Cancer service decisions delayed until after general election

Controversial decisions on the reorganisation of cancer services throughout the State - which are expected to see oncology surgery transferred from smaller hospitals to larger centres as well as the centralisation of other facilities - will not be made until after the general election scheduled for next summer.

Reforms set out in the Government's recently published cancer strategy call for the development of new regional cancer centres which would have a sufficient caseload to maintain clinical expertise, leading to improved outcomes for patients. However, a new Health Service Executive (HSE) plan for implementing the strategy proposes that these regional cancer centres will not be selected until next June at the earliest.

The implementation plan also suggests that the proposed new national director of cancer, who would run oncology services around the State, should be appointed next February.

The move towards centralisation of cancer services is expected to generate hostility from local groups opposed to the downgrading of existing smaller hospitals. However, the Government's cancer strategy states that at present there are too many hospitals and too many consultants providing surgical care for many types of cancer.

It says there is uncertainty over whether smaller hospitals can adapt and implement future changes in the delivery of cancer care as, among other things, they have too low a caseload to maintain clinical expertise.

The cancer strategy proposes the development of four managed cancer control networks, each serving a population of about one million people. Each of these would have a fully integrated service to include primary care, hospital care, palliative care, psycho-oncology and supportive care.

According to the strategy, these networks would allow hospitals to co-operate to provide services when the population base of each hospital may be too small for them to do this in isolation. "The emphasis in such a network will be on connection and partnership rather than isolation and self-sufficiency, on distribution of resources rather than centralisation, and on maximising the benefits for all patients," it says.

Under the strategy, each network would be self-sufficient in dealing with all but a small number of comparatively uncommon or complex cancers.

The new HSE implementation plan says that work on the development of the cancer centres should get under way next month. It says the criteria to be used to select the centres, as well as the process to be followed in designating these, should be drawn up next spring.

However, the actual decisions on where the centres will be located and which hospitals would provide specific services would not begin until April and would not be completed until the summer.