Statement on Cancer Services by Minister for Health and Children Mary Harney, T.D. Seanad Eireann, Tuesday 20 November 2007

20 November 2007

At the outset I want to reiterate the apology I made in the House to those women at Portlaoise who had been caused needless anxiety by a necessary review of their mammograms. Most of all, I apologise to those women who have been badly let down by a false negative initial reading of their mammogram. We owe it to them to do all in our power to ensure it never happens again. At the very least, these women are now to get the expert care they should have received from the start.

I welcome the opportunity of the debate to reiterate our plans to deliver the best possible cancer care and control in Ireland.

There is one, and only one, over-riding motivation in this. It is not about money. It is not about hospitals and institutions, winners or losers. It is not about consultants and staffing. It is not about constituencies or counties, rural versus urban, East versus West, large versus small, town versus country, HSE versus Health Boards. It is about none of those.

It is simply about the best cancer care.

We are going to make significant changes in cancer care because it is the best way to offer the best cancer care possible to all present and future patients in Ireland.

I say to women and men, if you have cancer, this plan will give you the best chance of survival.

If you are worried about cancer, this is the best assurance we can give you that the best care will be there if you need it.

If you live in rural Ireland or outside a major city, you deserve the same care as a person living right beside a major cancer hospital. And you will get it.

It is a fundamental to this cancer plan that you will get the best cancer care, completely independent of your income, your address or your age.

We can only do this, and we will do it, for all the people of Ireland with teams of cancer specialists working together in major centres on a large number of cases.

We will provide you with as many aspects of your cancer care as close to your home as possible. And if you do need help traveling to a major centre for surgery, for example, we will assist you too.

We are at the start of this journey to achieve these things. I recognise that, in some parts of the country, people are worried, as we leave present and past arrangements behind, will we really reach the destination?

I am very confident we will. And I am also confident that we will bring with us the best aspects of what we have provided up to now, as we expanded our cancer services in recent years. There are excellent individual surgeons, excellent nursing staff, excellent levels of real care and support being provided. We value it all, and I am determined that none of it will be lost as we make the transition to the best quality assured cancer care we can possibly organise.

We will work with all concerned who provide care now to make sure of this.

Background

The background to our plans is the following. Last year, the Government strongly endorsed ‘A Strategy for Cancer Control in Ireland 2006’ which was prepared by the National Cancer Forum and launched in June 2006.

While the HSE is the centre piece of the delivery of these services, the framework also provides for the role of HIQA and the voluntary sector. It also makes recommendations to allow quality of care standards to be applied equally between the public and private sector.

The implementation of the Cancer Control Strategy is a major priority for me and for the Government. It is one of the very basic reasons why we set up the HSE to replace the Health Boards, so that national level decisions could be made and implemented to deliver the best possible health outcomes nationally, for all people. I believe that there is now a real opportunity for cancer control to be the key driver of the overall health reform programme. It will require a significant change in how things are done at the moment. To facilitate this, the HSE has decided to establish a National Cancer Control Programme and to appoint Prof. Tom Keane as its Director.

Prof. Tom Keane took up his position yesterday. He is on secondment from his post as Consultant Radiation Oncologist and Head of the Division of Radiation Oncology at the British Columbia Cancer Agency in Vancouver. I wish to acknowledge the valuable contribution by the British Columbia Cancer Agency to the Irish healthcare system on seconding Prof. Keane for a period of two years to lead and manage the establishment of the HSE National Cancer Control Programme. Prof. Keane has my full support and that of the Government in this regard.

HSE National Cancer Control Programme

Prof. Keane is expected to quickly designate clinical national leaders for Radiation, Surgical and Medical Oncology. I understand that the HSE is making arrangements to enable him to take control of all new cancer developments from 1 January 2008 and progressively all existing cancer services and related funding and staffing.

Working with people, Prof. Keane intends to designate the locations for a range of cancer specialties (from among the eight centres) by early January. He will therefore be engaging in detailed planning to facilitate these designations and the orderly phased transfer of services between locations.

The designation of cancer centres aims to ensure that patients receive the highest quality care while at the same time allowing local access to services, where appropriate. Patients enjoy a 20% improvement in survival if they are treated in specialist centres which provide multidisciplinary care. Where diagnosis and treatment planning is directed and managed by multi-disciplinary teams based at the cancer centres, then much of the treatment (other than surgery) can be delivered in local hospitals.

The implementation of the managed cancer control networks will mean having the appropriate capacity at the cancer centres as we move services from other locations. It will be necessary for the distribution of other acute services in the hospital sector to be rebalanced by the National Hospitals Office. It is likely that those hospitals withdrawing from the provision of surgical oncology will be in a position to receive non-oncology services displaced from the cancer centres as a result of their increased oncology workloads and resulting demands on core services and facilities.

The HSE plans to have completed 50% of the transition to the eight designated cancer centres by end 2008 and 80-90% by end 2009.

Changing how we do things

Much has been spoken about the requirement for extra resources to be provided in the designated centres in support of the implementation of the standards for symptomatic breast disease.

