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Comprehensive cancer care must be provided in public healthcare system – Ó Caoláin

7 November, 2007


Speaking during Statements on Cancer Care in the Dáil today Sinn Féin Health Spokesperson Caoimhghín Ó Caoláin TD criticised Health Minister Mary Harney's statement in response to the scandal at Portlaoise Hospital.

He said, "One can only gasp with astonishment at Health Minister Harney's statement in response to this crisis. She said 'It has happened because of our failure in the past to put in place centres of excellence, which could never have happened under the old health board regime.'

"She speaks of 'our failure' as if it were the failure of Irish society as a whole. But Minister Harney and Taoiseach Ahern have been in government continuously for over a decade now. They have had at their disposal resources undreamed of by any previous government, the fruit of the most prosperous era in the history of the Irish economy. Yet they have presided over failing, chaotic and inequitable health services. They have failed to meet the needs of the people at national, regional and local level. They promised us a world class health service. We have a two-tier, disorganised, disjointed and ailing health service. And this Government's main so-called solution is privatisation.

"I totally refute the gross misrepresentation by the Minister and the HSE chief when they claim that people are opposed to centres of excellence. I have not heard anyone speaking in opposition to such centres. I have not heard anyone say that there should be centres of excellence for cancer at every hospital in the country.

"What has been said and rightly said is that existing cancer services cannot and must not be taken away in the absence of centres of excellence. That is what this Government and the HSE are trying to do.

"Look at the debacle over the provision of radiotherapy, a key component in centres of excellence. Minister Harney wanted these provided by public-private partnership. A report to the HSE said that this process would take until 2015. We then heard a series of conflicting statements from Minister Harney and Professor Drumm with the HSE chief saying the public system can provide the radiotherapy facilities. We have heard conflicting dates for the provision of centres of excellence - 2009, 2011, 2015. The need for these centres has been officially identified since 2000.

"What is needed urgently by our whole population is comprehensive cancer care provided in the public healthcare system and available to all based on need alone, regardless of ability to pay and without discrimination based on geographic location. Nothing less is acceptable." ENDS

Full text of Deputy Ó Caoláin's contribution:

Statements on Crisis in Cancer Care 7.11.07

People throughout the country have been absolutely appalled at the plight of the women who were given the all-clear after breast cancer screening but who have now been diagnosed with cancer. Many more women may well be affected. Our sympathy and solidarity goes to these women.

It is scandalous that so many women should have been let down so badly. 3,000 mammograms have been reviewed in the Midland Regional Hospital in Portlaoise alone. The same may be required in other hospitals.

There are now conflicting claims about what lies at the root of the mammography scandal at Portlaoise. There is an urgent need for a thorough investigation. Any investigation must be open and transparent.

Thousands of women must feel betrayed and bewildered as they listen to the conflicting claims.

Neither the Health Service Executive nor Health Minister Mary Harney can shirk their responsibility for this situation. The HSE is directly responsible for public hospital services. It has a duty to ensure that proper standards are maintained.

It is disgraceful for HSE Chief Executive Professor Brendan Drumm to try to shift the blame for this situation onto the people of Portlaoise and the Midlands because, like people in other regions, they have opposed any threatened downgrading and loss of services at their hospital.

The claims of Health Minister Harney and of Professor Brendan Drumm in relation to the mammography scandal have been totally undermined by the letter revealed yesterday. The letter to management at the Midland Regional Hospital, Portlaoise, and dated 13 December 2006, from the radiology department advised that to deliver the highest standard of patient care it needed an imaging system, which could produce mammograms of the best possible diagnostic quality.

The correspondence expressed concern about the age of the mammography machine and advised that a digital system was needed instead of the film system, which at times was affected by dirt from the darkroom environment.

This morning another radiologist, David O'Keefe of Galway, has stated that there is inadequate regulation of radiological equipment in our hospitals. He pointed out that it has been recognised since 2002 that standards were required but that there had been no agreement. And, most damningly, he claimed that agreement was still being delayed because of the reluctance of the HSE and the Department of Health and Children to replace old equipment. I want to hear the Minister's response to that. If that claim is true it is a huge scandal in itself. Are patients being denied proper screening because the Government and HSE will not spend the money on new equipment?

So much for the claim of the Minister for Health and Children that the problem in Portlaoise arises from the absence of centres of excellence. So much for Professor Brendan Drumm's disgraceful attempt to blame the people of Portlaoise and the Midlands for this scandal.

One can only gasp with astonishment at Health Minister Harney's statement in response to this crisis. She said:

"It has happened because of our failure in the past to put in place centres of excellence, which could never have happened under the old health board regime."

She speaks of 'our failure' as if it were the failure of Irish society as a whole. But Minister Harney and Taoiseach Ahern have been in government continuously for over a decade now. They have had at their disposal resources undreamed of by any previous government, the fruit of the most prosperous era in the history of the Irish economy. Yet they have presided over failing, chaotic and inequitable health services. They have failed to meet the needs of the people at national, regional and local level. They promised us a world class health service. We have a two-tier, disorganised, disjointed and ailing health service. And this Government's main so-called solution is privatisation.

I totally refute the gross misrepresentation by the Minister and the HSE chief when they claim that people are opposed to centres of excellence. I have not heard anyone speaking in opposition to such centres. I have not heard anyone say that there should be centres of excellence for cancer at every hospital in the country.

