Wednesday, 8 April 2009
Seanad Eireann Debate
Senator Jerry Buttimer: I thank the Cathaoirleach for allowing me to raise this important matter of the transfer of the breast cancer treatment unit from the South Infirmary-Victoria University Hospital to Cork University Hospital. This is my second time to raise this matter on the Adjournment. If we support the principles of the national cancer strategy, the breast care unit of the South Infirmary Victoria University Hospital should remain on that site. It is a specialised centre. It is a centre of excellence that has diagnosed and treated over many years the necessary high caseload requirement to create exceptional expertise in site-specific cancer. In 2008, the excellent staff in the South Infirmary Victoria University Hospital diagnosed 290 new primary breast cancer cases.
The co-located BreastCheck diagnosed 122 new primary breast cancer cases, all of which were treated at the South Infirmary-Victoria University Hospital, bringing the total treated to 412. In comparison, Cork University Hospital diagnosed and treated 141 new primary breast cancers.
It is frightening that retired surgeon Mr. John Kelly was forced to state at a public meeting that “if he were a woman he would be very concerned about the transfer in its current format”. It is frightening also that a leading breast surgeon, Mr. Denis Richardson, referred to the decision to transfer “as a political decision, not a medical one” in the Irish Examiner in March of this year. Why are we not listening to the clinicians involved? Do women’s lives mean so little that we can glibly enforce a decision politically that destroys a breast care unit in the region?
We must look to the national cancer strategy and the network of hospitals. Networking is possible in Dublin. The Minister’s argument that this is based on encouraging academic pursuit is spurious. The fact remains that in Cork, if the political will exists, the networking of Cork University Hospital with South Infirmary-Victoria University Hospital is advisable, feasible and is the only safe way to protect patient care. This is not about doctors or political bases or power struggles, it is about the lives of patients and their families. There are different rules for different parts of the country. Why is Cork different? Misdiagnosis, early diagnosis and detection are critical words in many women’s lives in the city and county.
The last time I raised this issue in the Seanad, I received in reply descriptive comments and vague answers that did not address a single question I asked. It was stated by the Minister of State, Deputy Moloney, that the relocation of the South Infirmary breast disease service to Cork University Hospital would create a critical mass of specialists of all oncology disciplines on a single site. That is not the case at all. In Cork we already have a critical mass of specialists of all oncology disciplines on a single site — South Infirmary-Victoria University Hospital. We can argue about radiation oncology and pathology but the bottom line is that we must rethink the implementation programme for the national cancer strategy in the context of creating centres of excellence. There is already a centre of excellence. Not all of the eight designated centres have radiation oncology or pathology. If pathology can occur on-site, someone should inform the National Cancer Institute in Washington to cancel the current largest ever worldwide breast pathology trial, the TAILORx trial. It is not too late to save €5 million of taxpayers’ money that will destroy an excellent service. We can stay on the present site.
The last time I raised this issue, I did not get the promised reply from the Department. This is not just about politics or power bases, it is about women’s lives. We have built the centre of excellence and if we are to treat people properly and with dignity, why are we dismantling it?  That fundamental question remains to be answered, as do questions about the cost factor. We can save more than €5 million by stopping the transfer. Other figures are worth bearing in mind, particularly those for diagnosis and detection in South Infirmary-Victoria University Hospital in comparison with Cork University Hospital.
Why are we not listening to the clinicians involved? Do women’s lives mean so little we can glibly enforce a decision that destroys an excellent breast care unit in the area and move it to Cork University Hospital? I appeal to the Minister of State to answer these questions and tell me the Minister will return to consult those involved.
Deputy Seán Haughey: I welcome the opportunity to set out the current position on the restructuring of cancer services, and in particular the transfer of cancer services from South Infirmary-Victoria University Hospital to Cork University Hospital.
Senators may recall that the issue of the transfer of cancer services from SIVUH was discussed in the Seanad last October. In that debate, Deputy John Moloney outlined the rationale and objectives of the restructuring of cancer services under the national cancer control strategy. 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. Although Ireland’s cancer survival rates have been increasing faster than most other countries, they are still lower than those in other OECD countries and we must focus on improving them.
There is a strong link between improved cancer outcomes and high levels of hospital activity. This means we must move away from fragmentation in cancer care to create a cancer care system that is consistent with international best practice in cancer control. The national cancer control strategy was clear that to achieve this, there should be eight cancer centres in Ireland, each serving a population of around 500,000.
