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Harney bears direct responsibility for cancer waiting times – Ó Caoláin

24 April, 2008


Speaking in the Dáil today Sinn Féin Health Spokesperson Caoimhghín Ó Caoláin TD said Health Minister Mary Harney bears direct responsibility for a situation where public patients with symptoms which might indicate cancer have to wait for up to 18 months for vital tests.

Speaking during statements on cancer care Deputy Ó Caoláin said, "Last month it was revealed this week that public patients are still facing waiting times of up to a year and a half for vital tests, including colonoscopy examinations, for suspected cancers. This is in spite of all the false promises from Minister Harney and the Taoiseach about improvements in cancer care, especially diagnostics.

"Last October Susie Long died of cancer after her diagnosis was delayed for months because she was on a waiting list for a colonoscopy. At that time the Taoiseach admitted that Susie Long had been let down by the system.

"Deputy Harney has been in this Government for over a decade. She has been Minister for Health & Children since 2003. She bears direct responsibility for a situation where public patients with symptoms which might indicate cancer have to wait for up to 18 months for vital tests. There is no excuse for this.

"Health Minister Harney and the HSE are about to put in place a plan which will concentrate cancer care in just eight so-called centres of excellence, four of them in Dublin, leaving large swathes of the country without proper access. Even in advance of this, services at local hospitals are being cut. None of the proposed eight centres is located north of a line from Dublin to Galway.

"No-one is arguing for radiation oncology facilities in every hospital in the country. But eight centres with such facilities are too few and they are, as I and others have repeatedly pointed out, totally unbalanced in terms of regional spread, leaving much of the population very badly served or not served at all.

"What is needed is a truly all-Ireland and regionally based cancer treatment service. Radiation oncology should be delivered within the regions. Cancer sufferers are being subjected to long and painful journeys for treatment. Many patients feel too ill to travel and choose not to avail of radiotherapy as a result. The resources are there to deliver radiotherapy on a regional basis and the Government needs to go back to the drawing board.

"What is needed urgently is comprehensive public 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

Note to editor - Full text of Deputy Ó Caolain's speech follows:

Full text of Deputy Ó Caolain's speech follows:

Last month it was revealed this week that public patients are still facing waiting times of up to a year and a half for vital tests, including colonoscopy examinations, for suspected cancers. This is in spite of all the false promises from Minister Harney and the Taoiseach about improvements in cancer care, especially diagnostics.

Last October Susie Long died of cancer after her diagnosis was delayed for months because she was on a waiting list for a colonoscopy. At that time the Taoiseach admitted that Susie Long had been let down by the system.

Deputy Harney has been in this Government for over a decade. She has been Minister for Health & Children since 2003. She bears direct responsibility for a situation where public patients with symptoms which might indicate cancer have to wait for up to 18 months for vital tests. There is no excuse for this. The Minister says it is unacceptable. If it was unacceptable when she became Tánaiste in 1997 she has had a decade to address it and has failed. And her Fianna Fáil colleagues in Government share that responsibility.

That is the context in which we discuss the latest reports on failures in cancer care delivery.

The reports on the cases of Rebecca O'Malley and Barrington's Hospital can only be described as indictment of the Health Service Executive and its management of cancer services. Basic principles of patient care were violated by the HSE. The right of patients to information about their cases and to prompt and meaningful responses to their concerns were denied.

In the report of its inquiry into the Rebecca O'Malley case the Health Information and Quality Authority states: "The impression gained was of a system that delayed or avoided difficult decisions."

The report demonstrates that when Rebecca O'Malley raised her concerns about her misdiagnosis there was no real effort to assist her and to inform her of the facts of her case and how it had been handled. It was up to the patient herself to pursue the case through the system and with great difficulty. No-one within the hospital system or the HSE took the lead in responding to the patient.

HIQA found "a collective lack of accountability, cohesion and focus on the needs of the patient".

When the report was issued Rebecca O'Malley stated:

"I asserted myself and demanded answers to my reasonable questions. The system responded to my efforts by erecting, through ignorance or inertia, a wall of deafening silence that is so typical of the walls that patients regularly have to climb in an arduous effort to make the health system accountable to the very people it exists to serve."

The HIQA report demonstrates that the system failures with regard to patient care and properly informing patients that were exposed in the Portlaoise breast cancer scandal are replicated across the hospital system for which the HSE is responsible. The Barrington's Hospital report illustrates the lack of proper regulation and accountability of the private hospital system.

One media commentator put it very well when he said that "by over-centralising decision-making the HSE has emasculated regional managers to the point where front-line services are compromised".

Human error will always occur in the delivery of healthcare. That is inevitable. No-one should try to fool people into thinking otherwise. No system is perfect and better management cannot eliminate human error. But what the system must do is be opennd transparent. It must be prepared to admit its mistakes. Above all it must give patients full and frank information.

