Plan to restructure cancer care in hospitals

The Government's new strategy for the provision of cancer care is to recommend a radical restructuring of how hospitals treat the condition.

The blueprint, to be finalised next month, will propose the establishment of four integrated networks of specialist cancer units, each with a catchment population of around one million people.

Two networks are expected to be led from Dublin, while the others would be led from Galway and Cork.

Hospitals in the network would be designated as regional or supra-regional centres.

The Government's advisory body on cancer care, the National Cancer Forum, which is drawing up the strategy, will recommend that hospitals designated as regional centres should treat only certain types of common cancers such as breast, colon, lung (except surgery) and prostate.

The second tier of hospitals, the supra-regional centres, would deal with cancer of the pancreas, oesophagus, lung (surgery), rectal and gynaecological malignancies.

A small number of cancers, such as those of the brain and bone, as well as children with tumours, should be treated in national centres, the forum will recommend.

Controversially, the forum will also propose that State investment in cancer-care equipment and technology should be based on the specific designation of the hospital.

Confidential internal documentation, drawn up for members of the forum earlier this month, maintained that "it would not be justified in terms of caseload, staffing or cost to have each cancer centre equipped to the same specification".

The forum documents recommend that hospitals designated as regional centres should have X- ray, CAT scanning and ultrasound facilities, and provide surgical, medical oncology and haematology services.

The hospitals designated as supra-regional centres should have radiotherapy facilities, MRI scanning services and should provide complex surgical and genetic services.

The forum proposes that sophisticated PET scanning services and bone marrow transplantation should be reserved for the national centres.

The forum documents indicate that smaller hospitals could lose out on some services under the restructuring.

"There is uncertainty over the ability of smaller hospitals to adapt and implement future changes in the delivery of cancer care, especially for complex cancers.

"Several factors contribute to this uncertainty, including insufficient caseload to maintain clinical expertise in the use of complex treatment techniques, staff training, quality assurance and risk management strategies," the documents say.

The forum documents also indicate that the new strategy will contain a charter of patients' rights in relation to cancer services.

The documents also argue that "it is essential" that the Government implements in full the provisions of its primary care strategy.

This would see the expansion of teamworking between GPs and other healthcare professionals.