Extra transplant consultant would save lives and money, says Crumlin cancer doctor

It is a “no-brainer” for the HSE to employ a consultant to treat children needing stem cell transplants in Dublin rather than, as is the current practice, sending them to England at a cost of €200,000 per child, according to one of Ireland’s leading children’s doctors.

Prof Owen Smith, consultant in childhood cancer at Our Lady's Children's Hospital in Dublin and Regius professor of physics at Trinity College Dublin, also says this would allow the HSE to generate income by treating children from Northern Ireland who currently also have to go to England for this specialist treatment.

The transplantation unit at the hospital already treats children with leukaemia and aplastic anaemia and “we have the beds and could also transplant those children from the Republic of Ireland with serious conditions that include sickle cell disease, Hurler’s syndrome and immune-deficiency that currently are sent to the UK at great expense”, he says.

Smith says that stem cell transplant activity at the hospital “has increased exponentially, not only in terms of numbers but also in complexity, making it one of the biggest paediatric transplant programmes in Great Britain and Ireland.”

The transplants are done at a new state- of-the-art unit – the National Centre for Paediatric Haematopoietic Stem Cell Transplant – and it is the only one on the island of Ireland to have been accredited by the European Joint Accreditation Committee (Jacie). "This is the recognised international standard for accreditation of stem cell transplant centres. We welcome the accreditation and now we want more children to benefit from the care we provide. We just need the additional expertise," he said.

Smith has given the HSE a business plan outlining the benefits of the HSE employing a consultant paediatric haematologist with a special interest in stem cell transplantation.

“Between seven and nine children a year in Northern Ireland require some sort of stem cell therapy, and these children currently go to the UK which is a nonsense really when they could come south to us where we have the capacity to do it.”

The unit in Crumlin has four High Efficiency Particulate Air (Hepa) filtered single ensuite rooms for the child and parents as well as an isolation lobby to protect the immune-compromised child from infection.

Among its patients at the moment is six-year-old Daniel Rogan from Strabane, Co Tyrone. He needed a bone marrow stem cell transplant for aplastic anaemia.

He was referred to Our Lady’s Children’s Hospital from the Royal Children’s Hospital in Belfast when a bed was not immediately available for him at Bristol Children’s hospital.

Daniel’s consultant, Dr Christine MacArtney, trained at Our Lady’s Hospital in Crumlin.

According to Daniel’s father, Brian, “When we were first told about Dublin we didn’t know anything about it but she was able to assure us about the excellent service it turned out to be. We were also able to come down and see the facility before Daniel came down. It was very reassuring to see what we were coming to and we wanted it done as soon as we could.”

It also means Daniel is not apart from his brother Matthew, who is seven, for long periods.

He had his transplant in August and now sees Smith weekly. His mother, Caroline, says, “We were able to pack up the car, come down this morning, and go back this evening for bedtime. We can see our other son and we are keeping our family together.

“You feel this is still part of your community. We feel comfortable, at ease with the people. All of the staff are fantastic.”

Brian agrees, saying, “The care is first class. It is not just the friendliness of people, it is the very professional and actual medical care he has got that is first class.

“We would like other parents and children from Northern Ireland to come to Dublin, to know they don’t have to go to England.”

The HSE pays for children from the Republic using the Treatment Abroad Scheme (Tas) and while it covers the cost of the procedure it does not cover accommodation or other costs for parents or family.

Smith said, “Would it not be good fiscal sense to deliver the service here at much less cost and in a centre of excellence that is Jacie approved?”

The HSE confirmed that since 2012, Tas has paid for 26 children with sickle cell disease, Hurler’s syndrome and immuno-deficiency problems to be treated in the UK at a total cost of €2,409,180. It said 12 of them received stem cell treatments. It refused to release the cost of any specific treatment.

Prof Smith says to start the unit in Dublin would cost under €1 million and each transplant costs about €200,000.

“You will always have these children with sickle cell disease, with immune deficiency disorders and we are talking about probably €3-€4 million leaving the country to pay for their treatment and the sums don’t add up so there is a net deficit.”

To provide the service here would, he says, generate income for the HSE.

The NHS is paying the HSE to treat children like Daniel; he is the second child from Northern Ireland to receive his treatment at the unit in the past year.

“It is a silly misuse of precious resources and it is utterly pointless doing [transplants] the current way when we can do it all here. Really it is a no-brainer and there is no bigger driver of peace and reconciliation than children and adolescent health,” says Prof Smith.

The HSE says, “Our Lady’s Hospital Crumlin has submitted a proposal to support stem cell transplantation, to include an additional transplant consultant physician, which is currently under consideration as part of the planning process for the 2015 Service Plan.

“The priorities for 2015 are dependent on the budget available to the HSE and the service priorities identified in the HSE 2015 Service Plan.”