Will the lessons be learned? The signs are that they will not. As far as the HSE and the Government are concerned ruthless centralisation is the name of the game in both the management of our health services and in the delivery of care, especially hospital care.

Health Minister Harney and the HSE are about to put in place a plan which will concentrate cancer care in just eight so-called centres of excellence, four of them in Dublin, leaving large swathes of the country without proper access. Even in advance of this, services at local hospitals are being cut. None of the proposed eight centres is located north of a line from Dublin to Galway.

The term 'centres of excellence' has been bandied about and something needs to be said about it. We should start from the premise that every centre where cancer care of whatever type is delivered ought to be a centre of excellence. By placing the emphasis on eight centres only the Government and the HSE promote the belief that care delivery at other sites must be inferior. That is a fallacy and a dangerous fallacy. It would also be a travesty if the reports under consideration here today were to be used to promote the policy of over-centralisation.

No-one is arguing for radiation oncology facilities in every hospital in the country. But eight centres with such facilities are too few and they are, as I and others have repeatedly pointed out, totally unbalanced in terms of regional spread, leaving much of the population very badly served or not served at all.

What is needed is a truly all-Ireland and regionally based cancer treatment service. Radiation oncology should be delivered within the regions. Cancer sufferers are being subjected to long and painful journeys for treatment. Many patients feel too ill to travel and choose not to avail of radiotherapy as a result. The resources are there to deliver radiotherapy on a regional basis and the Government needs to go back to the drawing board.

Cancer patients have been denied life-saving treatment because successive governments have failed to provide the radiation oncology facilities that are required. The Government has had ample time and a booming economy to plan and budget for the provision of radiotherapy centres.

The State could and should have taken the lead and provided these centres directly as public facilities open to all on the basis of need alone. Instead the Government committed itself to public-private partnerships (PPP) to deliver them. Then it was found these would take too long. Then a review was ordered.

Minister Harney has told us that the planned centres may have to be provided entirely by the private sector. Professor Drumm has told us the public sector can do it. The disconnent and lack of clear management and timely and effective decision-making that has been exposed in the reports we are considering today is no surprise. It is replicated at the very top with Minister Harney and her Government colleagues and at the highest level in the HSE.

It was a cancer patient, the late Susie Long, who most recently and starkly highlighted the injustices of our two-tier healthcare system. It is a system that does not provide adequate care for cancer patients. It is a system where you can get a faster life-saving diagnosis if you are a paying customer. Public patients like Susie Long have to wait. In her case that wait in the second-class queue proved fatal.

This Fianna Fáil/PD/Green Government is attempting to shirk its responsibility for the chaotic state of cancer care services.

The mammography issue at Barrington's Hospital in Limerick has exposed the failure of the Government to ensure that private hospitals are properly accountable. The Health Information and Quality Authority was established in legislation in 2006 but it was empowered only to monitor services provided by the Health Service Executive. It does not have powers to hold private hospitals fully accountable. We pointed this out during the Dáil debate on HIQA the Bill but the Government ploughed on regardless.

Through the infamous 'co-location' scheme this Government is encouraging the development of more private for-profit hospitals without proper accountability. When we last addressed cancer care here I asked the Green Party members in Government if remember their opposition to co-location. I am still waiting for an answer.

Fianna Fáil-led Governments for the past 11 years have has presided over a catalogue of failures and delays in cancer care. These include:

· Failure to fully roll out the long-promised Breastcheck service with many women now having to wait until 2009 to get their first appointment

· Failure to deliver the long-promised radiation oncology centres.

· Failure to plan radiation oncology services for other regions, leading to totally inadequate provision in the northern half of the island. This is compounded by the failure to ensure full cross-border co-operation in cancer services.

· Failure for years to establish national screening services for cervical cancer, with such a national screening programme only due to begin this summer.

· Failure to heed the testimony of current and former patients and staff at St. Luke's Hospital in Dublin about the need to review the decision to close that centre of excellence.

When cancer was last addressed here during private members time in September the HSE cutbacks were just beginning. At that time Minister Harney and Professor Drumm said they should not affect patient care. We are only now beginning to see their full impact now. Patients are being effected right across the country.

The Government has ensured that there will be no democratic accountability for these decisions. It has insulated the HSE from any responsibility to the local communities it is supposed to serve. Minister Harney has insulated herself from proper accountability in this Dáil.

The HSE at national level is clearly not competent to strategically manage cancer care. The Government should urgently revise its plan to provide only eight centres of excellence for cancer care. It should ensure that all necessary resources for cancer care are provided and that management at local and regional level is competent to deliver these services.

What is needed urgently is comprehensive public 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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