The draft cancer strategy opts for a model of regional and supra-regional centres, writes Martin Wall.
A common theme is evident throughout the Government's main healthcare reform documents.
The controversial Hanly report recommended the establishment of networks of hospitals with services such as maternity based in regional centres. The Hollywood report proposed that radiotherapy be concentrated in Dublin, Cork and Galway.
Now the draft chapters of the Government's forthcoming National Cancer Strategy essentially opt for the same model of regional and supra-regional centres.
Both Hanly and the draft cancer strategy have major implications for the way hospitals operate. Smaller hospitals would be linked with larger centres and would concentrate on more common conditions. The critics will call it down-grading, the Government will argue that it represents an investment in their long-term future.
About 20,000 people in Ireland are diagnosed with cancer annually and around 7,500 patients die from the disease.
Draft proposals for the new national cancer strategy, which is to be finalised in February, would see the establishment of four networks of integrated hospitals, each with a catchment population of one million people.
The various hospitals in the regional network would be capable of dealing with all forms of cancer with the exception of a small number of rarer types which would be dealt with in a national centre.
Under the proposals, which were circulated earlier this month to members of the National Cancer Forum, regional hospitals would deal with the more common forms of cancer such as breast, colon or prostate.
The supra-regional centres would have a broader and more complex range of diagnostic and therapeutic services and would deal with other forms of cancer such as pancreatic, oesophageal or rectal.
"The caseload for each site specific cancer should inform the decision as to which level [ regional, supra-regional or national] in the system should take the primary lead in management," the Cancer Forum documents say. "Whereas a limited number of centres might generate sufficient workload for the management of breast or colon cancer, they could not support the management of more complex but less common cancers such as cancer of the pancreas or oesophagus."
The documents do not set out which hospitals should be designated as regional or supra- regional centres. However, they say this process should reflect existing designations in terms of radiotherapy and breast screening.
Currently radiotherapy is provided in Cork University Hospital and University College Hospital in Galway. Six Dublin hospitals are competing for a Department of Health contract to provide two radiotherapy facilities in the capital.
The National Cancer Forum has also proposed that the designation of a hospital should determine the level and type of equipment or technology provided by the Department of Health. "It would not be justified, in terms of caseload, staffing or cost, to have each cancer centre equipped to the same specifications."
The documents also propose that regional hospitals should have X-ray, CT and ultrasound facilities as well as surgery, medical oncology and haematology services. However, they say that MRI scanning, radiotherapy and complex surgery should be reserved for the supra-regional centres.
The documents maintain that it is essential that the Government implements, in full, its primary care strategy which would see the establishment of teams of doctors, nurses and other healthcare professionals.
However, large-scale State investment in the proposed new primary care centres may not come on stream until 2007 or 2008.
The strategy will also recommend that a health professional operating within primary care should act as a liaison for patients. They would co-ordinate primary care and other services.
The National Cancer Forum documents also contain a draft charter of rights for patients with cancer.
This includes proposals that specific care plans (including psychological support as well as medical management) be drawn up for each patient.
It recommends that patients should have access to all therapeutic options and that all patients be considered for participation in clinical trials.
It proposes that definitive timeframes should be set and adhered to for the delivery of pathology results in accordance with international best practices. It proposes that all patient data should be returned to GPs within 24 hours.
It also recommends a surveillance programme with three-monthly check-ups for the first two years, six-monthly check-ups for up to five years and yearly check-ups thereafter.