review, multidisciplinary meetings, education and research.

The developments under the expert group report describe an overall framework through which radiotherapy services can be developed and provided in the most co-ordinated and effective manner. The expert report on the development of radiation oncology services marks a significant milestone in radiation oncology services nationally and its guidelines and recommendations are essential in the development of these services for cancer patients over the next number of years.

Mr. Cummins: Information on Maurice Cummins  Zoom on Maurice Cummins  The bottom line is that the Government continues to ignore Waterford. However, it does so at its peril and the next general election will be similar to the recent local elections. There is no solace in the Minister of State’s response for the people of Waterford and those suffering from cancer.

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