THE FUNDAMENTAL requirements for safe, quality care are now in place in the State’s eight designated centres for the diagnosis and surgical treatment of breast cancer, an independent review has found.
The review, carried out by the Health Information and Quality Authority (Hiqa) and published yesterday, stated that while some improvements remain to be made, all the centres are meeting the “key requirements” set out in national standards for the service.
It said information provided by the centres for January to August 2009 indicated just four of the eight centres – Beaumont, Cork, Galway and Limerick – were meeting the target of offering an appointment to urgent referrals within two weeks. However, by the end of last year all centres were meeting this target.
Overall, 17,611 new patients were referred to the symptomatic breast cancer services from January-August 2009. Nearly 6,000 were classed as urgent referrals.
All centres have also faced “significant challenges” in offering an appointment to 95 per cent of women who receive non-urgent referrals within 12 weeks.
The report said more women, mainly younger patients, are being referred to the service with benign disease, even though the service was set up to diagnose and treat malignant disease, and this is contributing to waiting times.
It is believed the increase in referrals has followed controversy over the delayed diagnosis of some patients. The authority said there needs to be a coherent response by the HSE and the National Cancer Control Programme (NCCP) to this group of patients currently waiting longer than they should.
The NCCP stressed last night that waiting times have improved since the authority’s review, and 96 per cent of non-urgent referrals are now being seen within 12 weeks.
Separately, the review found not all centres were ensuring patients who required surgery received it within 20 working days of diagnosis.
This standard was not met at the Mater, Limerick Regional, St James’s or St Vincent’s hospitals. The Mater had a 50 per cent compliance rate, but the authority noted that at the time of its review the locum consultant breast surgeon in the hospital did not have formal theatre access time and there were no ring-fenced surgical inpatient beds for breast cancer patients.
The lack of service level agreements between the designated cancer centres and centres providing radiotherapy is, the report said, “a significant cause for concern and could have adverse consequences for patients”. It said this needed to be addressed.
Of the progress made since breast cancer diagnosis was moved from 33 hospitals in 2007 to eight hospitals at the end of 2009, the most significant has been that designated centres have arrangements for the multidisciplinary care of patients.
All centres were found to have some clinical audit arrangements in place, but the review found no evidence that any patient outcome information was being shared between the centres to facilitate comparisons to drive improvements nationally.
It said: “There was no evidence of a nationally agreed definition of delayed diagnosis or a consistent approach across the eight centres for clinicians to audit and report these clinical incidents.”
It said, given that delayed diagnosis, although rare, occurs in the best centres in the world, this issue had to be addressed.
A small number of patients attending each centre were interviewed. They indicated high levels of satisfaction.
Transport was raised by Letterkenny patients having to travel to Galway. In Waterford “instances of missing letters, delayed or inconsistent results from both private and public services” were reported.
Reorganisation of cancer services begins to pay off: page 14; Editorial comment: page 15