Deficiencies in care of cancer

NOW THAT we have three reports into suboptimal breast cancer care in the State - the Portlaoise, Barringtons and O'Malley investigations - it is timely to reflect on what their findings mean for cancer care and the wider health system.

It is clear that women with breast cancer have been exposed to an unacceptably wide variation in the standard of care provided by different hospitals in the State.

Although many units offered patients good quality care in line with the O'Higgins guidelines on the management of symptomatic breast disease - based on a vital framework of multidisciplinary care and triple assessment - others did not. A common theme emerged from the reports: ad-hoc and suboptimal care has caused missed diagnosis, haphazard investigation and unnecessary surgery in public and private hospitals.

This is unacceptable when it has been clear from as far back as 2000 that women with breast cancer are at least 20 per cent more likely to survive if they are treated in specialist centres operating to best practice guidelines. As the most common fatal cancer in women and one where mortality in the State is 15 per cent higher than the EU average, the inadequacies exposed by the breast cancer reports partially explain these statistics.

On a positive note, we can look forward to the implementation of plans by Prof Tom Keane, interim director of the State's national cancer control programme, to establish eight specialist breast cancer centres here.

He is committed to ensuring that 60 per cent of women will have access to optimal breast care by the end of this year, with 90 per cent assured of top quality treatment by December 2009. But Prof Keane must be vigilant to ensure that neither financial constraints nor local political considerations stymie his plans.

The reports also show a need for clinical leadership in the health service. Although they demonstrate an excellent quality of care by some doctors, elsewhere it is evident that senior doctors need to play a more active role in ensuring the services they offer do not fall short of minimum standards. It is incumbent on them to face up to this task irrespective of the difficulties caused by centralised financial control and management diktat.

What of the implications of the breast cancer reports for the wider health service? Rather than providing reassurance to the public, they raise issues of significant ongoing concern. The Health Service Executive (HSE) has been shown to lack clinical governance, with poor communication endangering patient safety. A lack of statutory regulation in the private hospital sector must also be remedied.

It is significant however, that while a TNS mrbi poll in this newspaper last November found that some 53 per cent of people believed the health service had deteriorated in the last three years, just 4,000 people came out in support of a trade union backed health system protest last weekend. This may be a sign the public is suffering from health reform fatigue. Or it could be that, despite systemic problems, people have faith they are likely to be looked after adequately when illness strikes.

© 2008 The Irish Times

This article appears in the print edition of the Irish Times