Several small hospitals would lose specialist cancer surgery services under proposals drawn up by the Government's main advisory body on oncology, writes Martin Wall
In a confidential internal discussion document, the National Cancer Forum argues that arrangements for delivery of cancer services in Ireland do not generally accord with best practice and there should be greater centralisation of specialist services.
It says there are clear differences in treatment and survival outcomes for patients with cancer depending on where they live, revealing that a report on five-year survival from cancer, carried out by the National Cancer Registry, had found significant differences in treatment patterns between health board areas.
The report suggests some hospital units see too few patients with particular forms of cancer and recommends centralisation of care into regional and supraregional centres.
The document forms part of the preparation of a new overall national cancer strategy that is due to be finalised later in the year. But the implementation of the recommendations could propel the Government into more controversy over health policy as local communities have traditionally viewed any move towards centralisation as a downgrading of local hospitals.
"International experience in oncology surgery especially in relation to complex procedures is that it should be limited to those hospitals that have adequate case volume and the appropriate skill mix and support services in the various modalities of care.
"There is insufficient case volume to support the number of consultants and hospitals engaged in oncology surgery," the internal discussion paper states.
Forum chairman Prof Paul Redmond said last night there was abundant evidence that when there was sufficient volume of patients being treated by multi-disciplinary teams that the outcome for patients with common cancers improved. He said the practice of doing the occasional case of particular surgery each year could not be continued.
He accepted that while some of the smaller hospitals could lose some types of cancer care under the proposals, they would not be completely excluded. Some smaller units, he said, could play a lead role in the delivery of some forms of treatment or surgery for specific forms of cancer.
The proposals for regional, supraregional and national cancer centres are broadly in line with the recommendations of the Hanly report. The proposals would also be in keeping with the recent Hollywood report, which recommended that radiotherapy facilities be concentrated in four areas.
In its discussion paper, considered at a meeting in Government Buildings in July, the forum proposes that there should be a network of hospitals with a defined role in the provision of integrated specialist cancer care.
It argues that a small number of expert cancer centres must deliver or directly lead the delivery of care to those with the condition.
Prof Redmond said there were two models under discussion by the forum. One would see the proposed cancer networks tied into the Government's hospital reforms so that there would be four cancer networks, one for each of the proposed healthcare administrative regions.
The other option would be for hospitals around the country to seek accreditation on the basis of facilities and skills available to specialise in the treating of particular forms of cancer.
The document says the proposed specialist cancer centres should serve a minimum population.
The forum document was drawn up on foot of submissions from groups such as the Royal College of Surgeons in Ireland and Comhairle na nOspidéal, the State agency that regulates senior consultant appointments in hospitals. According to the forum report, Comhairle na nOspidéal accepted there were "a significant number of consultants doing small numbers of certain procedures and this may lead to worse patient outcomes".