Achievements in cancer care
All Irish families are touched by cancer. A year ago the country was still reeling from a series of cancer misdiagnosis scandals. What has happened 2009 in cancer care is a remarkable achievement.
The cancer strategy was published in 2006 – and it recommended cancer services be centralised in eight designated centres. Up to 2007/8, cancer services provided in 35 hospitals around the country. Now they are provided in these eight specialist centres.
Because of the specialised nature of cancer and the small size of Ireland’s population, in order to provide quality cancer care, it is necessary for services and professionals to have a certain through put of patients.
Last week, the last of the eight centres in Cork was opened which means that the transition from 35 to eight hospitals is now more or less complete.
So do we now have state of the art cancer services?
No, not all of them are state of the art but they are much, much better than they were and some of them are really excellent. I was speaking to Prof Tom Keane at lunch time today. Tom Keane is an Irish doctor living in Canada who came home to be the acting head of the Cancer Control Programme for two years. He arrived in November 2008, when we were still in the middle of the misdiagnosis scandals. Speaking today, he said they were pretty close to being the best in the world in breast cancer diagnosis and care, way ahead of many countries.
Mary Professor Keane saw the biggest success of 2009 was not the transfer of services from 35 hospitals to eight within the timeframe (while he obviously is pleased with the progress) he believes that their biggest achievement was convincing the public that this is the right thing to do.
And while we know of the pubic distrust of services and the objections to closing down cancer services, particularly in Sligo, Prof Keane feels now that it is done, everyone is behind it, or almost everyone. He thinks there is a very strong consensus that the National Cancer Control Programme is the way to go.
I asked him what were the critical factors in achieving this change in mindset. He identified a few factors:
- good communications. Tom Keane is a consummate communicator – calm, convincing, very straight, political. He is a very impressive man
- persistence, both of the cancer control programme and also the political persistence behind this and here we have to give Mary Hareny credit. Most other times, there has been any attempt to centralise hospital services, politicians have buckled but she held firm. And Minister Harney has provided real leadership in radical improvements in cancer care in Ireland.
The cancer misdiagnosis scandals also had an impact. When they happened in 2008, they were used to explain why we need specialised centres and how that rationalisation has to happen to achieve quality care and patient safety and better patient outcomes.
So the change was allowed to happen by strong consistent messages, the support of the medical profession and political support and this all swayed public opinion.
Most doctors were in support of the cancer plan, knowing what was in the interest of patient safety.
What happened in cancer services was the redeployment of staff to new centres or different roles. And this is another area where Tom Keane has had great success because he managed to implement in the cancer services what the unions and government fell out over in advance of the budget ie redeployment of staff, more flexible working hours and Keane said to me today that the new eight specialist centres could not have worked without the cooperation of the unions on this.
There has also been progress in community cancer services in 2009. Traditionally in Ireland, cancer services were very hospital oriented. Currently there is a very quiet but important programme of community oncology, of educating GPs and nurses so that much of the patient’s care can be managed in the community – this results in earlier detection and better outcomes for patients.
However, there are some areas where progress still needs to be made and these are top of the NCCP priority list for 2010.
• The top four killers are colorectal, lung, prostate and breast cancers.
• The plan is to have all of these as comprehensive as breast cancer services
• Mary Harney announced a colorectal screening programme in the budget.
• the NCCP are busy getting rapid access clinics for lung and prostate cancer up and running in the eight specialist centres.
• All will be in place by middle of 2010, which means all public patients referred by a GP will be seen within 2 weeks.
Also Tom Keane has been very smart in getting cancer care money ring fenced, plus an additional €20 million has been allocated to cancer control programme in 2010 including money for two new radiotherapy in St James & Beaumont.
And although there are improvements, there are still differences in how public and private cancer patients treated. It is hard to specify this because we don’t have good data or information on it.
What we do know is that public cancer services have been significantly invested in and developed, they are centralised to eight specialist centres and much better than before.
And while 50% of the population has private health insurance, many people with private insurance are treated as public patients or in public facilities as private patients. For example, 100% of pancreatic cancer patients are treated publicly, about 80% of breast and bowel are.
When I put this to Tom Keane today his point was if you have good access and good quality services then people won’t opt for private care.
In breast cancer care, over 90% are seen within two weeks whether public or private so totally equally playing field.
The rapid access clinics are being put in place to assure this for lung and prostate cancer. But some public patients still have to wait longer for access to some aspects of cancer care than private patients.