What has been said and rightly said is that existing cancer services cannot and must not be taken away in the absence of centres of excellence. That is what this Government and the HSE are trying to do.

Look at the debacle over the provision of radiotherapy, a key component in centres of excellence. Minister Harney wanted these provided by public-private partnership. A report to the HSE said that this process would take until 2015. We then heard a series of conflicting statements from Minister Harney and Professor Drumm with the HSE chief saying the public system can provide the radiotherapy facilities. We have heard conflicting dates for the provision of centres of excellence - 2009, 2011, 2015. The need for these centres has been officially identified since 2000.

Minister Harney and Professor Drumm castigated local campaigners. I applaud them. A year ago I stood on a platform with Co-Operating for Cancer North West in County Donegal. They were demanding a cross-border centre of excellence for cancer care in the North West which had been completely left out of the Government's plan. They rightly pointed out that Donegal people could not be expected to rely on a tentative arrangement with already hard-pressed services in Belfast. Yesterday the group met the Minister for Health and Children and were positive afterwards that there would be progress on delivering such a centre in the North West. I hope that this is the case. It emphasises the need for local and national campaigns to vindicate the healthcare rights of communities.

The Minister's plan for the location of centres of excellence with radiotherapy only in Dublin, Waterford, Cork and Galway is not sufficient. It leaves the northern half of the country very badly served. I repeat again, nobody is looking for these facilities at every crossroads. We seek regional coverage and no discrimination based on where you live. I urge the Minister to proceed with the centre in the North West and I urge her to look again at the gap in the HSE North East region and in adjacent areas north of the Border. We need a similar cross-border solution to that proposed for the North West.

This latest crisis over mammography exposes the overall lack of coherent policy and planning by Government and gross mismanagement at HSE level. On the one hand we see hospitals such as Portlaoise with out-dated equipment. On the other hand we have the situation in hospitals such as Dundalk where the HSE has allowed the new CT scanner to lie idle for months - a CT scanner personally unveiled by the Minister herself before the General Election. Where is the coherence and good management in that? Yet this is what we were promised in the brave new world of the HSE.

The crisis in mammography is mirrored in the situation with cervical screening. The Well Woman organisation has expressed concern over the ongoing outsourcing of smear tests to the U.S. for analysis, and by the absence of any clear information as to what cytology laboratories will be used to underpin the National Cervical Screening Programme from January 2008.

The outsourcing of cervical smear tests for analysis to private laboratories in the USA could lead to inconsistencies in the interpretation of results by Irish doctors, which could have ramifications for women with abnormal smears.

Before any roll-out of the National Cervical Screening programme, Well Woman is anxious to have the following questions answered in relation to smear analysis and I urge the Minister to answer them as a matter of urgency:

· If U.S. laboratories are to be used, who will take responsibility In Ireland for making judgement calls in borderline cases?

· Will this person/s be a suitably qualified and experienced cytologist?

Well Woman takes over 9,500 cervical smears each year. In the key age group of women aged 25 - 40, they estimate that some 8% of these patients will need to be referred on to the hospital system for further investigation (colposcopy).

They point out that currently the colposcopy service across Dublin is patchy. The service in Tallaght Hospital operates efficiently with acceptable waiting times, whereas the northside of Dublin is extremely poorly served with entirely unacceptable delays before women with potentially significant cervical pathology can be seen. This pressure on the northside has been made worse recently by the ending of colposcopy services in Beaumont Hospital, putting added pressure on the colposcopy clinics offered by the Rotunda and the Mater, which have not increased their capacity sufficiently to meet this extra demand on services. Well Woman perceives a greater need for colposcopy services in areas of social / economic deprivation, as can be illustrated by statistics from Well Woman's Coolock clinic - which proves a significantly higher rate of referral for GMS patients as opposed to private patients, even those who live in the same geographic area.

Well Woman informs us that to date they are unaware of any communication from the National Cervical Screening Service to primary care doctors over details of the service contract, payment to smear takers, reporting requirements, compilation of the population register, start date, how women will be contacted, etc. Well Woman believe that at this stage, this makes the quoted rollout date of January 2008 unrealistic.

All of this is very worrying and needs to be addressed as a matter urgency unless we are to have the mammography scandal repeated in relation to cervical cancer screening.

I would also ask the Minister to address the issue of cancer services in Tallaght Hospital. I am told the hospital features in a referral guide issued by the HSE in May 2007 as a hospital for patients to be referred to from general practise. The document is called "General Practioners Cancer Referral Guides" and was issued after extensive consultation by the regional oncology director of the HSE. The hospital is trying to ascertain the position as they were part of regional cancer plans in May and were removed from the plan in September. What is the position?

In conclusion, the current crisis in mammography is being used by the Minister and the HSE to justify their drive to over-centralise our hospital services and to downgrade local hospitals. That is a disgrace and it is the opposite of what is needed now. The women concerned need answers as to what went wrong. Women generally need the services and they need services that work and are seen to work.

What is needed urgently by our whole population is comprehensive cancer care provided in the public healthcare system and available to all based on need alone, regardless of ability to pay and without discrimination based on geographic location. Nothing less is acceptable.

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