This is fundamentally about bringing together people with the best expertise together to deliver the best care. Building up our centres of excellence is about continuing to build up teams of excellent people delivering excellent care in major centres. That’s what we will see – not necessarily new cranes on the skyline and new buildings. Of course, we will continue to add investment to provide facilities for patients and to support clinical expertise. But the main focus will be on people working together in new ways.

We will be changing how we do things, not simply doing more of what we do already. In Ireland, we have high admission rates for cancer compared to other countries. And when patients with cancer come into hospital, they spend on average far longer in hospital than patients in other countries, that is, longer than they need to.

We know, therefore, that we can make better use of our existing hospital resource for cancer patients while not compromising on the objective of improving the quality of care and improving cancer survival. To exemplify this, I am advised that there is very significant variation in the time that patients with similar care requirements spend in hospital as between different centres. The average length of stay for patients having breast cancer surgery, for example, between hospitals varies from as low as four days to in excess of ten days. The best patient care should mean that people are ready to go home as quickly as possible, the moment they are medically ready, as they would wish.

We have been making progress in this area too. From 1997 to 2006, the length of stay for women having breast surgery has fallen by three days on average, from 9 to 6 days. The effect of this is that we have increased the number of women who have been treated with surgery each year by almost half - 44% - while at the same time actually slightly reducing the numbers of bed days that they require. This not only represents a significant improvement in the efficiency of our hospitals, but it is a significant improvement in access to the services that women with breast cancer have received in the last decade. No patient wants to stay in hospital longer than medically necessary. So let us ensure that this trend continues.

Symptomatic Breast Disease Services

I am expecting Prof. Keane to make a significant priority of symptomatic breast disease services. I am confident that there is now a clear pathway that is understood by all to enable the implementation of the Quality Assurance Standards for Symptomatic Breast Disease Services in accordance with the timeframes set by the HSE last September. I welcome the important and significant progress made by the HSE in announcing the cessation of services in hospitals undertaking low volumes of breast cancer surgery.

Yes, the difficulties in recent months have been a source of worry for the women concerned, for their families and for the wider public. However, we must begin to learn the lessons from these cases, and to take all actions necessary to minimise the chance of mistakes.

I strongly favour a culture of blame-free reporting of adverse incidents and I look forward to this being promoted more in our health services.

Quality Assurance Standards for Symptomatic Breast Disease

At present there are approximately 2,500 (new) breast cancer cases per year in Ireland. Data quoted in the OECD Report published last week shows that there has been a very rapid increase in survival for breast cancer in Ireland in the last decade – greater than in most other OECD countries. We are now getting close to the EU average. We ourselves recognise that there is room for improvement in cancer mortality relative to other EU 15 countries - a fact that has already been clearly set out in the Strategy for Cancer Control. That is precisely why the journey we are embarking on now is so necessary.

The two most important contributors to improving this pattern will be enhanced access to earlier diagnosis through the roll-out of BreastCheck and the implementation of the Quality Assurance Standards for Symptomatic Breast Disease Services. BreastCheck has commenced the screening process in the South and the West.

Cancer Survival

There have been major developments and improvements in cancer services over the past number of years. Ongoing work in the National Cancer Registry shows that survival for most cancers continues to improve in Ireland — for example, breast cancer patients diagnosed during 1999-2003 had a 5-year relative survival - 6.7% points higher than those diagnosed 1994-1998. But clearly there is some way to go before we can attain the survival performance of the best European countries.

Support required from Medical Community

I particularly want to appeal to our doctors to work with us and lead this change to the best cancer services. All doctors are aware of the evidence about what provides the best outcomes for their patients. I am encouraging them to support Professor Tom Keane in the tough challenge he has taken on as Director of the National Cancer Programme. With the support of the many excellent cancer doctors that we have at the moment, I am confident that Professor Keane will succeed.

Monitoring Arrangements

I will chair regular review meetings involving the HSE and Prof. Keane to monitor delivery of the programme. Progress will also be considered on an ongoing basis by the Cabinet Sub-Committee on Health & Children. My Department will engage on an ongoing basis with the HSE in relation to detailed arrangements for the progression, monitoring and evaluation of the programme.

Public Opinion

I believe that one result of recent events is that the public better understand and accept the rationale for the development of cancer centres and the changes that must follow. It is now incumbent on all of us in the health system to ensure that we deliver on this.

Conclusion

In conclusion, a Cheann Comhairle, there have been major developments in cancer control.

We are embarking on a journey towards the best cancer care we can provide in our country. We will take with us the value we have built up in the recent expansion of cancer services. We are asking people to come with us. There will be no reduction of cancer care services as we go on this journey, only an assurance of improvement in quality and outcomes.

We are moving in the right direction and we have a national leader in Prof. Keane to ensure cancer is given the priority and expertise it deserves.

We will work to ensure the implementation of the National Cancer Control Programme is fully supported and that it is given every opportunity for success and ultimately for excellent patient treatments and care. This can and will benefit our cancer patients nationally and prove that Ireland can become a benchmark for other countries in the provision of quality assured cancer care. Both I and the Government are committed to delivering these improvements.