Following on from the strategy, as many people will by now be aware, the HSE established the national cancer control programme to implement the strategy and designated eight cancer control centres nationally, within four managed cancer control networks. Four of these hospitals are located in Dublin, to serve the Dublin north-east and Dublin mid-Leinster regions. University Hospital Galway and the Mid-West Regional Hospital, Limerick serve the western region. The southern region is served by Waterford Regional Hospital and Cork University Hospital.
The national cancer control programme, under the directorship of Professor Tom Keane, has been working steadily to accomplish the transfer of cancer services from other hospitals into these eight designated centres. Much media and public attention has been focused on breast cancer services, which were the first priority for the cancer programme. This focus on breast cancer has tended to make us forget about the restructuring of services for other cancers and it is perhaps worth remembering that the designated cancer centres are not only breast cancer centres, they will need to deal with other complex and difficult cancers also.
However, as the debate is about breast cancer services specifically and about the transfer of these services from SIVUH, I will concentrate on this issue now. Compliance by hospitals with the national quality assurance standards for symptomatic breast disease is important in improving the quality of care in Ireland for women with symptomatic breast disease. To comply with the standards, 17 hospitals, including Mercy University Hospital in Cork, were directed by the HSE in September 2007 to cease breast cancer services. Further reductions in the number of hospitals providing symptomatic breast disease services have since taken place in line with the transfer of services to the eight designated cancer centres nationally. By the end of this year, breast cancer services will only be delivered in the eight designated hospitals plus an outreach service in Letterkenny.
In the southern region, the transfer of breast services from South Infirmary Victoria University Hospital to Cork University Hospital remains to be done. This will create a critical mass of specialists of all oncology disciplines on a single geographic site. The national cancer control programme believes that the best interests of the women of Cork and of the southern region will be served by this consolidation.
A high level planning group is in place to facilitate engagement and working arrangements for the transfer of breast cancer services. A parallel programme of work on identification of services suitable for reconfiguration and relocation is being carried out by the office of the southern network manager for the HSE.
In preparation for the transfer from SIVUH, the national cancer control programme has approved a €5 million once-off capital grant to develop the necessary facilities on the Cork University Hospital site. The relocation of services from SIVUH must await the completion of this work and is therefore scheduled for September.
The presence of BreastCheck, the national breast screening programme, will significantly reduce the number of symptomatic breast cancer presentations in the southern region. The static screening unit for the region was officially opened by the Minister for Health and Children in December 2007. This unit will remain at SIVUH for the time being following the relocation of symptomatic breast services to CUH. Approximately 12,000 women were screened in the southern region in 2008.
As I have already said, much media and public attention has been focused on breast cancer services, but it is important to remember that the relocation of breast cancer services from SIVUH is part of a much wider restructuring of cancer services with the aim, as I stated, of improving outcomes, including survival. In this regard, the national cancer control programme is this year also focusing on lung cancer and prostate cancer with the aim of improving access to early diagnosis and multidisciplinary decision making for both of these cancers. A key initiative in 2009, therefore, is the establishment of rapid access diagnostic clinics in the designated centres for these cancers. The programme is also focusing this year on the reorganisation of services for pancreatic cancer, for reconstructive surgery for head and neck cancer and for brain tumours and in this regard it has been agreed that there will be a single national programme for the management of brain tumours and other central nervous system tumours across the two sites of Beaumont and Cork University Hospital.
In conclusion, the goals of the national cancer control programme are better cancer prevention, detection and survival through a national service based on evidence and best practice for all cancers, including breast cancer. Under the programme, the Government is therefore committed to the restructuring of cancer services into the designated eight centres, including symptomatic breast disease services. Together with the roll-out of BreastCheck, the national breast screening programme, this will ensure that women will have the best chance for early detection and treatment of breast cancer.
Senator Jerry Buttimer: The Minister spoke about the relocation of services to create a critical mass of specialists of all disciplines. That is already there, in a single geographical site. The Minister also referred to the eight so-called designated centres of excellence. Not all of them have radiation oncology or pathology services. I cannot understand the logic of this transfer when BreastCheck was built on the same campus as the South Infirmary Victoria University Hospital. I am appalled about the €5 million. However, forget about the money. This is about women and giving confidence to patients, and we are not doing that. This is not the Minister of State’s responsibility and I appreciate his attendance in the House to reply on this matter. I hope he does not lose his job next week because, in fairness, he is regularly in the Seanad. However, we must give assurances to women, but we are not doing that.
|Last Updated: 15/12/2010 22:23:13||Page of 10|