Cancer care problems widespread, expert says

[ by  www.irishhealth.com]

The doctor whose concerns initiated the suspension of the breast cancer service at Barrington’s private hospital in Limerick says shortcomings in cancer care exist in both public and private hospitals.

“It is not only the private sector. There are other hospitals [apart from Barrington’s] that are private that have similar difficulties, and there are HSE hospitals, smaller ones, which are similar.”

Dr Rajnish Gupta, Regional Director of Cancer Services in the Mid-West, told irishhealth.com that he totally agreed with the eight centres of excellence plan for cancer care announced in September.

But he said continual buck-passing between the Health Service Executive (HSE) and the Department of Health was getting in the way of effective reform.

"It is a collective problem, in the whole institution, beyond breast cancer," Dr Gupta said.

“When you look after ladies with breast cancer, it is the whole management of the lady that is needed,” he said. “The majority of those being tested will not have cancer, so you must make sure that you pick up those who do. Then all aspects, surgical, radiological, oncological, breast care nursing, must be provided.”

In August all breast cancer services at Barrington’s were suspended at the request of the Department of Health, and an inquiry was set up into cases going back four years.

Dr Gupta had written to the Health Information and Quality Authority (HIQA) in late July. He told irishhealth.com that he had been worried about Barrington’s for a number of years.  However as Barrington’s is private, HIQA’s remit, like the Department of Health, does not extend to private facilities.

So the review announced, to be chaired by Henrietta Campbell, the former Chief Medical Officer in Northern Ireland, is independent of the Department of Health. Barrington’s is co-operating with the inquiry and will have right to comment on any draft report.

Dr Gupta said it was an anomaly that the health authorities said they had no power over private operators, yet sent many people for private procedures under the National Treatment Purchase Fund.

“I don’t understand why the Minister could intervene in private nursing homes, but cannot intervene in other private situations.”

He expressed concern at private laser surgery and plastic surgery, which is not regulated.

Dr Gupta said he feared the over-reliance on management lines and bureaucracy in the HSE was interfering with effective patient care. "Our hospital manager now has to sign for orders of paper, and I heard of one case where a general manager had to sign for two boxes of elastic bands," he said.

He said this was inappropriate use of a senior manager's time, and that responsibility should be taken for more important issues.

Dr Gupta said professionals in the HSE were currently being 'crucified' because of the budget over-spend. 

The Barrington’s cases are totally unrelated to the situation at the Midland Regional Hospital in Portlaoise. A radiologist from there is on administrative leave and 3,000 mammograms have been re-examined. Forty-two were found to need a re-check.

Seven women have been told they do have cancer, having originally been given the all-clear.

The HSE has since listed 20 cancer centres around the country in which it has confidence that multidisciplinary breast cancer care is being delivered.

Mullingar Hospital was excluded from this list and its breast services are to move to the Mater, while
Portlaoise's services at to link with St Vincent's in Dublin.

As part of the plan to centralise cancer services in eight major centres, breast cancer services have already been discontinued in 13 other smaller centres around the country.

noreen(noreenx)  Posted: 15/11/2007 16:25

I think it is all very well that cancer care units are being moved to improve quality but a procedure should be put in place for those people who have to travel. When I had cancer 7 years ago, I had to go to Dublin for my chemo and radio treatment. It was very costly travelling by bus,train and cr and when I was feeling very sick, had to rely on family and friends to take me up and down.

Anonymous   Posted: 16/11/2007 09:19

This Noreen has been totally overlooked. The Canadian model may well provide excellent standards or care and the new centres of exellence may be second to none but they are of little use if patients cannot travel to them. Excellence in isolation is not excellence.

JamesH  Posted: 16/11/2007 12:02

Anon & Noreen, the issue of travel has not been overlooked and had repeatedly been mentioned by the Irish Cancer Society. It should be an issue that can be addressed. Don't forget that BC Canada is geographically the same size as France & Germany together (i.e massive compared to Ireland) and yet they only have 4 centres of excellence. The fundamental thing is that if the public and politicians are fully committed to the overall idea, all obstacles such as travel can be overcome. The alternative is to continue as we are, with poorer survival rates than the international best practice. If you want obstacles to stop us moving towards international best international practice, that is easy to do. The brave, hard but right thing is to come up with ways of overcoming the obstacles.

brandy  Posted: 16/11/2007 21:09

Sirs, If I read the 'article' correctly...it only confirms what many of us believe....that over-bureaucratising (in order to develop votes for the 'important' people) is endemic in our 'so-called' democracy!!! Can we not now, if we are intelligent/righteous enough, realise that ALL HUMANS HAVE A RIGHT TO EQUAL HEALTH-CARE...no matter where they live or no matter what their circumstance ?? Noreen...the 'so-called' Celtic tiger' was a 'lovely' device used by so many political 'wannabees' to convince voters that 'King Midas' would rub-up against them!! In my opinion this was only a 'ruse' to insure their ample opportunity to provide for themselves and their families on the gravy train ! If some one did an independent audit on how much tax-payer's money was 'wasted' in the 'celtic-tiger' years...as opposed to securing health for the electorate...perhaps people would realise what a corrupt country we 'agree' to live in !!

Anonymous   Posted: 19/11/2007 10:30

Yes James, travel (i.e. access) SHOULD be an issue that can be addressed - but will it be? I have my doubts. Canada is geographically the same size as France & Germany together, they only have 4 centres of excellence but an excellent transport system. IF politicians are fully committed to the overall idea - and it's a big IF, all obstacles such as travel can be overcome, but will they. I mean it's a lovely system for me, living in the suburbs and my mother with her family close by but not so good for those in isolated areas

JamesH  Posted: 19/11/2007 11:43

Anon, I agree that "if politicians are fully committed to the overall idea - and it's a big IF, all obstacles such as travel can be overcome, but will they". I would go further and say that all members of the public need to be committed to the overall idea and march in the streets to have it implemented as soon as possible in order to deliver a service to best international practice. However, my fear is that a lot of the public are going with the "what we have, we keep" attitude and lobbying their local politicians on this basis. You then have the Sligos & Mayos and so on, marching on the streets to try and hamper the implementation. The Gov have (for a change) produced a national coherent strategy to replace the fragmented, ad hoc service that we currently have. Don’t forget that it is the current service that delivered Portlaoise, and you have the local politicians and local people campaigning to keep it.!!! So yes I am worried when I hear people talking about travel as a reason not implement the new strategy. This I believe is the wrong attitude. Politicians will go with the public flow; that is their nature in the world of vote-getting. So it is down to the public to demand a service based on the best available internationally, instead of finding excuses to remain with the status quo. I fear that deep down they want a world-class service at their particular doorstep even though this is impossible to achieve at everyone’s doorstep in a low population like Ireland.

r(MQZ11200)  Posted: 19/11/2007 14:32

I am beginning to wonder why this debate is being dominated by travel discussions!This is not the 1950s.The vast majority of people have easy access to a car nowadays. In any event there will be chemotherapy available in far more hospitals than the so called centres of excellence-this takes up most of the travel times as chemo sometimes needs weekly trips. The most important thing is that these units are funded and built quickly. Finally I see on the news that women are calling for a centre of excellence in the midlands.If one looks at the figures there were less than 50 cases treated in 2006 in Tullamore,Portlaoise & Mullingar combined.Women are already travelling to the larger centres in great numbers

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